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ATIONAL LIBRARY  OF MEDICINE     NATIONAL LIBRARY OF MEDICINE
 
 
 
 
HYGIENE   f"
THE   NURSERY
INCLUDING THE GENERAL REGIMEN AND FEEDING OF
  INFANTS AND CHILDREN; MASSAGE, AND THE
    DOMESTIC  MANAGEMENT OF THE ORDI-
      NARY EMERGENCIES OF EARLY LIFE.
LOUIS STARR, M.D.,
LATE CLINICAL PROFESSOR OF DISEASES OF CHILDREN IN THE HOSPITAL OF
  THE UNIVERSITY OF PENNSYLVANIA ; PHYSICIAN TO THE CHILDREN'S
     HOSPITAL; CONSULTING PODIATRIST TO THE MATERNITY
           HOSPITAL, PHILADELPHIA, ETC.
         THIRD EDITION.

    WITH TWENTY-FIVE ILLUSTRATIONS./^*." t-\



         PHILADELPHIA:       V_^"^
P. BLAKISTON,  SON  &  CO.,
         IOI2 WALNUT STREET.
              189I.
V" 
A,
>t ex
W5
Copyright, 1891, by Louis Starr, m.d.
PRESS OF WM. r. FEU. * CO..
  1920-24 SANSOM STREET
    PHILADELPHIA 
                      TO

        MY  LITTLE PATIENTS,

                SOME OF WHOM,

IN THE  RAPID PASSING OF TIME, MAY SOON ASSUME
               PARENTAL DUTIES,

                THIS VOLUME

       IS AFFECTIONATELY DEDICATED. 
 
PREFACE TO THE  THIRD EDITION.
  The sheets  of the third edition of the Hygiene
of the Nursery have been thoroughly revised, and
some alteration made in their arrangement.  A new
chapter on Massage has been  inserted, comprising
a sketch of the ordinary methods of manipulation,
with their application to the more common disorders
requiring such treatment.  This the author trusts
will prove useful to mothers and nurses.
                                LOUIS STARR.
1818 South Rittenhouse Square,
   Philadelphia, February, i8gi.
Vll 
PREFACE  TO THE SECOND EDITION.
  The very flattering reception of the first edition
of the Hygiene of the Nursery has encouraged its
reintroduction to the public.
  In the preparation of the second issue the original
matter has been thoroughly revised, and numerous
additions have been made.
  The author must  again acknowledge  the assist-
ance of Dr. Allen J. Smith and the most effective
aid of Dr. W. M. Powell.
                                LOUIS STARR.
  Philadelphia, April, i88g.
viii 
PREFACE TO THE  FIRST EDITION.
   Having a firm belief in the proverb that "an
 ounce of prevention is worth a pound of cure," the
 author has endeavored, in the succeeding pages, to
 point  out a series  of hygienic  rules which,  if
 applied to the nursling, can hardly fail to maintain
 good health, give vigor to the frame and so lessen
 susceptibility to disease.
   He  feels, too, that intelligent parents are  ever
 ready to be instructed and willing to cooperate in
 the great work of preventing disease—the  highest
 aim of scientific medicine.
   While every woman of ordinary brain-power can
 do much to keep her baby well, she  should recog-
 nize  that years  of  training  and experience  are
 necessary to acquire  the ability to put the full value
 upon symptoms, and to handle the tools of medi-
cine.  Therefore, little or no reference has  been
made to drugs or methods of medical treatment.
  The  first  chapter  is  written with  the object of
                       ix 
X        PREFACE  TO THE FIRST EDITION.
hinting to the mother when, by deviations from the
features of health,  she may expect the onset of dis-
ease and call in professional counsel.  The last  is
offered, not as a complete guide to the practice of
physic, but simply for the sake of giving informa-
tion upon questions that often arise in the nursery.
  The child's  doctor,  in  our day, regulates his
patient's diet, clothing, bathing and exercise, and
looks  into the hygiene of the  nursery  before  he
orders medicines, and if the mother has sound ideas
upon these subjects she is no mean assistant.
  The author's thanks are due  to  Dr. W. M.
Powell for efficient  aid in the preparation of the
manuscript and index, and to Dr. Allen J. Smith
for the illustrations.
                                LOUIS STARR.
 Philadelphia, September, 1888. 
CONTENTS.
                   CHAPTER I.                PAGH
The Features of Health..............    17

                   CHAPTER II.
The Nursery,...................    62

                   CHAPTER III.
The Nurse-Maid..................    80

                   CHAPTER IV.
Clothing......................    85

                   CHAPTER V.
Exercise and Amusements..............   107

                   CHAPTER VI.
Sleep.............,..........   119

                  CHAPTER VII.
Bathing,.....................   125

                  CHAPTER VIII.
Food........................   150

                   CHAPTER IX.
Dietary,.....................   213

                   CHAPTER X.
Massage,.....................   236

                  CHAPTER XI.
Emergencies....................   248

Index,.......................   287
                        xi 
 
HYGIENE  OF  THE  NURSERY.
               CHAPTER I.

           THE FEATURES OF  HEALTH.

  Every ill child presents certain well-defined alter-
ations in the manner of performance of the various
functions of his body.  Thus, the pulse and respi-
ration may be altered  in character and frequency;
the surface temperature may be elevated; the color
and  condition of the skin may be changed;  the
appetite may be diminished; weight may be lost,
and so on.  These alterations from the normal state
are termed symptoms.
  Healthy children, on the other hand, as uniformly
show evidences of their well-being, which, for want
of a better name, may be called  the features  of
health.   Of these, every mother should have a full
knowledge, so that by appreciating variations she
may anticipate the complete development of disease,
and early summon skilled aid, at the time when it
is of most  service.
  Early life must be divided  into two  periods,
namely,  infancy and  childhood.  Infancy  is  the
      2              17 
i8
HYGIENE  OF THE  NURSERY.
time  elapsing between birth and  the  complete
eruption of the milk teeth, an event that transpires
about the end of the second year of life.   Child-
hood extends from this age  to the development of
puberty, or to the age of thirteen  or fifteen years.
It is important to remember these two divisions, as
frequent reference will  be  made  to them  in  the
subsequent pages.
  With this  brief preparation,  the  study  of  the
features of health may be  entered upon.
  i. The Face.—The face of a healthy, sleeping
child wears an expression  of absolute repose. The
eyelids are completely closed, the lips very slightly
parted,  and, though a faint sound of rhythmical
breathing may be heard, there  is no visible move-
ment of the nostrils.  When awake and undisturbed,
the healthy infant's face has a  look of wondering
observation of whatever is going on about it.   As
age advances, intelligence gradually supplants  the
wondering gaze, and no one  can be unfamiliar with
the bright, round, happy face of perfect childhood,
so indicative of careless contentment, and so mobile
in response to emotions.
  Examples of Variations  in Disease.—Incomplete
closure  of the eyelids, rendering the whites of  the
eyes visible during sleep, is a symptom in  all acute
and chronic diseases of a severe type;  it is also to
be observed  when  rest is  rendered  unsound  by 
THE  FEATURES  OF HEALTH.         19
pain, wherever seated.   Twitching of the eyelids,
associated  with  oscillation of  the  eyeballs  or
squinting, herald the visit of convulsions.  Widening
of the orifices of the nose with movements of the
nostrils to and fro, point to embarrassed breathing
from disease of the lungs or their pleural  invest-
ment.   Contraction of the brows indicates pain in
the  head;  sharpness of the nostrils, pain in the
chest, and a drawn upper lip, pain in the abdomen.
To make a general  rule, it may be stated, that the
upper third of the face  is altered in  expression in
affections of the brain; the middle third in diseases
of the chest, and the lower third in diseases of the
organs contained in the abdominal cavity.
  2. The Skin and General Appearance.—In the
new-born infant the color of the skin varies  from
a deep  to a light shade  of red.   After the first
week this redness fades  away,  leaving the surface
yellowish-white.  At times this yellow color  is so
marked that it might be mistaken for jaundice  were
it not that the whites of the eyes remain perfectly
pearly, which is never the case in the disease men-
tioned.   After the  second week all discoloration
disappears and the skin assumes its typical appear-
ance.
  With certain  well-known  natural  variations  in
complexion  the  skin of  a  healthy child  is beauti-
fully white and transparent.  The cheeks, palms  of 
20         HYGIENE OF THE NURSERY.
the hands and soles of the feet have a delicate pink
color, while the general  surface is rosy in a warm
atmosphere and marbled with  faint  blue spots or
lines in a cold one.  As  age advances the coloring
becomes more  pronounced, and until  the comple-
tion of childhood  the complexion is much fresher
than in adult life.
  Other characters  of  the  healthy skin  are,  a
velvety  smoothness  and softness, a scarcely per-
ceptible moisture, and a great degree of elasticity.
  If an infant be stripped the large size of the head
and trunk, and the relatively short arms and even
shorter legs, will strike the observer  at once.  This
disproportion, especially  noticeable  in  the head, is
an actual one.  For  if in a child of one year, for
example, the distance  from the lower edge of the
chin to the top of  the head be measured, it will be
found to be equal to  one-fourth of the entire length
of the body.  The vertical length of the head, too,
falls but little  short of that of the trunk, and the
latter in turn is nearly as long  as the legs.
  Again, the abdomen is  full and prominent, making
the chest look, in comparison, rather contracted and
narrow, and the navel is  less deeply sunken than in
adults.
  These features,  which will  be referred to  more
minutely in a  later section, are most marked  in
young infants, and undergo gradual alterations as 
THE FEATURES OF HEALTH.
21
growth progresses and the child develops into the
lithe, active youth or maiden.
  The shape  of the head varies greatly between
the round, bullet form  and the elongated oval one.
When it  has been  subjected to much  pressure,
instrumental  or  otherwise, during  delivery,  it is
often so distorted as to shock the expectant mother.
Little  fear of permanent disfigurement  need  be
entertained, however, as the deformed head usually
assumes a natural shape in time.  The same is true
of less noticeable depressions,  prominences and
irregularities.  But it  should be remembered that
restoration to symmetry  must  be left  entirely to
nature, as any attempt to  mould  the skull by pres-
sure rarely fails to injure the delicate brain beneath.
  The anterior  fontanelle,  or,  as it is called  by
nurses, " the opening of the  head," is readily seen
and felt in infants under  a year old.   In the nor-
mal state  it is  level with, or very slightly depressed
below, the surrounding  bones  of the  skull, and
may be observed to   pulsate,  or  rise  and fall,
rhythmically.   It is soft  to  the touch and yields
readily to pressure.
  Examples of Variations in Disease.—Lividity  of
the eyelids and  lips is  a sign of imperfect  oxidiza-
tion  of the blood, and  points  to disease of the
heart   or  lungs.  A decided  yellow color of the
skin and whites  of the  eyes is seen in jaundice;  an 
22
HYGIENE OF THE NURSERY.
earthy tinge of the face, in long-standing disease of
the bowels; a waxy pallor  in kidney disease, and
paleness in any acute or chronic affection attended
by exhaustion.
  Marked squareness of the head with projection
of the forehead, a widely-open fontanelle, and a

                      Fig. i.
                  b
       DIAGRAM SHOWING SHAPE OF HEADS.
a, Normal head; b, Hydrocephalic head ; c, Rickety head.
relatively small face indicate rickets.  A very large,
globular head is characteristic of hydrocephalus or
"water on the  brain;"  bulging of the fontanelle is
also a symptom of this  disease.  In this connection
it must be observed, however, that certain children
are born with relatively large, globe-shaped heads, 
           THE FEATURES OF HEALTH.        2$

though in every respect healthy.  The peculiarity
is  especially apt to be  observed when one of the
parents—notably the  father—has the same charac-
teristic.  In order to indicate disease, the deformity
must be marked and combined with a widely open,
bulging fontanelle, or with indications of impaired
brain activity.  Depression of the fontanelle shows
general debility and the need of food or stimulants.
   The accompanying  diagram, Fig. I, will aid in
explaining this subject.
   Great  distention  of the abdomen is usually due
to an  accumulation of gas in the  intestines,  and
indicates disease of this portion  of the  digestive
tract;  marked depression, on the other hand, is
encountered  in serious brain affections, in cholera
infantum, inflammation of the intestines  and dys-
entery.
   3. Development.—To be robust the newly-born
infant  must  have  a certain  average length  and
weight.  The  length  varies between sixteen  and
twenty-two inches, and  the weight between six and
eight pounds.
   From the  first day, growth or increase in length
and weight, steadily progresses, according  to  cer-
tain definitely fixed rules.
   Length increases most rapidly during the  first
week of life ;  afterward the progress is almost uni-
form up to the fifth month, and then  it becomes less 
24         HYGIENE OF THE NURSERY.

rapid, though still  uniform, until the end of the
twelfth month.
  These facts may be seen in the following table :—
AGS.	LENGTH.
Birth.	19.5 inches.
I month	20.5 "
2 "	21. "
3 "	22. "
4 "	23.
5 "	23-5 "
6 "	24. "
7 "	245 "
8 "	25. "
9 "	25-5 "
IO "	26.
n "	26.5 «
12 "	27. "
  During the second year the increase is from three
to five inches; in the third from two to three and
a half inches;  in the fourth from  two  to three
inches, and from this age up to the sixteenth year
the average annual gain is from one and two-thirds
to two inches.
  In the first three  days of life there is  always a 
           THE FEATURES OF HEALTH.         25

loss of weight, but by the seventh  day the babe
should have regained weight and be  as heavy as at
birth.  The period of  most  rapid  gain  in  this
respect is during the first five months of life.  The
maximum  is attained during  the second  month,
when the increase is from  four to seven ounces
each week.  Throughout the  next three  months
the increase amounts to about five ounces per week,
and in the remaining months of the first year, from
two to five ounces.
  The subjoined table shows  the average rate of
gain:—
AGE.	WEIGHT.	
Birth.	7 pounds.	
I month	7U "	
2 "	9lA "	
3 "	II "	
4 "	«# "	
5 "	14 "	
6 "	15 «	
7 "	16 "	
8 "	17 "	
9 "	18 "	
IO "	19 "	
n "	20 "	
12 "	21 "	
 
26         HYGIENE OF THE NURSERY.

  From the first to the  tenth year there should be
a yearly gain of at least four or five pounds, and
after, to the  sixteenth year, of about eight pounds
in the same period.
  Parents frequently  over-estimate the weight of
their  children  by placing  them upon the scales
when completely  dressed.  To be  accurate, the
weight of the  clothing must be subtracted.  This
may be estimated at about three pounds for a child
of three to five years, four pounds for one of eight
years, and eight pounds at fifteen years.
  Another reliable evidence of the proper progress
of development is the increase in the  girth of the
chest.   Taking an infant weighing seven  pounds
and measuring nineteen and a half inches at birth,
this should be a little over thirteen inches.  By the
fourth month  it  should be  increased  to fifteen
inches;  by the sixth,  to sixteen; by the twelfth, to
about seventeen; .by  the fifth year to twenty-one,
and by the sixteenth year to thirty.
  As already  mentioned, the  proportions of the
different  members of the  frame in infancy differ
materially from those of adolescence.
   Primarily the head and secondarily the body are
large when compared with the arms and legs, but
in the progress of healthy development this dis-
proportion is  gradually  lessened  until the perfect
human  figure  is  attained.    This developmental 
THE FEATURES OF HEALTH.         27
process, however, does not affect all parts of the
body equally, as may be seen in the accompanying
diagram.*  (Fig. 2.)
  The description is so well put in the journal from
which  this figure is taken that I cannot  do better
than quote it word for word.

                      Fig. 2.
DIAGRAM SHOWING RELATIVE STATURE FROM I TO 22 YEARS OF AGE.
  " The six figures  represent the average relative
stature of males of the ages of one, five, nine, thir-
teen, seventeen, and twenty-two years.  It will be no
ticed that the figures all stand on a level plain.  The
tops of the heads are connected by a dotted line, and

* " Babyhood," Vol. II, page 311.  Paper by Leroy M. Yale, m.d. 
28
HYGIENE  OF THE  NURSERY.
the height of each figure is divided into four equal
parts, the points of division being  connected with
the corresponding ones in each figure.   If the rate
of growth were  uniform  the  dotted lines connect-
ing the  heads  would, of course, be straight if a
child  for every  year were included in  the rank.
But in the earlier  years the growth is much more
rapid than it is later, and hence the line is a curve,
rising  quite suddenly at  the  first, and  becoming
flatter toward  the end of growth.  It is to  be
understood that these are all  averages—including,
but not  showing, the extremes  of slowness and
rapidity of growth as well as  fitfulness of growth.
The diagram also shows the different development
of  different parts of the person.  The  head,  for
instance, in the  child of one year is nearly one-
fourth of the whole height; that of the adult is about
two-thirteenths, or, to  use  the  phrase  of artists,
the little child is not much more than four heads
high, while  the  adult of twenty-two is  about six
and one-half heads high; and even this  is a much
larger head than the  average adult has.   Notice
that the third dotted line, marking one-half of the
total height, crosses the navel  in the infant, while
in the adult  the half height mark  is but little above
the juncture of the legs and the body, which shows
how much larger, proportionately, the body of an
infant is  than an adult's.   If this same line be fol- 
           THE FEATURES OF HEALTH.         29

lowed it will be noticed that it keeps well up in the
abdomen until after the age of nine.   Between that
age and puberty the growth of the lower extremi-
ties  is usually  very rapid, and  the well-known
' shooting up'  of boys and girls  takes  place, the
whole person  growing, but the lower part  in par-
ticular.   Similar changes of location will be  noticed
by following the  quarter-lines, but the changes are
not so abrupt."
  It may be  well to  mention here that children
will  often remain, for  a considerable  time, almost
stationary in height, and then have periods  of very
rapid growth.  The latter is often to be observed
in the  ninth   or tenth year,  and  again  at the
approach of puberty.  Variations in weight-gain
are also often to be observed; these seem  to hold
a definite relation to the fluctuations in the  rapidity
of height-increase.
   Besides these points, which are the most reliable
evidences of the  proper progress of development,
there are certain features  that appeal more  directly
to the notice of parents, and on this account deserve
consideration.   The age at which a child sits erect,
at which it creeps, walks or talks, are instances of
the class of features referred to.
   The head can usually be held  erect by  the end
of the third month and the body  maintained in the
sitting posture a month later.  By the sixth month 
3<D         HYGIENE OF THE NURSERY.

the infant can sit  up with  ease, accomplish many
movements with the arms, hands and fingers, and
enjoy playthings.   At the eighth month he may be
able to creep;  by the ninth or tenth, to drag him-
self upon his feet with the  assistance of his hands
and arms and  some artificial support; by the elev-
enth, to walk^with assistance; by the fourteenth, to
walk alone, and by the eighteenth, to run.
  At  eight  months  an infant will  imitate sounds
and articulate several  syllables;  at ten, can often
speak one or  two words, and  after  twelve months
is able to join several words together.
  The anterior  fontanelle  should  be completely
closed at some period between the fifteenth  and
twentieth months.
  Tears  begin to be secreted during the third or
fourth month, and saliva, between the fifth and sixth.
  After birth both hair and eyes often change color
as age advances.  When an alteration takes place
in the eyes, it begins about  the sixth  or eighth
week  and may be to either  a lighter or darker hue.
Changes in the hair begin later, the tendency always
being to darken, and  the most marked alteration
occurring between the seventh and fourteenth years.
  Examples of Variations in Disease.—If on being
measured and weighed, a child be found to fall
short of  the normal standard for its age, and if, at
the same time, there  is a want of plumpness of 
           THE FEATURES  OF HEALTH.         31

body, roundness of limb, and firmness of flesh, the
existence of some fault  in  diet or in the digestion
and absorption of food must be inferred.
  A delay in walking may be due to general feeble-
ness or to paralysis of the  muscles of one or both
legs, and  a limping gait  with  pain  in  the knee
suggests hip-joint disease.
  Closure  of  the fontanelle  is  retarded by the
disease called  rickets, and  also  by hydrocephalus
and constitutional syphilis.
  It is well to be cognizant of the fact  that  girls
develop more rapidly than boys, and that the second
or later children of the same family, by imitating
their elders in the nursery, learn to talk and walk
earlier than those who are  born first.
  4. Position and Gestures.—The  complete re-
pose  depicted  on the countenance of  a sleeping
child  when free from illness  is shown also  by the
posture of the body.  The head lies easy on the
pillow, the trunk rests on the side, slightly inclined
backward,  the limbs assume various but  always
most   graceful  attitudes,  and  no  movement  is
observable  but the gentle  rise and  fall of the
abdomen  in respiration.   In the waking state, the
child, after early infancy, is rarely still. The move-
ments of the arms, at first awkward, soon become
full of purpose as he reaches to handle and examine
various objects  about  him.   The legs  are idle 
32         HYGIENE  OF THE NURSERY.
longer, though these, too, soon begin to move about
with method, feeling the ground, in preparation, as
it were, for creeping and walking.
  Examples of Variations in Disease.—Restless sleep
with a desire to be rocked, fondled or  "walked" in
the nurse's arms, are common symptoms of acute
attacks  of illness,  especially when  attended by
pain.   Children  beyond  the age  of  infancy toss
about uneasily in  bed or demand a  change  from
the bed  to the  lap, under similar circumstances.
Extreme and long-continued drowsiness and quiet-
ness,  on the  other  hand,  often   precede  the
onset  of such  specific  fevers  as  scarlatina  or
measles.
  Sleeping with the  head thrown back and the
mouth open indicates enlarged tonsils; a tendency
to " sleep high," or with the head and shoulders
elevated  by the  pillow, accompanies disease of the
heart and lungs, and "sleeping cool," that is, resting
only after the bed clothing has been  kicked off, is
an early  symptom of rickets.
  Frequent carrying of the  hand to the head, ear
or mouth shows headache, earache, or the pain of
a coming tooth, as the case may be, while constant
rubbing of the nose is a feature of irritation of the
bowels or stomach.
  Should the  thumbs be drawn into  the palms of
the hands,  and the fingers  tightly  clasped over 
THE  FEATURES OF HEALTH.        33
them, or if the toes be strongly flexed or extended,
a convulsion may be expected.
  5. The Voice.—Crying is the chief if not the
only method that  the  young  infant possesses of
making known his displeasure, discomfort or suffer-
ing, and affords almost the sole means of determin-
ing the characters  of the voice at  this early age.
Again, even long after the powers of speech have
been developed, the cry continues to be the main
channel of complaint.
  One rarely hears a healthy  child cry, unless a
harsh word, a fall or a blow cause a passing storm
of grief, anger  or  pain.   Hence, frequent, peevish
crying points to some  disturbance of the  healthy
balance.
  The sound of the voice, whether in  crying or
speaking, should have a clear ring, without either
muffling,  hoarseness  or nasal  tone.   Weeping
should accompany  crying, after the establishment
of tear secretion.   Cough, although not a normal
vocal sound, is  also worthy of attention.
  Examples  of Variations in  Disease.—Incessant,
unappeasable crying is  usually due  to earache or
hunger; it frequently, too, is caused by the constant
pricking  of  a badly-adjusted  safety-pin  or other
mechanical irritant.
  If crying  occur  during an attack of coughing it
is an indication of  some painful affection of the
      3 
34         HYGIENE OF THE NURSERY.

chest; if just before or after an  evacuation of the
bowels, of intestinal pain.
  When the cry has a nasal tone it should suggest
swelling of  the lining  membrane of the nose, or
other obstructing condition.  Thickening and indis-
tinctness occur with  throat  affections.  A  loud,
brazen  cry is a precursor of spasmodic croup, and
a  faint, whispering cry  of  true  or membranous
croup.  Hoarseness points to disease of the lining
membrane of the  larynx, either catarrhal or syphi-
litic in  nature.
   Finally,  a manifest unwillingness to cry can be
seen in pneumonia  and pleurisy,  when  the dis-
ease is severe  enough to interfere materially with
breathing.
   Tear-secretion  having been  established,  it is  a
bad omen if the secretion be arrested during  the
progress of an illness, but an equally good one if
there be no suppression, or  if there be a reestab-
lishment after suppression.
   The  cough, like the  voice, may be  brazen in
 spasmodic croup, hoarse in laryngeal  catarrh,  and
 suppressed in  true croup.  The qualities "tight-
 ness " and " looseness " are readily appreciated and
 give a good idea of the progress of lung affections,
 especially bronchitis, the former being an evidence
 of the beginning, the latter of the favorable termina-
 tion of an attack. 
THE  FEATURES  OF HEALTH.        35
  Cough is always unproductive, that is, unattended
by expectoration, in children under seven years of
age.
  6. Mode of Drinking and Swallowing.—By
watching  an infant  taking  the breast or  bottle,
some information can be obtained of the condition
of the mouth and throat, and of the respiratory
organs.
  A  healthy  child  drinks  continuously without
stopping to breathe, and swallows easily.
  Examples of Variations in Disease.—If there be
any soreness of the mouth  the nipple will be held
only for a moment and then dropped with a cry of
pain.   When the throat is affected in infants, swal-
lowing is performed with a gulp and an expression
of pain passes over  the face, and no more efforts
are made than required to satisfy the first cravings
of hunger.  Older children,  under similar circum-
stances, drink little and refuse solid food.
  An infant suffering from the oppressed breathing
of pneumonia or severe bronchitis, seizes the nipple
with  avidity, swallows quickly several times and
then pauses for  breath.  In older children the act
of drinking, which should be continuous, is  inter-
rupted in the same way.
  If the finger be put into the mouth of a healthy
baby it will be vigorously sucked  for some little
time.  Diminution of this act of suction  during a 
36         HYGIENE OF THE NURSERY.

severe illness  is a sign of danger; its  reestablish-
ment a good omen.   In conditions of stupor  it is
noticeably absent.
  7. Appetite.—Hunger and appetite must not be
regarded as synonymous terms.  The former is the
craving of all the tissues of the  body for  nutritive
material, or food, and is expressed by a sinking or
craving sensation in the stomach.  The latter, on
the other hand, though  it is certainly an attendant
of hunger, is  simply a  sensation of the desire for
something with a food-taste, having its seat in  the
mouth and surrounding parts. Appetite having its
post,  as it were, at the entrance of the stomach,
may be regarded as a gate-keeper to  supervise
everything presented for  entrance and to reject all
that may be injurious either to the stomach or the
general economy.
  Like its analogue the  gate-keeper, the trust-
worthiness of the appetite may be destroyed by
over-indulgence and bad habits.  Under the  last
head come the constant administration of too much
or too  little  food, the  use  of over-rich food and
irregularity in meal hours.
  A healthy appetite—that is one that leads a child
to consume with enjoyment the food set before
him—may be encouraged by muscular and mental
exercise; by contentment; by regular habits as to
the hours of eating; by the use  of plain food only, 
THE FEATURES  OF HEALTH.          37
and by varying the food, in a greater or less degree,
according to the age.  If the quantity of food con-
sumed at  the  regular  meals does not come up to
the parent's standard of sufficiency, it does nothing
but harm to resort to too dainty feeding and to an
encouragement to eat between meals.
  There can be no question that a good appetite is
a useful as well as a pleasant faculty for a child to
possess, for there is no doubt that food eaten with
relish is much  better digested and therefore more
serviceable  in nutrition  than that which  is simply
crowded into the stomach.
  Examples of Variations in Disease.—Loss of appe-
tite is encountered in  febrile attacks  and in acute
disorders  of the stomach.   Inordinate appetite, on
the contrary, is usually  met with when too strong
food has  been administered.   Here the  increased
hunger is  due to the  fact  that the food administered,
while it may be very rich in nutritive properties, is
ill-adapted to the delicate digestive power of early
life, and thus, by  not  being properly  prepared  for
absorption, places the  child in  the anomalous po-
sition of starving in  the midst of plenty.  In more
advanced  children gluttony may depend upon gas-
tric irritation, a condition which often leads older
and presumably wiser  heads to over-indulgence at
table.
  8. Eructation.—Eructation or regurgitation is 
38         HYGIENE OF THE NURSERY.

readily produced  and of frequent  occurrence in
infancy, on  account of the vertical position  and
more cylindrical outline  of the stomach  at  this
period of life.
  Babies suckled at a freely-secreting breast often
eructate, though  they may be in the best possible
health.  In  these cases, the supply of food being
large, the  infant, as  it lies at  the breast, is apt to
draw more than  it needs and  more than  it  can
digest, and the  stomach,  through a wise provision
of nature, rids itself of the superabundance by the
simple act of regurgitation.  In  this process, which
in reality is an evidence of health, there is no vio-
lent muscular effort, as in retching or vomiting, nor
any evidence of nausea, and the material ejected is
the  breast milk  alone, either entirely unaltered or
slightly curdled.
   In older  children, expulsion  of the  contents of
the stomach, or vomiting, may also occur after the
stomach has been overladen.  If the act be followed
by relief from a feeling of general distress, head-
ache and pain in the upper abdomen, it is not to be
regarded as a symptom of disease.
   Examples of  Variations in Disease.—Vomiting,
with its violent muscular effort  and the attendance
of the train of symptoms  embraced  under the  term
nausea—namely, paleness, languor, faintness  and
an increased  secretion of saliva—occurs in many 
THE  FEATURES OF HEALTH.         39
different conditions.  It may indicate disease of the
stomach, of the intestines, of the lungs  or their
pleural investment, and of the brain; or it may be
an initial symptom of one of the eruptive  fevers,
scarlet fever or  measles, for  example, which con-
dition, when existent, can only be determined by
closely observing the special case.
  The character of the material  ejected from the
stomach is  more definite.   Thus, the expulsion of
mucus is a  symptom  of gastric  catarrh.    The
regurgitation of mouthfuls of curdled milk, partly
digested food and liquid,  so  sour that it  causes a
grimace to pass over the face, is an  indication of
dyspepsia with fermentation and the formation of an
irritant acid.  The appearance of lumbricoid worms
in the vomit, a not  very infrequent occurrence,
shows, without dispute, the existence of these para-
sites in the digestive canal.
  9.  The Faecal Evacuations.—The daily  num-
ber of evacuations of the bowels natural for a child
varies greatly with its age.  For the first six weeks
there should be three  or four movements  every
twenty-four hours. After this  time up to the end
of the second year, two movements  a day  is the
normal average.   Subsequently,  the frequency  is
the same as in adults—once per diem—though two
or three movements in the same interval may occur,
especially after  over-feeding  or after eating food 
40         HYGIENE OF THE NURSERY.
difficult of digestion, and  must be looked upon as
conservative rather than as the evidence of ill-health.
  During the first period the  passages have  the
consistence of thick soup, are  yellowish-white or
orange-yellow in  color, with sometimes a tinge of
green; have  a  faint faecal, slightly sour odor,  and
are  acid  in  reaction.   In the second, they  .are
mushy or imperfectly/<?r^^, of uniform consistence
throughout, brownish-yellow in color, and have a
more  faecal odor.   The last two characters become
more  marked as additions are made to the diet.
After  the completion  of the  first  dentition  the
motions have the same appearance as in adult life;
they are formed, are brownish in color,  and have a
decided faecal odor.
  Examples of Variations in Disease.—Many altera-
tions  occur  in  disease.   The  frequency  of  the
movements  may be increased, constituting diar-
rhoea,  or lessened, constituting constipation.   In
the  former condition the consistency is diminished,
in the latter, increased.  Instead of  being uniform
throughout, the movement may be mixed, partly
liquid, partly solid, indicating imperfect digestion,
and curds of milk or pieces of undigested solid food
may be mingled with the mass.  Flaky, yellowish
or yellowish-green evacuations, containing whitish,
cheesy lumps, are also met with in  cases of indiges-
tion.  Scanty, lumpy evacuations, dark brown or 
THE FEATURES  OF HEALTH.         41
even black  in color, and mixed with mucus,  are
characteristic of intestinal catarrh.   Doughy, gray-
ish, or clay-colored motions show an inactive liver.
An intermixture of blood, altered blood clots, and
shreds of mucous membrane, indicate ulceration of
the intestinal  lining, such as occurs  in intestinal
inflammation, typhoid fever, dysentery  and tuber-
cular disease.   Watery,  almost odorless passages
occur  in the latter  stages of summer  complaint;
most offensive, carrion-like  motions, in  both catar-
rhal and tuberculous  ulceration of the intestines,
and  sour-smelling evacuations in the diarrhoea of
sucklings.   The discovery of worms in the move-
ments  is the only certain evidence of the existence
of intestinal parasites.
  This mere outline of the changes that may take
place will serve to show how much  may be learned
from the evacuations, and the importance of pre-
serving them for the physician's inspection.
  10. The Urine.—It is  impossible  to make a
definite statement as to  the number  of times  the
urine is voided by a healthy infant in each twenty-
four hours.   In  any given case the frequency will
differ very much from  day to day, depending upon
the temperature  of  the  surrounding  air and  the
amount of  moisure  that it  contains.   Sometimes
it will  be necessary to change the napkin every
hour during the  day  and three  or four times at 
42         HYGIENE OF THE NURSERY.

night.  Again, it may remain dry for six, eight, or
even ten hours.  Neither condition indicates dis-
ease.  If, however, the urine is not passed for twelve
hours, a careful examination should be made.
  Between these two extremes there is a wide range
of variation.
  As the child  grows older the frequency dimin-
ishes, and at the age of three years the number of
voidings  will be reduced to six or eight during the
waking  hours, and  perhaps one at night.  When
the desire does arise during sleep, the child, if in a
normal state, wakes up and demands  the chamber,
and  never passes urine  unconsciously.   Wetting
the bed, therefore,  or the  involuntary passage of
the urine during sleep, is indicative of an abnormal
condition and  requires investigation.   From a few
observations, I am led to believe that the quantity
of urine voided by  healthy children  from  the
fourth to the seventh years is not nearly so large
as supposed; eighteen to twenty ounces being the
average in several  cases  in which  I have lately
made measurements.
  The urine of an infant, while it wets, should not
stain the napkin.
  Examples of Variations  in Disease.—In  certain
cases of bad digestion the urine becomes very con-
centrated and high-colored, and gives a light yellow
tinge to the napkin.  When the stain is decidedly 
THE FEATURES  OF HEALTH.         43
yellow, jaundice is  indicated, and other symptoms
of this condition should be looked for.
  In older children a high-colored urine, and one
which  deposits a whitish or purplish sediment on
standing,  is symptomatic  of  acute digestive dis-
order, either catarrhal in  its nature, or secondary
to some acute  febrile affection.  A smoky, blackish
hue, looking as if there had been an admixture of
soot, is  characteristic of the acute kidney disease
that often follows in  the wake of scarlet  fever; in
this state, too, there  is a great diminution in the
amount passed.
   Painful urination points to  inflammation of the
urethra, a narrow orifice, a highly acid condition of
the excretion,  or stone in the bladder.
   11. The Respiration.—In adults there are two
well-marked types of respiration, viz., the abdominal
and the superior costal.  The abdominal—met with
in perfection in adult males—is the type in which
the movements of inspiration  and expiration are
performed by the  muscles of the abdomen  and
lower third of the chest.  In superior  costal respi-
ration, on the  other hand, the movements are  most
marked in the upper third of the chest;  this form
is best developed in healthy adult females.
   In children the respiration  is  chiefly abdominal
in type, irrespective of sex, and it is not  until just
before the age of puberty that the movements in 
44         HYGIENE  OF THE  NURSERY.

the female change, becoming superior costal.  Con-
sequently, in estimating the number of movements
per minute it is best to place the fingers lightly on
the upper abdomen.  The count should always be
made by the watch, the most convenient time for
the observation being while the child sleeps.
  Soon after birth the number of movements per
minute is 44, between the ages of two months  and
two years, 35,  and between two and twelve years,
23.  During sleep the  frequency is reduced about
twenty per cent.
  Children under  two  years, while awake, breathe
unevenly and irregularly; there are frequent pauses
followed by hurry and precipitation, and some of
the movements are shallow, others deep.  In sleep
there is greater regularity.  After  the second year
the movements become steady and even, like those
of adults.  All children, however, but particularly
the very young, are subject to  a great increase in
the rapidity of respiration under the excitement of
muscular movement and mental emotion.
  Perfectly healthy children  breathe through the
nose, and so softly that it is necessary to place the
ear close to the face to hear  the breezy sound of
the ingoing and outgoing air.
  Examples of Variations in Disease.—Accelerated
breathing occurs  during the  course  of diseases
attended by severe fever.   Acute affections of the 
            THE  FEATURES OF HEALTH.         45

 lungs are especially characterized by this alteration,
 and the more the breathing area is  lessened the
 greater is the increase.  Thus,  in pneumonia, 60,
 80 or  100 movements a minute are not  at all
 unusual.  To speak broadly, rapid breathing may
 be caused by  an elevation in the body temperature,
 by an interference with the blood aeration and by
 thoracic or abdominal pain.
   Diminished frequency—the  movements  being
 reduced to  16,  12, or  even  8  in the minute — is
 encountered  in certain brain affections; namely, in
 chronic hydrocephalus, and the later stages of
 tubercular meningitis.  In such cases the rhythm
 may  be  greatly  altered — a  tidal  form  being
 assumed,  in which the breathing ebbs and  flows,
 beginning with an act v/hich is scarcely perceptible
 or audible, gradually growing deeper until  a full,
 noisy respiration is made, and then slowly subsiding
 into a period of absolute quiet, variable in its dura-
 tion.  This is termed Cheyne-Stokes' respiration.
   A dry, hissing  sound, or  a moist sound  of
 snuffling indicates  partial obstruction of the nasal
 passages; oral respiration  shows their complete
 occlusion.
  Yawning, one  of the modifications of the res-
piratory act,  if it recur frequently,  denotes great
failure  of the vital powers and  is an unfavorable
prognostic element. 
46         HYGIENE OF THE NURSERY.
  12. The Pulse.—To obtain  any  reliable data
from the pulse it must be felt during perfect quiet.
During sleep is the best time, but if the child can-
not be caught in this condition, advantage may be
taken of its placidity while feeding or amused by a
toy.   With very young  infants  it is sometimes
impossible to  feel  the beat  of the  artery at  the
wrist, and it is necessary to ascertain the frequency
of the pulse by listening to  the heart.  After the
second month feeling the  pulse at the wrist in the
ordinary way is not difficult.
  The  child's  pulse  differs  from the adult's  by
being  much more frequent, more  irregular,  and
more irritable.
  The  frequency, or the  number of  beats  per
minute, varies with the age.   The following is the
average rate:—
From birth, to the 2d month,			160 to 130
From the 2d to the 6th month,			130 to 120
" " 6th " 12th "			120 to no
" " 1st " 3d year, . " " 3d " 5th " " " 5th " ioth " " " ioth " 12th "			no to 100 100 to 90 90 to 80 80 to 70
  These figures represent the pulse in a waking,
but passive state.   During sleep  the frequency is
less.  Thus, between  the  second and ninth  years,
there are about sixteen beats less per minute while
asleep  than when  awake; between  the ninth  and 
           THE  FEATURES OF HEALTH.        47

twelfth years, eight less; and  between the twelfth
and fifteenth years, only two  less.   Below the age
of two years the disparity is even greater.
  The irregularity of the pulse  in  childhood is
confined  to an  alteration of the rhythm, in  other
words, of the  intervals at which the beats succeed
each other and the relative strength and volume of
each  beat.  It is  most  marked in infants and is
greatest during sleep, when the  pulse is slowest.
  The feature of irritability, that is, the facility
with which the frequency is increased  by muscular
activity and mental  excitement, is greater in pro-
portion to the youth of the child.  A rise of 20, 30,
or even  40 beats  a  minute  is  not  uncommon in
early infancy,  under the excitement of the slightest
effort or  disturbance.
   Examples of Variations in Disease.—On account
of the wide variations  in  health,  little meaning
need  be attached to alterations of  the  rhythm  and
frequency while unassociated with other abnormal
features.   When so associated they become impor-
tant in determining the existence of disease.
   Increased frequency is a constant attendant of the
febrile state.  The extent of the increase  corre-
sponds with the degree of elevation of temperature,
though the pulse curve always runs higher than the
temperature curve.   As a rule, the more  frequent
the pulse the  higher the fever.  In  estimating the 
48         HYGIENE OF THE NURSERY.

risk of the increase, however, the law of the fever
in question must be taken into consideration.  For
example, in scarlet fever  a pulse of  160 is  usual
and not indicative of especial gravity.   In measles,
the same degree of acceleration would be abnormal
and show great danger.
  Jaundice and inflammation of the kidneys  are
accompanied by a diminution of the pulse rate.
  Irregularity is met with  in diseases of the brain
and  heart, and sometimes in nervous and  blood-
impoverished children.
  13. The  Temperature.—By placing the hand
upon the surface of the body we can readily detect
marked  variations  in the temperature;  thus  the
nose  and extremities  feel cold in  diseases associ-
ated  with  depression of  the vital  forces, and  the
palms of the hands and back of the head feel  hot
in those attended by fever.  But  the  only possible
means of detecting slight variations  or  of obtain-
ing   reliable  information  concerning  normal  or
abnormal body-heat is by the employment  of an
accurate thermometer.   Clinical  thermometers, as
these instruments are called, are made entirely of
glass, and are usually furnished  in  the shapes seen
in Figs. 3 and 4, p. 49.
   Both of these instruments are graduated accord-
ing  to the Fahrenheit scale and provided with a
self-registering  index,  which  is  simply  a short 
THE FEATURES OF HEALTH.
49
column  of mercury separated from that in the bulb
of the thermometer.
                                  Fig. 4.
Bulb with
Mercury.
—98.50 normal mark.

