transcriber's note: every effort has been made to replicate this text as faithfully as possible, including inconsistencies in spelling and hyphenation; changes (corrections of spelling and punctuation) made to the original text are listed at the end of this file. ] united states. department of labor children's bureau publications no. 303-308 washington, d. c. 1944 if your baby must travel in wartime [illustration] if your baby must travel in wartime have you been on a train lately? the railroads have a hard job to do these days, one they are doing well. but before you decide on a trip with a baby, you should realize what a wartime train is like. so let's look into one. this train is crowded. at every stop more people get on--more and still more. soldiers and sailors on furloughs, men on business trips, women--young and not so young--and babies, lots of them, mostly small. the seats are full. people stand and jostle one another in the aisle. mothers sit crowded into single seats with toddlers or with babies in their laps. three sailors occupy space meant for two. a soldier sits on his tipped-up suitcase. a marine leans against the back of the seat. some people stand in line for 2 hours waiting to get into the diner, some munch sandwiches obtained from the porter or taken out of a paper bag, some go hungry. and those who get to the diner have had to push their way through five or six moving cars. you will want to think twice before taking your baby into such a crowded, uncomfortable place as a train. and having thought twice, you'd better decide to stay home unless your trip is absolutely necessary. but suppose you and your baby _must_ travel. well then, you will have to plan for the dozens of small but essential things incidental to traveling with a baby and equip yourself to handle them. going by train? unless you appreciate the fact that babies and toddlers are very special people with very special requirements, you are in for a lot of trouble if you attempt a train trip with them. planning should be done well in advance. [illustration: take only what you must] you will need to make your train reservations early. select the first or middle of the week for traveling. stay off trains on week ends or holidays. travel then is like a bargain-counter rush. travel arrangements of any kind are hard to make nowadays. railroads are geared to military needs and civilians take what is left over. if you are going on a very long trip, try by all means to arrange for a stop-over or two with relatives or friends. it will give you a chance to rest and get things in order again. when you travel by coach. if you are traveling by coach, let us hope you are in one of the up-to-date coaches with comfortable reclining seats rather than in one of the not-so-modern coaches found on other trains. if it is a de luxe coach and if your child is 2 or 3 years of age, you may be able to get a seat reservation for him. otherwise you will have to hold him on your lap. remember, too, if you have trouble, that the travelers aid is always willing to help. its workers can help you locate friends or relatives. they can help you if you lose your tickets or your money, or if any similar emergencies occur while you are en route. they can get a doctor for you if you or your baby become ill. they can tell you of good restaurants to eat in or of places where you can rest or feed your baby. you can even arrange by telegram with the travelers aid to have someone meet you at the station from which you are leaving or at which you are arriving to help you. if you are a serviceman's wife, the uso can help you, too. _plan well and travel light._--after you have made all your travel arrangements, gather your forces at home. write out in detail your youngster's schedule and list the food, clothes, and other supplies needed. travel light, so far as your own personal belongings are concerned, lighter than you've ever imagined you could. your aim is to take on the train enough for essential comfort and not one item more. limit yourself to one dark dress or suit. many mothers have found an apron a convenience, one that could be slipped over their dresses when they were caring for their babies. additional clothing for yourself can be checked and sent on ahead. _clothes, diapers, and such._--carry an abundance of changes for the baby or toddler. but plan to dress him simply in clothes that are easy to put on and take off. remember weather may change and many trains are air-cooled. so take along a warm outer garment, preferably a sweater, and a blanket for the baby. unless your baby has completely mastered the art of keeping dry, use disposable diapers if you can possibly get them. if you cannot get them, then the next best bet is a supply of standard diaper linings--specially treated papers about the size of ordinary cleaning tissues, used with cloth diapers. many mothers prefer to use cloth diapers at night. some babies become badly chafed if only paper diapers are used. used cloth diapers can be wrapped in wax paper and repacked in your suitcase or put into a waterproof bag. if your baby is sufficiently trained to use his own toilet seat, by all means take it along. he is less likely to be frightened if there is this one familiar thing in his strange surroundings. some toilet seats come with a carrying case. if the one you have did not, then use a canvas laundry case or a shopping bag for this purpose. pack the baby's clothes, diapers, and blankets into a special suitcase or bag. keep it unlocked and easily accessible on the train. _milk for the baby._--if your baby is breast-fed, feeding him is relatively easy. food for babies who are not breast-fed presents a difficult problem. [illustration: week ends are worst] [illustration: trouble ahead!] for traveling, the simplest formula is one of evaporated milk. milk can be obtained in small cans, and an individual feeding can be made up when feeding time comes. then no refrigeration is needed. for such a feeding you will need to carry the following equipment, all of which should be assembled in one container, such as a heavy shopping bag or a medium-sized duffle bag: _bottles and caps_--boiled and ready for use. take enough for all feedings during the trip, plus some extras for water. wrap each bottle separately. _nipples_--boiled and put in a boiled jar with a lid. _can opener_ (or some other instrument to open small cans of evaporated milk). _milk in small cans._ the cans should be washed off before you leave home. _vacuum bottle containing boiled water._ sugar or syrup may be added to the water if desired. _funnel_--to put water into bottles. this should be boiled and wrapped in clean paper. if your baby has not been on evaporated milk, and your doctor agrees that it is satisfactory for him, you should introduce him to it, several days or even a week before you start on your trip if he gets used to new things slowly. before you leave home, you can prepare the mixture of hot boiled water, with or without sugar or syrup, and carry it in a vacuum jug on the train. then mix this mixture and the evaporated milk as you need it. your doctor will tell you the correct proportions. usually the hot water in the vacuum bottle, when added to the milk, will make the feeding the right temperature for the baby. carry small cans of milk, using whatever is needed for one feeding only. perhaps you can drink what is left in the can yourself or give it to a fellow traveler. do not save it to use later. the one thing you cannot do is to run the risk of giving your baby contaminated or sour milk. _never attempt to carry the milk warm in a vacuum jug._ if you do, the bacteria that are present in milk will multiply many times, with the result that when the milk is fed to the baby, it will make him sick. you can carry boiled nipples in a jar, as already suggested, or you can use nursing bottles with caps that make it possible to reverse the nipples into the bottle and thus keep them sterile. _water for the baby._--for baby's protection, it is very important that you do not give him water that has not been boiled. usually it is better to take several bottles of boiled water from home even though you may find it possible to obtain boiled water on the train. or plan to use the boiled water from the vacuum jug. _other food for the baby._--orange juice and cod-liver oil usually cannot be carried conveniently. there is no harm in letting your baby go without these during the time when you will be traveling. unless your baby is on a special diet, don't load yourself down with canned foods under present traveling conditions. your baby can get along for a few days on his milk. plan to use as little food as you think you can get by with. if your baby is a hearty eater and you fear that he will miss his cereal, then carry dry ready-prepared baby cereal, to which you can add hot water from the vacuum bottle. you will need to take a dish and a spoon in the shopping or duffle bag. foods that require heating will have to be omitted. some children do not object to cold food. if yours does not, and if he has a big appetite, you can take canned vegetables or fruits, which he can eat from the can. take rusks or crackers along for emergency use. in planning these solid foods, remember that nothing can be heated except by the addition of hot water from your vacuum jug, and that no utensils can be washed on the train. [illustration: boys in the bleachers] _food for young children._--meals for toddlers are not so much of a problem as meals for babies are. packing a lunch of customary foods will not be difficult for the short trip. this may include bread-and-butter sandwiches, wrapped in wax paper; cookies or crackers; canned tomato or fruit juice; and canned evaporated milk. (several large paper bags to be used as "waste baskets" are a convenience.) but for a long trip you may have to rely on getting your meals in the diner even though this is more expensive. some railroads, however, don't serve meals to civilians until after servicemen are fed, so you may need to take along some food even though you are planning to use the diner. be sure to go to meals early. most little children are thrilled at the idea of eating on the train and tell about the experience for many days afterward. for a toddler's diet the railroads even now can usually supply cooked cereals, baked potatoes, green vegetables, well-cooked meats, fruits, and milk. some dining cars provide half portions for children, but if they don't, no one will object if you order a meal for yourself and give part of it to junior. but in case you are unable to get into the diner, it is wise to take some simple things for your toddler and yourself to eat. [illustration: fun in the diner] _keeping baby clean._--mothers sometimes attempt to bathe babies on a train in the washroom basins. don't do it. it isn't sanitary. it is better to let your baby go unbathed during the trip than to run the risk of infection. clean his face and hands off with cold cream and cleansing tissues and let it go at that. [illustration: solid food and solid comfort] when changing diapers, use oil and cotton and cleansing tissue. change the baby where he lies instead of trying to take him back to the dressing room. keep handy at all times a small emergency diaper kit in a rubber-lined bag, so you can stop anywhere and take care of the baby if necessary. _keeping baby comfortable._--adjustable canvas seats are available, chiefly for use in automobiles, but they are very helpful for train travel, too. they are light and can be folded and put in a suitcase. some come in their own carrying cases. they give the child a restful change from the car seat. _sleeping in the coach._--if you travel by coach, the chances are you are going to have to sleep with your baby cradled in your arms. you may be able to rent a pillow, which will make the night more comfortable for you and your baby. in most coaches lights are turned down at night and often babies sleep undisturbed. the night trip will be harder on you than it is on the baby. when you travel by pullman. there is far more space and better service in pullman accommodations, and if there is any way that you can manage to have them, you should do it for your own and your baby's sake. accommodations on the pullman are worth the extra cash, if you have the cash. even though you may be unable to reserve a lower berth in advance, it may be possible to arrange with the pullman conductor to exchange your upper for a lower. the greater convenience of a lower berth is worth the extra cost. if your baby is very tiny (under 3 months), he can travel by basket if you go by pullman. for your baby's food, it is wise to use an evaporated-milk formula as described on pages 6 and 9. for any type of travel this formula is probably the safest and the easiest. for a short daytime trip or an overnight trip, you may be able to arrange ahead of time to keep the bottles in the refrigerator of the dining car. if you do so, you must be very sure, though, that the dining car is not to be taken off the train at any point before you reach your destination. if you can safely use the refrigerator of the diner, you can prepare your feedings before you leave. chill them thoroughly, carry the bottles containing the milk mixture in your sterilizer, and as you board the train, hand it to the porter to put into the refrigerator. when baby is ready for food, the porter will heat a bottle and bring it to you. don't forget to include a few bottles of boiled water in your quota of bottles. if you are traveling in the pullman, you can put the baby or young child to bed at his regular time and expect him to sleep soundly until morning. [illustration: don't do it! it isn't sanitary!] [illustration: it's harder on you] if your baby is very young, you may use the basket for sleeping purposes. berths are wide and long and you can keep the baby, basket and all, with you at night. change and feed the baby in the berth each morning before getting him up. put the older child in the half of the berth next to the window, carefully padding the window sill and window with a pillow to prevent head bumping and in winter to keep the youngster warm. carry along a waterproof sheet to give the porter when he makes up the berth. if the child is under 4, this is a wise precaution even though he may be perfectly trained at home. entertaining the young child. little children get tired on a long trip, and who can blame them? you can keep them entertained if you take along a few carefully selected toys: colored crayons, pencils, tablets, a favorite doll, and story books. a familiar toy should be included, as new ones are not so comforting. children like books under such circumstances, and you should have several small ones with you. books about trains and engines will be good fun. keep a small toy or two in your purse for odd moments--when you are waiting for your meal in the diner, for example, or when you are waiting for a train. it is a good plan to have a pencil handy and paper for you to draw on to amuse your youngster, or for him to scribble on if he is old enough. another good thing to have with you is a small cloth picture book that can be rolled up into a compact cylinder. fellow travelers. most people like children, so don't get too upset if jimmy talks with his fellow passengers. many grown-ups find an alert, friendly child a delightful diversion on a long and tiresome trip. almost always when you tell the person to whom the child is talking, "send jimmy back if he annoys you," you get the assurance, "he's perfectly all right. i enjoy talking to him." accept such statements at their face value. don't cramp jimmy's style "in winning friends and influencing people." there are times, although they will be rare, when you may need to curb jimmy's friendliness--when he shows too much interest in an obviously undesirable or uninterested person. bring him back to your seat to hear a story or to eat an apple and then keep him busy until he forgets about the stranger. [illustration: too much is enough] [illustration: a time to make friends] you will need to keep your eyes glued on overfriendly grown-ups who in a burst of enthusiasm may give your youngster candy or other undesirable food. many adults are thoughtless about food for children, and if you are unfortunate enough to meet one of these individuals, you will need to be tactful but firm. you can't afford to run the risk of having a sick child. many times people will offer to carry your suitcase, to watch one child while you attend to another, to carry your toddler into the dining car, or to keep an eye on your sleeping baby while you go to the rest room. [illustration: journey's end] use good judgment about accepting such offers to help you. they are usually made in good faith and with the best intentions in the world. and you'll certainly need some help if you're traveling with a youngster in these days of overworked train crews and few redcaps. but don't ever leave your baby with a stranger in a railroad station, and do hesitate to leave him with a total stranger on the train. don't leave him for very long with anyone; he may be frightened when you go away. don't trust your baby to anyone who has a cold or any other visible illness that the baby might catch. going by bus? as a rule busses are even more crowded than trains, and there is far less space. and traveling by bus with a baby or young child requires even better planning than travel by train. there are a few things you will need to know about bus travel before you start out. busses make 15-minute rest stops every 2 hours and 40-minute to 1-hour stops three times a day for meals. any child who occupies a seat is required to have a half-fare ticket even though he is under 5. by all means plan your trip for the first or the middle of the week, avoiding the week-end travel peak if at all possible. if you are going on a long trip, plan stop-overs that will break your journey. everything that was said about clothes, supplies, and equipment for traveling by train coach will be needed when you travel by bus. if anything, your things will need to be packed even more compactly. if your baby is breast-fed, traveling will be easier than if he is not. you will need to plan with your doctor about putting your baby on an evaporated-milk formula if he is bottle-fed. remember, too, that you will have to count on preparing his feedings during rest and meal stops. emergency supplies of food for yourself and your young child will be necessary even though you hope to buy your meals on the way. restaurants in bus depots are overcrowded and you may not be able to get food in the time you have. for a short trip you had better plan on carrying food for yourself and your youngster. going by car? families going to strange cities to establish new homes are still able to obtain gasoline with which to travel by car. a few tips on automobile travel may therefore be of value. proper care of your baby when traveling by car can be summed up in this way: clean milk, clean water, clean food, and as little change as possible from the regular schedule to which he is accustomed. most young children enjoy riding in an automobile although they do get tired and bored on long trips. there are many things that you can do to make traveling by car easier. when your baby is small, take him in his carrying basket, if you have one, and put him on the back seat in a coach or sedan or on the back ledge of a coupe, if it is wide enough. small canvas hammocks that fasten onto the back of the front seat may still be available and are a real boon to the baby who must travel. if your baby's crib fits into the back of the car, you will have it ready for him to sleep in when he reaches his new home. when your baby can sit up, there are canvas seats available that hook over the top of the car seat. these will keep the child comfortable and erect and allow him to look out the window without stretching his neck. the young child can take his afternoon nap stretched out on the back seat and covered with a light robe or coat. plan your packing of luggage with this in mind. the baby's food must loom large in your plans if he is not breast-fed. you will either have to find a place each night where you can prepare his feedings and devise a way for keeping them on ice and heating them while you travel, or you will have to put the baby on the evaporated-milk formula described on pages 6 and 9. if you plan to prepare his usual feedings you must take along all the equipment to do it. small portable stoves using canned heat can be used to heat the feeding, or you can stop in restaurants and ask a waitress to have the bottle heated for you. the important thing is to have a feasible plan worked out for doing it. cereal, canned food, and oranges may be obtained along the way. when stopping for meals, be sure to select good places where well-cooked food can be obtained for young children. be certain that the milk served the youngsters is pasteurized. and insist that the milk be served directly from the bottle (opened at the table). order sensibly for the children, getting them the same type of meal you would supply them at home. by all means carry your own water, and for the baby or young child it should be boiled. give the youngsters a drink from your own supply before stopping for food. don't let them drink water from drinking fountains, hotels, or tourist homes. this does not mean that the water may not be all right; it is merely a precautionary measure against digestive upsets. if you are traveling by car, you will be able to take along the baby's own toilet equipment, and remember to carry it with you into rest rooms, hotels, or tourist homes. don't attempt to drive too many miles in one day when a baby is a passenger. babies require many stops, and rest periods for a toddler should be frequent. plan to stop each night by 5:30 or 6 o'clock. this will give you time to select a hotel or tourist room and get the baby or toddler comfortably to sleep by his usual bedtime. if toddlers are part of your carload, you will have amusement problems. gather together a number of small toys and place them in a box of their own. if yours is a two-seated automobile, allow the youngster to change his seat often. sometimes he will enjoy riding in the front seat; at other times he will want to play with his toys or take a nap in the back seat. it will help to keep him amused if you can think up stories to tell him about the things he sees along the way--the children, the cattle, the trains, and the factories. songs you know by heart will be used many times over, too. * * * * * a job this traveling with babies in wartime! certainly not something to attempt lightly. but if you must travel with your baby, you'll be doing a real war service if you make it as painless as you can to the transportation system, your baby, and yourself. the bureau gratefully acknowledges the work of mr. gluyas williams, who illustrated this booklet as a contribution to the war effort. united states department of labor frances perkins, _secretary_ children's bureau katharine f. lenroot, _chief_ children in wartime no. 6 bureau publication 307 for sale by the superintendent of documents, u. s. government printing office washington 25, d. c. price 5 cents [ transcriber's note: the following is a list of corrections made to the original. the first line is the original line, the second the corrected one. days or even a week before you start on your trip if he get used to new days or even a week before you start on your trip if he gets used to new ] frontispiece. to "rhymes for harry and his nurse-maid". [illustration: nursery furniture. _pa 21._] [illustration: a simple tale will oft prevail, when sober prose is spurn'd; the charm of rhyme beguiles the time, and still a lesson's learn'd. ] rhymes for _harry_ and his nurse-maid. a simple tale will oft prevail, when sober prose is spurn'd; the charm of rhyme beguiles the time, and still a lesson's learn'd. thus lines for youth, in simple truth, we never will despise; for maxims old, tho' frequent told, may still assist the wise. london: william darton and son, holborn hill. preface. it is with feelings of great humility, from a sense of her own deficiency in the important duties of a mother, that the writer of the following rhymes submits them to the public. her wish is to convey a few useful hints to nurse-maids, as well as to those mothers who have had but little experience in the care of children. many young mothers, more especially in the middle circles of life, have scarcely leisure to make education a study; while others, perhaps, do not reflect on the very great importance of early habits; to such persons, the few practical observations contained in the notes, may not be unacceptable. the subjection of the will, in the first place, by _mild_ yet firm and persevering conduct, will generally ensure success to the parent, and will save the child _hours_ and even _days_ of fretfulness and sorrow. the employment of a nurse-maid is a responsible one; those who really perform their duty from pure and conscientious motives, will not lose their reward; and though such may feel _themselves_ to be placed in a very humble situation, they are, in reality, laying the foundation for future happiness or misery. in the first three years of childhood, that basis is often formed upon which the conduct of future life is built. if self-will, and a spirit of contradiction, be allowed to take deep root in the infant mind, divine grace _only_ can counteract their evils. but, on the other hand, if good feelings be cherished, and the evil passions (which _all_ have more or less, by nature,) be gradually subjected, early blossoms of virtue will appear; and, by the blessing of providence, those beautiful fruits will be matured, by which the tree may be known to be good; and by which, from the cradle to the grave, the designs of the benevolent creator will be accomplished. [illustration: nurse's first thoughts about her baby. _pa 7._] [illustration: finding a pin which had pricked baby. _pa 8._] the writer only wishes to say, that these rhymes were undertaken at the particular request of a valued friend of hers, who has bestowed much of his time, with truly benevolent intentions, in adding to the instruction and amusement of the rising generation; and she cannot but acknowledge the obligation she feels for the kind assistance he has lent her in several of the subjects which occupy the following pages. the design of the writer is, that _each piece_ shall convey some hint which may tend to the physical or moral advantage of the child, in those duties which immediately devolve upon a mother, and her nurse-maid; so that, while they are amusing their little ones with the recital of a simple narrative, adapted to the most humble capacity, they may sometimes be pleasantly reminded of their own obligations. m. a. rhymes, &c. nurse's first thoughts about her baby. little baby, just new born, naked, trembling, and forlorn, my hand the willing help supplies, to ease thy pain, and soothe thy cries; nor can i tell thee little dear, how much we're pleased to see thee here. o, it will be my sweet delight to serve thee with this milk so white! but tho' my babe so nicely feeds, i'll only give just what it needs; if i the spoon too often fill, 'twould make my baby sick and ill. mamma too will be able soon to feed her babe without a spoon, and _that_ we know is better far than milk and barley-water are. finding a pin which had pricked baby. hark! i hear my baby weeping, tho' it seemed so nicely sleeping; sure its wrapping is not right! i fear there is some string too tight. ah! now i find the reason why,- my precious baby well might cry. upon its bosom, close within the barrow-coat, i've found a pin; but i can tell thee o'er and o'er, no pin shall ever prick thee more; some buttons shall be snugly set upon the flannels of my pet. ah, baby dear, so feeble, fair! thou call'st forth many an anxious care! thou canst not speak thy pain or wo, or tell me whence thy pleasures flow; then o'er my babe a watch i'll keep, and guard it when 'tis fast asleep. [illustration: the crust.--teething. _pa 15._] [illustration: babes are fretful when suddenly aroused from sleep. _pa 16._ ] baby asleep again in the cot. should any cause of inward pain make baby cry or start again, i'll warm its feet before the fire, or see what else it may require; over my shoulder gently throw and rock my baby to and fro. and now, asleep within the cot, it must be neither cold nor hot. if cold, i know it shortly will awake, and feel itself quite ill; and if 'tis wrapp'd too tight and warm, tho' babe may feel no present harm, 'twill be relax'd, and feeble grow, and shortly lose its healthy glow. but with a blanket _warm_, yet _light_, and pillow not too great a height, with nothing else to tease or cumber, baby will most sweetly slumber. washing. my baby must be clean and neat, with cap and pinafore complete; i'll daily sponge its little head, and wash its skin, so soft and red. my seat must not be over high, lest babe roll off my lap, and cry: upon my knee, i'll safely hold, and do it quick for fear of cold. hush, hush, my dear! i'll not be long; washing will make thee stout and strong: thy little nerves 'twill help to brace, 'twill make thee have a rosy face. some helpless babes scarce ever get a wholesome washing, like my pet; then weak, and weaker still, they grow, no sprightliness or pleasure show; whereas, by constant daily care, with skin so fresh, and clean brush'd hair, they might have stouter grown, and stronger, and liv'd in cheerful health much longer. restless nights. when a babe is uneasy and restless in bed, "child's cordial" will soothe it to sleep, it is said; and ignorant people, who know not its harm, think this dangerous stuff has a powerful charm. but _one drop_ of such poison i never will give, because i would rather my darling should live; and i know very well, if this cordial i try, that baby will want more and more, till it die. tho' made with such art as to lull and give ease, it lays the foundation for lasting disease; no mother deserves a sweet babe for her prize, who would poison her infant, to silence its cries. and a nurse who loves baby, or values her place, will ne'er use this drug; 'tis a sin and disgrace; well then, i will try with much patience and care, to soothe my dear babe, or some food to prepare; and the true satisfaction of doing my best will repay all my labour and sweeten my rest. a walk in the country. must we take a nice walk?- where are spencer and hat? why, my harry looks pleas'd, when i tell him of that! we must trip rather briskly, not saunter and stay; then we catch the fresh breeze as it hastens away. and now for the gate,- let us open it, dear; we have got to the field, and the daisies appear. the cowslips and buttercups[1] make it look yellow; must i pluck one, to give to my sweet little fellow? come, look at this flower- ah! now he has caught it; well really, my harry, i scarce could have thought it! and now, to his mouth, he is bearing the prize, ah! i see very well that i have not been wise. some insect may lurk on the stalk or the leaves; i must take it away, though my darling it grieves. [1] the writer has been told that one species of the buttercup is poisonous: and there are many flowers which it would be hurtful for children to suck. note.--children are sent out into the country for the benefit of fresh air and exercise; but it is impossible to say what evils arise through the thoughtlessness of some nurse-maids, who will even let their helpless babes sit upon the cold grass, in order that _they_ may loiter with their associates. [illustration: baby asleep again in the cot. _pa 9._] [illustration: washing. _pa 10._] a walk in the town. how cheerful is the live-long day, when babe and i together stray! among the fields and daisy-flowers, we love to spend the happy hours; but when mamma shall send us down to make her markets in the town, much we shall see to please the boy and make him almost jump for joy: horses and carts will please him well, and twenty things we need not tell. but then we must not stop too long, mamma would say that we did wrong. we must not saunter in the street, or chatter with the folks we meet, but hasten homeward with our store, until we reach the well-known door: with dirty feet we'll not be seen, for mary's steps are neat and clean. if harry for my basket begs, i must not let him break my eggs, or lose my curds, or spill, or waste; but find some toy to suit his taste: then harry, nurse, and basket-store, will safely land at home once more. teething. babies, when cutting teeth, oft cry, and bite their little thumbs; aught they can seize, they'll often try to carry to their gums. some people give them coral bright with bells all hung together; and some will give them glass to bite, or ivory, or leather.[2] but things that are so hard as glass mamma approves of never; they grieve and hurt poor babes, alas! and make them worse than ever. a nurse should _then_ be very kind in finding what will please, a crust of bread, if they're inclined, will nourish and not tease. their diet should be thought of too, with care about their dress: lancing, when teeth are nearly thro,' makes babies suffer less. [2] the writer was recommended to try a piece of leather, and has found it to produce less irritation than any of the hard substances so often used. some mothers prefer indian-rubber. babies are fretful when suddenly aroused from sleep. come, come, my sweet deary has slept rather long, but now that he's waking i'll sing him a song. but softly awhile- i must not be forgetful, that suddenly rousing makes harry quite fretful. i must not with haste toss my baby about, if i make too much noise i shall grieve him, i doubt. then be-boo, my darling, my bosom shall hide thee; i'll pat thee, and kiss thee, no fear shall betide thee. ah! how sweetly he smiles, now i've gained all my ends; for my baby and i can soon make-up good friends. [illustration: learning to walk. _pa 17._] [illustration: in-doors play. _pa 18._] learning to walk. my baby trips with steps complete, and loves to stand upon his feet; but then 'tis only when i hold his finger, that he feels so bold; until his limbs are firmer grown i must not let him stand alone; i'll notice every new desire, that, while i _teach_, i may not _tire_; his little wants with care supply, and guard against each danger nigh. we'll sometimes walk, and sometimes rest, just as my darling likes the best: for ah! his legs are young and slender, his tripping toes are soft and tender; much at once he cannot bear, needing patience, thought, and care. yet frequent walking, not _too long_, will make his little limbs grow strong. in-doors play. look out, my dear, how fast it rains, pelting upon the window panes! we'll shut them till the storm is o'er, lest it should rain upon the floor. when all above seems clear and dry, again we'll throw the windows high; the shower makes all look green and fair, and wholesome is the freshen'd air. come, harry, get his ball the while- (harry loves play, it makes him smile.) we'll roll it on the floor, and then quickly we'll fetch it back again. and, if i think his looks betray some anxious wish for change of play, we'll try a hundred little tricks, we'll fetch his horse, his cart, his bricks; and, when he seems well pleas'd, we'll strive to keep good-temper all alive: with kindness and obliging aim i'll join in every childish game, nor interrupt with thoughtless air, aught that has claim'd my harry's care. [illustration: see how my harry hangs his head. _pa 19._] [illustration: bed-time. now, on the little cap we'll put. _pa 20._] [illustration: never grieve one to please another. _pa 22._] [illustration: warm feet. _pa 24._] harry has a sister. when little sister jane arriv'd, harry was two years old; his dimpled cheeks and lively air a cheerful temper told. well pleas'd, he sat by nurse's side, as she the babe would dress. and, though he kiss'd or patted her, _too_ hard he did not press. he learn'd to wait upon himself, his pinafore to loose, now on he'd nicely put his socks, and clasp his little shoes. he nimbly went up stairs or down, at nurse or mother's call; but then, he took _fast hold_ the while, lest he should get a fall. bed-time. see how my harry hangs his head, and rubs his little peepy; 'tis time to trot up stairs to bed when babies are so sleepy. then let us put his playthings by, jane's rattle, and her dolly; we must not leave all things awry, to make more work for molly. come trip up stairs with nimble feet, --a kiss for dear mamma; hark, hark, she says "farewell my sweet," and harry says, "ta, ta." (he does not say--"mamma, do let me stop a little longer?" indulgence soon would spoil her pet, and make his will grow stronger.) now, we must all the windows shut, and let the curtains down; now, on the little cap we'll put, and now the sleeping gown. my harry must lie still, and keep the bed-clothes nice and even; "ta, ta,"--he'll soon be fast asleep, for, hark! the clock strikes seven. [illustration: harry has a sister. _pa 19._] [illustration: and, though he kiss'd or patted her, _too_ hard he did not press. _pa 19._] nursery furniture. harry can skip, or jump, or play, just at his own desire; but once he was a careless boy, and went too near the fire. and had not nurse, with watchful eye, beheld, and quickly turn'd his pinafore had caught the flame, his hair had all been burn'd. papa had seen a guard so nice, that fitted round a fire; he order'd one for harry's room, with closely platted wire. see now he plays with nimble step, and fearless of all harm; and yet he can, on winter days, his little fingers warm. a lamp, two yards above the floor, is fasten'd to the wall; for candles, on a table put, might quickly get a fall. a basin and a jug, and soap, with water from the well, plac'd on a little frame of wood, suit nurse and harry well. and nicely furnish'd is our room, with things that will not spoil; mamma too kind and thoughtful is to make much care or toil. she likes her darling babes to play at liberty and ease, and still, in having useful things, takes care they do not tease. never grieve one to please another. poor jane! what is it grieves her so? why sobs her little heart? she cries, because she wants to have her brother's nice new cart. but harry now is so intent unloading all his store, she must, my darling, wait awhile, until his game is o'er. to please and gratify, we must not rob and grieve another; justice should always be our guide, and feeling for the other. and tho' 'tis pleasant, when a child will _freely_ give or lend; if we _oblige them to be kind_, we soon defeat our end. we'll pacify with kindest art, and other thoughts excite; we'll try, with tender care, to lead, the infant wish aright. we _must_ a good beginning make for every useful lesson; we _must_ enforce from earliest years the practice of submission. n. b.--a little publication, entitled "hints for the improvement of early education," the writer recommends to the increased attention of every conscientious mother.--these rhymes make but very humble pretensions, and are likewise much limited, from various considerations; so that many of the more important subjects of education could not be touched upon. warm feet. harry looks so sick and ill, harry is so cold and chill, nurse does almost think, and fear, something's the matter with her dear. let me feel his little feet, if they're nicely warm, my sweet! ah! they are both damp and cold; and that should never be, i'm told. let us fetch the little tub, and water warm, his feet to rub; we'll bathe them well; then by and by we'll wash them clean, and wipe them dry. if feet are cold, mamma can tell her children will not long be well; and often have i heard her say, "that case admits of no delay." harry at dinner. my harry is not quite so good at dinner as i wish; he sometimes is a dainty boy, unless he likes the dish. he, sometimes says he does not like his pudding and his meat, if, on the sideboard he can see a pie or custard sweet. but mother does not choose her boy should follow ways like these; and if his plate he does not clean, he has no pie nor cheese. mamma knows that, whate'er she gives her boy, is always good; and she is never pleas'd to hear remarks about his food. how many a half-starv'd little boy has nought whereon to feed! while happy henry, day by day, has all that he can need. note. what a privilege those children enjoy who are allowed to take their meals with their parents! many children are really brought up in habits of daintiness and gluttony, through the mistaken kindness of nurses, who are not aware that they are laying the foundation for future misery. and who is more miserable than the epicure? surrounded by the blessings of a bountiful giver,--and yet dissatisfied with _all_! surely poverty, with thankfulness, is not half so wretched a condition! [illustration: nurse telling harry a tale, about catching flies. _pa 27._] [illustration: the girl who hurt herself with the table. _pa 30._] taking medicine. what have i got in this blue cup? 'tis senna-tea: come, drink it up. now come, my little harry, haste; what! say he does not like the taste? these raisins, with a crust of bread, will make a pleasant taste instead, there! now 'tis gone,--both taste and smell; my little boy has managed well; mamma shall know her darling can drink senna-tea, just like a man: for, tho' it is not nice to take, med'cine oft cures both pain and ache. some naughty children will not try to drink their senna-tea, but cry; then worse and worse they grow, instead, and often lie for weeks in bed, when early care, without delay, might send their poorliness away. when nurses have a sickly charge, their stock of patience should be large; their kindness and obliging care, should teach them peevishness to _bear_; but _then_, in what is _needful_,--_right_, their hold should be both _firm_ and _tight_; then love and confidence would still meet in obedience to their will, and children would not dare to be unruly with their senna-tea. note. the practice of giving children sweet things, such as comfits and lozenges, cannot be too much reprobated. they fill children with ill-humors, by impairing digestion; they disorder the bowels, by producing an unnatural fermentation; they prevent the relish and enjoyment of plain food, and create in the little sufferer a continual craving for indulgencies. a little dried fruit, on proper occasions, is not unwholesome. nurse telling harry a tale, about catching flies. now, harry, i've a tale to tell, so sit upon this chair; it is of what one day befell a little maid so fair. she had a trick of catching flies, and as i understand, regardless of their shape or size, would clasp them in her hand. a sly young bee that knew the way some window-plants to gain, yet choosing an unwise delay was creeping on the pane: the thoughtless child, on mischief bent, soon caught him by the wing; but she, on cruelty intent, was punished with a sting. nurse heard a cry of pain and grief, and tho' it seems quite funny, the little girl soon found relief from poultice made of honey.[3] now since that time, i do expect, she'll hurt poor flies no more; the little maid will oft reflect on all she's done before. o, harry, it is sad, indeed, to hurt a living thing! and those who do it, _really need_, a _rod_, if not a _sting_. [3] spirits of hartshorn, if immediately applied, will likewise effectually remove the pain of a sting. spirits of turpentine, in case of a burn or scald, is a valuable acquisition to a nurse-maid's closet. its constant application till the fire is extracted, prevents those bad consequences which sometimes arise from neglect, or inefficient means. [illustration: a little boy who was afraid in the dark. _pa 32._] [illustration: nurse's reflections on the advantages of truth and sincerity. _pa 34._] another tale. a little girl, i also knew, with cheeks of red, and eyes of blue; and though she was at learning quick, she had full many an awkward trick. she ate so fast,--so often spoke,- mamma was much afraid she'd choke; her spice she ate, too, with such haste, she would not let her brother taste. and habits such as these 'twas thought, she learn'd from what her nurse had taught.[4] this little girl would often climb, and so it happen'd that, one time, attempting more than she was able, she fell against a dining table. loud did she cry "i've hurt my head! o, naughty table!" then she said, and sobbing loud, and crying more, began to beat the table sore. mamma was sadly griev'd to find her darling to such tricks inclin'd, but watchful care, with language mild, soon check'd this temper in the child. "such foolish ways, my harry! shock! _he_ knows a table feels no knock: and, if it did, he would not _like_, he would not even _dare_, to strike. he knows the maxim of the good- 'do as you wish that others should.' revenge makes naughty passions grow, it plants the root of endless wo; a boy that follows long this plan, will fight when he is grown a man." [4] in order to induce children to take their food, some persons are apt to say, "come, my dear, make haste, or brother (or sister) shall have it! no, no, brother! you shall not have it!" now every expression of this kind will infallibly create selfishness and greediness. a mode of conduct directly opposite should be enforced; that children may be taught to find their chief happiness in promoting the pleasure of their brothers and sisters, even by the sacrifice of their own. nurse's third tale, about a little boy who was afraid in the dark. young andrew fearful was a child most pleasing to behold, his temper was so sweet and mild, and he was four years old. but one sad failing andrew had, tho' gay as any lark, with scarce one habit that was bad, he did not like the dark. as soon as candlelight appear'd on evening fireside table, to walk about he scarcely dared, though he was strong and able. and shadows flitting on the wall, made andrew jump and stare; he thought some mischief would befall with such great monsters there. mamma, in many a pleasant way, contriv'd the help he needed; and glad i am that i can say, her care at last succeeded. she took him to a room quite dark, and led him by the hand to some known object, as a mark, and then they both would stand. the room shut in, without a light, he did not much enjoy, and andrew fear'd to step aright; so foolish was this boy. but growing bolder, he would try the furniture to handle; and andrew, _fearless_ by and by, scarce wish'd to have a candle, mamma, a paper nicely tied. would place behind the curtain, with figs, or pomfret cakes, supplied, and then the joy was certain. the shadows which he used to fear, became his great delight; with joy mamma beheld her dear so pleas'd with candlelight. thus many a pleasant hour beguil'd, young andrew's courage grew; mamma was happier in her child, and he was happier too. note. nurses are not sufficiently aware of the importance of guarding against early impressions of fear. in this respect, as in many others, it is much easier to prevent a bad habit, than to cure one. too much care and tenderness of feeling cannot be used towards those children who have unfortunately imbibed a fear of the dark; yet, on the other hand, judicious care should be exercised, that the habit may not be fostered by over-indulgence. [illustration: harry at dinner. _pa 24._] [illustration: taking medicine. _pa 26._] nurse's reflections on the advantages of truth & sincerity. if children are taught the whole lesson of truth, "'twill bud in their childhood, and blossom in youth." this maxim i learnt from the pen of a sage, whose vigor of mind was still green in old age: and much do i wish that my charge may be found on that ladder of learning where truth is the ground; the foundation so broad makes the ladder stand even; and truth's certain steps lead with safety to heaven. then, first, i'll be careful what language i use, that simple chaste words may express all my views: i'll watch o'er my actions with studious aim, that i may not, in future, deserve any blame; that bad habits may not from my errors proceed, or my fair little plants be o'ergrown with a weed, my word and my promise shall always abide. and truth and sincerity sit side by side. should i promise a thing which i do not perform, i lay the foundation for much future harm: if children learn falsehood from nurses or mothers, when grown up they will practise deceit upon others. then nought but the truth to my child shall be spoken: if i once make a promise, it _shall not be broken_.[5] as the best thing of all, i will constantly try to watch over _myself_ with a vigilant eye; my passions and faults so to mend or remove, that all may be lost in obedience and love; that, in practice, i never may knowingly swerve, from the wishes of those whom i honour and serve: but with eye _singly fix'd_, to my duty inclin'd, let me show forth a meek and a teachable mind; on reproof or instruction not daring to trample, may i always remember the _force of example_! [5] nurses should also be very cautious how they use threats to children. if they threaten to tell mamma any thing, or to withhold any indulgence in case of naughtiness, let it be strictly attended to. if it be _not_ attended to, children are great observers, and will soon find that but little regard is paid to truth; and thus incalculable evils may be the result. some nurses, and even mothers, are apt to bribe their children in this way: "if my dear will do this, i'll give him a sugar-plum;" or, "will he do so or so, if i give him a sugar-plum?" thus bringing down the standard of parental authority to the petulance or caprice of the child.--can obedience ever be expected from one whose self-will is thus nurtured? surely it must be from want of reflection, that mothers entail so much trouble upon themselves and their children! finis. j. may, printer, &c. dover. [illustration: a walk in the country. _pa 12._] [illustration: a walk in the town. _pa 14._] one shilling books, with copper-plates. bird fancier, (the british) _plates_. book of trades, 12 mo. _cold._ british sovereigns, from william the conqueror to william the fourth, 12mo. _cold._ crocus (the) containing original poems for young persons, by i. e. m. 12mo. _plts. col._ early seeds, to produce spring flowers, by mary elliot, 12mo. _cold._ industry and idleness. ladder to the alphabet, 12mo. _cold._ little scenes, 12mo. _cold._ little truths better than great fables, 2 parts. pet lamb; (the) to which is added the ladder to learning, &c. 12mo. _cold._ plain things for little folks, by mary elliot. present for a little boy, 12mo. --- --- little girl, ditto. rational exhibition, 12mo. rose, (the) containing original poems, by mary elliot, 12mo. _cold._ rural amusements, 12mo. _cold._ simple studies. natural history. quadrupeds, 12mo. _cold._ ditto, ditto, birds, ditto. simple scenes in rural life, 12mo. _cold._ wild garland, (the) 12mo. _cold. plates_. yellow shoe strings, or the good effects of obedience to parents, 18mo. transcriber's note: obvious printer errors have been corrected. otherwise, the author's original spelling, punctuation and hyphenation have been left intact. images generously made available by the internet archive/american libraries.) mrs. leslie's books for little children. the little frankie series. books written or edited by a. r. baker, and sold by all booksellers. question books on the topics of christ's sermon on the mount. vol. i. for children. vol. ii. for youth. vol. iii. for adults. lectures on these topics, _in press_. mrs. leslie's sabbath school books. tim, the scissors grinder. sequel to "tim, the scissors grinder." prairie flower. the bound boy. the bound girl. virginia. the two homes; or, earning and spending. the organ-grinder, _in press_. question books. the catechism tested by the bible. vol. i. for children. vol. ii. for adults. the dermott family; or, stories illustrating the catechism. vol. i. doctrines respecting god and mankind. " ii. doctrines of grace. " iii. commandments of the first table. " iv. commandments of the second table. " v. conditions of eternal life. mrs. leslie's home life. vol. i. cora and the doctor. " ii. courtesies of wedded life. " iii. the household angel. mrs. leslie's juvenile series. vol. i. the motherless children. " ii. play and study. " iii. howard and his teacher. " iv. trying to be useful. " v. jack, the chimney sweeper. " vi. the young housekeeper. " vii. little agnes. the robin redbreast series. the robins' nest. little robins in the nest. little robins learning to fly. little robins in trouble. little robins' friends. little robins' love one to another. the little frankie series. little frankie and his mother. little frankie at his plays. little frankie and his cousin. little frankie and his father. little frankie on a journey. little frankie at school. [illustration: frankie in his jumper.] little frankie and his mother. by mrs. madeline leslie, author of "the home life series;" "mrs. leslie's juvenile series," etc. boston: crosby and nichols. 