 Index, read from top,
   stands now at 980.
CURVED THERMOMETER.
3.5° normal mark.
Index, read from top,
 stands now at 98.50.
STRAIGHT THERMOMETER.
Temperature  is  usually taken in  the rectum of
     4 
50         HYGIENE OF THE  NURSERY.

the infant or young child, in the arm-pit of one old
enough to understand the  importance of keeping
the arm in the  proper position, and in the mouth
of a child still older.  In the first locality a straight
thermometer  is  the best to use, in the last two a
curved instrument will be found more convenient.
   Supposing the rectum be chosen as the place of
observation, it is  first necessary to be sure that
this portion of  the gut is free from faeces.  The
upper end of  the stem of the thermometer is then
held between the thumb and finger, and the index,
by a few vigorous shaking movements, is forced
down so far that its upper extremity will be well
below the normal  mark, to 95° for instance; next,
the bulb is covered with  sweet  oil or vaseline and
gently  inserted through the anus into the rectum
for a  sufficient distance  to conceal completely the
mercury.   Here it is  allowed  to  remain for  five
minutes  by the watch, and  on  being removed the
degree of temperature is read from the top of the
index.   The position of the patient in the meanwhile
is  upon the back, on the nurse's lap, with the legs
elevated and controlled by her left hand, the right
hand being used in steadying the thermometer.
   If the arm-pit be selected, place the child on his
back,  and  dry this region  of  all  moisture;  next
shake down the index and insert the bulb well into
the cavity; lay the arm across the chest, place the 
           THE FEATURES OF HEALTH.         5 I

hand on  the  opposite  shoulder and  hold in this
position for five minutes.
   When taking the temperature in the mouth direct
the child to lie down  on his back and  instruct him
not to bite upon  the delicate glass.  Then, having
seen that the instrument is thoroughly clean and
that the top of the index is below the normal point,
insert the bulb, crosswise, beneath the tongue.   The
teeth must  be lightly closed so as to hold it  in
position, and the lips closely shut about  its  stem.
For the  three  minutes  necessary to complete the
observation, breathing must be performed entirely
through the nose.
   One more fact is important, namely, that a simul-
taneous observation  in the three  positions  men-
tioned will not furnish identical  results; the rectal
temperature being, normally, from i° to 2° higher,
and  the oral at least i°  higher, than that of the
arm-pit in the same individual.
   When properly used the thermometer is of great
value in the nursery ;  at the same time,  under oppo-
site conditions, it maybe the source of much unne-
cessary alarm to over-anxious parents.   To prevent
the latter  misfortune,  all who intend to use the in-
strument should be familiar with the healthy range
of temperature and some of the characteristic varia-
tions in disease.
   During  the first week of healthy life  the temper- 
 52         HYGIENE OF THE NURSERY.

 ature fluctuates considerably.   After this the pue-
 rile norme—98.5°  to 990 F.—is  established, but
 until  the fourth or  fifth month it  is greatly influ-
 enced by  physiological  causes of  variation, the
 fluctuations ranging between .9° and 3.60.  By the
 fifth month regular morning and  evening oscilla-
 tions begin to  be noticeable,  and certain definite
 laws are followed.   Thus there is a fall in the even-
 ing of i° or 2°.  The greatest fall occurs between
 7  and 9 p.m., and the minimum is reached at, or
 before, 2 a.m.   After 2 a.m. there is a gradual rise,
 the maximum being reached between 8 and 10 a.m.
 Throughout the  day the  oscillation  is  trifling.
 These variations  are independent of eating and
 sleeping.
   It  may be taken for granted, therefore, that a
 temperature between 980 and  990 in the  morning
 and  97.5° and 98.5 ° in the evening is the range to
 be expected in a healthy child beyond  the age of
 five months.
   Examples of  Variations in Disease.—In disease
 there may be either  a rise above or a fall below the
 normal standard.
   Fever is  always  associated  with an  elevation.
 Rapid and  transient  rises  attend  slight catarrhs
and passing indigestions.  Prolonged rises indicate
inflammatory  and  essential fevers,  for example,
typhoid, scarlet fever and measles. 
THE FEATURES  OF HEALTH.         53
  The degree of elevation marks the type of the
fever.  This is moderate when the mercury stands
at 1020, severe  at  1040 or 105 °, and very  grave
above 1070.  The duration of the elevation and the
peculiar range of the oscillations (for there are oscil-
lations in disease as well as in health) determine the
nature of the fever.  The febrile  oscillations differ
from the healthy, in that the lowest marking is
noticed in the morning, the highest in the evening.
  Variations in the typical range of any given fever
are important prognostic omens—a sudden fall of
the temperature, together with   improvement in
the general symptoms, indicates  the  beginning of
convalescence—a similar  fall, with an increase of
the general  symptoms, is a precursor of death.
When the morning temperature is equal to that of
the preceding evening, there is  great  danger; if
higher, greater danger still.  Marked remission in
continued fevers  is  generally a forerunner of con-
valescence.
  Abnormal depression of temperature is occasioned
by hemorrhage and by the loss of fluids  in cholera
infantum or entero-colitis.  It is  also met  with in
anaemia, in wasting from  insufficient  nourishment,
in diseases of the heart and lungs attended by im-
perfect oxidation of the  blood, and  it constantly
attends collapse and  the death agony.  A tempera-
ture of 970 is dangerous in children, and for every 
54         HYGIENE OF THE NURSERY.

degree of reduction below this point the risk for life
is more than proportionately increased.
  14. The Mouth and Throat.—In infants, gentle
pressure of the fingers upon the chin is sufficient to
cause wide opening of the mouth.  An older child
will  frequently open the mouth when  requested,
but if he refuses, the finger, or, far better, the handle
of a spoon, or some other smooth, flat instrument,
may be inserted in the mouth, and downward pres-
sure made upon the tongue, when the jaws will be
widely separated.  In some cases, when the child
is old enough to do as he is bid, the fauces can be
seen by directing the mouth to be opened wide and
the tongue to be alternately protruded and retracted,
or a prolonged sound of " Ah " to be made.  With
the refractory, and always with infants, the tongue
has to be held down by a spoon-handle  or tongue-
depressor.  If there be resistance, the patient must
be  taken on the lap  of the nurse,  who holds  his
back against her breast, directs his  face toward a
bright light, and controls the movements of his
hands and feet.
   The healthy oral mucous membrane has a deep
pink color, and is smooth, moist and warm to the
touch.  The color is deeper on the lips and cheeks,
lighter on the gums.   The  latter, up to the sixth
month, as a rule, have a moderately sharp edge.
Subsequently,  the edge  begins  to  broaden  and 
           THE FEATURES  OF HEALTH.         55

soften, and the color of the  investing mucous mem-
brane deepens to a vivid  red, and becomes hot, as
the teeth begin to force their way through.
  The tongue should be freely movable.  It is pink
in color, and the dorsum  or upper surface, marked
in the centre by a  slight longitudinal depression,
has a velvety appearance, and is soft, moist  and
warm to the finger.  The velvety nap  is due to  the
numberless hair-like processes of the filiform papil-
lae.   There are also scattered over the surface,  but
most clearly at the tip, a number of eminences,  the
size of a small  pin's head,  circular  in  outline, and
deeper pink than the  general surface—the fungi-
form papillae.   While far back, defining  the papil-
lary layer, are the circumvallate papillae, numbering
about twelve, and  arranged in a  V-shaped row.
These have  the form of  an inverted cone,  sur-
rounded by an angular elevation.
  The hard palate, or roof of the mouth, is roughened
anteriorly by transverse ridges.   The soft palate—
its continuation—is smooth, and its mucous mem-
brane is paler than that  of the rest of the mouth.
The fauces, or walls of the throat, on  the contrary,
are redder.   In the triangular  recess between  the
half arches of the  palate the tonsils can always be
seen.  They should be about the size and shape of
almond.kernels, and they present a number of  cir-
cular openings, the orifices of pouches, into which 
56         HYGIENE OF THE NURSERY.

the follicles open.  The uvula—or, in popular lan-
guage, the palate—is  short and tongue-shaped.
The posterior wall of the throat should be  red,
smooth and moist.
  Examples of Variations in Disease.—Fever makes
the mouth hot and dry, and causes the tongue to be
frosted or coated.  Affections of the stomach and
bowels are  usually  attended by coating  of the
tongue.  Inflammation of the mouth itself reddens
the lining membrane, makes it hot  and tender to
the touch, increases its moisture, alters the surface
of the tongue and leads to the formation of aphthae
and to ulceration.
  15. Dentition.—The eruption of the twenty milk
teeth may, like  other  physiological processes, be
unattended by noticeable symptoms, but in many
instances it is accomplished with difficulty, giving
rise to disturbances which, on the one  hand, may
be so trifling as  simply to annoy the infant, or, on
the other, so serious as to endanger life.
  Normally, the teeth are cut in groups, each effort
being succeeded by a pause or period of rest.   The
diagram and table on page  57 show the grouping,
the date of eruption and the duration of the pauses,
the  numbers, 1   to  5, indicating the  groups to
which the individual teeth  belong and their order
of appearance, and the letters a  and b  the prece-
dence of eruption in the different groups. 
THE FEATURES OF  HEALTH.
57
  The  pauses are, to say the least, most helpful,
giving  the infant's system an opportunity to rest
after each effort, to recover from  any coincident ill-
ness, and to prepare for the next strain.
  Even under normal conditions the edges of the

                        Fig. 5.
DIAGRAM SHOWING ERUPTION OF MILK TEBTH.
1 1, Between the 4th and 7th months. Pause of 3 to-9 weeks. 2222, Between
 the 8th and ioth months.  Pause of 6 to 12 weeks. 333333, Between the
 12th and 15th months. Pause until the 18th month. 4 4 4 4, Between the 18th
 and 24th months.  Pause of 2 to 3 months. 5 5 5 5, Between the 20th and
 30th months.

gums  lose  their  sharpness  and  become  swollen,
rounded and  reddened  as  the teeth  approach the
surface.   At the same time the saliva is  increased
in  quantity, and  the mouth  is unnaturally warm 
58         HYGIENE  OF THE  NURSERY.
and the seat of abnormal sensations, evidenced by
the tendency to bite upon any object that comes to
hand;  in other words, there is a condition of mild
catarrh of the mucous membrane.  The consequent
discomfort, though, is not sufficient to interfere with
the child's appetite, good humor or sleep, and when,
after a few days, the margin of the tooth is free, all
the local symptoms vanish.
  Examples of Variations.—Abnormal  dentition is
manifested  either by departures from the laws of
development  already stated, or by actual difficulty
in the process of cutting.
  The standard rules for the eruption  of the teeth
may be departed from in three ways:—
   i.  The appearance of the  teeth may be premature.
Children may be born with  one or more of their
teeth already cut; these are usually imperfect, and
soon  fall out, to be replaced, at the proper age, by
well-formed milk teeth.   Sometimes, however, they
remain permanently, as in  a case that came under
my  own  observation.   Natal teeth  are  always
incisors. Instances of the lower  central incisors
being cut in  the third month  are not uncommon.
Girls  are more  apt than boys  to  cut  their teeth
early, and,  as an early dentition is likely to be an
easy one, the  occurrence is to be looked upon as
fortunate.
  2.  Dentition may be delayed.  This deviation is 
THE FEATURES OF HEALTH.         59
more frequently seen and of more consequence than
the first.  Bottle-fed  babies, as a class, are more
tardy in cutting their  teeth than those reared at the
breast.  With  such,  though healthy  in every re-
spect, a delay of one  or two months is a common
and  not at  all serious event.   On  the  contrary,
whatever  the method of feeding, if no teeth have
appeared by the end  of a year, it may be assumed
that the child's general nutrition is faulty, or  that
rachitis is present.   Delay does  not necessarily
imply  difficulty in cutting the teeth, though the
two conditions are often associated.
   3. The teeth may appear out of their  regular
order.   Bottle-fed infants are most  likely to  show
this irregularity, which is of some importance as an
indication of general feebleness.  In other instances,
however,  it  is merely a family peculiarity, and, as
such, bears no special significance.
   Difficult  dentition  gives rise to  two classes of
affections, viz., local, and  sympathetic or reflex.
Difficulty,  like delay, is   more apt to occur  in
hand-fed  babies  than  in those nourished  entirely
from the healthy breast, but beyond this it is impos-
sible to prognosticate the  ease or difficulty of den-
tition.  The author  has frequently seen the  most
 robust infants suffer  at the time of eruption of each
group  of teeth,  and has  also observed  puny and 
60          HYGIENE OF THE  NURSERY.
feeble subjects pass through the process with little
or no trouble.
  The  third  and fourth groups of teeth  are most
prone to make trouble, and when the child is born
at such a time of the year as to bring the eruption
of these during the hot months, illness of some sort
may be anticipated.  This  is often dangerous and
sometimes  fatal;  hence the popular dread  of the
" second summer."
  The order of eruption of the permanent teeth is
as follows:—

  The two central incisors of lower jaw, from the 6th to 8th year.
   "    "       "   " upper  "     "  7th to 8th  "
   " four lateral  "   ......     "  8th to 9'h  "
   "  " first bicuspids,......     "  9th to loth  "
   "  " canines,........     "  ioth to nth  "
   "  " second bicuspids,  . . . •     "  12th to 13th  "

  These replace the temporary teeth ;  those which
are developed de novo appear thus:—

       The four first molars, from the 5th to 7th year.
        "   "  second molars, from the 12th to 13th year.
        "   "  third molars, from the 17th to 21st year.

  There  are, therefore,  twelve  more permanent
teeth, making thirty-two  in all—sixteen in each
jaw. 
THE FEATURES OF HEALTH.         61
  The diagram, Fig. 6, will  aid  in  explaining the
process :—
                       Fig. 6.
DIAGRAM SHOWING RELATION BETWEEN PERMANENT AND TEMPORARY TEETH.
The figures i, 2, 3, etc., indicate the groups of teeth and the order of their
  appearance.
  Second dentition is a common cause of ill health
in late childhood.  The disorders produced by this
process,  however,  are not so well defined nor  so
dangerous as those  of primary  dentition,  and, in
consequence, the relation of cause and effect is often
overlooked.
  It is probable that the first  and seventh sets are
the most apt to give rise to both local and consti-
tutional disturbances. 
62         HYGIENE OF THE NURSERY.
              CHAPTER  II.

                 THE NURSERY.

  Every well-regulated house in which there  are
children should be provided with two nurseries, one
for occupation by day, the other by night.
  Before entering further into the subject, however,
attention  must  be directed  to the fact that  the
American city-bred child, belonging to the class in
which it is possible to provide separate rooms for
nurseries, is to a greater or less degree a migratory
creature.   For when the first warm days of May or
early June make the parents bask at open windows,
the child is hurried off to a suburban hotel or farm-
house or to the  sea-coast.  Again, so soon  as  the
cold evenings of late September suggest the com-
fort of an open  fire, equal energy is exhibited to
get him back to cosy winter quarters.   In summer,
most of the waking  hours are spent in the open
air, in winter, the greater proportion indoors, hence
the day nursery must be regarded  as a  winter
resort, and  as  such  must  possess qualities  that
would render it uninhabitable  by the  child in  hot
weather.  The night nursery should have, though
to a much less degree, the  same qualities.   In 
THE NURSERY.
63
other words, to put the whole subject in a nut-shell,
the nurseries for winter use should be warm and
freely exposed to the sun; for summer use, cool
and rather shaded, though always perfectly dry.
  Since the  child spends so much time in the open
air during warm  weather, the nurseries will be dis-
cussed  in this chapter  purely from  their winter
standpoint,  and will  be described  under  the  fol-
lowing heads:—
  Situation.—Any room in the house will not do
for a  day nursery.  Rather, on the contrary, must
the best room be selected.   It should have a south-
west  exposure, and be, if possible, so situated in
the building  as  to  allow of  at least two broad
windows,* one in the southern end and one in the
western side.  Into such a room the sun plays with
full force  from a  few  hours after rising until nearly
the time of  setting.   The third floor of a house is
a better elevation for  the nursery, especially if there
be an attic  above, than  either of the  lower floors,
partly because such  rooms are remote from the
ordinary domestic disturbances, but chiefly because
they are drier and more readily heated, and being
elevated,  are  less  cut  off from  sunlight by sur-
rounding buildings.
  The night,  should, if possible, adjoin and com-
* Nursery windows must always be strongly barred. 
64         HYGIENE OF THE NURSERY.

municate with the day nursery, though this feature
is less important  than proximity to the parents'
sleeping-room. It should have a good-sized window
so placed  that it will freely admit sunlight during
the day.   When the nurseries connect, the opening
of communication must be capable of being com-
pletely closed by a well-fitting door or folding doors,
so that one room may be  thoroughly aired without
chilling the other.
  Neither apartment ought to  communicate with
a bath-room  having  sewer connections;  in fact,
although  it may be an object of complaint from the
nurse, the further off such a bath-room  is the better
for the health of the child.
  While  it is a  matter of difficulty to accomplish
in  an ordinary city house, it  is, nevertheless, a
necessary thing to have the nurseries in close prox-
imity to, or even in  communication with, the apart-
ment in which the parents sleep; for then the nurse
is forced  to be morally purer and physically more
attentive than if she have a section of the house to
herself.
  Many mothers  prefer to  keep  their children  at
night. Under this condition, the bedroom.becomes
the night nursery, and its situation must be as care-
fully selected, and its hygiene as particularly guard-
ed, as the regular night nursery; when, too, there
are several children in the family, the risk of over- 
THE NURSERY.
65
crowding in such apartments must be recognized
and carefully guarded against.  The factor of dis-
turbed rest, by the different hours of retirement of
children and parents, is, also, one of importance.
On all of these accounts, a night nursery, under the
control of a competent nurse, is, in my opinion, to
be preferred.
  Size.—The amount of-atmospheric air required
by a healthy child to accomplish thorough oxidiza-
tion of the blood in  respiration is about  the same
as that demanded by adults.   Therefore the small-
est  admissible room  for either a day or night nur-
sery for a single child  must have a capacity of
eight feet cube.   For more than one child the rule
ordinarily given  is, to multiply this  figure—eight
feet cube—by  the  number  of individuals.  This
rule works well enough for a family of two or three
children, but if the number  be greater, the size of
apartments  required  would  much  exceed   any
that could be found in ordinary houses.  Lack of
space, then, must be made  up  by  more  perfect
methods of ventilation.  To put the question in a
more practical form,  a room nine or ten feet high,
twenty feet long and fifteen feet broad will  readily
accommodate, either  for playing or sleeping  pur-
poses, two or three  children, with one attendant,
provided foul air  be  constantly removed and fresh
air supplied by ventilation.
      5 
66         HYGIENE OF THE NURSERY.
  In every room the undermost stratum of air, and
the one in which the child  must pass the greater
part of his time, whether awake or asleep, has a
much lower temperature than the middle, and this,
again, than the highest—the tendency of the heated
air  being always to  rise to  the  top.   Now, the
greater the height of the apartment, the cooler will
be the floor and its  neighborhood; consequently, a
lofty ceiling—namely, one over  ten, or, at  most,
twelve feet—while it  makes  an imposing show, is
far  from  being  desirable for  a nursery, where ease
of heating and  the  comfort and health of the occu-
pants are the ends to  be attained.  On the other
hand, a ceiling  less than eight feet high will tend
to make the room close, stuffy and over-warm, and
correspondingly unhealthy.
   Lighting.—As already indicated, the only per-
missible light for a  day nursery is that derived from
the sun,  and the more plentiful this is, and the more
directly  it enters, the better.  The night nursery
may be  illuminated by gas, by an  oil lamp, by a
candle or a night light.  Writers ordinarily recom-
mend the last three, upon the supposition that gas,
while burning, not only consumes a  considerable
proportion of the oxygen of the air, but gives off
certain injurious products  of combustion.   This
may be true to a certain extent, but the disadvan-
tages  are  greatly  discounted by the increase in 
THE NURSERY.
67
convenience and the greater safety, so far as causing
fire is concerned.
  Gas certainly may be used  in  the late afternoon
and evening;  so far as the night  hours are con-
cerned, should a light be  constantly required, the
best means of obtaining it is from one of the regular
night lights.
  A very admirable form of such lights is shown
in Fig. 7.   This light,  called the " Pyramid  Night
Fig. 7.
night light.
Light," consists  of a low, brass stand,  having a
movable pyramidal glass  chimney, and  provided
with a porcelain  cup upon which the candle rests.
The candle  itself is about one  inch and  a half in
height and breadth, and is so constructed that the
combustible material is completely incased in a fire-
proof plaster-of-Paris cup.  Each candle  will burn
eight or ten hours.   These lights are perfectly safe 
68         HYGIENE OF THE NURSERY.
and may  be utilized for  the further  purpose of
keeping food or water warm.
  For occasional  use  at night, nothing  can be
better or of more ready service than gas.
  The safest way to make a light is to use a safety-
match, and the taking of a flame from  an open fire
or the use of ordinary friction matches are danger-
ous and to be strongly discouraged.
  Furnishing.—This  heading  may be made to
include the finish of the floor, walls and ceiling, as
well as the necessary articles of  furniture and their
arrangement.
  The floor, which ought to be  laid with  good
yellow pine boards, should have a  hard finish.  To
accomplish  this, the crevices between the boards
and all the nail holes must first be  filled with putty,
then,  after this  has dried, coated with a  rapidly-
drying, hard  shellac  varnish, next sandpapered,
when the varnish has had time  to harden  thor-
oughly, and, finally, finished  by a second  coat of
shellac.   This gives  a  light-colored floor  that
brightens the room and at the same time is readily
cleaned.   A  dark  staining, besides being  sombre,
always looks soiled.   A painted floor  is not easily
cleaned.   Should either of the latter be already in
a nursery, their defects may be  overcome  by a
well-laid parquet floor.
  A carpet tacked  to the floor is not to be recom- 
THE  NURSERY.
69
mended;  far better is it to have rugs, which can be
frequently taken up  and well shaken, the house-
maid having  in  the meanwhile free access to the
floor itself.
   Paint is the best finish for the walls.   Individual
taste will of course weigh  in the selection of the
color and amount of decoration, though a light tint,
but still one not trying to the eyes, is most desirable.
Next to paint, varnished paper is to  be preferred.
Within the  past few years light  and  soft tinted
fabrics, covered with  the  representations in figure
of familiar nursery legends, have been for sale by
paper  dealers.   Such papers  render  the nursery
attractive  to  older children, and, to a great extent,
take the place of pictures.   Paint, however, has the
advantage, in that it may be washed and thoroughly
disinfected in case of the occurrence of contagious
disease.
  To return to the subject of pictures, it is best to
interdict  any  that are valuable  or  expensively
framed.   A few highly-colored,  striking prints
taken  from one  of the  good  weekly  illustrated
papers,  and fixed to the painted wall by glue, will
give as  much  pleasure to the childish eyes as the
works   of the  best artists.   They can,  too, be
changed from time  to time, and after exposure to
contagious germs can, without regret,  be removed
and burned, in  the process of cleaning. 
70          HYGIENE OF THE NURSERY.

  The ceiling of the rooms should always be painted
with some light  color, and be perfectly free  from
ornamentation.
  In the matter of furniture, the day nursery should
contain a table at which the older children may take
their meals or use in play and study; one or more
large  chairs  and  several  small  ones;  a  plentiful
supply of toys and  picture  books, and, if there  be
room enough, a chest of  drawers or wardrobe for
clothing, and so  on.  All  the furniture  must  be
plain, that it may be more easily kept clean.
  The centre of the room  must  be kept clear, to
give an opportunity for play.  The table, therefore,
should be a folding one, that it may be placed out
of the way against the wall and take up the  least
space possible when  not in use.   Any other heavy
article of furniture  must also occupy  a position
against the wall and be fitted with castors, so that
it can  be readily moved to facilitate cleaning the
floor beneath.
  The toys may vary in character with the  age  of
the child—soft, white India-rubber ones for infants,
more  complicated mechanism for older children;
but inexpensive toys are the best, because they can
be most frequently changed. The same is true of
books.  For both, by the way, there should  be a
special drawer or closet provided, where  they can
be put out of the way when not required. 
THE  NURSERY.               71
  A few plants, a bird or a globe of fish add bright-
ness to the child's room and greatly assist in culti-
vating good taste and in affording amusement.
  The night nursery must  contain the beds, the
bathing and toilet  utensils, several  chairs—one
being a rocker—a small table,  a  medicine closet
and a chest of drawers or other convenient recep-
tacle for clothing and extra bed covering.
  It is essential to have a separate bed for the nurse
and one for each child; they should be placed so
as to be protected from any chance draught of air,
be far enough apart to allow of a free passage be-
tween, and the bed of the youngest, or of an ill child,
ought to be nearest the one belonging to the nurse.
  Old-fashioned pitchers and basins are to be pre-
ferred to stationary washstands.  The latter, though,
are so convenient—especially when  supplied with
hot- and cold-water faucets—that they may be per-
mitted when the waste pipe is short and runs directly
through the wall into.a rain spout, instead of com-
municating with the sewer, and when the nurse can
be trusted not to use them as a convenient means
of disposing of the ordinary chamber waste.
  Each child should have'his or her  own brushes,
combs, sponges, soap and towels, and all  of them
must be kept clean  and sweet and have a place of
their own.
  The medicine closet must be allowed to contain 
72          HYGIENE OF  THE NURSERY.

only such  articles  as  may be  often  required, and
can be used with safety by a person of average in-
telligence; for example, olive oil, vaseline, oxide of
zinc ointment,  talcum powder, soda mint,  sweet
spirits of nitre, syrup  of ipecacuanha, chalk  mix-
ture,  etc.   Any  preparation  containing  opium—
even  paregoric—is especially out  of place in the
nursery medicine chest.
  Feeding bottles, implements for the heating and
preparation of food and for bathing, also belong to
the furniture of the nurseries, but their consideration
may be conveniently postponed to later sections.
  Heating.—Each room requires an accurate ther-
mometer, so hung that it may record the mean tem-
perature;  not too  close to  the  fireplace  nor the
windows, where it runs the chance of being unduly
heated or chilled.
  The temperature of the day nursery should range
between 68° and  700 F.,  that of the night  nursery
from 640 to 68°.
  The proper method of heating is by an open fire-
place in which either wood or coal is burnt.   Either
of these fires is superior to a furnace, simply because
they serve  a double purpose, namely, heating and
ventilating.  My  personal preference is for an old-
fashioned hearth, where oak or other quietly burn-
ing logs can be  used, since a wood fire  is more
readily lighted and regulated, and is a better venti- 
THE NURSERY.
73
lator than one of coals.  Still, in our climate, with
its manifold and sudden changes, it  is so essential
to have a source of heat constantly at hand that it
is difficult  to banish the furnace  register from any
living room.  Therefore, while recognizing the dis-
advantage of furnace heat, in that it makes the air
too dry, it is well to supply the nurseries with both
means of heating, using  the open fire in moderate
weather and the furnace only in the presence  of
severe cold.
  In  my experience, where the  nurseries are  so
situated as to receive direct sunlight through ample
windows, there is  rarely any need of furnace heat
except  in the early morning, before the servants
have time to make up the wood or coal fire.
  Care  must be taken to guard every open fireplace
with a high fender, one that can neither be knocked
down nor climbed over by an active  child.
  Ventilation.—In  addition to  furnishing ample
space in the nurseries, it  is  necessary to provide a
constant supply of fresh air  by ventilation.
  By all odds the best ventilator is an open fireplace
in which wood is burnt.  Such a  fire, by creating a
draught up the chimney, carries off the impure air,
and there are few doors and windows so closely
fitting that they prevent the entrance of fresh air
to supply the place of that so removed.
  Should this  not prove  sufficient,  one  of the 
74         HYGIENE OF THE  NURSERY.
windows may be  utilized, the upper  sash being
slightly lowered and the lower sash slightly raised,
the openings being sufficient to allow of the entrance
and exit of air, but not enough to cause a current
or draught in the room.
  When the rooms are heated by a furnace or stove,
some permanent ventilator must be used.  For the
egress  of foul air an opening may be made in the
chimney at a convenient distance from the floor;
this may be guarded by an ordinary adjustable
register, such as is used to regulate the entrance
of heated air from the furnace flue.
  The same purpose* may also be accomplished by
making an opening in the upper  part of the door;
this should be guarded by a movable  sash, or  by
one of the ventilating appliances  to  be mentioned
later.
  To allow of the free entrance of pure air, one of
the glass lights  may  be replaced by a plate of tin
having  a multitude of minute perforations, or a
ventilator made to fit the window  may be used.
  The  best of these are shown in  the four following
figures.
  One apparatus, Fig. 8, consists  of two pieces of
board,  one of which slides upon the other, so that
it may be readily adapted to any breadth  of win-
dow frame.  Each portion has  a  circular opening
to which is  fitted a tin or  sheet-iron  pipe, eight 
THE NURSERY.
75
inches long by four inches in diameter, and having
a slight upward bend.  These pipes are provided
with a solid diaphragm, Fig. 9, readily moved by a
Fig. 8.
WINDOW VENTILATOR.
Fig. 9.
       WINDOW VENTILATOR IN PROFILE, SHOWING DAMPER.

handle, and intended to regulate the quantity of air
admitted.   When in position, the pipes, of course,
project inward. 
76         HYGIENE OF THE NURSERY.

  The wheel window ventilator, Fig. IO, consists of
a movable  diaphragm and a revolving wheel, the
whole varying from six to eight inches in diameter.
When placed in position, which  is readily done by
cutting a circular hole in a  window pane or in the
door, the  difference in temperature between the
interior and  exterior of  the rooms will create a

                     Fig. io.
WHEEL VENTILATOR.
current, and cause the wheel to revolve noiselessly.
The revolving wheel, while it  prevents a draught,
allows of the passage of two currents, that of fresh
air inward and foul air outward, and the diaphragm
enables  one to control the supply of air.
  An admirable domestic arrangement for ventila-
tion consists of a board  eight or ten  inches  in 
THE  NURSERY.
77
height placed across, and close to, the window sill,
as in Fig. 11.
  This, when the lower sash is raised, as indicated
by the dotted lines, allows of a free entrance of air
without a draught, the current being directed up-
ward (as shown by the arrows).
  Together  with the above careful provision  for
constant purification of the atmosphere,  it is essen-

                     FlG. II.
BOARD VENTILATOR IN PLACE.
tial to "air"  thoroughly  both of  the nurseries
through widely opened  windows.  With the day
nursery this  must  be done whenever the  child
leaves it for any length of time, care being taken to
close the windows, and get the temperature to the
proper degree before his return. The night nursery
should be  aired after the children leave  it in the
morning, and after the.mid-day nap. 
78         HYGIENE OF THE NURSERY.

  The air of the nurseries should, of course, never
be unnecessarily contaminated.  Cooking or smok-
ing in the rooms are to be especially avoided.  In
regard to the latter, there is no doubt that children
are often made sick by the fumes of tobacco, and
that,  of  all  forms, cigarette smoke is the most
injurious.
  Cleaning.—It is hardly necessary to say that the
nurseries must be kept  perfectly  clean.   Napkins
and bed  clothing that have been soiled by the dis-
charges  from  the bladder or bowels must  be re-
moved at once from the  room, and the practice of
hanging  diapers wet with urine before the nursery
fire to dry  should  be  emphatically discouraged.
Equal care must  be taken to promptly empty and
clean chamber vessels after use.
  The furniture, woodwork and  window glass, as
well as the floors, must be kept clean and free from
dust by  wiping with a damp cloth at least once a
week.
  Should there be a stationary washstand in either
room, it  is most important to thoroughly clean the
basin every day, and to disinfect the waste pipe, how-
ever short it may be, twice every week.  The latter
may be done with ammonia,copperas or Piatt's Chlor-
ides.   The process is very simple, and consists in
pouring down the pipe a gallon  or more of a diluted
solution of either of the  above articles.   Copperas 
THE NURSERY.
79
is the cheapest and in my opinion the best; a double
handful of it  in  an ordinary bucketful  of water
forms an efficient  disinfectant and deodorizer.
  The substance  known as Household Ammonia
may be  employed  in the  strength  of two table-
spoonfuls to a gallon  of water, and is  especially
useful where there  is a suspicion that the interior
of the waste pipe has become coated with a layer
of soap.
  Piatt's Chlorides  is used  in the proportion of one
part to  four of water, and  is very efficient, though
more expensive than either of the other  materials.
  The nurseries must  never be  cleaned whilst the
children are occupying them. 
80         HYGIENE OF THE NURSERY.
               CHAPTER III.

                THE NURSE-MAID.

   While the mother is the natural guardian of the
 physical and moral welfare  of  her children, the
 nurse-maid has a considerable influence over both;
 for the former, however  anxious and watchful, has
 so many other duties, both  domestic and social,
 that she  must absent herself at times  from the
 nursery;  the latter, on  the contrary,  lives  there.
 By day, and often, too, at night, she has the care
 of the children, attending to their  apartments, to
 their persons,  food and clothing, participating in
 their amusements and exercise, and watching over
 their sleep.   The selection of a nurse-maid, there-
 fore, is a matter of much importance.
   The celebrated Dr. West, in discussing the nurs-
 ing of sick children, makes the following statement
 in regard to a  nurse's qualifications:  " Indeed, if
 any  of you have entered on  your office (hospital
 nursing) without a  feeling of  very earnest love to
 little children—a feeling  which  makes you  long
to be  with  them,  to take care of them, to  help
them—you  have made a great  mistake in under-
taking such duties  as you are now engaged in." 
THE  NURSE-MAID.
8l
Now, though this  was addressed  to those who
were occupied in caring for ill children, it is alike
applicable to the nurse whose chief  duties are with
the healthy.
  Love of children, therefore, is essential in a good
nurse, but it must be combined with several other
traits of,character, since love alone will not com-
pensate for such faults as stupidity, inexperience,
forgetfulness and lack of judgment.
  What, then, are the qualifications to be sought
for?
   ist.  The woman should be in the prime of life,
between twenty-five and fifty, for example.   For if
she be under the former age, she is  apt to be frivo-
lous and think more of her " afternoon out" and of
her male friends  than of her charge,  while if over
the latter, besides being set in  her ways and opin-
ionated, she is usually too worn out for efficient day
service and too prone to heavy sleeping to be trusted
for night duty.
  2d. Strength, activity and freedom  from disease
are necessary.  The first  quality does  not always
go with a large accumulation of flesh ;  in fact, the
reverse is apt to be the case.   A stout nurse looks
motherly and  comfortable in  the nursery, but she
may, by her very bulk and consequent heat-pro-
ducing power, render  a young infant wretched  in
warm  weather.   I  should avoid such  an one  as
       6 
82         HYGIENE OF THE NURSERY.
much as I should another whose back pained when
she swept the floor or carried the baby out for an
airing.
  Consumption of the lungs, indicated by a cough,
and  syphilis,  indicated,  usually, by an  eruption
upon the skin, are  two  diseases to be especially
avoided.   Besides these  two, which  are to be
shunned   because they  positively  endanger  the
child's health, there are others that, without doing
appreciable  harm,  render  the sufferer's  presence
unbearable in the nursery.  These chiefly offend
through  the  sense  of smell, as  in  the  case of old
leg ulcers; too  freely perspiring feet;  over-active
axillary  glands; certain  forms of chronic catarrh
of the nose, throat  or nostrils ;  and of decayed or
badly kept teeth.
  3d. While beauty  is not to be specially sought
after, the  maid's face should, at  least, have a cheer-
ful expression.   A markedly  homely or sinister
face is a  disadvantage, and  still more  so is  any
decided  deformity.   This   reference  to  personal
appearance,  at first sight, perhaps, seems trivial,
but any one who has seen  much of children can-
not  fail to have noticed how  a young child  will
crow and hold  out its  arms to  the  bearer of  a
placid, comely and smiling face,  and turn away
from one that wears a sombre and  unsympathetic
expression.   Much is said about the magic of touch
in managing young children, but I have observed 
THE  NURSE-MAID.
83
that their eyes always seek  the face and  eyes of
those about them, and that it is what they see there
that guides their instinct for like or dislike.
  4th.  Children resemble dogs and horses so far as
the instinct  of knowing those who love them  is
concerned, and the element of love toward babies
is, as already hinted, the  most important feature in
the disposition of a nurse.  A woman  having this
quality will never be cross or impatient, and, by the
very contagion of  her good nature, prevents her
charges from being fretful and makes her  nursery
happy.  Besides love, with the patience and con-
sideration it implies, truthfulness is a most  import-
ant trait of character, not only  for the  physical
welfare  of the  child, but also that, since  children
are such imitative creatures, the bad habit of lying
may not be formed.
  A truthful, loving woman is generally a cheerful
one;  if not, her place is out of the nursery, for
children must be  happy to  be  healthy,  and the
constant contact with sadness will bring unhappi-
ness to any child.
  Gentle speech is  also  a desideratum.  Children
will never learn politeness if every sentence they
hear in the nursery is spoken in the fewest, shortest
words, and " please " and " thank  you " are good
elements of a nurse's conversation.
  5th. The nurse-maid  should have a sufficiently
developed mind to  follow out and remember gen- 
84         HYGIENE OF THE NURSERY.

eral directions, whether given by the physician or
mother, and to do  routine work without constant
supervision.  A certain amount of experience is a
good thing, and on  this account it is a recommend-
ation  for a woman  to  have had a partial  hospital
training, to have nursed children before, or to have
been a mother.  On  the other  hand, one must
beware of the self-opinionated  maid, who,  having
cared for several children, thinks she knows every-
thing, and will be controlled by neither professional
nor maternal directions.  Such women are as igno-
rant and inefficient  as they are common.
  6th.  Cleanliness is essential in a nurse.  A slov-
enly maid will keep neither her children nor their
nurseries clean.  Therefore insist upon the nurse
not only washing her  face and hands as occasion
requires, but upon her bathing her whole body two
or three times a week, and upon her wearing fresh,
well-aired clothing.
  7th.  So  far as habits  are concerned, absolute
temperance and early rising are the most desirable.
Early  rising,  however, implies an  early hour  of
retiring, and  care must be  taken to afford ample
facilities for so doing.
  8th.  Every nurse-maid should be impressed with
the importance of informing the parents of all con-
ditions connected with the health of the child that
may demand attention, and of revealing  at once
any injury  that may have been sustained. 
CLOTHING.
85
               CHAPTER IV.

                   CLOTHING.

  In introducing this subject, it may be well to call
attention to two important points  that are often
either unrecognized or overlooked.
  1 st. All children, but particularly infants, have
little power to resist  the depressing influences of
continued cold, and on this account require warm
clothing.
  Too much  cannot  be said against the fashion
which, for the sake of supposed  beauty,  demands
that  children  should  be dressed  in a way to leave
their  legs and knees  bare.   Even  in the  house,
and except  in extreme tropical weather, this bar-
barous practice is injurious, as  it exposes  a  con-
siderable part of  the body to constant chilling.
The  physician knows, and the intelligent layman
should be readily convinced of, the  bad effects of
such  protracted abstraction of  body-heat.   The
explanation  is  simple: every child is supplied by
nature with a certain definite quantity  of nerve
force  destined  to be expended each day in main-
taining what physiologists term " the functions of
the body,"  namely, breathing,  circulation  of the 
86         HYGIENE OF THE NURSERY.
blood, digestion, heat-production, and so on.  Now,
if an undue proportion of this nerve force be con-
sumed in producing body-heat, as must be the case
when so  large  a surface  is  left  bare,  the other
functions  will be robbed of force.   From this rob-
bery the digestion suffers most.  With feeble diges-
tion comes constipation or its opposite, diarrhoea.
Again, if  the  surface be chilled, the blood  which
should circulate in the skin is driven to the interior
of the body, and the vessels of the  mucous mem-
brane  become surcharged.  This surcharging, or
congestion, causes the condition known as catarrh,
which, affecting the lining membrane of the alimen-
tary tract, causes vomiting and diarrhoea;  and, in
the case of the lungs, bronchitis.
   Mothers who allow  their children to have their
legs and  knees covered with  the " hideous " long
stocking  or  drawers, often  come  to me and com-
plain that Mrs. So-So's children have bare legs, and
are even  healthier and more  robust-looking than
theirs.  Some children are born hardier than others,
but no one knows, in the long run, how much better
in health, in  after life, are those whose vital forces
have  been husbanded and  strengthened in infancy
and childhood.   I cannot waver in my opinion.  I
have  been too often  called  to  the bedside of these
poor little " robust " children whose health, and even
life, had been spared had their clothing been better 
CLOTHING.
87
adapted to their tender years.  One great argument
advanced by the advocates of bare knees is that in
olden time all children were clad with  their arms
and neck, as well as knees, bare.  No one  says
how many died by the wayside.  What  mother
would, on a winter's day, care to sit on the floor or
walk through the halls  with  her own knees  un-
covered?  The mother  who protests  the  loudest
I have always  observed  to  be warmly dressed
herself.
  2d. Infants and children have soft tissues.  This
statement applies as  well  to the bones, as  to  the
muscles.  Therefore, the clothing should fit loosely,
that it may not interfere with the motion of the
limbs,  with the rise and fall of the chest in respira-
tion, or with the necessary freedom of the mus*cles
of the abdominal wall or  intestinal canal, one of
which  is concerned in respiration, the other, in the
no less important function of digestion.
  Let  the clothing, then, be warm and loose.
  Thought  for  the infant's clothing  must begin
before its birth, with the  filling of the " baby's bas-
ket."  This should contain the following articles :—
  A nainsook slip.
  A flannel skirt.
  A merino shirt, high neck and long sleeves.
  A flannel band, twenty-two inches long and six
inches wide. 
88
HYGIENE OF THE NURSERY.
  A soft woolen shawl, to be used for a wrap in
cold weather.
  Worsted socks.
  Two linen diapers.
  Large and small safety-pins.
  One pair blunt-pointed scissors.
  Two soft towels.
  Castile soap.
  Small silk sponge.
  Powder box and puff.
  Soft hair-brush.
  Cold-cream or vaseline.
  Linen bobbin.
  Fine old linen, for infant's mouth.
  So soon  as the child  is born and the cutting of
the cord frees it from maternal connection, it is the
rule to wrap it in a piece of soft flannel and  place
it in a position of safety until, certain necessary
attentions having been  rendered  to the mother, a
convenient  time arrives for washing.  After this
operation, which will be  described on a future page,
the child is dressed for the first time.  Every infant
requires knitted worsted  shoes, or, as  they are
popularly called, " socks," a napkin and an abdom-
inal belt or " binder;"  the  rest of the dress—the
body-clothing  proper—consists  usually  of three
garments, which vary in pattern with individual
ideas and tastes. 
CLOTHING.
89
  The "socks" are made of silk  thread  or soft
worsted yarn fashioned by needles into the shape of
shoes, and of such a size as to fit the foot loosely,
while covering the leg two inches or more above
the ankle.   They are held in position by a loosely
tied  tape or a  narrowed band of stitches—the
mechanism of which every knitter will understand
—near the  top.   Stockings are unnecessary, and
are rarely used before the clothes are shortened.
  The napkin or  diaper  may be  made  either of
linen  or muslin, the former material being preferred,
as it  is less  heating and less liable to cause chafing
of the skin when wet.  It must be folded in such a
way that it  may not cause pain by undue pressure
upon  the back or abdomen.
  A soiled napkin can never be safely used a second
time,  even though the soiling medium  be simply
urine  and the subsequent drying be thorough.  In
consequence, an abundant supply is  essential.  The
least  dampness  renders  its  use dangerous,  and
while  insisting upon the  washing  of  all  soiled
napkins, it is equally important that they be aired
for at least  twelve hours  before being used again,
that they may be surely dry.  One must be most
careful, too, to insist upon  the laundress using only
pure  soap and avoiding  soda in washing,  for the
constant  contact of diapers impregnated with irri-
tating substances is sure  to produce troublesome 
90          HYGIENE OF THE  NURSERY.
excoriation of the buttocks and  neighboring  deli-
cate skin.
   The "binder" may be of fine, soft  flannel or  of
knitted wool.  In either case it should extend  from
the brim of the pelvis or hip bones to  the lower
ribs.   I  prefer a knitted band made narrower in the
centre than at either extremity.   Any woman  who
is apt with her knitting needles can make one, and
the product has  the  advantages of being readily
applied  and of keeping its position without the aid
of either strings or pins. *  When a flannel band is
preferred,  it  should be wide  enough to  cover the
same area, and long  enough  to go  a little more
than around the abdomen.  It is best fixed in posi-
tion by two  small safety-pins.  Such a band is dif-
ficult to keep  in place, collects  more perspiration
than  the  more  net-like  knitted  binder, and the
necessary pins may cause inconvenience.
   Several  bands  are required to be on hand at the
same time for the sake of  proper cleanliness,  and,
  * Formula for Crochetted Baby-band.—Single zephyr in ridge
stitch, that is, half stitch, in which, going back and forth, only the
back half of the  stitches in the lower row are picked up.  Begin
on a chain of fifty and crochet forty-eight ridges, hence ninety six
rows.   Join by a  row of tight stitches or by sewing.  Finish off at
bottom by a row of plain stitches and at top by a picot-edging (five
chains  and a tight stitch back into the first).—" Babyhood," Vol.
in, p. 33- 
CLOTHING.
91
as they should be worn up to the end of the second
year, it is necessary to replace them, set by set, as
the growth of the child demands.
  The body-clothing is usually composed of three
separate pieces :  a shirt, a petticoat and an outside
dress or " slip."   The shirt should be  long enough
to extend from the neck to the  lowest part of the
trunk and have sleeves reaching to the wrists.   It
may be made of merino or of soft worsted yarn.
In either case it should fit loosely and be fastened
at the  neck with tape or buttons.  The petticoat
must be long enough to extend from the waist to
six or eight inches below  the  feet.  The proper
material for the skirt  is light, white flannel.  This
is gathered at the top  into a muslin band, which
must be deep enough to reach from the hips to the
arm pits, and wide enough to lap over considerably
at the  back;  it is  fastened by  small safety-pins.
The over-width is to allow for increase in size.
  An equally good waist  can be made with arm-
holes and buttoned in the back.
  The  dress or slip is made of fine cambric, cut in
one piece, opening well at the back that it may be
readily slipped on and off.
  Another, and I think a preferable outfit, consists,
also, of three  garments.   The first or under gar-
ment, made of soft, white flannel, is long enough to
extend from the neck to ten inches below the feet 
92         HYGIENE  OF THE  NURSERY.
 —about twenty-five  inches in total measurement—
 with  wide arm-holes.   All the seams  must be
 smooth, and  the  hem  at the neck turned outward.
 The next garment, cut in  the same way, but one-
 half inch larger, and five inches longer, is made of
 muslin.  The slip is also cut " Princess," has long
 sleeves, a longer skirt  than either of the other gar-
 ments, and all are fastened behind by small buttons.
   When dressing the infant these three coverings
 are put  together, sleeve fitting  to sleeve, and  the
 whole passed over the little one's head, then but-
 toned behind, and the process is complete.
   The advantages of the last method of dressing
 are:—
   1st.  Perfect freedom to  the  organs  contained
 within the chest, abdomen and pelvis.
   2d. Suspension of the clothing from the  shoul-
 ders.
   3d. Saving of time to the mother and fatigue to
 the infant in the process of dressing.
   4th.  A uniform covering of the whole body.
   So  much  for the  day clothing.   At night the
 dress  should consist of the flannel and the outer
 garment.
   In the foregoing, my intention has been to lay
especial stress upon  the advantage of holding the
garments in place by tape or buttons rather than by
pins, and it should be noticed, that a baby may be 
CLOTHING.
93
 completely dressed with but one pin in its clothing,
 namely, that fastening the napkin.   This, which is
 allowed only for the sake of convenience, must be
 a  safety-pin, the  ordinary pointed pin  being an
 abomination in the nursery.
   It is hardly necessary to  say that, for the  sake
 of cleanliness, an abundant supply of body-clothing
 should be at hand;  a mother, particularly, must
 recognize that " cleanliness is  next to godliness,"
 and provide accordingly.   Let her remember, too,
 that fresh clothing must be thoroughly " aired " or
 dried before it is put upon  the infant.
   Sometimes, to keep the body-clothes dry, a piece
 of thin rubber cloth is placed over the napkin; this
 does nothing but harm, for it over-heats the parts,
 and when  the  diaper  is wet with  urine, makes a
 poultice of it,  and thus macerates the  skin and
 causes irritating and painful excoriation.
   At the age of six months in summer and of eight
 months in winter, provided, in both cases,  the health
 be good, the clothing  may be " shortened."  This
 change introduces several  important   questions,
 namely, the covering of the legs and knees, and the
 selection of shoes and stockings.
   The shortening  process  makes no change in the
body-clothing except that the skirts end a short dis-
tance below the knees, at about the point to which
an ordinary shoe top comes; this, of course, prac- 
94         HYGIENE  OF THE NURSERY.

tically leaves the legs, from the top of a short stock-
ing to the lower edge of the napkin, exposed.  As
already hinted,  it is necessary for the health of the
infant to  keep this comparatively large surface pro-
tected, except,  perhaps, during  a few  extremely
hot days in mid-summer.   There are two ways of
accomplishing this :  either by drawers or by stock-
FlG. 12.
ings long enough to extend from the feet to the
napkin, to which they may be attached by safety-
pins or ordinary " fasteners."   The best drawers are
those made in two pieces, one for each leg, as shown
in Fig. 12.
  These, as furnished in  the shop, are made of
merino, but any clever woman should be able to 
CLOTHING.
95
cut them out of Canton flannel and make them at
home.   They must fit the legs moderately closely,
and have  a buttonhole  at the  top, so that when
passed over the napkin they may be  buttoned to
the waist of the skirt on its inner side, and so be
held up.  These drawers are not  readily soiled, as
they cover the legs only, and the napkin comes be-
tween.  They must, of course, be made of material
to suit the season—heavy in winter, light in summer.
  When stockings alone  are  used they must be
long enough to come  well above the knees,  and
should be held  in position by "supporters" instead
of garters, since the  latter, being necessarily tight,
bind the limbs, and  often, by interfering with  free
circulation, cause cold  feet.  The supporter must
be adjusted  to  make only the required amount of
traction, and this always in a direction  parallel with
the axis of the  body.  The stocking foot ought to
fit easily, but without wrinkling, and  at the same
time have a rounded rather than a conical-shaped
toe.   For although  the  silk, woolen,  or  cotton
material of which the stocking is composed may be
yielding, it is elastic, and consequently capable of
exerting a certain amount of pressure upon  the
foot;  and there is little doubt  that the persistent
compression made by a short, sharply conical point,
cramps the toes, crowds them together, and some-
times, even, forces them to overlap one another. 
96         HYGIENE OF THE NURSERY.

  Colored stockings are often  preferred to white,
but they are only permissible, provided the coloring
matter be well fixed in the texture and not of such
a nature as to cause irritation of the skin.   Every
stocking should be  turned  inside  out, carefully
examined, and all  knots  and  ends removed, the
smallest of which hurt the tender little feet.  Were
this matter oftener looked to, many an unexplained
tear would be avoided.
  As with the drawers, so with the hose; several
weights should be provided to correspond with the
varying demands of the seasons for greater or less
warmth, and in both cases a sufficient supply must
be  kept to allow of frequent  changing.
  The shoes are prominent  items of the clothing;
their shape, size and manner of fastening, and the
make-up of the soles being  the important matters
for  consideration.
  An infant's  feet are plumper than those of the
adult, and all  the tissues, but especially the bones,
are softer.  They  may be  readily deformed  by
protracted pressure from badly constructed shoes,
despite the assertions of unhandy shoemakers, who
say that the feet are shapeless masses  of fat, for
which  any leathern bag having the semblance of a
shoe will serve as a covering.
  Throwing  out the  element of fleshiness, the
characteristics  of the  perfectly formed  baby and 
CLOTHING.
97
adult foot do  not materially differ.   In the first
place, the inner and outer margins are very different
in contour.  Secondly, the heel and  middle third
of the foot is firm and presents little mobility in its
component  bones, whereas the anterior  third,  in-
cluding the toes, is very mobile.  The toes again
bear much the same relation to the rest of the foot
as the  fingers to the hand.  This is particularly
noticeable in the great toe, which, instead of inclin-
ing toward a line  passing along  the  centre of the
foot, points away from it, in the same manner as the
thumb from the hand, although, of course, to a  far
less degree.  An inclination of the great toe toward
the mid-line of the foot is undoubtedly often seen in
adults, but in  them it is  a deformity resulting from
badly  made  shoes, and  one that gives a conical
contour to the toes, cripples the movements of the
great toe, and greatly interferes with  the ease  of
walking, just as a contraction and permanent  draw-
ing of the thumb  toward the palm  of the  hand
would  materially  lessen the  usefulness of that
member.
  The normal  position of the toes just described
will be readily  understood from  the tracing of the
sole of the right foot as shown in Fig.  13.
  The most striking  features of this  diagram are,
the expanded position of the toes ; the width of the
anterior part of the foot compared with  the heel, 
98
HYGIENE OF THE NURSERY.
and the straight outer and curved inner margins of
the foot.   The  line  A  B represents the axis of
walking, which,  while nearly parallel to E  F, the
Fig. 13.
                TRACING OF NORMAL FOOT.


inner edge of the foot, forms quite an angle with
C D, the centre line.
  In the normal foot the great toe is directly in the
axis of walking, a position in which, of course, it 
CLOTHING.
99
is of much greater service than if it were inclined
inward toward the line C D.
  Now, if a line be drawn closely around the mar-
gin of the above imprint, it will give the exact shape
of a perfect shoe sole for the right foot; or taking
                                        «
                      Fig. 14.
 Left Foot.    Right Foot.
SHAPE OF PROPER SHOE SOLES.
the imprint of both feet, we get the outlines shown
in Fig. 14.
  On first  sight, one would suppose that  a  shoe
with a sole so shaped would look very awkward,
but when made by a skillful shoemaker, it differs
very little in appearance from those ordinarily sold 
IOO        HYGIENE OF THE NURSERY.
in the shop, with the exception that it is broader in
the toes.
  Another important fact is clearly demonstrated
by Fig. 14, namely, the absolute necessity of having
the shoes made " right and left," and the fallacy of
supposing that one or other shoe may be used on
either foot indiscriminately.
  Besides having a correct shape, the shoes should
be long enough not to cramp  the toes  and bend
them down and backward  upon themselves.  At
the same  time it is a mistake to have  them too
long, allowing the foot to slide back and forth, as
this  leads  to  the formation of either blisters or
corns.   Let the shoe fit snugly about the heel and
instep, and easily at the toes, and all is well.   I say
easily at the toes, because many an otherwise good
shoe is ruined by having  the uppers at the points
too scanty, so that  the toes are  forced against the
sole  and subjected to painful pressure.
  The best method of fastening is by a lace, since
this  admits of  making  one part  of  the  upper
tight and another part loose, according to circum-
stances.
  Elastic fastenings, as in  so-called congress shoes,
are not good  for children; and when buttons are
used, the nurse must not necessarily leave them in
the position fixed by the shoemaker, but move one
or more as the size of the  ankle demands. 
CLOTHING.
IOI
  The thickness of the soles depends upon the age
of the child.   Before walking  is attempted, they
may be thin, flexible, and of uniform thickness from
heel to toe; afterward they should be made heavier
and more resisting, in order to protect the tender
feet, and  should be  decidedly thicker at the heel,
that this part  of  the foot may be elevated.  A
clear-cut heel,  however, as in boots adapted  for
adults, is not  to  be recommended in children's
shoes before the age of six or eight years.
  Sometimes a careful mother may notice that, for
a short time after stockings and shoes are put upon
her baby, the feet are cooler than before.  Undue
pressure  about the ankle, with  consequent inter-
ference with the blood circulation in the feet, is the
cause of  this, and  the remedy is to remove occa-
sionally the coverings, chafe the feet into warmth,
and see that the shoe-top is not so  tightly laced or
buttoned as to constrict the ankle.
  So  far, all that has  been  said  of the  clothing
after  " shortening" refers  to  the  day and  house
garments.  It remains now to consider the night
dress and  the  extra  wraps  to be worn  out of
doors.
  At bedtime, all the  clothing worn during the day
being removed, the baby is washed, and after the
application of a fresh  napkin  and  binder, is ready
for the night dress.   This consists of a shirt and an 
102
HYGIENE  OF THE NURSERY.
especial  gown.  The shirt  should always be of
flannel,  a light  gauze in summer and a  heavier
wool in winter; its pattern may be the same as that
worn by day, though its texture ought to be a trifle
lighter.   The best pattern of a winter night-gown is
a long,  plain  slip, with  a  drawing  string  at the
bottom, to prevent exposure of the feet and limbs,
should  the  child kick off the bed  covering during
sleep.   It ought to be made of flannel, or the more
easily washed Canton flannel. In  summer, a loose
muslin  slip  of the  same design, but without the
drawing string, may be worn. There is even more
temptation by night  than by day  to use a rubber
cloth over the napkin, to protect the body and bed
clothing, but never do this.
  It is  a good  plan  to  provide the  child with a
flannel garment corresponding to the dressing gown
of the  adult,  and  with a pair of  bedroom shoes.
The latter  are  composed  of soft leather or felt
soles and knitted uppers, and are  fastened around
the ankle by a soft elastic.   Both of these will be
found useful in the  many occasions when the child
has to be taken up at night.
  When dressing a child for exercise in the open
air  in  cold weather, do not put on  the extra,
outer clothing  until immediately before  leaving
the house, and  remove  it  directly on returning.
A long  cloak, with or without capes or fur, accord- 
CLOTHING.
103
ing to the degree of cold, and a pair of long, warm
leggings,  constitute  the  extra  covering for the
body.  Protect  the head, in winter, by  a  close-
fitting, thick cap; the hands, by worsted gloves or
mittens.
  In summer the child may go out of doors in the
same dress worn in the house, the head being pro-
tected from the direct rays of the sun by a broad-
brimmed, light straw hat.
  Every mother must decide for  herself when her
child  is  to doff the  costume of babyhood  and
assume that  of  the boy or girl.   There are two
points  that must always  be  considered, however,
namely,  the time  of  dispensing with  the  napkin
and with the  abdominal belt.  Abandon the nap-
kin,  and substitute ordinary  drawers, as soon as
the child can be trusted to make known the calls
of nature—a period that varies considerably with
the care and skill  in training.  The binder should
always be worn until the completion of the eruption
of the  milk teeth,  or  until about the  end of the
second year.
  In clothing  the  boy or girl, be particular to se-
cure warmth, freedom of movement and cleanliness.
The first  is accomplished by enveloping the whole
body—no  matter  what the season—in woollen
underclothing.  This means high-necked and long- 
104        HYGIENE  OF THE NURSERY.
sleeved flannel shirts and flannel drawers extending
down  to  the  ankles.   It is hardly  necessary  to
mention that the thickness of these garments must
vary with the  seasons, but  it is quite worth while
insisting  upon  woollen  under-garments,  except
during the  very excessively hot days of midsum-
mer.   This provision being made, and the shape of
the shoes  and stockings *  looked into, it  matters
little what may be the fancy df the mother in regard
to outer clothing.
   Freedom of movement refers not only  to  the
limbs, but to the chest and abdomen, which should
never  be constricted, lest the important organs they
contain be crippled in their action.  Loose-fitting
clothes accomplish  this  object;  but it is to  be
understood that looseness or ease in fit does  not
necessarily imply that the dress must be awkward,
ill-fitting and a source of mortification to the wear-
er.  On the contrary, clothes must be easy and yet
well cut and stylish.
   To be clean, the child must have a plentiful sup-
ply of clothing, so that  changes may be  made as
  * It is impossible for either a stocking or shoe to fit accurately
unless the toe nails be kept in good order.  In cutting the toe nails
there is, as in every other affair of life, a right and  a wrong way.
Cut the nail directly across, without rounding the corners.  Should
the latter be done, the nail is apt to grow into the  flesh and give
suffering to the child and work to the surgeon. 
CLOTHING.
105
frequently as. required.  Clean, cheap clothes look
much better than soiled finery.
  The night dress of a child five or six years  old
consists, during winter, of a light, high-neck and
long-sleeve merino shirt and night drawers of Can-
ton flannel;  in summer, of a gauze undershirt, with
short sleeves and muslin night drawers.
  Cold  weather  calls  for a warm  overcoat, hat,'
mittens  and leggings,  or rubber boots  in wet  or
snowing weather, when the child leaves the warmth
of the house.   Should the cold be so  great as  to
necessitate ear tabs and a neck wrap for protection,
a child under six years is better off in the nursery.
  As to rain-proof clothing, and our climate calls
often for both rubber boots and a long mackintosh,
it must  be remembered that such  coverings, while
impervious to moisture from without, are no more
pervious to  body moisture or, in other words, to
perspiration, which  secretion  they encourage   by
their warmth.   Of course, when perspiration is  re-
tained, the underclothing becomes moist, and there
is a  great risk of surface chilling  and consequent
catarrh.   Therefore,  it is a good plan, when water-
proof garments have been worn for any length of
time, to take off the  underclothing as soon as shel-
ter is reached, to  rub the surface into a glow with a
coarse towel and  then redress the child. 
106        HYGIENE OF THE  NURSERY.

  Before concluding  this chapter,  let me advise
that  the change from winter  to spring or summer
clothing be not  made at any  fixed date, under the
supposition that it is the  time to change, and the
weather should be warm, whether it is or not.  In
our Eastern climate it is  unusual to have settled,
warm weather until June.  May has  a certain num-
ber of warm  days, but  they  are quickly followed
by cooler ones.  Consequently the safe plan  is to
keep on the heavy winter flannels until hot weather
surely sets in, changing,  in  the meanwhile, the
outer clothing to suit each day. 
EXERCISE AND AMUSEMENTS.       107
               CHAPTER V.

           EXERCISE AND AMUSEMENTS.

   Healthful exercise, especially when taken in the
 open air and sunshine, invigorates  the nerves; se-
 cures an active performance of such vital functions
 as circulation, respiration and digestion;  maintains
 a  hearty appetite and regular  movement of the
 bowels, and develops the muscles.
   Symmetry of development is essential, and on this
 account  any exercise or  play that  brings but one
 or a few sets of muscles into action, must be dis-
 countenanced.  ' The muscles control the bones, and
 should  one set be comparatively feeble, the bones
 they  move are dragged  out  of form by  stronger
 opposing sets.   Probably  the most important groups
 of muscles to render strong  are those of the back
 which hold the spine in proper position.   When
 these are weak—the greatest weight of the trunk
 being toward  the front—the  backbone has a ten-
 dency to be drawn forward in such a way that the
 movements of the chest  are  crippled, and respira-
tion so interfered  with that the blood is imperfectly
aerated, nutrition fails, and  the  child becomes a
weak, puny invalid. 
108        HYGIENE OF THE NURSERY.
  Curvature of the spine—the deformity here re-
ferred to—may also interfere with other functions;
for  instance, digestion, elimination  of urine and
the motion of the legs.  Bone deformities are more
apt to occur in children than in adults, because, in
the former, the bones, not being thoroughly set
and  hardened, are more  readily  influenced  by
irregular muscular action.
  Marking, then, the  necessity for equal muscular
development, the subject of exercise may be taken
up in detail.
  The first  exercise the infant gets will be in the
nurse's  arms.   Shortly (three  or four days) after
birth  the babe may be taken from its crib two or
three times a day, and, being placed upon its back
on a pillow, carried about the room for ten or fifteen
minutes.  In the second month, longer walks may
be taken, the pillow being  discarded and the infant
carried in a reclining position in the arms, with the
head and body thoroughly supported.
  By the fourth month the child will have gained
sufficient muscular strength to maintain  a sitting
posture  for a short time,  provided  the head and
shoulders be supported by  the nurse's  hand, and in
this way it  may be carried about on  the  right or
left arm—and it is most important not to use one
arm constantly—for its daily training.
  At the end of the eighth month a healthy child 
EXERCISE AND AMUSEMENTS.        IO9
ceases to require  support to the head  and back
when carried, but not before.
  After the infant ceases to be merely a sleeping
and  eating animal, and  begins to  show signs of
humanity, at about the fourth month, for example,
he should be laid upon a soft mattress or sofa sev-
eral times each day and allowed to do as he pleases.
  Under these circumstances,  he rolls about and
kicks his legs, clasps and unclasps his fists, moves
his arms, and crows  or cries.  All of these move-
ments serve a purpose ; the legs  gain strength for
future walking; the hands, for grasping; the arms,
for carrying, and the vocal organs, for speaking.
  A certain class of  nurses  seem unable to com-
prehend  that a  baby is a tender creature;  tender
not only in age, but in the texture of all its tissues.
They support a young  infant  upright upon their
knees and  violently jolt it up and down, under the
supposition  that it gives pleasure,  and  should the
child cry they add  to its torment by a peculiar
" song."  Gentle movement  is as pleasant  to the
child as  riding in  an  easily  running carriage on a
smooth  road to an adult; knee-jolting as unpleas-
ant and harmful as a journey  over the worst cor-
duroy road.   The so-called singing must  cause
only pain.
  The question of out-door exercise  arises soon
after birth.  Daily airings are  requisite for perfect 
110        HYGIENE OF  THE NURSERY.
health so soon as the child has arrived at the proper
age,  and providing  always that  the weather  be
favorable.  The  fifth month is the proper age  for
children  born in the early fall and winter, and the
second month, for those born in summer.  In cool
weather they should be taken out in a baby carriage
or in the nurse's arms, for an hour in the morning
and  half an hour in the afternoon, while the sun is
shining.  In summer, they  may pass the greater
part  of their waking hours in the open air.   In
damp and  rainy weather, when  there is a strong
east  or north wind blowing, or when the mercury
stands below 200 F., young children are b'etter off
in the nursery.  The  hardening process,  in  our
climate, so' far from being successful, usually results
in an  attack  of bronchitis or something  worse,
which may  house the child for a long time, and
thus deprive him of the advantage of subsequent
favorable weather.
  How shall the baby be taken out ?  The  answer
to this question involves the consideration of two
points, namely, the clothing and the means of con-
veyance.   The former has already been referred to.
  As to  the method of conveyance, the arm is to
be preferred for very young infants, especially in
cold  weather, because they are apt to be uncomfort-
able  in a baby carriage, and because as they must,
when carried, be held close to the  nurse's body, 
EXERCISE AND AMUSEMENTS.
II I
 they are kept warm by the heat given off from the
 bearer.
   After the fourth month a carriage may be used.
 Now there are good and bad baby carriages, as well
 as a right and a wrong way of trundling them; and
 here again the mother must not forget that the baby
 is a tender creature and very easily hurt.
   The  best kind of carriage  is none too good for
 the  load it is destined to carry.   It  should run
 smoothly, without jolt or jar; its wheels should be
 kept from creaking by the frequent application of
 some mineral  oil, as "sewing-machine oil;" the bed
 must be soft and comfortable, lateral support being
 given to the body by  two  long, narrow and soft
 pillows; the infant must never be  strapped down,
 and the parasol must be always at hand, and so
 arranged as to  shade the tender eyes from bright
 sunlight.
   While the carriage is  a convenience to the nurse,
 it is never to be  regarded as a place of security for
 the child, to be  left on the sidewalks or in windy
 places  while  the wheeler exchanges gossip with
 fellow-nurses  or enters a house to visit  friends.
 However good its  springs may be, they are never
 easy enough to allow  of rude jolting or of mount-
 ing a raised curbstone by mere dint of hammering
and muscle force.
  After the age  of  nine or ten months, a healthy 
112        HYGIENE  OF THE  NURSERY.
child will  begin  to  creep; at the end of a year he
will make efforts to stand, and from four to eight
months later will be able to walk by himself.  Chil-
dren,  however,  present  great  differences  in this
respect, and a delay of a few months must not be
considered abnormal.   Second children are usually
more active  than those born first, since they imitate
and are encouraged by the example of their elders.
  So soon as efforts  at  creeping are made  there
need be no fear that  insufficient exercise will be
taken;  the care should be, rather, to  prevent over-
fatigue, as the  babe, delighted  by its  new-found
powers, will be inclined to exert them all day long.
  So soon as creeping begins, the question  arises
whether or not the nursery floor is a permissible
field for exercise.  This depends  entirely upon the
child's  health, the state of the weather and the con-
dition of the nursery.  Remember always that the
stratum of air next to the floor  is much lower in
temperature than the middle or upper.  In some of
the biting days of winter it becomes so cold  as to
make the feet  and legs of an  adult uncomfortable,
and completely to chill a child, who, in creeping,
has his whole body in it for long periods.  There-
fore, should a child be  delicate, should  he have
either bronchitis or catarrh of the digestive  tract,
should  the  weather be very cold,  or should the
heating of the chamber be imperfect, it  is better to 
EXERCISE AND AMUSEMENTS.        II3
keep him off the floor and let him take his exercise
on the nurse's bed, which may be stripped down to
the mattress for the purpose.  Colds are contracted
and many more are  protracted by playing on  the
floor in winter.
  Many nurses, and some mothers, have  an idea
that a child should walk at a certain fixed age, and
when this  time arrives, put into  practice various
plans for teaching the process.  Beware of this, for
go-carts, leading-strings, baby-jumpers and all con-
trivances of this ilk have a tendency to flatten  the
chest, distort the  spine or deform the legs.   The
proper and only safe plan is  to let the child teach
himself to walk.  This he readily does, first through
the act of creeping, in which he exercises  every
muscle  of the body without throwing undue weight
upon the soft bones.  When by this exercise he has
sufficiently strengthened the muscles, he  will in-
stinctively seek to do more ; first in an effort  to get
upon the feet, in which, though failure occurs over
and over  again, he  perseveres until successful in
standing with  support,  then without, and finally
ends in  walking.
  The  first acquisition of the power of walking
should not be  over-taxed, and for a month or more
the carriage is the best means  of airing; but  so
soon as sufficient strength  is acquired  for active
exercise—a  somewhat  variable  age—the  child
      8 
114        HYGIENE  OF THE  NURSERY.
should walk  out and pass as much  time as the
weather and  nursery  requirements permit, in the
open air.  Set walks, however, are an abomination
to the child  as well  as to the adult.   City-bred
children suffer most in this respect, as they are too
frequently sent out merely to walk a certain number
of blocks, or  for a fixed time, and  it is  no wonder
that they quickly tire of such exercise  and prefer
their  nurseries to the streets.   The only way to
avoid this is to give an object to the outing, as, for
example, a household errand or the purchase of a
cheap toy.  In  the country, on the  other hand,
children run about and amuse themselves according
to their own pleasure, visit the garden or the  farm,
and involuntarily  take  that  kind and  degree of
exercise best  calculated  to promote the growth and
development of their bodies.
   Delicate, scrofulous  and consumptive  children
preeminently  require pure air and  an out-door life,
though many of them are too feeble to take  suffi-
cient exercise on foot.   For such, when the parents'
purse allows, a donkey or  a  pony should be pro-
vided.  Driving may give  sufficient exercise at
first;  but so  soon as enough strength is gained,
riding is to be preferred, as it keeps the  mind  more
healthfully occupied, strengthens the muscles, ex-
pands the chest and produces a  healthy appetite
and digestion. 
EXERCISE AND AMUSEMENTS.       I I 5
  In the earlier years of life the girl and boy play
together and take nearly the same sort.and amount
of exercise.  As time  goes on, however, and the
girl approaches  nearer and nearer to maidenhood,
she too frequently begins to look upon her brother's
game of ball or romping play as too  rough, and
spends a constantly increasing time indoors acquir-
ing the manners and the sedentary habits  of her
elders of the  same sex.
  This  tendency is often encouraged by parents,
who prefer polished manners to physical strength,
and, above all, dislike  their daughters becoming
"tom-boys."    One must  admit  that  polished
manners are a great attraction; but as a woman has
more important duties  than  shining in a drawing-
room,  they are  of  little intrinsic value when un-
combined with the fine carriage and good figure
which belong only to robust health.
  In regard to the carriage and figure, it is useless
to try to assist their formation by the aid of braces
and corsets.  The latter are  especially to be con-
demned. Unless most cautiously used, they induce
undue  contraction of the lower part of the  chest
and displace  the solid organs (liver especially) of
the  abdomen, interfering primarily with respiration
and digestion,  and secondarily with the general
processes  of nutrition.   An erect carriage  can be
better secured by attention to the general health; 
I l6        HYGIENE OF THE NURSERY.
suitable diet; regulation of the bowels; cold bathing
and sponging, and exercise short of fatigue, not of
particular muscles only, but of the whole frame.
  My advice, therefore, is to let the girls join in the
boys' play.  By this plan  the latter gain,  because
they are naturally forced to be more gentle, and the
former,  because their rapidly-developing frames get
the requisite amount of exercise.  It  is well, how-
ever, to curb the  ambition of the girls to equal the
athletic powers  of the boys, for their muscular
strength is less.  Without letting the subjects know,
keep a  strict lookout upon the general morals, for
it  is absurd to  shut  one's  eyes to this  risk in
mingling the sexes in later childhood and youth.
  Amusements.—A child's  life must be devoted to
the cultivation of his mind and his body, an undue
development of either resulting in an  incomplete
manhood or womanhood.
  After writing the above sentence  I  was called.
from my desk to  the bedside of a little sufferer, and
on my way met two boys, both about nine years of
age, and both patients of  mine.  The  first had a
spirituelle face, and spoke  to me with a tip of the
hat and the grace of a little Chesterfield; but his
features were  pinched, so it seemed  to  me, while
his face was anxious and his legs were hardly thick
enough to carry his body.   Nevertheless, his arms
were full of books, which, as I had curiosity enough 
EXERCISE AND AMUSEMENTS.       I 17
to examine, I found to be a Greek grammar, Caesar
and the elements  of algebra.   I  felt sorry for the
overtaxed little brain, and he showed no symptoms
of joy at release from school, for he  was on his
way home  to study all his books, to get the teach-
er's approval and a high mark  on the  morrow.
Scarcely a  block away I  met my  next  little friend ;
his cheeks were rosy, his  arms  and  legs sturdy,
and his eyes brimful of health and fun.  The bur-
den of books he bore was  light, and his teacher
probably considered  him stupid; but his  simple
" Halloo, Doctor, I am off for a  game of ball this
afternoon," and his jolly smile, were more pleasing
than all the learning of the first little gentleman.
   The lesson taught by these  two children is very
plain  to my mind, and the question which will come
out ahead  in the long run is  easily answered; for
health has no handicap in the race of life.
   It is right, of course, to let  the children  study—
after the sixth year; but the brain is not to be cul-
tivated at the expense of the body ; in other words,
our boys and girls must have  plenty of play.
   The subject of childish diversion is a broad one,
and it is only possible to outline it  here.  Let the
healthy child play as much as possible in the open
air, and let him be  as  active as he pleases; for his
own sensations will tell him when to stop and when
to begin again.  The only cautions are not to over- 
Il8        HYGIENE OF THE NURSERY.
look him too much ;  to let him make as much noise
as he wishes out of doors and in his own kingdom
—the nursery;  to make him play those  games
which will exercise  all the muscles of the body
equally, and to guard him, when heated, from drink-
ing ice  water or  from lying on  the cold, damp
ground or sitting in a draught.  It must be remem-
bered, also, that play is the child's business, so that
during convalescence from a debilitating disease it
must be regulated  according to the strength.
   Before closing this  chapter  a  protest  must be
entered against roller-skates and bicycles; the first
are dangerous to life  and limb, and the last, though
not so liable to result in broken limbs,  produce,
from the position it is necessary to assume, a narrow-
ing of the upper portion of the chest. 
SLEEP.
II9
               CHAPTER  VI.

                     SLEEP.

   For some time after birth infants spend the inter-
vals between  being fed, washed and dressed,  in
sleep, and thus pass fully eighteen out of the twenty-
four hours.  As age advances, the amount of sleep
required becomes less, until  at two years thirteen
hours, and at three years eleven hours, are enough.
The amount of sleep required will, however, vary
considerably in different children, but an observant
mother can soon determine this question for herself.
   Any marked diminution in the average duration
of sleep, or any decided restlessness indicate  dis-
ease, and demand attention from the physician.  At
the same time, sleep, perhaps more than any other
item of nursery regimen, is  a matter of training,
and many a mother, by want of judicious firmness,
has rendered the early years of her child's life not
only a burden to himself, but an annoyance to the
entire household.
  One cannot  too  soon begin to form  the good
habit of regularity in sleeping hours, and so  far as
circumstances  admit, the following  rules may be
enforced:— 
120
HYGIENE  OF THE  NURSERY.
  From  birth to the end  of the  sixth or  eighth
month the infant must sleep from  11 p.m. to 5 a.m.,
and  as  many  hours  during  the day as  nature
demands and the exigencies of the nursery permit.
This does not mean that the baby  is not to  be put
to bed until nearly midnight; on  the contrary, he
should practically settle for the night at six or seven
o'clock, but the last feeding should be at  eleven
o'clock.  After this he must rest undisturbed until
the early morning hour, when he should be fed and
sleep again.
  From eight months to the end of two and a half
years, a morning nap should be taken, say from 12
m. to 1.30 or 2 p.m., the child being undressed and
put to bed.  Occasionally an afternoon nap for half
an hour or more seems necessary, though, as a rule,
sleep at night is more  undisturbed and refreshing
if this be omitted.  The night's rest  must begin at
7 p.m.  If a late meal be required,  the child  can be
taken up at about ten o'clock, but if past the age
for this, he may sleep  undisturbed until he wakes
of his own accord, some time between 6 and 8 a.m.
So soon  as thoroughly awake the child must be
taken up, washed and dressed, and given breakfast.
This is the only way to cultivate the habit of early
rising, which promotes both bodily and mental wel-
fare,  and  of all  habits is  the most conducive to a
long and healthy life. 
SLEEP.
121
   By early rising it is not meant that the child shall
be roused from a sound sleep by a  rough voice or
hand at a certain fixed hour  in winter and an ear-
lier one  in summer, simply for the whim of a fad-
ridden and over-prompt parent.  Quite the reverse.
Let the child wake of his own accord, for he will do
so—whether it be late or early—after he has had
enough sleep; and, if he must get up at a certain
hour—and never fix it before  7  a.m.—make the
rousing  process  as gentle and gradual as possible.
Sudden rousing excites the brain, quickens the pul-
sation of the  heart, and, if repeated, may lead to
serious consequences.
   From  two and a  half to  four years,  an hour's
sleep  may or  may not be taken in the morning,
according to the disposition and needs of the sub-
ject, but a child should invariably be put to bed at
seven in  the evening and  not be permitted to rise
until  six or seven o'clock on the following morn-
ing.
   After the fourth or fifth years, few children will
sleep in the daytime;  they are ready for  bed  by 8
p.m., and must be allowed to sleep for ten hours or
more.
   A later retiring hour than 9 p.m. ought never to
be encouraged until after  the twelfth or fifteenth
year.   Any postponement  of the  usual hour for
going to  bed is injurious, and should abridgment 
122        HYGIENE OF THE NURSERY.
of sleep  be accompanied by the excitement  of a
child's party or the like the rest obtained is broken
and productive of a pale  face and nerveless frame
on the succeeding day.
  The position and  general features  of the night
nursery have  already been described, and it  only
remains to say that when occupied by day it must
be darkened so as to favor sound sleeping.
  The bed (and where there are several children
in the family  each should  have its own) must be
so situated in  the room as to be out of the way of
draughts.  Curtains, while  they protect,  prevent
the access of  fresh air, and it is far  better  to ward
off a draught by a movable, folding screen.
  The form of bed  known as a " crib"  may be
occupied until the sixth year.  The sides must be
high, to  prevent the child from falling out and in-
juring himself, and the movable side should work
upon hinges rather  than move up  and  down  in
slots.
  Springs and a soft horsehair mattress, protected
by a  gum cloth, placed  beneath a double sheet,
under  ordinary circumstances constitute the  bed
proper.   Sometimes  a feather mattress  is admissi-
ble, but this is only when  the child  is feeble, and
requires artificial aid to keep up the normal body-
heat during sleep.
  The objection to feathers is, that the body, sink- 
SLEEP.
123
ing deeply in, is so completely enveloped that it is
subjected to an undue degree of heat, which relaxes
and weakens the system and  renders it very sus-
ceptible to the injurious influences of cold.
  The bed-covering is composed of a sheet, one or
more  blankets—according to the weather—and a
spread.  These must be warm enough to maintain
a healthy temperature, but, at the same time, not
so heavy as to oppress the child.
  Especial care should be taken not to cover the
nose or mouth, and it is much better to keep the
air of the nursery at a proper, even temperature by
an open fire  than to  secure warmth to the body
alone by weighty bed-coverings.
  The pillow ought to be small, rather thin than
the reverse, and made, except for  very  young in-
fants, of soft horsehair.
  A bed should  never  be made up directly upon
the child's leaving it, for then it is saturated with the
nocturnal  exhalations from the body.   So soon as
vacated, the bed-coverings must be thrown over the
backs of chairs, the mattress shaken up, and,  the
windows of the chamber being thrown open, allowed
to air for an hour or more.
  In the matter of bed-clothing, cleanliness is as
important as in body-clothing, and the nurse must
never neglect to re-make a bed if the sheets become
wet with urine or otherwise soiled, no  matter at 
124        HYGIENE OF THE NURSERY.
what  hour of the night the accident may occur.
Much  trouble in this direction  may be avoided,
however, by regularly taking up the child at  the
time of the last feeding and encouraging a thorough
evacuation of the bladder.
  Children should never  sleep in the same room
with persons who are ill, whether  the disease be
acute  or chronic.  Sleeping  with those having a
long-standing  cough  or consumption of the lungs
is especially to be avoided.  Do not get the baby
into the habit of being rocked or walked to sleep,
and do not allow older children  to sleep too soon
after a meal, as  the processes of digestion are  apt
to produce restlessness and uneasiness.  Again, a
bright  light or conversation in the bedroom should
never be permitted after the children have settled
to rest.
  Finally, teach  the  nurse to  make up  the bed
neatly and smoothly, and direct her  to turn the pil-
low and smooth  out the sheets, should her charge
be restless at night.  By this latter procedure sound
sleep is often brought to a fretful child. 
BATHING.
125
               CHAPTER  VII.

                    BATHING.