117 washington street. entered, according to act of congress, in the year 1860, by a. r. baker, in the clerk's office of the district court of the district of massachusetts. electrotyped at the boston stereotype foundry. little frankie and his mother. chapter i. frankie's silver cup. do you wish to know who little frankie was, and where he lived? come and sit down in your pretty chair by my side, and i will tell you. frankie was not the real name of this little boy. when he was a tiny baby, not much larger than black dinah, his father came home one night from his store, and asked, "have you named the baby yet, mamma?" "no," she answered, "i have not; but i have been thinking that if you are pleased, i should like to call him frank." "frank, frank, frankie," said his father, repeating it over and over again, to hear how it would sound. "yes, i like the name; and then my friend, mr. wallace, is called frank. yes, frank it shall be." "while he is a baby, we will call him frankie," said his mamma. so that was the way he obtained so pretty a name. about a week after this, there came one day a man on horseback riding up to the front door. he jumped briskly down upon the wide stone step, and rang the bell with a loud, quick jerk, which seemed to say, i am in a hurry. margie, the errand girl, ran to the door, when the man gave her a box wrapped nicely in a piece of yellow paper, and tied with a small red cord. then he sprang upon the saddle, and galloped away down the avenue into the road. margie carried the box into the parlor, and gave it to her mistress. mamma looked at the name on the paper, and her bright, loving eyes grew still brighter. she took her scissors and cut the cord which held the paper around the box, then pulled off the cover, and what do you think was there? why, a large piece of pink cotton nicely folded about a beautiful silver cup, on one side of which was marked the name _little frankie_. mamma laughed as she read it, and felt sure the pretty present came from mr. wallace. she ran gayly up stairs into the nursery, where the baby was sitting in the lap of his nurse, shaking his coral bells. "here, my darling," she said; "see what a nice cup has come for you; look! it is so bright i can peep at your rosy face in it." baby crowed and stretched out his tiny hands, but he could not quite reach it; and if he could he would have tried to crowd it into his mouth. so mamma took him in her arms, and squeezed him very tight, and kissed him ever so many times, until the little fellow was quite astonished. then she held him off a little to look at him; and her eyes were so brimful of love that frankie was never tired of gazing into them. by and by, mamma carried the baby and the new cup down to the parlor; for papa had just come in, and was already calling for them. papa admired the present very much, and said that his friend, mr. wallace, was a noble fellow, and he should be glad if their little frankie made as good a man. then papa danced around the room, "to give his boy a little exercise," he said, "and make him grow." but mamma screamed, and was afraid so much shaking would take away her baby's breath. "come, then," said papa, "we will sit down and trot a little." he seated the little fellow on his knee, and began, "this is the way the lady rides, trot, trot, trot, trot. this is the way the gentleman rides, de canter, de canter, de canter, de canter. this is the way the huntsman rides, de gallop, de gallop, de gallop." frankie laughed and cooed, and as soon as his papa stopped, kicked his little feet to have it go again. chapter ii. frankie's little nurse. frankie lived in a quiet, pleasant village about twenty miles from the city. his home was a pretty cottage with a steep roof rising above the windows of the second story. in front there was a smooth, green lawn, and at the side a lovely flower garden, with nicely gravelled walks leading through it. then back of the house there were beds of peas, and beans, and turnips, and beets, and all kinds of good things for the table. frankie had a brother whose name was willie, and who was five years older than he. there had been a dear sister, too, but when she was only one year old, the saviour called her home to heaven; and she went with a sweet smile upon her lip. beside his father, and mother, and willie, there were in frankie's home, jane, the cook, sally, the nurse, and margie, a little girl seven years of age, who loved dearly to dance about and amuse the baby boy. she was the daughter of jane, and her father had been dead many years. she had begun to go to school; but as soon as the teacher rang the bell for the scholars to go home, margie caught her bonnet from the hook, and ran away as fast as she could go, she was so impatient to see little frankie. early in the morning, long before his mamma was ready to awake, the little fellow would open his eyes and crow, and sing his morning song. then he would try to get his tiny toes into his mouth. as soon as margie heard him, she would knock softly at the door, and ask, "may i come in and play with frankie?" if you were to see her, you would think she was quite an old lady; she went around so steadily, and not at all like a school girl. first, she took all the pillows from the cradle, and shook them up. then she laid them back so that the baby could sit up and see her play to him. when all was ready, she would go to the side of the bed, and frankie's papa would put him carefully into her arms, and then turn over to take another nap. it was very strange that with all margie's singing and laughing, and crying "catchee, catchee, now catch baby;" and with frankie's happy shouts of delight, papa and mamma could sleep quite soundly. but the instant the little fellow cried, as he sometimes did when he hurt his gums against his coral ring, and margie said, "o dear! has he hurt him? margie's sorry," mamma would spring from bed and be wide awake in a minute. there was one other member of the family whom i have not yet mentioned. it was not a brother, nor a sister, but a large black dog, whose name was ponto. he was a very handsome fellow, with his shining black hair, and his white ring about his neck; and he held his head up and looked you right in the face, as if he knew that he was above common dogs. ponto liked to run in the garden with willie, and catch the sticks his young master threw to him between his teeth. but best of all he liked to follow him to the nursery, and watch the motions of the new comer. frankie's eyes grew very large the first time he felt ponto's cold nose on his arm; and he cried, when the great, black creature began to lick his hands and face. mamma tried to push ponto away, and willie laughed most merrily. this, you know, was ponto's way of showing that he was fond of the dear baby; and from this time a strong affection sprang up between them. while frankie slept, the dog lay down by the cradle, to be sure that no harm came to his precious charge; and when he awoke, ponto made a noise, meaning, "i'll take care of you, baby." [illustration] chapter iii. frankie's jumper. frankie was now six months old. he had begun to sit upon the floor. first he could only sit there by having pillows placed all about him. then one day nurse took away the pillows, and said the little fellow must learn to do without them. she set him up very straight, and put a large book outside his clothes between his feet, so that he could not easily fall over. then she took her sewing and sat down on the floor beside him. frankie laughed, and thought this was very fine; but in one minute he reached a little too far, and over he went right on to his nose. nurse caught him up before he had time to cry, and tossed him up and down until he had forgotten his trouble; then she set him down again. so that by the time mamma came home from a long walk, he had almost learned to sit alone. o, how much pleased mamma was! she took off her bonnet and shawl, laughing all the time, and then she stopped ever so many times while she was giving the little fellow his dinner, and squeezed him closer to her side, and told him he was getting to be a brave boy indeed. hearing so much that was merry, ponto roused himself from his sleep, and began to rap with his tail on the floor. then, when frankie crowed out a pretty sound, he sprang upon his feet, and looked around a minute with his great, black eyes, when he gave a loud bark, "_bow, wow, wow_." little boy, i say, "_bow, wow, wow_." one day willie went with his mother to call upon a lady who had a baby girl just about as old as frankie. the servant asked them to go to the nursery and see the baby in her jumper. o, what a funny sight that was! how the two mammas, and the nurse, and willie laughed, to see the little creature dance about from one side of the room to the other. frankie's mamma said her little boy must have a jumper too. the lady, whose name was ida mills, gave her the pattern of the little jacket her baby wore when she jumped; and mrs. gray said she would ask her husband to call and see the jumper, so that he could tell the carpenter how to make one. in two days frankie's jacket was ready, and his jumper too. his mamma had told him all about it. but he only laughed and cooed the same as ever, and did not seem at all to understand it. when papa came home to dinner that day, he heard such a loud noise from the nursery, that he ran quickly up there to see what was the matter. when he opened the door he saw his little boy fastened to a long pole, which swung about the room like a crane, and mamma on her knees trying to teach him to touch his little toes to the floor, and make himself dance. there, too, were jane, the cook, and sally, the nurse, laughing, while margie and willie were clapping their hands every time frankie gave a spring. just then ponto came running up the stairs, and as soon as he saw his little master, he began to bark most furiously. he did not like to see him hung up so, and he meant to give his opinion about it. frankie had for a long time been fond of using his feet, and had often done so in his mother's lap, until he almost sprang out of her arms; but at first he did not know what mamma wanted him to do. but presently he began to jump; and when he found how easily he could set himself to dancing, he was so much pleased that he gave a scream of delight. willie ran to the other side of the room, and put his coral bells in a chair, and called out, "come, frankie, come to brother;" and the little dancer jumped across the room as briskly as if he had done it every day of his life. o, what laughing there was then! what shouting! what clapping of hands! mamma ran to kiss her baby, and call him her darling boy. all this time the dinner was on the table; and at last, jane said, "o, dear, the dinner will be as cold as a stone!" but papa and mamma said they had rather see frankie learn to jump, than to eat the best dinner that ever was cooked. chapter iv. frankie's brother willie. it was a long time before ponto became reconciled to see frankie in his jumper. he barked loud and long, as if he was afraid his little friend would hurt himself, tied up in so strange a manner. but baby grew every day more fond of this exercise; and as soon as he saw his mother take the jacket, he would spring so that she could hardly hold him still enough to fasten the buttons tightly to the wooden frame. one day, when he and his mamma were alone in the nursery, he grew very sleepy, and at last his little head nodded down, down, quite upon his breast. mamma laughed softly, and she waited a minute to see what he would do. presently he awoke a little, and touched his toes to the floor to make the jumper spring, and get himself to sleep again. then she took him in her arms, and after loosing the buttons to his jacket, laid him in his cradle for a nice nap. one day willie came running into the room when mamma was singing to the baby, who was not well. he was a good boy, and knew that he must not make a noise; so he took a cricket, and sat down by her side. he loved to hear the gentle lullaby; but now he wondered why mamma looked so sober. pretty soon he saw one, two, three, tears drop right upon frankie's head. her face was always so full of smiles that he knew not what to make of it. she got up to put the baby in the cradle, and then she saw willie looking at her as if he wondered what this meant. "come here, my dear," she said softly, laying his head on her shoulder. "mamma has been praying the good god for you and your little brother." "are you afraid frankie is going to die, as sister did?" asked willie; "i saw some tears on your cheeks." "no, dear," said mamma. "i was thinking how kind god was to give me two such dear boys. then i looked at frankie's hands, such pretty little fingers and thumbs, and i asked god never to let them do that which was naughty, never to allow them to strike or take what did not belong to them." willie gazed a moment at his hands; i suppose he was trying to think whether they had been naughty hands or good hands. presently he said, "toes can't do wrong, i think, mamma, as hands can." "ah, yes, my dear," said his mother. "only yesterday i knew a little boy whose feet were very naughty, and walked away where he had been forbidden to go." willie's face grew very red. "i forgot about that," he said in a whisper. "do you remember," asked his mother, "the lady who visited here with her little girl, and how she used to kick and stamp her feet when she could not do exactly as she wished? were those good feet, and do you think her heavenly father was pleased to see how she was using them?" "o, no, indeed, mamma! but i guess god liked it when i used my feet to carry james wells's ball home, because he would have lost it if i had not given it to him." "yes, dear, your feet and your hands, too, were good then; and beside that, there was a kind feeling in your heart, which made you wish to carry the ball to the poor boy." "i'm glad i did it," said willie, smiling in his mother's face. "did you think any thing about frankie's mouth?" "yes, indeed, i prayed that my darling baby might use his sweet little mouth to praise god, and that never, no, never might a naughty word come out of it. o, how dreadful it is to think that little boys or little girls should use the gifts of the good god to disobey his holy laws!" chapter v. frankie's new lessons. when frankie was a year old, his mamma thought it quite time for him to learn to go to bed by himself. so she took him up in her chamber, and shut the blinds, to keep out all the flies. then she gave him his luncheon, and laid him on willie's trundle-bed. this was low; and she thought, if he tried to get off, it would not hurt him as much as if it were higher. "now," said she, "my darling must be good, and shut his eyes, and go to sleep; and then mamma will come and put on his pretty cap and shoes, and take him to ride in his little wagon." she kissed him, and went into the dressing room, to see what he would do. but frankie did not like this at all, and he began to cry as loud as he could, and call for his mamma to come back. when he found this did no good, he stuck up his stomach, and kicked his feet, and at last he held his breath until his mamma was frightened, and ran to hold him up. "frankie is naughty," she said; "mamma can't kiss a naughty boy." then she laid him down again, and started to go away. but he cried as loud as ever, until mamma was obliged to pat his dear little hands until they looked quite red. she went away, and stood where she could look through the crack of the door. he called "mamma," two or three times, and then, tired with his crying, he fell asleep. "dear little frankie!" she said, coming to the bed and kissing the tears off his rosy cheeks. "it made mamma's heart ache to whip him." in a few days the little fellow had learned this new lesson; and though he missed his mother's arms folded tenderly about him, and the sweet smiles which mingled with the hushaby in his infant dreams, yet he grew reconciled to it at last, and became a very good baby. every day now he learned something new; first to say, "wee," for willie; then to hide his tiny head behind a handkerchief, as margie did when she played peep a-boo with him. another time he held out his hand for the brush, and tried to smooth willie's hair; but instead of that he tangled the close curls most terribly, so that the poor boy could hardly keep from crying when mamma combed them out again. one morning sally was ill, and obliged to stay in bed. margie wished to play with frankie while her master, and mistress, and willie were at prayers; but mamma said, "no; frankie may come to prayers too." papa took the large bible, and willie stood close by his side, his little finger pointing to the verses as the reading went on; and the baby sat on his mother's knee, his eyes very wide open, to see all that was going on. he looked first at mamma, and wondered, i suppose, that she did not smile. then he turned to papa, who was reading serious words in a solemn tone. he gazed next in willie's face; but willie was intent upon the book. at last he caught a glimpse of margie's laughing eyes, and he spoke right out. the little girl had not heard one word of the reading. she had been watching frankie, to see how he would behave; and now, before she thought where she was, she laughed aloud. but when she saw that her laughing had made willie smile and turn from his book, and that her mistress looked very sorry, she was sorry too, and covered her blushing face with her little apron. frankie sat very still while they sang a pretty hymn beginning:- "majestic sweetness sits enthroned upon the saviour's brow." but when papa and mamma kneeled down, he tried to kneel too; and seeing that mamma shut her eyes, he closed his, but opened them again in a minute, and tried to get away to run to willie. "frankie is now a year and a half old," said papa, "and must learn to be still at prayers." "can't he come to dinner, too, papa?" asked willie. "i am almost sure he will be good." "i am willing, if mamma is," said papa. "we will try him," said mamma. in the middle of the forenoon a man came to the door bringing a new high chair for frankie to sit at dinner. papa had been to the store and bought it for his baby boy. "o, what a kind papa!" frankie was very good the first day and the second day he came to dinner; but after that he did not behave as well. he pushed away the plate on which mamma had mashed a nice potato for him, and tried to reach a dish in which jane had put some squash. his little fingers were covered with squash, and mamma had to ring the bell for margie to bring the sponge and wash them. the next day, when papa held down his head to ask god to bless the food, frankie bent his face down to the table, and muttered over something. i suppose he thought he too was praying. "will god care?" asked willie. "baby don't know that it is naughty to pray so." "god never expects children to behave any better than they know how," replied mamma. chapter vi. frankie's teeth. frankie's brother willie had never been to school, but had learned to read and spell at home, reciting his lessons to his mamma. papa said he was now old enough to recite with other boys. so mamma bought him a little satchel, with a strap to put over his shoulder. then she put in it his slate, with a pencil and sponge tied to it, his reading book, and a new arithmetic with pictures of marbles, and birds, and boys in it. she washed his face and hands very clean, and curled his hair, which was so long it hung over his shoulders; then she dressed him in his new suit, with his nice shining collar basted into the neck, so as to have him quite ready when his young companion called for him to go to the new school. willie felt very happy this bright morning. he liked the idea of going with the other boys to school. he thought it would be fine fun to play ball at recess. there was another reason for his feeling happy. can you guess what it was? it was not that his clothes were new, and, as he could see in the glass, fitted him very well. no, it was because he had two pockets in his pantaloons. before this time he had never had but one, and now he felt smart indeed to be able to place both hands in his pockets. he walked backwards and forwards before the long mirror in his mother's chamber, admiring himself exceedingly. mamma laughed heartily at the airs he put on; but before he went out, she told him no persons but rowdies walked with their hands in their pockets; that papa never did, and she should be very sorry to see her willie walk so. for a few days frankie's cheeks had been very red indeed, so that sally said he looked as handsome as a picter; but mamma was afraid it was because he was not well. he had a large tin bath tub in the form of a boat, and one morning, when she put him in it, she found his flesh was very hot. she took him out into the flannel blanket, which she always spread in her lap, and rubbed him quickly, that he should not become chilled; then she coaxed him to let her put her finger into his mouth to feel whether he had any teeth which troubled him and made him look so feverish. he had already quite a mouth full of teeth; but she soon found that there were two large back teeth trying to force their way through the gums. "poor little fellow," she said; "mamma is sorry his teeth ache." she laid his aching head on her bosom, and passed her soft hand soothingly over it, back and forth, a great many times, chanting his favorite little song, until at length he fell asleep. "once there was a little man, where a little river ran; and he had a little farm, and a little dairy, o! and he had a little plough, and a pretty dapple cow, which he often called his pretty little pharaoh. "and the little maiden, ann, with her pretty little can, went a milking when the morning sun was beaming, o! but she fell,--i don't know how,- and she stumbled o'er the plough, and the cow was much astonished at her screaming, o! "then the funny little man to the little river ran, to procure a little shiner for his dinner, o! then he brought it on a hook to the pretty little cook, and she placed it on the table with his ladle, o! "then the little maiden ran with her pretty little can, and brought some nice sweet milk from good mooley, mrs. pharaoh! and she poured it in a bowl for the clever little soul; and she placed it by his dish, while he sat at table, o!" then she went and laid him in her own bed, and took her sewing to sit down beside him till he awoke. presently nurse came in with mamma's bonnet in her hand, and mamma's shawl on her arm, as the lady had told her she was going to walk. but now she said, "frankie is ill, and i shall not leave him to-day." "i thought he was not very well this morning," said nurse, "for he was very worrisome, and would not eat his breakfast." mamma sat with her sewing for nearly an hour, while frankie slept, only once in a while he would moan as if he was in pain; and then she put her hand on his head again. when he awoke his eyes were heavy, and instead of jumping out of her lap to play, he laid his head down on her shoulder. "does frankie want some breakfast?" asked mamma. he nodded his head; but when nurse brought him some nice bread and milk in his silver porringer, he only took one taste of it, and then said, "patty want water." he could not well say frankie, but always called himself patty. for several days the poor boy was quite sick, and his mamma never left him except to run for a few moments to her meals. when he was in great pain, she soothed him, rocked him, and carried him about the chamber. then, when he felt a little better, she sang him pretty songs, or told him stories, or showed him the pictures in his little books. there was one little song he always loved to hear; and once, when papa and mamma were singing at prayers, he made them laugh by saying, "mamma, sing patty tune, pitty tee." he could not talk plain; but he meant "pretty tree." perhaps you have never heard this song; and i will repeat it for you:- "out in a beautiful field there stands a pretty pear tree, pretty pear tree with leaves. what is there on the tree? a very pretty branch. branch on the tree, tree in the ground. "out in the beautiful field there stands a pretty pear tree, pretty pear tree with leaves. what is there on the branch? a very pretty bough. bough on the branch, branch on the tree, tree in the ground. "out in the beautiful field there stands a pretty pear tree, pretty pear tree with leaves. what is there on the bough? a very pretty nest. nest on the bough, bough on the branch, branch on the tree, tree in the ground. "out in a beautiful field there stands a pretty pear tree, pretty pear tree with leaves. what is there in the nest? a very pretty egg. egg in the nest, nest on the bough, bough on the branch, branch on the tree, tree in the ground. "out in a beautiful field there stands a pretty pear tree, pretty pear tree with leaves. what is there in the egg? a very pretty bird. bird in the egg, egg in the nest, nest on the bough, bough on the branch, branch on the tree, tree in the ground." chapter vii. frankie's breakfast. frankie was now old enough to like to hear stories, and almost every day he asked, "pease tell me tory, mamma." sometimes, when he did not feel like playing, he would ask her a great many times in a day. one morning she went into the nursery, after she had eaten her own breakfast, and found sally feeding him with his bread and milk. "he spits it out, ma'am," she said, "and won't let it down his throat." "patty want pig, mamma," said the little boy. he meant that he wanted a fig. "has he had a fig this morning?" asked mamma. "yes, ma'am," said nurse. "willie came in eating one, and frankie cried for it. so willie gave it right up to him, though he had only taken one mouthful. i think he is the generousest boy, ma'am, that i ever see." mamma smiled, and seemed very happy when she heard this. you know nothing makes mammas so happy as to know that their little boys and girls are good. she said to herself, "dear child, i will give him another when he comes in." then she took frankie in her arms, and told nurse to go and eat her own breakfast. she tucked the bib nicely around his neck, and then she began to feed him. but, as sally said, he would not let it down, but spit it all over his clothes and mamma's hand. "patty want pig," he said again. "no, darling, you must eat your breakfast now," said mamma. "though it is not so sweet as a fig, it is very good, and will make my little boy grow and be strong, so that he can run out to play like willie." "patty want pig, mamma," said the baby, putting up his hand to pat mamma's face. "patty want pig vely much." "frankie shall have a fig by and by," said mamma; "now i will tell him a little story. "once there was a little boy; his name was harry. he had no kind mamma to give him good breakfasts. his mamma had gone to heaven to live with god. "little harry was poor, and often when he woke up he was very hungry. but he could not lay his head on his mamma's breast, because she was dead, you know. poor little harry used to cry for somebody to come and take care of him. all babies need some person to hold them and rock them." "patty got mamma," cried the little boy. "yes, darling, frankie has a mamma who loves him dearly, and tries to take good care of him, and makes him nice warm clothes. but harry had none. the woman who let him live in her house was too busy to attend to him; so, when he was cold, or hungry, or tired, and wanted to lay his poor, weary head in her lap, she had no time to let him do so. dear little fellow, it would have done him so much good to have some kind mamma take him in her lap and squeeze him close to her breast, as mamma does frankie, and call him her darling, dear little harry. i think he would have stopped crying at once, and he would have looked up in her face and smiled his thanks." frankie was so much pleased with the story, that he put up his little mouth to kiss mamma; and when he had done so, he patted her face softly, and said, "patty love oo." he could not say "you." "one day," said mamma, "a kind lady called at the poorhouse where harry lived. he was sitting on a little bed in the corner, crying; but he stopped when the lady went in. his hair had not been combed for many days; his face was very dirty where the tears had run down over his thin, pale cheeks; his clothes were soiled and torn; but the lady pitied him very much. when she found he had no mamma, and that his papa was at work a great way off, she wrapped her shawl about the poor baby, and took him home in her carriage. "first of all she gave him a cup of milk to drink, and then she told nurse to bring some warm water in a tub, and some soap and towels, for she was going to wash the poor baby. she did not wonder then that the poor little fellow cried, for he was all sore, because he had had no kind mamma to wash him and put on nice powder. she kept him in the water a long time, and washed him very clean; and then she told the nurse to go up garret and bring a small trunk with some baby clothes in it. she had a little baby once, and these were his clothes. then she tried to get the snarls out of his hair, and by this time harry was so tired, he was glad to go to sleep. "when he woke up he began to cry again, for he thought he was back in his old home; but as soon as he saw the kind lady, he smiled very sweetly. he held out his arms for her to take him. she had some warm bread and milk all ready, and she took him in her lap and put a towel round his neck and fed him. "he did not spit it out on his clean clothes, but he ate it all, and liked it very much; and then he looked up in the kind face that was bending over him so fondly, and smiled, and tried to stroke her cheek. this was all the way he knew how to thank her for his good breakfast." when mamma had told the story, she took frankie's cup and began to feed him, and he did not spit out one mouthful, but ate the whole, even the last drop. chapter viii. frankie's dolly. when willie was a little boy about two years old, a good lady came to see his mother. her name was bryant, but willie could not speak such a very hard word; so, after trying a long time, he called her bear. papa and mamma laughed heartily, and said that was a funny name; but in a few days they began to call her bear too; and after a while they thought it was a very pretty name. do you know why they liked it so much? because good bear was fond of willie, and very kind to him, and because willie said it in such a cunning way. one day mamma folded up a little blanket for willie to carry to bed for a baby, and bear said, "i will make him a pretty dolly, and dress it all up, so that he can have it to play with." that very day she began to work upon it. mamma gave her nice pieces of cloth, and she made a black face, and curly hair, and red lips, and a very flat nose, and white eyes. papa laughed when they showed it to him, and said, "he hoped willie wouldn't be afraid of it." then bear made arms, and hands, and legs, with red shoes, on the feet. then she made a skirt, and a dress, and a sack for dinah to put on when she was cold, and a bonnet for her to wear when she went to walk. she did not let willie see it until it was all ready for him to play with, and then she, and mamma, and nurse stood looking to see what he would do with it. "pretty dinah," said mamma, kissing the dolly, and then putting it into willie's arms. at first the little fellow looked and looked, but did not touch his new baby or smile at all; but presently, when mamma said, "willie got two babies," and putting the one made of a blanket by the side of it, he began to understand what it was for. when willie was four years old, bear made some new clothes for dinah, a jacket and pantaloons, and changed her name to john. this, willie did not like; and one day hung dolly by a string to the nob of the shutter, because he was not good, he said. when frankie was old enough to play with a baby, dear kind bear had gone away where they could never see her pleasant smile again; but mamma made a new dress, and put it on over the pantaloons, and called dolly dinah again. while she was sewing on it, the tears ran out of her eyes and dropped on her work. willie ran to ask her what was the matter, and she said, softly, "i am thinking of bear, my dear, and how she would have loved our little frankie if she had lived." "i am going to heaven some day," said willie; "and i'll ask her to come back. i know she will, when i tell her you cry so." "if we are good, my dear boy," said mamma, wiping her eyes, "and try to please the saviour, and to obey all his holy commands, we shall go to live with her in heaven; but she can never come back to us." "i'm trying to grow good every day, mamma," said willie. this was a long time before. now frankie loved dinah dearly; and when he went to ride, she had to go too. he used to hug her and kiss her just as mamma did him; and in all his plays with margie, dinah was set up in a chair, and had to play too. * * * * * transcriber's note: all punctuation errors have been corrected. riverside educational monographs edited by henry suzzallo president of the university of washington seattle, washington the meaning of infancy by john fiske 1883 contents introduction i. the meaning of infancy from "excursions of an evolutionist" ii. the part played by infancy in the evolution of man from "a century of science" outline introduction the new significance of education the last century has witnessed an unprecedented development in the significance of education. one direct consequence has been an increased reverence for childhood. in this movement which has increased the dignity of children and schools, two large forces have been at work,--one social and the other scientific. the growth of the democratic spirit among men and institutions has made the education of children a public necessity, and lifted the school to a position of high social importance. the application of the theory of evolution to man and his life has revealed human infancy as one of the largest factors making for the superiority of man in the struggle for existence, and given to childhood a vast biological importance. the necessities of democracy and the truths of science, acting more or less independently of each other, have given to education a breadth of meaning which it did not possess before. they have shown that infancy is the largest opportunity and education the most powerful instrument for the conscious adjustment of man to the physical and social world in which he lives. _democracy changes the function of schools_ it was the attempt of democracy to educate all of its children which was the initial and important event that provoked large changes in our notions of the social function of education. as long as the school was for the few, and such it was in the less liberal periods of history, the school tended to be an authoritative institution with more or less rigid methods of procedure. with fixed ideas of truth and the means of acquiring truth, it was to a considerable degree unbending in its attitude toward youth. even if freedom from economic toil and social regulation permitted, only the type of mind that could fit the school's established institutional ways could endure its discipline and achieve its rewards. other types of mentality it would not receive or retain as students. under such an organization the school was selective of a special kind of talent. it was not an instrument, so adjustable in its methods of appeal and instruction, that every manner of child could gain considerable of the wisdom of the world. but when a more democratic order was established, the function of the school underwent a considerable change. democracy granted to all men freedom in manhood; to safeguard its privileges, it had to educate all men in childhood. the school for selected scholars had to be transformed into a school for every variety of citizen. with every child sent to school by order of the state, the teacher had to forego his traditional aloofness, and to adjust his methods of teaching so that every member of the enlarged school community could come into a knowledge of the civilization in which he lived. with the inclusion of the blind, the deaf, the slow of mind, and the restless of spirit,--individuals left out of the old scheme of education and now reverently educated by the new democratic order in spite of all their defects,--the school becomes more flexible and variable in its methods of transmitting truth. more of the knowledge of human life is brought within the comprehension of children; more men are brought into a large and sympathetic participation in the activities of our civilization. in the truest sense the school becomes an instrument of adjustment between childhood and society. _evolutionary thought interprets childhood_ if the democratic movement emphasized the factor of social adjustment in the school's function, it was the scientific movement of the last half-century which drew attention to infancy as a superior opportunity for biological adjustment among all the contributions of modern evolutionary science to educational thought, none is, more striking or more far-reaching in its implications than that special group of generalizations which states the biological function of a prolonged infancy in man. interpreting this period, of helplessness and dependence as one of plasticity and opportunity, it has shown that the greater power of man in adjusting himself to the complex conditions of life is due to his educability, which in turn is the outcome of his lengthened childhood. this "doctrine of the meaning of infancy," for such it has been called, is perhaps best known to the teaching profession through those enlargements and applications of the doctrine which have been made by mr. nicholas murray butler in his exposition of "the meaning of education." as a belief, it is at least as old as the period of the ancient greek philosopher, anaximander. as a doctrine in our modern thought, it owes its influential reappearance to certain evolutionary hypotheses of mr. alfred russel wallace, which in turn stimulated mr. john fiske to that further inquiry which resulted in those first cogent and extended statements of the doctrine which have been the basis of so many subsequent educational applications. _mr. fiske's presentation of the meaning of infancy_ because of the fundamental importance of mr. fiske's presentation of "the doctrine of the meaning of infancy," his views are here reprinted in detail. the material consists of an essay and an address. the first of these, "the meaning of infancy," is a brief and simplified restatement of those theories of man's origin and destiny as first suggested in his lectures at harvard university in 1871, and later developed more fully in the "outlines of cosmic philosophy," part ii, chapters xvi, xxi, and xxii. the second of these, "the part played by infancy in the evolution of man," is an address delivered by mr. fiske as the guest of honor at a dinner at the aldine club, new york, may 13, 1895. together these two papers constitute the most detailed and valuable elucidation of the doctrine that we possess. in offering them to the teaching profession and the reading public in this form, it is with the sincere hope that this biological interpretation of childhood and education will lend a new spiritual dignity to the whole institution of education. it must certainly be gratifying to those who are profound believers in the efficacy of education, to note that its significance is wider than its service to particular persons and states; that education is, in truth, the conscious and latest mode of that wider world-evolution which has been in progress since the beginning of time. i the meaning of infancy what is the meaning of infancy? what is the meaning of the fact that man is born into the world more helpless than any other creature, and needs for a much longer season than any other living thing the tender care and wise counsel of his elders? it is one of the most familiar of facts that man alone among animals, exhibits a capacity for progress. that man is widely different from other animals in the length of his adolescence and the utter helplessness of his babyhood, is an equally familiar fact. now between these two commonplace facts is there any connection? is it a mere accident that the creature which is distinguished as progressive should also be distinguished as coming slowly to maturity, or is there a reason lying deep down in the nature of things why this should be so? i think it can be shown, with very few words, that between these two facts there is a connection that is deeply in-wrought with the processes by which life has been evolved upon the earth. it can be shown that man's progressiveness and the length of his infancy are but two sides of one and the same fact; and in showing this, still more will appear. it will appear that it was the lengthening of infancy which ages ago gradually converted our forefathers from brute creatures into human creatures. it is babyhood that has made man what he is. the simple unaided operation of natural selection could never have resulted in the origination of the human race. natural selection might have gone on forever improving the breed of the highest animal in many ways, but it could never _unaided_ have started the process of civilization or have given to man those peculiar attributes in virtue of which it has been well said that the difference between him and the highest of apes immeasurably transcends in value the difference between an ape and a blade of grass. in order to bring about that wonderful event, the creation of man, natural selection had to call in the aid of other agencies, and the chief of these agencies was the gradual lengthening of babyhood. such is the point which i wish to illustrate in few words, and to indicate some of its bearings on the history of human progress. let us first observe what it was then lengthened the infancy of the highest animal, for then we shall be the better able to understand the character of the prodigious effects which this infancy has wrought. a few familiar facts concerning the method in which men learn how to do things will help us here. when we begin to learn to play the piano, we have to devote much time and thought to the adjustment and movement of our fingers and to the interpretation of the vast and complicated multitude of symbols which make up the printed page of music that stands before us. for a long time, therefore, our attempts are feeble and stammering and they require the full concentrated power of the mind. yet a trained pianist will play a new piece of music at sight, and perhaps have so much attention to spare that he can talk with you at the same time. what an enormous number of mental acquisitions have in this case become almost instinctive or automatic! it is just so in learning a foreign language, and it was just the same when in childhood we learned to walk, to talk, and to write. it is just the same, too, in learning to think about abstruse subjects. what at first strains the attention to the utmost, and often wearies us, comes at last to be done without effort and almost unconsciously. great minds thus travel over vast fields of thought with an ease of which they are themselves unaware. dr. nathaniel bowditch once said that in translating the "mecanique celeste," he had come upon formulas which laplace introduced with the word "obviously," where it took nevertheless many days of hard study to supply the intermediate steps through which that transcendent mind had passed with one huge leap of inference. at some time in his youth no doubt laplace had to think of these things, just as rubinstein had once to think how his fingers should be placed on the keys of the piano; but what was once the object of conscious attention comes at last to be well-nigh automatic, while the night of the conscious mind goes on ever to higher and vaster themes. let us now take a long leap from the highest level of human intelligence to the mental life of a turtle or a codfish. in what does the mental life of such creatures consist? it consists of a few simple acts mostly concerned with the securing of food and the avoiding of danger, and these few simple acts are repeated with unvarying monotony during the whole lifetime of these creatures. consequently these acts are performed with great ease and are attended with very little consciousness, and moreover the capacity to perform them is transmitted from parent to offspring as completely as the capacity of the stomach to digest food is transmitted. in all animals the new-born stomach needs but the contact with food in order to begin digesting, and the new-born lungs need but the contact with air in order to begin to breathe. the capacity for performing these perpetually repeated visceral actions is transmitted in perfection. all the requisite nervous connections are fully established during the brief embryonic existence of each creature. in the case of lower animals it is almost as much so with the few simple actions which make up the creature's mental life. the bird known as the fly-catcher no sooner breaks the egg than it will snap at and catch a fly. this action is not so very simple, but because it is something the bird is always doing, being indeed one out of the very few things that this bird ever does, the nervous connections needful for doing it are all established before birth, and nothing but the presence of the fly is required to set the operation going. with such creatures as the codfish, the turtle, or the fly-catcher, there is accordingly nothing that can properly be called infancy. with them the sphere of education is extremely limited. they get their education before they are born. in other words, heredity does everything for them, education nothing. the career of the individual is predetermined by the careers of his ancestors, and he can do almost nothing to vary it. the life of such creatures is conservatism cut and dried, and there is nothing progressive about them. in what i just said i left an "almost." there is a great deal of saving virtue in that little adverb. doubtless even animals low in the scale possess some faint traces of educability; but they are so very slight that it takes geologic ages to produce an appreciable result. in all the innumerable wanderings, fights, upturnings and cataclysms of the earth's stupendous career, each creature has been summoned under penalty of death to use what little wit he may have had, and the slightest trace of mental flexibility is of such priceless value in the struggle for existence that natural selection must always have seized upon it, and sedulously hoarded and transmitted it for coming generations to strengthen and increase. with the lapse of geologic time the upper grades of animal intelligence have doubtless been raised higher and higher through natural selection. the warm-blooded mammals and birds of to-day no doubt surpass the cold-blooded dinosaurs of the jurassic age in mental qualities as they surpass them in physical structure. from the codfish and turtle of ancient family to the modern lion, dog, and monkey, it is a very long step upward. the mental life of a warm-blooded animal is a very different affair from that of reptiles and fishes. a squirrel or a bear does a good many things in the course of his life. he meets various vicissitudes in various ways; he has adventures. the actions he performs are so complex and so numerous that they are severally performed with less frequency than the few actions performed by the codfish. the requisite nervous connections are accordingly not fully established before birth. there is not time enough. the nervous connections needed for the visceral movements and for the few simple instinctive actions get organized, and then the creature is born before he has learned how to do all the things his parents could do. a good many of his nervous connections are not yet formed, they are only formable. accordingly he is not quite able to take care of himself; he must for a time be watched and nursed. all mammals and most birds have thus a period of babyhood that is not very long, but is on the whole longest with the most intelligent creatures. it is especially long with the higher monkeys, and among the man-like apes it becomes so long as to be strikingly suggestive. an infant orang-outang, captured by mr. wallace, was still a helpless baby at the age of three months, unable to feed itself, to walk without aid, or to grasp objects with precision. but this period of helplessness has to be viewed under another aspect. it is a period of plasticity. the creature's career is no longer exclusively determined by heredity. there is a period after birth when its character can be slightly modified by what happens to it after birth, that is, by its experience as an individual. it becomes educable. it is no longer necessary for each generation to be exactly like that which has preceded. a door is opened through which the capacity for progress can enter. horses and dogs, bears and elephants, parrots and monkeys, are all teachable to some extent, and we have even heard of a learned pig. of learned asses there has been no lack in the world. but this educability of the higher mammals and birds is after all quite limited. by the beginnings of infancy the door for progressiveness was set ajar, but it was not all at once thrown wide open. conservatism stilt continued in fashion. one generation of cattle is much like another. it would be easy for foxes to learn to climb frees, and many a fox might have saved his life by doing so; yet quickwitted as he is, this obvious device never seems to have occurred to reynard. among slightly teachable mammals, however, there is one group more teachable than the rest. monkeys, with their greater power of handling things, have also more inquisitiveness and more capacity for sustained attention than any other mammals; and the higher apes are fertile in varied resources. the orang-outang and gorilla are for this reason dreaded by other animals, and roam the undisputed lords of their native forests. they have probably approached the critical point where variations in intelligence, always important, have come to be supremely important, so as to be seized by natural selection in preference to variations in physical constitution. at some remote epoch of the past--we cannot say just when or how--our half-human forefathers reached and passed this critical point, and forthwith their varied struggles began age after age to result in the preservation of bigger and better brains, while the rest of their bodies changed but little. this particular work of natural selection must have gone on for an enormous length of time, and as its result we see that while man remains anatomically much like an ape, be has acquired a vastly greater brain with all that this implies. zoologically the distance is small between man and the chimpanzee; psychologically it has become so great as to be immeasurable. but this steady increase of intelligence, as our forefathers began to become human, carried with it a steady prolongation of infancy. as mental life became more complex and various, as the things to be learned kept ever multiplying, less and less could be done before birth, more and more must be left to be done in the earlier years of life. so instead of being born with a few simple capacities thoroughly organized, man came at last to be born with the germs of many complex capacities which were reserved to be unfolded and enhanced or checked and stifled by the incidents of personal experience in each individual. in this simple yet wonderful way there has been provided for man a long period during which his mind is plastic and malleable, and the length of this period has increased with civilization until it now covers nearly one third of our lives. it is not that our inherited tendencies and aptitudes are not still the main thing. it is only that we have at last acquired great power to modify them by training, so that progress may go on with ever-increasing sureness and rapidity. in thus pointing out the causes of infancy, we have at the same time witnessed some of its effects. one effect, of stupendous importance, remains to be pointed out. as helpless babyhood came more and more to depend on parental care, the correlated feelings were developed on the part of parents, and the fleeting sexual relations established among mammals in general were gradually exchanged for permanent relations. a cow feels strong maternal affection for her nursing calf, but after the calf is fully grown, though doubtless she distinguishes it from other members of the herd, it is not clear that she entertains for it any parental feeling. but with our half-human forefathers it is not difficult to see how infancy extending over several years must have tended gradually to strengthen the relations of the children to the mother, and eventually to both parents, and thus give rise to the permanent organization of the family. when this step was accomplished we may say that the creation of man had been achieved. for through the organization of the family has arisen that of the clan or tribe, which has formed, as it were, the cellular tissue out of which the most complex human society has come to be constructed. and out of that subordination of individual desires to the common interest, which first received a definite direction when the family was formed, there grew the rude beginnings of human morality. it was thus through the lengthening of his infancy that the highest of animals came to be man,--a creature with definite social relationships and with an element of plasticity in his organization such as has come at last to make his difference from all other animals a difference in kind. here at last there had come upon the scene a creature endowed with the capacity for progress, and a new chapter was thus opened in the history of creation. but it was not to be expected that man should all at once learn how to take advantage of this capacity. nature, which is said to make no jumps, surely did not jump here. the whole history of civilization, indeed, is largely the history of man's awkward and stumbling efforts to avail himself of this flexibility of mental constitution with which god has endowed him. for many a weary age the progress men achieved was feeble and halting. though it had ceased to be physically necessary for each generation to tread exactly in the steps of its predecessor, yet the circumstances of primitive society long made it very difficult for any deviation to be effected. for the tribes of primitive men were perpetually at war with each other, and their methods of tribal discipline were military methods. to allow much freedom of thought would be perilous, and the whole tribe was supposed to be responsible for the words and deeds of each of its members. the tribes most rigorous in this stern discipline were those which killed out tribes more loosely organized, and thus survived to hand down to coming generations their ideas and their methods. from this state of things an intense social conservatism was begotten,--a strong disposition on the part of society to destroy the flexible-minded individual who dares to think and behave differently from his fellows. during the past three thousand years much has been done to weaken this conservatism by putting an end to the state of things which produced it. as great and strong societies have arisen, as the sphere of warfare has diminished while the sphere of industry has enlarged, the need for absolute conformity has ceased to be felt, while the advantages of freedom and variety come to be ever more clearly apparent. at a late stage of civilization, the flexible or plastic society acquires even a military advantage over the society that is more rigid, as in the struggle between french and english civilization for primacy in the world. in our own country, the political birth of which dates from the triumph of england in that mighty struggle, the element of plasticity in man's nature is more thoroughly heeded, more fully taken account of, than in any other community known to history; and herein lies the chief potency of our promise for the future. we have come to the point where we are beginning to see that we may safely depart from unreasoning routine, and, with perfect freedom of thinking in science and in religion, with new methods of education that shall train our children to think for themselves while they interrogate nature with a courage and an insight that shall grow ever bolder and keener, we may ere long be able fully to avail ourselves of the fact that we come into the world as little children with undeveloped powers wherein lie latent all the boundless possibilities of a higher and grander humanity than has yet been seen upon the earth. ii the part played by infancy in the evolution of man the remarks which my friend mr. clark has made with reference to the reconciling of science and religion seem to carry me back to the days when i first became acquainted with the fact that there were such things afloat in the world as speculations about the origin of man from lower forms of life; and i can recall step by step various stages in which that old question has come to have a different look from what it had thirty years ago. one of the commonest objections we used to hear, from the mouths of persons who could not very well give voice to any other objection, was that anybody, whether he knows much or little about evolution, must have the feeling that there is something degrading about being allied with lower forms of life. that was, i suppose, owing to the survival of the old feeling that a dignified product of creation ought to have been produced in some exceptional way. that which was done in the ordinary way, that which was done through ordinary processes of causation, seemed to be cheapened and to lose its value. it was a remnant of the old state of feeling which took pleasure in miracles, which seemed to think that the object of thought was more dignified if you could connect it with something supernatural; that state of culture in which there was an altogether inadequate appreciation of the amount of grandeur that there might be in the slow creative work that goes on noiselessly by little minute increments, even as the dropping of the water that wears away the stone. the general progress of familiarity with the conception of evolution has done a great deal to change that state of mind. even persons who have not much acquaintance with science have at length caught something of its lesson,--that the infinitely cumulative action of small causes like those which we know is capable of producing results of the grandest and most thrilling importance, and that the disposition to recur to the cataclysmic and miraculous is only a tendency of the childish mind which we are outgrowing with wider experience. the whole doctrine of evolution, and in fact the whole advance of modern science from the days of copernicus down to the present day, have consisted in the substitution of processes which are familiar and the application of those processes, showing how they produce great results. when darwin's "origin of species" was first published, when it gave us that wonderful explanation of the origin of forms of life from allied forms through the operation of natural selection, it must have been like a mental illumination to every person who comprehended it. but after all it left a great many questions unexplained, as was natural. it accounted for the phenomena of organic development in general with wonderful success, but it must have left a great many minds with the feeling: if man has been produced in this way, if the mere operation of natural selection has produced the human race, wherein is the human race anyway essentially different from lower races? is not man really dethroned, taken down from that exceptional position in which we have been accustomed to place him, and might it not be possible, in the course of the future, for other beings to come upon the earth as far superior to man as man is superior to the fossilized dragons of jurassic antiquity? such questions used to be asked, and when they were asked, although one might have a very strong feeling that it was not so, at the same time one could not exactly say why. one could not then find any scientific argument for objections to that point of view. but with the further development of the question the whole subject began gradually to wear a different appearance; and i am going to give you a little bit of autobiography, because i think it may be of some interest in this connection. i am going to mention two or three of the successive stages which the whole question took in my own mind as one thing came up after another, and how from time to time it began to dawn upon me that i had up to that point been looking at the problem from not exactly the right point of view. when darwin's "descent of man" was published in 1871, it was of course a book characterized by all his immense learning, his wonderful fairness of spirit and fertility of suggestion. still, one could not but feel that it did not solve the question of the origin of man. there was one great contrast between that book and his "origin of species." in the earlier treatise he undertook to point out a _vera causa_ of the origin of species, and he did it. in his "descent of man" he brought together a great many minor generalizations which facilitated the understanding of man's origin. but he did not come at all near to solving the central problem, nor did he anywhere show clearly why natural selection might not have gone on forever producing one set of beings after another distinguishable chiefly by physical differences. but darwin's co-discoverer, alfred russel wallace, at an early stage in his researches, struck out a most brilliant and pregnant suggestion. in that one respect wallace went further than ever darwin did. it was a point of which, indeed, darwin admitted the importance. it was a point of which nobody could fail to understand the importance, that in the course of the evolution of a very highly organized animal, if there came a point at which it was of more advantage to that animal to have variations in his intelligence seized upon and improved by natural selection than to have physical changes seized upon, then natural selection would begin working almost exclusively upon that creature's intelligence, and he would develop in intelligence to a great extent, while his physical organism would change but slightly. now, that of course applied to the case of man, who is changed physically but very slightly from the apes, while he has traversed intellectually such a stupendous chasm. as soon as this statement was made by wallace, it seemed to me to open up an entirely new world of speculation. there was this enormous antiquity of man, during the greater part of which he did not know enough to make history. we see man existing here on the earth, no one can say how long, but surely many hundreds of thousands of years, yet only during just the last little fringe of four or five thousand years has he arrived at the point where he makes history. before that, something was going on, a great many things were going on, while his ancestors were slowly growing up to that point of intelligence where it began to make itself felt in the recording of events. this agrees with wallace's suggestion of a long period of psychical change, accompanied by slight physical change. well, in the spring of 1871, when darwin's "descent of man" came out, just about the same time i happened to be reading wallace's account of his experiences in the malay archipelago, and how at one time he caught a female orang-outang with a new-born baby, and the mother died, and wallace brought up the baby orang-outang by hand; and this baby orang-outang had a kind of infancy which was a great deal longer than that of a cow or a sheep, but it was nothing compared to human infancy in length. this little orang-outang could not get up and march around, as mammals of less intelligence do, when he was first born, or within three or four days; but after three or four weeks or so he would get up, and begin taking hold of something and pushing it around, just as children push a chair; and he went through a period of staring at his hands, as human babies do, and altogether was a good deal slower in getting to the point where he could take care of himself. and while i was reading of that i thought, dear me! if there is any one thing in which the human race is signally distinguished from other mammals, it is in the enormous duration of their infancy; but it is a point that i do not recollect ever seeing any naturalist so much as allude to. it happened at just that time that i was making researches in psychology about the organization of experiences, the way in which conscious intelligent action can pass down into quasi-automatic action, the generation of instincts, and various allied questions; and i thought, can it be that the increase of intelligence in an animal, if carried beyond a certain point, must necessarily result in prolongation of the period of infancy,--must necessarily result in the birth of the mammal at a less developed stage, leaving something to be done, leaving a good deal to be done, after birth? and then the argument seemed to come along very naturally, that for every action of life, every adjustment which a creature makes in life, whether a muscular adjustment or an intelligent adjustment, there has got to be some registration effected in the nervous system, some line of transit worn for nervous force to follow; there has got to be a connection between certain nerve-centres before the thing can be done, whether it is the acts of the viscera or the acts of the limbs, or anything of that sort; and of course it is obvious that if the creature has not many things to register in his nervous system, if he has a life which is very simple, consisting of few actions that are performed with great frequency, that animal becomes almost automatic in his whole life; and all the nervous connections that need to be made to enable him to carry on life get made during the foetal period or during the egg period, and when he comes to be born, he comes all ready to go to work. as one result of this, he does not learn from individual experience, but one generation is like the preceding generations, with here and there some slight modifications. but when you get the creature that has arrived at the point where his experience has become varied, he has got to do a good many things, and there is more or less individuality about them; and many of them are not performed with the same minuteness and regularity, so that there does not begin to be that automatism within the period during which he is being developed and his form is taking on its outlines. during prenatal life there is not time enough for all these nervous registrations, and so by degrees it comes about that he is born with his nervous system perfectly capable only of making him breathe and digest food,--of making him do the things absolutely requisite for supporting life; instead of being born with a certain number of definite developed capacities, he has a number of potentialities which have got to be roused according to his own individual experience. pursuing that line of thought, it began after a while to seem clear to me that the infancy of the animal in a very undeveloped condition, with the larger part of his faculties in potentiality rather than in actuality, was a direct result of the increase of intelligence, and i began to see that now we have two steps: first, natural selection goes on increasing the intelligence; and secondly, when the intelligence goes far enough, it makes a longer infancy, a creature is born less developed, and therefore there comes this plastic period during which he is more teachable. the capacity for progress begins to come in, and you begin to get at one of the great points in which man is distinguished from the lower animals, for one of those points is undoubtedly his progressiveness; and i think that any one will say, with very little hesitation, that if it were not for our period of infancy we should not be progressive. if we came into the world with our capacities all cut and dried, one generation would be very much like another. then, looking round to see what are the other points which are most important in which man differs from the lower animals, there comes that matter of the family. the family has adumbrations and foreshadowings among the lower animals, but in general it may be said that while mammals lower than man are gregarious, in man have become established those peculiar relationships which constitute what we know as the family; and it is easy to see how the existence of helpless infants would bring about just that state of things. the necessity of caring for the infants would prolong the period of maternal affection, and would tend to keep the father and mother and children together, but it would tend especially to keep the mother and children together. this business of the marital relations was not really a thing that became adjusted in the primitive ages of man, but it has become adjusted in the course of civilization. real monogamy, real faithfulness of the male parent, belongs to a comparatively advanced stage; but in the early stages the knitting together of permanent relations between mother and infant, and the approximation toward steady relations on the part of the male parent, came to bring about the family, and gradually to knit those organizations which we know as clans. here we come to another stage, another step forward. the instant society becomes organized in clans, natural selection cannot let these clans be broken up and die out,--the clan becomes the chief object or care of natural selection, because if you destroy it you retrograde again, you lose all you have gained; consequently, those clans in which the primeval selfish instincts were so modified that the individual conduct would be subordinated to some extent to the needs of the clan,--those are the ones which would prevail in the struggle for life. in this way you gradually get an external standard to which man has to conform his conduct, and you get the germs of altruism and morality; and in the prolonged affectionate relation between the mother and the infant you get the opportunity for that development of altruistic feeling which, once started in those relations, comes into play in the more general relations, and makes more feasible and more workable the bonds which keep society together, and enable it to unite on wider and wider terms. so it seems that from a very small beginning we are reaching a very considerable result. i had got these facts pretty clearly worked out, and carried them around with me some years, before a, fresh conclusion came over me one day with a feeling of surprise. in the old days before the copernican astronomy was promulgated, man regarded himself as the centre of the universe. he used to entertain theological systems which conformed to his limited knowledge of nature. the universe seemed to be made for his uses, the earth seemed to have been fitted up for his dwelling place, he occupied the centre of creation, the sun was made to give him light, etc. when copernicus overthrew that view, the effect upon theology was certainly tremendous. i do not believe that justice has ever been done to the shock that it gave to man when he was made to realize that he occupied a kind of miserable little clod of dirt in the universe, and that there were so many other worlds greater than this. it was one of the first great shocks involved in the change from ancient to modern scientific views, and i do not doubt it was responsible for a great deal of the pessimistic philosophizing that came in the seventeenth and eighteenth centuries. now, it flashed upon me a dozen years or so ago--after thinking about this manner in which man originated--that man occupies certainly just as exceptional a position as before, if he is the terminal in a long series of evolutionary events. if at the end of the long history of evolution comes man, if this whole secular process has been going on to produce this supreme object, it does not much matter what kind of a cosmical body he lives on. he is put back into the old position of theological importance, and in a much more intelligent way than in the old days when he was supposed to occupy the centre of the universe. we are enabled to say that while there is no doubt of the evolutionary process going on throughout countless ages which we know nothing about, yet in the one case where it is brought home to us we spell out an intelligible story, and we do find things working along up to man as a terminal fact in the whole process. this is indeed a consistent conclusion from wallace's suggestion that natural selection, in working toward the genesis of man, began to follow a new path and make psychical changes instead of physical changes. obviously, here you are started upon a new chapter in the history of the universe. it is no longer going to be necessary to shape new limbs, and to thicken the skin and make new growths of hair, when man has learned how to build a fire, when he can take some other animal's hide and make it into clothes. you have got to a new state of things. after i had put together all these additional circumstances with regard to the origination of human society and the development of altruism, i began to see a little further into the matter. it then began to appear that not only is man the terminal factor in a long process of evolution, but in the origination of man there began the development of the higher psychical attributes, and those attributes are coming to play a greater and greater part in the development of the human race. just take this mere matter of "altruism," as we call it. it is not a pretty word, but must serve for want of a better. in the development of altruism from the low point, where there was scarcely enough to hold the clan together, up to the point reached at the present day, there has been a notable progress, but there is still room for an enormous amount of improvement. the progress has been all in the direction of bringing out what we call the higher spiritual attributes. the feeling was now more strongly impressed upon me than ever, that all these things tended to set the whole doctrine of evolution into harmony with religion; that if the past through which man had originated was such as has been described, then religion was a fit and worthy occupation for man, and some of the assumptions which underlie every system of religion must be true. for example, with regard to the assumption that what we see of the present life is not the whole thing; that there is a spiritual side of the question beside the material side; that, in short, there is for man a life eternal. when i wrote the "destiny of man," all that i ventured to say was, that it did not seem quite compatible with ordinary common sense to suppose that so much pains would have been taken to produce a merely ephemeral result. but since then another argument has occurred to me: that just at the time when the human race was beginning to come upon the scene, when the germs of morality were coming in with the family, when society was taking its first start, there came into the human mind--how one can hardly say, but there did come--the beginnings of a groping after something that lies outside and beyond the world of sense. that groping after a spiritual world has been going on here for much more than a hundred thousand years, and it has played an enormous part in the history of mankind, in the whole development of human society. nobody can imagine what mankind would have been without it up to the present time. either all religion has been a reaching out for a phantom that does not exist, or a reaching out after something that does exist, but of which man, with his limited intelligence, has only been able to gain a crude idea. and the latter seems a far more probable conclusion, because, if it is not so, it constitutes a unique exception to all the operations of evolution we know about. as a general thing in the whole history of evolution, when you see any internal adjustment reaching out toward something, it is in order to adapt itself to something that really exists; and if the religious cravings of man constitute an exception, they are the one thing in the whole process of evolution that is exceptional and different from all the rest. and this is surely an argument of stupendous and resistless weight. i take this autobiographical way of referring to these things, in the order in which they came before my mind, for the sake of illustration. the net result of the whole is to put evolution in harmony with religious thought,--not necessarily in harmony with particular religious dogmas or theories, but in harmony with the great religious drift, so that the antagonism which used to appear to exist between religion and science is likely to disappear. so i think it will before a great while. if you take the case of some evolutionist like professor haeckel, who is perfectly sure that materialism accounts for everything (he has got it all cut and dried and settled; he knows all about it, so that there is really no need of discussing the subject!); if you ask the question whether it was his scientific study of evolution that really led him to such a dogmatic conclusion, or whether it was that he started from some purely arbitrary assumption, like the french materialists of the eighteenth century, i have no doubt the latter would be the true explanation. there are a good many people who start on their theories of evolution with these ultimate questions all settled to begin with. it was the most natural thing in the world that after the first assaults of science upon old beliefs, after a certain number of bible stories and a certain number of church doctrines had been discredited, there should be a school of men who in sheer weariness should settle down to scientific researches, and say, "we content ourselves with what we can prove by the methods of physical science, and we will throw everything else overboard." that was very much the state of mind of the famous french atheists of the last century. but only think how chaotic nature was to their minds compared to what she is to our minds to-day. just think how we have in the present century arrived where we can see the bearings of one set of facts in nature as collated with another set of facts, and contrast it with the view which even the greatest of those scientific french materialists could take. consider how fragmentary and how lacking in arrangement was the universe they saw compared with the universe we can see to-day, and it is not strange that to them it could be an atheistic world. that hostility between science and religion continued as long as religion was linked hand in hand with the ancient doctrine of special creation. but now that the religious world has unmoored itself, now that it is beginning to see the truth and beauty of natural science and to look with friendship upon conceptions of evolution, i suspect that this temporary antagonism, which we have fallen into a careless way of regarding as an everlasting antagonism, will come to an end perhaps quicker than we realize. there is one point that is of great interest in this connection, although i can only hint at it. among the things that happened in that dim past when man was coming into existence was the increase of his powers of manipulation; and that was a factor of immense importance. anaxagoras, it is said, wrote a treatise in which he maintained that the human race would never have become human if it had not been for the hand. i do not know that there was so very much exaggeration about that. it was certainly of great significance that the particular race of mammals whose intelligence increased far enough to make it worth while for natural selection to work upon intelligence alone was the race which had developed hands and could manipulate things. it was a wonderful era in the history of creation when that creature could take a club and use it for a hammer, or could pry up a stone with a stake, thus adding one more lever to the levers that made up his arm. from that day to this, the career of man has been that of a person who has operated upon his environment in a different way from any animal before him. an era of similar importance came probably somewhat later, when man learned how to build a fire and cook his food; thus initiating that course of culinary development of which we have seen the climax in our dainty dinner this evening. here was another means of acting upon the environment. here was the beginning of the working of endless physical and chemical changes through the application of heat, just as the first use of the club or the crowbar was the beginning of an enormous development in the mechanical arts. now, at the same time, to go back once more into that dim past, when ethics and religion, manual art and scientific thought, found expression in the crudest form of myths, the aesthetic sense was germinating likewise. away back in the glacial period you find pictures drawn and scratched upon the reindeer's antler, portraitures of mammoths and primitive pictures of the chase; you see the trinkets, the personal decorations, proving beyond question that the aesthetic sense was there. there has been an immense aesthetic development since then. and i believe that in the future it is going to mean far more to us than we have yet begun to realize. i refer to the kind of training that comes to mankind through direct operation upon his environment, the incarnation of his thought, the putting of his ideas into new material relations. this is going to exert powerful effects of a civilizing kind. there is something strongly educational and disciplinary in the mere dealing with matter, whether it be in the manual training school, whether it be in carpentry, in overcoming the inherent and total depravity of inanimate things, shaping them to your will, and also in learning to subject yourself to their will (for sometimes you must do that in order to achieve your conquests; in other words, you must humour their habits and proclivities). in all this there is a priceless discipline, moral as well as mental, let alone the fact that, in whatever kind of artistic work a man does, he is doing that which in the very working has in it an element of something outside of egoism; even if he is doing it for motives not very altruistic, he is working toward a result the end of which is the gratification or the benefit of other persons than himself; he is working toward some result which in a measure depends upon their approval, and to that extent tends to bring him into closer relations to his fellow man. in the future, to an even greater extent than in the recent past, crude labour will be replaced by mechanical contrivances. the kind of labour which can command its price is the kind which has trained intelligence behind it. one of the great needs of our time is the multiplication of skilled and special labour. the demand for the products of intelligence is far greater than that for mere crude products of labour, and it will be more and more so. for there comes a time when the latter products have satisfied the limit to which a man can consume food and drink and shelter,--those things which merely keep the animal alive. but to those things which minister to the requirements of the spiritual side of a man, there is almost no limit. the demand one can conceive is well-nigh infinite. one of the philosophical things that have been said, in discriminating man from the lower animals, is that he is the one creature who is never satisfied. it is well for him that he is so, that there is always something more for which he craves. to my mind, this fact most strongly hints that man is infinitely more than a mere animate machine. outline i. the meaning of infancy 1. the relation between progress and infancy 2. man's method of learning 3. the mental inheritance of animals 4. infancy and educability of animals 5. infancy is a period of plasticity 6. educability varies widely in different creatures 7. increased intelligence means prolonged infancy 8. the socializing effects of infancy 9. the use of this capacity for progress in the past ii. the part played by infancy in the evolution of man 1. the grandeur of natural causation 2. the problem of man's ascendancy 3. natural selection seizes on intelligence 4. a long infancy characteristic of man 5. a complex life requires a longer infancy 6. infancy fosters sociability and the family 7. group life increases the social and moral bonds 8. spiritual man is evolution's terminal factor 9. man marks a development along new lines 10. hand-work in the evolution of intelligence 11. the educational value of aesthetic effort 12. man's spirituality is prophetic of his destiny [illustration: cover] little miss peggy: only a nursery story "would i could paint the serious brow, the eyes that look the world in face, half-questioning, doubting, wondering how this happens thus, or that finds place." _my opposite neighbour._ [illustration: "'what is the matter, little girls?' said the lady." p. 181] little miss peggy: only a nursery story by mrs. molesworth with pictures by walter crane london: macmillan & co. and new york 1887 to the memory of e. l. the dear young friend who suggested its name to this little story, and from whose late home, so intimately associated with her, this dedication is made. bindon, _august_ 1887. contents chapter i page a breakfast party 1 chapter ii the white spot on the hill 18 chapter iii "the children at the back" 33 chapter iv "real" fancies 48 chapter v the little red shoes 65 chapter vi fellow-feelings and slippers 81 chapter vii a bun to the good 98 chapter viii under the big umbrella 114 chapter ix the opposite house 131 chapter x "soap-bubbling" 145 chapter xi up fernley road 162 chapter xii the shoes-lady again 178 list of illustrations "what is the matter, little girls?" said the lady. _frontispiece_ page he had to drum with a spoon, first in one fat hand and then in the other 2 they were settled on the hearth-rug--baby on peggy's lap 17 "see hal," she said, "over there, far, far away, neely in the sky, does you see that bluey hill?" 27 she was rather a terrible-looking old woman; she always wore a short bed-gown ... and she was generally to be seen with a pipe in her mouth 35 "tell me what the little white house is reely like" 52 peggy stood still, her eyes fixed on the baby shoes 68 "here's the other shoe, i've just founded it" 92 suddenly a window above opened, and mother whelan's befrilled face was thrust out 109 an umbrella rolling itself about on the pavement 127 "to be sure," she said, in her most gracious tone. "'tis the beautiful pipes i have" 138 the boys, boy-like, thought little but of who could blow the biggest bubbles 149 hushed light smiley to sleep, her arm clasped round peggy 177 chapter i a breakfast party "henry was every morning fed with a full mess of milk and bread." mary lamb. "no," said peggy to herself, with a little sigh, "the naughty clouds has covered it up to-day. i can't see it." "miss peggy," came nurse's voice from the other side of the room, "your breakfast's waiting. come to the table, my dear, and stand quiet while master thor says the grace." [illustration: "--baby, who required a great deal of room to himself at table, baby though he was. he had so many things to do during a meal, you see, which grown-up children think quite unnecessary. he had to drum with a spoon, first in one fat hand and then in the other; he had to dip his crust first in nurse's cup of tea and next in hal's jug of milk to see which tasted best, and there would have been no fun in doing either if he hadn't had to stretch a long way across; and besides all this he felt really obliged now and then to put his feet upon the table for a change, one at a time, of course."] nurse spoke kindly, but she meant what she said. peggy turned slowly from the window and took her place among her brothers. she, and thorold and terence, the two oldest boys, sat opposite nurse, and beside nurse was baby, who required a great deal of room to himself at table, baby though he was. he had so many things to do during a meal, you see, which grown-up children think quite unnecessary. he had to drum with a spoon, first in one fat hand and then in the other; he had to dip his crust first in nurse's cup of tea and next in hal's jug of milk to see which tasted best, and there would have been no fun in doing either if he hadn't had to stretch a long way across; and besides all this he felt really obliged now and then to put his feet upon the table for a change, one at a time, of course. for even he, clever as he was, could not have got both together out of the bars of his chair without toppling over. nurse had for some time past been speaking about beginning "to break master baby in," but so far it had not got beyond speaking, and she contented herself with seating him beside her and giving him a good quarter of the table to himself, the only objection to which was that it gave things in general a rather lopsided appearance. at the two ends sat baldwin and hal. hal's real name, of course, was henry, though he was never called by it. baldwin, on the contrary, had no short name, partly perhaps because mamma thought "baldie" sounded so ugly, and partly because there was something about baldwin himself which made one not inclined to shorten his name. it suited him so well, for he was broad and comfortable and slow. he was never in a hurry, and he gave you the feeling that you needn't be in a hurry either. there was plenty of time for everything, for saying the whole of his name as well as for everything else. that made a lot of brothers, didn't it? five, counting baby, and to match them, or rather not to match them--for five and one are not a match at all--only one little girl! she wondered about it a good deal, when she had nothing else more interesting to wonder about. it seemed so very badly managed that she should have five brothers, and that the five brothers should only have one sister each. it wasn't always so, she knew. the children at the back had plenty of both brothers and sisters; she had found that out already. but i must not begin just yet about the children at the back; you will hear about them in good time. there was a nice bowl of bread-and-milk at each child's place, and as bread-and-milk is much better hot than cold, it was generally eaten up quickly. but this morning, even after the grace was said, and the four brothers who weren't baby had got on very well with theirs, peggy sat, spoon in hand, gazing before her and not eating at all. "what's the matter, miss peggy?" said nurse, when she had at last made baby understand that he really _wasn't_ to try to put his toes into her tea-cup, which had struck him suddenly as a very beautiful thing to do; "you've not begun to eat. are you waiting for the sugar or the salt, or can't you fix which you want this morning?" for there was a very nice and interesting rule in that nursery that every morning each child might choose whether he or she would have salt or sugar in the bread and milk. the only thing was that they had to be quick about choosing, and that was not always very easy. peggy looked up when nurse spoke to her. "peggy wasn't 'toosing," she said. then she grew a little red. "_i_ wasn't 'toosing," she went on. for peggy was five--five a good while ago--and she wanted to leave off baby ways of talking. "i was wondering." "well, eat your breakfast, and when you've got half-way down the bowl you can tell us what you were wondering about," said nurse. peggy's spoon, already laden, continued its journey to her mouth. but when it got there, and its contents were safely deposited between her two red lips, she gave a little cry. "oh!" she said, "it doesn't taste good. there's no salt or sugar." "'cos you didn't put any in, you silly girl," said thor. "i saw, but i thought it'd be a good lesson. people shouldn't wonder when they're eating." "peggy wasn't eating; she was only going to eat," said terry. "never mind, peg-top. thor shan't tease you. which'll you have? say quick," and he pulled forward the sugar-basin and the salt-cellar in front of his sister. "sugar, pelease," said peggy. "it's so 'told this morning." at this thor burst out laughing. "what a peggy-speech," he said. "sugar's no warmer than salt." "yes," said baldwin, solemnly, from the other end of the table. "'tis. there's sugar in toffee and in jam, and they're hot, leastways they're hot to be made. and there's salt in ices, for mamma said they're made with salt." "what rubbish!" said thor. "nurse, isn't it rubbish? and when did you ever see ices, i'd like to know, baldwin?" "i did," baldwin maintained. "onst. but i'll not tell you when, if you say rubbish." "it is rubbish all the same, and i'll prove it," said thor. "you know that nice smooth white sugar on the top of bridescake?--well, they ice that to put it on--i know they do. don't they, nurse?" "they call it icing, to be sure," nurse replied. "but that's no proof that ices themselves mayn't be made with salt, master thor, for when you come to think of it ices have sugar in them." "to be sure they have," thor cried, triumphantly. "nurse has proved it--that sugar's no warmer than salt," which was not what nurse had intended to say at all. but now peggy, who all this time had been steadily eating, looked up again. "peggy was wondering," she said, "what's clouds. is clouds alive?" thor was all ready with his "you silly girl" again, but this time terry was before him. "they can't be alive," he said. "they've got no hands, or feet, or mouths, and noses, and eyes, and----" "they _has_ noses," said peggy, eagerly. "peggy's seen them, and they has wings--the little ones has wings, they fly so fast. and p'raps they has got proper faces on their other sides, to look at the sun with. i've seen shiny bits of the other sides turned over." "yes," said baldwin, solemnly again, as if that settled it, "so has i." "but they're not alive, peggy, they're really not. they fly because the wind blows them," said terence. "oh!" said peggy, with a deep-drawn breath, "i see. then if we all blowed very hard at the window, if we all blowed together, couldn't we blow them away? i do so want to blow them away when they come over my hills." but when she had said this she grew very red, just as if she had told something she had not meant to tell, and if any one had looked at her quite close they would have seen that there were tears in her eyes. fortunately, however, no one had noticed her last words, for thorold and terence too had burst out laughing at the beginning of her speech. "fancy us all blowing out of the window together," they said. and they began puffing out their cheeks and pretending to blow very hard, which made them look so funny that peggy herself burst out laughing too. "i'll tell you what," said thor, when they were tired of laughing, "that reminds me of soap-bubbles, we haven't had any for such a time. nurse, will you remember to let us have them the first wet half-holiday? mamma'll let us if you will." "and the pipes?" said nurse. "there was six new got the last time, and they were to last, certain sure till the next time, and then----" "oh i know," said thor, "we took them to school and never brought them back. never mind--we'll get some more from old mother whelan. she always keeps lots. we'll keep our halfpennies for two saturdays--that'll do. but we must be going, terry and baldwin. _i'm_ all ready." and he jumped up as he spoke, and pulled his satchel of books from under his chair, where he had put them to be all ready. baldwin slowly got down from his place, for he was not only broad, but his legs were very short, and came up to nurse to be helped on with his little overcoat, while terence began rushing about the room in a fuss, looking for one of his books, which as usual couldn't be found at the last minute. "i had it just before breakfast, i'm _sure_ i had," he went on repeating. "i haven't finished learning it, and i meant to look it over. oh dear, what shall i do?" the nursery party was too accustomed to terry's misfortunes to be much upset by them. peggy sat still for a moment or two considering. then she spoke. "terry," she said, "look in baby's cot." off flew terence, returning in triumph, grammar in hand. "i'll learn it on the way to school. how did you know it was there, peggy?" "i sawed you reaching over to kiss baby when you comed in to ask nurse for a new shoe-lace this morning," said peggy, with great pride. "good girl," said terence, as he slammed the door and rushed downstairs to overtake his two brothers. the nursery seemed very quiet when the three big boys had gone. quiet but not idle; there was always a great deal to do first thing of a morning, and peggy had her own share of the doing to see to. she took off her own breakfast pinafore and put on a quite clean one--one that looked quite clean anyway, just as if it had never been on, even though it had really been used two or three times. peggy called it her "prayers pinafore," and it always lasted a whole week, as it was only worn to go down to the dining-room for five or ten minutes. then she washed her hands and stood still for nurse to give a tidying touch to her soft fair hair, though it really didn't need it,--peggy's hair never looked messy,--and then she took off hal's over pinafore which he wore on the top of his blouse at meal-times, and helped him to wash his hands, by which time nurse and baby were also ready, and the little procession set off on their journey. if the prayers bell had not sounded yet, or did not sound as they made their way down, nurse would stop at mamma's door and tap, and the answer was sure to be "come in." then nurse would go on downstairs with baby, and peggy and hal would trot in to see mamma, and wait a moment or two till she was ready. she was almost always nearly ready, unless she was very, very tired; and in that case she would tell them to go downstairs and come up and see her again after prayers, as she was going to have breakfast in bed. they rather liked these days, though of course they were sorry for mamma to be so tired, but it was very interesting to watch her having her breakfast, and generally one or two dainty bits of toast and marmalade would find their way to the two little mouths. it was only since last winter that mamma had been so often tired and not able to get up early. before then she used always to come up to the nursery to see her six children at breakfast, and prayers were early enough for the three boys to stay for them, instead of having them at school. for mamma was not at all a "lazy" mother, as you might think if i did not explain. but last winter she had been very ill indeed, so ill that papa looked dreadfully unhappy, and the boys had to take off their boots downstairs so as not to make any noise when they passed her door, and the days seemed very long to peggy and hal, worst to peggy of course, for hal was still so little that almost all his life belonged to the nursery. it was during that time that peggy first found out the white spot on the hill, which i am going to tell you about, for she used to climb up on the window-sill and sit there looking out at whatever there was to see for hours at a time. this morning mamma was evidently not tired, for just as the children got to the landing on to which her door opened, out she came. "well, darlings," she said, "there you are! have the boys got off to school all rightly, nurse?" "oh yes, ma'am," nurse was beginning, but peggy interrupted her. "terry loosed his book, mamma dear, and peg--_i_ founded it; i knewed where it was 'cos i used my eyes like you said." "that was a very good thing," said mamma. she had talked to peggy about using her eyes a good deal, for peggy had rather a trick of going to sleep with her eyes open, like many children, and it becomes a very tiresome trick if it isn't cured, and makes one miss a great many chances of being useful to others, and of enjoying pleasant things one's self. "poor terry--i wish he wasn't so careless. where was his book this time?" "in such a funny place, mamma dear," said peggy. "in baby's cot," and at the sound of his name baby crowed, which made both peggy and hal burst out laughing, so that mamma had to hold their hands firmly to prevent their tumbling down stairs. after prayers were over nurse took baby and hal away, but papa said peggy might stay for a few minutes. "i've scarcely seen you the last day or two, old woman," he said; "you were fast asleep when i came home. what have you been about?" "about," peggy repeated, looking puzzled. "well--what have you been doing with yourself?" he said again. "i've been doing nothing with _myself_," peggy replied, gravely. "i've done my lessons and my sewing, and i've used my eyes." "well, and isn't all that yourself?" asked papa, who was rather a tease. "you've done your sewing with your fingers and your lessons with your mind, and you've used your eyes for both--mind, fingers, eyes--those are all parts of yourself." peggy spread out her two hands on the table and looked at the ten pink fingers. "them's my fingers," she said, "but i don't know where that other thing is--that what thinks. i'd like to know where it is. papa, can't you tell me?" there came a puzzled look into her soft gray eyes--mamma knew that look; when it stayed long it was rather apt to turn into tears. "arthur," she said to peggy's papa, "you're too fond of teasing. peggy dear, nobody can see that part of you; there are many things we can't ever see, or hear, or touch, which are real things all the same." peggy's face lightened up again. she nodded her head softly, as if to say that she understood. then she got down from her chair and went up to her father to kiss him and say good-bye. "going already, peg!" he said. "don't you like papa teasing you?" "i don't mind," said peggy, graciously; "you're only a big boy, papa. i'm going 'cos nurse wants me to keep baby quiet while she makes the beds." but when she got round to the other side of the table to her mother, she lingered a moment. "mamma," she whispered, "_it's_ not there this morning--peggy's fairy house. it's all hided up. mamma----" "well, darling?" "are you _sure_ it'll come back again?" "quite sure, dear. it's only hidden by the clouds, as i've told you before. you know you've often been afraid it was gone, and it's always come again." "yes, to be sure," said peggy. "what a silly little girl i am, mamma dear." and she laughed her own little gentle laugh. i can't tell how it was that peggy's little laugh used sometimes to bring tears to her mother's eyes. when she got up to the nursery again she found she was very much wanted. nurse was in the night nursery which opened into the day one, and looked out to the back of the house just as the other looked to the front. and baby was sitting on the hearth-rug, with hal beside him, both seeming far from happy. "baby's defful c'oss, peggy," said poor hal. and baby, though he couldn't speak, pouted out his lips and looked very savage at hal, which of course was very unreasonable and ungrateful of him, as hal had been doing everything he could to amuse him, and had only objected to baby pulling him across the floor by his curls. "oh baby," said peggy, "that isn't good. poor hal's hair--see how you've tugged it." for baby was still grasping some golden threads in his plump fists. "him sinks zem's feaders," said hal, apologetically. he was so fond of baby that he couldn't bear any one to say anything against him except himself. "but baby must learn hairs isn't feathers," said peggy, solemnly. "and it isn't good to let him pull the feathers out of his parrot either, hal," she continued, "for some day he might have a _live_ parrot, and then it would be cooel, and the parrot would _bite_ him--yes it would, baby." this was too much for baby. he drew the corner of his mouth down, then he opened it wide, very wide, and was just going to roar when peggy threw her arms round him and kissed him vigorously. "he's sorry, hal--dear baby--he's so very sorry. kiss him, hal. let's all kiss together," and the three soft faces all met in a bunch, which baby found so amusing that instead of continuing his preparations for a good cry, he thought better of it, and went off into a laugh. "that's right," said peggy. "now if you'll both be very good boys i'll tell you a story. just wait a minute till i've tooked off my prayers pinafore." she jumped up to do so. while she was unfastening it her eyes moved to the window; she gave a little cry and ran forward. the day was clearing up, the sun was beginning faintly to shine, and the clouds were breaking. [illustration: "and in another moment they were settled on the hearth-rug--baby on peggy's lap--on, and off it too, for it was much too small to accommodate the whole of him; hal on the floor beside her, his curly head leaning on his sister's shoulder in blissful and trustful content." p. 17] "mamma was right," exclaimed peggy, joyfully; "i can see it--i can see it! i can see my white house again, my dear little fairy house." she would have stayed there gazing out contentedly half the morning if her little brothers had not called her back. "peggy," said hal, plaintively, "do tum. baby's pulling hal's 'air adain." "peggy's coming, dear," said the motherly little voice. and in another moment they were settled on the hearth-rug--baby on peggy's lap--on, and off it too, for it was much too small to accommodate the whole of him; hal on the floor beside her, his curly head leaning on his sister's shoulder in blissful and trustful content. chapter ii the white spot on the hill "o reader! had you in your mind such stores as silent thought can bring, o gentle reader! you would find a tale in everything. what more i have to say is short, and you must kindly take it: it is no tale; but, should you think, perhaps a tale you'll make it." w. wordsworth. "telling stories," when the teller is only five and some months old, and the hearers one and a quarter and three, is rather a curious performance. but peggy was well used to it, and when in good spirits quite able to battle with the difficulties of amusing hal and baby at the same time. and these difficulties were not small, for, compared with baby, hal was really "grown-up." it is all very well for people who don't know much about tiny children to speak of them all together, up to--six or seven, let us say--as "babies," but we who think we _do_ know something about them, can assure the rest of the world that this is an immense mistake. one year in nursery arithmetic counts for ten or even more in _real_ "grown-up" life. there was a great difference between peggy and hal for instance, but a still greater between hal and baby, and had there been a new baby below him again, of course it would have been the greatest of all. peggy could not have explained this in words, but she knew it thoroughly all the same, and she had learnt to take it into account in her treatment of the two, especially in her stories telling. in reality the story itself was all for hal, but there was a sort of running accompaniment for baby which he enjoyed very much, and which, to tell the truth, i rather think hal found amusing too, though he pretended it was for baby's sake. this morning her glance out of the window had made peggy feel so happy that the story promised to be a great success. she sat still for a minute or two, her arms clasped round baby's waist, gently rocking herself and him to and fro, while her gray eyes stared before her, as if reading stories in the carpet or on the wall. "peggy," said hal at last, giving her a hug--he had been waiting what he thought a very long time--"peggy, 'do on--no, i mean begin, p'ease." "yes, hal, d'reckly," said peggy. "it's coming, hal, yes, now i think it's comed. should we do piggies first, to please baby before we begin?" "piggies is _so_ silly," said hal, disdainfully. "well, we'll kiss him instead--another kiss all together, he does so like that;" and when the kissing was over--"now, baby dear, listen, and p'raps you'll understand _some_, and if you're good we'll have piggies soon." baby gave a kind of grunt; perhaps he was thinking of the pigs, but most likely it was just his way of saying he would be very good. "there was onst," peggy began, "a little girl who lived in a big house all by herself." "hadn't she no mamma, or nurse, or--or--brudders?" hal interrupted. "no, not none," peggy went on. "she lived quite alone, and she didn't like it. the house was as big as a--as a church, and she hadn't no bed, and no chairs or tables, and there was very, _very_ high stairs." "is there stairs in churches?" asked hal. peggy looked rather puzzled. "yes, i think there is," she said. "there's people high up in churches, so there must be stairs. but i didn't say it _were_ a church, hal; i only said as big as a church. and the stairs was for baby--you'll hear--p'raps there wasn't _reelly_ stairs. now, baby; one day a little piggy-wiggy came up the stairs--one, two, three," and peggy's hand came creeping up baby's foot and leg and across his pinafore and up his bare arm again, by way of illustrating piggy's progress, "and when he got to the top he said 'grumph,' and poked his nose into the little girl's neck"--here peggy's own nose made a dive among baby's double chins, to his exceeding delight, setting him off chuckling to himself for some time, which left peggy free to go on with the serious part of the story for hal's benefit--"and there was a window in the big house, and the little girl used to sit there always looking out." "always?" asked hal again. "all night too? didn't her ever go to bed?" "she hadn't no bed, i told you. no, she didn't sit there all night, 'cos she couldn't have see'd in the dark. never mind about the night. she sat there all day, always looking out, 'cos there was something she liked to see. if i tell you you won't tell nobody what it was, will you. hal?" hal looked very mystified, but replied obediently, "no, won't tell nobody," he said. "well, then, i'll tell you what it was. it was a----" but at this moment baby, having had enough of his own meditations, began to put in a claim to some special attention. the piggy had to be summoned and made to run up and down stairs two or three times before he would be satisfied and allow peggy to proceed. "well, peggy?" said hal eagerly. "it was a----" oh dear, interrupted again! but this time the interruption was a blessing in disguise. it was nurse come to fetch baby for his morning sleep. "and thank you, miss peggy, my dear, for keeping him so nice and good. i heard you come up, and i knew they'd be all right with you," she said, as she walked away with baby, who was by no means sure that he wanted to go. "now," said hal, edging closer to peggy, "we'll be comfable. go on, peggy--what she sawed." "it was a hill--far, far away, neely as far as the sky," said peggy in a mysterious tone. "when the sun comed she could see it plain--the hill and what was there, but when the sun goed she couldn't. there was a white spot on the hill, hal, and that white spot was a lovely white cottage. she knowed it, though she'd never see'd it." "how did she know it?" "her mam--no, that's wrong, she hadn't no mamma--well, never mind, _somebody_'d told her." "were it _god_?" asked hal, in an awestruck whisper. "i don't know. no, i don't think so. i think it's a little naughty to say that, hal. no, dear, don't cry," for signs of disturbance were visible in hal's round face. "you didn't mean, and it isn't never naughty when we don't mean, you know. we'll go on about the little girl. she knowed it was a lovely cottage, and she wanted _very_ much, as much as could be, to go there, for the big house wasn't pretty, and it was dark, nearly black, and the cottage was all white." "her house wasn't as nice as _zit_, were it? zit house isn't b'ack," said hal. "no," said peggy, doubtfully. "_it_ wasn't as nice as this, but the white house was much prettier than this." "how?" asked hal. "oh!" said peggy, letting her eyes and her fancy rove about together, "i think it was beautiful all over. it was all shiny white; the walls was white, and the carpets was white, and the tables and the chairs was white--all shiny and soft like--like----" "baby's best sash," suggested hal. "well, p'raps--that'll do. and there was a cow and chickens and sheep, and a kitchen where you could make cakes, and a garden with lots of flowers and strawberries----" "all white?" asked hal. "no, of course not. strawberries couldn't be white, and flowers is all colours. 'twas the _droind-room_ that was all white." "and the milk and the eggs. zem _is_ white," said hal, triumphantly. "very well. i didn't say they wasn't. but the story goes on that the little girl didn't know how to get there; it was so far and so high up. so she sat and cried all alone at the window." "all alone, _poor_ little girl," said hal, with deep feeling. "kick, peggy, kick, i'm 'doing to cry; make it come right _kick_. the crying's just coming." "make it wait a minute. i can't make it come right all so quick," said peggy. "it's going to come, so make the crying wait. one day she was crying d'edful, worst than never, 'cos the sun had goned, and she couldn't see the white cottage no more, and just then she heard something saying, 'mew, mew,' and it was a kitten outside the window, and it was just going to fall down and be killed." "that's not coming right. i _must_ cry," said hal. "but she opened the window--there now, you see--and she pulled the kitten in, so it didn't fall down, and it was so pleased it kissed her, and when it kissed her it turned into a fairy, and it touched her neck and made wings come, and then it opened the window again and flewed away with the little girl till they came to the white cottage, and then the little girl was quite happy for always." "did the fairy stay with her always?" asked hal. "no; fairies never does like that. they go back to fairyland. but the little girl had nice milk and eggs and cakes, and she made nosegays with the flowers, and the sun was _always_ shining, so she was quite, _quite_ happy." "her couldn't be happy all alone," said hal. "i don't like zat story, peggy. you haven't made it nice at all. it's a nonsense story." hal wriggled about and seemed very cross. poor peggy was not so much indignant as distressed at failing in her efforts to amuse him. what was the matter? it couldn't be that he was getting sleepy--it was far too early for his morning sleep. "it isn't a nonsense story," she said, and she glanced towards the window as she spoke. yes, the sun was shining brightly, the morning clouds had quite melted away; it was going to be a fine day after all. and clear and white gleamed out the spot on the distant hill which peggy loved to gaze at! "come here, hal," she said, getting on to her feet and helping hal on to his, "come with me to the window and you'll see if it's a nonsense story. only you've never to tell nobody. it's peggy's own secret." [illustration: 'and above the top of all the houses, clear though faint, was now to be seen the outline of a range of hills, so softly gray-blue in the distance that but for the irregular line never changing in its form, one could easily have fancied it was only the edge of a quickly passing ridge of clouds. peggy, however, knew better. "see, hal," she said, "over there, far, far away, _neely_ in the sky, does you see that bluey hill?"'] hal forgot his crossness in a minute; he felt so proud and honoured. peggy led him to the window. it was not a very pretty prospect; they looked out on to a commonplace street, houses on both sides, though just opposite there was a little variety in the shape of an old-fashioned, smoke-dried garden. beyond that again, more houses, more streets, stretching away out into suburbs, and somewhere beyond all that again the mysterious, beautiful, enchanting region which the children spoke of and believed in as "the country," not really so far off after all, though to them it seemed so. and above the tops of all the houses, clear though faint, was now to be seen the outline of a range of hills, so softly gray-blue in the distance that but for the irregular line never changing in its form, one could easily have fancied it was only the edge of a quickly passing ridge of clouds. peggy, however, knew better. "see, hal," she said, "over there, far, far away, _neely_ in the sky, does you see that bluey hill?" of course he saw, agreeing so readily that peggy was sure he did not distinguish rightly, which was soon proved to be the case by his announcing that "the 'ill were sailing away." "no, no, it isn't," peggy cried. "you've mustooked a cloud, hal. see now," and by bringing her own eyes exactly on a level with a certain spot on the glass she was able to place his correctly, "just over that little bubble in the window you can see it. its top goes up above the bubble and then down and then up again, and it never moves like the clouds--does you see now, hallie dear?" "zes, zes," said hal, "but it's a _wenny_ little 'ill, peggy." "no, dear," his sister explained. "it only looks little 'cos it's so far away. _you_ is too little to understand, dear, but it's true that it's a big hill, neely a mounting, hal. mamma told me." "oh," said hal, profoundly impressed and quite convinced. "mountings is _old_ hills, or big hills," peggy continued, herself slightly confused. "i don't know if they is the papas and mammas of the little ones, but i think it's something like that, for onst in church i heard the clergymunt read that the little hills jumped for joy, so they must be the children. i'll ask mamma, and then i'll tell you. i'm not quite sure if he meaned the same kind, for these hills never jumps--that's how mamma told me to know they wasn't clouds." "zes," said hal, "but go on about the secret, peggy. hal doesn't care about the 'ills." "but the secret's _on_ the hills," replied peggy. "look more, hal--does you see a teeny, _teeny_ white spot on the bluey hill? higher up than the bubble, but not at the top quite?" hal's eyes were good and his faith was great. "zes, zes," he cried. "i does see it--kite plain, peggy." "well, hallie," peggy continued, "_that's_ my secret." "is it the fairy cottage, and is the little girl zere now?" hal asked, breathlessly. peggy hesitated. "it is a white cottage," she said. "mamma told me. she looked at it through a seeing pipe." "what's a seeing pipe?" hal interrupted. "i can't tell you just now. ask mamma to show you hers some day. it's too difficult to understand, but it makes you see things plain. and mamma found out it was reelly a cottage, a white cottage, all alone up on the hill--isn't it sweet of it to be there all alone, hallie? and she said i might think it was a fairy cottage and keep it for my own secret, only i've telled you, hal, and you mustn't tell nobody." "and is it all like baby's best sash, and are there cakes and f'owers and cows?" asked hal. "i don't know. i made up the story, you know, hal, to please you. i've made lots--mamma said i might. but i've never see'd the cottage, you know. i _daresay_ it's beautiful, white and gold like the story, that's why i said it. it does so shine when the sun's on it--look, look, hal!" for as she spoke the sunshine had broken out again more brilliantly; and the bright, thin sparkle which often dazzles one between the showers in unsettled weather, lighted up that quarter of the sky where the children were gazing, and, to their fancy at least, the white spot caught and reflected the rays. "oh zes, i see," hal repeated. "but, peggy, i'd like to _go_ zere and to see it. can't we go, peggy? it would be so nice, nicer than making up stories. and do you think--oh do you think, peggy, that p'raps there's _pigs_ zere, real pigs?" he clasped his hands entreatingly as he spoke. peggy must say there were pigs. poor peggy--it was rather a comedown after her fairy visions. but she was too kind to say anything to vex hal. "i thought you said pigs was silly," she objected, gently. "playing pigs to make baby laugh is silly," said hal, "and pigs going to market and stayin' at 'ome and roast beefin', is _d'edful_ silly. but not real pigs." "oh well, then, _you_ may think pigs if you like," said peggy. "i don't think i will, but that doesn't matter. you may have them in the cottage if you like, only you mustn't tell thor and terry and baldwin about it." "i won't tell, on'y you _might_ have them too," said hal discontentedly. "you're not kind, peggy." "don't let's talk about the cottage any more, then," said peggy, though her own eyes were fixed on the far-off white spot as she spoke. "i think p'raps, hallie, you're _rather_ too little to care about it." "i'm not," said hal, "and i do care. but i do like pigs, real pigs. i sawed zem in the country." "you can't remember," said peggy. "it's two whole years since we was in the real country, hallie, and you're only three and a half. i know it's two years. i heard mamma say so to papa, so you wasn't two then." "but i did see zem and i do 'amember, 'cos of pictures," said hal. "oh yes, dear, there is pictures of pigs in your scrap-book, i know," peggy agreed. "you get it now and we'll look for them." off trotted hal, returning in a minute with his book, and for a quarter of an hour or so his patient little sister managed to keep him happy and amused. at the end of that time, however, he began to be cross and discontented again. peggy did not know what to make of him this morning, he was not often so difficult to please. she was very glad when nurse came in to say it was now _his_ time for his morning sleep, and though hal grumbled and scolded and said he was not sleepy she carried him off, and peggy was left in peace. she was not at a loss to employ herself. at half-past eleven she usually went down to mamma for an hour's lessons, and it must be nearly that time now. she got her books together and sat looking over the one verse she had to learn, her thoughts roving nevertheless in the direction they loved best--away over the chimneys and the smoke; away, away, up, up to the fairy cottage on the distant hill. chapter iii "the children at the back" "it seems to me if i'd money enough, my heart would be made of different stuff; i would think about those whose lot is rough." mrs. hawtrey. these children's home was not in a very pretty place. in front, as i have told you, it looked out on to a rather ugly street, and there were streets and streets beyond that again--streets of straight, stiff, grim-looking houses, some large and some small, but all commonplace and dull. and in and out between these bigger streets were narrower and still uglier ones, scarcely indeed to be called streets, so dark and poky were they, so dark and poky were the poor houses they contained. the street immediately behind the children's house, that on to which its back windows looked out, was one of these poorer ones, though not by any means one of the most miserable. and ugly though it was, peggy was very fond of gazing out of the night nursery window on to this street, especially on days when it was "no use," as she called it to herself, looking out at the front; that meant, as i daresay you can guess, days on which it was too dull and cloudy to see the distant hills, and above all the white spot, which had taken such hold on her fancy. for she had found out some very interesting things in that dingy street. straight across from the night nursery window was a very queer miserable sort of a shop, kept by an old irishwoman whose name was mrs. whelan. it is rather absurd to call it a shop, though it was a place where things were bought and sold, for the room in which these buyings and sellings went on was mrs. whelan's kitchen, and bedroom, and sitting-room, and wash-house, as well as her shop! it was on the first floor, and you got up to it by a rickety staircase--more like a ladder indeed than a staircase, and underneath it on the ground-floor lived a cobbler, with whom mrs. whelan used to quarrel at least once a day, though as he was a patient, much enduring man, the quarrels never went farther than the old irishwoman's opening her window and shouting down all manner of scoldings to the poor fellow, of which he took no notice. [illustration: "she was rather a terrible-looking old woman; she always wore a short bed-gown, that is a loose kind of jacket roughly drawn in at the waist, of washed out cotton, which never looked clean, and yet somehow never seemed to get much dirtier, a black stuff petticoat, and a cap with flapping frills which quite hid her face unless you were very near her, and she was generally to be seen with a pipe in her mouth. her voice was both loud and shrill, and when she was in a temper you could almost hear what she said, though the nursery window was shut." p. 35] on sundays the cobbler used to tidy himself up and go off to church "like a gentleman," the boys said. but mrs. whelan, alas, never tidied herself up, and never went to church, and though she made a great show of putting a shutter across that part of the window which showed "the shop," nurse had more than once shaken her head when the children were dressing for church, and told them not to look over the way, she was sadly afraid the shutting or shuttering up was all a pretence, and that mrs. whelan made a good penny by her sunday sales of tobacco and pipes to the men, or maybe of sugar, candles, or matches to careless housekeepers who had let their stock run out too late on saturday night. she was rather a terrible-looking old woman; she always wore a short bed-gown, that is, a loose kind of jacket roughly drawn in at the waist, of washed-out cotton, which never looked clean, and yet somehow never seemed to get much dirtier, a black stuff petticoat, and a cap with flapping frills which quite hid her face unless you were very near her, and she was generally to be seen with a pipe in her mouth. her voice was both loud and shrill, and when she was in a temper you could almost hear what she said, though the nursery window was shut. all the neighbours were afraid of her, and in consequence treated her with great respect. but like most people in this world, she had some good about her, as you will hear. good or bad, the children, peggy especially, found mrs. whelan very interesting. peggy had never seen her nearer than from the window, and though she had a queer sort of wish to visit the shop and make closer acquaintance with the old crone, she was far too frightened of her to think of doing so really. the boys, however, had been several times inside mrs. whelan's dwelling, and used to tell wonderful stories of the muddle of things it contained, and of the old woman herself. they always bought their soap-bubble pipes there, "three a penny," and would gladly have bought some of the toffee-balls and barley-sugar which were also to be had, if this had not been strictly forbidden by mamma, in spite of their grumbling. "it isn't so _very_ dirty, mamma," they said, "and you get a lot more for a penny than in a proper shop." but mamma would not give in. she knew what mrs. whelan was like, as she used sometimes to go over herself to talk to the poor old woman, but that, of course, was a different matter. "i don't much like your going there at all," she would say, "but it pleases her for us to buy some trifles now and then." but in her heart she wished very much that they were not obliged to live in this dreary and ugly town, where their poor neighbours were rarely the sort of people she could let her children know anything of. mamma, in _her_ childhood, had lived in that fairyland she called "the country," and so had papa, and they still looked forward to being there again, though for the present they were obliged to make the best of their home in a dingy street. it seemed much less dull and dingy to the children than to them, however. indeed i don't think the children ever thought about it at all. the boys were busy at school, and found plenty of both work and play to make the time pass quickly, and peggy, who might perhaps have been a little dull and lonely in her rather shut-up life, had her fancies and her wonders--her interesting things to look at both at the front and the back of the house, and mamma to tell all about them to! and this reminds me that i have not yet told you what it was she was _most_ fond of watching from the night nursery window. it was not mrs. whelan or the cobbler; it was the tenants of the third or top story of the rickety old house--the family she always spoke of to herself as "the children at the back." such a lot of them there were. it was long before peggy was able to distinguish them "all from each other," as she said, and it took her longer still to make names by which she could keep a clear list in her head. the eldest looked to her quite grown-up, though in reality she was about thirteen; she was a big red-cheeked girl, though she lived in a town; her arms were red too, poor thing, especially in winter, for they were seldom or never covered, and she seemed to be always at work, scrubbing or washing, or running out to fetch two or three of the little ones in from playing in the gutter. peggy called her "reddy," and though it was the girl's red cheeks and arms which made her first choose the name, in a while she came to think of it as meaning "ready" also, for peggy did not know much about spelling as yet, and the thought in her mind of the look of the two words was the same. for a good while peggy fancied that reddy was the nurse or servant of the family, but one day when she said something of the kind to her own nurse she was quickly put right. "their servant, my dear! bless you, no. how could they afford to keep a servant; they've hard enough work to keep themselves, striving folk though they seem. there's such a many of them, you see, and mostly so little--save that big girl and the sister three below her, there's none really to help the mother. and the cripple must be a great charge." "what's the cripple, nursey?" peggy asked. "why, miss peggy, haven't you noticed the white-faced girl on crutches? you must have seen her dragging up and down in front of the house of a fine day." "oh yes," said peggy, "but i didn't know that was called cripple. and she's quite little; she's as little as me, nurse!" "she's older than she looks, poor thing," said nurse--"maybe oldest of them all." this, however, peggy could not believe. she fixed in her own mind that "crippley" came after the two boys who were evidently next to reddy--she did not give the boys names, for they did not interest her as much as the girls. having so many brothers of her own and no sister, it seemed to her as if a sister must be the very nicest thing in the world, and of all the children at the back, the two that she liked most to watch were a pair of little girls about three years older than herself, whom she named "the smileys," "brown smiley" and "light smiley" when she thought of them separately, for though they were very like each other, the colour of their hair was different. they were very jolly little girls, poorly clad and poorly fed though they were, taking life easily, it seemed--too easily in the opinion of their eldest sister reddy, and the sister next above them--between them and crippley, according to peggy's list. this sister was the only one whose real name peggy knew, by hearing it so frequently shouted after her by the mother and reddy. for this child, "mary-hann," was rather deaf, though it was not till long afterwards that peggy found this out. "mary-hann" was a patient stupid sort of girl, a kind of second in command to reddy, and she was like reddy in appearance, except that she was several sizes smaller and thinner, so that even supposing that her arms were as red as her sister's they did not strike one in the same way. below the smileys came another boy, who was generally to be seen in their company, and who, according to peggy, rejoiced in the name of "tip." and below tip were a few babies, in reality i believe never more than three, during the years through which their little over-the-way neighbour watched them. but even she was obliged to give up hopes of classifying the babies, for there always