  A well-known English writer states, that " water
to the body—to the whole body—is a necessity of
life, of health, and  of happiness; it wards off dis-
ease, it braces the nerves, it hardens the frame, it is
the finest tonic in the world."
  On the word " tonic " the whole subject hinges.
Every one knows that food, even  in such a simple
form as milk, may be given to excess, with the pro-
duction of illness, and that medicines are yet more
easily abused.  Why, then, if the bath be a  tonic
agent, may it not be  often used injudiciously and
to the detriment of  the child ?
  Intelligent nurses who have  grown gray in ser-
vice, often say they have seen babies " washed into
heaven."  This act  has never been actually accom-
plished  in  my experience, but  it has been often
enough approached  to justify introducing this chap-
ter with the caution  that, should the infant be ailing,
the bath had better be discontinued until the  phy-
sician can  be consulted.  This, of course, does not
preclude ordinary cleanliness, for every part of the 
126        HYGIENE OF THE NURSERY.
child's body liable to become soiled can be readily
cleaned by the use of a  moist sponge, with  or
without soap, and without bringing into  play any
of the medicinal or, in other words, tonic effects of
the bath.
  The initial, bath is to be given as soon after birth
as the nurse, having made  the mother comfortable,
can turn  her  attention to the  child.  This  bath
differs somewhat from those that succeed  it during
infancy, in the  fact  that it involves  a special pro-
cedure, namely,  the removal  of  the tenacious,
paste-like material  which  usually adheres to the
skin of the newly-born.
  This substance, the vernix caseosa, is  a fatty var- .
nish or deposit  secreted by the  glands of the  skin.
While the foetus is in the womb, it probably acts as
a protecting agent, but if allowed to remain  long
after delivery,  it becomes dry  and hard, and, in
addition  to impeding the  healthy  activity of the
skin, leads to excoriations or various  eruptions.
  To remove it, first rub the whole surface gently,
though thoroughly, with  a bit  of flannel covered
with fresh lard  or olive oil; next, wash  off the soft-
ened  and greasy coating  with a sponge  saturated
with warm water and soap, and finally,  complete
the bath by immersing the body in warm  water  for
one or two minutes.
  After this preliminary cleansing, one bath a day 
BATHING.
127
should be the rule until the completion of the third
year of life.
  The monthly nurse must bathe the child while
she remains in attendance ; afterward the mother is
the proper person, unless the nurse-maid be excep-
tionally careful  and experienced ; and even in this
event the mother should superintend the process.
  A tub with a  supply of water, a  piece of soft
flannel for a wash rag, a fine sponge, a bit of good
bath table, a, a, elastic tapes for steadying tub.
soap and several soft towels are the necessary arti-
cles. A long apron made of soft flannel is also useful,
and it is well to provide  a low  chair and a bit of
oilcloth to place on the floor underneath the  tub.
The former enables the bather to get more  on a
level with her work and make a deeper lap for the
child to rest in, and the latter  receives  any water
that may be splashed about.  A stand is now made
to hold the baby's bath tub, Fig. 15, and is so con- 
128        HYGIENE OF THE NURSERY.

trived that it can be folded up and laid away when
not in use.  It is convenient, inasmuch as it obviates
the necessity of stooping over, by bringing the child
more on a level with the bather.  It has straps and
hooks attached to the sides to  hold the tub firmly
in place while in use.
  An ordinary, oblong tin tub,  painted white inside
and large  enough to give  plenty of room, is to be
preferred to either a  porcelain basin or a wooden
tub.  When in use, the tub should be placed on the
floor, for the sake of firm support, or on the bath
table, and afterward  must be  well cleaned,  dried
and aired.
  Water for the bath ought to be pure and soft, and
should it  be muddy or otherwise foul, the  nurse
must take the trouble to filter it.  The character of
softness is an  important one, and when it  is impos-
sible to obtain anything but hard water  from  the
ordinary sources  of supply, a special  provision
ought  to be  made for the collection of rain water.
The  quantity used at a time should be sufficient to
cover the child up to the neck when placed in  the
tub in a semi-reclining position.
  A matter of great importance is the temperature
of the water.   Some—fortunately very few—people
use cold water from  the first, under the impression
that  it is strengthening.   So far from this being the
case, cold water, instead of " hardening,"  depresses 
BATHING.
129
the vital forces  and frequently produces inflamma-
tion of the eyes, nasal catarrh and inflammation of
the lungs and bowels.
  While  cold baths are not to be recommended,
one must not go to the other extreme, and use too
hot water;  for this also weakens  the  frame and
renders it  more  susceptible  to  the  attack  of
disease.
  Ninety-five  degrees  Fahrenheit  in winter, and
from eighty-five to ninety-two degrees in summer
are the proper temperatures.  As the heat of water
cannot be estimated by the hand with any degree
of accuracy, it  is essential to use a bath thermom-
eter.  See Fig. 16.
  Place this  instrument in the water and allow it
to remain a few moments, so as  to  get a full effect
upon the mercury.  Should  the water be too hot,
it may be  readily  cooled by the addition of cold
water, or, if too low in temperature, as easily raised
to the proper degree by pouring in hot water.
  It is impossible to insist  too  strongly upon the
necessity of uniformly using the bath thermometer.
Several times  in my experience a tin bath tub has
been filled with water so hot  that its  sides burned
the delicate skin of the little  hand  placed  upon
it;  fortunately, in  such instances, the consequent
screams led to careful investigation,  and no seri-
ous damage resulted.  On the other hand, I have
       9 
130
HYGIENE  OF THE  NURSERY.
 fig. 16.   feit the water cold enough to pain the
         fingers.  Don't neglect the thermome-
         ter, then!
           A piece of flannel is very  useful for
         the first part of the bathing.  It readily
         takes  soap,  and,  being  soft, can be
         thoroughly rubbed over the skin without
         danger of injury.  A large, soft sponge,
         however, is best suited to the finishing of
         the bath, for it holds more water than  a
         flannel wash rag, and enables the bather
         to  stream the water over the  child's
         body, and thus get the stimulating effect
         of a miniature shower bath at the same
         time that  the dirt  and superfluous soap
         are washed away from the surface.  The
         wash rag  and sponge must, by the way,
         be  the child's exclusive  property, and
         are not to be used  twice in  succession
         without being thoroughly  cleaned and
         dried in the open air.
            Unscented Castile  or glycerine soaps
         are the best to use.   Common soaps are
         irritating  to the skin, and even the purest
         and most bland  articles must be  em-
         ployed with  care;  that  is, neither too
         frequently nor too  profusely, lest they
lead to eczema or other cutaneous disorders.  When
	
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   BATH
THERMOMETER 
BATHING.
131
any skin disease is present, the physician's advice
must be had  not only as  to the use of soap, but
also  in reference to the  propriety  of  the bath
itself.
  Two  towels are required for each bath.   These
should be large and composed of fine, soft material.
They  must  be  dry  and  warm,  and  perfectly
clean before they are applied to the surface of the
child.
  The bath apron should be made of two pieces of
soft,  white flannel; one long enough to extend from
the waist almost to the feet of the bather, and broad
enough to completely cover the front of her gown;
the other quite  as  broad  but about four  inches
shorter.  Both pieces are sewed to a waist belt,
forming, in reality, two aprons ; the upper of which
is thrown over the shoulder when the infant is being
lifted from the tub,  and then  used as  a dry and
warm covering when he reaches the lap.  After the
bath, the apron, being more or less wet, must be
taken off and thoroughly dried.  Several such arti-
cles should be provided, as they must be frequently
washed  to keep them clean  and free from odors.
  Any low chair will  do to use in bathing,  though
as  those usually sold in the shops have not a suf-
ficiently broad seat to give a comfortable support,
it is better to make one by sawing off the legs of an
ordinary wooden kitchen chair. 
132        HYGIENE OF THE NURSERY.
  The bath must be given at a regular time each
day.  The best  hours are in the morning, midway
between  two feedings, at ten o'clock, for instance;
and in the evening, just before  the infant gets  his
last bottle and goes to bed.  The first is perhaps  the
better  hour, but regularity is the  more important
point.
  At the time selected, place the tub containing  the
water,  heated to a proper temperature, in a warm
and  sheltered part of the room, and  around it ar-
range,  within convenient reach of the hand,  the
various requisites of the bath.
  Upon  undressing  the  child,  wet his head first;
then let  the head and  shoulders  rest on the  left
forearm  and  lower  the child  gently into   the
water,  that his body may be covered  as far  as  his
neck.  Take a  wetted and sponged  flannel wash
rag in  the right hand, and pass  it rapidly but thor-
oughly over the body, avoiding the eyes.   Pay
particular attention  to the  arm-pits, to the region
between the folds of the buttocks and to the groins.
This done, take a large, well-filled sponge  in  the
right hand and squeeze the contents over the body.
The chief force of this miniature douche must  fall
upon the back and loins, and the child, during  the
operation, must be lifted clear of the bath-water  by
the left arm and  hand.
  The sponge is used simply to  clear off the dirt 
                    BATHING.                 I33

 loosened by the wash rag, and to remove all super-
 fluous soap;  therefore, so soon as this is accom-
 plished, the child  should be lifted from the tub to
 the lap and enveloped in a towel, or  better still in
 the loose folds of  the bathing apron.   The drying
 process now begins and  consists  in  absorbing the
 moisture from the skin.   This is  done by a series
 of very gentle patting movements  with a  towel
 folded over the palm of the hand.  In drying  a
 baby, especial  attention   must be given to  those
 portions of the body where the natural folds form
 crevices in which  water may lodge.   Unless these
 parts be thoroughly dried,  serious consequences
 may ensue.  If it  be retained in a normal crevice—
 the fold  of the buttocks or behind the ears—it
 causes in a short time troublesome excoriation.
  " Never allow anything smaller than the elbow to
 enter the ear," is excellent advice; though, during
 the bath should water get in and be  allowed to
 remain, it  may lead to ear-ache and abscesses, and
 in extreme, though not  rare, cases, to deafness.
 In the event of this a blunt cone formed out of a
 soft handkerchief will quickly absorb the moisture,
 and  will  do no harm if inserted but a very  short
 distance within the orifice.
  The nose can readily be cleaned by the soft cone-
shaped handkerchief, especially if  a little vaseline
be added to facilitate the process. 
I34        HYGIENE  OF THE NURSERY.

  After the infant is patted perfectly dry—not rudely
rubbed  with  a  towel—the  whole surface,  but
especially the region on each  side of the  spine,
should be rubbed with the naked palm until  the
skin becomes slightly red.  This modified massage
ends the  bath, and the  child must then be dressed
as quickly as possible.
  Several important  points yet remain to be men-
tioned.   Never give a bath  immediately after  a
meal  nor when the  child is  either cold or over-
heated.   Never suddenly or  rudely plunge  the
body  into the water, and never allow the  time of
actual immersion to exceed five minutes.   Under
no  circumstances  should the  head and  face be
allowed to dip beneath the surface.  Should  this
happen, the  child will  become  so frightened that
it will be difficult to get him  to enter  the  water
again; and  here, by the way,  it may be well to
state  that if there  be repugnance to the bath, the
tub may be covered over with a blanket, and the
child  being  placed upon it, may be slowly lowered
into the  water  without seeing  anything to  excite
his  fears.
  The question of the propriety of using powder
after a bath  is often asked by mothers.  Powdering
has always  seemed  to me to be  a  lazy way of
absorbing moisture that should be taken up by a
dry towel, and unless there be some excoriation or 
BATHING.
135
other indication for  its use, the  skin can  be kept
cleaner and healthier without  it.   In  cases, too, in
which  some disorder of the skin would seem  to
warrant its employment, better and quicker results
are ordinarily obtained by  the application of cold
cream, oxide of zinc ointment or vaseline.
  The rule of one bath a day may be exceeded in
very hot weather, when, in addition to the morning
full bath, the body may be sponged twice daily with
water at a temperature of 900 F.  This, contrary
to what might be expected,  has a greater and more
permanently cooling effect than bathing with cold
water.
  From what has been written, one might suppose
that the details of  an infant's bath are endless;  so
they must seem when given  in  full.  A  skillful
bather, however, ought to fulfill every requisite and
complete the bath in a period of time not exceeding
twenty minutes at the  very outside, and this must
include not only the  actual five minutes'  immersion,
but the  preparation of the bath  and the  drying
process.
  After the third year three full baths  a week are
quite  sufficient.  An evening hour is now to  be
preferred, but the water must still be heated to 900
F. in  winter, though it may be cooler in the heat
of summer.  While, at this age, the  child has his
three full baths weekly, for the purpose of securing 
I36        HYGIENE OF  THE NURSERY.
absolute cleanliness, he must be sponged every day
with water, cool or warmed according to the season.
  The sponge bath  is best  given in the  morning,
soon after the child  has  roused himself from sleep
and before any food is given.   The nurse, for this,
must provide herself with a large basin containing
water at a temperature of 750 in summer and 850
in winter, a large, fine sponge and several towels.
The bath-apron being donned and the child's night-
clothes removed, the  sponge  filled with water is
passed rapidly over the whole surface of the body  ;
then the child must be wrapped up in the apron
and the skin first dried gently with a soft towel and
then  rubbed  into  redness with the  open  hand.
When this process  is completed—and it should be
done in at least ten  minutes—the clothing is put on
rapidly, and the child is ready and usually hungry
for his morning meal.  No soap need be used in
these baths.
   In the tri-weekly cleansing bath the process of
washing  is much the same as in infancy. That is, the
bath tub being filled with water at a temperature of
about 900, the child is put into it up to his neck and
thoroughly  soaped with a  wash  rag,  and  next
douched  clean with a large  sponge.   Here, also,
the  head must be  wet first;  the  body immersion
must not last longer than five minutes, and the dry-
ing must be done quickly and with a patting rather 
BATHING.
137
than a rubbing movement.  Ample reaction of the
skin must be secured by gently rubbing with the
palm of the hand, especially over the spine.
   The washing of the  head is  a most  important
matter, as  it cleanses the scalp and prevents the
formation of scurf, and adds beauty to the hair.  At
the same  time the  nurse  must be  careful how she
dries the hair.  To rub it gently with a soft towel
and then brush it out with a fine hair brush is the
proper plan.   Combing, in so far as it means dress-
ing the hair and  cleansing the scalp  with  a fine
comb, must never be allowed, as it not only thins
the hair by pulling it out by the roots, but also
irritates the scalp and produces eruptions upon it.
   As the child approaches puberty he must gradu-
ally  be taught to  wash  himself,  and should  be
encouraged to form the habit of bathing every day.
The  bath at this age  should be  a  sponging  rather
than a soaking  process ;  it is best taken in the
morning directly after rising, and  the temperature
of the  water may range from 65 ° to 75°, though
delicate children may require it warmer, especially
during winter weather.
   When  childhood merges into youth, while the
sponge is still preferable to the plunge, water may
be used, all the year round, just as  it flows from the
faucet.   The temperature  will be,  of course, quite
low at times, but  so long  as the  bath is taken in a 
I38        HYGIENE OF THE NURSERY.
warm room, completed quickly, and followed by a
sense of stimulation and warmth, nothing but good
results.
  Whatever room be used for  the purpose of the
toilet, the child, if he be old enough to bathe him-
self, should occupy it alone, so that the whole body
may  be stripped naked; otherwise washing cannot
be thoroughly  or  effectually accomplished.  The
paraphernalia required  are:  a  large basin, a tin
chamber tub or the  ordinary  fixed bath tub;  a
piece of  coarse flannel,  one  yard long  and  half a
yard wide; a large sponge;  a tablet of soap; a soft
towel and a Turkish bath-towel.
  Having drawn a sufficient quantity  of water—
two-thirds of the basinful, or two or three inches
in either of the tubs—the successive steps of the
bath are as follows:  Wash  the hands with soap;
dip the head and face into the  water;  re-soap the
hands and rub and wash the head, face, neck, chest,
and arm-pits; take  the  wetted sponge  and go all
over the parts  previously covered by  the  soaped
hands; fold the flannel into a long band, dip it into
the water, and, holding an end in either hand, throw
it over the shoulders, and move it  several times
from side to side, then up and down, and then across
the back and loins; dip the sponge into water again,
and  holding the head and shoulders over the tub,
stream the water once or twice over the head, neck 
BATHING.
U9
 and face ; step into the bath, re-soap the hands and
 pass them quickly up and down the legs and over
 the feet.  Fill the sponge and squeeze its contents
 over each leg;  finally, sit  down and with soaped
 hands  wash  the  region between the  buttocks,
 removing the suds  by  a  few splashes  of water.
 Next, step from  the tub and dry the body quickly,
 taking care to remove  all the moisture from the
 ears, from between the toes and from the different
 folds of the body. The drying is to be accomplished
 by brisk rubbing, first with the soft towel and then
 with the Turkish towel.  The back and loins are the
 most difficult to reach, but if the towel be thrown
 over the shoulders, as one would a skipping  rope,
 and moved from side to side several times, the dry-
 ing of these  parts is accomplished without trouble.
   A boy should wash his head as above described
 each morning; a girl, who has  long hair, at least
 once a week.
   Any loitering  over the bath is attended with the
 danger of chilling.  Never occupy more time than
 fifteen minutes in the whole process.
   These daily sponge baths are ordinarily quite
 sufficient to keep the person perfectly clean ; some-
 times, however, it is necessary to take, in addition,
 a full, warm bath at  intervals  of a week.  These
baths are relaxing if too  prolonged; ten minutes is
the maximum time for  remaining in the water. 
140        HYGIENE OF THE NURSERY.
After leaving'the tub there must be no exposure to
draughts.   The best hour for such a bath is in the
evening; some time after the last  meal and just
before  going to bed.
  Sea-water baths are useful for a child of any age,
although ordinary sea bathing is  not to be recom-
mended until  the  child  is old  enough and strong
enough to  hold his own  in a moderate surf—after
the eighth  year, for instance.  A younger  subject
may, when at the  seaside, be  dressed  daily in a
bathing suit and allowed  to splash for a time at the
edge of the surf.  The process  of carrying a child
against his will into the  waves and immersing his
head, as is  often done, is  cruel and productive of so
much terror that more harm than good results.
  In our climate, the proper season for sea bathing
is from the middle  of  June until  the  middle of
September.
  On arriving at the coast, it  is  always well to pre-
pare for the plunge in the sea by giving, on the
first day,  a warm salt-water bath. -  On the day
following,  about three  hours after breakfast, the
child may don his bathing dress.  Immediately  on
entering the water, the  head must be thoroughly
wetted. After this, the bath may be protracted for
fifteen, or at most twenty, minutes.  To get the
invigorating effects of a surf  bath, it should never
be repeated oftener than once a day, and in some 
BATHING.
141
cases  it is better to allow a day to  intervene, or
even to enter the water only twice a week.  Drying
and dressing should be rapidly performed, and a
half-hour's brisk walk  is very useful  in  promoting
reaction and causing free  circulation of the  blood.
Should the bather feel  faint after coming out of the
water, he must be wrapped in towels and given half
a tumblerful of milk containing one or more tea-
spoonfuls  of brandy or whisky.
  When the child is either cold or perspiring freely,
the bath must not be undertaken.
  The bathing suit  should be of light flannel, made
in one piece like a  pair of moderately loose night
drawers, but with short arms  and legs; it should
open only over the shoulders, where, when put on,
it is fastened by buttons. This arrangement permits
of easy removal after the bath when the flannel is
saturated  with  sea  water, and  is, in consequence,
heavy and sticky.
  The question of  sea bathing suggests that of
swimming.  Boys, and girls also, should learn to
swim early.  The art is not only a safeguard, but a
means of  most  pleasant and invigorating exercise.
It develops  the muscles,  expands the chest,  aids
digestion,  strengthens  the whole frame, and  pro-
motes energy, courage and self-reliance.
  Swimming, like every  other exercise, must be
taken  in moderation.  Even with this care it is not 
142        HYGIENE OF  THE NURSERY.
always beneficial.  The  bather  should leave  the
water experiencing a pleasant glow over the whole
surface of the body; the spirits and appetite should
be increased, and there ought to be a sensation of
augmented strength.   If,  on the contrary, it should
disagree, there is a sense of  chilliness, with  lassi-
tude and depression of spirits; the face is pinched
and  pale, and the  lips and finger nails are apt to
look blue.
  Swimming in salt water is more invigorating than
in fresh.  Apart from  the different quality of  the
two  waters, the  battling  with  the waves in  the
former  case  is  more  exhilarating,  and  the  sea
breezes, blowing  upon the body, carry with  them
health and strength.  Every one must have noticed
the increased softness  and beauty of the  skin and
the greater lustre of the hair  after a sojourn at  the
seaside.
  It may be serviceable  next briefly to detail  the
different baths in common use as well as those most
often directed by physicians, with some  reference to
their effects upon the system.
  Concerning temperature, the bath may be:—
           i. Cold,  temperature 500 to  65 ° F.
           2. Cool,      "    650 to  750 "
           3. Temperate,  "    750 to  850 "
           4. Tepid,      "    850 to  920 "
           5. Warm,      "    920 to  980 "
           6. Hot,       "    980 to 1120 " 
BATHING.
143
  When giving a cold bath, strip the child in a warm
room, and rub him thoroughly with the palm of the
hand  until the  whole body, especially the spinal
region, is warm.  Let him then stand in a tub con-
taining  enough  hot  water to cover the feet,  and
sponge  him  rapidly  with the cold  water.  The
temperature of the latter must never be below 6o°
F., and  the  addition of half an ounce of rock  salt
or a tablespoonful of concentrated sea water to the
gallon, renders it more stimulating and insures a
complete  reaction.   After sponging, the  surface
must  be thoroughly and  quickly dried with a soft
towel and shampooed with the  open hand until
aglow.
  This bath, provided the degree of cold does not
exceed  the  resisting powers of  the  child, is  a
powerful tonic, producing rapid tissue changes and
increasing nutrition.   Should the water  be  too
cold, or the sponging continued  too long, reaction
does not follow the primary shock, and the result is
fatigue, exhaustion, or even dangerous  prostration.
This bath, therefore, must be used with caution  and
only under a physician's advice. The cases in which
it is of most service  are  those in which there is a
sluggish circulation with  poor appetite and feeble
digestion; in which the nutrition  is impaired, as in
rickets, and in certain spasmodic nervous disorders.
  A cooled bath  is sometimes  prescribed, and may 
 144        HYGIENE OF THE NURSERY.

be employed with advantage in conditions attended
with very high fever.  The child  is first  immersed
in water at 95°, and this is gradually lowered to 700
by the addition of cold water, the process occupy-
ing from fifteen to thirty minutes.
   Analogous to this bath is the cold pack.  Fold a
sheet in such a way as to be long enough to extend
from the child's arm-pits to his feet, and wide enough
to encircle completely his body;  dip it in water at
8o° and lay it smoothly upon a cot, the mattress of
which must be protected by a rubber Mackintosh.
When all is  in readiness, place the child upon the
sheet, and wrap  it around  his body and legs.  A
blanket must  then  be thrown over the sheet and
the pack  left  undisturbed for ten  minutes.  Then
lift the child out quickly and envelop him in a warm
blanket and allow him to remain at rest for some
little time.
   In  the absence of the physician, sponging with
water, at a temperature of 700 or 8o°, is the only
safe  bath to employ to reduce temperature.  In
giving this bath,  strip the  child and  place him in
bed between blankets, while the nurse, inserting her
hand  between, must  pass a  damp sponge slowly
over the surface.  Five to ten minutes may be con-
sumed in  this operation, though, if the child com-
plain of chilliness, discontinue the sponging at once;
a sensation of cold, too, indicates the use of warmer 
                     BATHING.                 I45

 water.  The operation may be repeated several times
 daily, or as often as every two hours in urgent cases,
 and when the heat reduction is of short duration.
   The  hot bath, 95° to ioo°, is employed for vari-
 ous purposes—to  relieve nervous  irritability, to
 promote  sleep,  to produce sweating, and to draw
 the blood to the surface in the event of congestion
 of some  internal organ.  Whether a full  bath or
 merely a  foot bath be required, five minutes  is suf-
 ficient time for  immersion;  then, with or without
 drying, according to the degree of sweating desired,
 the whole body, or only the feet and legs in case
 of a foot bath, must be enveloped in a blanket, and
 the child  put to  bed.  To render  these baths more
 stimulating, a teaspoonful to a tablespoonful of mus-
 tard flour may be added, and the child held  in the
 water until the  arms of the  nurse begin to tingle.
 The hot bath is purely stimulating, and it is import-
 ant not to continue it too long, lest the primary and
 only desirable effect be followed by depression.
   The blanket bath is useful in  producing perspira-
 tion.  Wring a blanket out of hot water and wrap
 it  around  the child; then throw three or four dry
 blankets over him and leave him for half an hour;
 rub the body then with  a soft towel, to absorb  the
moisture thoroughly, and keep  the child in bed.
  There are  several medicated baths in frequent
domestic use, which it may be useful to describe.
      10 
I46        HYGIENE  OF THE  NURSERY.
  Mustard Bath.—Take from two teaspoonfuls to
two tablespoonfuls of mustard flour ; hot water, two
to four gallons.
  In form  of foot bath it produces sweating and
determines the blood to the surface.   As a general
bath it acts as a powerful stimulant.
  Salt-water Bath.—Take four  tablespoonfuls of
rock salt, or Ditman's sea salt, or concentrated sea
water; water, hot or cool, according to season, four
gallons.
  To be used as a general bath every morning  in
chronic tuberculosis, scrofula, rickets, and  general
debility.   Bath to be followed by thorough rubbing
of the surface, especially over the spine.
  Bran Bath.—Take one pint of bran ; tie up in a
muslin bag, place  in a  quart of water, boil for an
hour, squeeze bag thoroughly into the water, and
add to four gallons of warm water.
  Useful in eczema and other skin diseases.
  Soda Bath.—Take one  tablespoonful of bicar-
bonate of sodium; warm water, four gallons.
  Used in skin affections.
  Compresses  are  often useful.   The wet com-
press consists simply of a  roll of flannel or soft
linen dipped in cold water and wrung out, and then
applied  to  the part  indicated.   Cover this with
a piece of oiled silk rather larger than the com-
press. 
BATHING.
H7
      There are several  matters that bear a more or
   less close relation to the subject of bathing.  These
   are the care of the teeth, nails and hair.
      The teeth must be cleaned morning and evening,
   and the cleansing process must be begun with the
,   appearance of the first tooth.  Ordinarily,  a soft
   wash rag folded  over  the forefinger, dipped in cool
   water and thoroughly rubbed over the teeth, is suf-
   ficient  to  keep the early teeth clean, and  does not
   injure  the tender  gums.  Should a dark-colored
   scum form at the junction of the tooth and gum, a
   little prepared chalk or other bland tooth-powder
   may be used in addition.  If it be impossible  to get
   at the point of discoloration  in this way, shape with
  - a penknife a moderately hard bit of wood into the
   form shown in Fig. 17, then either bite or rub the
   woody fibres at the extreme end into a sort
   of bunch, wet this, dip it in the  tooth-pow- FlG'I7-
   der and gently rub at the discoloration until
   it disappears, taking care not to make the
   gum bleed. Over a piece of wood so shaped
   one may also wrap a bit of soft cambric and
   use water and powder as before.
     Take good care of the milk teeth, for if
  they become  decayed  and  broken off or
  lost, their permanent substitutes are apt to
        ,   a                                jaav.iv run
  come in irregularly and produce a lasting cleaning
              °    J      r               *> TEETH.
  deformity. 
I48        HYGIENE OF THE NURSERY.
  The tooth brush can be used after a number of
the milk teeth have been cut.  The bristles should
be very soft and fine, and it must be employed with
gentleness.  Unless there should be some discolor-
ation, no powder need be used.
  The child  should early learn to clean  his own
teeth.
  The importance of taking care of the toe nails
has  already  been referred  to  in the  chapter  on
clothing.  The finger nails should  not be allowed
to grow too long; at the same time it is a bad plan
to cut them close to the quick.  In trimming them,
use  a moderately dull pair of scissors, and do not
round them too much.   When hang-nails appear,
they must be cut close with sharp scissors.  The
fingers and toes should  be inspected carefully after
each bath, to see  if they require attention.
   Directions have already been given in regard to
washing the hair.  All that remains to be said now
is to repeat  the  caution against  the use of a fine
comb, and to protest against the employment of
hair-oil  and  hair-washes.  The best scent for the
hair is  an occasional dressing of soap and water;
the  best  beautifier,  a thoroughly  good brushing
with good brushes, and the latter should be em-
ployed every morning and evening.
   Besides keeping the long hair of a girl free from
scent and grease, do not dress it over the ears or tie 
BATHING.
149
 it up tight and make it " like a cap of iron over the
 skull."
   If the  hair  be well  brushed  and the scalp thus
 sufficiently stimulated, there will be enough natural
 oil secreted  to keep it tidy; artificial oily applica-
 tions only act temporarily, and  by blocking up the
 pores of the skin  tend to make the hair drier and
 harder to keep in order.
   Should  there  be a tendency  for the hair to fall
 out,  wash the scalp  thoroughly  and  frequently
 with  soap and  water, and  stimulate  it  by  firm
 brushing and the use of a wash  such as the follow-
 ing :—

  Take of—
    Aromatic spirits of ammonia,.....one fluidounce.
    Tincture of  cantharides,   . . one and a half fluidrachms.
    Glycerine,.............half a fluidounce.
    Rose water,............seven fluidounces.
                                            Mix.

  A  tablespoonful of this may be rubbed into the
scalp once every day, the rubbing to be followed
by washing with  a sponge and vigorous brushing.
  In  such cases, however,  it is best  to  seek the
advice of a physician, for falling out of the hair may
be due to a variety of causes. 
150
HYGIENE OF THE NURSERY.
             CHAPTER  VIII.

                     FOOD.

  The choice of food  and the method of feeding
bear so close a  relation to age that it is necessary,
in studying these questions, to  regard them from
the standpoint of the  two stages of a child's  life
mentioned in the first chapter; that is to say, the
periods of infancy and childhood.
  Infancy.—An infant may be fed in one of three
ways: ist, from  the mother's breast; 2d, from the
breast of a foster mother or wet nurse; and 3d, from
a bottle, by the method known as artificial or hand-
feeding.
   1 st. Feeding from the maternal breast. There can
be no doubt that this, being the natural, is at the
same time the  proper method  of nourishing  the
human  infant; and fortunate is  the babe that, in
our  day of  advanced  civilization and city-living,
can  draw from  the breast of a  robust mother an
abundant supply of pure, health-giving, tissue-build-
ing food.
   It follows, therefore, that  every woman  who is
free  from  certain  contra-indicating diseases, to be
mentioned later, should  nourish her  child solely 
FOOD.
151
from her breast up to the age of eight months, and
partially to the  end of the  first year, or, failing in
either limit, so long as possible.
  The infant should be put to the breast as soon as
the mother has recovered somewhat from the fatigue
of labor—some four or eight hours after birth.  Of
course no milk can be drawn at this early date, but
the babe gets a small quantity of thin, watery fluid,
called colostrum, which affords sufficient nourish-
ment, and at the same time, from its laxative prop-
erties, clears away the greenish  or  black, viscid
material  that collects  in the infant's intestinal canal
during intra-uterine life.   This procedure, too, is of
great advantage to the mother, for it insures proper
contraction of the womb, draws out the nipples, and
encourages the formation of milk.
  As the secretion of milk is never fully established
until the third day after labor, it stands to  reason
that no food  other than the colostrum is required
before that time.  Hence, the practice of filling the
infant's  stomach with gruel,  sugar and water, and
other sweetened mixtures, is more than useless, for
it diminishes the activity of sucking and the conse-
quent  stimulation of milk  production.  Put the
child  to the  breast  every two hours  while  the
mother  is  awake, and there  need be  no fear of
starvation.
  After the third day, should the breasts not yield 
152        HYGIENE  OF THE  NURSERY.
a supply of milk, a little sound cow's milk diluted
with double its  quantity of  water and sweetened
with sugar of  milk,  may  be given every  fourth
hour, the babe being put to the breast in the
meanwhile.  So soon as  the  flow begins, however,
the artificial feeding is to be discontinued.
  Usually on the fourth day milk is secreted and
regular  lactation commences.   Many  untrained
mothers make  a failure  of nursing because they
know nothing of the manner of giving suck; of the
length  of time  the  child  should be kept at the
breast; of the proper  time for, and interval between
feeding, and of the importance of regularity.  Upon
these points the physician  should give minute in-
structions.
  When giving the breast,  the infant must be held
partly on its  side, on the right or left arm, accord-
ing  to  the gland about to  be  drawn, while the
mother must bend her body forward, so that the
nipple may fall  easily into the child's mouth, and
steady the breast with the first and second finger of
the disengaged hand, placed  above and  below the
nipple.   In case the milk runs too freely—a condi-
tion very apt to excite vomiting—the flow is easily
regulated by gentle pressure with the supporting
fingers.  Each of the breasts should be drawn alter-
nately, the  contents of one being usually sufficient
for a meal; and a healthy child may be allowed to 
FOOD.
153
nurse until  satisfied, when he will stop of his own
accord, drop the nipple  and fall asleep with  milk
still flowing over his lips.
  During the first six weeks the breast is required
every second hour, from  5  a.m. until  11  p.m.  At
night the infant  should be put  in  a  crib by the
mother's bed, or in an adjoining room, under the
care of a competent nurse, and there remain quietly
until the morning feeding.  This secures the mother
six hours of uninterrupted repose, a matter of great
importance  to her general  health and  consequent
capacity for prolonged lactation.  As to the infant,
he may rebel at first, and wake and cry, so that it is
necessary to quiet him with a little milk and water
administered from a  bottle; but often after a few
days, and certainly at the end of a week or two, the
good  custom of sleeping at night is formed, and
there is no further trouble.
  Regularity in meal hours is even of more import-
ance in early than in  adult life, on account of the
natural feebleness of digestion.  To secure this, it
is only necessary to have a little perseverance, for
infants are such creatures of habit that a short train-
ing brings them into the way of expecting food only
at  certain times, and, when healthy, they wake to
suck the breast with almost the precision  of the
clock.  While insisting upon  this rule, one must
recognize the fact that, although in the vast majority 
154        HYGIENE  OF THE  NURSERY.
of instances a two-hours' interval is most suitable
up to the second month, there is no absolute law as
to the number of  daily nursings.  Some  infants
seem to need food less frequently, and it is best to
respect their peculiarity and not force the breast
upon them  so long as  they sleep well, do not fret
when awake, and thrive generally.   Others, again,
may require  it oftener, every hour  and a half, per-
haps, and once or twice at night.  In these excep-
tional cases an appropriate schedule can only  be
made by close observation of individual character-
istics.
  A common and most  ruinous mistake is to resort
to constant feeding  as a means  of pacifying crying.
Babies certainly do cry from  hunger, but just  as
frequently the crying results from colic, or from the
discomfort and pain of indigestion.   Every mother
should be able to recognize the difference.   The cry
from hunger usually begins after a sound sleep.  It
is not peevish, and  stops at the sight of the breast,
when the infant rouses himself, presents an expres-
sion of pleasure, clinches his hands and flexes his
limbs.  The cry of colic is violent and paroxysmal;
the face is livid and wears an expression of suffer-
ing ;  the abdomen is  distended  and hard; the
hands and feet are  cold; the legs are drawn up or
kicked violently about;  and an explosion of wind
from the mouth or bowels ends the attack.   A 
FOOD.                  155
peevish cry, hot skin and  sour breath attend indi-
gestion.
   It stands without saying that the cry of hunger
must be relieved by giving food;  but this  is the
very worst thing to  do under other circumstances,
for it both  breaks  up  good  habits and produces
serious mischief. The paiivof colic and the discom-
fort of indigestion are chiefly due to the accumula-
tion of flatus resulting from the fermentation of food.
Mothers soon  learn, and unfortunately infants too,
that the breast milk temporarily relieves suffering.
This it does in the same  way as any other  warm
liquid; but, unlike  a simple fluid, milk  only adds
more material to the already fermenting contents of
the  gastro-intestinal canal, and  every  nursing is
soon followed by more pain, until  between crying
and  sucking and sucking  and crying, the infant's
life is passed in misery, if not cut short altogether.
Instead of continuous feeding, the plan for relief is
to decrease the quantity of food by increasing the
intervals between nursing and by abridging the time
of lying at the breast, while medicines are employed
to strike at the root  of the evil.
  After  the  sixth week the interval between nurs-
ings  may be slowly increased until, by the fourth
month, it reaches three hours. During this period,
also, the time of lying at the breast may be gradu-
ally lengthened, for  the  quantity of milk secreted 
I56        HYGIENE  OF THE NURSERY.
and the child's  appetite and capacity for food are
all augmented as the days pass by.  At the end of
the sixth  month, feeding every fourth hour suits
some  children well,  but as a rule  the three-hour
interval must be adhered to from the fourth month
to the end of lactation.
   Many authorities recommend additional artificial
feeding, alternating with nursing, after the sixth or
eighth month.  Such a plan is perfectly proper, if
the babe ceases to gain strength and flesh while on
the breast.  If otherwise, the maxim of not inter-
fering  with  any course  that  is  doing well is as
applicable here as elsewhere, and the breast may be
relied  upon  entirely until the  time  comes  for
weaning.
   Should  additional  nutriment be required,  the
food must be selected with due reference to  age and
prepared in the same manner as in regular hand-
feeding.
   The date of weaning cannot be fixed for all cases,
since  it must depend  upon two conditions,—the
health of the mother and the development of  the
child.   When the former continues to be robust
and the child steadily grows and gains flesh, lacta-
tion can be prolonged until the tenth or twelfth
month.   If persevered in longer, the mother's
strength begins to  fail, her milk  is  lessened in
quantity or becomes poor in quality, the child's 
FOOD.
157
 nutrition suffers, and he grows pale, thin and flabby,
 and may develop the disease known as rickets.
   Change in the manner of feeding may be accom-
 plished gradually or suddenly.  In gradual weaning,
 about four weeks are required to prepare for the
 absolute withdrawal of the breast.   For instance,
 if suck be  given every three hours, from  5  a.m.
 until 11 p.m., or seven times a day, there  should be,
 during the first week of preparation, one  artificial
 feeding and six nursings daily; during the second,
 two and five;  during the  third, four and  three;
 during the fourth, six  and one.  Then  the  breast
 must  be entirely withheld.   Carefully prepared
 milk-food, administered from  a bottle, is the best
 substitute.  At the age of ten months  a  mixture
 that ordinarily agrees well is :—
   B .  Cream.............I tablespoonful.
       Milk..............8 tablespoonfuls.
       Sugar of milk..........I teaspoonful.
       Water.............3 tablespoonfuls.
  This is to be poured into a perfectly clean bottle,
warmed in a water bath, and taken through a clean,
plain rubber tip.  Should the  quantity  (six fluid-
ounces*)  be  insufficient to   satisfy the  child's
appetite, all the ingredients except the cream may
* One fluidounce = two tablespoonfuls.
  One fluidrachm = one teaspoonful. 
I58        HYGIENE OF THE NURSERY.
be increased  until the mixture measures  eight or
even twelve fluidounces, according to the demand.
  When such accidents as fever, disordered diges-
tion, with  vomiting and  diarrhoea,  or  the actual
cutting of one  or  more  teeth occur during the
period  of  preparation, the  number of  artificial
feedings must be  reduced, or the breast resumed
until the disturbance be passed; then the course
may be begun again and carried to its completion.
  Usually there  is little trouble in weaning infants
in this way.  Sometimes they become fretful under
the change and may refuse food entirely for a day
or more; but a little determination  on the part of
the mother and the cravings  of hunger will soon
overcome this difficulty.
  Occasionally the child refuses to suck milk from
a bottle or to drink it from a cup  or spoon, in fact
seems to object  to  any form of liquid food except
that drawn from the mother, while at the same time
he  is eager for bread or other solid food.  Under
these circumstances  prepare  for  each  meal  a
moderate portion of either rice pudding or junket.
After these have been taken for a day or  two, add
to each meal  a little milk, reducing  the amount of
pudding or junket; stir  the whole together and
feed from a spoon ; next day still further reduce the
solid and increase the liquid, and  so proceed until
finally a taste for milk is cultivated. 
                      FOOD.                  t59