seemed to be _a_ baby about the same age, and one or two others just struggling into standing or rather tumbling alone, and for ever being picked up by reddy or her attendant sprite mary-hann. such were peggy's "children at the back." and many a dull day when it was too rainy to go a walk, and too cloudy to be "any use" to gaze out at the front of the house, did these poor children, little as they guessed it, help to make pass more quickly and pleasantly for the sisterless maiden. many a morning when hal and baby were asleep and nurse was glad to have an hour or so for a bit of ironing, or some work of the kind down in the kitchen--for my peggy's papa and mamma were not rich and could not keep many servants, so that nurse, though she was plain and homely in her ways, was of far more use than a smarter young woman to them--many a morning did the little girl, left in the night nursery in charge of her sleeping brothers, take up her stand at the window which overlooked mrs. whelan's and the cobbler and the smileys with all their brothers and sisters. there was always something new to see or to ask nurse to explain afterwards. for ever so long it took up peggy's thoughts, and gave much conversation in the nursery to "plan" how the ten or eleven children, not to speak of the papa and mamma, _could_ all find place in two rooms. it kept peggy awake at night, especially if the weather happened to be at all hot or close, to think how _very_ uncomfortable poor reddy and crippley and mary-hann and the smileys must be, all sleeping in one bed as nurse said was too probably the case. and it was the greatest relief to her mind, and to nurse's too, i do believe, to discover by means of some cautious inquiries of the cobbler when nurse took him over some of the boys' boots to mend, that the family was not so short of space as they had feared. "they've two other rooms, miss peggy, as doesn't show to the front," said nurse, "two attics with sloping windows in the roof to their back again. and they're striving folk, he says, as indeed any one may see for theirselves." "then how shall we plan it now, i wonder," said peggy, looking across to the smileys' mansion with new respect. but nurse had already left the room, and perhaps, now she was satisfied their neighbours were not quite so much to be pitied, would scarcely have had patience to listen to peggy's "wonderings" about them. so the little girl went on to herself-"i should think the downstairs room is the papa's and mamma's and the teeniest baby's, and perhaps crippley sleeps there, as she's ill, like me when i had the hooping-cough and i couldn't sleep and mamma kept jumping up to me. and then the big boys and tip has one room--'ticks,' nurse calls the rooms with windows in the roof. i think i'd like to sleep in a 'tick' room; you must see the stars so plain without getting up; and--and--let me see, reddy and mary-hann and the smileys and the old babies--no, that's too many--and i don't know how many old babies there is. we'll say _one_--if there's another it must be a boy and go in the boys' tick--and that makes reddy and mary----" "miss peggy, your mamma's ready for your lessons," came the housemaid's voice at the door, and peggy hurried off. but she was rather in a brown study at her lessons that morning. mamma could not make her out at all, till at last she shut up the books for a minute and made peggy tell her where her thoughts were wool-gathering. "not so very far away, mamma dear," said peggy, laughing. she never could help laughing when mamma said "funny things like that." "not so very far away. i was only wondering about the children at the back." she called them always "the children at the back" when she spoke of them--for even to mamma she would have felt shy of telling her own names for them. and then she went on to repeat what nurse had heard from the cobbler. mamma agreed that it was very interesting, and she too was pleased to think "the children at the back's house," as peggy called it, was more commodious than might have been expected. but still, even such interesting things as that must not be allowed to interfere with lessons, peggy must put it all out of her head till they were done with, and then mamma would talk about it with her. "only, mamma," said peggy, "i don't know what com--commo--that long word you said, means." "i should not have used it, perhaps," said mamma. "and yet i don't know. if we only used the words you understand already, you would never learn new ones--eh, peggy! commodious just means large, and not narrow and squeezed up." peggy nodded her head, which meant that she quite understood, and then the lessons went on smoothly again. when they were over, mamma talked about poor people, especially about poor children, to peggy, and explained to her more than she had ever done before about what being poor really means. it made peggy feel and look rather sad, and once or twice mamma was afraid she was going to cry, which, of course, she did not wish her to do. but peggy choked down the crying feeling, because she knew it would make her mother sorry and would not do the poor people any good. "mamma," she said, "it _neely_ makes me cry, but i won't. but when i'm big can't i do something for the children at the back?" "they won't be children then, peggy dear. you may be able to do something for them without waiting for that. i'll think about it. i don't fancy they are so _very_ poor. as i have been telling you, there are many far poorer. but i daresay they have very few pleasures in their lives. we might try to think of a little sunshine for them now and then." "the smile----" began peggy, but she stopped suddenly, growing red--"the littler ones do play a good deal in the gutter, mamma dear," she said, anxious to state things quite fairly; "but i don't think that's _very_ nice play, and the sun very seldom shines there. and red--the big ones, mamma dear, and the one that goes on--i can't remember the name of those sticks." "crutches," said mamma. "yes, crutches--_her_ never has no plays at all, i don't think. she'd have more sunshine at the 'nother side of our house, mamma dear." mamma smiled. peggy did not understand that mamma did not mean "sunshine" exactly as she took it; she forgot, too, that of actual sunshine more fell on the back street than she thought of. for it was only on dull or rainy days that she looked out much on the children at the back. on fine days her eyes were busy in another direction. "i'll think about it," said mamma. so peggy for the present was satisfied. this talk about the smileys and the rest of them had been a day or two before the morning on which we first saw peggy--the morning that thor tried so to make fun of her about choosing sugar in her bread and milk, because it was cold. mamma had not said any more about the children at the back, and this particular morning peggy herself was not thinking very much about them. her head was running a good deal on the white cottage and all her fancies about it, and she was feeling rather disappointed that she had not succeeded better in amusing hal by her stories. "it must be, i suppose," she said to herself, "that he's rather too little for that kind of fancy stories. i wonder if baldwin would like them; it would be nice to have somebody to make fancies with me." but somehow baldwin and the fairy cottage did not seem to match. and thor and terry were both much too big--thor would laugh at her, and terry would think it a waste of time; he had so many other things to amuse himself about. no, peggy could not think of any one who would "understand," she decided, with a sigh! chapter iv "real" fancies "mine be a cot beside the hill." samuel rogers. just then came the usual summons to her lessons. mamma was waiting for her little girl in the corner of the drawing-room, where she always sat when she was teaching peggy. it was a very nice corner, near the fire, for though it was not winter it was rather chilly, and mamma often felt cold. thor used to tell her that she should take a good run or have a game of cricket to warm her; it would be much better than sitting near the fire. peggy thought it was rather unkind of thor to say so, but mamma only laughed at him, so perhaps it was just his boy way of speaking. peggy said her lessons quite well, but she looked rather grave; no smiles lighted up her face, and when lessons were over she sat still without speaking, and seemed as if she scarcely knew what she wanted to do with herself. "is there anything the matter, dear?" mamma asked. "i'm rather tired, i think, mamma," peggy replied. "tired!" mamma repeated, in some surprise. it wasn't often that peggy talked of being tired. "what is that with? you've not been worrying yourself about the children who live over mrs. whelan's, i hope? you mustn't do that, you know, dear; it would do you harm and them no good." for mamma knew that peggy sometimes did "worry" about things--"once she takes a thing in her head she'll work herself up so, for all she seems so quiet," nurse would say. "no, mamma dear," peggy replied; "i'm not tired because of that. i like thinking about the children at the back. i wish----" "what?" said mamma. "i wish i'd sisters like them. i'm rather lonely, mamma. i do think god might have gaved _one_ sister to peggy, and not such a great lot to the children at the back." "but you have your brothers, my dear little girl. you might have been an only child." "the big ones is always neely at school, and hal's too little to understand. it's hal that's tired me, mamma dear. he was so d'edfully cross afore nurse put him to bed." "cross, was he?" said mamma. "i'm afraid he must be getting those last teeth. he may be cross for some time; if so, it would not do to leave him." she seemed to be speaking to herself, but when she caught sight of peggy's puzzled face she stopped. "tell me about hal, dear," she went on. "what was it that tired you so?" "i was trying to amuse him and tell him stories about my white cottage up on the hill, and he was so cross. he couldn't understand, and he said they was 'nonsense' stories." "he is too little, perhaps, to care for fancies," said her mother, consolingly. "you must wait till he is a little older, peggy dear." "but when he's older he'll be a _boy_, mamma," said peggy; "he'll be like thor and terry, who don't care for things like that, or baldwin, who thinks stories stupid. oh, mamma, i wish i had a sister. _that's_ what i want," she added, with conviction. mamma smiled. "poor peggy," she said. "i'm afraid it can't be helped. you can never have a sister near your own age, and i'm afraid a baby sister, even if you had one, would be no good." "oh no, we've had enough babies," said peggy, decidedly. "but, mamma, mightn't there be some little girl who'd play with me like a sister? if there _is_ a fairy living in that cottage, mamma, how i do wish she would find a little girl for me!" mamma looked a very little bit troubled. "peggy dear," she said, "you mustn't let your fancies run away with you too far. i told you they would do you no harm if you kept plain in your head that they _were_ fancies, but you mustn't forget that. you know there couldn't really be a fairy living in that little white cottage." "no," peggy agreed, "i know that, mamma, because fairies _really_ live in fairyland." she looked up gravely into her mother's face as she said so. mamma could not help laughing. "fairies _really_," she said, "live in peggy's funny little head, and in many other funny little heads, i have no doubt. but nowhere----" [illustration: "mama dear," she began, "will you tell me what the little white house is reely like, then? if you will, i'll promise not to think there's fairies there--only----" "only what, dear?" "if you don't mind," said peggy, very anxious not to hurt her mother's feelings, "i'd _rather_ not have pigs. i don't think i like pigs very much." p. 52] "mamma, mamma," peggy interrupted, putting her fingers in her ears as she spoke, "i _won't_ listen. you mustn't, mustn't say that. i must have my fairies, mamma. i've no sisters." "well, keep them in fairyland then, or at least only let them out for visits now and then. but don't mix them up with real things too much, or you will get quite a confusion, and never be sure if you're awake or dreaming." peggy seemed to consider this over very seriously. after a minute or too she lifted her face again, and looked straight into her mother's with her earnest gray eyes. "mamma dear," she began, "will you tell me what the little white house is _reely_ like, then? if you will, i'll promise not to think there's fairies there--only----" "only what, dear?" "if you don't mind," said peggy, very anxious not to hurt her mother's feelings, "i'd _rather_ not have pigs. i don't think i like pigs very much." "well, we needn't have pigs then. but remember i can only 'fancy' it. i've never seen that particular cottage, you see, peggy. but i have seen other cottages in brackenshire, and so i can fancy what it _most likely_ is. you see there are different kinds of fancying--there's fancying that is all fancy, like fairy stories, and there's fancying that might be true and real, and that very likely is true and real. do you understand?" "yes," said peggy, drawing a deep breath. "well, mamma, go on real-fancying, please. what's that place you've been at--brat--what is it?" "brackenshire," mamma replied. "that's the name of that part of the country that we see far off, from the windows upstairs." "and is all the cottages white there, and is they _very_ pretty?" asked peggy, with deep interest. "oh, mamma, do tell me, quick." "i don't know if they're all white, but i think they are mostly. and there are some pretty and some ugly. of course it depends a good deal upon the people that live in them. if they're nice, clean, busy people, who like their house to be neat and pretty, and work hard to keep it so, of course it's much more likely to be so than if they were careless and lazy." "oh," said peggy, clasping her hands. "i do so hope my cottage has nice people living in it. i _think_ it has, don't you, mamma? it looks _so_ white." "my dear peggy," said mamma, smiling, "we can't tell, when it's so far away. but we may hope so." "yes," said peggy, "we'll hope so, and we'll think so." but then a rather puzzled look came over her face again, though she smiled too. "mamma," she went on, "there's such a funny thing come into my head, only i don't know quite how to say it. i think that the far-away helps to make it pretty--why is far-away so pretty, mamma?" mamma smiled again. "i'm afraid i can't tell you why. wouldn't it spoil some things if we knew the why of them, little peggy?" peggy did not answer. this was another new thought for her, and rather a difficult one. she put it away in her mind, in one of the rather far back cupboards there, and locked it up, to think about it afterwards. "mamma," she said, coaxingly, "i want you to tell me a real fancy about the cottage. it will be so nice when i look at it to think it's most likely _reely_ like that." "well, then, let us see," mamma began. "wait just one minute, mamma dear, till i've shut my eyes. first i must get the bluey hills and the white spot into them, and then i'll shut them and see what you tell. yes--that's all right now." so mamma went on. "i fancy a cottage on the side of a hill. the cottage is white, of course, and the hill is green. not very green--a kind of brown-green, for the grass is short and close, nibbled by the sheep and cows that find their living on the hill most of the year. the cottage is very white, for last summer it had a nice wash all over, and that lasts clean a good while in the country. there is a little low wall round it shutting it in from the hillside, and this wall is not very white, though it once was so, for it is covered with creeping plants, so that you can scarcely see what its own colour is. at the front of the house there is a little garden, quite a tiny one--there are potatoes and gooseberry bushes and cabbages at one side, but in front of them are some nice old-fashioned flowers, and at the other side there are strawberry plants, and behind them some rose-bushes. in summer i am sure there will be some pretty roses." "oh how nice," said peggy; "go on, go on, please." "there is a funny little wooden shed behind the house, leaning against the wall, which has a door big enough for a child to go in by, or a big person if they stooped down very much, and besides this it has a _very_ little door in the wall, leading on to the hillside. can you guess what the shed is for, peggy, and what the tiny door is for?" peggy thought and thought, but her country knowledge was but scanty. "i can't think," she said. "it couldn't be for pigs, 'cos there isn't any in the cottage. nor it couldn't be for cows, 'cos cows is so big." "what should you say to cocks and hens, peggy? there are to be fresh eggs there, aren't there? and chickens sometimes. i rather think they take eggs and chickens to market, don't they?" "oh yes, i'm sure they do. how stupid i am! of course the little wooden house is for cocks and hens. you're making it lovelily, mamma. what is it like inside, and who lives in it? i do so want to know." "inside?" said mamma. "i'm almost afraid you might be disappointed, peggy, if you've never been in a real cottage. there are so many that look very pretty outside and are not at all pretty inside. but at least we may think it is neat and clean. there are only two rooms, peggy--a kitchen which you go straight into, and another room which opens out of it. the kitchen is very bright and pleasant; there is a table before the window with some flower-pots on it, in which both winter and summer there are plants growing. there is a large cupboard of dark old wood standing against the wall, and a sort of sofa that is called a settle with cushions covered with red cotton, standing near the fireplace. there are shelves, too, on which stand some dishes and two or three shining pots and pans, the ugly black ones are kept in a little back kitchen where most of the cooking is done, so that the front kitchen should be kept as nice as possible." "that makes another room, mamma dear. you said there was only two." "oh, but it's so very tiny you couldn't call it a room. the second room is a bedroom, but the best pieces of furniture are kept there. there is a nice chest of drawers and a rocking-chair, and there is a very funny wooden cradle, standing right down on the floor, not at all like baby's cot. and in this cradle is a nice, fat, bright-eyed little baby." "a baby," said peggy, doubtfully. "yes, to be sure. there's always a baby in a cottage, unless you'd rather have a very old couple whose babies are grown-up men and women, out in the world." "no," said peggy, "i don't want that. a very old woman in a cottage would be _razer_ like a witch, or else it could make me think of red riding-hood's grandmother, and that is _so_ sad. no, i don't mind the baby if it has a nice mamma--but only one baby, pelease, mamma dear. i don't want _lots_, like the children at the back, they're always tumbling about and sc'eaming so." "oh no, we won't have it like that. we'll only have one baby--a very contented nice baby, and its mamma is very nice too. she's got quite a pretty rosy face, and she stands at the door every morning to see her husband go off to his work, and every evening to watch for him coming back again, and she holds the baby up in her arms and it laughs and crows." "yes," said peggy, "that'll do. and the eggs and the chickens, mamma?" "oh yes, she takes great care of the cocks and hens, and never forgets to go outside the garden to feed them on the hill, and in the evening they all come home of themselves through the little door in the wall. there's a very nice cat in the cottage too; it sits purring on the front steps on fine days, as if it thought the cottage and garden and everything else belonged to it. and----" but suddenly the clock struck. up started mamma. "peggy, darling, i had no idea it was so late. and i have to go out the moment after luncheon, and i have still two letters to write. i am a greater baby than any of you! run off, dear, and tell nurse i want to speak to her before i go out." "and to-morrow," said peggy, "to-morrow, will you tell me some more about the white cottage, mamma? it _is_ so nice--i don't think you're a baby at all, mamma. a baby couldn't make it up so lovelily." and peggy set off upstairs in great content. the white spot would give her more pleasure than ever, now that she knew what sort of _real_ fancies to have about it. "and to-morrow," she said to herself, "to-morrow mamma will tell me more, lots more. if i say my lessons very goodly, p'raps mamma will tell me some more every day. and p'raps hallie would like those kinds better than about fairies, and wouldn't call _them_ nonsense stories." poor little peggy--"to-morrow" brought news which put her pretty fancies about the white cottage out of her head for a while. she gave her mother's message to nurse, and after dinner nurse went downstairs. when she came up again she looked rather grave, and peggy thought perhaps she was unhappy about hal, who was still cross and had bright red spots on his cheeks. "does you think poor hallie is ill, nurse?" asked peggy in a low voice, for hal not to hear. "no, my dear, it's only his teeth. but they'll make him fractious for a while, i'm afraid, and he's not a very strong child, not near so strong as baby and the big boys." "poor hallie," said peggy, with great sympathy. "i'll be very good to him even if he is very cross, nurse." nurse did not answer for a minute, and she still looked very grave. "why do you look so sad, nurse, if it isn't about hal?" asked peggy, impatiently. "did i look sad, miss peggy? i didn't know it. i was thinking about some things your mamma was speaking of to me." "oh!" said peggy, "was it about our new frocks? mamma and you is always very busy when we need new frocks, i know." "yes, dear," said nurse, but that was all. then peggy and hal and nurse and baby went out for a walk. they did not go very far, for it was what nurse called a queer-tempered day. between the gleams of blue sky and sunshine there came sharp little storms and showers. it was april weather, though april had not yet begun. "which way are we going?" peggy asked, as they set off, she and hal hand-in-hand, just in front of nurse and the perambulator. she _hoped_ nurse would say "up fernley road," because fernley road led straight on towards the hills--so at least it seemed to peggy. their street ran into fernley road at one end, so that fernley road was what is called at right angles with it, and peggy felt sure that if you walked far enough along the road you _could_ not but come to "the beginning of the hills." but to-day peggy was to be disappointed. "we can't go far, miss peggy, and we must go to field's about master hal's new boots. it looks as if it might rain, so perhaps we'd better go straight there. you know the way, miss peggy?--right on to the end of this street and then turn to the left." peggy gave a little sigh, but trotted on quietly. hal began grumbling. "what is i to have new boots for?" he said. "i doesn't want new boots." "oh, hal," said peggy, "i think it's very nice indeed to have new boots. they shine so, and sometimes they do make such a lovely squeaking." but hal wasn't in a humour to be pleased with anything, so peggy tried to change the subject. "nurse says we are to turn to the left at the end of this street," she said. "does you know which is the left, hal? _i_ do, 'cos of my pocket in my frock. first i feel for my pocket, and when it's there i say 'all right,' and then i know that's the right, and when it isn't there i _can't_ say 'all right,' and so i know the side it isn't at is the left." hal listened with some interest, but a slight tinge of contempt for feminine garments. "boys has pockets at each sides, so all boys' sides is right," he said. but peggy was by this time in the midst of her researches for her pocket, so she did not argue the point. "here it is!" she exclaimed, "all right, so the nother side is left. _this_ way, hallie," and very proud to show nurse that she had understood her directions, she led her little brother down the street into which they had now turned. there were shops in this street, which made it more amusing than the one in which the children lived, even though they had seen them so often that they knew pretty well all that was worth looking at in the windows--that is to say, in the picture-shops and the toy-shops, and perhaps in the confectioner's. all others were passed by as a matter of course. field's, the shoemaker's, was not quite so stupid as some, because under a glass shade, in the midst of all the real boots and shoes, were half a dozen pairs of dolls' ones, which peggy thought quite lovely, though apparently no one else was of her opinion, as the tiny things stayed there day after day without a single pair being sold. peggy herself could remember them for what seemed to her a very long time, and baldwin, who owned to having admired them when he was "little," assured her they had been there since she was quite a baby; he could remember having "run on" to look at them in the days when he and terry had trotted in front and nurse had perambulated peggy behind. the little boots and shoes came into peggy's mind just now, partly perhaps because hal was hanging back so, and she was afraid he would be cross if she asked him to walk quicker. "let's run on and look at the tiny shoes in field's window," she said. "we can wait there till nurse comes up to us. she'll see us." this roused hal to bestir himself, and they were soon at the shoemaker's. "_isn't_ they sweet?" said peggy. "if i had a gold pound of my very own, hal, i'd buy some of them." "would you?" said hal, doubtfully. "no, if _i_ had a gold pound i'd----" but just then nurse came up to them and they were all marched into the shop. chapter v the little red shoes "pif-paf pottrie, what trade are you? are you a tailor?" "better still!" "a shoemaker?" brothers grimm. there was another reason why the children liked field's shop. at the back of it was a sort of little room railed off by a low wooden partition with curtains at the top, into which customers were shown to try on and be fitted with new boots or shoes. this little room within a room had always greatly taken peggy's fancy; she had often talked it over with her brothers, and wished they could copy it in their nursery. inside it had comfortable cushioned seats all round, making it look like one of the large, square, cushioned pews still to be found in some old churches, pews which all children who have ever sat in them dearly love. there was always some excitement in peeping into this little room to see if any one was already there; if that were the case the children knew they should have to be "tried on" in the outer shop. to-day, however, there was no doubt about the matter--miss field, who acted as her father's shop-woman, marshalled them all straight into the curtained recess without delay; there was no one there--and when peggy and hal had with some difficulty twisted themselves on to the seats with as much formality as if they were settling themselves in church, and nurse had explained what they had come for, the girl began operations by taking off one of hal's boots to serve as a pattern for his size. "the same make as these, i suppose?" she asked. "no, miss, a little thicker, i think. they're to be good strong ones for country wear," said nurse. peggy looked up with surprise. "for the country, nursie," she said. "he'll have weared them out before it's time for us to go to the country. it won't be summer for a long while, and last year we didn't go even when summer comed." nurse looked a little vexed. miss field, though smiling and good-natured, was not a special favourite of nurse's; she was too fond of talking, and she stood there now looking very much amused at peggy's remonstrance. "if you didn't go to the country last year, miss margaret," said nurse, "more reason that you'll go this. but little girls can't know everything." peggy opened her eyes and her mouth. she was just going to ask nurse what was the matter, which would not have made things better, i am afraid, when baby changed the subject by bursting out crying. poor baby--he did not like the little curtained-off room at all; it was rather dark, and he felt frightened, and as was of course the most sensible thing to do under the circumstances, as he could not speak, he cried. "dear, dear," said nurse, after vainly trying to soothe him, "he doesn't like being in here, the poor lamb. he's frightened. i'll never get him quiet here. miss peggy, love," forgetting in her hurry the presence of miss field, for before strangers peggy was always "miss margaret," with nurse, "i'll have to put him back in his perambulator at the door, and if you'll stand beside him he'll be quite content." [illustration: "baby did not interrupt her; he was quite content now he was out in the light and the open air, and amused himself after his own fashion by crowing and chuckling to the passers-by. so peggy stood still, her eyes fixed on the baby shoes. they were of all colours, black and red and bronze and blue--it was difficult to say which was the prettiest." p.p. 68-69] and nurse got up as she spoke. peggy slid herself down slowly and reluctantly from her seat; she would have liked to stay and watch hal being fitted with boots, and she would have liked still more to ask nurse what she meant by speaking of the country so long before the time, but it was peggy's habit to do what she was told without delay, and she knew she could ask nurse what she wanted afterwards. so with one regretful look back at the snug corner where hal was sitting comfortably staring at his stockinged toes, she trotted across the shop to the door where baby, quite restored to good humour, was being settled in his carriage. "there now, he'll be quite happy. nurse will come soon, dear. just let him stay here in the doorway; he can see all the boots and shoes in the window--that will amuse him." "yes," said peggy, adding in her own mind that she would have a good look at the dear, tiny dolls' ones and fix which she would like to buy if she had the money. baby did not interrupt her; he was quite content now he was out in the light and the open air, and amused himself after his own fashion by crowing and chuckling to the passers-by. so peggy stood still, her eyes fixed on the baby shoes. they were of all colours, black and red and bronze and blue--it was difficult to say which were the prettiest. peggy had almost decided upon a red pair, and was wondering how much money it would take to buy them, when some one touched her on the shoulder. she looked up; a lady was standing behind her, smiling in amusement. "what are you gazing at so, my dear? is this your baby in the perambulator? you had better wheel him a little bit farther back, or may i do so for you?--he has worked himself too far into the doorway." peggy looked up questioningly in the lady's face. like many children she did not like being spoken to by strangers in any unceremonious way; she felt as if it were rather a freedom. but the face that met hers was too kind and bright and pleasant to resist, and though peggy still looked grave, it was only that she felt rather shy. "yes," she said, "he's our baby. i was looking at those sweet little shoes. i didn't see baby had pushed hisself away. thank you," as the lady gently moved the perambulator a little farther to one side. "you and baby are not alone? are you waiting for some one?" she asked. "nurse is having hal tried on for new boots," peggy replied, "and baby didn't like the shop 'cos it were rather dark." "and so his kind little sister is taking care of him. i see," said the lady. "and what are the sweet little shoes you like so much to look at? are they some that would fit baby?" "oh no," said peggy, "they'd be too little for him. baby _is_ rather fat. oh no, it's _those_ under the glass basin turned upside down," and she pointed to the dolls' shoes. "aren't they lovely? i've seen them ever since i was quite little--i suppose they'd cost a great lot," and peggy sighed. "which do you think the prettiest?" asked the lady. "the red ones," peggy replied. "well, i almost think i agree with you," said the lady. "good-bye, my dear, don't let baby run himself out into the street." and with a kind smile she went on into the shop. she passed back again in a few minutes. "still there?" she said, nodding to peggy, and then she made her way down the street and was soon out of sight. peggy's attention, since the lady had warned her, had been entirely given to baby, otherwise she might perhaps have noticed a very wonderful thing that had happened in the shop-window. the pair of red dolls' shoes was no longer there! they had been quietly withdrawn from the case in which they, with their companions, had spent a peaceful, but it must be allowed a rather dull life for some years. in another minute nurse and hal made their appearance, and hal had a parcel, which he was clutching tightly in both hands. "my new boots is _so_ shiny," he said, "i do so hope they'll squeak. does you think they will, nursie? but isn't poor peggy to have new boots, too? _poor_ peggy!" peggy looked down at her feet. "mine isn't wored out yet," she said; "it would take all poor mamma's money to buy new boots for us _all_." "never fear," said nurse, who heard rather a martyr tone in peggy's voice, "you'll not be forgotten, miss peggy. but master hal, hadn't you better put your boots in the perambulator? you'll be tired of carrying them, for we're not going straight home." hal looked as if he were going to grumble at this, but before he had time to say anything, miss field came hurrying out of the shop. "oh, you're still here," she said; "that's all right. the lady who's just left told father to give this little parcel to missie here," and she held out something to peggy, who was so astonished that for a moment or two she only stared at the girl without offering to take the tiny packet. "for me," she said at last. "yes, missie, to be sure--for you, as i say." peggy took the parcel, and began slowly to undo it. something red peeped out--peggy's eyes glistened--then her cheeks grew nearly as scarlet as the contents of the packet, and she seemed to gasp for breath, as she held out for hal and nurse to see the little red shoes which five minutes before she had been admiring under the glass shade. "nursie, hal," she exclaimed, "see, oh see! the sweet little shoes--for me--for my very own." nurse was only too ready to be pleased, but with the prudence of a "grown-up" person she hesitated a moment. "are you sure there's no mistake, miss?" she said, anxiously. "do you know the lady's name? is she a friend of missis's, i wonder?" the girl shook her head. "can't say, i'm sure," she replied. "she's a stranger to us. she only just bought a pair of cork soles and these here. there's no mistake, that, i'm sure of. she must have seen the young lady was admiring of them." "yes," said peggy, "she asked me which was the prettiest, and i said the red ones." "you see?" said miss field to nurse. "well, missie, i hope as they'll fit miss dolly, and then you'll give us your custom when they're worn out, won't you?" and with a good-natured laugh she turned back into the shop. "it's all right, nursie, isn't it? do say it is. i may keep them; they _is_ mine, isn't they?" said peggy, in very unusual excitement. nurse still looked undecided. "i don't quite know what to say, my dear," she replied. "we must ask your mamma. i shouldn't think she'd object, seeing as it was so kindly meant. and we can't give back the shoes now they're bought and paid for. it wouldn't be fair to the lady to give them back to field just to be sold again. it wasn't _him_ she wanted to give a present to." "no," said peggy, trotting along beside the perambulator and clasping her little parcel as hal was clasping his bigger one, "it was _me_ she wanted to please. she's a _very_ kind lady, isn't she, nursie? i'm sure they cost a great lot of money--p'raps a pound. oh! i do so hope mamma will say i may keep them for my very own. can't we go home now this minute to ask her?" "we shouldn't find her in if we did," said nurse, "and we've had nothing of a walk so far. but don't you worry, miss peggy. i'm sure your mamma will not mind." peggy's anxious eager little face calmed down at this; a corner of the paper in which her treasures were wrapped up was torn. she saw the scarlet leather peeping out, and a gleam of delight danced out of her eyes; she bent her head down and kissed the speck of bright colour ecstatically, murmuring to herself as she did so, "oh, how happy i am!" nurse overheard the words. "missis will never have the heart to take them from her, poor dear," she thought. "she'll be only too pleased for miss peggy to have something to cheer her up when she has to be told about our going." and peggy, in blissful ignorance of any threatening cloud to spoil her pleasure, marched on, scarcely feeling the ground beneath her feet; as happy as if the tiny red shoes had been a pair of fairy ones to fit her own little feet. mamma was not at home when they got in, even though they made a pretty long round, coming back by fernley road, which, however, peggy did not care about as much as when they set off by it. for coming back, of course she could not see the hills without turning round, nor could she have the feeling that every step was taking her nearer to them. the weather was clearing when they came in; from the nursery window the sky towards the west had a faint flush upon it, which looked as if the sunset were going to be a rosy one. "red at night," peggy said to herself as she glanced out; "nursie, that means a fine day, doesn't it?" "so they say," nurse replied. "then it'll be a fine day to-morrow, and i'll see the cottage, and i'll put the little shoes on the window-sill, so that they shall see it too--the _dear_ little sweets," chattered the child to herself. hal meanwhile was seated on the floor, engaged in a more practical way, namely, _trying_ to try on his new boots. but "new boots," as he said himself, "is stiff." hal pulled and tugged till he grew very red in the face, but all in vain. "oh, peggy!" he said, "do help me. i does so want to hear them squeak, and to 'upprise the boys when they come in." down went kind peggy on the floor, and thanks to her the boots were got on, though the buttoning of them was beyond her skill. hal was quite happy, though. "they do squeak, don't they, peggy?" he said; "and nurse'll let me wear them a little for them to get used to my feet 'afore we go to the country." "you mean for your feet to get used to them, hallie," said peggy. "but there's lots of time for that. why, they'll be half wored out before we go to the country if you begin them now." "'tisn't nonsense," said hal, sturdily. "nurse said so to that girl in the shop." peggy felt very puzzled. "but, hal," she was beginning, when a voice interrupted her. it was nurse. she had been downstairs, having heard the front door bell ring. "miss peggy, your mamma wants you. she's come in. you'll find her in her own room." "nursie," she said, "hal's been saying----" "you mustn't keep your mamma waiting," said nurse. "i've told her about the little shoes." "i'll take them to show her--won't she be pleased?" said peggy, seizing the little parcel which she had put down while helping hal. and off she set. she stopped at her mother's door; it was only half shut, so she did not need to knock. "mamma dear, it's me--peggy," she said. "come in, darling," mamma's voice replied. "i've brought you the _sweet_ little red shoes to see," said peggy, carefully unfolding the paper which held her treasures, and holding them out for mamma's admiration. "they are very pretty indeed--really lovely little shoes," she said, handling them with care, but so as to see them thoroughly. "it was _very_ kind of that lady. i wonder who she was? of course in a general way i wouldn't like you to take presents from strangers, but she must have done it in such a very nice way. was she an old lady, peggy?" "oh yes!" said peggy, "quite old. she was neely as big as you, mamma dear. i daresay she's _neely_ as old as you are." mamma began to laugh. "you little goose," she said. but peggy didn't see anything to laugh at in what she had said, and her face remained quite sober. "i don't understand you, mamma dear," she said. "well, listen then; didn't hal buy a pair of new boots for himself to-day?" mamma began. "no, mamma dear. nurse buyed them _for_ he," peggy replied. "or rather _i_ bought them, for it was my money nurse paid for them with, if you are so very precise, miss peggy. but never mind about that. all i want you to understand is the difference between 'big' and 'old.' hal's boots are much bigger than these tiny things, but they are not on that account _older_." peggy began to laugh. "no, mamma dear. p'raps hallie's boots is younger than my sweet little red shoes, for they has been a great long while in the shop window, and baldwin and terry sawed them when they was little." "not 'younger,' peggy dear; 'newer,' you mean. boots aren't alive. you only speak of live things as 'young.'" peggy sighed. "it is rather difficult to understand, mamma dear." "it will all come by degrees," said mamma. "when i was a little girl i know i thought for a long time that the moon was the mamma of the stars, because she looked so much bigger." "i think that's very nice, mamma, though, of course, i understand it's only a _fancy_ fancy. i haven't seen the moon for a long time, mamma. may i ask nurse to wake me up the next time the moon comes?" "you needn't wait till dark to see the moon," said mamma. "she can often be seen by daylight, though, of course, she doesn't look so pretty then, as in the dark sky which shows her off better. but, of course, the sky here is so often dull with the smoke of the town that we can't see her as clearly in the daytime as where the air is purer." "like in the country, mamma," said peggy. "it's _always_ clear in the country, isn't it?" "not quite always," said mamma, smiling. "but, peggy dear, speaking of the country----" "oh yes!" peggy interrupted, "i want to tell you, mamma, what a silly thing hallie _would_ say about going to the country;" and she told her mother all that hal had said about his boots, and indeed what nurse had said too; "and nursie was just a weeay, teeny bit cross to me, mamma dear," said peggy, plaintively. "she wouldn't say she'd mistooked about it." mamma looked rather grave, and instead of saying at once that of course nurse had only meant that hal's boots should last till the summer, she took peggy on her knee and kissed her--kissed her in rather a "funny" way, thought peggy, so that she looked up and said-"mamma dear, why do you kiss me like that?" instead of answering, mamma kissed her again, which almost made peggy laugh. but mamma was not laughing. "my own little peggy," she said, "i have something to tell you which i am afraid will make you unhappy. it is making _me_ very unhappy, i know." "poor dear little mamma," said peggy, and as she spoke she put up her little hand and stroked her mother's face. "don't be unhappy if it isn't anything _very_ bad. tell peggy about it, mamma dear." chapter vi fellow-feelings and slippers "if i'd as much money as i could tell i never would cry 'old clothes to sell'!" _london cries._ mamma hesitated a moment. then she began. "you know, peggy, my pet," she said, "for a good while now i haven't been as strong and well as i used to be----" "stop, mamma, stop," said peggy, with a sort of cry, and as she spoke she threw up her hands and pressed them hard against her ears; "i know what you're going to say, but i can't bear it, no, i can't. oh mamma, you're not to say you're going to die." for all answer mamma caught peggy into her arms and kissed her again and again. for a minute or two it seemed as if she could not speak, but at last she got her voice. and then, rather to peggy's surprise, she saw that although there were tears in mamma's eyes, and even one or two trickling down her face, she was smiling too. "my darling peggy," she said, "did i frighten you? i am so, so sorry. oh no, darling, it is nothing like that. please god i shall live to see my peggy as old as i am now, and older, i hope. no, no, dear, it is nothing so very sad i was going to tell you. it is only that the doctor says the best way for me to get quite well and strong again is to go away for a while to have change of air as it is called, in some nice country place." "in the country," said peggy, her eyes brightening with pleasure. "oh, how nice! will it perhaps be that country where my cottage is? oh, dear mamma, how lovely! and when are we to go? may we begin packing to-day? and how could you think it would make me unhappy----" she went on, suddenly remembering what her mother had said at first. mamma's face did not brighten up at all. "peggy dear, it is very hard for me to tell you," she said. "of course, if we had all been going together it would have been only happy. but that's just the thing. i can't take you with me, my sweet. baby must go, because nurse must, and hallie too. but the friend i am going to stay with can't have more of us than the two little ones, and nurse, and me--it is very, very good of her to take so many." "couldn't i sleep with you, mamma dear?" said peggy in a queer little voice, the tone of which went to mamma's heart. "my pet, hallie must sleep with me, as it is. my friend's house isn't very big. and there's another reason why i can't take you--i'm not sure if you could understand----" "tell it me, please, mamma." "the lady i am going to had a little girl just like you--i mean just the same age, and rather like you altogether, i think. and the poor little girl died two years ago, peggy. since then it is a pain to her mother to see other little girls. when you are bigger and not so like what her little girl was, i daresay she won't mind." peggy had been listening, her whole soul in her eyes. "i understand," she said. "i wouldn't like to go if it would make that lady cry--if it hadn't been for that--oh mamma, i could have squeezed myself up so very tight in the bed! you and hallie wouldn't have knowed i were there. but i wouldn't like to make her cry. i am so sorry about that little girl. mamma, how is it that dying is so nice, about going to heaven, you know, and _still_ it is so sorry?" "there is the parting," said mamma. "yes--that must be it. and, mamma, i hope it isn't naughty, but if you were to die i'd be _very_ sorry not to see you again just the same--even if you were to be a very pretty angel, with shiny clothes and all that, i'd want you to be my own old mamma." "i would be your own old mamma, dear. i am sure you would feel i was the same." "i'm so glad," said peggy. "still it is sad to die," and she sighed. "mamma dear, you won't be very long away, will you? it'll only be a little short parting, won't it?" "only a few weeks, dear. and i hope you won't be unhappy even though you must be a little lonely." "if only i had a sister," said peggy. but mamma went on to tell her all she had planned. miss earnshaw, a dressmaker who used sometimes to come and sew, was to be with peggy as much as she could. she was a gentle nice girl, and peggy liked her. "she has several things to make for me just now," said mamma, "and as she lives near, she will try to come every day, so that she will be with you at dinner and tea. and fanny will help you to dress and undress, and either she or miss earnshaw will take you a walk every day that it is fine enough. and then in the evenings, of course, the boys will be at home, and papa will see you every morning before he goes." "and i daresay he'll come up to see me in bed at night too," said peggy. then she was silent for a minute or two; the truth was, i think, that she was trying hard to swallow down a lump in her throat that _would_ come, and to blink away two or three tiresome tears that kept creeping up to her eyes. two days later and they were gone. mamma, nurse, hal, and baby, with papa to see them off, and two boxes outside the cab, and of course a whole lot of smaller packages inside. peggy stood at the front-door, nodding and kissing her hand and making a smile, as broad a one as she possibly could, to show that she was not crying. when they were gone, really gone, and fanny had shut the door, she turned kindly to peggy. "now, miss peggy, love, what will you do? miss earnshaw won't be here till to-morrow. i'll try to be ready so as to take you out this afternoon if it's fine, for it's not a half-holiday. it'd be very dull for you all day alone--to-morrow the young gentlemen will be at home as it's saturday." a bright idea struck peggy. "fanny," she said, "did mamma or nurse say anything about soap-bubbles?" fanny shook her head. "no, miss. but i'm sure there'd be no objection to your playing at them if you liked. i can easy get a little basin and some soap and water for you. but have you a pipe?" peggy shook her head. "it isn't for me, fanny, thank you," she said. "it's for my brothers most. i'd like to make a surprise for them while mamma's away." "yes, that would be very nice," said fanny, who had been charged at all costs to make peggy happy. "we'll talk about it. but i'd better get on with my work, so as to get out a bit this afternoon." "very well. i'll go up to the nursery," said the little girl. the nursery seemed very strange. peggy had never seen it look quite so empty. not only were nurse and the little ones gone, but it seemed as if everything belonging to them had gone too, for nurse had sat up late the night before and got up very early this same morning to put everything into perfect order before leaving. the tidiness was quite unnatural. peggy sat down in a corner and gave a deep sigh. just then she did not even care to turn to the window, where the sunshine was pouring in brightly, sparkling on the two little scarlet shoes, standing side by side on the sill, where peggy placed them every fine morning, that they might enjoy the sight of the white cottage on the hill! "i almost wish it was raining," she half whispered to herself, till she remembered how very disagreeable a wet day would have been for mamma and the others to travel on. "i hope it will be a sunny day when they come back," she added, as a sort of make-up for her forgetfulness. and then she got up and wandered into the other room. here one of hal's old shoes, which had fallen out of a bundle of things to be given away which nurse had taken downstairs just before going, was lying on the floor. peggy stooped and picked it up. how well she knew the look of hal's shoes; there was the round bump of his big toe, and the hole at the corner where a bit of his red sock used to peep out! it gave her a strange dreamy feeling as she looked at it. it seemed as if it could not be true that hallie was far away--"far, far away" by this time, thought peggy, for she always felt as if the moment people were in the railway they were whizzed off hundreds of miles in an instant. she stroked the poor old shoe lovingly and kissed it. i don't think just then she would have parted with it for anything; it would have cost her less to give away the lovely little scarlet ones. the thought of the old clothes turned her mind to the children at the back. "i wonder if nurse gave them any of hal's and baby's old things," she said to herself. and she went to the window with a vague idea of looking to see. she had not watched the smileys or their relations much for some days; she had been busy helping mamma and nurse in various little ways, and her mind had been very full of the going away. she almost felt as if she had neglected her opposite neighbours, though, of course, they knew nothing about it, and she was quite pleased to see them all there as usual, or even more than usual. for it was so fine a day that reddy and her mother were evidently having a grand turn-out--a sort of spring cleaning, i suppose. small pieces of carpet, and one or two mats, much the worse for wear, were hanging out at the open windows. reddy's head, tied up in a cloth to keep the dust out of her hair, was to be seen every minute or two, as she thumped about with a long broom, and mary-hann presently appeared with a pail of soapy water which she emptied at a grid in the gutter. mary-hann looked rather depressed, but reddy's spirits were fully equal to the occasion. had the window been open, peggy felt sure she would have been able to hear her shouting to her sister to "look sharp," or to "mind what she was about," even more vigorously than usual. the rest of the family, excepting, of course, the boys, were assembled on the pavement in front of mr. crick the cobbler's shop. he too had opened his window to enjoy the fine day, and in the background he could be dimly seen working, as dingy and leathery as ever. mrs. whelan's frilled cap and pipe looked out for a moment and then disappeared again. apparently just then there was nobody or nothing she _could_ scold. for the poor children on the pavement were behaving very quietly. the smileys had stayed at home from school to mind the babies, with a view to smoothing the way for the spring cleaning, no doubt, and were sitting, each with a child on her lap, in two little old chairs they had carried down. crippley was rocking herself gently in her chair beside them, and the last baby but two, as peggy then thought, was on his knees on the ground, amusing himself with two or three oyster shells and a few marbles. all these particulars peggy, from her high-up nursery window, could not, of course, see clearly, but she saw enough to make her sigh deeply as she thought that after all, the smileys were much to be envied. "i daresay they're telling theirselves stories," she said to herself. "they look so comfable." just then the big baby happened to come more in sight, and she saw that one of the things he was playing with was a little shoe--an odd one apparently. he had filled it with marbles, and was pulling it across the stones. up jumped peggy from her seat on the window-sill. "oh!" she exclaimed, though there was no one to hear, "it must be the nother shoe of this. what a pity! they'd do for tip, and p'raps they've thought there wasn't a nother. how i would like to take it them! i'll call fanny and see if she'll run across with it." downstairs she went, calling fanny from time to time as she journeyed. but no fanny replied; she was down in the kitchen, and to the kitchen peggy knew mamma would not like her to go. she stood at last in the passage wondering what to do, when, glancing round, she noticed that the back-door opening into the yard was temptingly open. peggy peeped out--there was no one there, but, still more tempting, the door leading into the small back street--the door just opposite the smiley mansion--stood open, wide open too, and even from where she was the little girl could catch sight of the group on the other side of the narrow street. she trotted across the yard, and stood for a minute, the shoe in her hand, gazing at the six children. the sound of their voices reached her. "halfred is quite took up with his shoe," said brown smiley. "i told mother she moight as well give it he--a hodd shoe's no good to nobody." "'tis a pity there wasn't the two of 'em," said crippley, in a thin, rather squeaky voice. "they'd a done bee-yutiful for----" [illustration: '"for tip--yes, that's what _i_ were thinking," cried an eager little voice. "here's the other shoe; i've just founded it." and little peggy, with her neat hair and clean pinafore, stood in the middle of the children holding out hal's slipper, and smiling at them like an old friend.' p. 92] "for tip--yes, that's what _i_ were thinking," cried an eager little voice. "here's the other shoe; i've just founded it." and little peggy, with her neat hair and clean pinafore, stood in the middle of the children holding out hal's slipper, and smiling at them, like an old friend. for a moment or two they were all too astonished to speak; they could scarcely have stared more had they caught sight of a pair of wings on her shoulders, by means of which she had flown down from the sky. then light smiley nudged crippley, and murmured something which peggy could not clearly hear, about "th' young lady hopposite." "thank you, miss," then said crippley, not quite knowing what to say. "here, halfred, you'll have to find summat else to make a carridge of; give us the shoe--there's a good boy." halfred stopped playing, and still on his knees on the pavement stared up suspiciously at his sister. brown smiley, by way of taking part in what was going on, swooped down over him and caught up the shoe before he saw what she was doing, cleverly managing to hold her baby on her knee all the same. "'ere it be," she said. "sarah, put florence on lizzie's lap for a minute, and run you upstairs with them two shoes to mother. they'll do splendid for tommy, they will. and thank the young lady." sarah, otherwise light smiley, got up obediently, deposited _her_ baby on crippley's lap and held out her hand to peggy for the other shoe, bobbing as she did so, with a "thank you, miss." peggy left off smiling and looked rather puzzled. "for tommy," she repeated. "who is tommy? i thought they'd do for tip. i----" it was now the sisters' turn to stare, but they had not much time to do so, for halfred, who had taken all this time to arrive at the knowledge that his new plaything had been taken from him, suddenly burst into a loud howl--so loud, so deliberate and determined, that peggy stopped short, and all the group seemed for a moment struck dumb. brown smiley was the first to speak. "come, now, halfred," she said, "where's your manners? you'd never stop tommy having a nice pair o' shoes." but halfred continued to weep--he gazed up at peggy, the tears streaming down his smutty face, his mouth wide open, howling hopelessly. "poor little boy," said peggy, looking ready to cry herself. "i wish i'd a nother old shoe for him." "bless you, miss, he's always a-crying--there's no need to worry," said crippley, whose real name was lizzie. "take him in with you, sarah, and tell mother he's a naughty boy, that's what he is," and light smiley picked him up and ran off with him in such a hurry that peggy stood still repeating "poor little boy" before she knew what had become of him. quiet was restored, however. peggy, having done what she came for, should have gone home, but the attractions of society were too much for her. she lingered--crippley pushed sarah's empty chair towards her. "take a seat, miss," she said. "you'll excuse me not gettin' up. onst i'm a-sittin' down, it's not so heasy." peggy looked at her with great interest. "does it hurt much?" she asked. lizzie smiled in a superior way. "bless you," she said again, "_hurt's_ no word for it. it's hall over--but it's time i were used to it--never mind about me, missy. i'm sure it was most obligin' of you to bring the shoe, but won't your mamma and your nurse scold you?" "my mamma's gone away, and so has my nurse," said peggy. "i'm all alone." all the eyes looked up with sympathy. "deary me, who'd a thought it?" said brown smiley. "but there must be somebody to do for you, miss." "to what?" asked peggy. "of course there's cook, and fanny, and my brothers, and my papa when he comes home." brown smiley looked relieved. she was only a very little girl, not more than three years older than peggy herself, though she seemed so much more, and she had really thought that the little visitor meant to say she was quite, quite by herself. "oh!" she said, "that's not being real alone." "but it is," persisted peggy. "it is very alone, i can tell you. i've nobody to play with, and nothing to do 'cept to look out of the window at you playing, and at the nother window at----" "the winder to the front," said lizzie, eagerly. "it must be splendid at your front, miss. father told me onst you could see the 'ills--ever so far right away in brackenshire. some day if i could but get along a bit better i'd like fine to go round to your front, miss. i've never seed a 'ill." lizzie was quite out of breath with excitement. peggy answered eagerly, "oh i do wish you could come to our day nursery window. when it's fine you can see the mountings--that's old, no, big hills, you know. and--on one of them you can see a white cottage; it does so shine in the sun." "bless me," said lizzie, and both the smileys, for sarah had come back by now, stood listening with open mouths. "father's from brackenshire," said light smiley, whose real name was sarah. she spoke rather timidly, for she was well kept in her place by her four elder sisters. for a wonder they did not snub her. "yes, he be," added matilda, "and he's told us it's bee-yutiful over there. he lived in a cottage, he did, when he were a little lad." "mebbe 'tis father's cottage miss sees shining," ventured sarah. but this time she was not so lucky. "rubbish, sarah," said lizzie. "there's more'n one cottage in brackenshire." "and there's a mamma and a baby--and a papa who goes to work, in my cottage," said peggy. "so i don't think it could be----" but here she grew confused, remembering that all about the white cottage was only fancy, and that besides the smileys' father _might_ have lived there long ago. she got rather red, feeling somehow as if it was not very kind of her not to like the idea of its being his cottage. she had seen him once or twice; he looked big and rough, and his clothes were old--she could not fancy him ever having lived in her dainty white house. just then came a loud voice from the upper story, demanding sarah. "'tis mother whelan," said brown smiley, starting up. "rebecca said as how i was to run of an errant for her. it's time i were off." peggy turned to go. "i must go home," she said. "p'raps i'll come again some day. if mamma was at home i'd ask her if you mightn't come to look out of the nursery window," she added, turning to lizzie. "bless you," said the poor girl, "i'd never get up the stairs; thank you all the same." and with a deep sigh of regret at having to leave such pleasant company, peggy ran across the street home. chapter vii a bun to the good "the little gift from out our store." the yard door was still open; so was the house door. peggy met no one as she ran in. "fanny's upstairs, p'raps," she said to herself. but no, she saw nothing of fanny either on the way up or in the nursery. she did not feel dull or lonely now, however. she went to the back window and stood there for a minute looking at crippley and light smiley, who were still there with the two babies. how funny it seemed that just a moment or two ago she had been down there actually talking to them! she could scarcely believe they were the very same children whom for so long she had known by sight. "i am so glad i found the shoe," thought peggy. "i wish, oh i do wish i could have a tea-party, and 'avite them all to tea. i daresay the father could carry crippley upstairs--he's a very big man." the thought of the father carried her thoughts to brackenshire and the cottage on the hill, and she went into the day-nursery to look if the white spot was still to be seen. yes, it was very bright and clear in the sunshine. peggy gazed at it while a smile broke over her grave little face. "how i do wish i could go there," she thought. "i wonder if the smileys' father 'amembers about when he was a little boy, quite well. if he wasn't such a 'nugly man we might ask him to tell us stories about it." then she caught sight of the little scarlet shoes patiently standing on the window-sill. "dear little shoes," she said. "peggy was neely forgetting you," and she took them up and kissed them. "next time i go to see the smileys," she thought, "i'll take the red shoes with me to show them. they _will_ be pleased." then she got out her work and sat down to do it, placing her chair where she could see the hills from, the little shoes in her lap, feeling quite happy and contented. it seemed but a little while till fanny came up to lay the cloth for peggy's dinner. she had been working extra hard that morning, so as to be ready for the afternoon, and perhaps her head was a little confused. and so when peggy began telling her her adventures she did not listen attentively, and answered "yes" and "no" without really knowing what she was saying. "and so when i couldn't find you, fanny, i just runned over with the 'nother shoe myself. and the poor little boy what was playing with the--the _not_ the 'nother one, you know, did so cry, but i think he soon left off. and some day i'm going to ask mamma to let me 'avite them all to tea, for them to see the hills, and----" but here peggy stopped, "the hills, you know, out of the window." "yes, dear; very nice," said fanny. "you've been a good little girl to amuse yourself so quietly all the morning and give no trouble. i do wonder if the washerwoman knows to come for the nursery things, or if i must send," she went on, speaking, though aloud, to herself. so peggy felt perfectly happy about all she had done, not indeed that she had had the slightest misgiving. the afternoon passed very pleasantly. it was quite a treat to peggy to go a walk in a grown-up sort of way with fanny, trotting by her side and talking comfortably, instead of having to take hal's hand and lugging him along to keep well in front of the perambulator. they went up the ferndale road--a good way, farther than peggy had ever been--so far indeed that she could scarcely understand how it was the hills did not seem much nearer than from the nursery window, but when she asked fanny, fanny said it was often so with hills--"nothing is more undependable." peggy did not quite understand her, but put it away in her head to think about afterwards. and when they came home it was nearly tea-time. peggy felt quite comfortably tired when she had taken off her things and began to help fanny to get tea ready for the boys, and when they arrived, all three very hungry and rather low-spirited at the thought of mamma and nurse being away, it was very nice for them to find the nursery quite as tidy as usual--indeed, perhaps, rather tidier--and peggy, with a bright face, waiting with great pride to pour out tea for them. "i think you're a very good housekeeper, peg," said terence, who was always the first to say something pleasant. "not so bad," agreed thorold, patronisingly. baldwin sat still, looking before him solemnly, and considering his words, as was his way before _he_ said anything. "i think," he began at last, "i think that when i'm a big man i'll live in a cottage all alone with peggy, and not no one else." peggy turned to him with sparkling eyes. "a _white_ cottage, baldwin dear; do say a white cottage," she entreated. "i don't mind--a white cottage, but quite a tiny one," he replied. "hum!" said thor, "that's very good-natured, i must say. there'll be no room for visitors, do you hear, terry?" "oh yes; p'raps there will sometimes," said peggy. "you'll let your poor old terry come, won't you, peg-top?" said terence, coaxingly. "dear terry," said peggy. "haven't you been very dull all day alone, by the bye?" terence went on. "not very," peggy replied. "fanny took me a nice walk, and this morning----" but she stopped short before telling more. she was afraid that thorold would laugh at her if she said how much she liked the children at the back, and then she had another reason. she wanted to "surprise" her brothers with a present of pipes for soap-bubbles, and very likely if she began talking about the back street at all it would make them think of mrs. whelan's, and then they might think of the pipes for themselves, which peggy did not wish at all. she felt quite big and managing since she had paid a visit to the smileys, and had a plan for going to buy the pipes "all by my own self." "to-morrow," said thorold, "there's to be a party at our school. we're all three to go." peggy's face fell. "it's saturday," she said. "i thought you'd have stayed with me." terence and baldwin looked sorry. "_i'll_ stay at home," said terry. "no," said thor, "i really don't think you can. they're counting on you for some of the games. peg won't mind much for once, will you? i'm sorry too." but before peggy had time to reply, baldwin broke in. "i'll stay at home with peg-top," he said, in his slow, distinct way. "it won't matter for me not going. i'm one of the little ones." "and we'll go a nice walk, won't we, baldwin?" said peggy, quite happy again. "and i daresay we may have something nice for tea. i'll ask papa," she added to herself. "i'm sure he'll give me some pennies when he hears how good baldwin is." miss earnshaw came the next morning, and in the interest of being measured for her new spring frock, and watching it being cut out, and considering what she herself could make with the scraps which the young dressmaker gave her, the time passed very pleasantly for peggy. miss earnshaw admired the red shoes very much, and was interested to hear the story of the unknown lady who had given them to peggy, and told a story of a similar adventure of her own when she was a little girl. and after dinner she, for fanny was very busy, took peggy and baldwin out for a walk, and on their way home they went to the confectioner's and bought six halfpenny buns with the three pennies papa had given peggy that morning. at least the children thought there were only six, but greatly to their surprise, when they undid the parcel on the nursery table, out rolled seven! "oh dear!" said peggy, "she's gave us one too many. must we go back to the shop with it, do you think, miss earnshaw? it's such a long way." "i'll go," said baldwin, beginning to fasten his boots again. but miss earnshaw assured them it was all right. "you always get thirteen of any penny buns or cakes for a shilling," she said; "and some shops will give you seven halfpenny ones for threepence. that's how it is. did you never hear speak of a baker's dozen?" still peggy did not feel satisfied. "it isn't comfable," she said, giving herself a little wriggle--a trick of hers when she was put out. "six would have been much nicer--just two for each," for miss earnshaw was to have tea with her and baldwin. the young dressmaker smiled. "you _are_ funny, miss peggy," she said. "well, run off now and get ready for tea. we'll have fanny bringing it up in a minute." peggy, the seventh bun still much on her mind, went slowly into the night nursery. before beginning to take off her hat she strolled to the window and looked out. she had seen none of the children to-day. now, brown smiley was standing just in front of the house, a basket on her arm, staring up and down the street. she had been "of an errant" for mrs. whelan, but mrs. whelan's door was locked; she was either asleep or counting her money, and the little girl knew that if she went on knocking the old woman would get into a rage, so she was "waitin' a bit." she liked better to do her waiting in the street, for she had been busy indoors all the morning, and it was a change to stand there looking about her. peggy gazed at her for a moment or two. then an idea struck her. she ran back into the nursery and seized a bun--the odd bun. "they're all mine, you know," she called out to baldwin; "but we'll have two each still." baldwin looked up in surprise. "what are you going to do with it?" he began to say, but peggy was out of sight. she was soon downstairs, and easily opened the back door. but the yard door was fastened; she found some difficulty in turning the big key. she managed it at last, however, and saw to her delight that brown smiley was still there. "brown," began peggy, but suddenly recollecting that the smileys had real names, she stopped short, and ran across the street. "i can't 'amember your name," she exclaimed, breathlessly, "but i've brought you this," and she held out the bun. brown smiley's face smiled all over. "lor', miss," she exclaimed. "you are kind, to be sure. mayn't i give it to lizzie? she's been very bad to-day, and she's eat next to nought. this 'ere'll be tasty-like." "lizzie," repeated peggy, "which is lizzie? oh yes, i know, it's crippley." brown smiley looked rather hurt. "it's not her fault, miss," she said. "i'd not like her to hear herself called like that." peggy's face showed extreme surprise. "how do you mean?" she said. "i've made names for you all. i didn't know your real ones." brown smiley looked at her and saw in a moment that there was nothing to be vexed about. "to be sure, miss. beg your pardon. well, she that's lame's lizzie, and me, i'm matilda-jane." "oh yes," interrupted peggy. "well, you may give her the bun if you like. it's very kind of you, for i meant it for you. i'd like----" she went on, "i'd like to give you more, but you see papa gaved me the pennies for us, and p'raps he'd be vexed." "to be sure, to be sure, that'd never do," replied matilda, quickly. "but oh, miss, we've been asking father about brackenshire, and the cottages. 'tis brackenshire 'ills, sure enough, that's seen from your front." "i knew that," said peggy, in a superior way. but brown smiley was too eager to feel herself snubbed. "and oh, but he says it is bee-yutiful there--over on the 'ills. the air's that fresh, and there's flowers and big-leaved things as they calls ferns and brackens." "and white cottages?" asked peggy, anxiously. "there's cottages--i didn't think for to ask if they was all white. my! if we could but go there some fine day. father says it's not so far; many's the time he's walked over there and back again the next morning when he first comed to work here, you see, miss, and his 'ome was still over there like." "yes, in the white cottage," said peggy. she had made up her mind that it was unkind not to "let it be" that the smileys' father had lived in that very cottage, for he did seem to be a nice man in spite of his bigness and his dingy workman's clothes. if he wasn't nice and kind she didn't think the children would talk of him as they did. [illustration: "i can't 'amember your name," she exclaimed breathlessly, "but i've brought you this," and she held out the bun. brown smiley's face smiled all over. "lor', miss," she exclaimed. "you are kind to be sure. mayn't i give it to lizzie? she's been very bad to-day, and she's eat next to nought. this 'ere'll be tasty-like." * * * * * but suddenly a window above opened, and mother whelan's befrilled face was thrust out. "what are ye about there then, and me fire burning itself away, and me tea ready, waiting for the bread? what's the young lady chatterin' to the like o' you for? go home, missy, darlin', go home." p.p. 107-9] but she spoke absently; matilda-jane's words had put thoughts in her head which seemed to make her almost giddy. brown smiley stared at her for a minute. "how she do cling to them cottages being white," she thought to herself, "but there--if it pleases her! she's but a little one." "white if you please, miss," she replied, "though i can't say as i had it from father." but suddenly a window above opened, and mother whelan's befrilled face was thrust out. "what are ye about there then, and me fire burning itself away, and me tea ready, waiting for the bread? what's the young lady chatterin' to the likes o' you for? go home, missy, darlin', go home." the two children jumped as if they had been shot. "will she beat you?" whispered peggy, looking very frightened. but brown smiley shook her little round head and laughed. "she won't have a chance, and she dursn't not to say beat us--father'd be down on her--but she doesn't think nought of a good shakin'. but i'll push the basket in and run off if she's in a real wax." "good-bye, then. you must tell me lots more about the hills. ask your father all you can," and so saying, peggy flew home again. "where've you been, what did you do with the bun?" asked baldwin, as soon as she came in to the nursery. "i runned down with it, and gaved it to a little girl i saw in the street," said peggy. "very kind and nice, i'm sure," said miss earnshaw. "was it a beggar, miss peggy? you're sure your mamma and nurse wouldn't mind?" she added, rather anxiously. "oh no," said peggy. "it's not a _beggar_. it's a proper little poor girl what nurse gives our nold clothes to." "oh," said baldwin, "one of the children over the cobbler's, i suppose. but, peggy," he was going on to say he didn't think his sister had ever been allowed to run down to the back street to speak to them, only he was so slow and so long of making up his mind that, as fanny just then came in with the tea, which made a little bustle, nobody attended to him, and miss earnshaw remained quite satisfied that all was right. the buns tasted very good--all the better to peggy from the feeling that poor lame lizzie was perhaps eating hers at that same moment, and finding it "tasty." "does lame people ever get quite better?" she asked the young dressmaker. "that depends," miss earnshaw replied. "if it's through a fall or something that way, outside of them so to say, there's many as gets better. but if it's _in_ them, in the constitution, there's many as stays lame all their lives through." peggy wriggled a little. she didn't like to think about it much. it sounded so mysterious. "what part's that?" she asked; "that big word." "constitootion," said baldwin, as if he was trying to spell "constantinople." miss earnshaw laughed. she lived alone with her mother, and was not much used to children. but she was so pleasant-tempered and gentle that she easily got into their ways. "i shouldn't use such long words," she said. "our constitution just means ourselves--the way we're made. a strong, healthy person is said to have a good constitution, and a weakly person has a poor one." baldwin and peggy both sat silent for a minute, thinking over what she said. "i don't see how that's to do with crippling," said peggy at last. "does you mean," she went on, "that p'raps lame people's legs is made wrong--by mistake, you know. _in course_ god wouldn't do it of purpose, would he?" baldwin looked rather startled. "peggy," he said, "i don't think you should speak that way." peggy turned her gray eyes full upon him. "i don't mean to say anything naughty," she said. "_is_ it naughty, miss earnshaw?" the young dressmaker had herself been rather taken aback by peggy's queer speech, and for a moment or two scarcely knew what to say. but then her face cleared again. "god can't make mistakes, miss peggy," she said, "and he is always kind. all the same there's many things that seem like one or the other, i know. it must be that there's reasons for them that we can't see--like when a doctor hurts anybody, it seems unkind, but it's _really_ to do them good." "like when our doctor cutted poor baby's tooths to make them come through," said peggy, eagerly. "they was all _bleeding_, bleeding ever so, miss earnshaw. baby didn't understand, and he was _very_ angry. he always sc'eams at the doctor now. i almost think he'd like to kill him." baldwin opened his mouth wide at these bloodthirsty sentiments of baby's. he was too shocked to speak. "but it is only 'cos he doesn't understand," peggy went on, placidly. "_i_ don't sc'eam at the doctor. i speak to him quite goodly, 'cos, you see, _i_ understand." baldwin closed his mouth again. he looked at peggy with admiring respect. "yes," agreed miss earnshaw, greatly relieved at the turn their talk had taken, "that's just it, miss peggy. you couldn't have put it better." "peggy," said baldwin, "when you're big you should be a clergymunt." chapter viii under the big umbrella "as i was going up pippin hill, pippin hill was dirty, there i met a pretty miss, and she dropped me a curtsey." _old nursery rhyme._ nothing particular happened during the next few days. peggy's little life went on regularly and peacefully. miss earnshaw came every morning, and either she or fanny took peggy a walk every afternoon, except twice when it rained, to the little girl's great disappointment. the second of these wet days happened to be friday. peggy stood at the front nursery window that morning looking out rather sadly. there were no hills--no white spot to be seen, of course. "i wonder what the smileys do when it rains all day," she said to herself. "i think i'll go to the back window and look if i can see any of them." she had scarcely caught sight of her neighbours for some days. only now and then she had seen the little ones tumbling about on the pavement, and once or twice the elder girls had brought their chairs down and sat there sewing. lizzie had never come out. peggy feared she must be still ill, and perhaps that made the others extra busy. it was not likely any of them would come out to-day, as it was raining so; but _sometimes_ she was able to see their faces at the window. and on a rainy day some of the little ones at least would perhaps be looking out. she turned to go to the other nursery when miss earnshaw spoke to her. "i wouldn't be so vexed at its being wet to-day, miss peggy, if i was you," she said. "it'll be much worse if it's wet to-morrow, for it's your brothers' half-holiday." "is to-morrow saturday?" asked peggy. "to be sure it is. and i'm afraid i can't possibly stay here in the afternoon. i've got to go to see a lady some way off about some work. i wish she hadn't fixed for saturday. if it's fine it won't matter so much. fanny and i were saying you could all go a nice walk--the young gentlemen and you, with her. but if it's wet i don't know however she'll manage you all in the house." suddenly peggy's eyes began to sparkle. "miss earnshaw," she said, "i've thought of something. if you'll ask fanny, i'm sure she'll say we can; we've not had them for such a long time, and i've got my four pennies and a halfpenny--that'll get six, you know, in case any's brokened." miss earnshaw looked at her and then began to laugh. "miss peggy dear, you must tell me first what you mean," she said. "your thoughts come so fast that they run ahead of your words. what is it you mean to get six of--not buns?" "buns!" repeated peggy. "you can't blow bubbles with buns. no, of course i meant pipes. nice white pipes to blow soap-bubbles." "oh, to be sure," said miss earnshaw. "that's a very good idea, miss peggy, in case to-morrow afternoon's wet, and i shouldn't wonder if it was." "and you'll ask fanny?" "of course; you can ask her yourself for that matter. i'm sure she's the last to grudge you anything that'd please you and the young gentlemen. and even if soap-bubbles are rather messy sometimes, it's easy to wipe up. it's not like anything dirty." "soap must be clean, mustn't it?" said peggy, laughing. "but don't tell the boys, pelease, dear miss earnshaw. i do so want to 'apprise them. i can get the pipes to-morrow morning. i know where to get them," and quite happy, peggy trotted off to take out her money-box and look to be quite sure that the three pennies and three halfpennies were there in safety, where for some weeks they had been waiting. "bless her heart," said the young dressmaker. "she is the sweetest little innocent darling that ever lived." after looking over her pennies peggy turned to the window. no, none of the smileys were to be seen. "never mind," said peggy to herself. "i'll p'raps see them to-morrow when i go for the pipes. i almost hope it'll be a wet day. it will be so nice to blow soap-bubbles. only," and she sighed a little, "it does seem such a very long time since i sawed the white cottage." to-morrow _was_ rainy, very rainy, with no look of "going to clear up" about it. the boys grumbled a good deal at breakfast at the doleful prospect of a dull half-holiday in the house. "and papa's going away to-day till monday," said thorold; "so there'll be no going down to the dining-room to sit beside him while he's at dinner for a change." "poor papa," said peggy, "he'll get very wet going such a long way." "nonsense, you little goose," said thor, crossly. "people don't get wet in cabs and railway carriages." "i forgot," said peggy, meekly. "you shouldn't call her a goose, thor," said terence. "it's very disagreeable to travel on a very rainy day. i've often heard people say so." "i wish i was going to travel, rainy or not, i know that," grumbled thorold. "here we shall be mewed up in this stupid nursery all the afternoon with nothing to do." "there's lots of things to do," said baldwin. "i think i'll write a letter to mamma for one thing. and i want to tidy my treasure-box and----" "you're a stupid," said thorold. "you're too fat and slow to have any spirit in you." "now, thorold, i say that's not fair," said terry. "would it show spirit to grumble? you'd be down upon him if he did. there's no pleasing you." "_i_ know something that would please him," said peggy, who was trembling between eagerness to tell and determination _not_ to tell her "surprise." "what?" said thor, rather grumpily still. "i'm not going to tell you till you come home. and it'll only be if it's a rainy afternoon," said peggy. terence and baldwin pricked up their ears. "oh, do tell us, peg-top," they said. but the little girl shook her head. "no, no," she replied. "i've promised myself--_quite_ promised not." "there's a reason for you," said thor. but his tone was more good-natured now. he felt ashamed of being so cross when the little ones were so kind and bright. "i'll really, _truly_ tell you when you come back from school," said peggy, and with this assurance the boys had to content themselves. miss earnshaw arrived as usual, or rather not as usual, for she was dripping, poor thing, and had to leave her waterproof downstairs in the kitchen. "what weather, miss peggy," she said, as she came in. "i thought it would be a wet day, but not such a pour. it is unfortunate that i have to go so far to-day, isn't it? and i'm sorry to leave you children alone too." "never mind," said peggy, cheerily; "we'll be quite happy with the soap bubbles. i've got my money quite ready. mayn't i go and get the pipes now?" "out, my dear? in such weather!" exclaimed miss earnshaw. "oh, but it's _quite_ near," said peggy. "just hop out of the door and you're there. the boys always buy their pipes there, and mamma goes there herself sometimes to see the old woman." "well, wait a bit, any way. it can't go on raining as fast as this all the morning surely. it's real cats and dogs." peggy looked up in surprise. "cats and dogs, miss earnshaw?" she repeated. "oh, bless you, my dear, it's only a way of speaking," said the dressmaker, a little impatiently, for she was not very much accustomed to children. "it just means raining _very_ hard." peggy went to the window to look out for herself. yes indeed it was raining very hard. the little girl could not help sighing a little as she gazed at the thick even gray of the clouds, hiding like a curtain every trace of the distant hills she was so fond of. "i won't put out the little red shoes to-day," she said to herself, "there's nothing for them to see." then other thoughts crept into her mind. "i wonder if it's raining at the white cottage too," she said to herself. and aloud she asked a question. "miss earnshaw, pelease, does it ever rain in the country?" she said. "rain in the country! i should rather think it did. worse than in town, you might say--that's to say, where there's less shelter, you'll get wetter and dirtier in the country, only of course it's not the same kind of really black sooty rain. but as for mud in country lanes! i shall see something of it this afternoon, i expect." "oh, i'm so sorry," said peggy. "i thought it never rained in the country. i thought it was always quite pretty and lovely," and she sighed deeply. "i wonder what people who live in little cottages in the country do all day when it rains," she said. "why, my dear, much the same as other folk, i should say. they have their rooms to clean, and their dinner to cook, and their children to look after. still i daresay it'd be a bit drearier in the country of a right-down wet day like this, even than in town. i've never lived there myself, except for a week at a time at most, but mother was all her young days in the country." "everybody's fathers and mothers lived there," said peggy, rather petulantly. "why don't peoples let their children live there now?" miss earnshaw laughed a little. peggy did not like her to laugh in that way, and she gave herself a little wriggle, though poor miss earnshaw certainly did not mean to vex her. "there are plenty of children in the country too, miss peggy," she said. "mother's youngest sister has twelve." "twelve," repeated peggy, "_how_ nice! at least if there's lots of sisters among them, and no very little babies. do they live over in that country?" she went on, pointing in the direction of the invisible hills, "that country called brack---you know the name." "brackenshire," said miss earnshaw, "no, my mother comes from much farther off. a very pretty place it must be by what she says. not but what brackenshire's a pretty country too. i've been there several times with the sunday school for a treat." "and did you see the hills and the white cottages?" asked peggy breathlessly. "oh yes, the hills are beautiful, and there's lots of cottages of all kinds. they look pretty among the trees, even though they're only poor little places, most of them." "the white ones is the prettiest," said peggy, as if she knew all about it. "yes, i daresay," said miss earnshaw, without paying much attention; she had got to rather a difficult part of the sleeve she was making. "did you ever walk all the way there when you was a little girl?" peggy went on. "oh yes, of course," miss earnshaw replied, without the least idea of what she was answering. "really!" said peggy, "how nice!" then seeing that the dressmaker was absorbed in her work: "miss earnshaw," she said, "i'm going for the pipes now. it isn't raining _quite_ so fast, and i'll not be long." "very well, my dear," miss earnshaw replied, and peggy went off to fetch her pennies from the drawer in the other nursery where she kept them. she had a new idea in her head, an idea which miss earnshaw's careless words had helped to put there, little as she knew it. "if i see the smileys," thought peggy, "i'll tell them what she said." she glanced out of the window, dear me, how lucky! there stood brown smiley looking out at the door, as if she were hesitating before making a plunge into the dripping wet street. it did seem at the back as if it were raining faster than in front. peggy opened the cupboard and took out her little cloak which was hanging there. "i won't put on my hat," she thought, "'cos nurse says the rain spoils the feavers. i'll get a numbrella downstairs, and then i _can't_ get wet, and here's my pennies all right in my pocket. i do hope brown smiley will wait till i get down." she made all the haste she could, and found, as she expected, an umbrella in the stand downstairs. it was not very easy to open, but she succeeded at last, then came, however, another difficulty, she could not get herself and the umbrella through the back door together. "dear me," thought peggy, "i wonder how people does with their numbrellas. they _must_ open them in the house, else they'd get wet standing outside while they're doing it. i never looked to see how nurse does, but then we almost never go out when it's rainy. i 'appose it's one of the hard things big peoples has to learn. oh, dear! _won't_ it come through?" no, she couldn't manage it, at least not with herself under it. at last a brilliant idea struck peggy; anything was better than closing the tiresome thing now she _had_ got it opened--she would send it first and follow after herself. so the umbrella was passed through, and went slipping down the two or three steps that led into the yard, where it lay gaping up reproachfully at peggy, who felt inclined to call out "never mind, poor thing, i'm coming d'reckly." and as "d'reckly" as possible she did come, carefully closing the door behind her, for fear the rain should get into the house, which, together with the picking up of the umbrella, far too big and heavy a one for a tiny girl, took so long that i am afraid a good many drops had time to fall on the fair uncovered head before it got under shelter again. but little cared peggy. she felt as proud as a peacock, the umbrella representing the tail, you understand, when she found herself outside the yard door, which behaved very amiably, fairly under weigh for her voyage across the street. she could see nothing before her; fortunately, however, no carriages or carts ever came down the narrow back way. half-way over peggy stopped short--she had forgotten to look if brown smiley was still standing there. it was not easy to get a peep from under the umbrella, without tilting it and herself backwards on to the muddy road, but with great care peggy managed it. ah dear, what a disappointment! there was no little girl in front of the cobbler's window, but glancing to one side, peggy caught sight of the small figure with a shawl of "mother's" quaintly drawn over the head, trotting away down the street. with a cry peggy dashed after her. "oh, brown smiley," she called out, "do come back. i'm too frightened to go to buy the pipes alone," for what with her struggles and her excitement, the little damsel's nerves were rather upset. "oh, brown smiley--no--no, that's not her name, oh what _is_ your name, brown smiley?" and on along the rough pavement behind the little messenger she rushed, if indeed poor peggy's toddling, flopping from one side to another progress, could possibly be called "rushing." [illustration: "but an umbrella rolling itself about on the pavement, an umbrella from which proceeds most piteous wails, an umbrella from underneath which, when you get close to it, you see two little feet sticking out, and by degrees two neat black legs, and then a muddle of short skirts, which by rights should be draping the legs, but have somehow got all turned upside down like a bird's feathers ruffled up the wrong way--_such_ an umbrella, or perhaps i should say an umbrella in such circumstances, may certainly be called a strange sight, may it not?" p. 127] it came to an end quickly--the paving-stones were rough and uneven, the small feet had only "my noldest house-shoes" to protect them, and the "numbrella" was sadly in the way; there came suddenly a sharp cry, so piercing and distressful that even matilda-jane, accustomed as she was to childish sounds of woe of every kind and pitch, was startled enough to turn round and look behind her. "can it be halfred come a-runnin' after me?" she said to herself. but the sight that met her eyes puzzled her so, that at the risk of mother whelan's scoldings for being so long, she could not resist running back to examine for herself the strange object. this was nothing more nor less than an umbrella, and an umbrella in itself is not an uncommon sight. but an umbrella rolling itself about on the pavement, an umbrella from which proceeds most piteous wails, an umbrella from underneath which, when you get close to it, you see two little feet sticking out and by degrees two neat black legs, and then a muddle of short skirts, which by rights should be draping the legs, but have somehow got all turned upside down like a bird's feathers ruffled up the wrong way--_such_ an umbrella, or perhaps i should say an umbrella in such circumstances, certainly may be called a strange sight, may it not? matilda-jane simpkins, for that was brown smiley's whole long name, thought so any way, for she stood stock still, staring, and the only thing she could collect herself enough to say was, "lor'!" but her state of stupefaction only lasted half a moment. she was a practical and business-like little person; before there was time for another cry for help, she had disentangled the umbrella and its owner, and set the latter on her feet again, sobbing piteously, and dreadfully dirty and muddy, but otherwise not much the worse. then matilda-jane gave vent to another exclamation. "bless me, missy, it's _you_!" she cried. "whatever are you a-doing of to be out in the rain all alone, with no 'at and a humbrella four sizes too big for the likes of you, and them paper-soled things on yer feet? and, oh my! ain't yer frock muddy? what'll your folk say to you? or is they all away and left you and the cat to keep 'ouse?" "i was running after you, brown smiley," sobbed peggy. she could not quite make out if matilda-jane was making fun of her or not, and, indeed, to do matilda justice, she had no such intention. "i was running after _you_," peggy repeated, "and you _wouldn't_ stop, and i couldn't run fast 'cos of the numbrella, and so i felled down." "never mind, missy dear, you'll be none the worse, you'll see. only, will they give it you when you go home for dirtying of your frock?" "give it me?" repeated peggy. "yes, give it you; will you get it--will you catch it?" said matilda, impatiently. "i don't know what you mean," peggy replied. matilda wasted no more words on her. she took her by the arm, umbrella and all, and trotted her down the street again till they had reached the smiley mansion. then she drew peggy inside the doorway of the passage, whence a stair led up to mrs. whelan's, and to the simpkins's own rooms above that again, and having shut up the umbrella with such perfect ease that peggy gazed at her in admiration, she tried to explain her meaning. "look 'ere now, miss;" she said, "which'll you do--go straight over-the-way 'ome, just as you are, or come in along of _huz_ and get yerself cleaned up a bit?" "oh, i'll go in with you, pelease," sobbed peggy. "p'raps miss earnshaw wouldn't scold me. she let me come, and i didn't fell down on purpose. but i _know_ she wouldn't let me come out again--i'm sure she wouldn't, and i do so want to get the pipes my own self. you'll take me to mrs. whelan's, won't you, dear brown smiley?" "i'll catch it when she sees i haven't done her errant," said matilda. "but never mind; she'll not be so bad with you there, maybe. come up with me, missy, and i'll get rebecca to wipe you a bit," and she began the ascent of the narrow staircase, followed by peggy. chapter ix the opposite house "there was an old woman that lived in a shoe, she had so many children she didn't know what to do." _nursery rhymes._ in spite of her misfortunes, peggy could not help feeling very pleased at finding herself at last inside the house she had watched so often from the outside. it was certainly not a pretty house--a big person would probably have thought it a very poor and uninteresting one; but it was not dirty. the old wooden steps were scrubbed down once a week regularly, so there was nothing to strike the little girl as disagreeable, and it seemed delightfully queer and mysterious as she climbed the steep, uneven staircase, which grew darker and darker as they went on, so that but for brown smiley's voice in front, peggy would not have had the least idea where she was going. "there's mother whelan's door," matilda said in a half whisper, as if afraid of the old woman's pouncing out upon them, and peggy wondered how she knew it, for to her everything was perfectly dark; "but we'll go upstairs first to rebecca," and on they climbed. suddenly, what seemed for a moment a blaze of brilliant light from the contrast with the darkness where they were, broke upon them. peggy quite started. but it was only the opening of a door. "is that you, matilda-jane? my, but you have been sharp. i should think old whelan 'ud be pleased for onst." the speaker was reddy; she stood in the doorway, her bare red arms shining, as they always did, from being so often up to the elbows in soap and water. "oh, rebecca, don't say nothin', but i've not been of my errant yet. now, don't ye begin at me--'tweren't of my fault. i was a-'urryin' along when i saw miss 'ere a-rollin' in the wet with her humberellar, and i 'ad to pick her up. she's that muddy we were afeard they'd give it her over the way--her mar's away. so i told her as you'd tidy her up a bit. come along, missy. rebecca's got a good 'eart, has rebecca; she'll clean you nicely, you'll see." for at the sound of rebecca's sharp voice poor peggy had slunk back into the friendly gloom of the staircase. but she came creeping forward now, so that reddy saw her. "lor'!" said the big girl, "little miss from the hopposite winder to be sure." this quite restored peggy's courage. "have you seen me at the window?" she said. "how funny! i've looked at you lotses and lotses of times, but i never thought of you looking at me." to which both sisters replied with their favourite exclamation, "lor'!" just then came a voice from inside. "shut the door there, rebecca, can't you? if there's one thing i can't abide, and you might know it, it's a hopen door, and the draught right on baby's head." rebecca took peggy by the hand and drew her into the room, and while she was relating the story of little missy's misfortunes to her mother, little missy looked round her with the greatest interest. it was a small room, but oh, how full of children! dinner was being got ready "against father and the boys coming home," matilda said, but where father and the boys could possibly find space to stand, much less to sit, peggy lay awake wondering for a long time that night. she counted over all those already present, and found they were all there except lizzie, the lame girl. and besides the two babies and alfred, whom she knew by sight, she was amazed to see a fourth, a very tiny doll of a thing--the tiniest thing she had ever seen, but which they all were as proud of as if there had never been a baby among them before. at this moment it was reposing in the arms of mary-hann; light smiley, whose real name was sarah, you remember, was taking charge of the two big babies in one corner, while reddy and her mother were busy at the fire, and "halfred" was amusing himself quietly with some marbles, apparently his natural occupation. what a lot of them! peggy began to feel less sure that she would like to have as many sisters as the smileys. still they all looked happy, and their mother, whom peggy had never seen before, had really a very kind face. "i'll see to the pot, rebecca," she said; "just you wipe missy's frock a bit. 'twill be none the worse, you'll see. and so your dear mar's away missy. i 'ope the change'll do her good." "yes, thank you," said peggy. "she's gone to the country. did you ever live in the country? and was it in a white cottage?" mrs. simpkins smiled. "no, missy, i'm town-bred. 'tis father as knows all about the country; he's a brackenshire man." "oh yes," said peggy, "i forgot. it's miss earnshaw's mother i was thinking of." "but father," said matilda, "_he_ can tell lots of tales about the country." "i wish he was at home," said peggy. "but i must go, now my frock's cleaned. some day p'raps i'll come again. thank you, reddy," at which rebecca, who had been vigorously rubbing peggy's skirts, stared and looked as if she were going to say "lor'!" "i'm going to buy soap-bubble pipes at mrs. whelan's," peggy went on, for she was losing her shyness now; "that's what i comed out in the rain for. we're going to play at soap-bubbles this afternoon, 'cos it's too wet to go out a walk." all the smileys listened with great interest. "mayn't brown--i mean matilda-jane--come with me, pelease?" said peggy. "i'm _razer_ frightened to go to buy them alone; sometimes that old woman does look so cross." "she looks what she is then," said reddy, "'cept for one thing; she's awful good to lizzie. she's a-sittin' down there this very minute as is, is lizzie, to be out o' the way like when mother and me's cleaning, you see, miss." brown smiley's face had grown grave. "i dursn't let mother whelan see as i've not gone," she said, "but if missy doesn't like to go alone--not as she'd be sharp to the likes of you, but still----" "_i'll_ go," said little sarah, light smiley, that is to say. "jest you see to the childer will ye, mary-hann?" she shouted to the deaf sister. "i won't be harf a minute." "and you, matilda-jane, off with you," said rebecca, which advice brown smiley instantly followed. sarah took peggy's hand to escort her down the dark staircase again. light smiley was, of all the family perhaps, peggy's favourite. she was two years or so older than her little opposite neighbour, but she scarcely looked it, for both she and brown smiley were small and slight, and when you came to speak to them both, sarah seemed a good deal younger than matilda; she was so much less managing and decided in manner, but on the present occasion peggy would have preferred the elder smiley, for to tell the truth her heart was beginning to beat much faster than usual at the thought of facing mrs. whelan in her den. "isn't you frightened, light smiley?" asked the little girl when the two stopped, and peggy knew by this that they must be at the old woman's door. "oh no," sarah replied. "tisn't as if we'd been up to any mischief, you see. and lizzie's there. she's mostly quiet when lizzie's there." so saying she pushed the door open. it had a bell inside, which forthwith began to tinkle loudly, and made peggy start. this bell was the pride of mrs. whelan's heart; it made such a distinction, she thought, between her and the rest of the tenants of the house, and the more noisily it rang the better pleased she was. sarah knew this, and gave the door a good shove, at the same time pulling peggy into the room. "what's it yer afther now, and what's become of matilda-jane?" called out the old woman, not, at the first moment, catching sight of peggy. "it's little missy from over-the-way," sarah hastened to explain; "she's come to buy some pipes of you, mother whelan." [illustration: "to be sure," she said in her most gracious tone. "'tis the beautiful pipes i have. and 'tis proud i am to say the purty young lady," and on she went with a long flattering speech about peggy's likeness to her "swate mother," and inquiries after the lady's health, all the time she was reaching down from a high shelf an old broken cardboard box, containing her stock of clay pipes. p. 138.] mrs. whelan looked at peggy where she stood behind sarah, gravely staring about her. "to be sure," she said in her most gracious tone. "'tis the beautiful pipes i have. and 'tis proud i am to say the purty young lady," and on she went with a long flattering speech about peggy's likeness to her "swate mother," and inquiries after the lady's health, all the time she was reaching down from a high shelf an old broken cardboard box, containing her stock of clay pipes. peggy did not answer. in the first place, thanks to the old woman's irish accent and queer way of speaking she did not understand a quarter of what she said. then her eyes were busy gazing all about, and her nose was even less pleasantly occupied, for there was a very strong smell in the room. it was a sort of mixed smell of everything--not like the curious "everything" smell that one knows so well in a village shop in the country, which for my part i think rather nice--a smell of tea, and coffee, and bacon, and nuts, and soap, and matting, and brown holland, and spices, and dried herbs, all mixed together, but with a clean feeling about it--no, the smell in mrs. whelan's was much stuffier and snuffier. for joined to the odour of all the things i have named was that of herrings and tobacco smoke, and, i rather fear, of whisky. and besides all this, i am very much afraid that not only a spring cleaning but a summer or autumn or winter cleaning, were unknown events in the old woman's room. no wonder that peggy, fresh from the soft-soap-and-water smell of the simpkins's upstairs, sniffed uneasily and wished mrs. whelan would be quick with the pipes; her head felt so queer and confused. but looking round she caught sight of a very interesting object; this was lizzie, rocking herself gently on her chair in a corner, and seeming quite at home. peggy ran--no she couldn't run--the room was so crowded, for a counter stood across one end, and in the other a big square old bedstead, and between the two were a table and one or two chairs, and an old tumble-down chest of drawers--made her way over to lizzie. "how do you do, crip--lizzie, i mean? i hope your pains aren't very bad to-day?" "not so very, thank you, miss," said the poor girl. "it's nice and quiet in here, and the quiet does me a deal o' good." peggy sighed. "i don't like being very quiet," she said. "i wish you could come over to the nursery; now that hal and baby and nurse are away it's dreffully quiet." "but you wouldn't care to change places with me, would you, missy?" said lizzie. "i'm thinking you'd have noise enough if you were upstairs sometimes. my--it do go through one's head, to be sure." peggy looked very sympathising. "aren't you frightened of _her_?" she whispered, nodding gently towards mrs. whelan. "not a bit of it," said lizzie, also lowering her voice; "she's right down good to me, is the old body. she do scold now and then and no mistake, but bless you, she'd never lay a finger on me, and it's no wonder she's in a taking with the children when they kicks up a hextra row, so to say." peggy's mouth had opened gradually during this speech, and now it remained so. she could not understand half lizzie's words, but she had no time to ask for an explanation, for just then light smiley called to her to come and look at the pipes which were by this time waiting for her on the counter. they were the cleanest things in the room--the only clean things it seemed to peggy as she lifted them up one by one to choose six very nice ones. and then she paid her pennies and ran back to shake hands with lizzie and say good-bye to her--she wondered if she should shake hands with mrs. whelan too, but fortunately the old woman did not seem to expect it, and peggy felt very thankful, for her brown wrinkled hands looked sadly dirty to the little girl, dirtier perhaps than they really were. "i like your house much better than hers," said peggy, when she and light smiley were down at the bottom of the stairs again; "it smells much nicer." "mother and rebecca's all for scrubbing, that's certing," replied sarah, with a smile of pleasure--of course all little girls like to hear their homes praised--"but she's not bad to lizzie, is old whelan," as if that settled the whole question, and peggy felt she must not say any more about the dirty room. light smiley felt it her duty to see "missy" safe across the street. peggy's hands were laden with the precious pipes, and sarah carried the big umbrella over the two of them. they chattered as they picked their way through the mud and stood for a minute or two at the yard-door of peggy's house. light smiley peeped in. "lor'," she said, expressing her feelings in the same way as her sisters, "yours must be a fine house, missy. all that there back-yard for yerselves." "you should see the droind-room, and mamma's room; there's a marble top to the washing-stand," said peggy, with pride. "lor'," said sarah again. "some day," peggy went on, excited by sarah's admiration, "_some_ day when my mamma comes home, i'm going to ask her to let me have a tea-party of you _all_--in the nursery, you know. the nursery's nice too, at least i daresay you'd like it." "is that the winder where you sees us from?" asked sarah. "matilda-jane says as how we could see you too quite plain at it if you put your face quite close to the glass." "i can't," said peggy. "there's the toilet-table close to the window--at least, it's really a chest of drawers, you know, but there's a looking-glass on the top and a white cover, so it's like a toilet-table for nurse, though it's too high up for me. i have to stand on a chair if i want to see myself popperly." "dear!" said sarah sympathisingly. "and i can only see you by scrooging into the corner, and the curting's there. no, you couldn't ever see me well up at the window. but that's not the nursery where we'd have tea. that's only the night nursery. the other one's to the front; that's the window where you can see the hills far away." "in the country, where father used to live. oh yes, i know. i heerd matilda-jane a-asking 'im about it," said sarah. "oh, and did he tell you any more? do ask him if it's really not far to get there," said peggy, eagerly. sarah nodded. "i won't forget," she said; "and then, missy, when you axes us to the tea-party, i'll be able to tell you all about it." she did not mean to be cunning, poor little girl, but she was rather afraid peggy might forget about the tea-party, and she thought it was not a bad plan to say something which might help to make her remember it. "yes," peggy replied, "that would be lovely. do make him tell all you can, light smiley. oh, i do wish mamma would come home now, and i'd ask her about the tea-party immediately. i'm sure she'd let me, for she likes us to be kind to poor people." sarah drew herself up a little at this. "we're not--not to say _poor_ folk," she said, with some dignity. "there's a many of us, and it's hard enough work, but still----" "oh, don't be vexed," said peggy. "i know you're not like--like beggars, you know. and i think _we're_ rather poor too. mamma often says papa has to work hard." sarah grew quite friendly again. "i take it folks isn't often rich when they've a lot of children," she began, but the sound of a window opening across the street made her start. "bless me," she said, "i must run. there's rebecca a-going to scold me for standing talking. good-bye, miss, i'll not forget to ask father." and sarah darted away, carrying with her the umbrella, quite forgetting that it was peggy's. peggy forgot it too, and it was not raining so fast now, so there was less to remind her. she shut the door and ran across the yard. the house door still stood open, and she made her way up to the nursery without meeting any one. chapter x "soap-bubbling" "and every colour see i there." _the rainbow_, charles lamb. there was no one upstairs. miss earnshaw had gone down to the kitchen to iron the seams of her work, without giving special thought to peggy. if any one had asked her where the child was she would have probably answered that she was counting over her money in the night nursery. so she was rather surprised when coming upstairs again in a few minutes she was met by peggy flying to meet her with the pipes in her hand. "i've got them, miss earnshaw; aren't they beauties?" she cried. "and i don't think my frock's reely spoilt? it only just looks a _little_ funny where the mud was." "bless me!" exclaimed the young dressmaker, "wherever have you been, miss peggy? no, your frock'll brush all right; but you don't mean to say you've been out in the rain? you should have asked me, my dear." she spoke rather reproachfully; she was a little vexed with herself for not having looked after the child better, but peggy was one of those quiet "old-fashioned" children, who never seem to need looking after. "i did ask you," said peggy, opening wide her eyes, "and you said, 'very well, my dear.'" miss earnshaw couldn't help smiling. "i must have been thinking more of your new frock than of yourself," she said. "however, i hope it's done you no harm. your stockings aren't wet?" "oh no," said peggy; "my slippers were a weeny bit wet, so i've changed them. my frock wouldn't have been dirtied, only i felled in the wet, miss earnshaw, but brown--one of the little girls, you know, that lives in the house where the shop is--picked me up, and there's no harm done, is there? and i've got the pipes, and won't my brothers be peleased," she chirruped on in her soft, cheery way. miss earnshaw could not blame her, though she determined to be more on the look-out for the future. and soon after came twelve o'clock, and then the young dressmaker was obliged to go, bidding peggy "good-bye till monday morning." the boys came home wet and hungry, and grumbling a good deal at the rainy half-holiday. peggy had hidden the six pipes in her little bed, but after dinner she made the three boys shut their eyes while she fetched them out and laid them in a row on the table. then, "you may look now," she said; "it's my apprise," and she stood at one side to enjoy the sight of their pleasure. "hurrah," cried terry, "pipes for soap-bubbles! isn't it jolly? isn't peggy a brick?" "dear peggy," said baldwin, holding up his plump face for a kiss. "poor old peg-top," said thor, patronisingly. "they seem very good pipes; and as there's six of them, you and i can break one a-piece if we like, terry, without its mattering." peggy looked rather anxious at this. "don't try to break them, thor, pelease," she said; "for if you beginned breaking it might go on, and then it would be all spoilt like the last time, for there's no fun in soap-bubbling by turns." "no, that's quite true," said terry. "you remember the last time how stupid it was. but of course we won't break any, 'specially as they're yours, peggy. we'll try and keep them good for another time." "did you spend all your pennies for them?" asked baldwin, sympathisingly. "not quite all," said peggy. "i choosed them myself," she went on, importantly. "there was a lot in a box." "why, where did you get them? you didn't go yourself to old whelan's, surely?" asked thor, sharply. "yes, i runned across the road," said peggy. "you always get them there, thor." "but it's quite different. i can tell you mamma won't be very pleased when she comes home to hear you've been so disobedient." poor peggy's face, so bright and happy, clouded over, and she seemed on the point of bursting into tears. "i weren't disobedient," she began. "miss earnshaw said, 'very well, dear,' and so i thought----" [illustration: "they were soon all four very happy at the pretty play. the prettiness of it was what peggy most enjoyed the most; the boys, boy-like, thought little but of who could blow the biggest bubbles, which, as everybody knows, are seldom as rich in colour as smaller ones." p. 149] "of course," interrupted terry; "peggy's never disobedient, thor. we'll ask mamma when she comes home; but she won't be vexed with you, darling. you won't need to go again before then." "no," said peggy, comforted, "i don't want to go again, terry dear. it doesn't smell very nice in the shop. but the _children's_ house is very clean, terry. i'm sure mamma would let us go _there_." "those simpkinses over old whelan's," said terry. "oh yes, i know mother goes there herself sometimes, though as for that she goes to old whelan's too. but we're wasting time; let's ask fanny for a tin basin and lots of soap." they were soon all four very happy at the pretty play. the prettiness of it was what peggy enjoyed the most; the boys, boy-like, thought little but of who could blow the biggest bubbles, which, as everybody knows, are seldom as rich in colour as smaller ones. "i like the rainbowiest ones best," said peggy. "i don't care for those 'normous ones thor makes. do you, baldwin?" baldwin stopped to consider. "i suppose very big things aren't never so pretty as littler things," he said at last, when a sort of grunt from terry interrupted him. terry could not speak, his cheeks were all puffed out round the pipe, and he dared not stop blowing. he could only grunt and nod his head sharply to catch their attention to the wonderful triumph in soap-bubbles floating before his nose. there was a big one, as big as any of thorold's, and up on the top of it a lovely every-coloured wee one, the most brilliant the children had ever seen--a real rainbow ball. they all clapped their hands, at least peggy and baldwin did so. thorold shouted, "hurrah for terry's new invention. it's like a monkey riding on an elephant." but peggy did not think that was a pretty idea. "it's more like one of the very little stars sitting on the sun's knee," was her comparison, which baldwin corrected to the moon--the sun was too yellow, he said, to be like a no-colour bubble. then they all set to work to try to make double-bubbles, and thor actually managed to make three, one on the top of the other. and terry made a very big one run ever so far along the carpet without breaking, bobbing and dancing along as he blew it ever so gently. and as a finish-up they all four put their pipes into the basin and blew together, making what they called "bubble-pudding," till the pudding seemed to get angry and gurgled and wobbled itself up so high that it ended by toppling over, and coming to an untimely end as a little spot of soapy water on the table. "pride must have a fall, you see," said thor. "it's like the story of the frog that tried to be as big as an ox," said terence, at which they all laughed as a very good joke. altogether peggy's pipes turned out a great success, and the rainy afternoon passed very happily. the sunday that came after that saturday was showery, sunny, and rainy by turns, like a child who having had a great fit of crying and sobbing can't get over it all at once, and keeps breaking into little bursts of tears again, long after the sorrow is all over. but by monday morning the world--peggy's world, that is to say--seemed to have quite recovered its spirits. the sun came out smiling with pleasure, and even the town birds, who know so little about trees, and grass, and flowers, and all those delightful things, hopped about and chirruped as nicely as could be. the boys set off to school in good spirits, and while fanny was taking down the breakfast-things peggy got out the little red shoes, and set them on the window-sill, where they had not been for several days. "there, dear little red shoes," she said, softly, "you may look out again at the pretty sun and the sky, and the fairy cottage up on the mounting. you can see it quite plain to-day, dear little shoes. the clouds is all gone away, and it's shinin' out all white and beautiful, and i daresay the mamma's standin' at the door with the baby--or p'raps," peggy was never very partial to the baby, "it's asleep in its cradle. yes, i think that's it. and the hens and cocks and chickens is all pecking about, and the cows moo'in. oh, _how_ i do wish we could go and see them all, don't you, dear little shoes?" she stood gazing up at the tiny white speck, to other eyes almost invisible, as if by much gazing it would grow nearer and clearer to her; there was a smile on her little face, sweet visions floated before peggy's mind of a day, "some day," when mamma should take her out "to the country," to see for herself the lovely and delightful sights that same dear mamma had described. suddenly fanny's voice brought her back to present things. fanny was looking rather troubled. "miss peggy, love," she said, "cook and i can't think what's making miss earnshaw so late this morning. she's always so sharp to her time. i don't like leaving you alone, but i don't know what else to do. monday's the orkardest day, for we're always so busy downstairs, and your papa was just saying this morning that i was to tell miss earnshaw to take you a nice long walk towards the country, seeing as it's so fine a day. it will be right down tiresome, it will, if she don't come." "never mind, fanny," said peggy. "i don't mind much being alone, and i daresay miss earnshaw will come. i _should_ like to go a nice walk to-day," she could not help adding, with a longing glance out at the sunny sky. "to be sure you would," said fanny, "and it stands to reason as you won't be well if you don't get no fresh air. i hope to goodness the girl will come, but i doubt it--her mother's ill maybe, and she's no one to send. well, dear, you'll try and amuse yourself, and i'll get on downstairs as fast as i can." peggy went back to the window and stood there for a minute or two, feeling rather sad. it did seem hard that things should go so very "contrarily" sometimes. "just when it's such a fine day," she thought, "miss earnshaw doesn't come. and on saturday when we _couldn't_ have goned a walk she did come. only on saturday it did rain very badly in the afternoon and she didn't stay, so that wasn't a pity." then her thoughts went wandering off to what the dressmaker had told her of having to go a long way out into the country on saturday afternoon, and of how wet and muddy the lanes would be. peggy sighed; she _couldn't_ believe country lanes could ever be anything but delightful. "oh how _very_ pretty they must be to-day," she said to herself, "with all the little flowers coming peeping out, and the birds singing, and the cocks and hens, and the cows, and--and----" she was becoming a little confused. indeed she wasn't _quite_ sure what a "lane" really meant--she knew it was some kind of a way to walk along, but she had heard the word "path" too,--were "lane" and "path" quite the same? she wondered. and while she was wondering and gazing out of the window, she was startled all of a sudden by a soft, faint tap at the door. so soft and faint that if it had been at the window instead of at the door it might have been taken for the flap of a sparrow's wing as it flew past. peggy stood quite still and listened; she heard nothing more, and was beginning to think it must have been her fancy, when again it came, and this time rather more loudly. "tap, tap." yes, "certingly," thought peggy, "there's somebody there." she felt a little, a _very_ little frightened. should she go to the door and peep out, or should she call "come in"? she asked herself. and one or two of the "ogre" stories that thorold and terry were so fond of in their "grimm's tales," _would_ keep coming into her head--stories of little princesses shut up alone, or of giants prowling about to find a nice tender child for supper. peggy shivered. but after all what was the use of standing there fancying things? it was broad, sunny daylight--not at all the time for ogres or such-like to be abroad. peggy began to laugh at her own silliness. "very likely," she thought, "it's miss earnshaw playing me a trick to 'apprise me, 'cos she's so late this morning." this idea quite took away her fear. "it's you, miss earnshaw, i'm quite sure it's you," she called out; "come in quick, you funny miss earnshaw. come in." but though the door slowly opened, no miss earnshaw appeared. peggy began to think this was carrying fun too far. "why don't you come in quick?" she said, her voice beginning to tremble a little. the door opened a little farther. "missy," said a low voice, a childish hesitating voice, quite different from miss earnshaw's quick bright way of speaking, "missy, please, it's me, sarah, please, miss." and the door opened more widely, and in came, slowly and timidly still, a small figure well known to peggy. it was none other than light smiley. peggy could hardly speak. she was so very much astonished. "light smiley--sarah, i mean," she exclaimed, "how did you come? did you see fanny? did she tell you to come upstairs?" sarah shook her head. "i don't know who fanny is, missy. i just comed in of myself. the doors was both open, and i didn't meet nobody. i didn't like for to ring or knock. i thought mebbe your folk'd scold if i did--a gel like me. mother knows i've comed; she said as how i'd better bring it myself." and she held up what peggy had not noticed that she was carrying--the big umbrella that had caused so much trouble two days before. "the numbrella," cried peggy. "oh thank you, sarah, for bringing it back. i never thought of it! how stupid it was of me." "mother told me for to bring it to the door and give it in," sarah went on. "i didn't mean to come upstairs, but, the door was open, you see, miss, and i knowed your nussery was at the top, and--i 'ope it's not a liberty." "no, no," said peggy, her hospitable feelings awaking to see that her little visitor was still standing timidly in the doorway, "i'm _very_ glad you've comed. you don't know how glad i am. it's so lonely all by myself--miss earnshaw hasn't come this morning. come in, light smiley, do come in. oh how nice! i can show you the mountings and the little white cottage shining in the sun." she drew sarah forwards. but before the child looked out of the window, her eyes were caught by the tiny red slippers on the sill. "lor'," she said breathlessly, "what splendid shoes! are they for--for your dolly, missy? they're too small for a baby, bain't they?" "oh yes," said peggy, "they're too small for our baby, a great deal. but then he's very fat." "they'd be too small for ours too, though she's not a hextra fine child for her age. she were a very poor specimint for a good bit, mother says, but she's pickin' up now she's got some teeth through. my--but them shoes is neat, to be sure! they must be for a dolly." "_i've_ no doll they'd do for," said peggy, "but i like them just for theirselves. _i_ always put them to stand there on a fine day; they like to look out of the window." sarah stared at peggy as if she thought she was rather out of her mind!