   Sudden weaning  is not  advisable unless, while
the breast is being presented, there is an absolute
refusal to take artificial food from either a bottle or
a spoon.  This is most apt to occur when food has
been given too frequently, and when the breast has
been used as a means to quiet crying.  The plan is
also to be recommended when the mother's health
becomes so affected  as to render any further suck-
ing a positive peril  to the  child's  life; attacks of
erysipelas or of smallpox are instances in point.
  The physician is often forced to decide upon the
advisability of premature weaning.   His  decision
must  be  made  cautiously and   after  thorough
investigation of two propositions, namely: a, the
effect of further lactation upon the health of the
mother, and b, the requirements of the child.
  a. Lactation being a physiological process is not
a drain upon the systemic strength so long as the
functions  of  nutrition  are actively performed, but
under other  circumstances  it very frequently be-
comes  so.  Premature weaning is necessary when
the mother is attacked by any acute disease threat-
ening dangerous temporary prostration,  such as
typhoid or typhus fever.   A change must  also be
made if pulmonary consumption be developed, or,
being already present, rapidly advances under the
drain of milk secretion.  Ordinarily, however, the
general  condition that leads to withdrawal of the 
l6o        HYGIENE  OF THE  NURSERY.
breasts  is one of simple  loss of strength and flesh
on the part of the mother.
  Undoubtedly these indications often warrant  the
procedure, but every one who has seen much of
children's practice must have met with many cases
in which the advice to wean has been given care-
lessly and unnecessarily, and in which  the child
might have had  its natural food had  proper atten-
tion been given to the health of the mother.
  If a woman be worn out by household cares; if
she wear herself out by a round of dinners, balls or
shopping, or if she expose herself to injurious at-
mospheric conditions and eats improper food, she
grows  weak  and thin  whether she be nursing or
not; and a woman heedless of her health will prob-
ably care little whether  she suckles  her child or
gives it up to a wet-nurse or to the bottle.
  In addition to making nursing the important duty
of her life for the time  being, a mother must be as
free from household cares as possible.  Mental and
physical fatigue is to be avoided, sufficient exercise
must  be taken to  maintain a  healthy appetite and
digestion, and abundant  time  devoted to rest and
sleep.   Beyond securing  a plentiful supply of plain
and easily digestible food, with a judicious portion
of meat, vegetables, and  fruit, it is unnecessary to
give special attention to the diet.
  Should the secretion of milk be scanty, it may 
FOOD.
161
often be increased by the free use of animal broths,
chocolate, gruel, or milk, and sometimes the moder-
ate employment of stimulants, in the form of ale and
porter, may be necessary.   Such tonics as malt ex-
tract, ferrated  elixir of cinchona, bitter wine of iron,
and  the preparation known as " beef,  wine and
iron," are useful when  there is anaemia, or  when
the general failure of strength cannot be overcome
by food and attention to hygienic rules.
   The  ordinary local  conditions  indicating the
necessity  of premature  weaning, on the mother's
account, are fissures of the nipple  and  mammary
abscess.
   Fissure  being usually  a unilateral  condition, it
is only  necessary to retire  the affected  side from
duty and nourish the  child alternately from the
unaffected gland  and from the bottle until healing
takes place, the disabled breast being pumped  in the
meantime to keep  up secretory activity.  Should
both sides be affected, weaning  may be imperative,
on account of the extreme pain produced by  suck-
ing,  though, even under  these circumstances, an
effort must be made to maintain the flow of milk by
regular  pumping.  Sometimes  women are able to
struggle through the attack by taking advantage of
the relief and protection afforded by  a nipple-shield.
  Fissures of the nipple may be preceded by vari-
ous diseases of the delicate skin of the part.   They
      u 
162        HYGIENE OF  THE NURSERY.
result, also, from want of cleanliness or from keep-
ing the nipple too moist, as when constant sucking
is allowed or when there is a continual flow of milk.
They may be prevented by proper  attention to
the nipple before confinement.   During the latter
months of pregnancy  the clothing  covering  the
breast must be loose, and the wearing of a wire  tea-
strainer over the nipple to prevent pressure  has
been recommended by one authority.  Each day,
for three months before labor, the nipples should
be washed thoroughly with hot water in the even-
ing and anointed with cocoa-butter in the morn-
ing.  At the same  time,  should the nipples be
small or retracted, the woman must be taught to
use her thumb and finger to draw them out.  This
process is not  only an advantage in giving proper
size and shape, but brings the skin into good con-
dition without hardening it.   The application of
alcoholic and astringent lotions are not to be recom-
mended.   They  tend to harden the tissue, which
should be soft and pliable rather than tanned,  and
render the nipples liable to crack.
  When a fissure exists, it is best first to see whether
or not nursing  can  be continued by means of a
nipple-shield.  Should  the child refuse this, a good
plan is to fill the shield with warm milk and invert
it over the nipple.  The infant then draws the fluid
at once and without difficulty, and will often con- 
                      FOOD.                   T63

 tinue sucking until the breast milk  follows.   After
 nursing and removing the shield, the  nipple must
 be dried thoroughly with absorbent cotton, and the
 following lotion applied with a camel's-hair brush :—
   Take of—
        Boracic acid.........twenty grains.
        Mucilage of acacia......one fluidounce.   Mix.
   b.  On the part of the infant, there are several in-
 dications for anticipating the time of withdrawing
 the mother's breast.  It must be done if the occur-
 rence of pregnancy or the recurrence of menstrua-
 tion render the milk unwholesome; if the mother
 contracts a dangerous contagious  disease, as small-
 pox,  scarlet fever, or erysipelas ;  if the mammary
 glands  become inflamed; if  the  breast  does not
 afford sufficient nourishment  and artificial food be
 refused; and, finally, if dentition be markedly de-
 layed and the premonitory symptoms of rickets
 appear.   As to the amount of nourishment, it  must
 be remembered that the breast milk may be of  good
 quality, but so diminished in  quantity that it  is in-
 sufficient; or, while abundant in quantity, so  poor
 in quality that it  does not  meet  the demands of
 nutrition.  Even without a minute examination of
 the milk, it is possible to form  a good idea of which
 condition is present from the behavior of the infant
 in the act of sucking.  If the milk be good in quality
but deficient in quantity, the babe, when put to the 
164        HYGIENE OF THE NURSERY.

breast, seizes the nipple as if famished, and draws
upon it vigorously for a time, and then drops it with
a scream of rage.  On the contrary, should there be
an abundant supply of poor milk, the nipple is
grasped languidly, the child lies a long time at the
breast and falls asleep there.  Consideration of the
final indication opens the question of the propriety
of regulating weaning by the progress  of dentition.
This is certainly a good guide, but not in the way
implied in the old precept, that the child must not
be  taken  from the  breast  until evolution  of the
stomach and eye teeth. Insufficient food is  one of
the chief  causes of rickets, and rickets more than
any other disease delays  dentition; consequently,
should the teeth not  pierce the gum  in time, the
inference is for other food rather than a continuance
of the faulty maternal supply.
  Upon deciding to  anticipate the  time of weaning,
the next point to  consider is whether the infant
shall be brought up  by hand or by a wet nurse.
  2d.  Feeding by a  wet-nurse.   The advantage of
feeding from the breast of a wet-nurse is that the
mother's milk is substituted by the milk of another
woman; in other words, that natural feeding is con-
tinued—a matter of  moment in all cases, and of in-
estimable  importance with delicate children.  The
disadvantage consists in the difficulty of finding, in
a woman belonging to the class  from which wet- 
FOOD.                  165
nurses come, all the moral and  physical characters
essential  to  a  good substitute, and the  fact that a
stranger is introduced into the household, often to
deceive and  annoy the family, and  on the slightest
provocation  to leave her charge to fate or to the
tender mercies of another of her kind.  For these
reasons it is  preferable, in the majority of instances,
to trust to careful bottle-feeding.   Nevertheless, as
some children  must have human milk if their lives
are to be saved, the rules for selecting a wet-nurse
must be understood.
  The woman  chosen must be strong and robust,
but rather spare than fat.  Her bill of health must
be perfectly  free from  hereditary tendency to men-
tal or physical disease  and from taint of syphilis,
consumption or scrofula.  She must be  cheerful,
good-natured,  active, careful,  and  temperate  in
habits.  Her age should be between twenty and
thirty years ; she  should understand the care of an
infant and the manner  of giving suck;  her child
ought to be  nearly the same age as the infant to be
adopted, and she must be able to afford an abundant
supply of good milk.
  The last quality can  be estimated by inspecting
the breasts, by examining some of the milk drawn by
a pump, and  by ascertaining the condition of the wo-
man's own child. The breasts of a good nurse are not
necessarily large, but are firm to the touch and pyri- 
166        HYGIENE OF THE NURSERY.
form in shape, with well-developed, prominent nip-
ples, and with the skin distinctly marbled with large
blue veins.  The milk, which ought to flow readily
on  pressure  or  on suction, should be opaque and
dull white in color, have a specific gravity of 1.031,
an alkaline reaction, and show, when placed under
the microscope, a number of minute, equal-sized,
fat  globules.  Its  quantity may be ascertained by
weighing the child before  and after sucking, the
normal gain being from three to six ounces. There
is, however, no better or more readily applied test
of the quality of a nurse than the size, weight, and
general development of her own child; and if it be
weak and ill-nourished, no amount of fitness in other
respects can warrant her engagement.
  Even when a woman is  found fulfilling in her
single  person all  the required conditions—a  rare
thing, indeed—it does  not  necessarily  follow that
her milk will suit the babe to be suckled. Then
changes and new trials must  be made until the
desired end be attained.
  The diet of a wet-nurse and the manner of wean-
ing, must be governed by the rules already given for
maternal feeding.
  Personally, I have had such good results from
carefully regulated bottle-feeding, that I have almost
given up the employment of wet-nurses, preferring
to regulate the artificial food myself rather than allow 
FOOD.
167
an ignorant woman to  supplement surreptitiously
her deficient supply of breast milk by an unskilfully
proportioned food—an  event  of  not uncommon
occurrence.
  3d. Artificial feeding.  In  my experience, there
are few American women, especially in the well-to-
do classes, who do not  look  upon  the duty of
nursing their babies as a pleasant one; but there are
many who are  completely unable  to  do  so, and a
vast  number in whom  the secretion of  milk  fails
after a few  weeks or months of lactation.  They
must, therefore, through no fault of their own, resort
to a wet-nurse or to artificial feeding. Usually, they
select the  last method, with results that vary in
direct proportion to the care and  intelligence dis-
played in carrying it out.
  There is no artificial food equal  to the  milk  of a
robust woman.   The fluid, however, secreted from
the glands of a  feeble or unhealthy mother, though
often sufficient in quantity to fill the suckling's stom-
ach and satisfy the cravings of hunger,  does not
contain enough pabulum to  meet  the demands of
nutrition.   In such  unfortunate cases, good cows'
milk, properly prepared, is a better food than the
bad breast milk.  More care and  trouble, though,
are involved in  bottle than in breast feeding. If the
child has been  nourished  in  the natural way—i.e.,
breast-fed—even for a kw weeks, or when the pow- 
168        HYGIENE OF  THE NURSERY.

ers of digestion are inherently active, the task is far
easier to accomplish.  In  these cases the stomach
and intestinal canal, inactive in foetal life, are trained
to their new duties under normal conditions, and so
prepared for the digestion of properly selected artifi-
cial food.  On the  contrary, if digestion be naturally
feeble, or if the infant must be bottle-fed from the
first, great difficulty  may  be expected, and  most
skilful handling is necessary.
   To insure success in hand-feeding, it must be re-
membered that an infant is not nourished alone by
the food he swallows, but  by that  portion of it he
digests  and assimilates.   The best diet, therefore,
is  one so adapted to age and digestive power that
everything eaten  will be  digested and absorbed.
But as children differ as  much in constitution as in
feature, it is impossible to formulate exactly a food
that will be applicable to  every case, or one that
needs no change from month to month of progress-
ing growth.  As  age and  strength increase, there
is  a corresponding development of the gastro-intes-
tinal functions and a demand for more  and stronger
food.   On  the  other hand, should  the system  be
accidentally reduced by disease, the digestion, sym-
pathizing  in the general debility, temporarily loses
its normal activity and assumes that  of an earlier
age.   In such a case more  nourishment is certainly
needed to build up the failing strength, but it is to 
FOOD.
169
be supplied by  giving  such food as can be  com-
pletely assimilated, and not by forcing down strong
food  merely because it is strong;  for the latter,
when not vomited, passes  through the bowels un-
digested, and the  little  creature starves to death in
the midst of plenty, or dies  from the ill effects of
the constant presence of fermenting food in the ali-
mentary canal.  On these accounts  many changes
in diet, as to quality and quantity, must be antici-
pated and made.
  Important matters, therefore, to be studied in de-
tail are: a, the selection of a proper substitute  for
the breast milk; b, the quantity to be given; c, the
method of preparation; d, the mode of administra-
tion ;  and, e, the means of preservation.
  a. Healthy breast milk must  be  taken as the
type of infants' food, and the nearer an artificial subr
stance can be made to approach it in chemical com-
position and physical properties, the  more  perfect
it is.
  Normal breast milk has a specific gravity of 1.031.
It is a persistently alkaline fluid, having a somewhat
animal, usually disagreeable,  and very rarely sweet-
ish taste.  It is bluish-white  in color and  thin and
watery in  consistence.
  According to  Leeds' very thorough analysis, it
contains:— 
I7O        HYGIENE OF THE NURSERY.
     Water.....
     Total solids  .  . .
     Total solids not fat
     Fat   ......
     Milk sugar  .  . .
     Albuminoids .  . .
     Ash......
  It contains,  then, nitrogenous material, carbo-
hydrates, salts and water—all the elements essential
to repair tissue waste, to  supply new material  for
growth and  to maintain body heat, or, in other
words, to constitute a perfect  aliment;  and these,
too, are  so proportioned in the combination as to
most easily and completely meet the demands.
  It must not be supposed, however, that the ele-
ments are uniformly present in the same proportion.
On the contrary, the  fluid varies both  at different
periods of lactation and in different  individuals.
  This fact  is the  most  striking  feature of the
above observer's work, which shows that the most
changeable constituent is the albumen, varying from
a maximum  of 4.86  per  cent, to a minimum of
0.85 ;  the next are the fats and salts, the maximum
being about three times the minimum, and the least
the sugar.  The latter, in fact, varies but little from
a standard of about  7  per cent.   The  function of
albumen is  nutritive;  that of milk sugar calori-
facient; hence  the point seems to be that nature,
while allowing a wide range of oscillation in the
86.766 per cent.
l3-234   "
 9.221   "
 4.013
 6.997
 2.058   "
 0.21     " 
FOOD.
171
rapidity  of tissue  building, carefully  provides  an
available fuel for the constant maintenance of animal
heat;  the supply of caloric due to cerebral impulses
and self-originated  locomotion  being  extremely
small in early infancy.
   In seeking a substitute for human milk, one natur-
ally turns to the domestic animals for the source of
supply.   Between the milk of the ass, cow, goat and
ewe there is little choice, so far as  composition is
concerned, though, perhaps, asses' milk  resembles
that of women a little more closely than the  others;
nevertheless, cows' milk is usually selected, because,
being plentiful,  it is easily obtained and cheap.
   Cows' milk* (market  milk) has a specific  gravity
of 1.029, is richer looking—that is, whiter and more
  * The characters of cows' milk may be determined with sufficient
accuracy in the following way :—
  Provide a urinometer, such as shown in Fig. 18, and which can
be obtained at any drug shop.  To obtain the specific gravity, fill
the  beaker to  such a point with milk that it will float the  specific
gravity glass, and read the degree of density from  the scale at a
level with the surface of the milk.  The chemical reaction is found
by inserting a piece of blue litmus paper, which should turn  slightly
red  a few moments after being wet.  In applying  this test small
pieces of litmus paper should be examined under and in the milk,
as exposure to air may redden paper dipped in milk though the
fluid itself may not be acid.  To ascertain the proportion of cream,
cut a narrow strip of paper four inches  long, and divide the upper
half-inch, by cross-markings, into twelve equal parts; paste this on
the beaker with the marked portion uppermost, and  the lower edge
coming accurately to the bottom of the beaker; then pour in  enough 
172         HYGIENE OF  THE  NURSERY.
opaque than  human  milk,  and  is slightly acid in
reaction unless  perfectly  fresh  from  pasture-fed
animals, when it may be neutral  or alkaline, and
contains—
     Water.............87.7  per cent.
     Total solids...........12.3
     Total solids not fat........8.48
     Fat...............3.75
     Milk sugar............4.42
     Albuminoids...........3.42
     Ash..............0.64
Fig. 1
  Comparing this analysis with that
previously given, it is readily seen
that the two fluids differ in specific
gravity  and  reaction,  and  that
cows'  milk  contains  more  nitro-
genous material, but less  fat and
much less sugar than woman's milk.
  The nitrogenous material differs
in quality as  well  as in quantity.
Konig, in a number of analyses that
closely correspond with those  of
Leeds, divides the nitrogenous con-
stituent into three groups; namely,
caseine, albumen and albuminoids,
milk to come just to the top of the paper, and place the whole aside
for twenty-four hours.   During this time the cream rises and appears
as a yellow layer at the top; this layer should have the depth often
or twelve spaces. 
FOOD.
173
basing the division  upon  the  different  effects  of
coagulating agents.
  Upon  this point  Leeds remarks: "Whilst by
present modes of analysis the separation  of the
so-called caseine from the so-called albumen is not
accurately performed, yet the results are approxi-
mately correct (Konig's),  and  have  a  very great
value in pointing out the most important of all the
differences  between  the  two secretions, which  is,
that the  fraction of the total albuminoids in cows'
milk which is  coagulable  by acids is  far greater
(perhaps  four times) than the non-coagulable part.
  " In woman's milk, on the contrary, the reverse is
true, and the non-coagulable part much exceeds
(perhaps  by more  than  twice)  the  coagulable
portion."
  This difference is readily tested by adding rennet
to the two fluids.  In the case of cows' milk the
caseine is coagulated into large, firm masses, while
with human milk a light, loose curd is formed.   In
the stomach  the acid  gastric juice has the same
effect, producing  in  the first instance a coagulum
most difficult to digest; in the other, one readily
attacked  and broken down by the gastro-intestinal
solvents.
  These  chemical and  physical properties of cows'
milk can  be altered  by various  methods of prepa-
ration, and unless this  be done there are few in- 
174        HYGIENE OF THE NURSERY.

stances in which it will not prove a poor substitute
for the natural food.
  Condensed milk  is frequently recommended by
physicians and largely used by the  laity, on their
own responsibility.  It keeps  better  than cows'
milk and  is supposed to be more readily digested
by young infants.  The latter supposition is a  mis-
taken one, and arises from the overlooked fact that
condensed milk is always given dissolved in a large
proportion of  water,  while  cows'  milk  is  too
frequently used  insufficiently diluted or otherwise
improperly prepared.   The author is convinced of
the accuracy of this statement from a number of
years' close study of the subject.
  Condensed milk contains a large  proportion of
sugar, forms fat quickly,  and thus makes large
babies ; sugar also counteracts the tendency to con-
stipation—often  a troublesome  complaint  in hand-
feeding.   These advantages are unquestioned, and,
together with the ease of preparation, are those
which place it so  high in the esteem of monthly
nurses.   It is equally true, however, that as a food
it  does not contain enough nutrient material  to
supply the wants of a growing  baby.
  Again,  more than half of the  saccharine ingre-
dient of this  preparation is cane  sugar, added for
the purpose of  preservation, and this  material is
very  liable, when  in  excess,  to ferment  in the 
FOOD.
175
alimentary canal, giving rise to irritant products that
impede digestion.
  Infants fed upon condensed milk, though fat, are
pale, lethargic and  flabby; although large, are far
from strong; have little  power to resist diseases;
often cut  their teeth  late, and are very likely to
drift into rickets.  It must be remembered also that
condensed milk, when long kept, or when packed in
imperfect cans, not unfrequently undergoes  decom-
position, and thus becomes utterly unfit for use.
  For  a  temporary change  of  diet, and as a  sub-
stitute during travelling  or under circumstances in
which sound cows' milk cannot be obtained, it may
be resorted to with  advantage.
  The  farinaceous  substances so often selected,
especially by the poor, to replace breast-milk, are
not only bad foods,  but have both directly and in-
directly a deleterious  effect  upon the processes of
nutrition.
  They are bad for  two reasons.  First, they differ
materially in  chemical composition  from  human
milk.  For  example,  in arrowroot,  which is the
favorite, the proportion of the tissue-building to the
heat-producing element  is as one to twenty,  while
in human milk it is about one to five.  Secondly, the
heat-producing principle, starch, must be converted
into sugar before it  can be absorbed.   This change
is accomplished in the body by the saliva and pan- 
I76        HYGIENE OF  THE NURSERY.

creatic juice,—secretions that are not fully estab-
lished until the fourth  month.
  While the starch lies  undigested  in the  gastro-
intestinal canal, it is subject to fermentation, result-
ing in the formation of irritant products that rapidly
induce  catarrh of the mucous membrane; a con-
dition  directly interfering  with the digestion  and
absorption  of  food.    Again, perfect   nutrition
demands rapid waste and removal of effete tissues
as well  as repair of the same.  This is effected by
oxidation.  Now sugars are known to have a much
greater affinity for oxygen than albuminates, and
when the diet consists of farinaceous material, the
little  sugar formed   and  absorbed appropriates
oxygen  that  otherwise would  go toward  the
removal of waste,  and  so retards  the  necessary
changes.
  Farinaceous food, as  such, is never permissible
before the fourth  month; earlier, it is  only to be
employed for  its mechanical action, as an addition
to milk preparations.  This will be mentioned later.
  The nutrient value  of  the cereals  and their pro-
ducts as they exist in so-called "infants'  foods,"
has been imperfectly  determined.   They are un-
doubtedly useful as mechanical attenuanis, but it
is  very questionable whether any of them, unless
prepared with milk,  can  permanently  meet the
demand of nutrition.   At the same time it is quite 
                      FOOD.                  \yy

 probable that  the soluble  albuminoid substances
 obtained by Liebig's process have a food value of
 their own, making them more serviceable than the
 starches.
   b. The quantity of food to be allowed each day
 varies with  the  appetite and  age.   Some  infants
 habitually eat little, others  much; as both  thrive,
 the question of the correct amount in a given case
 must be answered by observation.  So long as the
 child develops with normal rapidity and keeps well,
 he may be allowed to eat as much or as little as  he
 wants;  for, if food of proper strength be given  at
 proper intervals, the instinctive cravings of hunger,
 since they represent the wants of the system, rarely
 lead to excess in  either direction.  Nevertheless it
 is well to have  some guide.
   During the first four weeks, infants generally re-
 quire from twelve and-a-half to sixteen fluidounces
 of food; in the second  and third months,  about
 twenty-four fluidounces, and from this time  to the
 twelfth month from two to two and-a-half or even
 three pints.  After the twelfth month the quantity
 depends  upon whether  additions be  made  to the
 diet,  or milk food be used exclusively. When the
 daily amount reaches three pints, the limit  of the
capacity of the stomach is usually attained, and the
greater demand for nutriment, as growth advances
month by month,  must be met by adding  to the
      12 
I78        HYGIENE  OF THE  NURSERY.
strength of the food rather than  by increasing its
bulk.   These two factors, strength and quantity, are
intimately associated throughout  the whole period
of infancy, and in the earlier months a mere increase
in the latter is not always sufficient to maintain the
balance of nutrition.
  As a rule, infants are overfed, and this opens the
very interesting question of the normal capacity of
the stomach at different ages.  Rotch has recently
written an important paper upon  the subject.   He
states that, by actual measurement, the stomach of
an infant five days old holds 25 c.c, or six  and-a-
quarter fluidrachms, a quantity very far short of
that usually forced upon  the  babe  during the first
week.  Frowlowsky's investigations show that there
is a very rapid increase in the capacity of the stom-
ach during the first two months of life, while in the
third, fourth and fifth months the  increase is slight.
Guided by these data, the quantity of food  should
be rapidly augmented during the  first six or eight
weeks  of life and then held at the  same quantity up
to the fifth or sixth month.   Another considerable
increase is  also demanded between the  sixth and
the tenth months.
  While the author has been unable to verify the
above  measurements, and  has, on the contrary,
found no uniformity in the size of the stomach for
given ages, yet the following table (Rotch) is a use- 
FOOD.
179
ful one, and corresponds closely with  conclusions
drawn from clinical experience :—
GENERAL RULES FOR FEEDING.
Age.	Intervals of Feeding.	Average Amount at Each Feeding.	Average Amount in 24 Hours.
First week.	2 hours.	1 ounce.	10 ounces.
One to six weeks.	3% hours.	1J4 to 2 ounces.	12 to 16 ounces.
Six to twelve weeks and possibly to fifth or sixth month.	3 hours.	3 to 4 ounces.	18 to 24 ounces.
At six months.	3 hours.	6 ounces.	36 ounces.
At ten months.	3 hours.	8 ounces.	40 ounces.
  c. The object to be accomplished in the prepara-
tion of cows' milk  is to make it resemble  human
milk as much as possible in chemical composition
and physical properties. To do this, it is necessary
to reduce the proportion of caseine, to increase the
proportion of fat and  sugar, and to overcome the
tendency of the caseine to coagulate into large, firm
masses upon entering the stomach.
  Dilution with water  is all that need be done to
reduce the amount of caseine to the proper level;
but as this  diminishes the  already insufficient fat 
l80        HYGIENE OF THE NURSERY.
and sugar, it is essential to  add these materials to
the mixture of milk and water.  Fat is best added
in the form of cream, and of the sugars, either pure
white loaf sugar or sugar of  milk may be used.
The latter is greatly preferable, as it is  little apt to
ferment,  and  contains some of the salts  of milk,
which are of nutritive value.
   Firm clotting may be prevented by the addition
of an alkali or a small quantity of some thickening
substance.
   Lime water is the alkali usually selected.  It acts
by partially neutralizing the  acid of  the  gastric
juice, so  that the caseine is coagulated gradually
and in  small masses, or passes, in great part, un-
changed into the intestine, to be there digested by
the alkaline secretions.  As it  contains only half a
grain of lime to the fluidounce, the desired result
cannot be attained, unless at least a third part of the
milk mixture be lime water.  The quantity often
used—one or two teaspoonfuls to the bottle of food
—has  no  effect  beyond neutralizing  the  natural
acidity of the milk itself.  When lime water is con-
stantly employed, it becomes quite an item of ex-
pense if procured from the drug shop ; this outlay
is unnecessary, for it can be made quite as well in
the nursery.  Take a piece of unslaked lime as large
as a walnut, drop it into two quarts of filtered water
contained in an earthen vessel, stir thoroughly, allow 
FOOD.                    l8l
to settle, and use only from the top, replacing the
water and stirring as consumed.
   Instead of lime water, two to four grains of bi-
carbonate of sodium may be added  to each bottle,
or, better still, from five  to  fifteen drops of the sac-
charated solution of lime.
   This solution  is made in  the following way:—
   Take of—

     Slaked lime   ............i  ounce.
     Refined sugar, in powder.......2 ounces.
     Distilled water...........i  pint.
  Mix the lime and sugar by trituration in a mortar.  Transfer the
    mixture to a bottle containing the water, and having closed this
    with a cork, shake it occasionally for a few hours.  Finally,
    separate the clear solution with a siphon and keep it in a stop-
    pered bottle.

   Thickening substances—attenuants, such as bar-
ley-water, gelatine, or one of the digestible prepared
foods—act  purely mechanically by getting,  as it
were, between  the particles of caseine during co-
agulation,  preventing  their running together  and
forming a large,  compact mass.
   When an " infant's food " is used to act mechani-
cally, care should be taken to select one in which
the starch  has been  converted into  dextrine  and
grape  sugar by  the process of  manufacture.  The
articles known as " Mellin's Food " and  " Horlick's
Food"  can  be relied  upon.  One  teaspoonful of 
182         HYGIENE OF THE NURSERY.
either dissolved in a tablespoonful of hot water and
added to each portion of food, makes a very easily
digested mixture.
  For the successful management of children,  the
mother or nurse  must not only  be  familiar with
the  theory of feeding, but must practically under-
stand the  methods of preparing  food.   To  this
end  a schedule of  the diet of an  infant from birth
upward, with a sketch of the  modifications  that
have to be  made  most frequently, will serve as a
useful guide.
  Diet during the first week:—

      Cream.............2 teaspoonfuls.
      Whey.............3 teaspoonfuls.
      Water (hot)   ..........3 teaspoonfuls.
      Milk sugar...........«^ teaspoonful.
  For each portion; to be given every two hours from 5 a.m. to 11
   P. M., and in some cases once or twice at night; amounting to
   twelve fluidounces of food per diem.

  Diet from the second to the sixth week:—

      Milk............I tablespoonful.
      Cream............2 teaspoonfuls.
      Milk sugar..........^ teaspoonful.
      Water............ 2 tablespoonfuls.
  For one portion; to be given every two hours from 5 A. M. to II
   p. M.;  amounting to seventeen fluidounces of food per diem.
  Diet from the  sixth week  to the end of the sec-
ond month:— 
FOOD.
183
       Milk.............2^ tablespoonfuls.
       Cream............1   tablespoonful.
       Milk sugar..........yz teaspoonful.
       Water............2^ tablespoonfuls.
   For each portion; to be given every two hours; amounting to thirty
     fluidounces per diem.

   Diet from  the beginning of the third  month to
 the sixth month :—

       Milk.............5 tablespoonfuls.
       Cream............1 tablespoonful.
       Milk sugar..........1 teaspoonful.
       Water............2 tablespoonfuls.
   For each portion; to be given every two and a half hours, or thirty-
     two fluidounces per diem.

   Diet during  the  sixth  month;  six  meals  daily
 from 6 or 7 a. m.  to 9 or 10 p. m.

   Morning  and mid-day bottles each :—
      Milk.............9 tablespoonfuls.
      Cream............1 tablespoonful.
      Mellin's Food.........I teaspoonful.
      Hot  water..........2 tablespoonful.
  Dissolve the Mellin's Food in the hot water and add, with stirring,
    to the previously mixed milk and cream.

   Other bottles each :—
      Milk.............9 tablespoonfuls.
      Cream............1 tablespoonful.
      Milk sugar..........1 teaspoonful.
      Water............2 tablespoonfuls.
   This gives an equivalent of thirty-six fluidounces
of food in a day. 
184        HYGIENE OF THE NURSERY.
  In the seventh month the Mellin's Food may be
increased to two teaspoonfuls and given three times
daily.
  Throughout the eighth and  ninth  months five
meals a day will be sufficient.
  First meal at 7 a. m. :—
     Milk............13 tablespoonfuls
     Cream...........I tablespoonful.
     Milk sugar..........I teaspoonful.
     Water...........2 tablespoonfuls.

  Second meal  at 10.30 a.m.  Milk,  cream  and
water  in the same proportion; Mellin's Food, one
tablespoonful.
  Third meal at 2 p. m.—Same as second.
  Fourth meal at 6 p. m.—Same as  second.
  Fifth meal at  10 p. m.—Same as first.
  This gives forty fluidounces of food per diem.
  Instead of Mellin's Food, a teaspoonful of " flour-
ball " * may be added.
  Two meals of flour-ball daily—the second and
fourth—are all that can be digested.   To prepare
these,  rub one teaspoonful of the  powder with a
tablespoonful of milk into a smooth paste, then add
a second tablespoonful of milk, constantly rubbing
until a cream-like  mixture is  obtained.  Pour this
into  eight ounces of hot milk, stirring well, and it
* See Chap. ix. 
FOOD.                   185
is then ready for use.  The other meals should be
composed of milk,  cream, sugar of milk and water,
as already given.
  Mellin's Food and flour-ball may be substituted
by  oatmeal  or barley, or any one of  the  infants'
foods in which the  starch has been converted, by
Liebig's process, into dextrine and grape  sugar.
  Diet for the tenth and eleventh months:—
  First meal, 7 a. m. :—

     Milk............17 tablespoonfuls.
     Cream...........  I tablespoonful.
     Mellin's Food........  I tablespoonful.
     (Or flour-ball or barley jelly*) .  .  2 teaspoonfuls.
     Water (used only with Mellin's Food), 2 tablespoonfuls.

  Second meal, 10.30 a. m.—A breakfast-cupful of
warm milk (eight fluidounces).
  Third meal, 2 p. m.—The  yelk of an  egg lightly
boiled, with stale bread crumbs.
  Fourth meal, 6 p. m.—Same as first.
  Fifth meal, 10  p.m.—Same as second.
  On alternate days the third meal may consist of
a teacupful (six fluidounces) of beef tea containing
a few stale bread crumbs.
  A further  variation can be made by occasionally
using mutton, chicken or veal broth instead of beef
tea.f
*See Chap. ix.
f Ibid. 
186         HYGIENE OF  THE  NURSERY.
  As much more difficulty is experienced in feed-
ing  infants during the  first twelve  months than
during  the second, it would be well to pause here
to consider what had best be done in case the food
described should disagree.
  If, after feeding, vomiting occur, with the  expul-
sion of large, firm clots of caseine, the effect of add-
ing lime water or barley water must be tried.
  For instance, at the age of six weeks make each
bottle of:—

     Milk............2% tablespoonfuls.
     Cream...........I   tablespoonful.
     Milk sugar   .........   y2 teaspoonful.
     Lime water.........2^ tablespoonfuls.

  Or of:—
     Milk............2j£ tablespoonfuls.
     Cream...........1   tablespoonful.
     Milk sugar   .........   yz teaspoonful.
     Barley water.........2^ tablespoonfuls.

  Sometimes, particularly if there be diarrhoea, boil-
ing makes the milk more tolerable, and in this con-
dition it may be used instead of fresh milk in either
of the above mixtures.   Condensed milk, too, can
be employed temporarily, making each portion of:—
     Condensed milk.......1 teaspoonful.
     Cream...........I tablespoonful.
     Hot water   .........5 tablespoonfuls. 
FOOD.
I87
  Should further alteration be necessary, goats' or
asses' milk may be substituted for cows' milk, the
strong odor of the former and the laxative proper-
ties of the latter  being removed  by boiling.   One
ass is  capable of nourishing three children for the
first three months of life, two children for the fourth
and fifth months, and one child after  this period to
the ninth month.  The milk  should be used warm
from the udder.
  " Strippings " is another good substitute for cows'
milk.  It is  obtained  by re-milking  the cow  after
the ordinary daily supply has been drawn, and con-
tains much cream and but little curd.  Assimilable
proportions of this are:—

     Strippings...........2 tablespoonfuls.
     Water............4 tablespoonfuls.

  And if the small amount  of caseine, in such  a
mixture, be still undigested :—

     Strippings...........3 tablespoonfuls.
     Barley water..........3 tablespoonfuls.

  Another good food  is that  recommended by Dr.
A. V.  Meigs.  It consists of a combination of two
parts of the cream, containing from fourteen to six-
teen per cent, of fat;  one part average milk; two
parts lime water, and  three parts sugar water, the
latter  consisting of seventeen  and  three-fourths 
188        HYGIENE OF  THE NURSERY.

drachms * of milk sugar  to one pint of water. This
makes an alkaline mixture with the percentage of its
ingredients closely corresponding to human  milk.
  When, in spite of careful preparation, all of these
foods give rise  to  indigestion with fever, and  the
expulsion, by vomiting and diarrhoea, of hard curds
from the stomach and intestines, the  expedient of
predigesting the milk must be resorted to.
  The best method is to peptonize  the  milk by
pancreatin. f   That manufactured  under the name
of extractum  pancreatis, by Fairchild Brother &
Foster,  of New York, has proved most efficient in
my hands.   To accomplish  this artificial digestion,
put into a clean quart bottle five grains of extractum
pancreatis, fifteen grains of bicarbonate of sodium,
and four fluidounces of  cool, filtered water; shake
thoroughly together, and add a pint of fresh, cool
milk.  Place the bottle in water, not so hot but that
the whole hand can be held in it  for a minute with-
out discomfort, and keep the bottle there for exactly
thirty minutes.  At the end of that time put  the
bottle on ice to check further digestion and to keep
the milk from spoiling.   The fluid obtained, while
somewhat  less white in color than milk,  does  not
differ from  it in taste;  if, however, an  acid be
* About eighteen teaspoonfuls.
j- The subject of peptonization is further considered in Chapter ix. 
FOOD.
189
added, the caseine, instead of being coagulated into
large, firm curds, takes  the form of minute, soft
flakes, or  readily broken-down  feathery masses of
small size. When the process is carried just to the
point described, the caseine is only partly converted
into peptone ; but every succeeding moment of con-
tinued warmth lessens the amount of caseine until
peptonization is complete. Then the liquid is gray-
ish yellow in color; has a distinctly bitter taste, and
shows no coagulation whatever on the addition of
an acid.   This  artificial digestion, therefore, may be
carried just as far as circumstances indicate, although
it is ordinarily best to stop it short of complete con-
version, as children  object to the  markedly bitter
taste, and often, on account of it, absolutely refuse
the food.  Partial peptonization, too, is usually suf-
ficient to adapt the milk to ready assimilation.  To
seize the proper moment  for arresting the process,
the person conducting it must  be told to taste the
milk from time to time,  and as soon  as  the least
bitterness is appreciable, to remove the bottle from
the hot water and place it upon  ice for cooling and
use.  Such milk may be sweetened  with  sugar of
milk, and  given pure or diluted with water.   For an
infant of six weeks each meal may consist of:—
     Peptonized milk........6 tablespoonfuls.
     Milk sugar..........y2 teaspoonful.
     Water............2 tablespoonfuls. 
I9O         HYGIENE  OF THE NURSERY.
  To this, cream may be added when desirable, and
by diminishing the quantity of water and increasing
that of milk the strength of the food may be made
greater at any time.
  Although every precaution be taken, the last of
a quantity of predigested food is very apt to grow
bitter; and if the attendants will take the trouble, it
is much  better to peptonize every  meal separately.
This is readily done by obtaining a number of pow-
ders of pancreatin and bicarbonate of sodium, so
proportioned that  each  packet shall  contain  the
proper amount for one bottle of food.
  For example :—
  Take of—
     Extractum pancreatis.....nine  grains.
     Bicarbonate of sodium.....twenty-four grains.
  Mix and divide into twelve powders, and dispense in waxed papers.
  Directions.—Put one powder into a nursing bottle  with two
    fluidounces of filtered water and two fluidounces of fresh sweet
    milk; shake together and keep warm in a water-bath for about
    half an hour before feeding; sweeten with half a teaspoonful
    of milk sugar.
  The great advantages of partial peptonization are
that the  necessity  for lime water, barley water and
thickening  substances to  keep  apart  the curd  is
done away with, and that, when the  digestive dis-
turbance  requiring a careful preparation of food is
removed, an ordinary milk diet can be gradually re-
sumed by regularly  diminishing the  time artificial 
FOOD.
I9I
digestion is allowed to progress.  This changes the
caseine in a less and less degree, until, finally, it is
taken in its natural form.
   Instead of this ordinary peptonizing process, I
have for the  past  year  or  more employed the
"Peptogenic   milk   powder,"  prepared   by  the
chemists  already  referred to.   This  powder con-
tains a  digestive ferment, pancreatin;  an  alkali,
bicarbonate of sodium, and a  due proportion  of
milk sugar.
   The mode of employment is as follows:—
   Take of—

     Milk............4 tablespoonfuls.
     Water............4 tablespoonfuls.
     Cream............1 tablespoonful.
     Peptogenic milk powder .... I measure.*

   This  mixture is to be heated over a brisk flame
to a point that can  be comfortably sipped by the
preparer (about 115 ° F.) and  kept at  this  heat for
six minutes.  When properly prepared, the  resul-
tant, so-called " humanized  milk,"  presents  the
albuminoids in  a minutely coagulable and digestible
form ; has an alkaline reaction ; contains the proper
proportion of salts, milk sugar and fat, and has the
appearance of human milk.
* Measure provided with each can of powder. 
I92        HYGIENE OF THE NURSERY.
  Leeds gives the following analysis of this prepared
milk:—
     Water..............86.2 per cent.
     Fat...............4-5
     Milk sugar............7.     "
     Albuminoids...........2.     "
     Ash (salts)...........0.3    "
  This  corresponds very closely with his average
analysis of human milk.
  In using this powder, too, one can readily return
to a plain milk  diet by gradually  shortening the
time of heating;  in  other words, by slowly  dimin-
ishing predigestion.
  Great  and  deserving  stress  has  recently been
placed upon  a method of preparing, or  rather pre-
serving, cows' milk, known as " Sterilization."
  As milk exists in the  healthy cow's  udder it is
aseptic, i. e., free from  any poisonous or dangerous
ingredient,  but during  milking, and subsequent
handling and transportation, particles of manure or
various forms of dirt get  into it and are apt to set
up  fermentation or  other injurious change.  To
deprive these accidentally introduced organic im-
purities of  their activity, or, in other  words,  to
sterilize, it is  necessary to subject the fluid to high
heat under pressure.
  Several admirable implements have been devised
for conducting the process ; one of the most  simple, 
                     FOOD.                   I93

made after a  design  of my own, is shown in the
accompanying figure.
  This apparatus is made of tin, and consists of an
oblong  case  provided  with  a well fitting cover,
and having a movable perforated false bottom (d),

                     Fig. 19.
author's sterilizer.
which stands a  short  distance above the true one
and has  attached  a framework capable of holding
ten, six-ounce, nursing bottles.   On the outside
of the case is a row  of supports (b) for holding
inverted  bottles  while drying, and  at  the proper
      »3 
194        HYGIENE  OF THE  NURSERY.
distance  below these a gradually inclining gutter
(c) for carrying off the drip.   A movable water
bottle (a) is hung  to the side;  in this  each bottle
of food  may  be heated at the  time of adminis-
tration.
  The bottles are made of flint glass and accord-
ing to  the design  described  on  page 203, the
graduated markings being especially convenient for
measurement and  rendering the use of a separate
measuring glass unnecessary, a matter of no little
moment, as every  implement that comes in contact
with the milk in sterilization must be kept chemi-
cally clean. Ten bottles are used, so that the whole
supply of milk intended for a day's consumption can
be prepared at once.   Each bottle is provided with
a perforated rubber cork, which in turn  is closed by
a well fitting glass stopper.
  Sterilization should be performed in the morning
as soon as possible after the milk has been  served.
The process is  as follows :  First, see that the ten
bottles are perfectly clean and dry; pour into each
six fluidounces (12 tablespoonfuls) of milk ; insert
the perforated  rubber  corks,  without the  glass
stoppers, however;  remove the false bottom and
place the bottles  in  the frame;  pour into the case
enough water to fill it to the height of about two
inches;  replace  the  false  bottom carrying the
bottles ;  adjust lid, and put the whole on the kitchen 
FOOD.
195
range. Allow the water to boil and, by occasionally
removing the lid, ascertain that the expansion that
immediately precedes boiling has taken place in
the milk, then  press the glass stoppers into the
perforated corks, and thus hermetically close each
bottle. After this, keep the apparatus on the fire and
the water boiling  for  twenty minutes.  Finally,
remove the false bottom with the bottles ; pour out
the water, replace  and carry the whole, covered
with the lid, to the  nursery.
  When the hour of feeding arrives, put one  of the
bottles into the attached water bath and heat it to
the proper point for administration. The milk may,
of course, be diluted with filtered water, or receive
the additions ordinarily made to adapt it to children
of different ages.  The tip used—and a tube must
not be employed even here—should be thoroughly
cleaned and immersed for a few moments in boiling
water before it is attached to the bottle.
  So  soon as a bottle is emptied—and if the whole
of its  contents be not taken the remainder must be
thrown away—it is washed in the ordinary manner
with a solution of bicarbonate or  salicylate of so-
dium  (see p. 204) and placed in the rack (b) to drain
and dry.
  Milk sterilized by the above process will remain
sound for several days, according to  some authori- 
I96         HYGIENE OF THE NURSERY.
ties as many as eighteen,* when the heating is con-
tinued for thirty minutes.
  Sterilized milk is especially  useful  in travelling,
when  fresh  milk cannot be  obtained;  for use in
cities during the heat of summer, when milk is most
apt to undergo injurious changes;  for  the feeding
of delicate children, or for those suffering from dis-
ease of the  stomach or intestinal canal.
  Sometimes milk, in every form and however care-
fully prepared, ferments  soon after being swallowed
and excites vomiting, or causes  great flatulence
and discomfort, while  it affords  little  nourishment.
With these cases the best plan is to withhold milk
entirely for a time and try some other  form of food.
The following are good substitutes:—
      Mellin's Food.........1 teaspoonful.
      Hot water..........6 tablespoonfuls.
  For each portion; to be given every two hours at  the age of six
    weeks.
      Veal broth (y ft), of meat to the pint) 3 tablespoonfuls.
      Barley water.........3 tablespoonfuls.
  For one portion.
      Whey............3 tablespoonfuls.
      Barley water.........3 tablespoonfuls.
      Milk sugar..........y teaspoonful.
  * Since writing the above, this statement has been verified by my
own experiments. 
FOOD.
197
  A teaspoonful of the juice of raw beef* every
two hours will usually be retained when everything
else is rejected.
  Such foods are only to be used temporarily until
the tendency to fermentation witlfin the alimentary
canal ceases ; then milk may be gradually and cau-
tiously resumed.
  When infants approaching the end of the first
year become affected with indigestion, it is often
sufficient to reduce the strength and quantity of the
food to a point compatible with  digestive powers.
For  instance, at eight  months the food may be
reduced to that  proper  for a healthy  child of six
months, or even less.   Here, too, predigestion of
the food is very serviceable.
  If a few grains of extractum pancreatis be added
to a gobletful of thick, well-boiled starch  gruel, at
a temperature of 100° F., the gelatinous mucilage
quickly grows thinner and soon is transformed into
a fluid, the starch having been rendered soluble by
the action  of the pancreatin; by still  longer  con-
tact, the hydrated starch is converted into dextrine
and sugar.   Advantage  may be taken of this prop-
erty to render the foods containing  starch assimi-
lable.   Thus, to a mixture of barley jelly and milk,
e. g. .—
* See Chapter ix. 
I98        HYGIENE  OF THE NURSERY.
     Barley jelly..........2 teaspoonfuls.
     Milk sugar..........1 teaspoonful.
     Warm milk..........16 tablespoonfuls.
  Add three grains of extractum pancreatis, and five grains of bicar-
   bonate of sodium, and keep warm for half an hour before ad-
   ministering.

  The same  process may be employed with food
containing  oatmeal, arrowroot  or  wheaten  flour,
with a view of converting the starchy ingredients
into  digestible elements without materially altering
the taste.
  When  the  infant  has arrived  at an age to take
meat broths, these too, when digestion is enfeebled,
may be readily peptonized.*
  Returning to the regimen of the healthy infant, it
will be found that after the first year far less change
is required in the  food from month to month.
  Diet from the twelfth to the eighteenth month,
five meals per day :—
  First meal, 7 a. m.—A slice of stale bread, broken
and soaked in a breakfast-cup (eight fluidounces) of
new milk.
  Second meal, 10 a. m.—A teacup   of  milk (six
fluidounces) with  a soda  biscuit or  thin slice of
buttered bread.
  Third meal, 2 p. m.—A teacup of beef tea (six
* See Chapter ix. 
FOOD.
199
fluidounces)  with  a  slice  of bread.  One  good
tablespoonful of rice-and-milk pudding.
  Fourth meal, 6 p. m.—Same as first.
  Fifth meal, 10 p. m.—One tablespoonful of Mel-
lin's Food with a breakfast-cupful of milk.
  To alternate with this :—
  First meal, 7 a. m.—The yelk of an  egg lightly
boiled, with bread crumbs ;  a teacupful of new milk.
  Second meal,  10 a. m.—A teacupful of milk with
a thin slice of buttered bread.
  Third  meal,  2 p. m.—A  mashed baked  potato,
moistened with four tablespoonfuls of beef tea; two
good tablespoonfuls of junket.
  Fourth meal, 6 p. m.—A breakfast-cupful of new
milk with a slice of bread broken up  and soaked
in it.
  Fifth meal, 10 p. m.—Same as second.
  The fifth  meal is often  unnecessary, and  sleep
should never be disturbed for it; at the same time,
should the child awake an hour or so before the
first meal, he must break his fast upon a cup of warm
milk, and not be allowed to go hungry until the set
breakfast hour.
  Diet from eighteen months to the end of two and
one-half years, four meals a day:—
  First meal, 7 a. m.—A  breakfast-cupful  of new
milk; the yelk of an egg lightly boiled; two thin
slices of bread and butter. 
200
HYGIENE  OF THE NURSERY.
  Second meal, 11 a. m.—A teacupful of milk with
a soda biscuit.
  Third  meal, 2 p. m.—A breakfast-cupful of beef
tea, mutton or chicken broth ; a thin slice of stale
bread; a saucer of rice-and-milk pudding.
  Fourth meal,  6.30 p. m.—A breakfast-cupful of
milk with bread and butter.
  On alternate days:—
  First meal, 7 a. m.—Two  tablespoonfuls of thor-
oughly cooked oatmeal or wheaten grits with sugar
and cream ;  a teacupful of  new milk.
  Second meal, 11 a. m.—A teacupful of milk with
a slice of bread and butter.
  Third meal, 2 p. m.—One tablespoonful of under-
done mutton pounded to a paste;  bread and butter,
or mashed baked potato, moistened with good plain
dish gravy ; a saucer of junket.
  Fourth meal, 6.30 p. m.—A breakfast-cupful of
milk, a slice of soft milk  toast, or a slice or two of
bread and butter.
  When sickness supervenes, all  that is ordinarily
necessary is a reduction of the diet to plain milk, or
milk with Mellin's Food.
  An important point, often neglected, is the matter
of drink.  Even the youngest infant requires water
several times daily,  and the demand increases with
age.   The water must be  as pure  as possible and
should not be too  cold.    In the heat of summer, 
FOOD.
201
 however, bits of ice  and water moderately cooled
 by ice can be allowed without harm.
   The  foregoing schedule  must, of  course,  be
 regarded only as an  average.  Many children can
 bear nothing but milk food up  to the age of two or
 even three years, and, provided  enough be taken,
 no fear for their nutrition need be entertained.   If a
 child be thriving on milk, he is never to be forced
 to take additional food merely because a certain age
 has  been reached; let the healthy appetite be the
 guide.
   A young mother, in her solicitude to do her  best,
 often finds  great difficulty in  adhering to  simple
 rules in the diet of her child.  Mrs. A., who has had
 great experience with children, having had some
 herself, tells her that the child would thrive far bet-
 ter if it ate such and such a thing, and did not keep
 to weak milk foods.   Miss B. assures  her that  her
 cousin's last child grew much healthier after eating
 a  chop with  vegetables  and pudding  each  day.
 Aunt C. comes with the announcement—which she
 breaks gently—that she  knows the child is simply
 starving, and the ignorant nurse confirms the state-
 ment.
  All their seemingly convincing theories are very
 upsetting  to a mother who wants  only  to do what
is right.   She must  bear  in  mind, however,  that
some children  can eat  anything and live; but she 
202
HYGIENE OF THE NURSERY.
does not know how much better, more robust, and
disease-resisting they would be, did they adhere to
a simple diet.  Let her remember that the so-called
"weak milk foods" contain those nourishing quali-
ties to which nature, in her wisdom, has limited the
child's  powers of  digestion.  Therefore,  young
mothers, let well enough alone.
  d. Success in hand-feeding depends quite as much
on the administration as upon the preparation of the
food.
  From birth up to  such time as broth, bread, and
eggs are added to the diet, all the food should be
taken from a bottle.   Even  after this, as the bottle
is a comfort and insures slow feeding, it may  be
allowed for milk preparations, until the  child,  of
his own accord, tires of it.   The only feeding appa-
ratus to be admitted to the nursery is the simple
bottle and tip.  The bottle represented in Figure
20  is made, by my suggestion, by Mr. J. J. Otten-
ger, of  Philadelphia.  Its interior surface presents
no  angles for  the  collection of milk; it is easily
cleaned, and the graduated scale is convenient  for
nursery use.
  All complicated arrangements of rubber and glass
tubing  are not only an  abomination,  but a fruitful
source  of sickness  and  death. '  Rather  than  use
them, it is far better to feed the infant with a spoon.
In  England, a bottle with  a long rubber tube is 
                     FOOD.                  203

almost universally employed.   Should this be aban-
doned and a simple bottle and a rubber tip used, the
objections of some authors to bottle-feeding would
vanish.
Fig. 20.
GRADUATED NURSING BOTTLE.
  The bottle shaped as above must be of transparent
flint  glass, so that the slightest foulness can be de-
tected at a glance, and may vary in capacity from 
204        HYGIENE OF THE NURSERY.
six to twelve fluidounces, according  to  the  age of
the child.   Two should be  on hand at a time, to be
used alternately.   Immediately after  a meal  the
bottle must be thoroughly washed out with scald-
ing water, filled with  a solution of bicarbonate or
salicylate of sodium—one teaspoonful of either to a
pint of water—and thus allowed to stand until next
required;  then the soda solution being emptied, it
must be thoroughly  rinsed with cold water before
receiving the food.  The tips or nipples, of which
there should also be two, must be composed of soft,
           flexible India-rubber, and a conical shape
           is to be preferred, as being more readily
           everted and cleaned; the opening at the
           point must be free, but not large enough
           to permit  the milk to flow in  a  stream
           without suction. At the end of each feed-
           ing the nipple must be  removed at once
          from  the bottle, cleansed externally  by
rubbing with a  stiff brush  wet with  cold  water,
everted and treated  in the same way, and then
placed in cold water and allowed to  stand in a cool
place until again wanted.
   While taking these precautions  for perfect clean-
liness, the nurse must satisfy herself of their efficacy
by smelling both the bottle and the tip just before
they are used, to be sure of the absence of any sour
odor.
 
FOOD.
205
  Next to cleanliness of the feeding apparatus, it is
important to insist upon the separate preparation of
each meal immediately before it is to be given.  The
practice of making, in the morning, the whole day's
supply of food,  though it save trouble, is a most
dangerous  one.   Changes almost invariably  take
place in the mixture, and by the close of the day it
becomes unfit for consumption.
  When the graduated bottle is not at hand, a
common glass  graduate,  marked for  fluidrachms
and ounces and holding a pint, should be provided
for the nursery.   Some moments before meal-time,
so as to avoid hurry, measure the different fluid
ingredients of the food in  this, one after the other;
add  the requisite quantity of milk sugar, and mix
the whole thoroughly, by stirring with a spoon, and
pour into the feeding bottle.  When the graduated
bottle is employed, thorough shaking is sufficient.
The  food must now be heated to a temperature of
about 950 F.  This  can  be done by steeping the
bottle in hot water, or by placing it in a water-bath
over an alcohol lamp or gas jet.   Finally, apply the
tip and the meal is ready.
  When feeding,  the child must occupy a half-
reclining position  in the nurse's  lap.  The bottle
should be held by the nurse, at first  horizontally,.
but gradually more and more tilted up as it is emp-
tied,  the object  being to keep the neck always full 
206        HYGIENE OF THE NURSERY.
and prevent the drawing in and swallowing of air.
Ample time, say five, ten or fifteen minutes, accord-
ing to the quantity of food, should  be allowed for
the meal.   It is best  to withdraw the  bottle occa-
sionally for a brief rest,  and after the meal is over,
sucking from the empty bottle must  not be allowed,
even for a moment.
  e. For  children residing in cities, an  honest
dairyman  must be found, who will serve sound
milk and cream from  country cows  once every day
in winter,  and twice during the day in the heat of
summer.  The milk of ordinary stock cows is more
suitable than that from Alderney or  Durham breed,
as the latter is too rich, and, therefore, more difficult
to digest.   The mixed milk of a good herd is to be
preferred  to that from a single animal.  It is less
likely to be affected by  peculiarities of feeding, and
less liable to variation from  alterations in health or
different stages of lactation.
  The care of the herd  and of the milk is of great
consequence.  The cows should be healthy, and the
milk of any animal that seems  indisposed  should
not be mixed  with  that  from perfectly  healthy
animals.   The cows must not be fed upon swill or
the refuse of breweries, glucose factories,  or any
other fermented food.   They must  not be allowed
to drink stagnant water, and  must not  be heated or
worried before being milked. The pasture must be 
FOOD.
207
free  from noxious weeds, and the barn and  yard
must be kept clean.  The udder should be washed,
if dirty, before the milking.   The milk must be at
once  thoroughly  cooled.  This  is  best accom-
plished by placing the can in  a tank of cold spring
water,  or in  ice water, the water being of the same
depth as  the milk in the can.  It is well to keep the
water in the tank flowing; indeed, this is necessary
unless  ice water be used.  The can should remain
uncovered during the cooling and the milk should
be gently stirred.   The temperature should be
reduced to 6o° F. within an hour, and the can must
remain in the cold water  until the time for deliver-
ing.
  In summer,  when ready for delivery,  the  top
should be placed in position and a cloth wet in cold
water spread over the can, or  refrigerator cans may
be used.  At no season should the milk be frozen,
and at the same time no buyer should receive milk
having a temperature over 65° F.
  The milk and cream must be transported from
the dairy in  perfectly clean vessels.  To insure this
it is best  to provide two sets of small cans; one set
to be thoroughly cleansed and aired while the other
is taken  away by the milkman to bring back the
next  supply.   So  soon as  this arrives  in  the
morning, or in  the morning and evening in  hot
weather, the milk should be emptied into separate 
208         HYGIENE OF  THE NURSERY.

and absolutely clean earthenware or glass pitchers,
and  these put at once into a refrigerator reserved
exclusively  for them.   This may  stand in some
convenient spot near the nursery, but not in it, and
especially not in an adjoining bath room.   With a
good refrigerator there is  no difficulty in  keeping
milk perfectly sweet for twenty-four hours in winter
and for twelve hours in summer, except on intensely
hot days ; then it may be necessary to scald, lightly
boil  or sterilize the whole of the  supply when re-
ceived, in order to prevent  change.
   It is a well-known fact that milk is a fluid having
active  powers of absorption, and that it frequently
acts  as the medium cf transmission of the contagion
of such diseases as scarlatina, diphtheria and typhoid
fever.  Doctor V. C. Vaughan  has also  lately dis-
covered  in  milk a special poison which he terms
tyrotoxicon (cheese poison).
   The clinical elements of interest in  these  dis-
coveries is the close analogy between the symptoms
produced by the experimental use of tyrotoxicon
and those observed in cholera infantum—an analogy
suggestive of the possibility of the latter  disease
being  chiefly due  to poisoned  milk.   This causal
relation  is scarcely more  than a theory, though
certain well-known features of  the disease  seem to
bear  it out.  Thus, the affection occurs at a season
when  decomposition  of milk takes  place most 
FOOD.
209
rapidly;  it occurs at places where absolutely fresh
milk cannot be obtained;  it prevails among classes
of people whose surroundings are most favorable
to  fermentative changes; it  is  most fatal at an
age when  there is the greatest dependence upon
milk as a food, when the  gastro-intestinal  mucous
membrane is most susceptible  to irritants,  and
when irritation and nervous fevers  are most easily
produced.
  Drs. Newton  and Wallace, of the New Jersey
State Board of Health, have reported a number of
cases of poisoning  by  milk that occurred in differ-
ent hotels at  Long Branch.  These  observers found
that the  affected milk was all obtained from one
milkman,  and  that the  cows furnishing  it were
milked at the unusual hours of midnight and noon.
The noon milking was immediately placed in cans
without being cooled, and " carted eight miles
during the warmest part  of the day in a very hot
month."    It was  this  milk that produced the
poisonous effects, the morning's  milk being always
good.  No statement is made as to the health of
the cows or the nature of  the poison, but there is a
probability of its  having been tyrotoxicon, and of
this material  or its ferment  having  been generated
by the careless collection and transportation of the
milk,  combined  with  the  high  atmospheric tem-
perature. 
2IO
HYGIENE OF THE NURSERY.
  Childhood.—Children who have  cut their milk
teeth may be fed  for a twelvemonth—namely, up to
the age of  three and a half years—in the following
way :—
  First meal, 7 A. m.—One or two tumblerfuls of
milk, a saucer of  thoroughly  cooked oatmeal or
wheaten grits, and  a slice of bread and butter.
  Second meal, 11  a. m. (if hungry).—A tumblerful
of milk or a teacupful of beef tea with a biscuit.
  Third meal, 2  p. m.—A slice of underdone roast
beef or mutton or a bit of roast chicken or turkey,
minced as fine as  possible;  a baked potato thor-
oughly mashed with  a fork and moistened with
gravy;  a  slice of bread  and butter; a saucer of
junket or rice-and-milk pudding.
  Fourth meal, 7 p. m.—A tumblerful of milk and
one or two slices of well-moistened milk toast.
  From three and a half years up the child must
take his meals at the table with his parents, or with
some reliable attendant who will see that he  eats
leisurely.   The diet, while plain, must be varied.
The following list  will give an idea of the food to
be selected:—
                    breakfast.
   EVERY DAY.             ONE DISH ONLY EACH DAY.
Milk.            Fresh fish.         Eggs, plain omelette.
Porridge and cream. Eggs, lightly boiled.  Chicken hash.
Bread and butter.      "  poached.      Stewed kidney.
                  "  scrambled.      "  liver. 
FOOD.
211
  Sound fruits may be allowed before and after the
meal, according to taste, as oranges, grapes without
pulp  (seeds  not to be  swallowed), peaches,  thor-
oughly ripe pears, cantaloupes and strawberries.

                      DINNER.
   EVERY DAY.              TWO DISHES EACH DAY.
Clear soup.         Potatoes, baked.      Hominy.
Meat, roasted  or     "    mashed.     Macaroni, plain.
  broiled, and  cut  Spinach.           Peas.
  into small pieces.  Stewed celery.       String-beans, young.
Bread and butter.    Cauliflower.         Green corn, grated.
  Junket, rice-and-milk or other light pudding, and occasionally ice
cream, may be allowed for dessert.

                      SUPPER.
                      EVERY DAY.
               Milk.
               Milk toast or bread and butter.
               Stewed fruit.

  Fried food, highly-seasoned  or made-up  dishes
are to be  excluded, and no condiment  but salt is to
be used.
  Eating,  however little, between meals, must be
absolutely  avoided.   Keep a  young child  from
knowing  the taste of cakes or bonbons, or, having
learned it, let him feel that they are as unattainable
as the thousand other things beyond his reach, and
he soon ceases to ask for them.   Even  a piece of
bread between  meals  should be  forbidden.    His 
212        HYGIENE OF THE NURSERY.

appetite then remains natural, and he will eat proper
food at his regular meal hours.
  Filtered or spring water should be the only drink;
tea, coffee, wine or beer being entirely forbidden.
  As to the  quantity,  a healthy child may be per-
mitted to satisfy his appetite at each meal, under
the one condition that he eats slowly and masti-
cates thoroughly.
  In case of illness, the diet must be reduced  in
quantity and quality, according to the rules that are
applicable to adults. 
DIETARY.                 213
              CHAPTER  IX.

                    DIETARY.

  In the preceding chapter so much attention has
been devoted to the subject of the artificial feeding
of infants, and  so many formulas have been given
for the preparation of cows' milk as a substitute for
the natural food, or human milk, that it will only
be necessary here to refer briefly to a few milk mix-
tures, some of which have been  recommended by
other writers.   After describing these, the methods
of peptonization will be discussed, and, finally, the
mode of preparing a  number of  dishes adapted to
the nursery whether  occupied by well or ill chil-
dren.   In regard to the latter, however, the dishes
that ordinarily come upon the table will not be re-
ferred to, as any good cook ought to know how to
make them.
                  MILK FOODS.
                ARROWROOT FOOD.
     Milk,
     Cream,
     Lime water, .
     Arrowroot water.....Of each 2 tablespoonfuls.
     Sugar.........r teaspoonful.
  This is the  late  Dr.  J. F.  Meigs' formula for a 
# 214        HYGIENE  OF THE NURSERY.
child of about nine months of age.  The arrowroot
water is made in the proportion of one teaspoonful
of arrowroot to a pint of boiling water.

               CHAVASSE'S MILK FOOD.
      New milk,
      Water, warm.........Of each equal parts.
      Table salt..........A small pinch.
      Lump sugar .  . A sufficient quantity to slightly sweeten
                      the mixture.

   Let the milk and the water be of the same tem-
perature—900 F.—before mixing.  This prepara-
tion does well for a child of three or four months;
the  total quantity for each meal  being from eight
to twelve tablespoonfuls.

                  CONDENSED MILK.
      Condensed milk........1 teaspoonful.
      Water............6  tablespoonfuls.

   Use  hot water;  mix by stirring  and let  the
temperature fall to ordinary heat before administra-
tion.
                MILK AND CINNAMON.
      Milk sugar   ..........1 teaspoonful.
      Brandy..........• . . I teaspoonful.
      Milk.............y2 pint.
      Powdered cinnamon   ......A sufficiency to flavor.
  Mix thoroughly.
  Useful  in diarrhoea; may be administered warm
or cold. 
DIETARY.
215
                 MILK AND OATMEAL.
     Bethlehem oatmeal (fine powder)  . I  teaspoonful.
     Water............2 tablespoonfuls.
     Milk.............5 tablespoonfuls.
     Cream............I tablespoonful.
     Sugar of milk.........i  teaspoonful.

  Heat the water  just  short of boiling; stir  in the
oatmeal slowly until a smooth white mixture  is ob-
tained ; then add the other ingredients.
  This is adapted for an infant of three months, and
forms  a useful mixture in cases of constipation.
                 MILK-SUGAR FOOD.
     Milk.............I tablespoonful.
     Cream............2 tablespoonfuls.
     Lime water..........2 tablespoonfuls.
     Milk-sugar solution.......3 tablespoonfuls.

  For a  child  under  a month, quantity to be in-
creased as age advances, but no change to be made
in quality until after the eighth or ninth month.
  The milk-sugar solution consists of 17^ drachms
—a  little over  17  teaspoonfuls of milk  sugar to a
pint of pure water.
  This is the  food  recommended  by  Dr. A. V.
Meigs.
            MILK AND WHITE-OF-EGG FOOD.
     The whites of three eggs.
     Lime wattr..........3 tablespoonfuls.
     Milk.............1 Pint-
Shake the  egg and lime water forcibly together 
2l6        HYGIENE OF THE NURSERY.
for five minutes;  then add the milk  slowly with
constant stirring, occupying ten minutes in the pro-
cess ; keep in a cool place.

               PEPTONIZED FOODS.
   For  the process  of peptonization, or  predi-
gestion,  the  Extractum  Pancreatis,  prepared by
Fairchild Bros, and  Foster,  of New York, gives,
in my experience, the  most satisfactory  results,
and in all the receipts given below, this preparation
is to be used.

              PEPTONIZED MILK, No. i.
     One peptonizing tube.
     Water  ............I teacupful.
     Milk, fresh and cold......I pint.

   Put the powder contained in the tube into a clean
quart bottle;  add the cold water and  shake well;
then pour in the milk and  shake the mixture thor-
oughly again.  Place the  bottle in water of about
115° F., or so hot that the whole hand can be held
in it without discomfort for a  minute, and keep the
bottle  there for  twenty minutes.   Then  put the
bottle in contact with ice to check further digestion
and keep the milk from spoiling.
   Peptonized  milk should have a slightly, but not
decidedly, bitter taste.  It may be made palatable
by serving with grated nutmeg, sugar, or  a  little 
                     DIETARY.                 217

 brandy, or it  may be taken with Apollinaris or
 Vichy water.  In the latter case put the water first
 into the glass, then quickly pour in the peptonized
 milk and drink while effervescing.

               PEPTONIZED MILK, No. 2.
   Mix  the peptonizing powder, water and milk in
 a bottle, and place in a hot-water bath exactly as
 directed in the above.   Let the bottle remain in the
 hot water for two hours, then  pour into a saucepan
 and heat to boiling.   This  specially peptonized milk
 is used in making jellies, etc.   It may be immedi-
 ately used if required hot, or set aside on  ice for
 punches,  etc.
   The  object of raising the liquid  to the boiling
 point is. to abolish the activity of the pancreatin, so
 that  it  may not act secondarily upon other sub-
 stances prepared with the milk.

              SLIGHT PEPTONIZATION.
   Take the  same ingredients and  mix them  as
 before, but  immediately  place  the bottle on  ice
 without subjecting it to any heat.
  This preparation is  useful  in cases of enfeebled
digestive  power,  or  as  a  means of returning from
predigested, to ordinary milk.   It has no  especial
taste. 
218         HYGIENE  OF THE NURSERY.
             PEPTONIZED MILK GRUEL.
     One peptonizing tube.
     Wheat flour or arrowroot . .  .  .  I heaping teaspoonful.
     Water, cold.......  .  . y pint.
     Milk, cold...........I pint.

  Make  a smooth mixture of the arrowroot and
water; heat this with constant  stirring until it has
boiled briskly  for three minutes; next add the
milk; strain into a pitcher  and stir in the pepton-
izing  powder;  let the  mixture stand in the hot-
water bath, 1150 F., for thirty minutes;  then pour
into a clean bottle and place on ice.

             PEPTONIZED MILK PUNCH.
  Fill an  ordinary thin  glass tumbler one-third full
of cracked ice  ; pour on it from  one to four tea-
spoonfuls, according to the  child's age, of St. Croix
rum, and a dash of Curacoa; add sugar to taste, and
then fill the glass with peptonized  milk ; shake well
and grate a little nutmeg on top ;  strain.

            EFFERVESCING MILK  PUNCH.
  Prepare the  tumbler and  ice  as in the  above,
squeeze in the  juice of  half a lemon,  add sugar to
sweeten, and  fill the glass with half Apollinaris and
half peptonized milk.  The milk used  in this punch
must be prepared by  the second process. 
DIETARY.
219
              PEPTONIZED BEEF TEA.
  To one-quarter of a pound of  minced raw beef,
entirely free from  fat,  add one-half pint  of cold
water; cook over a slow fire, with constant stirring,
until it has boiled a few minutes,  then pour off the
liquor and beat or rub the meat to a paste; put the
latter into a jar with one-half pint of cold water, and
pour in the liquid previously obtained.  Add to this
mixture thirty grains of Extract of Pancreas and
twenty grains of bicarbonate of sodium ; shake all
well together, and  keep at a temperature of about
1 iO° F., stirring occasionally, for three hours.   Next
boil quickly, strain, and serve as  required.
               PEPTONIZED OYSTERS.
       (Originally suggested by the late Dr. N. A. Randolph.)
  Take half a dozen large oysters with their juice
and half a pint of water.  Heat in a saucepan until
they have boiled briskly for a few minutes.   Pour
off the broth and set aside.  Mince the oysters fine
in a wooden bowl, and reduce them to a paste with
a potato masher.   Next put the  oysters in a glass
jar  with the broth which  has been set aside and
add the contents of a peptonizing tube.  Let the jar
stand in hot water or in a warm place, where the
temperature is not above 1150 F., for one and a half
hours.  Next pour into a saucepan and add half a
pint of milk;  heat over the  fire  slowly to  boiling
point, and flavor with salt to taste, and serve hot. 
220
HYGIENE OF THE NURSERY.
               "HUMANIZED MILK."
     Peptogenic milk powder.....i measure.*
     Milk, fresh and cold.......4 tablespoonfuls.
     Water.............4 tablespoonfuls.
     Cream.............1 tablespoonful.

  Heat cautiously over a flame  for  six  minutes,
stirring cautiously with a spoon and tasting  often,
so that it shall not get too hot to be sipped—1150
F.  Then put into a nursing bottle, let it cool some-
what, and it is ready for administering.   The cup
should  be held by the hand, over the flame, thus
making it easy to  regulate the heat to which the
milk is  exposed.
  It is important to follow out these directions abso-
lutely, for should  the temperature of the mixture
not be maintained at a sufficiently high point, the
Pancreatin  contained in the  peptogenic  powder
will  perform its  work  imperfectly;  on the  other
hand, should the heat be too great all digestive
activity will be suspended.
  Humanized milk so prepared is  adapted to the
average infant's digestion.  As age advances, the
proportion of milk must be increased and the total
quantity of the mixture augmented.  As an increase
in quantity is made, it is necessary to preserve the
relations of the peptogenic  powder to the liquid;
namely, one measure to each four ounces and a half.

  * The proper measure is furnished with each box of powder. 
DIETARY.
221
  Sometimes it will be found necessary to carry the
process of predigestion further than can be accom-
plished by following  the  directions already given.
This may be readily done by increasing the length of
the time of heating.  One can thus easily produce in
the milk  any degree of change up to complete pep-
tonization, when the liquid becomes clear and very
bitter.  Conversely, when it is desirable—in case of
returning health, for  instance—to  resume a plain
milk diet, the time of heating is gradually shortened
until the  powder is  added to  the milk mixture just
at the time of feeding.  When the time comes to
abandon  the digesting powder entirely,  it  is most
important to supply  its place in  the food by  an
equal bulk of milk  sugar.
  The milk and cream referred to  are of such qual-
ity as can be  obtained from  a reliable city server;
extra rich milk or cream may, under some circum-
stances, require to be more diluted.

               MEAT  BROTHS,  ETC.
                 BEEF TEA, No. i.
  Take one pound  of lean beef and mince it;  put
it, with its juice, into an earthen vessel containing
a pint of clear water at a temperature  of 85° F.,
and  let the whole stand for one hour.   Strain well
through stout muslin, squeezing all juice from the
meat;  place on the  fire, and, while  stirring briskly, 
222
HYGIENE  OF THE NURSERY.
slowly heat the liquid just  to  the boiling  point.
Then remove at once and season with salt.
  When administering this, be careful to stir up
whatever sediment may be present.
                 BEEF TEA, No. 2.
  Take half a pound or a pound—according  to
strength required—of rump steak; cut it into small
pieces;  free it completely from fat and tendon, and
put it, with one pint of clear, cold water, into a cov-
ered saucepan.  Place by the side of the fire for five
hours ;  then let it simmer gently for two hours, and
finally skim thoroughly.  The  meat used should
be as fresh as possible, and the saucepan should
be of copper or tin, or be enameled on the inner
surface.
  Beef  tea must never  be allowed to boil, and in
reheating be careful to raise it only to the proper
point for drinking.
           BEEF TEA IN FIFTEEN MINUTES.
  Scrape one pound of lean beef into  fibres, and,
after placing it in a clean saucepan, pour on  half a
pint  of  boiling water;  then cover the  saucepan
closely,  and place  it  by the side of the fire for ten
minutes ; next strain  into a teacup; place this in a
basin»of ice-cold water and remove all fat from the
surface of the liquid,  first with a spoon and  finally
with a piece of stale bread or blotting paper; then 
DIETARY.
223
pour  into a warm cup and heat gently to the tem-
perature for drinking.
                BEEF ESSENCE, No. 1.
  Thoroughly mince  one pound of rump st#ak ;
place it with three tablespoonfuls of water in a mor-
tar;  pound it well and put it aside to soak for two
hours.  Then put it, with a pinch of salt, in a cov-
ered earthen jar; cement  the  edges of the  cover
with dough and tie a piece of cloth  over the top.
Place the jar in a pot half full of boiling water, and
keep  the whole  on the fire, simmering, for four
hours.  Then, through a  coarse sieve,  strain off
the liquid essence, which will amount to about six
ounces.
  One teaspoonful will be sufficient for a young
child.
                BEEF ESSENCE, No. 2.
  Half a pound of fresh beef must be  minced  as
finely as  possible; add to this  half a pint of pure
cold water, an eggspoonful of salt and five drops of
pure muriatic acid.  Mix well, and after standing
an hour,  pass through a conical sieve without pres-
sure, refiltering until the liquid runs  clear.   Next,
a second half pint of water  is poured on the residue
upon the sieve and allowed to filter  through with-
out pressure.
  The dose of this is two tablespoonfuls for a child of
twelve years, a teaspoonful for one under one year. 
224        HYGIENE OF THE NURSERY.
                 RAW-BEEF JUICE.
  Take one pound of sirloin of  beef; warm it in a
broiler before a quick fire; cut into cubes of about
one-quarter of an inch, and after placing in a lemon
squeezer or meat press, forcibly express the juice;
remove the fat that rises to the surface after cooling.
  This may be given warm or cold, and seasoned
with a little salt, in doses  of one teaspoonful every
two hours to a child of six months to a year old.
  The meat must never be actually cooked.

                    RAW BEEF.
  Cut a tenderloin beefsteak into the finest possible
pieces and  free it as nearly as may be from particles
of fat; then place in a mortar and pound until the
meat becomes pulpy ; next rub through a fine sieve
and season with salt and a little  black pepper.
  A teaspoonful of this pulp three or four times
daily will be sufficient for a child of one year old.

                CLEAR BROWN SOUP.
  Cut a shin of beef into pieces ;  put it into a sauce-
pan  with just enough water to cover it;  when it
boils, skim it, and add a  bundle of sweet  herbs, a
little  turnip, carrot, onion and  celery, and a little
pepper and salt.   Let the whole boil until the meat
is quite tender;  then strain, and let it  stand until
the next day.  After clearing it thoroughly from
fat, heat it again, adding as much browning as will 
DIETARY.
225
make the  soup the color you like.   Beat up two
eggs, with their crushed shells, till they are quite
a froth.  Put them into the soup with a whisk; let
it boil gently for ten minutes ; then strain it through
a cloth, and it will be perfectly bright.  (Dr. Ellis.)

                    CONSOMME.
   Make a beef broth by taking one or two pounds
of beef, according  to the strength required, from
the leg, round  or chuck; wash well; cut in pieces
and put on to boil in three quarts  of cold water.
While boiling, skim frequently, and when reduced
to one quart, take from the saucepan and strain; after
which return to the saucepan with a few thin slices
of onion, and  half  a pound of lean  beef, chopped
fine, and well mixed with three raw eggs; beat all
thoroughly with the broth, which is to be returned
to the fire and boiled for about half an  hour, or
until perfectly clear.
                  CHICKEN BROTH.
  A small chicken, or  half of a large  fowl, thor-
oughly  cleaned,  and with  all  the  skin and  fat
removed, is to be chopped, bones and all, into small
pieces; put these, with  a proper  quantity of  salt,
into a saucepan and add a quart of boiling water;
cover closely and simmer over a slow fire for two
hours ; after removing, allow to stand, still covered,
for an hour, and strain through a sieve.
      '5 
226         HYGIENE OF THE  NURSERY.
                 MUTTON BROTH.
     Lean loin of mutton .  . i pound (exclusive of bone).
     Water........3 pints.

  Boil gently  until very tender, adding  a  little salt
or onion, according to taste;  strain  into a basin,
and, when cold, skim off all the fat.   Warm, when
served.
  Should barley or rice be added, they  must be
first separately and thoroughly boiled, and added
when the broth is heated for use.

                   VEAL BROTH.
     Lean veal  ...... ^ to 1 pound, according to
                           strength required.
     Cold water......1 pint.

  Mince the  meat; pour  upon it a pint of cold
water; let  it  stand for  three  hours; then  slowly
heat to  boiling point, and  after boiling briskly for
two minutes, strain through a fine sieve and season
with salt.
                   OYSTER SOUP.
  Drain one pint of oysters through a colander for
five minutes, to remove  the liquor, and then  pour
over them one pint of boiling water, which must be
thrown aside;  add to the liquor already drained a
pint of boiling water and put over the fire in a porce-
lain-lined saucepan.  Boil  until all the scum has
risen and been skimmed off; then add half a  pint
of fresh milk, one water cracker rolled to a powder, 
DIETARY.
227
 a piece of butter, and a little salt and pepper; boil
 ten minutes, and just before the soup is to be served
 turn  in the oysters from the colander and let them
 scald for three minutes.

               ARROWROOT PUDDING.
   Mix a tablespoonful of arrowroot with cold water;
 put it over the fire  in  a porcelain-lined  saucepan;
 add a pint of boiling milk—stirring constantly—and
 one egg well beaten with  a tablespoonful of white
 sugar; let it boil five or ten minutes.
   If  baked pudding be preferred, it may be mixed
 in the same way  and baked, in a moderately quick
 oven, for twenty  or thirty  minutes.

                  BLANC MANGE.
      Gelatine...........y ounce.
      Water............y pint.
      Cream............1 pint.
      White sugar.........3 ounces.
      Extract of lemon.......Sufficient to flavor.

   Dissolve the gelatine in the water by means of
heat,  meanwhile  whipping  the cream and sugar
together and adding the lemon.  Next, while the
gelatine solution is  still warm, pour in the cream
slowly, and beat until stiff enough to drop from the
spoon; finally pour in moulds.
  Milk may be used instead of water in this prepa-
ration. 
228         HYGIENE  OF THE NURSERY.
                  HOMINY GRITS.
  Two tablespoonfuls of hominy, having been boiled
soft, are  rubbed  up with butter until quite light;
then, half a pint of boiled milk is added slowly, with
constant stirring; next strain through a  sieve and
boil again ; flavor with sugar or salt, and serve hot.
Rice may be prepared in the same way.
                     JUNKET.
     Milk.............I pint.
     Essence of pepsin (Fairchild's) .  . 2 teaspoonfuls.
  (Wine of pepsin or liquid rennet may also be used.)
  Heat the milk just to a temperature  that can be
readily borne in the mouth, and add, with gentle
stirring,  the  curdling agent;  allow to  stand until
firmly curded, and serve with  sugar, nutmeg, or
cream as desired.
                 JUNKET WITH EGG.
  A good custard may be made  by adding two
eggs, beaten  to  a froth  and  sweetened with four
teaspoonfuls of sugar, to the pint of milk, and then
curdling with essence of pepsin.  It is well to pour
this, when prepared, into coffee cups, one of which
will be enough to serve at a time.
                MILK AND GELATINE.
     Gelatine...........I tablespoonful.
     Barley water, hot.......yz pint.
     Powdered sugar........2 tablespoonfuls.
     Milk............1 pint.
  Dissolve the gelatine  in  the hot  barley water; 
                     DIETARY.                 229

 add the sugar, and then the milk; stirring all to-
 gether.
                    RICE-MILK.
      R|Ce.............2 tablespoonfuls.
      Corn starch ..........1 teaspoonful.
      Milk............2 pints.

   Boil in a farina  boiler until  each  grain  of the
 rice  becomes  saturated,  and the whole creamy
 in color.
                   RICE PUDDING.
   Take three ounces of rice, and  swell it very gently
 in one pint of new milk.   Let it cool; then stir into
 it one ounce of fresh butter, two ounces of pounded
 sugar, the yelks of three  eggs, and  some  grated
 lemon  rind.  Pour this into a  well-buttered  dish,
 but  do not  quite fill it, and  then lay lightly over
 the top the whites of three eggs which have been
 well  beaten  up with three tablespoonfuls of sifted
 sugar.  Put  the pudding directly into the oven, the
 heat of which  must be  moderate, and bake it for
 about twenty  minutes,  or till the egg crust has
 become lightly browned.