--indeed the children at the back had hinted to each other that missy, for all she was a real little lady, was very funny-like sometimes. but peggy was quite unconscious of it. "lor'," said sarah at last, "how can shoes see, they've no eyes, missy?" "but you can _fancy_ they have. don't you ever play in your mind at fancying?" asked peggy. "i think it's the nicest part of being alive, and mamma says it's no harm if we keep remembering it's not real. but never mind about that--do look at the hills, sarah, and oh, _can_ you see the white speck shining in the sun? _that's_ the cottage--i call it my cottage, but _p'raps_," rather unwillingly, "it's the one your papa lived in when he was little." "d'ye really think so?" said sarah, eagerly. "it's brackenshire over there to be sure, and father's 'ome was up an 'ill--deary me, to think as it might be the very place. see it--to be sure i do, as plain as plain. it do seem a good bit off, but father he says it's no more'n a tidy walk. he's almost promised he'll take some on us there some fine day when he's an 'oliday. i axed 'im all i could think of--missy--all about the cocks and 'ens and cows and pigses." "not pigs," interrupted peggy. "i don't like pigs, and i won't have them in my cottage." "i wasn't a-talking of your cottage," said sarah, humbly. "'twas what father told us of all the things he seed in the country when he were a boy there. there's lots of pigses in brackenshire." "never mind. we won't have any," persisted peggy. "but oh, light smiley, do look how splendid the sky is--all blue and all so shiny. i never sawed such a lovely day. i would so like to go a walk." "and why shouldn't you?" asked sarah. "there's no one to take me," sighed peggy. "it's monday, and fanny's very busy on mondays, and i told you that tiresome miss earnshaw's not comed." sarah considered a little. "tell you what, missy," she said, "why shouldn't we--you and me--go a walk? i'm sure mother'd let me. i've got my 'at, all 'andy, and i did say to mother if so as missy seed me i might stop a bit, and she were quite agreeable. i'm a deal older nor you, and i can take care of you nicely. mother's training me for the nussery." peggy started up in delight. she had been half sitting on the window-sill, beside the shoes. "oh, light smiley," she said, "how lovely! of course you could take care of me. we'd go up fernley road, straight up--that's the way to brackenshire, you know, and p'raps we might go far enough to see the white cottage plainer. if it's not a very long way to get there, we'd be sure to see it much plainer if we walked a mile or two. a mile isn't very far. oh, do let's go--quick! quick!" but sarah stopped her. "you'd best tell your folks first, missy," she said. "they'll let you go and be glad of it, i should say, if they're so busy, and seein' as they let you come over to our 'ouse, and your mar knowin' us and all." "it was miss earnshaw that let me go," said peggy, "and then she said she didn't know i'd goned. and thor said--oh no, he only said i shouldn't have goned to the shop. but i'll ask fanny--i'll tell you what i'll do. i'll put on my boots and my hat and jacket--you shall help me, sarah, and then we'll go down and i'll call to fanny from the top of the kitchen stairs and ask her if i may go out with you, sarah, dear. i'm sure she'll say i may." so the two little maidens went into the night nursery, where light smiley was greatly interested in looking at her own dwelling-place from other people's windows, and quite in her element too, seeing that she was being trained for the nursery, in getting out peggy's walking things, buttoning her boots, and all the rest of it. chapter xi up fernley road "but the way is long and toilsome, and the road is drear and hard; little heads and hearts are aching, little feet with thorns are scarred." _the children's journey._ light smiley kept looking round the room with great satisfaction. "it is nice in 'ere and no mistake," she said at last. "your 'ats and coats and frocks all in a row, as neat as neat, and these little white beds a sight to be seen. i should love for rebecca and matilda-jane to see it." "they will," said peggy, "when i avite you all to a tea-party, you know." sarah drew a deep breath. a tea-party in these beautiful nurseries seemed almost too good ever to come true. "is there a many nusseries as nice as this 'un, do you think, missy? i do 'ope as i'll get into a nice one when i'm big enough. one 'ud take a pride in keeping it clean and tidy." "i don't think this is at all a _grand_ one," peggy replied. "mamma's was much grander when she was little, i know. but, of course, she's very pertickler, and so's nurse, about it being very tidy." and then, peggy being ready, the quaint pair of friends took each other's hands and set off to the top of the kitchen stairs. "should we take the humberellar?" said sarah, suddenly stopping at the foot of the first little flight of stairs. "i don't think it looks any ways like rain, still one never knows, and i can carry it easy." in her heart she hoped peggy would say yes. for to sarah's eyes the clumsy umbrella was a very "genteel" one indeed, and she felt as if it would add distinction to their appearance. peggy, not looking at it from this point of view, hesitated. "p'raps it would do to keep the sun off us," she said. "my parasol's wored out, so i can't take it. mamma's going to get me a new one." sarah ran back and fetched the umbrella. when they got to the door at the top of the kitchen stairs, peggy opened it and called down softly, "fanny, are you there? can you hear me?" for she was not allowed to go down to the kitchen by herself. but no one answered. fanny was busy washing in the back kitchen with both doors shut to keep in the steam, and the cook had gone out to the butcher's. "fanny," called peggy again. then a voice came at last in return. "is it anything i can tell the cook when she comes in, please, miss?" and a boy came forward out of the kitchen and stood at the foot of the steep stone stairs. "i'm the baker's boy, and i met cook and she told me to wait; she'd be back with change to pay the book in a minute. there's no one here." peggy turned to sarah in distress. "fanny must be out too," she said. "well, it'll be all right if the boy 'ull tell her, won't it, missy? 'tisn't the cook," she went on, speaking to the boy herself, "'tis t'other one. jest you tell her when she comes in that miss has gone out a little walk with me--sarah simpkins--she'll know. i'll take good care of missy." "all right," said the boy, with no doubt that so it was, and thinking, if he thought at all, that sarah simpkins must be a little nurse-girl, or something of the kind about the house, though certainly a small specimen to be in service! he whistled as he turned away, and something in the cheerful sound of his whistle helped to satisfy peggy that all _was_ right! "he's a nice boy," she said to sarah. "he won't forget, will he?" "not he," sarah replied. "he'll tell 'em fast enough. and as like as not we'll meet 'em along the street as we go. is webb's your butcher, missy--'tis just at the corner of fernley road?" peggy shook her head. "i don't know," she said, feeling rather ashamed of her ignorance; "but i'd like to meet fanny, so, pelease, let us go that way." and off the two set, by the front door this time, quite easy in their minds though, as far as they knew, the baker's boy was the only guardian of the house. they trotted down the street in the sunshine; it was very bright and fine--the air, even there in the smoky town, felt this morning deliciously fresh and spring-like. "how nice it is," said peggy, drawing a deep breath; "it's just like summer. i'd like to go a quite long walk, wouldn't you, sarah?" light smiley looked about her approvingly. "yes," she said, "i does enjoy a real fine day. and in the country it must be right-down fust-rate." "oh, the country!" said peggy; "oh dear, how i do wish we could go as far as the country!" "well," said sarah, "if we walk fast we might come within sight of it. there's nice trees and gardings up fernley road, and that's a sort of country, isn't it, missy?" they were at the corner of the road by this time, but there was no sign of fanny or cook. "webb's" shop stood a little way down the other side, but as far as they could see it was empty. "p'raps your folk don't deal there," said sarah, to which peggy had nothing to say, and they stood looking about them in an uncertain kind of way. "we may as well go on a bit," said sarah at last, "that there boy's sure to tell." peggy had no objection, and they set off along fernley road at a pretty brisk pace. they had not very far to go before, as sarah said, the road grew less town-like; the houses had little gardens round them, some of which were prettily kept, and after a while they came to a field or two, not yet built upon, though great placards stuck up on posts told that they were waiting to be sold for that purpose. they were very towny sort of fields certainly, still the bright spring sunshine made the best of them as of everything else this morning, and the two children looked at them with pleasure. "there's nicer fields still, a bit farther on," said sarah. "i've been along this 'ere road several times. it goes on and on right into the country." "i know," said peggy, "it goes on into the country of the mountings. but, sarah," she said, stopping short, and looking rather distressed, "i don't think we see them any plainer than from the nursery window, and the white cottage doesn't look even as plain. are you sure we're going the right way?" "we couldn't go wrong," answered sarah, "there's no other way. but we've come no distance yet, missy, and you see there's ups and downs in the road that comes between us and the 'ills somehow. i suppose at the window we could see straight-forward-like, and then we was 'igher up." "yes, that must be it," said peggy; "but i would like to go far enough to see a _little_ plainer, sarah, wouldn't you? i've got the red shoes in my pocket, you know, and when we come to a place where we can see very nice and clear i'll take them out and let them see too." "lor'," said sarah, "you _are_ funny, missy." but she smiled so good-naturedly that peggy did not mind. after a bit they came to a place where another road crossed the one they were on. this other road was planted with trees along one side, and the shade they cast looked cool and tempting. "i wish we could go along that way," said peggy, "but it would be the wrong way. it doesn't go on to the mountings." sarah did not answer for a minute. she was trying to spell out some letters that were painted up on the corner of a wall, which enclosed the garden of a house standing in the road they were looking down. "'b, r, a,'" she began, "'b, r, a, c, k:' it's it, just look, missy. bain't that brackenshire as large as life? 'brackenshire road.' it must be this way," and she looked quite delighted. "but how can it be?" objected peggy. "this road _doesn't_ go to the hills, sarah. they're straight in front." "but maybe it slopes round again after a bit," said sarah. "lots of roads does that way, and runs the same way really, though you wouldn't think so at the start. it stands to reason, when it's got the name painted up, it must lead brackenshire way;" and then suddenly, as a man with a basket on his arm appeared coming out of one of the houses, she darted up to him. "please, mister, does this road lead to brackenshire?" she asked. the man did not look very good-natured. "lead to where?" he said, gruffly. "to brackenshire--it's painted up on the wall, but we want to be sure." "if it's painted up on the wall, what's the sense of askin' me?" he said. "if you go far enough no doubt you'll get there. there's more'n one road to brackenshire." sarah was quite satisfied. "you see," she said to peggy, running back to her, "it's all right. if we go along this 'ere road a bit, i 'specs it'll turn again and then we'll see the 'ills straight in front." peggy had no objection. fernley road was bare and glaring just about there, and the trees were very tempting. "it's really getting like the country," said peggy, as they passed several pretty gardens, larger and much prettier than the small ones in fernley road. "yes," light smiley agreed, "but though gardings is nice, i don't hold with gardings anything like as much as fields. fields _is_ splendid where you can race about and jump and do just as you like, and no fears of breakin' flowers or nothink." "do you think we shall come to fields like that soon?" said peggy. "if there was a very nice one we might go into it p'raps and rest a little, and look at the mountings. i wish we could begin to see the mountings again, sarah, it seems quite strange without them, and i'm getting rather tired of looking at gardens when we can't go inside them, aren't you?" sarah was feeling very contented and happy. she was, though a little body for her age, much stronger than peggy, as well as two years older, and she looked at her companion with surprise when she began already to talk of "resting." "lor', missy, you bain't tired already," she was beginning, when she suddenly caught sight of something which made her interrupt herself. this was another road crossing the one they were on at right angles, and running therefore in the same direction as fernley road again. "'ere's our way," she cried, "now didn't i tell you so? and this way goes slopin' up a bit, you see. when we get to the top we'll see the 'ills straight 'afore us, and 'ave a beeyutiful view." peggy's rather flagging steps grew brisker at this, and the two ran gaily along the new road for a little way. but running uphill is tiring, and it seemed to take them a long time to get to the top of the slope, and when they did so, it was only to be disappointed. neither mountains nor hills nor white cottage were to be seen, only before them a rather narrow sort of lane, sloping downwards now and seeming to lead into some rather rough waste ground, where it ended. peggy's face grew rather doleful, but sarah was quite equal to the occasion. a little down the hill she spied a stile, over which she persuaded peggy to climb. they found themselves in a potato field, but a potato field with a path down the middle; it was a large field and at the other end of the path was a gate, opening on to a cart track scarcely worthy the name of a lane. the children followed it, however, till another stile tempted them again, this time into a little wood, where they got rather torn and scratched by brambles and nettles as they could not easily find a path, and sarah fancied by forcing their way through the bushes they would be sure to come out on to the road again. it was not, however, till they had wandered backwards among the trees and brambles for some time that they got on to a real path, and they had to walk a good way along this till they at last came on another gate, this time sure enough opening into the high road. sarah's spirits recovered at once. "'ere we are," she said cheerfully, "all right. 'ere's fernley road again. nothink to do but to turn round and go 'ome if you're tired, missy. _i'm_ not tired, but if you'd rayther go no farther----" peggy did not answer for a moment; she was staring about her on all sides. the prospect was not a very inviting one; the road was bare and ugly, dreadfully dusty, and there was no shade anywhere, and at a little distance some great tall chimneys were to be seen, the chimneys of some iron-works, from which smoke poured forth. there were a good many little houses near the tall chimneys, they were the houses of the people who worked there, but they were not sweet little cottages such as peggy dreamed of. indeed they looked more like a very small ugly town, than like rows of cottages on a country road. "this isn't a pretty road at all," said peggy at last, rather crossly i am afraid, "it is very nugly, and you shouldn't have brought me here, sarah. i can't see the mountings; they is quite goned away, more goned away than when it rains, for then they're only behind the clouds. this isn't fernley road, light smiley. i do believe you've losted us, and peggy's so tired, and very, very un'appy." it was peggy's way when she grew low-spirited to speak more babyishly than usual; at such times it was too much trouble to think about being a big girl. poor sarah looked dreadfully distressed. "oh, missy dear, don't cry," she said. "if it bain't fernley road, it's _a_ road any way, and there's no call to be frightened. we can ax our way, but i'd rayther not ax it at the cottages, for they might think i was a tramp that'd stoled you away." "and what would they do then?" asked peggy, leaving off crying for a minute. "they'd 'av me up mebbe, and put us in the lock-ups." "what's that?" "the place where the pl'ice leaves folk as they isn't sure about." "prison, do you mean?" said peggy, growing very pale. "well, not ezackly, but somethin' like." peggy caught hold of sarah in sudden terror. "oh come along, light smiley, quick, quick. let's get back into the fields and hide or anything. oh come quick, for fear they should catch us." and she tugged at sarah, trying to drag her along the road. "stop, missy, don't take on so; there's no need. we'll just go along quietly and no one'll notice us, only you stop crying, and then no one'll think any 'arm. we'll not go back the way we came, it's so drefful thorny, but we'll look out for another road or a path. i 'spects you're right enough--this 'ere bain't fernley road." peggy swallowed down her sobs. "i don't think you look quite big enough to have stolened me, sarah," she said at last. "but i would like to get back into the fields quick. if only we could see the mountings again, i wouldn't be quite so frightened." they had not gone far before they came upon a gateway and a path leading through a field where there seemed no difficulties. crossing it they found themselves at the edge of the thorny wood, which they skirted for some way. peggy's energy, born of fear, began to fail. "sarah," she said at last, bursting into fresh tears, "peggy can't go no farther, and i'm so hungry too. i'm sure it's long past dinner-time. you must sit down and rest; p'raps if i rested a little, i wouldn't feel so very un'appy." sarah looked at her almost in despair. she herself was worried and vexed, very afraid too of the scolding which certainly awaited her at home, but she was not tired nor dispirited, though very sorry for peggy, and quite aware that it was she and not "missy" who was to blame for this unlucky expedition. "i'd like to get on," she said, "we're sure to get back into a road as'll take us 'ome before long. couldn't i carry you, missy?" "no," said peggy, "you're far too little. and i can't walk any more without resting. you're very unkind, light smiley, and i wish i'd never seen you." poor sarah bore this bitter reproach in silence. she looked about for a comfortable seat in the hedge, and settled herself so that peggy could rest against her. the sunshine, though it had seemed hot and glaring on the bare dusty road was not really very powerful, for it was only late april, though a very summerlike day. peggy left off crying and said no more, but leant contentedly enough against sarah. "i'm comf'able now," she said, closing her eyes. "thank you, light smiley. i'll soon be rested, and then we'll go on." but in a moment or two, by the way she breathed, sarah saw that she had fallen asleep. [illustration: "and at last, though she was really so anxious and distressed, the quiet and the milder air, and the idleness perhaps, to which none of the simpkins family were much accustomed, all joined together and by degrees hushed poor light smiley to sleep, her arms clasped round peggy as if to protect her from any possible danger." p. 177] "bless us," thought the little guardian to herself, "she may sleep for hours. whatever 'ull i do? she's that tired--and when she wakes she'll be that 'ungry, there'll be no getting her along. she'll be quite faint-like. if i dared leave her, i'd run on till i found the road and got somebody to 'elp carry her. but i dursn't. if she woked up and me gone, she'd be runnin' who knows where, and mebbe never be found again. poor missy--it'll be lock-ups and no mistake, wusser i dessay for me, and quite right too. mother'll never say i'm fit for a nussery after makin' sich a fool of myself." and in spite of her courage, the tears began to trickle down sarah's face. peggy looked so white and tiny, lying there almost in her arms, that it made her heart ache to see her. so she shut her own eyes and tried to think what to do. and the thinking grew gradually confused and mixed up with all sorts of other thinkings. sarah fancied she heard her mother calling her, and she tried to answer, but somehow the words would not come. and at last, though she was really so anxious and distressed, the quiet and the mild air, and the idleness perhaps, to which none of the simpkins family were much accustomed, all joined together and by degrees hushed poor light smiley to sleep, her arms clasped round peggy as if to protect her from any possible danger. it would have been a touching picture, had there been any one there to see. unluckily, not merely for the sake of the picture, but for that of the children themselves, there was no one. chapter xii the shoes-lady again "i'll love you through the happy years, till i'm a nice old lady." _poems written for a child._ when they woke, both of them at the same moment it seemed, though probably one had roused the other without knowing it, the sun had gone, the sky looked dull, it felt chilly and strange. peggy had thought it must be past dinner-time before they had sat down to rest; it seemed now as if it must be past tea-time too! sarah started up, peggy feebly clinging to her. "oh dear, dear," said sarah, "i shouldn't have gone to sleep, and it's got that cold!" she was shivering herself, but peggy seemed much the worse of the two. she was white and pinched looking, and as if she were half stupefied. "i'm so cold," she said, "and so hungry. i thought i was in bed at home. i do so want to go home. i'm sure it's very late, light smiley; do take me home." "i'm sure, missy, it's what i want to do," said poor sarah. "i'm afeared it's a-going to rain, and whatever 'ull we do then? you wouldn't wait 'ere a minute, would you, while i run to see if there's a road near?" "no, no," said peggy, "i won't stay alone. i'm very, very frightened, light smiley, and i think i'm going to die." "oh lor', missy, don't you say that," said sarah, in terror. "if you can't walk i'll carry you." "i'll try to walk," said peggy, picking up some spirit when she saw sarah's white face. and then the two set off again, dazed and miserable, very different from the bright little pair that had started up fernley road that morning. things, however, having got to the worst, began to mend, or at least were beginning to mend for them, though peggy and sarah did not just yet know it. not far from the edge of the field where they were, a little bridle-path led into a lane, and a few yards down this lane brought them out upon fernley road again at last. "i see the mountings," cried peggy, "oh, light smiley, peggy sees the mountings. p'raps we won't die, oh p'raps we'll get home safe again." but though she had been trying to be brave, now that she began to hope again, it was too much for her poor little nerves--peggy burst into loud sobbing. "oh, dear missy, try not to cry," said sarah. "there--there--where's your hankercher?" and she dived into peggy's pocket in search of it. and as she pulled it out, out tumbled at the same time the two little scarlet shoes, falling on the ground. "oh light smiley, my red shoes. they'll be all spoilt and dirtied," said peggy, as well as she could, for sarah was dabbing the handkerchief all over her face. sarah stooped to pick them up; both children were too much engaged to notice the sound of wheels coming quickly along the quiet road. but the sight of a speck of dirt on one of the shoes set peggy off crying again, and she cried for once pretty loudly. the wheels came nearer, and then stopped, and this made sarah look round. a pony-carriage driven by a lady had drawn up just beside them. the groom, sitting behind, jumped down, though looking as if he did not know what he was to do. "what is the matter, little girls?" said the lady. "it's, please'm--we've lost our road--it's all along o' me, mum--but i didn't mean no 'arm, only missy's that wore out'm, and----" but before sarah could get farther, she was stopped by a sort of cry from both the lady and peggy at once. "oh, oh," called out peggy, "it's the shoes-lady--oh, pelease, pelease, take me home," and she seemed ready to dart into the lady's arms. "i do believe," _she_ said, "i do believe it's the little girl i saw at the bootmaker's, and--yes, of course it is--there are the shoes themselves! my dear child, whatever are you doing to be so far from home--at least i suppose you live in the town?--and what have you got the dolly's shoes with you for?" "i brought them for them to see the mountings and the white cottage," sobbed peggy; "but i'm so cold and hungry, pelease take me home, oh, pelease, do." the lady seemed rather troubled. even if she had not remembered peggy, she would have seen in a moment that she was a little lady, though peggy looked miserable enough with her torn clothes, and scratched and tear-stained face. "poor child," she said, "tell me your name, and where you live." "i'm peggy, but i don't 'amember my nother name, 'cos i'm tired and it's very long," she said. the lady looked at sarah. sarah shook her head. "no, mum, i don't know it neither, but i knows the name of the street. 'tis bernard street'm--off fernley road, and their back winders looks over to us. we're simpkinses'm, and missy's mar knows as we're 'speckable, and mother she never thought when she told me to take back the humberellar, as i'd lead missy sich a dance. i'll never do for the nussery, no never. i'm not steady enough," and here light smiley gave signs of crying herself. it was not easy for the lady to make out the story, but by degrees, with patience she did so. but while talking she had lifted peggy into the carriage beside her, and wrapped her up in a shawl that lay on the seat, peggy nestling in, quite contentedly. "now," said the lady, "you get in too, sarah simpkins, and i'll drive you both home. i was on my way home out into the country, but i can't leave you here on the road. this is fernley road, but it's quite four miles from the town." in scrambled sarah, divided between fear of her own and peggy's relations' scoldings when they got home, and the delight and honour of driving in a carriage! the groom would have liked to look grumpy, i am quite sure, but he dared not. peggy, for her part, crept closer and closer to the lady, and ended by falling asleep again, so that it was a good thing light smiley was sitting on the other side, to keep her from falling out. the four miles seemed very short to sarah, and as they got into the outskirts of the town her face grew longer and longer. "i'm more'n half a mind to run away, i 'ave," she said to herself, quite unaware she was speaking aloud. "it'll be more'n i can stand, mother and rebecca and all on 'em down on me, for i didn't mean no 'arm. i'd best run away." the lady turned to her, hitherto she had not taken much notice of sarah, but now she felt sorry for the little girl. "what are you saying, my dear?" she said gently, though all the same her voice made sarah jump. "are you afraid of going home? you have not done anything naughty, exactly, as far as i understand. it was only thoughtless. i will go with you to your home if you like, and explain to your mother how it was." "oh thank you, mum," said sarah, eagerly, her spirits rising again at once; "you see, mum, i do so want to be in the nussery onst i'm big enough, and i was so afeared mother'd never think of it again. i only wanted to please little missy, for she seemed so lonely like, her mar and all bein' away and no one for to take her a walk. she's a sweet little missy, she is, but she's only a baby, so to say; she do have such funny fancies. 'twas all to see the cottage on the 'ills she wanted to come up fernley road so badly." "the cottage--what cottage?" asked the lady. sarah tried to explain, and gradually the lady got to understand what little peggy had meant about bringing the red shoes "to see the mountings and the cottage." "she's always a-talking of the country, and father lived there when he was a boy, and missy had got it in her 'ead that he lived in a white cottage, like the one she fancies about," sarah went on. "i would like to take her out into the real country, poor little pet," said the lady, looking tenderly at the sweet tiny face of the sleeping child. she loved all children, but little girls of peggy's age were especially dear to her, for many years before she had had a younger sister who had died, and the thought of her had come into her mind the first time she had seen peggy at the door of the shoe shop. "if i can see any of her friends i will ask them to let her spend a day with me," she went on, speaking more to herself than to sarah. as they turned into bernard street a cab dashed past them coming very fast from the opposite direction. it drew up in front of the house which sarah was just that moment pointing out to the lady as peggy's home, and a gentleman, followed by a young woman, sprang out. the door was opened almost as soon as they rang, and then the three, the other servant who had answered the bell, the young woman and the gentleman, all stood together on the steps talking so anxiously and eagerly that for a moment or two they did not notice the pony-carriage, and though the groom knew the whole story by this time and had jumped down at once, he was far too proper to do anything till he had his lady's orders. "ask the gentleman to speak to me," said the lady, "and you jump out, little sarah. i think he must be peggy's father." he had turned round by this time and came hurrying forward. the moment the lady saw him she knew she had guessed right. he was so like peggy--fair and gray-eyed, and with the same gentle expression, and very young looking to be the father not only of peggy, but of _big_ little boys like thor and terry. his face looked pale and anxious, but the moment he caught sight of the little sleeping figure leaning against the lady it all lighted up and a red flush came into his cheeks. "oh--thank god," he exclaimed, "my little peggy! you have found her! how good of you! but--she is not hurt?--she is all right?" "yes--yes--only cold and hungry and tired," said the lady eagerly, for peggy did look rather miserable still. "will you lift her out?" and as he did so, she got out herself, and turned to sarah. "may i bring this other child in for a moment," she said, "and then i can explain it all?" sarah followed gladly, but a sudden thought struck her, "please'm," she said, bravely, though the tears came to her eyes as she spoke, "p'raps i'd best run 'ome; mother'll be frightened about me." "but i promised you should not be scolded," said the lady; "stay," and she turned to fanny, "she lives close to, she says." "at the back--over the cobbler's," said sarah, readily. "can you let her mother know she's all right, then? and say i am coming to speak to her in a moment," said the lady, and fanny went off. she had been so terrified about peggy, and so afraid that she would be blamed for carelessness, that she dared not wait, though she was dying with curiosity to know the whole story and what one of the simpkins children could have had to do with it. peggy awoke by the time her father had got her into the dining-room, where cook had made a good fire and laid out peggy's dinner and tea in one to be all ready, for the poor woman had been hoping every instant for the last few hours that the little girl would be brought home again. it had been difficult to find peggy's father, as he was not at his office, and fanny had been there two or three times to fetch him. "oh dear papa," were peggy's first words, "i'm so glad to be home. i'll never go up fernley road again; but i did so want to see the cottage and the mountings plainer. and it wasn't light smiley's fault. she was very good to me, and i was very cross." this did not much clear up matters. indeed peggy's papa was afraid for a minute or two that his little girl was going to have a fever, and that her mind was wandering. but all such fears were soon set at rest, and when the lady went off with sarah, she left peggy setting to work very happily at her dinner or tea, she was not sure which to call it. "and you will let her come to spend the day with me to-morrow?" said the lady, as she shook hands with peggy's father. "i shall be driving this way, and i can call for her. i should not be happy not to know that she was none the worse for her adventures to-day." then the lady took sarah by the hand and went round with her to her home in the back street, telling the groom to wait for her at the corner. it was well she went herself, for otherwise i am afraid poor light smiley would not have escaped the scolding she dreaded. her mother and sisters had been very unhappy and frightened about her, and when people--especially poor mothers like mrs. simpkins, with "so many children that they don't know what to do"--are anxious and frightened, i have often noticed that it makes them very cross. as it was, however, the lady managed to smoothe it all down, and before she left she got not only sarah's mother, but rebecca and mary-hann and all of them to promise to say no more about it. "'tisn't only for myself i was feelin' so put about, you see, ma'am," said mrs. simpkins, "but when i sent over the way and found the little missy was not to be found it flashed upon me like a lightenin' streak--it did that, ma'am--that the two was off together. and if any 'arm had come to the little lady through one of mine, so to say, it would 'ave gone nigh to break my 'art. for their mar is a sweet lady--a real feelin' lady is their mar." "and a kind friend to you, i daresay," said the stranger. "couldn't be a kinder as far as friendly words and old clotheses goes," said mrs. simpkins. "but she's a large little fam'ly of her own, and not so very strong in 'ealth, and plenty to do with their money. and so to speak strangers in the place, though she 'ave said she'd do her best to get a place in a nice fam'ly for one of my girls." the lady glanced at the group of sisters. "yes," she said, "i should think you could spare one or two. how would you like to be in a kitchen?" she added, turning to rebecca. the girl blushed so that her face matched her arms, and she looked more "reddy" than ever. but she shook her head. "i'm afraid----" she began. "no, ma'am, thank you kindly, but i couldn't spare rebecca," the mother interrupted. "if it were for mary-hann now--matilda-jane's coming on and could take her place. only, for i couldn't deceive you, ma'am, she's rather deaf." "i shouldn't mind that," said the lady, who was pleased by mary-ann's bright eyes and pleasant face. "i think deaf people sometimes work better than quick-hearing ones, besides, it may perhaps be cured. i will speak about her to my housekeeper and let you know. and you, sarah, you are to be in the nursery some day." sarah grinned with delight. "not just yet," said mrs. simpkins; "she 'ave a deal to learn, 'ave sarah. schooling and stiddiness to begin with. she don't mean no 'arm, i'll allow." "no; i'm sure she wants to be a very good girl," said the lady. "she was very kind and gentle to little miss peggy. so i won't forget you either, sarah, when the time comes." and then the lady said good-bye to them all, and mrs. simpkins's heart felt lighter than for long, for she was sure that through this new friend she might get the start in life she had been hoping for, for her many daughters. peggy slept off her fatigue, and by the next morning she was quite bright again and able to listen to and understand papa's explanation of how, though without meaning to be disobedient, she had done wrong the day before in setting off with sarah simpkins as she had done. two or three tears rolled slowly down her cheeks as she heard what he said. "i meant to be so good while mamma was away," she whispered. "but i'll never do it again, papa. i'll stay quiet in the nursery all alone, even if miss earnshaw doesn't come back at all." for a message had come from the dressmaker that her mother was very ill, as fanny had feared, and that she was afraid she would not be able to leave her for several days. "it won't be so bad as that, dear," said her father. "mamma will be back in five days now, and i don't think you are likely to be left alone in the nursery--certainly not to-day;" and then he told her about the lady having asked her to spend the day out in the country with her, and that peggy must be ready by twelve o'clock, not to keep her new friend waiting. peggy's eyes gleamed with delight. "out into the country?" she said. "oh, how lovely! and oh, papa, do you think _p'raps_ she lives in a white cottage?" papa shook his head. "i'm afraid it's not a cottage at all where she lives," he said. "but i'm sure it is a very pretty house, and let us hope it is a white one." "no," said peggy, "you don't understand, papa--not as well as mamma does. i don't care what colour it is if it's only an 'ouse." and she couldn't understand why papa laughed so that he really couldn't correct her. "i'm afraid, peggy," he said, "you've been taking lessons from little miss simpkins. it's time mamma came home again to look after you." "yes, i wish mamma was come home again," said peggy. "we can't do without her, can we, papa?" but when the dear little pony carriage came up to the door, and peggy got in and drove off with her kind friend, she was so happy that she had not even time to wish for mamma. and what a delightful day she had! the lady's house was very pretty, and the gardens and woods in which it stood even prettier in peggy's opinion. and though it was not a cottage, there were all the country things to see which peggy was so fond of--cocks and hens, and cows, and in one field lots of sheep and sweet little lambkins. there were pigs too, which peggy would not look at, but ran away to the other end of the yard as soon as she heard them "grumphing," which amused the lady very much. and in the afternoon she went a walk with her friend through the village, where there were several pretty cottages, but none that quite fitted peggy's fancy. when they came in again peggy stood at the drawing-room window, which looked out towards brackenshire, without speaking. "you like that view, don't you, dear?" said the lady. "you can see the hills?" "yes," said peggy, "i can see the mountings, but not the white cottage. it's got turned wrong somehow, from here. i can only see _it_ from the nursery window at home," and she gave a very little sigh. "some day," said the lady, "some day in the summer when the afternoons are very long, i will drive you right out a long way among the hills, and perhaps we'll find the cottage then. for i hope your mamma will often let you come to see me, my little peggy." "yes," said peggy, "that would be lovely. i _wonder_ if we'd find the white cottage." no, they never did! the sweet long summer days came, and many a bright and happy one peggy spent with her kind friend, but they never found the white cottage on the hill. peggy knew it so well in her mind, she felt she could not mistake it, but though she saw many white cottages which any one else _might_ have thought was it, she knew better. and each time, though she sighed a little, she hoped again. but before another summer came round peggy and her father and mother, and thor, and terry, and hal, and baldwin, and baby had all gone away--far away to the south, many hours' journey from the dingy town and the fernley road, and the queer old house in the back street where lived the cobbler and old mother whelan and brown smiley and light smiley and all the rest of them. far away too from the hills and the strange white speck in the distance which peggy called her cottage. so it never was more than a dream to her after all, and perhaps--perhaps it was best so? for nothing has ever spoilt the sweetness and the mystery of the childish fancy--she can see it with her mind's eye still--the soft white speck on the far-away, blue hills--she can see it and think of it and make fancies about it even now--now that she has climbed a long, long way up the mountain of life, and will soon be creeping slowly down the other side, where the sun still shines, however, and there are even more beautiful things to hope for than the sweetest dreams of childhood. the end _printed by_ r. & r. clark, _edinburgh._ * * * * * transcriber's notes: obvious punctuation errors repaired. page 16, caption of illustration, "accomodate" changed to "accommodate" (to accommodate the whole) page 47, word "a" added to text (it a waste of time) page 101, the text mentions a "ferndale road". there are many references elsewhere to "fernley road" so this might be a misprint. it was retained. the nervous child published by the joint committee of henry frowde, hodder & stoughton 17 warwick square, london, e.c. 4 the nervous child by hector charles cameron m.a., m.d.(cantab.), f.r.c.p.(lond.) physician to guy's hospital and physician in charge of the children's department, guy's hospital "respect the child. be not too much his parent. trespass not on his solitude."--emerson. london henry frowde hodder & stoughton oxford university press warwick square, e.c. 1920 _first edition_ 1919 _second impression_ 1930 printed in great britain by morrison & gibb ltd., edinburgh preface to-day on all sides we hear of the extreme importance of preventive medicine and the great future which lies before us in this aspect of our work. if so, it follows that the study of infancy and childhood must rise into corresponding prominence. more and more a considerable part of the profession must busy itself in nurseries and in schools, seeking to apply there the teachings of psychology, physiology, heredity, and hygiene. to work of this kind, in some of its aspects, this book may serve as an introduction. it deals with the influences which mould the mentality of the child and shape his conduct. extreme susceptibility to these influences is the mark of the nervous child. i have to thank the editors of _the practitioner_ and of _the child_, respectively, for permission to reprint the chapters which deal with "enuresis" and "the nervous child in sickness." to dr. f.h. dodd i should also like to offer thanks for helpful suggestions. h.c.c. _march_ 1919. contents chap. page i. doctors, mothers, and children 1 ii. observations in the nursery 16 iii. want of appetite and indigestion 50 iv. want of sleep 64 v. some other signs of nervousness 73 vi. enuresis 89 vii. toys, books, and amusements 96 viii. nervousness in early infancy 104 ix. management in later childhood 117 x. nervousness in older children 131 xi. nervousness and physique 145 xii. the nervous child in sickness 160 xiii. nervous children and education on sexual matters 169 xiv. the nervous child and school 182 index 191 the nervous child chapter i doctors, mothers, and children there is an old fairy story concerning a pea which a princess once slept upon--a little offending pea, a minute disturbance, a trifling departure from the normal which grew to the proportions of intolerable suffering because of the too sensitive and undisciplined nervous system of her royal highness. the story, i think, does not tell us much else concerning the princess. it does not tell us, for instance, if she was an only child, the sole preoccupation of her parents and nurses, surrounded by the most anxious care, reared with some difficulty because of her extraordinary "delicacy," suffering from a variety of illnesses which somehow always seemed to puzzle the doctors, though some of the symptoms--the vomiting, for example, and the high temperature--were very severe and persistent. nor does it tell us if later in life, but before the suffering from the pea arose, she had been taken to consult two famous doctors, one of whom had removed the vermiform appendix, while the other a little later had performed an operation for "adhesions." at any rate, the story with these later additions, which are at least in keeping with what we know of her history, would serve to indicate the importance which attaches to the early training of childhood. among the children even of the well-to-do often enough the hygiene of the mind is overlooked, and faulty management produces restlessness, instability, and hyper-sensitiveness, which pass insensibly into neuropathy in adult life. to prevent so distressing a result is our aim in the training of children. no doubt the matter concerns in the first place parents and nurses, school masters and mistresses, as well as medical men. yet because of the certainty that physical disturbances of one sort or another will follow upon nervous unrest, it will seldom happen that medical advice will not be sought sooner or later; and if the physician is to intervene with success, he must be prepared with knowledge of many sorts. he must be prepared to make a thorough and complete physical examination, sufficient to exclude the presence of organic disease. if no organic disease is found, he must explore the whole environment of the child, and seek to determine whether the exciting cause is to be found in the reaction of the child to some form of faulty management. for example, a child of two or three years of age may be brought to the doctor with the complaint that defæcation is painful, and that there has existed for some time a most distressing constipation which has resisted a large number of purgatives of increasing strength. whenever the child is placed upon the stool, his crying at once begins, and no attempts to soothe or console him have been successful. it is not sufficient for the doctor in such a case to make an examination which convinces him that there is no fissure at the anus and no fistula or thrombosed pile, and to confine himself to saying that he can find nothing the matter. the crying and refusal to go to stool will continue after the visit as before, and the mother will be apt to conclude that her doctor, though she has the greatest confidence in him for the ailments of grown-up persons, is unskilled in, or at least not interested in, the diseases of little children. if, on the other hand, the doctor pursues his inquiries into the management of the child in the home, and if, for example, he finds that the crying and resistance is not confined to going to stool, but also takes place when the child is put to bed, and very often at meal-times as well, then it will be safe for him to conclude that all the symptoms are due to the same cause--a sort of "negativism" which is apt to appear in all children who are directed and urged too much, and whose parents are not careful to hide from them the anxiety and distress which their conduct occasions. if this diagnosis is made, then a full and clear explanation should be given to the mother, or at any rate to such mothers--and fortunately they are in the majority--who are capable of appreciating the point of psychology involved, and of correcting the management of the child so as to overcome the negativism. to attempt treatment by prescribing drugs, or in any other way than by correcting the faulty management, is to court failure. as charcot has said, in functional disorders it is not so much the prescription which matters as the prescriber. but the task of the doctor is often one of even greater difficulty. often enough there will be a combination of organic disturbance with functional trouble. for example, a girl of eighteen years old suffered from a pain in the left arm which has persisted on and off since the olecranon had been fractured when she was two years of age. she was the youngest of a large family, and had never been separated for a day from the care and apprehensions of her mother. the joint was stiff, and there was considerable deformity. the pain always increased when she was tired or unhappy. again, a girl had some slight cystitis with frequent micturition, and this passed by slow degrees into a purely functional irritability of the bladder, which called for micturition at frequent intervals both by day and night. in such cases treatment must endeavour to control both factors--the local organic disturbance must if possible be removed, and the faults of management corrected. it is a good physician who can appreciate and estimate accurately the temperament of his patient, and the need for this insight is nowhere greater than in dealing with the disorders of childhood. it can be acquired only by long practice and familiarity with children. in the hospital wards we shall learn much that is essential, but we shall not learn this. the child, who is so sensitive to his environment, shows but little that is characteristic when admitted to an institution. only in the nursery can we learn to estimate the influences which proceed from parents and nurses of different characters and temperaments, and the reaction which is produced by them in the child. the body of the child is moulded and shaped by the environment in which it grows. pure air, a rational diet, free movement, give strength and symmetry to every part. faults of hygiene debase the type, although the type is determined by heredity which in the individual is beyond our control. mothers and nurses to-day are well aware of the need for a rational hygiene. mother-craft is studied zealously and with success, and there is no lack of books to give sound guidance and to show the mean between the dangerous extremes of coddling and a too spartan exposure. yet sometimes it has seemed as if some mothers whose care for their children's physical health is most painstaking, who have nothing to learn on the question of diet, of exercise, of fresh air, or of baths, who measure and weigh and record with great minuteness, have had their attention so wholly occupied with the care of the body that they do not appreciate the simultaneous growth of the mind, or inquire after its welfare. yet it is the astounding rapidity with which the mental processes develop that forms the distinguishing characteristic of the infancy of man. were it not for this rapid growth of the cerebral functions, the rearing of children would be a matter almost as simple and uneventful as the rearing of live stock. for most animals faults of environment must be very pronounced to do harm by producing mental unrest and irritability. thus, indeed, some wild animal separated from its fellows and kept in solitary captivity may sicken and waste, though maintained and fed with every care. yet if the whole conditions of life for the animal are not profoundly altered, if the environment is natural or approximately natural, it is as a rule necessary to care only for its physical needs, and we need not fear that the results will be spoiled by the reaction of the mind upon the body. but with the child it is different; airy nurseries, big gardens, visits to the seaside, and every advantage that money can buy cannot achieve success if the child's mind is not at rest, if his sleep is broken, if food is habitually refused or vomited, or if to leave him alone in the nursery for a moment is to evoke a fit of passionate crying. the grown-up person comes eventually to be able to control this tremendous organ, this brain, which is the predominant feature of his race. in the child its functions are always unstable and liable to be upset. evidence of mental unrest or fatigue, which is only rarely met with in grown persons and which then betokens serious disturbance of the mind, is of comparatively common occurrence in little children. habit spasm, bed-wetting, sleep-walking, night terrors, and convulsions are symptoms which are frequent enough in children, and there is no need to be unduly alarmed at their occurrence. in adult age they are found only among persons who must be considered as neuropathic. to make the point clear, i have chosen examples from the graver and more serious symptoms of nervous unrest. but it is equally true that minor symptoms which in adults are universally recognised to be dependent upon cerebral unrest or fatigue are of everyday occurrence in childhood. broken and disturbed sleep, absence of appetite and persistent refusal of food, gastric pain and discomfort after meals, nervous vomiting, morbid flushing and blushing, headache, irritability and excessive emotional display, at whatever age they occur, are indications of a mind that is not at rest. in children, as in adults, they may be prominent although the physical surroundings of the patient may be all that could be desired and all that wealth can procure. it is an everyday experience that business worries and responsibilities in men, domestic anxieties or childlessness in women, have the power to ruin health, even in those who habitually or grossly break none of its laws. the unstable mind of the child is so sensitive that cerebral fatigue and irritability are produced by causes which seem to us extraordinarily trivial. in the little life which the child leads, a life in which the whole seems to us to be comprised in dressing and undressing, washing, walking, eating, sleeping, and playing, it is not easy to detect where the elements of nervous overstrain lie. nor is it as a rule in these things that the mischief is to be found. it is in the personality of mother or nurse, in her conduct to the child, in her actions and words, in the tone of her voice when she addresses him, even in the thoughts which pass through her mind and which show themselves plainly to that marvellously acute intuition of his, which divines what she has not spoken, that we must seek for the disturbing element. the mental environment of the child is created by the mother or the nurse. that is her responsibility and her opportunity. the conduct of the child must be the criterion of her success. if things go wrong, if there is constant crying or ungovernable temper, if sleep and food are persistently refused, or if there is undue timidity and tearfulness, there is danger that seeds may be sown from which nervous disorders will spring in the future. there are many women who, without any deep thought on the matter, have the inborn knack of managing children, who seem to understand them, and have a feeling for them. with them, we say, the children are always good, and they are good because the element of nervous overstrain has not arisen. there are other women, often very fond of children, who are conspicuously lacking in this power. contact with one of these well-meaning persons, even for a few days, will demoralise a whole nursery. tempers grow wild and unruly, sleep disappears, fretfulness and irritability take its place. yet of most mothers it is probably true that they are neither strikingly proficient nor utterly deficient in the power of managing children. if they lack the gift that comes naturally to some women, they learn from experience and grow instinctively to feel when they have made a false step with the child. although by dearly bought experience they learn wisdom in the management of their children, they nevertheless may not study the subject with the same care which they devote to matters of diet and hygiene. it is the mother whose education and understanding best fits her for this task. in this country a separate nursery and a separate nursery life for the children is found in nearly all households among the well-to-do, and the care for the physical needs of the children is largely taken off the mothers' shoulders by nurses and nursemaids. that this arrangement is advantageous on the whole cannot be doubted. in america and on the continent, where the children often mingle all day in the general life of the household, and occupy the ordinary living rooms, experience shows that nerve strain and its attendant evils are more common than with us. nevertheless, the arrangement of a separate nursery has its disadvantages. nurses are sometimes not sufficiently educated to have much appreciation of the mental processes of the child. if the children are restless and nervous they are content to attribute this to naughtiness or to constipation, or to some other physical ailment. their time is usually so fully occupied that they cannot be expected to be very zealous in reading books on the management of children. nevertheless, in practical matters of detail a good nurse will learn rapidly from a mother who has given some attention to the subject, and who is able to give explicit instructions upon definite points. it is right that mothers should appreciate the important part which the environment plays in all the mental processes of children, and in their physical