                 OATMEAL GRUEL.
  Mix a large tablespoonful of oatmeal with two
tablespoonfuls of cold water, stirring to bring to a
state of uniformity ; this pour into a pint of boiling
water in a  saucepan, and boil and stir well for ten
minutes.  Flavor with salt or sugar. 
23O        HYGIENE OF  THE  NURSERY.
   If the boiling be continued for half an hour, the
mixture thickens into a porridge.
                   SAGO JELLY.
   Take two tablespoonfuls of sago ; wash carefully;
soak for four hours in a half pint of cold water, and
then add half a pint of hot water, a pinch of salt, a
tablespoonful  of sugar and a little  grated lemon
peel; boil gently fifteen minutes, stirring constantly.
A little  port  wine or sherry  may  be  added just
before removing from the fire.
   May be served hot or cold.
                     TAPIOCA.
   Wash two  tablespoonfuls  of the best tapioca;
soak in fresh water  over night;  add a little salt, a
pint of milk or water, and simmer until quite soft,
stirring frequently if milk be used ;  then pour into
a  bowl and stir while cooling, at  the  same  time
adding sugar, some flavoring  substance and wine
if required.
                TAPIOCA PUDDING.
   Beat the yelks of two eggs with half an  ounce of
sugar;  stir  into a pint of tapioca mucilage made
with milk, as  directed  above,  and bake in  a slow
oven.
                 EGG-AND-BRANDY.
     Brandy............8 tablespoonfuls.
     Cinnamon water........8 tablespoonfuls.
     The yelks of two eggs.
     White sugar..........1 tablespoonful. 
DIETARY.
231
  Rub the yelks and sugar together ; then add the
cinnamon water and spirit.
  A dessertspoonful to two  tablespoonfuls may be
given every two hours, according to the age  of the
child.
                   WINE WHEY.
  Boil a pint of fresh milk ; while  boiling, pour in
eight tablespoonfuls of sherry wine ; bring it to the
boil  a second time, being careful not to stir it; so
soon as it boils, put it aside until the curd settles,
and pour off the clear whey.
                  FLAXSEED  TEA.
     Whole flaxseed..........1 ounce.
     Bruised licorice root . ..."".. 2 teaspoonfuls.
     Water, boiling..........1 tablespoonful.
  Pour the boiling water over the flaxseed and lico-
rice;  cover  lightly; digest  for three hours  near a
fire, and strain.   Two tablespoonfuls of lemon juice
may be used as the flavor, instead of the licorice.
  The following preparations are useful as additions
to milk in bottle feeding :—
                 CARAWAY WATER.
     Caraway seeds, crushed.....2 tablespoonfuls.
     Water.............I pint.
  Enclose the seeds in a small muslin bag, and boil
in the water until the latter is reduced to half a pint.
  One or two teaspoonfuls may be added  to the
bottle in case there be colic. 
232        HYGIENE  OF THE NURSERY.
                 BARLEY WATER.
  Put two teaspoonfuls of washed pearl barley into
a saucepan  with a pint of clear water, and  boil
slowly down to two-thirds of a pint; strain through
muslin.
  Employed to prevent the formation of large, com-
pact curds.
                   GELATINE.
  Put a piece of plate gelatine, an inch square, into
half a tumblerful of cold water, and let it stand for
three hours; then turn  the whole  into a  teacup,
place this in a saucepan  half full of water, and  boil
until  the gelatine is dissolved.   When cold,  this
forms into jelly.
  From one to two teaspoonfuls  may  be added to
each bottle of milk food.
  Employed for same object as the above.

                  FLOUR BALL.
  Take a pound of good wheat flour—unbolted, if
possible—tie it up very tightly in a strong pudding-
bag ;  place it in a saucepan of water and boil con-
stantly for ten hours ;  when cold remove the cloth;
cut  away the soft outer covering of dough that has
been formed, and reduce the hard, baked  interior
by grating.
  In the yellowish-white powder obtained, almost
all the starch has been converted into  dextrine by
the  process of cooking,  and the proportion of the 
DIETARY.
233
nitrogenous principle to the calorifacient is as one
to five—nearly the same as in human milk.
  This acts both mechanically and as a food.

                   LIME WATER.
  Take a piece of unslaked lime as large as a wal-
nut ; drop it into two quarts of filtered water  con-
tained in an earthen vessel;  stir thoroughly; allow
to settle, and use only from  the top;  replacing the
water, and  stirring as consumed.

                 OATMEAL WATER.
  First prepare an oatmeal porridge; take a heap-
ing teaspoonful of this, put  it into a quart of cool
water, heat, with  constant stirring,  to the boiling
point, and strain.
  This may be used in  milk-foods as a substitute
for ordinary water if constipation be present.

              PEARL BARLEY JELLY.
  Put two tablespoonfuls of washed pearl barley
into a quart saucepan with a pint and a half of clear
water and boil slowly down to a pint; strain, and
allow the liquid to set into a jelly.
  Used for same purpose as barley water.

                  RICE WATER.
  Put two tablespoonfuls of rice, thoroughly washed,
into a quart of water and place near the fire, where 
234        HYGIENE OF THE NURSERY.
it may soak and be kept warm for two hours ; then
boil slowly for  one hour, or until the water is  re-
duced one-half, and strain.
  Useful as a diluent for milk in cases of diarrhoea.

                     WHEY.
     Milk.............I pint.
     Essence of pepsin (Fairchild's)  .  .  2 teaspoonfuls.

  Heat the milk up to  a point that  can be agree-
ably borne by the mouth, and add the pepsin with
gentle stirring; let the whole stand until firm  co-
agulation has  taken place;  then beat with a fork
until the curd  is finely divided, and strain.

               NUTRITIOUS ENEMATA.
  The process  of peptonization, already described,
is very useful in the preparation of food for absorp-
tion by the lining membrane  of the rectum.  Any
of the predigested foods may  be used in this way,
the only caution being to administer  them in small
quantities—not over four  tablespoonfuls—and at
intervals of not less than four hours.   It is essential,
too, in rectal feeding to keep the lower bowel clear
by a daily laxative injection of warm water.
  When the materials  for  proper peptonizing  are
not at hand, one of the following  enemata  may be
used with advantage:— 
DIETARY.
235
             MEAT ENEMA WITH PEPSIN.
     Essence of meat, No. 2.....8 tablespoonfuls.
     Gelatine (page 174)......1 tablespoonful.
     Pepsin............4 grains.
     Muriatic acid.........4 drops.

  First mix the essence and gelatine, and warm in
a water bath at 1120 F.; then dissolve  the pepsin
in a teaspoonful of warm water by
the aid of the acid; stir it into the
first mixture and  let the whole re-
main warm for two hours.
  Administer warm with two drops
of laudanum to secure retention.
  The bulk of this enema is adapted
for  a child of eight to twelve years.
    BEEF-TEA AND BRANDY ENEMA.
    Strong beef tea .  . 3 tablespoonfuls.
    Cream  ..... 1 teaspoonful.
    Brandy.....1 teaspoonful.
  Stir all together, and administer
gently and slowly.
  Should this injection not be re-
tained, add two drops of laudanum
at each administration.
  The best syringe for these injections is shown in
Fig. 22.
SYRINGE FOR NUTRI-
 TIOUS ENEMATA. 
236        HYGIENE OF THE  NURSERY.
                CHAPTER X.

                    MASSAGE.

  Systematic manipulation is of great value both as
a means of preserving health  and as  a scientific
method of treating certain diseases in children.
  Mere rubbing or friction of the surface cannot be
included under massage in its  literal sense, still, it
is a useful  form of manipulation, and needs no spe-
cial instruction, being possible to any  intelligent,
soft-handed mother or nurse.
  Massage, on the contrary, is an art, and, like every
other art, requires study and patient preparation for
its successful practice.   It is a powerful remedy, too,
and, like other agents of its class, as potent for evil
as for good in unskilled hands. Therefore, to insure
good results, a trained masseuse is necessary—and
she must act under the direction of the physician.
  Massage includes several processes of manipula-
tion.   Those given by Murrell, from  whose excel-
lent little work* I have taken much of the descrip-
tion  of the different " movements,"  are ejfleurage,
petrissage, friction and tapotement.
* " Massage as a Mode of Treatment."  W. Murrell. 
MASSAGE.
237
  EfBeurage is a stroking movement made with the
palm of the hand passing with more or  less force
over the surface of the  body centripetally.   The
movements are made to follow as nearly as possible
the direction  of the muscle fibres,  and  for deep-
seated tissues the knuckles can  be used instead of
the palm.   This method is of minor value in itself,
but of great use when combined, as is the rule, with
the procedures to be described.
  Petrissage consists essentially in picking up a
portion of muscle or other tissue with both  hands,
or the fingers of one hand, and subjecting it to firm
pressure, at the same time  rolling it between the
fingers and the subjacent tissues.  The hands must
move simultaneously and in opposite directions, the
skin must  move with the  hands to avoid  giving
pain, and the thumb and fingers must be kept wide
apart in  order to  grasp a bulk of tissue, a whole
muscle belly, for instance.  The manipulation must
be  uniform, in  a  direction  from the extremities
toward the centre of the body, bearing in mind the
arrangement of groups of superficial muscles and
keeping well in the spaces between them.
  Friction, or  massage a  frictions, is performed
with the tips of the fingers.   It is a pressure move-
ment rather than a rubbing.  It is always  associated
with effleurage, and, to be of any use, must be per-
formed quickly and readily. 
238        HYGIENE OF THE NURSERY.

  Tapotement is a percussion which may be made
with the tips of the fingers, their palmar surfaces,
the palm of the  hand, the back of  the  half-closed
hand, one or other border of the hand, or with the
hand partly closed, so as to  contain, when brought
in contact with the surface of the body, a cushion
of air.
  The hand of the masseuse must be perfectly clean
and soft,  and the finger-nails short and smooth.
The length and frequency of the sittings must vary
with the  individual  case.  Murrell  is  in  favor of
short  and  frequent stances,  and also recommends
dry massage, that is, without the use of oil,  lini-
ments  or ointments; vaseline especially  is to be
avoided.
   Our knowledge of the physiological action of
massage is  based  upon experimental research and
clinical experience.  Experiments  were made by
Dr. Gopadze (quoted by Murrell) upon four medi-
cal students, who were  kept in  hospital and  sub-
jected  to  systematic  manipulations  for twenty
minutes  or more  daily.   The seance  began  with
effleurage, followed by  petrissage, friction  and
tapotement, and ending with  a  second effleurage.
The results were increased  appetite and a notable
gain in body weight.  The  body temperature fell,
never more than .5°, for about thirty minutes  after
each massage; then it rose  steadily, and an hour 
MASSAGE.
239
later  was generally a  degree higher than at the
commencement of the operation.  The movements
of breathing were uniformly increased in frequency,
depth and fulness.  The pulse varied with the kind
of " movement " used—light  surface effleurage in-
creased  its  frequency,  while petrissage  made  it
slower.
   Zabludowski, experimenting on himself and two
servants for eighteen days, noted increased bodily
and mental vigor and improved appetite and sleep.
   Clinical experience shows that massage increases
the activity of the circulation, reddens the skin and
elevates the  temperature in the part manipulated.
It also increases the electrical contractility of mus-
cular tissue, and stimulates the flow of lymph in
the  lymphatic  vessels.  Muscular  stiffness  and
fatigue  are  relieved, nervous irritability is calmed,
and restless and wakeful patients are soothed by it
into refreshing sleep.
   With these facts at hand, it is not difficult to see
what  a useful  agency we  possess in skillfully em-
ployed  massage.  By  its application we have the
power to prevent the wasting of muscles and to
augment muscle strength, to  build up such tissues
as fat and  blood,  to   improve nerve  force,  both
directly by producing  a better blood supply and
indirectly by relieving  irritability and  giving  rest
and sleep, and, finally,  to hasten the absorption of 
240
HYGIENE OF THE NURSERY.
waste tissue and of morbid effusions.   At the same
time it  must always be remembered that massage
is a powerful remedy.  A short seance with gentle
movements may do good in infantile palsy, for ex-
ample, but it does not follow that by doubling the
time or  force, twice as much benefit will be derived.
In fact, the reverse of the proposition is true; short,
gentle massage maintains the size and strength of
the  muscles,  while  long,   forcible  manipulation
causes them to waste quickly.   The  same  truth
runs  through  the whole question and  must  be
observed.
  Before entering upon the therapeutic application
of massage proper, it will be well  to revert to the
process  of  simple   rubbing,  already  mentioned.
This is of much value as a general hygienic mea-
sure.  Each day, after the  bath, the skin having
been  thoroughly dried by a  soft, warm towel, the
whole surface should be gently  rubbed with the
palm of the hand, the process occupying about five
minutes.  This increases the  circulation in the
minute  blood-vessels, encourages thorough  reac-
tion, aids nutrition  and  adds vigor  to the  frame.
Weakly  children especially  thrive under it.  In
older children, friction with  a soft towel may be
substituted for hand-rubbing, but this change should
not be made before the fifth or sixth year.
  Sometimes it is well  to  rub certain portions of 
MASSAGE.
24I
the body more thoroughly than others.  Thus in
rickets the  spine should receive especial attention,
in indigestion  and constipation  the abdomen, in
weak ankles the feet  and legs, etc.; though even
in these cases the general surface  must receive a
share.
   Massage may be employed with advantage in the
following diseases of childhood :—
   (a) Long-standing stomach or intestinal indiges-
tion  (chronic gastro-intestinal  catarrh).   In  this
condition the skin is  harsh, and  often so dry that
a shower of dead scales falls  from the surface on
the removal of the underclothing, the muscle tone
is faulty, general nutrition is impaired, and there is
a determination of blood from the surface  toward
the mucous membranes.   To get the skin active,
and in this way balance the circulation, is  an im-
p  rtant step in the reestablishment of normal diges-
tion, secretion and excretion, the essentials  of per-
fect nutrition.  To accomplish this, a full, warm
bath is administered  every  evening, just  before
bedtime, the  patient remaining in the water for five
minutes.  Then the surface is thoroughly dried, and
half an ounce of olive oil is gently rubbed into the
skin (inunction), the  child enveloped in  a light
blanket and put to bed.  After a little time sweat-
ing begins.  So soon  as the  sweating is free the
skin is again dried and the night-dress put on in
       16 
242        HYGIENE OF THE NURSERY.
preparation  for  sleep.   Next  morning,  at  some
convenient time after breakfast, the  child is sub-
jected to twenty minutes' massage (petrissage with
effleurage).  The inunctions are continued until the
skin becomes soft and active, and massage  is em-
ployed daily until there  is a decided improvement
in the amount of flesh  and general  strength—a
period generally of  two or three  weeks.  After-
ward, " movements " every third day will be suffi-
cient to complete the cure.
  In these cases massage not only aids the  baths
and inunctions in their general  action, but directly
and powerfully increases  nutrition and muscle force,
and  materially hastens an otherwise slow process
of recovery.
  (b) Constipation.   Manipulation  is  a very effi-
cient remedy  in habitual  constipation, and there
are many  cases that can be cured by it, combined
with a properly regulated diet,  without the  use of
drugs.  Petrissage of the large intestine is the best
method, instructions being given to follow  the natu-
ral course of the faeces through this portion of the
gut; thus, beginning in the right groin to proceed
upward to the lower border of the ribs on the right
side, to cross over, horizontally, to the same region
on the left side, and then downward to the left groin.
In this way the ascending transverse and descend-
ing colon are manipulated in order. 
MASSAGE.
243
  Five  or ten minutes  every morning, or every
morning and evening in  obstinate  cases, constitute
the proper duration and  frequency of the applica-
tions.  The pressure  must  be gentle, as delicate
underlying tissues are being dealt with.
  In this condition I have not found the dry method
so efficient as a combination of massage with  the
inunction of warm olive  oil.
  Sometimes  tapotement with the flat  hand,  the
hand  partly closed forming  a cushion, or with  the
margin of the  hand, is necessary, but the course of
the colon must always be followed.  The beneficial
action of this  mode of treatment  is, undoubtedly,
threefold: it increases the intestinal and other se-
cretions ;  it increases the expulsive action  of  the
intestinal muscular fibres, and it mechanically forces
accumulated faecal matter toward the natural gate
of exit.
  (c) Colic.  Every experienced mother knows how
often  " wind,"  the cause of colicky pain, is expelled
from the stomach  or  intestines by gently rubbing
the abdomen  with the  hand.   Any  approach  to
scientific manipulation is much more  efficient, and
two  or  three  minutes' effleurage may be resorted
to, as the urgency of the symptoms requires, with
the most satisfactory effect.   In this connection it
must  be remembered, also, that rubbing of the feet 
244        HYGIENE OF THE NURSERY.
to increase the circulation is  an important  aid in
relieving colic.
  (d) General  debility and  impoverished  blood.
These  conditions are  much  benefited  by  short,
frequently  repeated  courses  of massage.  In the
convalescence from many  diseases—both acute and
chronic—the  above  conditions  are present,  and
manipulation, by improving general nutrition, leads
to a rapid restoration of strength.
  (e)  Infantile paralysis.    Here  massage of the
paralyzed muscles brings more blood into them
and maintains their  nutrition  until,  in  favorable
cases, new nerve cells take on  the function of those
which have been destroyed.
   In infantile paralysis the affected  members are
always cold, and the  muscles contract feebly, if at
all, under the influence of electricity.  By system-
atic massage—petrissage  combined with effleurage
and both performed centripetally—an improvement
takes place with  more or less rapidity.   The  first
indication of this is an increase  in the temperature
of the parts, continuing for several hours after the
rubbing.  Then the  electrical contractility  of the
muscles begins  to return, and they  respond to a
battery-current   that  at   the  commencement is
entirely inoperative.
  In recent cases the sittings should be of short 
MASSAGE.
245
duration and frequently repeated, five to ten min-
utes, three or four times daily.  As improvement
advances, the frequency may be reduced, and  in
chronic cases twice a day will be sufficient at any
time.
  Electricity is of great aid in the treatment, but it
does not take  the place of  massage, for while it
causes contraction and congestion of the muscles
and an accumulation of blood in the skin, it does
not  have  the  same  power of  arresting rapid
wasting.  This branch of the  treatment  should
never be undertaken without the counsel of a phy-
sician.
  (/) St.  Vitus's  dance (chorea).  So far  as  this
branch of the management of chorea is concerned,
it requires to be  aided by proper diet and rest  in
bed.  On the onset of an  acute attack the  patient
is put to bed, given a full supply of good food and
allowed  to  rest  for two  days  without  massage.
Should the jerking movements be very violent, the
sides of the bed  are padded to prevent the child
bruising himself,  or, if too violent  for this, to give
security, he is slung in a hammock.
  At the end of this time the regular treatment is
initiated.  The child—at  seven years of age,  for
example—has,  at  5.30 a.m.,  half a  pint of warm
milk; 7 a.m., half a pint of milk and  three slices of
bread and butter (each slice  an  ounce in weight); 
246        HYGIENE OF THE NURSERY.
9.45 a.m., a teaspoonful of Horlick's dry malt in a
little milk; 10 a.m.,  massage  for fifteen minutes,
followed by half a  pint of warm milk; 12.30 p.m.,
a teacupful of rice pudding, half a pint of milk,
green vegetables and mashed potatoes; 4.15 p.m.,
half a  pint of warm milk, three slices of bread and
butter  and a  lightly boiled egg; 7  p.m., malt  as
before; 7.30 p. m., massage  for fifteen minutes, fol-
lowed  by half a pint of milk.  At the end of ten
days or a fortnight, the bread and butter is increased
to four slices at 7 a. m. and 4.15 p. m. ; a lean broiled
chop is added to the mid-day meal, and  an extra
pint of milk  is distributed over  the  twenty-four
hours.   After  two or three weeks the patient may
be allowed to  sit up in bed, well supported by pil-
lows, and may have a few toys to play with.   It is
a golden  rule, however, never to hurry a patient
with chorea out of bed.  The muscular strength is
more quickly  recovered  while at perfect  rest, and
too early exertion often causes a relapse.  While
carrying  out  this plan  appropriate medical  treat-
ment should be employed.
  (g)  Among other nervous diseases in which
massage is practiced with  success are facial par-
alysis;  neurasthenia and spinal irritability occurring
in girls about  the approach  of puberty, and that ill-
defined and painful  condition so often encountered
in young subjects and known as " growing pains." 
MASSAGE.
247
  (h) Accumulations of watery fluid between the
lungs and  the  chest wall (pleuritic effusions); en-
larged glands, and stiffened rheumatic joints are all
benefited by rubbing.  In these special instances
the manipulations are generally combined with the
use of ointments or  lotions, though the curative
effects cannot be attributed to the latter alone.
  In  concluding the  subject of massage in  child-
hood, it is  a point of importance to mention that
those cases in which the manipulation is  imme-
diately followed by  a sensation of comfort  or by
refreshing sleep are most benefited  by it.  On the
contrary, those cases that are  stimulated,  derive
little benefit, and perhaps positive injury from rub-
bing. This I have especially noted in cases of gen-
eral debility and impoverished  blood, and my own
experience has been confirmed by a number of
practical observers in whose judgment I have the
greatest confidence. 
248        HYGIENE OF THE NURSERY.
              CHAPTER  XI.

                  EMERGENCIES.

  In the  first Chapter, attention was directed to
certain deviations  from the features of health that
should lead the mother  or  nurse to suspect the
onset of disease.   In addition to these, it is of great
service to take into account the four seasons of the
year, and  to be informed of what diseases are most
apt to prevail during each.
  In the late fall  and early winter catarrhal affec-
tions  are  most apt to occur.   In catarrh  there is
an  increased secretion of mucus from  the lining
membrane of either the nose, the throat, the air-
tubes or the digestive canal, attended by fever, loss
of  appetite,  thirst and lassitude, with  sneezing,
hoarseness, cough, vomiting or  diarrhoea,  accord-
ing to the situation of the disease.
  As winter  advances, the bronchial tubes, the
lungs themselves and their investing membrane—
the pleurae—are liable  to attack, and the  signs of
bronchitis, pneumonia or  pleurisy to be developed.
  In the  changeable weather  of spring, together
with the  catarrhal and inflammatory disorders  al-
ready mentioned, epidemics of measles, scarlet fever 
EMERGENCIES.
249
and chicken pox are most prevalent;  while during
the summer months, disorders of the bowels, such
as diarrhoea, summer complaint  and cholera infan-
tum, swell the mortality lists of the larger cities.
  Again, the influence of any hereditary tendency
to disease should always be present in the mother's
mind, as this not only makes her alive to the possi-
bility of the onset of illness and leads her  to seek
medical advice in time, but also induces her  to
shield anxiously her child  from  known  exciting
causes, and to adopt hygienic measures calculated
to overcome the constitutional predisposition.
   In considering the question of emergencies, un-
der which term will be included both accidents and
certain  conditions of disease, no reference will  be
made to the  management  of  serious disorders.
These, even in their earliest stages,  must receive
the attention of a physician.

ACCIDENTS AND DISORDERS OCCURRING AT BIRTH
                OR SOON AFTER.
         INJURIES RECEIVED DURING BIRTH.
   The shape of the head is sometimes altered by
the compression it is subjected to during a pro-
longed and  difficult labor.   The deformity is usu-
ally in the direction-of elongation.   The distance
from  the  chin to the back  of the head  at times
measuring six inches or even more.  There  is  no 
25O        HYGIENE OF THE NURSERY.

ground  for apprehension  in  these  cases, and the
head will regain its natural shape without mechani-
cal interference.
  Swellings upon the  scalp are quite common.
They are due to pressure sustained  by the parts in
labor.  Such tumors gradually subside, if kept free
from compression and frequently bathed with cool-
ing lotions; of the latter, alcohol  and water, the
extract  of witch-hazel and water, or diluted lead
water are serviceable.
  The face may be congested and  blackened, and
the features disfigured and distorted from the same
cause.  A  natural  appearance, however, will  be
recovered in a few days  without any treatment.

         BLEEDING FROM  THE NAVEL STRING.
  This serious accident occasionally occurs  some
hours after birth.   It arises  from the cord being
carelessly tied or from its  being unusually large at
birth, and subsequent shrinking so that the ligature
ceases to close the blood vessels.
  To arrest the hemorrhage, the infant's  clothes
and flannel binder must be removed  and the cord
exposed;  then a new ligature,  composed of six
strands of strong linen thread, must be applied half
an inch  nearer the body than the original one, and
tied tight enough to compress thoroughly the ves-
sels,  but not so fight as  to cut through the cord. 
EMERGENCIES.               251
            ULCERATION OF THE NAVEL.
  The  cord  generally separates  from the  navel
between the fifth and fifteenth day after  delivery,
and  the parts should  then heal without trouble.
Occasionally, after the  falling of the cord, a small
growth, about as  large as  a pea, appears on  the
navel, giving rise to a discharge of thin liquid. This
may be relieved by applying a little powdered alum
and  afterward dressing with vaseline  or oxide of
zinc  ointment.
  Again, though rarely,  excoriation of the  navel
and  surrounding  skin takes  place,  and  rapidly
spreads, assuming an inflammatory character.   The
attention of the  physician must be called to  this.
Apply a warm-water dressing should  his visit be
delayed.

        SECONDARY BLEEDING FROM THE NAVEL.
  At the time of,  or several  days after, the  sepa-
ration  of the cord, bleeding may  take place from
the navel.  In this event,  which is fortunately un-
common, place the point of the finger over the part
and  steadily, but gently, press it until medical aid
can be obtained.
  When a bleeding  growth  appears at the navel,
wind a piece of very narrow tape closely around it
and leave the whole undisturbed.   Under these cir-
cumstances the hemorrhage quickly stops and the 
252        HYGIENE  OF THE NURSERY.
growth  soon sprouts  over the upper edge of the
tape and, strangulating itself, drops off.
          YELLOW STAINING OF THE SKIN.
  During the first few days of life, especially after
a difficult and tedious birth, there is apt to be intense
congestion of the skin, followed, as the redness fades,
by a brownish yellow discoloration.   This usually
disappears by the tenth day.  The coloration resem-
bles that of true jaundice, but there is  no yellow
staining of the whites of the eyes, nor  change in
the color  of the urine  or faeces.   Real jaundice
occasionally occurs and is a serious condition, re-
quiring careful management.
          RETENTION OF URINE AND F^CES.
  Infants  frequently  do not pass urine for many
hours after birth.  Sometimes not for days.  This
may be  due to complete  want of secretion or to
some temporary engorgement of the kidneys, which
can be relieved by drawing the blood to the surface
by immersion in a warm bath; a procedure to be
adopted in all cases  in which no urine is voided
during the first  twenty-four  hours of life.   Often,
in lieu of the bath, it  will suffice to lay a piece of
flannel, wrung out  of hot water, upon the lower
third of the abdomen—the region over the bladder.
  Occasionally some  physical malformation leads
to retention of urine, and it is the  duty of the nurse 
EMERGENCIES.
253
to be on the lookout, so that she may early call the
physician's attention to the matter.   The same con-
dition may also prevail  in  the  bowel,  and when
twelve  hours  elapse without  any evacuation the
parts ought to be carefully examined.
            SWELLING OF THE BREASTS.
  At birth, or within the following day or two, the
mammary glands of an infant may swell, become
hard and painful, and secrete a thin  fluid much
resembling milk.   Never make any pressure to re-
move the secretion, as it may lead to inflammation.
When the swelling  is moderate, judicious inaction
is best, but in severer cases, when the surface is red,
and the  parts  much swollen, and hard and tender
to the touch,  a hot-water dressing must be con-
stantly applied.
            INFLAMMATION OF THE EYES.
  This is a most important condition, and, from the
outset, requires the attention of  the physician and
the greatest care on the part of the nurse.
  The inflammation usually comes on about three
days after birth, in the  following manner: on wak-
ing from sleep, the child's  eyes are slightly glued
together;  their edges,  particularly at the corners,
are redder than is natural, and on turning down the
lower lid a little white  matter  will be observed  on
the  inside.    Light causes  pain  and  there is  a 
254        HYGIENE OF THE NURSERY.
tendency to keep the eyelids closed.   After a short
time the lids swell, become red on  their external
surfaces, and a large quantity of matter is secreted
and constantly pours from the eye.   Apart from
pure medicinal treatment, the nurse must keep the
eye free from discharge by constantly washing away
the matter secreted.   Burn the rags or cotton used
in this process at once, and it is most important for
the attendant not to carry any of the discharge to
her own eyes.

            HARE-LIP AND CLEFT-PALATE.
  These are deformities  requiring the attention of
the surgeon, and under ordinary circumstances his
aid should, in case of simple  hare-lip, be sought
within the first six months of the child's life, so that
the operation may  be well over  before dentition
begins.  The  fourth  month is the period of elec-
tion, but should  there be difficulty in sucking  and
any evidences of inanition, the operation may be
performed  at  an earlier age.  The  operation for
cleft-palate should  not be undertaken before  the
end of the second year.
   So far as the  mother is  concerned, the question
of importance is whether or not there is any inter-
ference with the act of sucking.  If  hare-lip be
trifling, the infant will be able to suck, provided the
mother's nipple be large and the milk flows freely; 
EMERGENCIES.
255
when the  reverse  is the  case, resort  to  a nipple
shield.  In grave cases, especially when hare-lip is
associated  with cleft-palate, the child is  unable to
suck either from the breast or from the bottle, and
must  be fed from a spoon.  Occasionally one can
succeed in  feeding a child  so affected from a bottle,
by resorting to a false palate.  This consists of a
bit of thin  india-rubber, cut the size and shape of

                      Fig. 23.
TIP WITH FALSE PALATE.
the roof of the mouth and fastened by several firm
stitches to an ordinary bottle tip (see Fig. 23).   In
using this instrument, the nurse must insert it into
the mouth in such a way that the rubber diaphragm
will come uppermost and bridge over the imperfect
portion of the palate.
                   TONGUE-TIE.
  In this condition the bridle beneath the  tongue
is either too short, or is attached so near the tip of 
256         HYGIENE OF THE NURSERY.
the tongue as to interfere, at  first, with the move-
ments of the organ  in  sucking, and, afterward, in
speaking.  Although frequently  suspected, it,  in
reality, occurs very rarely.  The best way to deter-
mine if tongue-tie exist or not, is to watch whether
the infant can protrude the tip of the tongue beyond
the lips.   If so, it will be able to suck a good nipple
readily, and  nothing need, nor ought, to be done.
Should the  reverse  condition prevail,  it will be
necessary to  nick the bridle, and, as there is con-
siderable danger of hemorrhage in this operation, a
surgeon must always be consulted.


    ACCIDENTS AND DISORDERS OCCURRING IN
           INFANCY AND CHILDHOOD.
                     BRUISES.
  A contusion or bruise must be treated as  soon
as received, if one would relieve pain, lessen swell-
ing and prevent the formation of a black and blue
spot.   Compresses wet  with hot water, a  light ice
bag,* or a lotion of fluid extract of witch-hazel, are
the best remedies.  A bruise upon the head in the
case of a young infant, and especially when followed
  * Heat and cold act in the same way upon the blood vessels, con-
tracting them and preventing the transudation of blood.  It is the
changes occurring in the blood after leaving the vessels that produce
the discoloration. 
                  EMERGENCIES.              257

 by paleness  and vomiting, is not to be carelessly
 overlooked, since it is sometimes the origin of con-
 vulsions.
                     SPRAINS.
   Do not make light of a  severe  sprain,  for the
 consequences are often more lasting than those of a
 broken bone.
   Much care and patience will be required in the
 management of  sprains, the great point being to
 secure  rest for the injured part.  Should the knee
 or ankle joint be involved, put  the  patient  to bed
 and swathe the part in a hot-water dressing, or in
 compresses soaked with arnica  or fluid  extract of
 witch-hazel.  When a joint of the upper extremity
 is involved, it is, of course, unnecessary to confine
 the child to  bed; but at the same  time the limb
 must be placed in such a position as to be as quiet
 as possible,  while the local applications already
 mentioned should be employed.    Later, passive
 motion  must  be practiced in  order to prevent per-
 manent stiffness.  A sprain,  however, needs the
 surgeon's attention as much as a broken bone.

                   FRACTURES.
  The breaking of a bone is indicated by deformity
of the limb, such as bending, shortening or  twist-
ing, and when this occurs, much  suffering  to the
patient and injury to the part may be saved by a
      17 
258        HYGIENE  OF THE NURSERY.
little careful management.   In lifting the child from
the spot where the accident happens and carrying
him to a bed, it should be one person's duty to sup-
port tenderly the  injured limb, instead of allowing
it to dangle loosely.  Once in bed, lay it  upon a
soft, rather broad pillow;  double this around the
limb, and  tie up tightly so as to  afford protection
from jars or shaking.
  Beyond this, nothing should be undertaken until
the physician arrives, except—in case of fracture of
the lower extremity—the preparation of the bed.
This consists in arranging a firm, though not too
hard, mattress, with two or three under blankets
for the sake of warmth.

                     CUTS.
  These may be  clean, as when made by a knife;
torn, by a broken plate;  or  abraded, by a fall on
hard, rough ground.  If large  and deep, the  sur-
geon  should be called at once.  In trifling cases,
the nurse must first thoroughly cleanse the wound
by sponging it with hot water, and  check the flow
of blood  by pressure, by the  application  of hot
water, or—should the hemorrhage  be obstinate—
by the use of a solution of alum.   In the case of a
knife  cut, the next  step is to press the edges to-
gether and fix them in this position by applying a
number  of  narrow  strips of  surgeon's adhesive 
EMERGENCIES.
259
plaster at short intervals across the wound.  A torn
wound may be dressed in the same way, but greater
care is required  to coadapt the edges.  For abra-
sions, the best application is a piece of lint covered
with vaseline or  other bland ointment.  The plaster
dressings need not be renewed until the strips be-
come loose, but  the  lint and vaseline may be
changed twice a day.  When  an artery is cut, the
flow of  blood must be checked by pressure on  the
vessel above the  seat of injury; in the case of  a
vein, below it.  Arterial blood flows in jets and is
scarlet;  venous blood runs in a continuous stream
and is purple in color.

                BURNS AND SCALDS.
  The danger from burns or scalds is in direct pro-
portion  to the extent of surface involved and  the
depth of tissue destroyed.  Fortunately, the major-
ity of cases  are  trifling, and usually the hands or
face are  the  parts that suffer.  In these instances
there are two things to be done; first, to relieve
pain, and second, to encourage healing.  To accom-
plish the former, apply a saturated  solution of
baking soda; for the latter use some mild ointment
—fresh  lard, for  example—and keep the injured
part protected from the air by a dressing of cotton
batting.
  Should the child's clothing take fire, remember 
26o        HYGIENE OF THE NURSERY.

that an upright position not only favors the spread
of the flames, but encourages their approach to the
neck and head.  Any movement of the body, too,
aids the flames by bringing fresh currents of air in
contact with the burning materials.  Therefore, do
not let the child  run about, but seize him, throw
him  down  upon  the floor and  envelop his body
closely in the hearth rug or a woolen table cloth.
  Should the child have fallen into a tub of scald-
ing water,  remove him immediately and  undress
him.  In taking off the clothing, be careful to do
it so gently as not to  break the blisters produced
by the moist heat, and should  the  underclothing
stick anywhere to the  surface, the garments must
be cut away piecemeal, leaving  the  adherent  por-
tions untouched.
  After the above preliminaries put him, in either
case, at once to bed.  Next, prepare a number of
pieces of old muslin corresponding in size with the
injured areas, spread these with fresh lard or cosmo-
line, apply them and cover all with a thick layer of
cotton batting.  Should the patient complain of cold
hands or feet, or of faintness, a little  whiskey or
brandy  may  be  administered  and  artificial  heat
applied  to  the  extremities if these  be uninjured.
Nothing else should be done without the physician. 
EMERGENCIES.
26l
                STINGS OF INSECTS.
  Children, being more  ignorant,  are more fre-
quently stung by bees, wasps, and  other  insects,
than adults.  Examine  the wound the first thing
with a magnifying glass, and if the sting be still in
the tissues, extract it with a  pair of tweezers, or
squeeze it out by firm pressure in the  neighborhood
of the puncture.   After  this, apply aromatic spirits
of ammonia or eau de Cologne.  These will relieve
the pain and itching.  When the sting produces
great pain and inflammation, apply a flaxseed poul-
tice  for  twenty-four  hours.   The  frequent  use,
afterward, of camphorated soap liniment  will be
productive  of good results.

            FOREIGN BODIES IN THE EAR.
  When a foreign substance has entered the ear, the
plan for its extraction depends  somewhat  on the
nature of the material.   In any case, however, bend
the child's head toward the affected side, cause him
to open his mouth as wide as possible, and at the
same time gently pull the external ear  upward and
backward.   In this way the external canal of the
ear is straightened and  stretched to  its widest ex-
tent, and a  small body  like a bead may drop out.
Another method is to wash the foreign body away
with warm  water  and a  syringe.  Should the  sub-
stance be of a nature to increase in size by  absorb- 
262        HYGIENE OF THE  NURSERY.

ing moisture, such as a pea or bean, its extraction
must  be left for the physician, though it  is to be
delayed no longer than absolutely necessary. When
an insect enters the ear, the external canal must at
once be filled with fresh olive oil.

            FOREIGN BODIES IN THE EYE.
  A simple  plan for removing cinders and the like
from the eye is to pull the upper eyelid forward and
downward, by grasping the eyelashes, and direct the
child  to look  upward.  In this way the lashes of
the lower lid are made to  sweep over the inside of
                     Fig. 24.
METHOD OP EVERTING UPPER EYELID.
the upper one, and thus may brush away the foreign
body.  If this be unsuccessful, and if the offending
substance be in sight, remove it with the corner of
a fine handkerchief.   If not seen on the eyeball, it
must  be  looked for  beneath  the lids.   It  is easy
enough to pull down the lower lid and  examine its 
EMERGENCIES.
263
internal surface; in the case of the upper lid, how-
ever, it  is necessary to perform  eversion; this is
done by drawing the lid downward and forward, and
turning it over a thin lead pencil.  (Fig. 24.) Direct
the child, in the meanwhile, to  look down.   When
the intruding body is disclosed by this process, it
may be  brushed  away by a little cotton  twisted
upon the end of a  match stick,  or better by a small
camel's-hair brush ; the touch must be very gentle,
and no prolonged effort made if the mote be im-
bedded.  Treat any slight  irritation following this
accident and the process  of  removal  by frequent
applications  of hot water.
            FOREIGN BODIES  IN THE NOSE.
  Children  frequently  insert  shoe buttons,  peas,
beans, and other small objects into the nose.  When
these are not  too  firmly fixed, or have not been
pushed too far up,  they may be removed by closing
the opposite nostril and causing  the child  to blow
his  nose forcibly.   Should any difficulty be expe-
rienced, it is better to consult a physician than use
persistent force.
          FOREIGN BODIES IN THE THROAT.
  A large, unchewed mass of food, a  fish bone, or
some metallic substance, such as a piece of money,
may become lodged at some point in the throat.
  When this occurs, immediately insert the finger 
264        HYGIENE OF THE NURSERY.

and thumb into the mouth, pass them as far down
the gullet as possible, and if any object be felt make
an attempt to pull it forth.
  Instead of lodging  in  the upper part of the gul-
let, the foreign body may be arrested midway in its
course to the stomach. Let the child then partially
masticate and swallow a piece of bread and several
mouthfuls of water, which will probably assist the
object's passage into  the stomach ; if not, medical
skill will be required.
   Foreign bodies, such as buttons  and coins, that
pass directly into the stomach give rise to  little
trouble, and soon find their way through the ali-
mentary canal, and are voided from the rectum with
the ordinary faecal evacuations.  Laxative medicines
are never needed unless the bowels  be absolutely
confined,  and then moderate doses of castor oil are
the most  suitable.

             BLEEDING FROM THE NOSE.
   Hemorrhage from  the nose is  sometimes so ex-
cessive as to lead to debility, or even threaten serious
results.  An injury or abrasion of the lining mucous
membrane is the usual cause of hemorrhage, though
it may result from certain constitutional conditions.
To arrest the bleeding,  put the child  upon a bed,
with  the  head and shoulders well elevated.   First
make pressure, with the thumb and index finger, on 
EMERGENCIES.
265
the root of the nose, /. e., that portion between the
eyes, or on  either  side of the nostrils where the
blood vessels ascending  from the  lip are felt to
pulsate.  Should this fail, after a  reasonable time,
plug the nostril from which the blood flows with a
cone-shaped  pledget of  absorbent cotton  or  lint;
this may either be dry or saturated with a solution
of alum and water  as hot as can  be borne.  The
inhalation of the  vapor of spirits of turpentine, or
the immersion of the feet and  legs  in a hot mus-
tard foot bath, are each  successful in some cases.
If the bleeding be obstinate, apply  a piece of ice
wrapped in flannel to the forehead or the back of
the neck.
                    EAR-ACHE.
  Ear-ache is a very common cause of crying in
infancy and childhood.   Screaming  from ear-ache
may be distinguished from that due  to  pain in the
bowels,  another fruitful source of crying, by the
former being more continuous, and by the child
frequently carrying his hand to his head; again, in
ear-ache the passages from the bowels are natural,
while in bowel-ache  they are usually altered in
character and offensive.
  Put into the ear, for  a short distance,  a small
piece  of absorbent cotton saturated with a  little
warmed olive oil containing a few drops of lauda-
num, or, better still, with a  two per  cent, solution 
266        HYGIENE OF THE NURSERY.

of cocaine.  At the same time dry or moist heat
may be applied to the external ear.
                COLD AND COUGHS.
  A cold in the head is indicated by watery eyes,
sneezing—with a discharge of mucus from the nose
—and  a  nasal  voice.  Simple remedies  are  often
efficacious.  Frequently grease  the forehead and
bridge of the nose with mutton suet;  insert a little
vaseline in the nasal orifices, and, should the skin
be hot, administer a mustard foot-bath.
  An  ordinary cold—or,  in medical language, a
bronchial  catarrh—is usually  preceded by a cold
in the head, and is indicated by a hoarse cough, in-
creased rapidity of breathing, and fever.
  The methods recommended for colds in the head
are also  useful here.  In addition, rub  the  chest
thoroughly, three times a day, with a liniment of
turpentine and sweet oil—one part to three; keep
the child in one room at a  temperature of J2° F.;
allow a light diet, and summon medical aid.
                    VOMITING.
  The most healthy infant, even though it be fed
at a normal breast,  often expels a portion of each
feeding.  This is an  act of regurgitation rather than
vomiting, and is, in  reality, a natural method of re-
lieving an over-burdened stomach.
  Vomiting proper  is preceded by the sensation of 
EMERGENCIES.
267
 nausea;  is followed by lassitude, and is  often at-
 tended by fever.  It indicates some disorder of the
 stomach.   For its relief, perfect rest for the whole
 body; several hours' starvation, or rest for  the
 stomach,  and  a reduction  in  the quantity and
 strength  of the food,  are necessary.   Bits  of  ice,
 soda-mint, lime water, and a mixture of equal quan-
 tities of cinnamon water and lime water, in teaspoon-
 ful doses, are simple and efficient remedies; a weak
 mustard plaster placed upon the pit of the stomach
 is always  useful.   Should the symptom be obsti-
 nate, however, the case becomes too serious for  the
 mother to manage on her own responsibility.

                      COLIC.
   Colic is a very common affection of infancy.   It
 usually occurs in the period between birth and  the
 end  of the third month, and  gives rise to much dis-
 comfort, both to  the infant and its attendants, by
 causing fretfulness, crying and wakefulness.  The
 treatment is very much  one of diet and  properly
 prescribed drugs.   Still, there  are  some domestic
 remedies which may be  used safely and with suc-
 cess.   Thus, the  body should be anointed twice a
 day with warm olive oil and enveloped in a broad
 flannel binder.  It is even more important to keep
the feet warm, and for  this purpose thick  socks or
long woolen stockings  should be worn, and,  in bad 
268        HYGIENE OF THE NURSERY.

cases, artificial  heat must  be applied  by hot water
bottles.  Medicines  are  indicated  chiefly  during
attacks of pain.  A serviceable prescription is ten
drops  of gin in a teaspoonful of sweetened warm
water,  or a small teaspoonful of hot soda-mint.  It
is  also well to  administer a teaspoonful of cara-
way water  after each nursing, or with each bottle
of food.
   When a paroxysm of pain is violent enough to
lead to depression of the fontanelle  and threaten
collapse, place  the infant  in  a  warm bath for five
minutes.  After removing and  carefully  drying
him, wrap him in a blanket; put a flaxseed poultice
with a dash of mustard over the abdomen; apply a
hot water bottle to the feet; relieve the bowels by
an enema of warm water, and by the mouth, give
him  ten drops of gin or brandy in warm water.   If
the fontanelle still  remain depressed, continue the
stimulant in doses and at  intervals proportioned to
the urgency of the symptoms.

                  CONSTIPATION.
   Habitual constipation  is such a common occur-
rence in infancy and childhood that  it warrants a
somewhat detailed  consideration.  The  methods
that  may safely  be  employed  to  clear the lower
bowel of accumulated faeces, or, in other words, to
relieve the actual state of  constipation, will  be first 
EMERGENCIES.
269
noticed, for this is always a necessary step when
there is painful straining, and in case there has been
no movement for a day or more.  For this purpose
injections are most efficient, and when given with
care, are entirely free from danger.
  A serviceable plan is  to inject into the rectum,
according to the age of the patient, from one to four
teaspoonfuls of warm olive oil; allow it to remain
for  six hours, and then use one or more injections
of castile soap and warm water; olive oil, soap and
warm water, or table salt and warm  water.  The
preliminary injection of oil softens the faeces, while
the subsequent  ones have the additional  effect of
distending the walls of the rectum, thus bringing
about  muscular contraction and expulsion of  its
contents.   Should a compact faecal  mass be present
at the anus and be  too bulky to escape—a condition
often visible during straining—more liquid must be
injected, and if this  fails the mass  must be broken
up  by  the finger and its  passage assisted by gentle
pressure upon the parts  behind the anus while ex-
pulsive  efforts are  being  made.   The process  of
breaking up is easy, as the anus is widely distended
at such times.  In obstinate cases little result may
follow  a  single administration of  the injections,
though  a course of one or two oil injections and
purgative enemata for several successive days rarely
fails to empty the bowel. 
27O        HYGIENE OF THE NURSERY.
  The best  syringe  for  children is one of hard
rubber  with  a long,  smooth,  nozzle, having  a
capacity of six fluidounces.  When oil  is injected,
the intention being to have it remain in the rectum
and act mechanically on  the faeces, its  retention is
best secured by firmly  pressing  a warmed pad of
flannel against the anus for five  minutes after  the
insertion, the patient, in the meanwhile, lying upon
his back.  The laxative enemata must vary in bulk
with the age  of the child, or, in  other words, with
the capacity  of the rectum;  one fluidounce (two
tablespoonfuls) will be sufficient for an infant  of six
weeks, while  from  four to  six fluidounces  are
required at  the age of two years.   The  quantity of
oil, salt, or soap to be used must depend upon the
quantity of  water—two teaspoonfuls of oil or  one
teaspoonful  of salt to eight  tablespoonfuls of water
being a good  proportion, and if soap be employed,
it  is sufficient to  stir a  bit in the water until suds
begin  to  form.  After drawing  the fluid—which
must  be tepid—into the syringe, grease the nozzle
well and gently insert it into the anus, directing the
point  a little toward the patient's  left; next, slowly
force down the piston until all the liquid is expelled
or complaints of  pain indicate that the bowel is
sufficiently distended.   If it be  possible to force
retention for a moment or two by pressure on the
anus, the movement will be  freer  and easier than if 
EMERGENCIES.
271
the fluid be allowed to  flow away at once.  The
best positions for the child are either on his back
with  his  legs  well  drawn up, or resting  on his
abdomen across the nurse's lap.
  Injections of glycerine  and  glycerine supposi-
tories are also  very useful for  the purpose of un-
loading the lower bowel.  When glycerine is em-
ployed, the quantity to be injected varies from one
to two  teaspoonfuls, according to the age of the
child, and the  best  instrument to use is the bulb
syringe, previously recommended.  See p. 235.
  For the prevention of further  constipation  the
diet must be regulated according to the rules given
in Chapter viii, and besides regulating the food and
hours for  meals, bathing, sleep, exercise  and cloth-
ing, care must be taken to  establish fixed habits of
defecation.
  In  my  experience the youngest infant  can  be
taught to  use a chamber, and if this vessel be pre-
sented each day at the same hour he soon falls into
regular ways.   Should faulty habits be established,
or constipation exist, resort to injections, and  ab-
dominal massage at the same hour each  day.
  After the third year the best period of the day
for  the bowels to be moved is immediately after
breakfast,  and  no call of duty  or pleasure  should
be allowed to interfere.  When constipation is to
be overcome natural  efforts must be made then. 
272        HYGIENE OF THE  NURSERY.

These efforts may at first be  ineffectual, but much
can be accomplished by perseverance in a daily,
sustained effort, for about ten  minutes.  When this
plan fails,  use injections or other methods of relief,
taking care to keep to a certain hour, that the for-
mation of a habit may be encouraged.
  Thorough rubbing of the abdomen is  often suc-
cessful  in  inducing a  movement of the bowels.
Gentle pressure  should  be  made with the palm of
a well-warmed hand, and the movements directed
first, from the brim of the pelvis on the right side,
upward to  the  rib margin, then across from the
right to the left, and finally  downward on the left
side from the margins  of the ribs to the brim of
the pelvis  again.  Such manipulation excites peri-
staltic action, and encourages  the passage of the in-
testinal contents along  the large bowel toward the
anus.  Ten minutes is quite long enough to continue
the rubbing.  The  manipulation may be rendered
more effective by using warm sweet oil,  or a weak
ammonia or turpentine liniment as an inunction.
  With children of six years and  upward,  daily
cold  spongings  of the body are  very  beneficial,
followed by frictions with  a  coarse towel until the
surface is red.
  Manna, phosphate of sodium, and soap supposi-
tories are among the medicines that may be safely
used in the nursery. 
                  EMERGENCIES.              273

  Manna, which imparts  a sweet taste, may be
dissolved in the food, and given from the bottle as
often  as  required; a piece  as big as a pea, once,
twice  or three times  a day, will be sufficient for an
infant of six months.
  Phosphate of sodium—an admirable laxative—
can also be administered with the food; five or ten
grains, three times daily, is the proper dose at the
same age.
  Soap suppositories must vary in  strength  with
the age.  At two months one grain of soap to ten

                     Fig. 25.
SOAP STICK.
grains of cocoa-butter is the proper proportion; at
one year the quantity of soap may be increased to
five grains  in  each suppository,  and  so on.  A
substitute for soap suppositories may be prepared
in the nursery,  as follows :  Cut from a bar of good
castile soap a piece two inches long and half an
inch thick.  Scrape  this into a cone, pointing one
end like a  sharpened pencil, but  with a blunter
point  and  more gradual  slope;  make  it  quite
smooth by  rubbing the surface with  a wet  rag
(see Fig. 25).   When the soap stick is used anoint
       18 
274        HYGIENE OF THE NURSERY.
the pointed end with vaseline and gently insert  it
into the rectum and hold  it there until the action
begins.   It is not desirable to leave any fragments
of soap in the rectum.
                   CONVULSIONS.
  Convulsions arise from  so many diverse causes,
that it is impossible to indicate more than what  is
to be done during  the fit  and prior to the arrival
of the physician.
  When the attack comes  on, the  child must be
undressed  at once and plunged  into a  hot bath
for five minutes;  this bath  must contain enough
mustard flour  to  stimulate  the  skin thoroughly.
This usually restores consciousness and checks the
muscular twitching.   Should there be a distinct
history  of  overloading of  the  stomach, give an
emetic of ipecacuanha, and  after this has operated,
a purgative dose of castor oil.  One or more doses
of bromide of potassium, five to  ten  grains, accord-
ing to the  age, may be also safely given; this salt
must always be administered in solution.

                     A CHILL.
  This is always a  serious occurrence and warrants
sending for the doctor.  Before his arrival, put the
child to bed, surround him  with bottles containing
hot water, place a moderately strong mustard plas-
ter over the abdomen or over the  region of the 
EMERGENCIES.
275
 heart, and  administer whiskey and hot water in
 small doses and at short intervals.
   The  ailments of children do not so  frequently
 begin with a chill, as do those of adults, but when
 they  do,  it is  a  more decided indication  of the
 future gravity of the attack.
                      FEVER.
   It is not my intention here to refer to the man-
 agement  of the  essential fevers, for I  hold that
 neither mother nor nurse is  capable of managing
 them without  professional assistance.  However,
 the table  on page 276, exhibiting  the features of
 the eruptive fevers will answer some of the ques-
 tions  which so frequently suggest themselves to
 the minds of anxious mothers.
   It may  be well to give a few directions as to the
 management of a  fever before the arrival  of  the
 physician.  Every  fever—whether  it be due to a
 poison circulating in the blood or to a passing irri-
 tation of little  or no  moment—is  attended  by the
 following symptoms, namely: heat of skin, lassitude,
 loss of appetite and thirst.  When these features
arise, the  mother must be  on  her  guard and take
steps to place her  charge in the best possible con-
dition.  Give the  child, the first thing, a mustard
foot bath ;* then put him to bed with only sufficient
* See page 146. 
276         HYGIENE  OF THE  NURSERY.
ERUPTIVE FEVERS.
B rt	0 0 0<j=	a 0 «	Character of Rash.	V a "S a	0 B i/i •2 8 k. — P	-1 ■si 2 & aS P c M 0 U
Measles.	10 to 14 days.	4th day at fever.or after 72 hours' ill-ness.	Small, dull, red pimples, appearing be-hind the ears and on face.	On 7th day of fever.	9 days.	From sec-ond day, for exactly 3 weeks.
Scarlet Fever.	2 to 7 days.	2d day of fever,orafter 24 hours' ill-ness.	General rosy blush appears firstaboutneck and shoulders.	On 5th day afterfever.	8 or 9 days. (This does not include sequels.)	Fourth day, for 6 or 7 weeks.
Typhoid Fever.	10 to 14 days.	7th to 14th day.	Rose-colored, slightly elevat-ed spots, few in number, chiefly on ab-domen.		14 to 21 days.	Not con-tagious.
Chicken-pox.	8 to 16 days.	2d day of fever ,or after 24 hours' ill-ness.	Appears i n crops on back and abdomen, small, red pap-ules rapidly passing into globular vesi-cles.	Th in scabs form about 4th day of fever.	4 to 7 days.	First day, f0 r two weeks.
Small-pox.	14 day™.	3d day of fever,or after 48 hours' ill-ness.	Small, hard, red pimples, becoming vesi-cles, then pus-tules, appear-ing first on face and neck.	Scabs f0 r m on 9th or ioth day of fever, and fall off about the 14th.	14 to 21 days.	First day, for about one month.
 
EMERGENCIES.
277
covering to keep  up a normal body  temperature.
Reduce the diet to the simplest possible basis, milk
food being the safest.   A moderate quantity of pure
water, or of some  effervescing saline water, and of
ice, may be  allowed.  Febrifuges, as aconite, or
even sweet  spirits of nitre, had best not be  given
without advice, and quinine or other  remedies are
not to be trifled with.
  Should head-ache  be  severe,  place cold  com-
presses  upon the forehead,  or a weak  mustard
plaster (one part of mustard to six of flour) on the
nape of the neck.
  Free  urination  should be  encouraged by hot
compresses over the bladder, and it is well to secure
a free action of the bowels by a mild saline laxative.

      CONTAGIOUS  DISEASES AND DISINFECTION.
  There are certain points connected with the  nurs-
ing of contagious  diseases and the subject of dis-
infection that are worthy of  mention.
  In every case of contagious disease, allow in the
room only those who are necessary to nurse the
sick.   The  nurse must avoid over-fatigue,  have
regular  meals of  digestible and  nourishing  food,
and fixed hours  for sleep  and  relaxation.  The
chamber selected for the sick room should be  large,
well ventilated, and  as near the top floor of the 
278        HYGIENE OF THE  NURSERY.

house as possible.  Upholstered and  stuffed furni-
ture, curtains,  hangings, carpet and other articles
capable of holding disease germs, are difficult to
disinfect, and  should be removed before the  en-
trance of the patient; in fact, to put this  matter in
a nutshell, the sick room should contain only such
furniture as will be absolutely needed by the patient
and  nurse.   Scrupulous cleanliness  is  essential.
Remove dirty dishes, vessels with discharges, soiled
napkins, and the  like, at once.
  Disinfectants are substances  that destroy  the
infective power of infectious materials,  and must
not be confounded with either antiseptics or arres-
tives of putrefaction, or with deodorizers or neutra-
lizes of bad smells.
  In the use of disinfectants, it is important to bear
in mind that contagious virus must be destroyed at
its source.  As this, of course, is the body of the
sick, all discharges must have their power for  evil
destroyed as soon as possible.  Receive discharges
from  the mouth  and nose, especially in cases of
scarlet fever and diphtheria, in bits of rags,  and
burn  them  immediately after use.   When the skin
is affected,  as in  scarlet  fever, for example,  the
flakes that fall away are highly infective.  To pre-
vent  these  becoming  disseminated,  the surface
should be anointed several times a  day with vase- 
EMERGENCIES.
279
 line, lard or cocoa-butter, either of which substance
 will be rendered more  efficient by the addition of
 carbolic acid (one part  to forty).
   Articles  used about  the patient, such as sheets,
 pillow-cases, blankets  and clothes, should not be
 removed from the chamber  until they have  been
 soaked for  at least an  hour in the following disin-
 fecting fluid:—

     Sulphate of zinc...........8 ounces.
     Carbolic acid.............1 ounce.
     Water................3 gallons.

   Place,  after  this, the  soiled articles in  boiling
 water for washing.
   Articles  not requiring to be frequently changed,
 such as pillows  and mattresses,  need fumigation.
 This may be accomplished at the termination of
 the sickness.
   Keep a small quantity of the above fluid or of a
 solution of corrosive  sublimate  (1 to 500) in all
 vessels used for  receiving the  discharges of the
 patient,  and, after these are  used,  empty  quickly
 and  clean with  boiling water.  Water closets or
 privy wells  into which  these discharges are poured
 must  also be disinfected each day with a  solution
 of copperas (one pound to the gallon).
   Fumigate the sick room itself as soon as the
patient leaves it.  To do this, tightly close the room 
280        HYGIENE OF THE NURSERY.
and  stuff all apertures,  such  as  keyholes, loose
window sashes, spaces under doors and so on, with
cotton or  rags.   Then  place a  quantity  of roll
sulphur,* broken into small fragments, in a  saucer,
standing either in a  large iron kettle or supported
by two bricks set in a tub partially filled with water.
Next, sprinkle a little alcohol over the sulphur and
apply a live coal, and  as soon as combustion  begins,
leave the  room,  shutting  the  door of exit.  The
room must remain closed for at least twelve hours
and then be thoroughly aired.
  Wood-work  and  walls, if  painted, should  be
wiped down  with a  solution of chloride of  lime
(one ounce to the pint) or carbolic acid (one drachm
to the pint), and  then scrubbed with soap and hot
water.  Re-papering  and fresh painting are neces-
sary in cases of scarlet fever or smallpox.
  The person of the  patient  or nurse may be dis-
infected  by washing with a two per  cent, solution
of carbolic acid.
  Both milk and water will carry disease  germs,
and  hence both  must be  thoroughly boiled when
there is  any danger  of  their being contaminated:
Never give delicacies or articles of food  that have
stood in the sick room to other members of the
household.
  * The quantity of sulphur required is three pounds for every
thousand cubic feet of space. 
EMERGENCIES.
28l
               VARIOUS DRESSINGS.
                    POULTICES.
   Poultices may be made with Indian meal, bread,
starch, ground slippery elm, flax-seed meal, or, in
fact, any material that will retain heat and moisture.
Flax-seed  meal is usually selected  because it is
bland and non-irritating; because it  contains con-
siderable  oil,  which  gives  it great heat-retaining
properties, and because it is cheap.
   All poultices should  be large, from half an inch
to an inch thick; applied as hot as can be borne,
and renewed as soon as cold.  A covering of oil-
silk or thin rubber cloth is  useful  to  prevent rapid
cooling.
               FLAX-SEED POULTICE.
   Take a perfectly clean bowl, pour in the requisite
quantity  of boiling  water, then add  the flax-seed
meal slowly, stirring continually with  a large spoon
to prevent the formation of  lumps, until it becomes
stiff enough not to  run freely.   Spread  between
two layers of old muslin, folding the  edges over so
as to avoid soiling the part  to which it is applied.

               THE JACKET POULTICE.
   The jacket  poultice, so often employed  in cases
of pneumonia, requires some skill in its preparation.
   For a child from one to three years old, use about
a pound of flax-seed meal in each poultice.
   Take a  piece of muslin  or a large  towel long 
282         HYGIENE OF THE NURSERY.

enough to go all around the patient's chest, and of
sufficient width, when folded on  itself, to extend
from  the collar bone to  a few inches below  the
lower end of the breast bone.  After the meal is
properly mixed, spread  it  evenly  over one entire
half, lengthwise, of the cloth, which should then be
folded over.  Place this around the chest, with the
open  edge upward, and fasten behind.   It should
be held up by a tape passing over  each shoulder.
  Put this  poultice on as  hot as the nurse  can
tolerate it against her cheek; cover with oil-silk
and renew every five or six hours.   When the cool
poultice is to  be  removed have  a hot fresh one
ready for immediate application.

                 BREAD POULTICE.
  Make a bread poultice by soaking a muslin bag
filled  with  bread  crumbs, for a few moments in
boiling water, then  squeeze it gently between two
towels until it does not drip.

               CHARCOAL POULTICE.
  The charcoal poultice is useful in foul and slough-
ing sores, and  is  prepared by incorporating some
powdered charcoal with a flaxseed, an Indian meal
or a bread poultice, and then sprinkling the surface
with more charcoal. 
EMERGENCIES.
283
                   PLASTERS.
                MUSTARD PLASTER.
  These plasters are used for the purpose of making
counter-irritation, and must be graduated in strength
according to the tenderness of the skin and the end
to be accomplished.  Pure  mustard  is very  irri-
tating and will quickly blister  the tender skin of a
child.   Flour  is  the ordinary diluent,  and  the
strength of the plaster  usually ranges from  one
part of mustard to three, six or even more parts of
flour.
  In making the plaster, take  one  teaspoonful of
mustard flour  and add  to it  three teaspoonfuls of
wheat  flour; mix them together thoroughly on a
plate, and put on as much hot water (never vinegar)
as may  be necessary to  make a soft mass.   Spread
evenly  over a  piece  of muslin.   To prevent the
mustard from adhering to the skin, place a piece of
gauze or thin muslin over the surface of the plaster;
turn down the edges as in poultices.
  Remove the plaster  after  the surface  becomes
quite red.
                  SPICE PLASTER.
  Take equal parts of ground ginger, cloves, cin-
namon, and allspice, and one-fourth part of cayenne
pepper; mix the  ingredients together on a plate,
and put the whole into a flannel bag about as large
as the hand, and wet with hot whiskey or alcohol. 
284        HYGIENE OF THE NURSERY.

  After the bag is filled it is better  to  quilt it;
otherwise, as it is usually worn some length of time,
the ingredients are apt to fall together  in a lump.
            DRY, HEATED APPLICATIONS.
  Make a bag  of thick flannel,  somewhat larger
than the part to be covered.  Half fill it  with hot
bran, hops, chamomile flowers, or whatever is to be
used.  Apply to the part on which it is intended to
act.  Retain it there by a bandage.  When the bag
and contents become cooled, quickly remove, sub-
stituting a few thicknesses of  hot flannel  until the
bag can again be heated by placing it on a tin plate
in the  oven, or  by  holding it over burning  coals,
being careful, of course, not to scorch  it.
              COLD WATER DRESSING.
  Take a piece of old linen or muslin large enough
to cover  the affected part.  Thoroughly  wet with
cold water.  Keep  constantly wet by re-dipping in
the cold  water,  or by gently  squeezing out  a wet
sponge on the  cloth, so  as  to keep it  wet without
dripping.   The  latter plan is the better, as it causes
no  disturbance of the parts beneath—an important
consideration in many cases.
               HOT WATER DRESSING.
  The hot water dressing is prepared  in the same
way as the above, substituting hot for cold  water,
and covering with oil-silk. 
EMERGENCIES.
285
            FLANNEL DIPPED IN SPIRITS.
  Take a piece of old, soft flannel.  Heat it before
the fire.  Then fold  it into the size  and  shape
required.  Dip into  hot water and wring it dry.
While this is being done by one person, some one
else should put some common whiskey into a shal-
low dish over  the fire, and heat it, being careful
that  the whiskey does not take fire.  As soon  as
thoroughly  heated,  dip the  flannel  into it and
squeeze out  any excess  of  spirits, which would
merely drip away, to the annoyance of the patient.
Have the surface exposed, and  rapidly apply the
flannel as hot  as can be  borne.  Over this place
another piece of dry flannel which has been heated
quite hot and folded like the first one.  If desirable,
a bandage may be brought around to secure them
in position.   As  soon as  the inner flannel, which
was dipped in the whiskey, has become somewhat
dry, another  cne should be  prepared at once and
applied  in its stead.

                TURPENTINE STUPE.
  A turpentine stupe is made by wringing a piece
of old flannel out of hot water and sprinkling a few
drops of  warm  spirits of  turpentine  on it.  It
should be covered with oil-silk while  applied, and
removed when  sufficient irritation of the surface is
produced. 
286        HYGIENE OF THE  NURSERY.
          ADMINISTRATION OF MEDICINE.
  The administration of medicine often  requires
considerable  skill, and  is a  task  in  which more
clumsiness than tact is often exhibited.  Teach the
nurse that a child cannot swallow so long as the
spoon is between the teeth, but that it is advisable
to depress the tongue a brief moment and withdraw
the spoon as soon as emptied.
   Should the child rebel, there are many ways by
which he  can be diverted, so that  he shall swallow
his medicine before he  knows it.   Also, should he
have a fondness for  any especial thing, such as
sugar, jelly, etc., the taste of the medicine may be
quite hidden by mixing it with the thing  he loves. 
INDEX.
A.
                 B.
Baby band, 90.
      jumper, dangers of, 113.
      powder, 134.
Baby's basket, the filling of, 87.
      carriage, no.
Barley jelly,  233.
        and milk, 198.
    water, 232.
Bath apron, 131.
    best hour for, 132.
    blanket, 145.
    bran,  146.
    cold, 129, 143.
     Bath, cooled, 143.
        hot, 145.
        mode of giving, 132.
        mustard, 146
        salt water, 146.
        sea, 140.
        soda, 146.
        table, 127.
        temperature of, 129.
        the initial, 126.
        thermometer, 130.
     Bathing, 125.
        suit, 141.
        utensils, 127.
     Bed coverings, 123.
        separate, 122.
        wetting the, 42.
     Beef  essence, 223.
        juice (raw), 197, 224.
        raw, 224.
        tea, 221-222.
            and brandy enema, 235.
            peptonized, 219.
     Beer, 212.
     Bicycles, dangers of,  118.
     Binder, the, 90.
     Birth, injuries received during, 249.
     Blanc mange, 227.
     Bleeding from the navel string, 250.
        from the nose, 252.
     Body clothing, 91.
        temperature, 49.
     Boots, rubber, 105.
     Botile tip, 204.
     Braces, 115.
     Brain, " water on the," 22.
     Bran  bath, 146.
     Bread poultice, 282.
     Breast milk, quality of, 170.
            specific gravity of, 169.
     Breasts, swelling of, 250.
     Breathing, accelerated, 44.
        diminished frequency of, 45.
     Broth, chicken, 225.
        mutton, 226.
        veal, 226.

287
Abdomen, depression of, 23.
    distention of, 23.
Abdominal belt, dispensing with, 103.
Abnormal depression of temperature,
    53-
Accidents at birth, 249.
    in childhood, 256.
Air, importance of  fresh, 109.
Ale, 161.
Ammonia, 79.
Amusements, 107-116.
Anaemia,  53.
Analysis of cows' milk, 172.
    of human milk, 170.
    of peptonized milk, 192.
Ankle, pressure about the, 101.
Aphthae, 56.
Appetite, 36.
    loss of", 37.
Applications, dry heated, 284.
Apron, the bath, 127-131.
Arrowroot food, 213.
    pudding, 227.
Artificial feeding, 167.
Asses' milk, 171.
Atmospheric air, the amount required
    for each child, 65.
Author's sterilizer,  193. 
288
INDEX.
Brows, contraction of, 19.
Bruises, 256.
Burns and scalds, 259.
                 C.

Cans for milk, 207.
Cap, 103.
Capacity of stomach, 178.
Caraway water, 231.
Carriage, proper kind of, no.
Castile soap, unscented, 130.
Cereals, 176.
Charcoal poultice, 282.
Lhavasse s milk food, 214.
Cheese poison, 208.
Cheyne-Stokes' respiration, 45.
Chicken broth, 225.
Child, position of, while being fed, 205.
Childhood, 18, 210.
Chill, a, 274.
Chorea, 245.
Cinchona, ferrated elixir of, 161.
Clear brown soup, 224.
Cleft palate, 254
Clinical thermometer, 45, 49.
Clothing, 85.
    change of, 106.
    shortening of, 93.
    warmth of, 80.
Coated tongue, 56.
Cold bath, 143.
    cream, 135.
    pack, 144.
Colds, 266.
Cold-water dressing, 284.
Colic, 154, 243, 267.
Colostrum,  151.
Compresses, 146
Condensed milk,  174, 186, 214.
Consomme, 225.
Constipation, 242, 268.
Contagion from milk, 208.
Contagious  disease, 277.
Contraction of brows, 19.
Convulsions, 19, 32, 274.
Cooled bath, 143.
Corsets, 115.
Cough, 34.
Cows, care of, 206.
Cows' milk, analysis of,  171.
Creeping, 112.
Crib, 122.
Cry of hunger, colic, etc., 33, 154.
Crying, 33.
    variations in  disease, 33,
Cuts, 258.
Deformed head, 21.
Dentition, 56.
    abnormal, 58.
    delayed and difficult, 58.
    second, as a cause of ill health, 61.
Development, 23.
    examples of variations in disease,
      3°-
Diagram showing relative stature, 27.
    showing  eruption  of  milk teeth,
      57-         .   .
    showing  relation between perma-
      nent and temporary teeth, 61,
Diarrhoea, 40.
Diet during the first four weeks, 177.
       the first week,  182.
       tenth and eleventh months,i85.
     from  the second to  the  sixth
          week, 182.
       the sixth week to  the end of
          two months, 182.
       the third to  the sixth month,
          183.
       the  seventh  to   the   ninth
          month, 184.
       the twelfth to  the eighteenth
          month, 198.
       eighteen months to two and a
          half years, 199.
       three and a half years up, 270.
    up to three and  a  half years, 199.
Dietary, 213.
Diseases, contagious, 277.
Disinfection, etc., 277.
Donkey, a, 114.
Drawers, separable, 94.
Dress, or slip, 91.
    night, 101.
Dressing gown, 102.
Drinking, 35, 200.
Drowsiness,  long-continued, 32.
                E.
Ear-ache, 32, 265.
Ear, foreign bodies in, 261.
Early rising, 121.
Ear tabs, 105.
Ears, water in, 133.
Effervescing milk punch, 218.
Effleurage, 237.
Egg and brandy, 230.
Emergencies, 248.
Enemata nutritious, 234.
Eructation of milk, 37.
Eruptive fevers, table of, 276. 
INDEX.
289
Essence of beef, 223.
Evacuations, faecal, 39.
Excoriations, 90.
Exercise, the infant's first, 108.
    out-door, 109.
Extract of malt, 161.
Eyeballs, oscillation of, 19.
Eyes, change of color of the, 30.
    foreign bodies in the, 262.
    inflammation of the, 253.
    lividity of the lids, 21.
Eyelids, incomplete  closure of, 18.
    twitching of, 19.
                 F.
Face, the, 18.
  •  congested or blackened, 238.
    examples of variations in disease,
      18.
Faecal evacuations, general characters
    of, 39-
Faeces, retention of, 252.
False palate, 255.
Farinaceous food, 176.
Features of health, 17.
Feeding, artificial, 167.
    by a wet-nurse, 164.
    from the maternal breast, 150.
    general rules for, 179.
    with cup or spoon,  158.
Fender, 73.
Fever, 47, 56, 275.
Fevers, table of eruptive, 276.
Feet, cold, 95.
    shape of, 97.
Filtered water, 212.
Finger nails, care of, 148.
Fireplace, open, 72.
Fissure of  nipples, 161.
Flannel dipped in spirits, 285.
Flaxseed tea, 231.
    poultice, 281.
Flour ball, 232.
Fontanelle, conditions of, 21, 22, 23.
    when it should close, 30.
Food, 150.
    arrowroot, 213.
    Chavasse's milk, 214.
    farinaceous, 176.
    fried, 211.
    milk, 213.
    milk sugar, 215.
    milk and white of egg, 215.
    quantity per diem, 177.
Foods, peptonized, 216.
Foot-bath, mustard, 146.
Foreign bodies in the ear, 261.
Foreign bodies in the eye, 262.
        in the nose, 263.
        in the throat, 263.
Fractures, 257.
Friction, 237, 240.
Fumigation, 279.
                 G.

Garments, method of fastening, 72.
Garter, 95.
Gastric juice, 173.
Gelatine, 232.
    and milk, 228.
Goats" milk, 171.
Gown, dressing, 102.
Graduated nursing bottle, 203.
Growth, 23, 27, 28.
Gruel, oatmeal,  229.
                H.
Habitual constipation, 256, 268.
Hair, change of color in, 30.
    falling out of, 149.
    tonic, 149.
Hand, carrying of, to head or mouth,
  32.
Hard palate, 55.
Hare-lip and cleft palate, 254.
Hat, light straw, 103.
Head, shape of, 21.
        after prolonged labor, 249.
    squareness of, 22.
    when it can be held erect, 29.
Health, the features of, 17.
Healthy skin, characters of, 20.
Hereditary  tendency, 249.
Hoarseness, 34.
Hominy grits, 228.
Horlick's Food, 181.
Hot bath, 145.
Hot-water dressing, 284.
Human milk, analysis of, 170.
    substitutes for, 196.
Humanized milk, 220.
Hunger, 36.
Hydrocephalus, 22.
Hygiene of the Nursery, 17.
                 I.
Ice water, 118.
Infancy, definition of, 17.
Infant, development of the, 25.
    drying of the. 133.
    fed upon condensed milk, 175.
19 
29O                            INDEX.
Infant foods, 176.
    initial bath of, 126.
    overfed, 178.
    position of, while feeding, 205.
    rocking of, 124.
    the hardening of an, no.
    the jolting of an, 109.
    when able to sit up, 108.
        creep, etc., 108.
Inflammation  of the eyes, 253.
Injuries received during birth, 249.
Insects, stings of, 249.
                 J.
Jacket poultice, 281.
Jaundice, 19, 21, 43.
Jeily, sago, 230.
Junket, 228.
    with egg, 228.
                 L.
Lactation, 152.
Lactometer, 172.
Leggings, 103, 105.
Legs, bare, 85.
Light, night, 67.
Lime, saccharated solution of, 181.
    water, 180, 233.
Lips, lividity of, 21.
                 M.

Malt extract, 161.
Mammary glands, inflammation  of,
  253-
Manna, 273.
Manners, 115.
Massage, 236.
    a frictions, 237.
    dry, 238.
Mattress, 122.
Meals, preparation of, 205.
    regularity of, 153.
Meat broths. 221.
    enema with pepsin, 235.
Medicine, administration of, 286.
    closet, contents of, 71, 72.
Meigs' Food, 215.
Mellin's Food, 181.
Menstruation, recurrence of, 163.
Milk and barley jelly, 198.
    and cinnamon, 234.
    and gelatine, 228.
    and oatmeal, 215.
Milk and white of egg food, 215.
    asses', 171, 187.
    boiled, j86,
    breast, 169.
        examination of, 171.
        regulation of the flow of, 152.
        scanty secretion of, 160.
        specific gravity of,  169.
        substitutes for, 171.
        to  ascertain  the   quantity
          sucked, 166.
    cows', 171.
    condensed, 174.
    food, 213.
    goats', 171, 187.
    humanized, 191, 220.
    keeping of, 2 7.
    mixed, 206.
    peptonized, 188, 216.
        analysis of, 192.
    poisoning, 208.
    powder, peptogenic, 192.
    predigested, 188.
    punch, 218.
        effervescing, 218.
    sound, 206.
    sterilized, 192.
    sugar, 215.
    teeth, 56.
    transportation of, 207.
Mind, cultivation of, 116.
Morals, general, 116.
Mouth, examination of, 54.
    inflammation of, 56.
    mucous membrane of, 55.
Mustard bath, 146.
    plaster, 283.
Mutton broth, 226.
                 N.

Nap, the morning, 120.
Napkins, 89.
Navel string, 250.
Neurasthenia, 246.
Newly-born  infant,  length,  weight,
  etc., 24.
Night dress, 101, 105.
    light, 67.
Nipple, fissures of, 161.
    protector, 162.
Nose, 19.
    bleeding from the, 264.
    foreign bodies in the, 263,
    rubbing of the, 32.
Nostrils, sharpness of, 19,
Nursery, 62. 
INDEX.                            29I
Nursery, cleaning the, 78.
    floor of the, 68.
    furnishing ot the, 70.
    heating of the, 72.
    height of ceiling of the, 66.
    hygiene of the, 17.
    lighting of the, 66.
    night, 62.
    situation of the, 63.
    size of the, 65.
    temperature of the, 72.
    ventilation of the, 73, 77.
    walls and ceiling, 69.
Nurse-maid, 80.
    cleanliness of, 84.
    face of, 82.
    selections of, age, etc., 81.
Nursing bottle, graduated, 203.
        tip, 204.
        bottle tip, for cleft palate, 255.
Nutritious enemata, 234.
                 o.
Oatmeal gruel, 229.
    water, 233.
Oral mucous membrane, 54.
    respiration, 45.
Overcoat, 105.
Oyster soup, 226.
Oysters, peptonized, 219.
Oxide of zinc ointment, 135.
                 P.

Palate, false, 255.
    hard and soft, 55.
Pancreatin, 188, 191.
Paralysis, infantile, 944.
    facial, 246.
Passages, character of, 40.
Pearl barley jelly, 233.
Peptogenic  milk powder, 19a.
Peptonized  beef tea, 219.
    food, 216.
    milk, 216.
    milk gruel, 218.
    milk punch, 218.
    oysters, 219.
Petrissage, 237.
Phosphate of sodium, 261.
Physiological  action of massage, 238.
Pictures in nursery, 69.
Pillow, the, 123.
Plasters, mustard, 283.
Plasters, spice, 283.
Piatt's chlorides, 70.
Play, 118.
Pleuritic effusions, 247.
Position and gestures, 31.
Pony, the, 114.
Poultices, 281.
    jacket, 281.
Powder, baby, 134.
Predigested milk, 188.
Pregnancy, occurrence of, 163.
Prepared chalk, 147.
Protector, nipple, 162.
Puberty, 137.
Pudding, arrowroot, 227.
    rice, 229.
    tapioca, 230.
Pulse, the, 46.
Pyramid night light, 67.
                 R.
Raw beef, 222.
        juice, 197, 224.
Reaction of cow's milk, 171.
    of human milk. 169.
Regurgitation of milk, 37.
Rennet, 173.
Respiration, 43.
Retention of fxces and of urine, 252.
Retiring, 121.
Rice milk, 229.
    pudding, 229.
    water, 233.
Rickets, 22, 32, 164.
Riding, 114.
Rising early, 121.
Rocking baby to sleep, 124.
Roller skates, 118.
Roof  of the mouth, 55.
Rubber cloth, 93,102.
Rules for feeding, 179.
                 S.
Sago jelly, 230.
Saliva, secretion of, 30.
Salt-water bath, 146.
Scalds, 259.
Scalp, swelling of, 250.
Sea-water baths, 140.
Second summer, dread of, 61.
Secondary bleeding from  the navel,
  251.
Shirt, night, 105.
Shoes, 96. 
292
INDEX.
Shoes, bedroom, 102.
    knitted, worsted, 89.
Short stockings, dangers of, 86.
Sick room, disinfection of, 277.
Skates, roller, dangers of, 118.
Skin, general appearance of, 19.
    of healthy child, 19.
    yellow staining of, 252.
Sleep, 119.
    variations in disease, 32.
Soap, Castile, 130.
    suppositories, 273.
Soda bath, 146.
Solution of lime, saccharated, 181.
Sore nipples, 162.
        prevention of, 162.
Sound milk, 206.
Soup, clear brown, 224.
    oyster, 226.
Spine, curvature of, 108.
Spinal irritability, 246.
Sponge, 130.
Sprains, 257.
Squinting, 19.
Starch gruel, 197.
Sterilizer, 193.
Stick for cleaning teeth, 147.
Stimulants, 161.
Stings of  insects, 261.
Stockings, 95.
Stomach,  capacity of, 178.
Strippings, 187.
Study,  too much,  116.
St. Vitus's dance, 245.
Substitutes for human milk, 171.
Suck,  manner of giving, 152.
Sugar of milk, 180.
Swallowing, 35.
Swelling of the breasts, 253.
Swimming, 14c.
Syphilis, 82.
Syringe for constipation, 270.
    nutritive enemata, 235.
                 T.

Table, the bath, 127.
    of the eruptive fevers, 276.
    showing increase in length, 24.
    showing increase in weight, 25.
Tapioca, 230.
Tapotement, 238.
Tea, 212.
Tears, secretion of, 30.
    suppression of, 34.
Teeth, care of, 147.
    children born with, 58.
Teeth, milk, 56.
    permanent, order of eruption, 60.
    premature appearance of, 58.
    stick for cleaning, 147.
Teething, increase of saliva in, 57.
    pauses in, 57.
Temperature of bath, 142.
    manner of taking, 48.
    normal, 52.
Thermometer, bath, 130.
    clinical, 49.
Throat, examination  of, 54.
    foreign bodies in the, 263.
Toes, normal position of, 97.
Toe nails, care of, 104.
Tongue, the, 55.
    coated, 56.
Tongue-tie, 255.
Tonsils, 32, 55.
Tooth brush, 148.
Towels, bath, 131.
Toys, 70.
Treatment of fissure of the nipple, 16:.
Turkish towels, 138.
Turpentine stupe,  285.
Twitching of eye lids, 19.
Tyrotoxicon, 208.
                 u.
Ulceration of the navel, 251.
Underclothing, woolen, 103.
Urination, painful, 43.
Urine, the, 41.
    amount voided in 24 hours, 42.
    high colored, 42.
    incontinence of, 42.
    retention of, 252.
    smoky, 43.
    suppression of, 42.
Uvula, the, 56.
                 V.

Variations in disease, 21.
Veal broth, 226.
Ventilation, 65, 73.
Ventilator board, 77.
    wheel, 76.
    window,  75.
Vernix caseosa, 126.
Voice, 33.
    variations in disease, 33.
Vomiting, 38, 266. 
                w.
Walking, delay in, 31.
Walks, 114.
Waste pipe, disinfection of, 78.
Water, filtered, 200.
    in the ears, 133.
    on the brain, 22.
Weaning, 156
    manner of, 157.
    premature, 159.
    sudden, 159.
Weather, cold, 105.
    damp and  rainy, 105.
Weight, table  showing  increase
  »5-
INDEX.                            293
Weight, yearly gain of, 25.
Wet-nurse, 164.
    selection of. 165.
Wetting the bed, 42.
Whey, wine, 231.
Window ventilator, 75.
                 Y.
Yawning, 45.
Yellow staining of the skin, 252.
Zinc ointment, 135. 
 
 
 
 
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