condition as well; that they should understand that good temper and happiness mean a proper environment, and that constant crying and fretfulness, broken sleep, refusal of food, vomiting, undue thinness, and extreme timidity often indicate that something in this direction is at fault. nevertheless, we must be careful not to overstate our case. we must remember how great is the diversity of temperament in children--a diversity which is produced purely by hereditary factors. the task of all mothers is by no means of equal difficulty. there are children in whom quite gross faults in training produce but little permanent damage; there are others of so sensitive a nervous organisation that their environment requires the most delicate adjustment, and when matters have gone wrong, it may be very difficult to restore health of mind and body. when a peculiarly nervous temperament is inherited, wisdom in the management of the child is essential, and may sometimes achieve the happiest results. heredity is so powerful a factor in the development of the nervous organisation of the child that, realising its importance, we should be sparing in our criticism of the results which the mothers who consult us achieve in the training of their children. a sensitive, nervous organisation is often the mark of intellectual possibilities above the average, and the children who are cast outside the ordinary mould, who are the most wayward, the most intractable, who react to trifling faults of management with the most striking symptoms of disturbance, are often those with the greatest potentialities for achievement and for good. it is natural for the mother of placid, contented, and perhaps rather unenterprising children, looking on as a detached outsider, seeing nothing of the teeming activities of the quick, restless little brain, and the persistent, though faulty reasoning--it is natural for her to blame another's work, and to flatter herself that her own routine would have avoided all these troublesome complications. the mother of the nervous child may often rightly take comfort in the thought that her child is worth the extra trouble and the extra care which he demands, because he is sent into the world with mechanism which, just because it is more powerful than the common run, is more difficult to master and takes longer to control and to apply for useful ends. it is through the mother, and by means of her alone, that the doctor can influence the conduct of the child. without her co-operation, or if she fails to appreciate the whole situation, with the best will in the world, we are powerless to help. fortunately with the majority of educated mothers there is no difficulty. their powers of observation in all matters concerning their children are usually very great. it is their interpretation of what they have observed that is often faulty. thus, in the example given above, the mother observes correctly that defæcation is inhibited, and produces crying and resistance. it is her interpretation that the cause is to be found in pain that is at fault. again, a mother may bring her infant for tongue-tie. she has observed correctly that the child is unable to sustain the suction necessary for efficient lactation, and has hit upon this fanciful and traditional explanation. the doctor, who knows that the tongue takes no part in the act of sucking, will probably be able to demonstrate that the failure to suck is due to nasal obstruction, and that the child is forced to let go the nipple because respiration is impeded. the opportunities for close observation of the child which mothers enjoy are so great that we shall not often be justified in disregarding their statements. but if we are able to give the true explanation of the symptoms, it will seldom happen that the mother will fail to be convinced, because the explanation, if true, will fit accurately with all that has been observed. thus the mother of the child in whom defæcation is inhibited by negativism may have made further observations. for example, she may have noted that the so-called constipation causes fretfulness, that it is almost always benefited by a visit to the country or seaside, or that it has become much worse since a new nurse, who is much distressed by it, has taken over the management of the child. to this mother the explanation must be extended to fit these observations, of the accuracy of which there need be no doubt. fretfulness and negativism with all children whose management is at fault come in waves and cycles. the child, naughty and almost unmanageable one week, may behave as a model of propriety the next. the negativism and refusal to go to stool are the outcome of the nervous unrest, not its cause. again, the nervous child, like the adult neuropath, very often improves for the time being with every change of scene and surroundings. it is the _ennui_ and monotony of daily existence, in contact with the same restricted circle, that becomes insupportable and brings into prominence the lack of moral discipline, the fretfulness, and spirit of opposition. lastly, the conduct of the nervous child is determined to a great extent by suggestions derived from the grown-up people around him. refusal of food, refusal of sleep, refusal to go to stool, as we shall see later, only become frequent or habitual when the child's conduct visibly distresses the nurse or mother, and when the child fully appreciates the stir which he is creating. the mother will readily understand that in such a case, where constipation varies in degree according as different persons take charge of the child, the explanation offered is that which alone fits with the observed facts. a full and free discussion between mother and doctor, repeated it may be more than once, may be necessary before the truth is arrived at, and a line of action decided upon. only so can the doctor, remote as he is from the environment of the child, intervene to mould its nature and shape its conduct. if the doctor is to fit himself to give advice of this sort, he must be a close observer of little children. he must not consider it beneath his dignity to study nursery life and nursery ways. there he will find the very beginnings of things, the growing point, as it were, of all neuropathy. a man of fifty, who in many other ways showed evidence of a highly nervous temperament, had especially one well-marked phobia, the fear of falling downstairs. it had never been absent all his life, and he had grown used to making the descent of the stairs clinging firmly to the stair-rail. family tradition assigned this infirmity to a fall downstairs in early childhood. but all children fall downstairs and are none the worse. the persistence of the fear was due, i make no doubt, to the attitude of the parents or nurse, who made much of the accident, impressed the occasion strongly on the child's memory, and surrounded him thereafter with precautions which sapped his confidence and fanned his fears. in what follows we will consider first the subject of nursery management, searching in it for the origin of the common disorders of conduct both of childhood and of later life. i have grouped these nursery observations under the heads of four characteristic features of the child's psychology--his imitativeness, his suggestibility, his love of power, and his acute though limited reasoning faculties. i feel that some such brief examination is necessary if we are to understand correctly the ætiology of some of the most troublesome disorders of childhood, such as enuresis, anorexia, dyspepsia, or constipation, disorders in which the nervous element is perhaps to-day not sufficiently emphasised. finally, we can evolve a kind of nursery psycho-therapeutics--a subject which is not only of fascinating interest in itself, but which repays consideration by the success which it brings to our efforts to cure and control. chapter ii observations in the nursery _(a)_ the imitativeness of the child it is in the second and third years of the child's life that the rapidity of the development of the mental processes is most apparent, and it is with that age that we may begin a closer examination. at first sight it might seem more reasonable to adopt a strictly chronological order, and to start with the infant from the day of his birth. since, however, we can only interpret the mind of the child by our knowledge of our own mental processes, the study of the older child and of the later stages is in reality the simpler task. the younger the infant, the greater the difficulties become, so that our task is not so much to trace the development of a process from simple and early forms to those which are later and more complex, as to follow a track which is comparatively plain in later childhood, but grows faint as the beginnings of life are approached. at the age, then, of two or three the first quality of the child which may arrest our attention is his extreme imitativeness. not that the imitation on his part is in any way conscious; but like a mirror he reflects in every action and in every word all that he sees and hears going on around him. we must recognise that in these early days his words and actions are not an independent growth, with roots in his own consciousness, but are often only the reflection of the words and actions of others. how completely speech is imitative is shown by the readiness with which a child contracts the local accent of his birthplace. the london parents awake with horror to find their baby an indubitable cockney; the speech of the child bred beyond the tweed proclaims him a veritable scot. again, some people are apt to adopt a somewhat peremptory tone in addressing little children. often they do not trouble to give to their voices that polite or deferential inflection which they habitually use when speaking to older people. listen to a party of nurses in the park addressing their charges. as if they knew that their commands have small chance of being obeyed, they shout them with incisive force. "come along at once when i tell you," they say. and the child faithfully reflects it all back, and is heard ordering his little sister about like a drill sergeant, or curtly bidding his grandmother change her seat to suit his pleasure. if we are to have pretty phrases and tones of voice, mothers must see to it that the child habitually hears no other. again, mothers will complain that their child is deaf, or, at any rate, that he has the bad habit of responding to all remarks addressed to him by saying, "what?" or, worse still, "eh?" often enough the reason that he does so is not that the child is deaf, nor that he is particularly slow to understand, but simply that he himself speaks so indistinctly that no matter what he says to the grown-up people around him, they bend over him and themselves utter the objectionable word. we all hate the tell-tale child, and when a boy comes in from his walk and has much to say of the wicked behaviour of his little sister on the afternoon's outing, his mother is apt to see in this a most horrid tendency towards tale-bearing and currying of favour. she does not realise that day by day, when the children have come in from their walk, she has asked nurse in their hearing if they have been good children; and when, as often happens, they have not, the nurse has duly recounted their shortcomings, with the laudable notion of putting them to shame, and of emphasising to them the wickedness of their backsliding--and this son of hers is no hypocrite, but speaks only, as all children speak, in faithful reproduction of all that he hears. those grown-up persons who are in charge of the children must realise that the child's vocabulary is their vocabulary, not his own. it is unfortunate, but i think not unavoidable, that so often almost the earliest words that the infant learns to speak are words of reproof, or chiding, or repression. the baby scolds himself with gusto, uttering reproof in the very tone of his elders: "no, no," "naughty," or "dirty," or "baby shocked." speech, then, is imitative from the first, if we except the early baby sounds with reduplication of consonants to which in course of time definite meaning becomes attached, as "ba-ba," "ma-ma," "na-na," "ta-ta," and so forth. action only becomes imitative at a somewhat later stage. the first purposive movements of the child's limbs are carried out in order to evoke tactile sensations. he delights to stimulate and develop the sense of touch. at first he has no knowledge of distance, and his reach exceeds his grasp. he will strain to touch and hold distant objects. gradually he learns the limitations of space, and will pick up and hold an object in his hand with precision. often he conveys everything to his mouth, not because his teeth are worrying him, or because he is hungry, as we hear sometimes alleged, but because his mouth, lips, and tongue are more sensitive, because more plentifully furnished with the nerves of tactile sensation. by constant practice the sense of touch and the precision of the movement of his hands are slowly developed, and not these alone, for the child in acquiring these powers has developed also the centres in the brain which control the voluntary movements. when the child can walk he continues these grasping and touching exercises in a wider sphere. as the child of fifteen or eighteen months moves about the room, no object within his reach is passed by. he stretches out his hand to touch and seize upon everything, and to experience the joy of imparting motion to it. the impulse to develop tactile sensation and precision in the movements of his hands compels him with irresistible force. it is foolish to attempt to repress it. it is foolish, because it is a necessary phase in his development, and moreover a passing phase. no doubt it is annoying to his elders while it lasts, but the only wise course is to try to thwart as little as we can his legitimate desire to hold and grasp the objects, and even to assist him in every way possible. but the mother must assist him only by allowing free play to his attempts. to hand him the object is to deprive the exercise of most of its value. incidentally she may teach him the virtue of putting things back in their proper places, an accomplishment in which he will soon grow to take a proper pride. if she attempts continually to turn him from his purpose, reproving him and snatching things from him, she prolongs the grasping phase beyond its usual limits. and she does a worse thing at the same time. lest the quicker hands of his nurse should intervene to snatch the prize away before he has grasped it, he too learns to snatch, with a sudden clumsy movement that overturns, or breaks, or spills. if left to himself he will soon acquire the dexterity he desires. he may overturn objects at first, or let them fall, but this he regards as failure, which he soon overcomes. a child of twenty months, whose development in this particular way has not been impeded by unwise repression, will pick out the object on which he has set his heart, play with it, finger it, and replace it, and he will do it deliberately and carefully, with a clear desire to avoid mishap. dr. montessori, who has developed into a system the art of teaching young children to learn precision of movement and to develop the nerve centres which control movement, tells in her book a story which well illustrates this point.[1] [footnote 1: _the montessori method_, pp. 84, 85.] "the directress of the casa del bambini at milan constructed under one of the windows a long, narrow shelf, upon which she placed the little tables containing the metal geometric forms used in the first lesson in design. but the shelf was too narrow, and it often happened that the children in selecting the pieces which they wished to use would allow one of the little tables to fall to the floor, thus upsetting with great noise all the metal pieces which it held. the directress intended to have the shelf changed, but the carpenter was slow in coming, and while waiting for him she discovered that the children had learned to handle these materials so carefully that in spite of the narrow and sloping shelf, the little tables no longer fell to the ground. the children, by carefully directing their movements, had overcome the defect in this piece of furniture." by slow degrees the child learns to command his movements. if his efforts are aided and not thwarted, before he is two years old he will have become capable of conducting himself correctly, yet with perfect freedom. the worst result of the continual repression which may be constantly practised in the mistaken belief that the grasping phase is a bad habit which persistent opposition will eradicate, is the nervous unrest and irritation which it produces in the child. a passionate fit of crying is too often the result of the thwarting of his nature, and the same process repeated over and over again, day by day, almost hour by hour, is apt to leave its mark in unsatisfied longing, irritability, and unrest. above all, the child requires liberty of action. we have here an admirable example of the effect of environment in developing the child's powers. a caged animal is a creature deprived of the stimulus of environment, and bereft therefore to a great extent of the skill which we call instinct, by which it procures its food, guarantees its safety from attack, constructs its home, cares for its young, and procreates its species. if, metaphorically speaking, we encircle the child with a cage, if we constantly intervene to interpose something between him and the stimulus of his environment, his characteristic powers are kept in abeyance or retarded, just as the marvellous instinct of the wild animals becomes less efficient in captivity. the grasping phase is but a preliminary to more complex activities. just as in schooldays we were taught with much labour to make pot-hooks and hangers efficiently before we were promoted to real attempts at writing, so before the child can really perform tasks with a definite meaning and purpose, he must learn to control the finer movements of his hands. once the grasping phase, the stage of pot-hooks, is successfully past--and the end of the second year in a well-managed child should see its close--the child sets himself with enthusiasm to wider tasks. to him washing and dressing, fetching his shoes and buttoning his gaiters, all the processes of his simple little life, should be matters of the most enthralling interest, in which he is eager to take his part and increasingly capable of doing so. in the montessori system there is provided an elaborate apparatus, the didactic material, designed to cultivate tactile sensation and the perception of sense stimuli. it will generally suffice to advise the mother to make use of the ordinary apparatus of the nursery. the imitativeness of the young child is so great that he will repeat in almost every detail all the actions of his nurse as she carries out the daily routine. at eighteen months of age, when the electric light is turned on in his nursery, the child will at once go to the curtains and make attempts to draw them. at the same age a little girl will weigh her doll in her own weighing-machine, will take every precaution that the nurse takes in her own case, and will even stoop down anxiously to peer at the dial, just as she has seen her mother and nurse do on the weekly weighing night. but at a very early age children appreciate the difference between the real and the make-believe. they desire above all things to do acts of real service. at the age of two a child should know where every article for the nursery table is kept. he will fetch the tablecloth and help to put it in place, spoons and cups and saucers will be carried carefully to the table, and when the meal is over he will want to help to clear it all away. all this is to him a great delight, and the good nurse will encourage it in the children, because she sees that in doing so they gain quickness and dexterity and poise of body. the first purposive movements of the child should be welcomed and encouraged. it is foolish and wrong to repress them, as many nurses do, because the child in his attempts gets in the way, and no doubt for a time delays rather than expedites preparations. the child who is made to sit immobile in his chair while everything is done for him is losing precious hours of learning and of practice. it is useless, and to my mind a little distasteful, to substitute for all this wonderful child activity the artificial symbolism of the kindergarten school in which children are taught to sing songs or go through certain semi-dramatic activities which savour too much of a performance acquired by precise instruction. if such accomplishments are desired, they may be added to, but they must not replace, the more workaday activities of the little child. the child whose impulses towards purposive action are encouraged is generally a happy child, with a mind at rest. when those impulses are restrained, mental unrest and irritability are apt to appear, and toys and picture books and kindergarten games will not be sufficient to restore his natural peace of mind. _(b)_ the suggestibility of the child we may pass from considering the imitativeness of the child to study a second and closely related quality, his suggestibility. his conception of himself as a separate individual, of his ego, only gradually emerges. it is profoundly modified by ideas derived from those around him. because of his lack of acquired experience, there is in the child an extreme sensitiveness to impressions from outside. take, for example, a matter that is sometimes one of great difficulty, the child's likes and dislikes for food. many mothers make complaint that there are innumerable articles of diet which the child will not take: that he will not drink milk, or that he will not eat fat, or meat, or vegetables, or milk puddings. there are people who believe that these peculiarities of taste correspond with idiosyncrasies of digestion, and that children instinctively turn from what would do them harm. i do not believe that there is much truth in this contention. if we watch an infant after weaning, at the time when his diet is gradually being enlarged to include more solid food, with new and varied flavours, we may see his attention arrested by the strange sensations. with solid or crisp food there may be a good deal of hesitation and fumbling before he sets himself to masticate and swallow. with the unaccustomed flavour of gravy or fruit juice there may be seen on his face a look of hesitation or surprise. in the stolid and placid child these manifestations are as a rule but little marked, and pleasurable sensations clearly predominate. with children of more nervous temperament it is clear that sensations of taste are much more acute. even in earliest infancy, children have a way of proclaiming their nervous inheritance by the repugnance which they show to even trifling changes in the taste or composition of their food. we see the same sensitiveness in their behaviour to medicines. the mixture which one child will swallow without resentment, and almost eagerly, provokes every expression of disgust from another, or is even vomited at once. in piloting the child through this phase, during which he starts nervously at all unaccustomed sensations and flavours, the attitude of mother and nurse is of supreme importance. it is unwise to attempt force; it is equally unwise, by excessive coaxing, cajoling, and entreaty, to concentrate the child's attention on the matter. if either is tried every meal is apt to become a signal for struggling and tears. the phase, whether it is short or long continued, must be accepted as in the natural order of things, and patience will see its end. the management of this symptom,--refusal of food and an apparently complete absence of desire for food,--which is almost the commonest neurosis of childhood, will be dealt with later. here it is mentioned because i wish to emphasise that if too much is made of a passing hesitation over any one article of food, if it becomes the belief of the mother or nurse that a strong distaste is present, then if she is not careful her attitude in offering it, because she is apprehensive of refusal, will exert a powerful suggestion on the child's mind. still worse, it may cause words to be used in the child's hearing referring to this peculiarity of his. by frequent repetition it becomes fixed in his mind that this is part of his own individuality. he sees himself--and takes great pleasure in the thought--as a strange child, who by these peculiarities creates considerable interest in the minds of the grown-up people around him. when the suggestion takes root it becomes fixed, and as likely as not it will persist for his lifetime. it may be habitually said of a child that, unlike his brothers and sisters, he will never eat bananas, and thereafter till the day of his death he may feel it almost a physical impossibility to gulp down a morsel of the offending fruit. so, too, there are people who can bolt their food with the best of us, who yet declare themselves incapable of swallowing a pill. another example of the force of suggestion, whether unconscious or openly exercised by speech, is given us in the matter of sleep. among adults the act of going to bed serves as a powerful suggestion to induce sleep. seldom do we seek rest so tired physically that we drop off to sleep from the irresistible force of sheer exhaustion. yet as soon as the healthy man whose mind is at peace, whose nerves are not on edge, finds himself in bed, his eyes close almost with the force of a hypnotic suggestion, and he drops off to sleep. with some of us the suggestion is only powerful in our own bed, that on which it has acted on unnumbered nights. we cannot, as we say, sleep in a strange bed. it is suggestion, not direct will power, that acts. no one can absolutely will himself to sleep. in insomnia it is the attempt to replace the unconscious auto-suggestion by a conscious voluntary effort of will that causes the difficulty. a thousand times in the night we resolve that now we _will_ sleep. if we could but cease to make these fruitless efforts, sleep might come of itself and the suggestion or habit be re-established. in little children the suggestion of sleep, provoked by being placed in bed, sometimes acts very irregularly. often it may succeed for a week or two, and then some untoward happening breaks the habit, and night after night, for a long time, sleep is refused. the wakeful child put to bed, resents the process, and cries and sobs miserably, to the infinite distress of his mother. it then becomes just as likely that the child will connect his bed in his mind, not with rest and sleep, but with sobbing and crying on his part, and mingled entreaties and scoldings from his nurse or mother. an important part in this perversion of the suggestion is played by the attitude of the person who puts the child to bed. often the nurse is uniformly successful, while the mother, who is perhaps more distressed by the sobbing of the child, as consistently fails, because she has been unable to hide her apprehension from him, and has conveyed to his mind a sense of his own power. just in the same way, grown-up people, filled with anxiety because of the helplessness of the young child, unable to divest their minds of the fears of the hundred and one accidents that may befall, or that within their own experience have befallen, a little child at one time or another, unconsciously make unwise suggestions which fill his mind with apprehension and terror. they do not like their children to show fear of animals. nor would they if it were not that their own apprehension that the child may be hurt communicates itself to him. the child is not of himself afraid to fall, it is they who suffer the anxiety and show it by treating the fall as a disaster. the child is not of himself afraid to be left alone in a room. it is they who sap his confidence in himself, because they do not venture to leave him out of their sight, from a nameless dread of what may happen. a little girl cut her finger and ran to her nurse, pleased and interested: "see," she said, seeing it bleed, "fingers all jammy." only when the nurse grasped her with unwise expressions of horror did she break into cries of fear. a town-bred nurse, who is afraid of cows, will make every country walk an ordeal of fear for the children. every mother must be made to realise the ease with which these unconscious suggestions act upon the mind of the little child, and should school herself to be strong to make her child strong, and to see to it that all this suggestive force is utilised for good and not for evil. it is upon this susceptibility to suggestion that a great part of his early education reposes. no one who is incapable of profiting by this natural disposition of the child can be successful in her management of him. turn where you will in his daily life the influence of this force of suggestion is clearly apparent. the child does without questioning that which he is confidently expected to do. thus he will eat what is given him, and sleep soundly when he is put to bed if only the appropriate suggestion and not the contrary is made to him. again we have seen that a perversion of suggestion of this sort is a common source of constipation in early childhood. if the child's attention is directed towards the difficulty, if he is urged or ordered or appealed to to perform his part, if failure is looked upon as a serious misfortune, the bowels may remain obstinately unmoved. in children as in adults a too great concentration of attention inhibits the action of the bowels, and constipation, in many persons, is due to the attempt to substitute will power for the force of habitual suggestion. no matter what other treatment we adopt, the mother must be careful to hide from the child that his failure is distressing to her. a cheerful optimism which teaches him to regard himself as one who is conspicuously regular in his habits, and who has a reputation in this respect to live up to is sure to succeed. to talk before him of his habitual constipation, and to worry over the difficulty, is as surely to fail. in the same way unwise suggestion can interfere with the passing of water at regular and suitable intervals. there are children who constantly desire to pass water on any occasion, which is conspicuously inappropriate, because their attention has been concentrated on the sensations in the bladder. often enough when at great inconvenience opportunity has been found, the desire has passed away, and all the trouble has proved needless. it is not too much to say that every occupation and every action of the day can be made delightful or hateful to the child, according to the suggestion with which it is presented and introduced. dressing and undressing, eating and drinking, bathing, washing, the putting away of toys, even going to bed, can be made matters of enthralling interest or delight, or a subject for tears and opposition, according to the bias which is given to the child's mind by the words, attitude, and actions of nurses and mothers. here we approach very near to the heart of the subject. stripped of all that is not essential we see the problem of the management of children reduced to the interplay between the adult mind and the mind of the receptive suggestible child. that which is thought of and feared for the child, that he rapidly becomes. placid, comfortable people who do not worry about their children find their children sensible and easy to manage. parents who take a pride in the daring and naughty pranks of their children unconsciously convey the suggestion to their minds that such conduct is characteristic of them. nervous and apprehensive parents who are distressed when the child refuses to eat or to sleep, and who worry all day long over possible sources of danger to him, are forced to watch their child acquire a reputation for nervousness, which, as always, is passively accepted and consistently acted up to. differences in type, determined by hereditary factors, no doubt, exist and are often strongly marked. yet it is not untrue to say that variations in children, dependent upon heredity, show chiefly in the relative susceptibility or insusceptibility of the child to the influences of environment and management. it is no easy task to distinguish between the nervous child and the child of the nervous mother, between the child who inherits an unusually sensitive nervous system and the child who is nervous only because he breathes constantly an atmosphere charged with doubt and anxiety. (_c_) the child's love of power let us study briefly a third quality of the child which, for want of a better name, i have called after the ruling passion of mankind, his love of power. perhaps it would be better to call it his love of being in the centre of the picture. it is his constant desire to make his environment revolve around him and to attract all attention to himself. somewhat later in life this desire to attract attention, at all costs, is well seen in the type of girl popularly regarded as hysterical. the impulse is then a morbid and debased impulse; in the child it is natural and, within limits, praiseworthy. a girl of this sort, who feels that she is not likely to attract attention because of any special gifts of beauty or intellect which she may possess, becomes conscious that she can always arouse interest by the severity of her bodily sufferings. the suggestion acts upon her unstable mind, and forthwith she becomes paralysed, or a cripple, or dumb, presenting a mimicry or travesty of some bodily ailment with which she is more or less familiar. "hysterical" girls will even apply caustic to the skin in order to produce some strange eruption which, while it sorely puzzles us doctors, will excite widespread interest and commiseration. now little children will seldom carry their desire to attract attention so far as to work upon the feelings of their parents by simulating disease. they have not the necessary knowledge to play the part, and even if they make the attempt, complaining of this or that symptom which they notice has aroused the interest of their elders, the simulation is not likely to be so successful as to deceive even a superficial observer. but within the limits of their own powers, children are past masters in attracting attention. the little child is unable to take part in any sustained conversation; most of his talking, indeed, is done when he is alone, and is addressed to no one in particular. but he knows well that by a given action he can produce a given reaction in his mother and nurse. a great part of what is said to him--too great a part by far--comes under the category of reproof or repression. he is forbidden to do this or that, coaxed, cajoled, threatened long before he is old enough to understand the meaning of the words spoken, although he knows the tone in which they are uttered and loves to produce it at will. how he enjoys it all! watch him draw near the fire, the one place that is forbidden him. he does not mean to do himself harm. he knows that it is hot and would hurt him, but for the time being he is out of the picture and he is intent on producing the expected response, the reproof tone from his mother which he knows so well. he approaches it warily, often anticipating his mother's part and vigorously scolding himself. he desires nothing more than that his mother should repeat the reproof, forbidding him a dozen times. the mind of all little children tends easily to work in a groove. it delights in repetition and it evoking not the unexpected but the expected. if his sport is stopped by his mother losing patience and removing him bodily from the danger zone, his sense of impotence finds vent in passionate crying. but if his mother takes no notice, the sport soon loses its savour. he is conscious that somehow or other it has fallen flat, and he flits off to other employment. mothers will complain that children seem to take a perverse pleasure in evoking reproof, appeals, entreaties, and exhortations. a small boy of four who had several times repeated the particular sin to which his attention had been directed by the frequency of his mother's warnings and entreaties, finding that on this occasion she had decided to take no notice, approached her with a troubled face: "are you not angry?" he said; "are you not disappointed?" in reality the naughty child is often only the child who has become master of his mother's or his nurse's responses, and can produce at will the effect he desires. the idea that the child possesses a strong will, which can and must be broken by persistent opposition, is based upon this tendency of the child. it is an entire misconception of the situation: strength of will and fixity of purpose are among the last powers which the human mind develops. in little children they are conspicuously absent. what appears to us as a fixed and persistent desire to perform a definite action in spite of all we can say or do, is often no more than the desire to produce the familiar tones of reproof, to traverse again the familiar ground, to attract attention and to find himself again the centre of the picture. if no one pays any attention and no one reproves, he soon gives up the attempt. if too much is made of any one action of the child, a strong impression is made on his mind and he cannot choose but return to it again and again. this little drama of the fireplace may teach us a great deal in the management of children. the wise mother and nurse will find a hundred devices to catch the child's attention and lure him away from the danger zone without the incident making any impression on his mind at all, and will not call attention to it by repeated reproofs or warnings which will certainly lead him straight back to the spot. in matters of greater moment the same impulse to oppose the will of those around him is seen. in considering the point of the child's susceptibility to suggestion, we have mentioned the refusal of sleep and the refusal of food. in both it is possible to detect the influence of this pronounced force of opposition. as the child lies sobbing or screaming in bed, every new approach to him, every fresh attempt at pacification, renews the force of his opposition in a crescendo of sound. but it is in his refusal of food that the child is apt to find his chief opportunity. meal-times degenerate into a struggle. there at least he can show his complete mastery of the situation. no one can swallow his food for him, and he knows it. he can clench his teeth and shake his head and obstinately refuse every morsel offered. he can hold food in his mouth for half an hour at a time and remain deaf to all the appeals of his helpless nurse. if she tries force, he quells the attempt by a storm of crying. if she declines upon entreaty and coaxing, he will not be persuaded. it is the little scene of the fireplace over again. the attempts at force or the attempts at persuasion, by making much of it, have concentrated the attention of the child upon the difficulty, and have taught him his own power to dominate the situation. it is right that parents should realise that the disturbing and irritating element in the child's environment is nearly always provided by the intrusion of the adult mind and its contact with the child's. some supervision and some intrusion, therefore, is of course absolutely necessary, but the best-regulated nursery is that in which it is least evident. something is definitely wrong if a child of two years will not play for half an hour at a time happily and busily in a room by himself. it is an even better test if the child will play amicably by himself with nurse or mother in the room, without the two parties crossing swords on a single occasion, without reproof or repression on the one side or undue attempts to attract attention on the other. if the child is entirely dependent upon the participation of grown-up persons in his pursuits, then not only do those pursuits lose much of their educative force, but they become a positive source of danger because of the constant interplay of personality with personality. the child who, seated on the ground, will play with his toys by himself, rises with a brain that is stimulated but not exhausted. only very rarely do we find that solitary play, or play between children, is too exciting. in older children of very quick intelligence and nervous temperament we occasionally find that the pace which they themselves set is too exciting or exhausting. i recall a little boy of seven, an only child of particularly wise and thoughtful parents, who was brought to me with the complaint that he exhausted himself utterly both in body and mind by the intense nervous energy which he threw into his pursuits. for instance, he had been interested in the maps illustrating the various fronts in the european war, with which the walls of his father's study were hung, and although left entirely by himself he had become intensely excited and exhausted by the eagerness with which he had spent a whole morning, with a wealth of imaginative force, in drawing a map of the garden of his house and converting it into the likeness of a war map, filled with imaginary army corps. such excessive expenditure of nervous force is unusual even in older children, and as in this case is found usually only when there is a pronounced nervous inheritance. in little children in the nursery, solitary play or play between themselves seldom produces nervous exhaustion. it is quite otherwise when the child is dependent to a too great extent upon the participation of adults. it is almost impossible for the mother and nurse not to take the leading part in the exchange of ideas, and no matter what may be their good intentions, the pace set is apt to be too great. environment, without the intrusion of the adult mind, is best able to adjust the necessary stimulus and produce development without exhaustion. play with grown-up persons, the reading aloud of story books, the showing of pictures, and so forth, undoubtedly have their own importance, but they should be confined within strict limits and to a definite hour in the daily routine. there is sometimes too great a tendency for parents to make playthings of their little children. save at stated times, they must curb their desire to join in their games, to gather them in their arms, to hold them on their knee, while they stimulate their minds by a constant succession of new impressions. with an only child, whose existence is the single preoccupation of the nurse and mother, and, often enough, of the father as well, it is difficult to avoid this fault. yet, if wisdom is not learnt, the damage to the child may be distressingly serious. he rapidly grows incapable of supporting life without this excessive stimulation. without the constant society and attention of a grown person, he feels himself lost. he cannot be left alone, and yet cannot enjoy the society he craves. he grows more and more restless, dominating the whole situation more and more, constantly plucking at his nurse's skirts, perversely refusing every new sensation that is offered him to still his restlessness for a moment. the result of all this stimulation is mental irritability and exhaustion, which in turn is often the direct cause of refusal of food, dyspepsia, wakefulness, and excessive crying. the devices by which children will attract to themselves the attention of their elders, and which, if successful, are repeated with an almost insane persistence, take on the most varied forms. sometimes the child persistently makes use of an expression, or asks questions, which produce a pleasant stir of shocked surprise and renewed reproofs and expostulations. one little boy shouted the word "stomachs" with unwearied persistence for many weeks together. a little girl dismayed her parents and continued in spite of all they could do to prevent her to ask every one if they were about to pass water. disorders of conduct of this sort are not really difficult to control. suitable punishment will succeed, provided also that the child is deprived of the sense of satisfaction which he has in the interest which his conduct excites. his behaviour is only of importance because it indicates certain faults in his environment and a certain element of nervous unrest and overstrain. the young child demands from his environment that it should give him two things--security and liberty. he must have security from shocks to his nervous system. it is true that from the greater shocks the children of the well-to-do are as a rule carefully guarded. no one threatens or ill-uses them. they are not terrified by drunken brawls or scenes of passion. they are not made fearful by the superstitions of ignorant people. nevertheless, by the summation of stimuli little emotions constantly repeated can have effects no less grave upon their nervous system. from this constantly acting irritation the child needs security. in the second place, he requires liberty to develop his own initiative, which should be stimulated and sustained and directed. without liberty and without security conduct cannot fail to become abnormal. (_d_) the reasoning power of the child before we proceed to a closer examination of the various symptoms of nervous unrest in detail, we may very briefly consider the scope and power of the child's understanding. as a rule i am sure that it is grossly underestimated. the mental processes of the child are far ahead of his power of speech. the capacity for understanding speech is well advanced, and an appeal to reason is often successful while the child is still powerless to express his own thoughts in words. because he cannot so express himself there is a tendency to underestimate the acuteness of his reasoning, to talk down to him, and to imagine that he can be imposed upon by any fiction which seems likely to suit the purpose of the moment. a child of eighteen months is not too young to be talked to in a quiet, straightforward, sensible way. only if he is treated as a reasonable being can we expect his reasoning faculties to develop. children dislike intensely the unexplained intervention of force. if a pair of scissors, left by an oversight lying about, has been grasped, the first impulse of the mother is to snatch the danger hurriedly from the child's hands, and her action will generally be followed by resistance and a storm of weeping. she will do better to approach him quietly, telling him that scissors hurt babies, and show him where to place them out of harm's way. watch a child at play after his midday meal. he has been out in his perambulator half the morning, and for the other half has been deep in his midday sleep. now that dinner is over he is for a moment master of his time and busily engaged in some pursuit dear to his heart. at two o'clock inexorable routine ordains that he must again be placed in the perambulator and wheeled forth on a fresh expedition. if the nurse does not know her business she will swoop down upon him, place him on her knee, and begin to envelop his struggling little body in his outdoor clothes, scolding his naughtiness as he kicks and screams. if she has a way with children she will open the cupboard door and call on him to help find his gaiters and his shoes because it is time for his walk. in a moment he will leave his toys, forgetting all about them in the joy of this new activity. if the reason for things is explained to children they grow quick to understand quite complicated explanations. a little girl, not yet two, was playing with her noah's ark on the dining-room table with its polished surface. the mother interposed a cloth, explaining that the animals would scratch the table if the cloth were not there. within a few minutes the child twice lifted the cloth, peering under it and saying, "not scratch table." yet how often do we find facetiously-minded persons confound their reasoning and confuse their judgment by foolish speeches and cock-and-bull tales, which, just because of their foolishness, seem to them well adapted to the infant intelligence. an attempt to deceive the child is almost always wrong, and because of our tendency to underestimate the child's intelligence it generally fails. if a little girl has a sore throat, and the doctor comes to see her, she knows quite well that she is the prospective patient. it is useless for the mother to begin proceedings by trying to convince her that this is not so--that mother has a sore throat too. such a plan only arouses apprehension, because the child scents danger in the artifice. closely connected with the reasoning powers of the child is the difficult question of the growth of his appreciation of right and wrong, or, to put it in another way, the growth of obedience or disobedience. sooner or later the child must learn to obey; on that there can be no two opinions. nevertheless, i think there can be no doubt that far more harm is done by an over-emphasis of authority than by its neglect. if the nurse or mother is of strong character, and the authority is exercised persistently and remorselessly, so that the whole life of the child is dominated, much as the recruit's existence in the barrack yard is dominated by the drill sergeant, his independence of nature is crushed. he is certain to become a colourless and uninteresting child; he runs a grave risk of growing sly, broken-spirited, and a currier of favour. if a child is ruthlessly punished for disobedience from his earliest years, there is, it need hardly be said, a grave risk that he will learn to lie to save his skin. i have seen a few such cases of what i may call the remorseless exercise of authority, and the result has not been pleasing. fortunately, perhaps, not many women have the heart to adopt this attitude to the waywardness of little children--a waywardness to which their whole nature compels them by their pressing need to cultivate tactile sensations, to experiment, and to explore. therefore, much more commonly, the authority is exercised intermittently and capriciously, with the result that the child's judgment is clouded and confused. conduct which is received indulgently or even encouraged at one moment is sternly reprimanded at another. every one who has the management of little children must above all see to it, whatever the degree of stringency in discipline which they decide to adopt, that their attitude is always consistent. the less that is forbidden the better, but when the line is drawn it must be adhered to. if once the child learns that the force which restrains him can be made to yield to his own efforts, the future is black indeed. from that day he sets himself to strike down authority with a success which encourages him to further efforts. i have known a child of five years terrorise his mother and get his own way by the threat, "i will go into one of my furies." the difficulty of successfully enforcing authority, and of carrying off the victory if that authority is disputed, should make mothers wary of drawing too tight a rein. the conflict between parent and child must always be distressing and must always be prejudicial to the child, whatever its outcome, whether it brings to him victory or defeat. he learns from it either an undue sense of power or an undue sense of helplessness, and the knowledge of neither is to his benefit. although frequently worsted in the conflict, nurses will often return to the attack again and again and hour after hour, restraining, reproving, forbidding, and even threatening. nor do they see that they are really goading the children into disobedience by their misdirected efforts at enforcing discipline. reproof, like punishment, loses all its effect when it is too often repeated, and the child soon takes it for granted that all he does is wrong, and that grown-up people exist only to thwart his will, to misunderstand, to reprove, or even to punish. in the nursery the word "naughty" is far too frequently heard. it is naughty to do this, it is naughty to do that. there is no gradation in the condemnation, and the child loses all sense of the meaning of the word. he himself proclaims himself naughty almost with satisfaction: his doll is naughty, the dog is naughty, his nurse and mother are naughty, and so forth. in reality the little child is peculiarly sensitive to blame, if he is not reproof-hardened. it is hardly necessary to use words of blame at all. if he is asked kindly and quietly to desist, much as we would address a grown-up person, and does not, he can be made to feel that his conduct is unpopular by keeping aloof from him a little, by disregarding him for the time being, and by indicating to him that he is a troublesome little person with whom we cannot be bothered. any one who has had much to do with children will realise that, if wrongly handled, they are apt to take a positive delight in doing what they conceive to be wrong. there is clearly a delightful element of excitement in the process of being naughty, of daring and of braving the wrath to come, with which they are so familiar and for which they care nothing at all. but the perverseness of which we are now speaking has a different origin. it arises only when children are reproved, appealed to, and expostulated with too often and too constantly. negativism is a symptom which is common enough in certain mental disorders. the unhappy patient always does the opposite of what is desired or expected of him. if he be asked to stand up he will endeavour to remain seated, or if asked to sit he will attempt to rise to his feet. like many other symptoms of nervous disturbance which we shall study later, this negativistic spirit is often displayed to perfection by little children when the environment is at fault and when grown-up people have too freely exercised authority. a mother, anxious to induce her little son to come to the doctor, and knowing well that her call to him to enter the room, as he stands hesitating at the door, will at once determine his retreat to the nursery, has been heard to say, "run away, darling, we don't want _you_ here," with the expected result that the docile child immediately comes forward. to the doctor, that such a device should be practised almost as a matter of course and that its success should be so confidently anticipated, should give food for thought. it may shed light on much that is to follow later in the interview. the question of punishment, like that of reproof, is beset with difficulty. there are fortunately nowadays few educated mothers who are so foolish as to threaten punishment which they obviously do not intend to administer and which the child knows they will not administer. it is clear that punishment must be rare or else the child will grow habituated to it, and with little children we cannot be brutal or push punishment to the point of extreme physical pain. it is more difficult to say, as one is tempted to say, that all punishment is futile and should be discarded. probably mothers are like schoolmasters in that no two schoolmasters and no two mothers obtain their effects in exactly the same way or by precisely the same means. nor do all children accept reproof or submit to punishment in the same way. some make light of it and take a pleasure in defying authority. others are unduly cast down by the slightest adverse criticism. it is generally true that extreme sensitiveness to reproof is a sign of a certain elevation of character. always we must remember that for a mother to inflict punishment, whether by causing physical pain or mental suffering, is to take on her shoulders a certain responsibility. it is a serious matter if she has misapprehended the child's act--if the sin was not really a sin, but only some perverted action, the intention of which was not sinful, but designed for good in the faulty reasoning of the child. a little girl, in bed with a feverish cold, was found shivering, with her night-dress wet and muddy. it was an understanding mother who found that her little brother, having heard somehow that ice was good for fevered heads, had brought in several handfuls of snow from the garden, not of the cleanest, and had offered them to aid his sister's recovery. it need hardly be said that punishment should always be deliberate. the hasty slap is nothing else than the motor discharge provoked by the irritability of the educator, and the child, who is a good observer on such points, discerns the truth and measures the frailty of his judge. the frequent repetition of words of reproof and acts of punishment has a further disadvantage that the older children are quick to practise both upon their younger brothers and sisters. there is something wrong in the nursery where the lives of the little ones are made a burden to them by the constant repression of the older children. but although set and artificial punishments are as a general rule to be used but sparingly, the mother can see to it that the child learns by experience that a foolish or careless act brings its own punishment. if, for example, a child breaks his toy, or destroys its mechanism, she need not be so quick in mending it that he does not learn the obvious lesson. if the baby throws his doll from the perambulator, in sheer joy at the experience of imparting motion to it, she need not prevent him from learning the lesson that this involves also some temporary separation from it. throughout all his life he is to learn that he cannot eat his cake and have it too. the use of rewards is also beset with difficulties. their coming must be unexpected and occasional. they must never degenerate into bribes, to be bargained for upon condition of good behaviour. rewards which take the form of special privileges are best. the æsthetic sense of children develops very early. from the very beginning of the second year they take delight in new clothes, and in personal adornment of all sorts. they show evident pleasure if the nursery acquires a new picture or a new wall-paper. they have pronounced favourites in colours. even tiny children show dislike of dirt and all unpleasant things. personal cleanliness should be clearly desired by all children. a sense of what is pleasant and what is unpleasant should be encouraged. any delay in its appearance is apt to imply a backwardness in development of mind or of body. only children who are tired out by physical illness or by nervous exhaustion will lie without protest in a dirty condition. affection and the attempt to express affection appear clearly marked even in the first year. too much kissing and too much being kissed is apt to spoil the spontaneity of the child's caresses. we must not, however, expect to find any trace in the young child of such a complex quality as unselfishness or self-abnegation. the child's conception of his own self has but just emerged. it is his single impulse to develop his own experience and his own powers, and his attitude for many years is summed up in the phrase: "me do it." we must not expect him to resign his toys to the little visitor, or the little visitor to cease from his efforts to obtain them. in all our dealings with children we must know what we may legitimately expect from them, and judge them by their own standards, not by those of adult life. we cannot expect self-sacrifice in a child, and, after all, when we come to think of it, obedience is but another name for self-sacrifice. if the tiny child could possibly obey all the behests that are heaped upon him in the course of a day by many a nurse and mother, he would truly be living a life of complete self-abnegation. surely it is because the virtue of obedience, the virtue that is proclaimed proverbially the child's own, is so impossible of attainment that it is become the subject of so much emphasis. as madame montessori has put it: "we ask for obedience and the child in turn asks for the moon." only when we have developed the child's reasoning powers, by treating him as a rational being, can we expect him deliberately to defer his wishes to ours, because he has learned that our requests are generally reasonable. chapter iii want of appetite and indigestion the mind of the child is so unstable and yet so highly developed, that symptoms of nervous disturbance are more frequent and of greater intensity than in later life. only rarely and in exceptional cases do certain symptoms, common in childhood, persist into adult life or appear there for the first time, and then usually in persons who, if they are not actually insane, are at least suffering from intense nervous strain. we have already mentioned the symptom of negativism and noted its occasional occurrence as an accompaniment of mental disorder in adult life, and its frequency among children who are irritable or irritated. similarly, we may cite the digestive neuroses of adult life to explain the common refusal of food and the common nervous vomiting of the second year of life. thus, for example, there exists in adult life a disturbance of the nervous system which is called "anorexia nervosa." a boy of nineteen was brought to the out-patient department of guy's hospital suffering from this complaint. he was little more than a skeleton, unable to stand, hardly able to sit, and weighing only four and a half stones. his mother, who came with him, stated that he had always been nervous, and that lately, after receiving a call to join the army as a recruit, his appetite, which had for some time been capricious, had completely disappeared. in spite of coaxing he resolutely refused all food, or took it only in the tiniest morsels, although at the same time it was thought that he sometimes took food "on the sly." a careful examination showed absolutely no sign of bodily disease. he was admitted to a ward for treatment by hypnotic suggestion, but before this could be begun he endeavoured to commit suicide by setting fire to his bed. a girl of twenty-four years of age had become almost equally emaciated. constant vomiting had persisted for many years and had defied many attempts at cure. it had even been proposed to perform the operation of gastro-enterostomy in the belief that some organic disease existed. in suitable surroundings and with the energetic support of a good nurse, who spent much time and care in restoring her balance of mind, the vomiting ceased, and she gained over two stones in weight. work was found for her in some occupation connected with the war, and she left the nursing home to undertake this, bearing with her four pounds which she had abstracted from the purse of another patient. those who have not opportunities of observing how all-powerful is the effect of the mind upon the body, and especially perhaps upon the process of digestion, may find it hard to believe that these distressing symptoms and profound changes in the aspect and nutrition of the patients were due entirely to mental causes and were symptoms in accord with the attempted suicide or the theft of the money. in nervous little children we shall not often find such complex actions as suicide or theft, although they do occur, but combined with other evidence of nervousness we shall meet commonly enough with a persistent setting aside of appetite and refusal of food and with continuous and habitual vomiting, from nervous causes. the experiments of pawlow and others have explained the dependence of digestion upon mental states. they show that even before the food is taken into the mouth, while the meal is still in prospect, there has been instituted a series of changes in the wall of the stomach, which gives rise to the so-called psychic secretion of gastric juice. these changes are preceded by the sensation of appetite, which is evoked not by the presence of food in the stomach--for the food has not yet been swallowed--but by the anticipation of it, by the sight and smell of food, as well as by more complex suggestions, such as the time of day, the habitual hour, the approach of home, and so forth. emotional states of all sorts--grief, anger, anxiety, or excitement--put a stop to the process or interfere with its action, so that the sense of appetite is absent, and the taking of food is apt to be followed by discomfort or pain or vomiting. no doubt good digestion leads to a placid mind, but it is equally true that a placid mind is necessary for good digestion. therefore we civilised people, living lives of mental stress and strain, try to increase the suggestive force of our surroundings and to provoke appetite by all devices calculated to stimulate the æsthetic sense. the dinner hour is fixed at a time when all work and, let us hope, all worry is at an end for the day. the dinner-table is made as pretty as possible, with flowers and sparkling glass. we are wise to dress for dinner, that with our working clothes we may put off our working thoughts. in the treatment of adult dyspepsia we seldom succeed unless we can place the mind at rest. we may advise a visit to the dentist and a set of false teeth, or we may administer a variety of stomach tonics and sedatives, but if the mind remains filled with nameless fears and anxieties we shall not succeed. in adult life the nervous person when subjected to excessive stress and strain is seldom free from dyspeptic symptoms of one sort or another, and what is true of adult life is even more true of childhood, when the emotions are more poignant and less controlled. then tears flow more readily than in later life, and tears are not the only secretions which lie under the influence of strong emotion. emotional states, which would stamp a grown man as a profound neurotic, are almost the rule in infancy and childhood, and may be marked by the same physical disturbances--flushing, sweating, or pallor, by the discharge of internal glandular secretions as well as by inhibition of appetite, by vomiting, gastric discomfort, or diarrhoea. naturally enough, mothers and nurses are wont to demand a concrete cause for the constant crying of a little child, and teething, constipation, the painful passage of water, pain in the head, or colic and indigestion are suggested in turn, and powders, purges, or circumcision demanded. there can be no doubt that nervous unrest is capable of producing prolonged dyspepsia in infancy and childhood--a dyspepsia which, while it obstinately resists all attempts to overcome it by manipulation of the diet, is very readily amenable to treatment directed to quiet the nervous system. where a primary dyspepsia exists for any length of time, the growth and the nutrition of the child is clearly altered for the worse. the character of the stools, their consistency, smell, and colour, is apt to be changed because the bacterial context of the bowel has become abnormal. rickets, mucous disease, lienteric diarrhoea, infantilism, prolapse of the rectum, and infection with thread-worms are common complications. no doubt children with primary dyspepsia are often nervous and restless, and the elements of infection and of neurosis are frequently combined. yet often we meet with cases in which the gastric or intestinal disturbance comes near to being a pure neurosis. the nutrition, then, seldom suffers to any very great extent, or to a degree in any way comparable to that which is characteristic of dyspepsia from other causes. emaciation, wrinkling of the skin, dryness and falling out of the hair, decay of the teeth, are not as a rule part of the picture of nervous dyspepsia. the child may be slim and thin and nervous looking, but as a rule he is active enough, with a good colour and fair muscular tone, so that one has difficulty in believing the mother's statements, which are yet true enough, as to the trouble which is experienced in forcing him to eat, or as to the frequency of vomiting. in early childhood the difficulty of the refusal of food often passes or diminishes when the child learns to feed himself with precision and certainty. to teach him to do so, it is not wise to devote all our attention to making him adept at this particular task. the fault is that the brain centres which control the movements of hands, mouth, and tongue have not been developed, because his activities in all directions have not been encouraged. it is much less trouble for a nurse to feed a little child than to teach him to feed himself, and if he is not given daily opportunities of practice he will certainly not learn this particular action. but the fault as a rule lies deeper. the child who cannot feed himself cannot be taught until fingers and brain have been developed in the thousand activities of his daily routine, by which he acquires general dexterity. a child who is still too young to feed himself is learning the dexterity which is necessary as a preliminary in every action of the day. if he can carry the tablecloth and the cups and saucers to the tea-table, imitating in everything the action of his nurse, it will be strange if he does not also imitate her in the central scene, the actual eating of the food. if, on the other hand, he is waited upon hand and foot, if he is restrained and confined, sitting too much passively, now in his perambulator, now in his high chair, now on his nurse's lap, his imitative faculties and his tactile dexterity alike remain undeveloped. the child who is slow in learning to feed himself shows his backward development in every movement of his body. one may note especially the stiff, "expressionless" hands, indicating a general neuro-muscular defect. i have seen many children of eighteen months or two years of age in whom the movements necessary for efficient mastication and swallowing had failed to develop satisfactorily. in some a pure sucking movement persisted, so that when, for example, a morsel of bread or rusk was put in the child's mouth, it would be held there for many minutes and submitted only to suction with cheeks and tongue. attempts to swallow in such a case are so incoordinate that they give rise frequently to violent fits of choking, which distress the child and produce resistance and struggling, while at the same time they alarm the mother or nurse so much that further attempts to encourage the taking of solid food are hastily and for a long time abandoned. in this helpless condition the other factors which tend to develop what we have called negativism have full play. the want of imitation and the lack of dexterity is not the sole or perhaps the main cause of the child's refusal of food and of the apparent want of appetite, but it is the cause of the failure to learn to feed himself, which places him in a condition which is peculiarly favourable to the operation of other factors. if only we can teach the child to feed himself, the difficulties of the situation become much less formidable. the first of the factors which encourage the persistent refusal of food is the extreme susceptibility of the child to suggestion. a particular article of diet may be refused on one occasion, perhaps in pique, because another more favoured dish was hoped for or expected, or perhaps because the taste is not yet familiar. then if on this occasion a struggle for the mastery is waged, and a painful impression is made on the child's mind connecting this particular dish with struggling and tears, from that day forward the child may persistently refuse it on every occasion it is offered. matters are made worse if the nurse, anticipating refusal, attempts to overcome the resistance by peremptory orders, or by excessive praise extolling the delicious flavour with such fervour that the child's suspicions are at once aroused. previous experience has made him connect these excessive praises with articles which have aroused his distaste. if these fads and fancies on the part of the child are to be avoided, it is essential that we should do nothing to focus his attention on his refusal. it is better that his dinner should be curtailed on one occasion than that taste and appetite should be perverted perhaps for years. every nurse or mother should cultivate an off-hand, detached manner of feeding the child, and should patiently continue to offer the food without uncalled-for comments or exhortations. let her always remember the force of suggestion on the child's mind, and that a confident manner which never questions the child's acceptance will meet with acceptance, while a hesitating address, from fear of the impending refusal, will be apt to meet with refusal. sometimes a still worse fault manifests itself, when nurse and mother speak before the child of the smallness of his appetite, and of his persistent refusal of this or that article of diet. the suggestion then acts still more powerfully on his mind. he is aware that the whole household is distressed by his peculiarity, and he grows to identify it with his own individuality, and to regard himself with some satisfaction as possessing this mark of distinction. if there is any difficulty of this sort it is often directly curative to reverse the suggestion and to speak before him of his improving appetite, and to say that he begins every day to eat better and better, even if to do so we have to break a good rule never to say to the child what is not strictly true. or once or twice we may take his plate away before he has finished, saying positively that he has eaten so much that he must eat no more. if in spite of every care antipathies to certain articles of food appear and persist, we must be content to bide our time. when the child grows of an age to reason, we should seize every opportunity to make him feel that his persistent refusal is a little ridiculous and childish. little by little the seed is sown, and will germinate till one day we shall note with surprise that he has taken of his own accord that which he has neglected for so long and with such obstinacy. but the force which is acting most strongly in producing this refusal of food is the force of which we have spoken in a previous chapter--the force which results in negativism, the force which is in reality the habit of opposition, the love of power, and the desire to attract attention. here again the refusal of food, if due to this cause, is never the sole manifestation of the fault. just as the delay in learning to swallow and to chew properly and to feed himself is part of a general want of dexterity and capacity manifested in all his actions, so it will seldom happen that the child's anxiety to oppose is only seen at meal-times. watch a nervous child in the nursery before the dinner hour. he is cross and restless and inclined to cry. the nurse hands him a doll, and he throws it away saying, "no, no doll." at the same moment he may catch sight of his ball, and it too is violently rejected, "no, no ball." everything in turn is treated in the same way. finally he falls upon his nurse, crying and beating her with his hands, saying, "no, no nurse." if that long-suffering woman at that moment summons him to dinner, it will be strange indeed if his attitude is not "no, no dinner," and "no, no" to every mouthful offered him. how strong this love of opposition may be is illustrated by the case of a little boy who was brought to me for refusal of food. three weeks before, he had been taken in a motor-car to his grandfather's to midday dinner on sunday, when his absolute refusal of food had spoiled the day and had occupied the attention and the efforts of the whole party. doubtless he had enjoyed himself, for three weeks later, when he caught sight of the car which was to bring him to me, and which he had not seen in the interval, he at once said, "not eat my dinner." this child's father told me that the sight or sound of the preparation of a meal was enough to bring on a paroxysm of opposition. now this force of opposition, as we have seen, only develops into a serious difficulty when the child's own will has been opposed too much, when authority has been too freely exercised, and when the child has been urged and entreated and reproved with too great frequency. his opposition grows with all counter-opposition. and he is not really naughty, only irritable and restless from the thwarting of his natural impulses, and unable to express his thoughts and desires. negativism will not often confine itself to meal-times. it will show clearly in all the actions of the child, and to get him to eat well and freely we must so change our management of him that negativism disappears or at least diminishes. there is no other way. no entreaty, no force, no threats of force will ever succeed, but will only make him worse, and, since negativism is due to mental unrest, the struggles and crying will only perpetuate the cause. the one way to banish negativism and overcome the opposition is to cease to oppose, and to practise this aloofness not so much at meal-times, for somehow by patience the child must be got to take his food, but in all our conduct to him. repression and reproof, and thwarting of the child's will, and coaxing and entreaty must cease. there is no fear that we shall thereby make the child unduly disobedient. we have already, in another chapter, decided that negativism is not strength of will on the part of the child which must be broken, but is the result of constant attempts to oppose his nature, and the consequent nervous unrest. if we cease to oppose, the symptoms will tend rapidly to disappear, the child will become busy and contented and happy in his play, and we shall hear no more of his refusal of food. if sometimes it recurs for a week or two, we shall know how to deal with it. in children, as with us, periods of nervous unrest and unhappiness are apt to recur in a sort of cycle. this cyclical character of mental disturbance is often a marked feature. we see it in epilepsy and in what the french have called folie circulaire. we see it in the dipsomaniac, in the intermittency of his craving for drink and of his periodical outbursts, and we see it in ourselves in those periods of depression which recur so often, we know not why. little children too sometimes get out on the wrong side of their beds, and never get right the whole long day. their own experience of the vagaries of mental states should lead mothers to be indulgent to the children in their days of cloud and to be particularly careful not to goad them by well-intentioned efforts into bursts of naughtiness and passion, each one of which tends to perpetuate the condition and increase the nervous unrest. we know how closely dependent is the sensation of appetite upon emotional states, and we must do all in our power--and the task is sometimes one of real difficulty--to keep the child's mind sufficiently at rest to preserve the healthy desire for food unimpaired. if there is no sign of appetite, but every sign of restlessness and irritability, we must seek in the management of the child until we find the fault. if food is taken mechanically and without appetite, if the preliminary changes in the stomach wall which are necessary for adequate digestion do not take place, but are inhibited by the mental unrest, the meal is apt to be followed by gastric pain and discomfort, or, more commonly with children, the stomach may promptly reject its contents. at the worst, nervous vomiting of this sort may follow almost every meal, although, again, it is curious to note how little, comparatively speaking, the nutrition of the child suffers. the vomiting too, as in adults, comes very near being a voluntary act, and mothers and nurses will often remark that they get the impression that it can be controlled at will. if once the diagnosis is made that the want of appetite or the vomiting is of nervous origin, the treatment of the condition is clear. sedative drugs directed towards quieting the nervous excitability may be of service, but tonics, appetisers, laxatives, and drugs with a direct action on the stomach will have but little effect. nor is there as a rule anything to be gained by modifying the diet or by excluding this or that article of food. the frequency of the vomiting is such that it is apt to have brought discredit one after the other upon almost every article of food which the child can take, with the result that many useful and necessary foods have been abandoned for long on the ground that they are the cause of the dyspepsia. a permanent cure will only be effected when the faults of environment have been overcome, when the cause of the nervous unrest has been removed, and when the child's mind is at peace. nervous vomiting of this kind is not difficult to control, if those in charge of the children can be made to understand that the cause lies in the anxiety which they themselves show before the child, increasing his own apprehension or adding to his sense of power or importance. once the child is convinced that his conduct excites no particular interest, the vomiting soon ceases. in more than one instance, vomiting which has persisted for many months has stopped at once after the matter has been fully explained to the parents. in the most inveterate case of this sort which has come under my notice, the child was regularly sick as soon as he caught sight of a white cloth being laid on the table for meals. yet even this child never vomited when he was under the charge of a particular nurse who had to return more than once to the family, and on each occasion was successful in breaking the habit. chapter iv want of sleep so far, almost all that has been written--and there has been a great deal of unavoidable repetition--has been devoted to an attempt to determine the causes which lead the child to refuse food and the methods which we adopt to prevent or overcome the difficulty. other neuroses may be studied in less detail, because they depend for their existence upon the same causes. for example, the habit of refusing sleep, which is as common and almost as distressing as the habit of refusing food, depends both upon a perversion of suggestion and upon the phenomenon that we have called negativism. if struggling and crying has occurred upon a series of nights, the child comes to associate his bed not with sleep but with tears. if a mother values her peace of mind, if she would spare herself the discomfort of hearing her child sob himself nightly into uneasy sleep, she must be wary how this all-important event of going to bed is approached. with a nervous and restless child the preliminaries of preparing for bed must be managed carefully and tactfully. the hour before bedtime is almost universally the most interesting of the whole day for the child. then the baby, with his best frock on, and books and toys, is the centre of interest in the drawing-room, till the clock strikes and the nurse appears at the door. suddenly it is all over, and inexorable routine sends him off to bed. the good nurse will give the child a little time to recover from the shock of her arrival, and will not hurry him. she knows that his little mind is slow to act, and that he must be led gradually to face a new prospect. if she hurries him, catching him up in her arms from the midst of his unfinished pursuits, resistance and tears are almost sure to follow, and the difficult task of the day--the putting to bed--has made the worst possible start. when this has happened on one or two successive evenings, the habit of resistance to going to bed becomes fixed, and, like all bad habits, is difficult to break. a nurse who has a way with children will arouse his interest in a new pursuit, in which he can play the chief part, the putting away of his picture books and toys. if he is too small to carry his own chair or table to its allotted place in the room, at least he can show his learning by pointing out the spot. in the waving of good-byes he is expert and takes a legitimate pride, and upstairs he has learnt that there are new delights. he himself can turn on the taps in the bathroom, and he can set every article in the proper place ready for use. all children love their bath, and if interest and good temper has been so far preserved, without a break, it will be ill-fortune if even the drying process is not carried off without a hitch. afterwards, for a little, nervous babies, whose brains still teem with all the excitements of the day, are best left to sit for a few moments by the nursery fire, while the nurse puts all the garments one by one to bed. each as it goes to rest will be greeted by him with cheerful farewells; and so does the force of suggestion act, till the central figure himself plays his part in the scene, of which he feels himself the controller and director, and climbs to bed. but if there has been a hitch anywhere, if the bugbear of negativism has appeared, if he has been scolded or coaxed or repressed too much and there have been tears and struggles, then going to bed is a poor preparation for instant and quiet sleep. with excitable, highly-strung children, the best laid plans and the most tactful nurse will not always succeed, and to place him in his cot is to provoke a storm of angry refusal and resistance. there are mothers who believe that the best way is then to turn out the light and leave the child to cry himself to sleep. this is a point on which no one can lay down rules which are applicable for all children. it may sometimes succeed, and the child may reason correctly and in the way we wish him to reason, deciding that the game is not worth the candle and so give it up. but with nervous, highly-strung children i doubt if this spartan conduct is commonly successful. often if the attempt is made, the troubled mother, listening to all these heart-breaking sobs, can bear it no longer, and goes back to the side of the cot to soothe and persuade him. then certainly the longer she has restrained her natural inclination, the longer the child has sobbed himself into a pitiful little ball of perspiration and tears, the more difficult will be her task in quieting him, the stronger will be the impression formed on the child's mind, and the greater will be the suggestion which will act under the same circumstances to-morrow. children who fall a prey to this uncontrolled crying, cry on because they cannot stop when they have begun. they do not then cry purposely or with a fixed intention, desiring to attain some object. they cry because their minds are not at rest, but are irritated and overwrought by the happenings of the day. we decided that it was useless to attempt by exhortations at meal-times to induce a nervous child to eat who habitually refuses food, and that we can only cure the condition by eliminating from his daily life the elements of repression and opposition which provoke the counter-opposition. and we must seek the same solution in this other difficulty of the refusal of sleep. it is useless to attempt to treat the symptom of refusal of sleep and to leave the cause of that symptom still constantly in action. if, in spite of our care to avoid unrest and irritation of the child's brain, sleep is refused, as may often happen, it is, as a rule, wise to cut short the crying if we can, before a vicious circle has been formed and the unrest has been intensified by the emotional storm. it is useless with little children to urge them to go to sleep or to coax. it is not usually wise to leave the child for a little and then to return. each time the child is left, each time the mother or nurse returns, the crying bursts forth again with renewed force and vigour. it is at least one good plan with a little child to turn the light out, and, treating the whole incident in the most matter-of-fact way possible, lightly to stroke his head or pat his back rhythmically without speaking. with older children, if the crying is more purposeful and less emotional, the mother may busy herself for a little with some task in the room, ostentatiously neglecting the storm and making no reference to it. if she speaks to the child at all she should do so in a matter-of-fact way, referring lightly to other matters. if only she can convince him that his conduct is a matter of indifference to her, the victory is won. it is because the child knows so well that his mother does care that he so often has the upper hand. it is not difficult to distinguish between a true emotional storm and the tyrannous cry of a wilful child who demands his own way. light and broken sleep is a common accompaniment of a too excitable and overstimulated brain. the placid child, who eats well, plays quietly, and does not cry more than is usual, as a rule sleeps so soundly that no ordinary sounds, such as conversation carried on in quiet tones in his neighbourhood, have the power to waken him. when he wakes, he does so gradually, perhaps yawning and stretching himself. the nervous child may move at the slightest sound, or with a sudden start or cry is wide awake at once. a hard mattress should be chosen without a bolster, and with only a low pillow. flannel pyjamas, which cannot be thrown off in the restless movements of the child, should be worn. the temperature of the room should be cool, and the air from the open window should circulate freely, while draughts may be kept from striking on the child by a screen. all the sensations of the nervous child are abnormally acute. thus, for example, an itching eruption, or tight clothing, will produce an altogether disproportionate reaction, and may result in a frenzy of opposition. especially such a child is sensitive to a stuffy atmosphere or to an excess of bedclothes. cool rooms and warm but light and porous clothing are essential. an electric torch, which can be flashed on the child for an instant, will assist the mother or nurse to make sure that the child has not thrown off all the bedclothing. sometimes want of sleep is accounted for by a real want of physical exercise. town children especially are apt to suffer from their limited opportunities of running freely in the open. it is often considered enough that the child seated in his perambulator should take the air for three or four hours daily, while much of his time indoors as well is devoted to sitting. it is necessary for his proper development that he should have opportunities of daily exercise in the open. if for any reason this is not always practicable, a large room, as free as possible from furniture, should be chosen, with windows thrown wide open, in which the child may romp until he is tired. it is rare for children of two or of three years of age, whose case we are now considering, to be troubled by bad dreams, nightmares, or night-terrors. if these should occur, obstructed breathing due to adenoid vegetations is sometimes at work as a contributory cause. finally, we should always remember that refusal of sleep is, for the most part, caused and kept up by harmful suggestions derived from mother and nurse, who allow the child to perceive their distress and agitation, who speak before the child of his habitual wakefulness, who unwittingly focus his attention on the difficulty. it is cured in the moment that the suggestion in the child's mind is reversed, in the moment when he comes to regard it as characteristic of himself not to make a fuss about going to bed, but to sleep with extraordinary readiness and soundness. let every one join together to produce this effect. let the suggestion act strongly on his mind that all these troubles of sleeplessness are diminishing, that night after night sees an improvement, and soon his reputation as a good sleeper will be established, and, as always with children, it will be rigidly adhered to. in assisting to break the habit of sleeplessness, and in the process of altering the character of the suggestions which act on the child's mind, we can be of the greatest assistance to the mother by prescribing a suitable hypnotic. as to whether it is right in insomnia in childhood to prescribe depressant drugs is a question on which very various opinions are held. that it is wrong and probably ineffective to trust entirely to the drugs is certainly true, but as a temporary measure, to break the faulty suggestion and the bad habit, their use is both legitimate and successful. the dose required in children relatively to the adult is much smaller. in grown people, some specific distress of mind, whether real or imaginary, may suffice to resist very large doses of hypnotic. in children it is rare to find the same resistance, and comparatively small doses have a very constant effect. with deeper and more refreshing sleep, the conduct of the child during the day almost always changes for the better. a sound sleep, for a few nights in succession, will produce apparently quite a remarkable change in the whole disposition of the child. when good temper and interest take the place of fretfulness and restlessness, we may confidently expect that the symptom of sleeplessness will begin to abate. sleeplessness by night and fretfulness by day form a vicious circle, and attempts must be made to break it at all points. chloral occupies the first place as a hypnotic for young children. in combination with bromide its effects are wonderfully constant and certain. two grains of chloral hydrate and two grains of potassium bromide with ten minims of syrup of orange, given just before bedtime, will bring sound sleep to a child of a year old. at three years the dose may be twice as great, and three times at six years. it is seldom that other means are required. aspirin for children seems relatively without effect. for children who are both sleepless and feverish, a grain of dover's powder, and a grain of antipyrin, for each year of the child's age up to three, is very helpful. lastly, if chloral and bromide cannot break the insomnia, and the condition of the child is becoming distressing, we can almost always succeed if we combine the prescription with an ordinary hot pack for twenty minutes. chapter v some other signs of nervousness habit spasm next to refusal of food and refusal of sleep perhaps the most frequent manifestation of nervous unrest is provided by the group of symptoms which we may call, with a certain latitude of expression, habit spasms. by a habit spasm is meant the constant repetition of an action which was originally designed to produce some one definite result, but which has become involuntary, habitual, and separated from its original meaning. the nervous cough forms a good example of a habit spasm. a cough may lose its purpose and persist only as a bad habit, especially in moments of nervousness, as in talking to strangers, in entering a room, or at the moment of saying "how do you do" or "good-bye." twitching the mouth, swallowing, elongating the upper lip, biting the lips, wrinkling the forehead so strongly that the whole scalp may be put into movement, and blepharospasm are all common tricks of little children which may become habitual and uncontrolled. in worse cases there may be constant jerking movements of the head, nodding movements, or even bowing salaam-like movements. in mild cases we may note hardly more than a restless movement of mouth or forehead, or constant plucking or writhing of the fingers whenever the child's attention is aroused, when he is spoken to, or when he himself speaks. in nervous children these movements, which should properly be confined to moments of real emotional stress, become habitual, and are displayed apart from the excitement of particular emotions. whatever their intensity, habitual and involuntary movements of this nature should not be overlooked, and should be regarded as evidence of mental unrest. they do not commonly appear during the first or second years of the child's life. they are more frequent after the age of five, but they may begin to be marked as early as the third year. with refusal of food and refusal of sleep they form the three common neuroses of early childhood. two of the three qualities which we have mentioned as characteristic of the child's mind are concerned in the causation of habit spasm. in the early stages the movement is sometimes due to imitation, but the susceptibility of the child to suggestion plays the chief part in determining its persistence. it is an interesting speculation how far tricks of gesture, attitude, or gait are inherited and how far they are acquired by imitation. a child by some characteristic gesture may strikingly call to mind a parent who died in his infancy. a whole family may show a peculiarity of gait which is at once recognisable. it is told of the son of a famous man, who shared with his father the distinctive family gait, that when a boy his ears were once boxed by an old gentleman who chanced to observe him hurrying to overtake his parent, and who resented what he took to be an act of impertinent caricature. in the reproduction by the child of the habitual actions of his parents, heredity is largely concerned, but imitation too plays its part. in habit spasm the force of imitation is clearly seen. a child who has developed a habit spasm of one sort or another will readily serve as a model to other children. the malady will sometimes spread through a school almost with the force of a contagious disorder. a child affected in this way may prove an unwelcome guest. the little visitor with a trick of contorting his mouth and grimacing is apt to leave his small host an expert in faithfully reproducing the action. a cough that is genuine enough in one member of the family may produce a crop of counterfeits in brothers and sisters. the force of suggestion acting upon the child's mind can clearly be traced. once his attention is focused upon the particular movement by unwise emphasis on the part of the parents, he loses the power to control its occurrence. this trio of common neuroses--refusal of food, refusal of sleep, and habitual involuntary movement--grows only in an atmosphere of unrest and apprehension. parents and nurses anxiously watch their development. they are distressed beyond measure to note their steady growth in spite of every attempt which they make to control or forbid them. and of all this unrest and unhappiness the child is acutely conscious. the whole household may become obsessed with the misfortune which has befallen it, and the mother, losing all sense of proportion, feels that she cannot regain her peace of mind until it has been overcome. the child is in need of mental and moral support from those around him, and all that he finds is an openly expressed apprehension and sense of impotence. even grown-up people, when their nerves are on edge, are apt to be obsessed by uncontrollable impulses or by vague and nameless apprehensions, and surely all have learnt the support they gain from contact and conversation with some one strong and sane, who treats their worries in such a matter-of-fact way that immediately they lose their power and become of no account. the child with habit spasm cannot control these movements. the more he is reproved or entreated, the less able does he find himself to hold them in check. he does not wish them to continue. he has lost control of what he once controlled, and the realisation of this is not pleasant, and may be alarming to him. yet when unconsciously he looks to his mother for support, he finds in her open dismay that which serves only to increase his uneasiness. she must subdue her own feelings and give the child strength. if she treats the whole thing in a matter-of-fact way, as a temporary disturbance which is of no importance in itself, and only has meaning because it implies that the brain has been over-stimulated, she will no longer exercise a prejudicial effect on the child. if the bad habit is taken as a matter of course, if too much is not made of it, if the child is encouraged to think that nobody cares much about it at all, then recovery will soon take place. it goes without saying that habit spasms and tics of all sorts are made worse by excessive emotional display and by nervous fatigue. on the other hand, if the child becomes absorbed in some interesting occupation, the movements will disappear for the time being. air swallowing, thigh rubbing, thumb sucking at a somewhat earlier age than that in which habit spasms become common, and before bed wetting appears as a formidable difficulty, we meet with another group of habitual actions which yet retain their voluntary character. among such habitual actions are thumb sucking, thigh rubbing, and air swallowing. if the child is old enough to express himself on the subject, he will explain that these actions are performed because of the satisfaction derived from them, because it is "comfy" and "nice." even if the child is too small to speak, the expression is that of beatitude and content. these actions are not confined to nervous children, and their occasional practice need not be taken to imply that there is any strong element of nervous overstrain. it is only when the action is repeated with great frequency and persistence, and when signs of irritation ensue if gratification is not obtained, that we are justified in classing it among the symptoms of mental unrest. the second of these actions, thigh rubbing, is found for the most part in little girls, and inasmuch as it consists of a stimulation of the sexual organs sometimes causes much distress to the parents. it is in reality a habit of small importance unless exercised with very great frequency. it is, of course, not associated in the child's mind with any sexual ideas, and is of precisely the same significance as the other two actions of the same class. children who can speak will refer to it openly without any sense of shame. as a rule the action is performed in a half-dream state, that condition between sleeping and waking which is found when the child is lying in the morning in her cot or in her perambulator after the midday nap. the child's attention should not be focused on the symptom. she should lie on a hard mattress, and when she wakes in the morning she should either leave her cot at once or she should be roused into complete wakefulness by encouraging her to play with her toys. little children should be taught to sleep with their hands folded and placed beside the cheek. if the movement occurs on going to sleep, it is best left alone and completely neglected. as a rule each child has his or her own favourite action of this class, and they are seldom combined in the same child. if thigh rubbing is very constant and obstinate and does not yield to the measures suggested, it may even sometimes be a successful manoeuvre to substitute the thumb-sucking habit in the expectation that this less distressing habit may eject the other more objectionable action. as a rule, however, a wise neglect and careful watching during the drowsy condition that follows sleep in a warm bed will succeed in stopping the practice of thigh rubbing before the end of the second or third year. apparatus designed to restrain movement of the child's legs or blistering the opposed surfaces of the thighs are both of no effect. they have indeed the positive disadvantage that they focus the child's attention on the practice. the habit ceases only when the child has forgotten all about it, and these devices serve only to keep it in remembrance. the same may be said of any system of punishments. further, we cannot always have the child under observation, and at some time or other opportunity will be found for gratification. of older children, in whom self-control and a sense of honour can be cultivated, i am not here speaking. air swallowing is less common than thigh rubbing, but belongs to the same group of actions and takes place in the same drowsy condition. the child will rapidly gulp down air which distends the stomach, and is then regurgitated with a loud sound. thumb sucking seldom distresses the mother to the same extent, and the proper attitude of tolerance is adopted towards it. if much is made of it, it is astonishing how persistent the habit may become, surviving all attempts to forbid it, to break it by rewards or punishments, or to render it distasteful by the application of a variety of ill-tasting substances smeared on the offending digit. pica and dirt eating certain other bad habits will become ingrained if attention is called to them, because of that curious spirit of opposition which characterises little children, and because of their susceptibility to suggestion. some children will constantly pluck out hairs and eat them, or will devour particles of fluff drawn from the blankets. others will seize every opportunity to eat unpleasant things, such as earth, sand, mud, or dirt of any sort. all tricks of this sort are best neglected and treated by attracting the child's attention to other things. in adult life they are associated with serious mental disturbance, in early childhood they are of little account, or at most suggest a certain nervousness which may be due to nervous irritation from faults of management which we must strive to correct. constipation as has been already mentioned, much of the common constipation of the nursery is due to neurosis. the excessive concentration of the nurse's thoughts on this daily question communicates itself to the child. the difficulty is emphasised, and an attempt is made to substitute will power for forces of suggestion which are at once inhibited by concentration of the mind upon the process. here also, just as in the refusal of food, a further stage of "negativism," that is, of active resistance with crying and struggling, is reached, so that complaint may be made by the mother that defæcation is painful. the same negativism may be shown in micturition, and mothers will give distressing accounts of the suffering of the child during the passing of water. breath-holding and laryngismus stridulus in some children, in the first two years of life, we find a definite and measurable increase in the irritability and conductivity of the peripheral nerves. the strength of current necessary to produce by direct stimulation of the nerve a minimal twitch of the corresponding muscle may be many times less than the normal. of this heightened irritability of the nervous system, to which the name "spasmophilia" has been given in america and on the continent, the most striking symptom is a liability alike to tetany or carpo-pedal spasm, to generalised convulsions, and to laryngismus stridulus. in addition, in most cases it is generally possible to demonstrate the presence of chvostek's sign and of trousseau's sign. chvostek's sign consists in a visible twitch of the facial musculature, especially of the orbicularis palpebrarum or of the orbicularis oris, in response to a gentle tap administered over the facial nerve in front of the ear. trousseau's sign is the production of tetany by applying firm and prolonged pressure to the brachial nerve in the upper arm. the ætiology of spasmophilia is still a matter for dispute, but the evidence which we possess is in favour of the view that we have here to deal with a disturbance of calcium metabolism. the calcium content both of the blood and of the central nervous system has been shown to be much lowered. it is in keeping with this that clinically we note how frequently spasmophilia and rickets occur in the same child. in some families the condition recurs through many generations. for our present purpose--the examination of some common neuroses of nursery life--it would be out of place to enter into a detailed consideration of this disorder of spasmophilia as a whole. the symptom of laryngismus stridulus--the so-called breath-holding--alone need concern us, and that for a special reason. the spasm of the glottis is produced under the influence of any strong emotion--in anger, for example, or in fear, in excitement or in crying for any reason. to control or prevent it we must direct attention not only to the condition of spasmophilia, but also to the management of the children who are always excitable and emotional. in these children every burst of crying, however produced, whether by a fall, by a fright, by the entrance of a stranger, or by a visit to a doctor, is apt to be ushered in by a long period of apnoea, due to spasm of the glottis and of the diaphragm. the first few expirations are not followed by any inspiration. for several seconds the silence may be complete, while the child steadily becomes more and more cyanosed, or the body may be shaken by incomplete expiratory movements and strangled cries which are suppressed because the chest is already in a position of almost complete expiration. in the worst cases, when the apnoea lasts a very long time, there may be convulsive twitching of the muscles of the face, or the attack may even terminate in general convulsions. very occasionally the spasm is actually fatal. in all fatal cases which have come to my notice the child at the moment of death had been alone in the room. i have met with no fatal case where the baby could be picked up and assisted. as a rule, therefore, the cause and mode of death must be conjectural, but when an infant is found dead in its cot unexpectedly, it would seem likely that it has waked from sleep with a sudden start, become excited, and, about to cry, has been seized by the fatal spasm. in two instances reported to me a cat had been found in the room with the dead child, and it was suggested that the animal had lain upon the child's face. both these children, however, were vigorous and capable of powerful movements of resistance. i think it more likely that the cat may have awakened them in fright, and that the emotional excitement, giving rise to the spasm, was the cause of the suffocation. that the apnoea in these extremely rare instances should end fatally produces a difficult position for the doctor. it need hardly be said that the seizures are alarming to the parents. for the sake of great accuracy in the statement of our prognosis are we to add a hundred times to the mother's alarm by stating the possibility of death? in each case we must use our own judgment. i believe that in a child over a year old the risk is almost negligible. fortunately in all save the rarest possible instances the apnoea yields and a deep inspiratory movement follows. as the air rushes past the glottis, which is still partially closed, a sound recalling the whoop of pertussis is heard. often this recurs throughout all the burst of crying which follows, and each inspiration is accompanied by a shrill stridulous sound. with the re-establishment of respiration the cyanosis rapidly fades, to be succeeded in some cases by pallor and perspiration. it need hardly be said that we should do all in our power to prevent these alarming and distressing attacks. each seizure predisposes to a repetition. in some children we notice that months and even years after an attack of whooping-cough, a slight bronchial catarrh may be sufficient to bring back the characteristic cough. in laryngismus in the same way we may suppose that the reflex path is made easy and the resistance lowered by constant use. fortunately the spasms are not usually difficult to control. calcium bromide, in doses of from two to four grains, according to age, three times daily, is generally successful with or without the addition of chloral hydrate in small doses. at the same time we must endeavour in every way possible to keep the child calm, by paying close attention to nursery management. the child with spasmophilia is as a rule excitable and easily upset, and although calcium bromide is a drug which offers powerful aid it is not able to achieve its effect unless we are able at the same time to guarantee a reasonable immunity from emotional upsets. it is for this reason that i have included some description of laryngismus, although its origin is undoubtedly very different from that of the other disorders of conduct which we have examined. migraine and cyclic vomiting the ætiology of cyclic or periodic vomiting in childhood is not yet completely understood. we do not know how far it is dependent upon disturbance of the liver, and it is still disputed whether the acidosis which accompanies it is the cause or the result of the profuse vomiting. into these difficult questions we need not at the moment enter. it is enough in the present connection to recognise that the great majority of children who suffer from cyclic vomiting are sensitive, excitable, and nervous, and that every one is agreed that the nervous system is intimately concerned in its causation. a close association between cyclic vomiting in children and that form of periodic headache known as migraine has often been observed. it is sometimes found that one or both parents of a child with cyclic vomiting suffer habitually from migraine. in a few instances the one condition has been observed to be gradually replaced by the other, the child with cyclic vomiting becoming in adult life a sufferer from migraine. there is indeed much which is common to the two conditions. the periodic nature of the seizure, often following a time when the general health and vigour appear to have been at their optimum, the extreme prostration, and the comparatively sudden recovery are found in both. in the cyclic vomiting of children, it is true, little complaint is made of headache, the visual aura is absent, and the vomiting is invariably the most prominent symptom. cyclic vomiting seldom occurs before the fourth year. it is characterised by sudden profuse and persistent vomiting and by very great prostration. all food, it may be even water, is promptly rejected. the vomited matter is generally stained with bile; occasionally the violence of the vomiting causes hæmatemesis. in many cases the temperature is raised; sometimes it may be as high as 103° f. the duration of an attack varies. in most cases it does not last longer than forty-eight hours. on the other hand, attacks lasting as long as a week are by no means unknown. within a short time of the onset the urine may be found to contain acetone bodies, the breath may smell distinctly of acetone, and the child may become torpid and drowsy or agitated and restless. at times there may be exaggerated and deepened respiratory movements--the so-called air hunger. in many cases, however, otherwise characteristic, these more severe manifestations are absent or but little apparent. recovery is usually rapid and complete. the child asks for food, which is retained. a fatal ending is very rare, though not unknown. the frequency of attacks is very various. sometimes months or even years may elapse between successive seizures; in other cases a fortnightly or monthly rhythm establishes itself. it is clear that both the frequency and the severity of the attacks are much influenced by the general state of the child's health. like migraine, cyclic vomiting appears to be a symptom of nervous exhaustion. it affects, for the most part, children who are intellectually alert, impressionable, and forward for their age, and who, when well, throw themselves into work or play with a great expenditure of nervous energy. often their physical development is unsatisfactory, and we must set ourselves to correct this as the first step in prevention. it is highly important that children suffering in this way should have free opportunities for exercise in the open country, and that all the excretory organs--the skin, kidneys, and bowels--should be acting freely and efficiently. the child should live a life of ordered routine. sleep should be sound and sufficient in amount. the diet must not exceed the strict physiological needs. many of these children appear to have a lowered tolerance for fats of all sorts, and it may be necessary to limit strictly the consumption of milk, cream, butter, and so forth. a daily administration of a small dose of alkali by the mouth is credited with preventing attacks. in the present connection, however, we shall not do wrong to emphasise the part played by the nervous system in the production of the attacks. in all cases of cyclic vomiting it should be our endeavour to recognise and remove the elements in the daily life of the child which are proving too exhausting. unexplained pyrexia in nervous children we sometimes meet with inexplicable rises of temperature. the pyrexia may have the same periodic character as that just noted in cases of cyclic vomiting. at intervals of three, four, or five weeks there may be a rise of temperature to 103° f., or even higher, which may last for two or three days before subsiding. in other cases the chart shows a slight persistent rise over many weeks or months. that in nervous children the temperature may be very considerably elevated without our being able to detect much that is amiss does not of course make it any the less necessary to be careful to exclude organic disease. pyelitis, tuberculosis, and latent otitis media occur with nervous children as with others and must not be overlooked. if, however, organic disease can be excluded, and if the pyrexia is the only circumstance which prevents the decision that the child is well and should be treated as well, then the thermometer may be overruled and the pyrexia neglected. chapter vi enuresis i have dealt in previous chapters with certain common disorders of conduct in childhood, which show clearly their origin in the apprehensions of the grown-up people who have charge of the children, and in the unwise suggestions which they convey to them. the same forces are at work in the production of enuresis, or bed wetting, although the matter is here often complicated by the development later on of a sense of shame and unhappiness in the child. there comes a time when the child passionately desires to regain control and is miserable about her failure, until the concentration of her thoughts on the subject becomes a veritable obsession. every night she goes to bed with this only in her mind. every night she falls asleep, miserably aware that she will wake to find the bed wetted. the suggestion impressed in the first place on the mind of the tiny child by injudicious management has become fixed by the growing sense of shame and the complete loss of self-confidence. it is usually taught that a great variety of causes is concerned in producing enuresis. it is said to be due to a partial asphyxia during sleep from adenoid vegetation. it is said to be caused by phimosis, and to be cured by circumcision. it is said that the urine is often too acid and so irritating that the bladder refuses to retain it for the usual length of time. it is said that enuresis may be due to a deficiency of the thyroid secretion, and that it can be cured by thyroid extract. such a number of rival causes may make us hesitate to accept the claims of any one of them. certainly i have not been able to satisfy myself that any one of these conditions exercises any influence at all or is commonly present in cases of enuresis. i think that if we examine a large number of cases of bed wetting in children we can come to no other conclusion than that the cause of the trouble is due to just such a pervasion of suggestion as we have been considering above. there are certain points in the behaviour of a child with enuresis which seem to point to this conclusion. _(a)_ in the first place, the trouble is seldom serious or very well developed in early childhood, and the reason for this, i take it, is that an occasional lapse in a child of perhaps two or three years of age is usually treated lightly and in the proper spirit of tolerance. it is only with children a little older that nurses and parents become distressed and begin unwittingly by urging the child to present the suggestion to her mind, that the bed may or will be wetted. hence the usual history is that control was partially acquired in the second year, but that, instead of later becoming complete, relapses began to be more frequent, and that since that time all that can be done seems only to make matters worse. _(b)_ in the second place, the influence of suggestion is shown by the behaviour of the child when removed to a hospital for observation. it is the invariable experience that the enuresis then promptly stops. in hospital the attitude of those around the child is entirely different. she has the comfortable and consoling feeling that in wetting the bed she is doing exactly what is expected of her. there is even a feeling that otherwise she is showing herself to be something of a fraud, and that she has then been admitted to the hospital on false pretences. hence, perhaps for the first time in many years, the child is free from the obsession, and the bed is not wetted. _(c)_ in the third place, it is easy to recognise in the history of many of the cases, the ill-effects of circumstances which add new force to the fear of failure or shake the confidence in the control which had been regained. thus a boy, an only child, who had suffered from enuresis till his seventh year, had regained complete control till his eleventh year, when he went to school. in his dormitory at school was a boy who had enuresis, and who was being fined and punished by the schoolmaster. the enuresis at once reappeared and continued unchecked so long as he was at school. as might be expected, school life is very inimical to cure, unless the trouble can be kept from the knowledge of the other boys. anything which directly increases the nervousness of the child--an illness, for example, with loss of weight and failure of nutrition, or some mental stress, such as the approach of an examination--is apt to accentuate the enuresis. _(d)_ in the fourth place, the incontinence sometimes spreads to the daytime, and the child is wet both by day and night. further, in bad cases it is not uncommon to find incontinence of fæces making its appearance also. these extensions of the fault only take place when the management continues to be very faulty, when the grown-up people around them are more than usually distressed and pessimistic, and have redoubled their expostulations and appeals. now these peculiarities of enuresis seem to me only explicable if we assume that the want of control is due to auto-suggestion, dependent at the beginning on the unwise attitude adopted towards the fault by the nurses and parents, and later kept up by the sense of shame and the mental distress involved. the forms of treatment which have been recommended from time to time are, as might be expected, very numerous. _(a) operative._--(i) removal of tonsils and adenoids, (ii) circumcision. _(b) manipulative._--(i) injection of saline solution under the skin in the perineal and pubic regions, with object of lowering the excitability of the bladder by counter-irritation. (ii) gradual distension of the bladder by hydrostatic pressure, (iii) tilting the foot of the bed so as to throw the urine to the fundus of the bladder, in order to protect the sensitive trigone from irritation. _(c) educative._--(i) curtailing the fluid drunk. (ii) waking the child at intervals during the night by an alarm clock or otherwise. (iii) rewards and punishments. _(d) medicinal._--(i) belladonna. (ii) thyroid extract. _(e) by suggestion._--(i) by simple suggestion. (ii) by hypnotic suggestion. i do not think that any single one of these various forms of treatment outlined under the first four heads has any effect other than to aid the suggestion of cure which we proffer in adopting it. removal of tonsils and adenoid vegetations might conceivably cure an enuresis which is nocturnal, it cannot account for an incontinence which spreads to the day. we might believe that to distend the bladder by hydrostatic pressure was a cure for incontinence of urine, and that it acted by removing the local cause,--the smallness and contraction of the bladder,--were it not that the loss of control is so apt to spread to the rectum as well. there is no evidence that the urine is peculiarly irritating. indeed, such evidence as we have goes to show that, as in some other neuroses, the urine in enuresis is unduly copious, and of very low specific gravity. incidentally, we have in this polyuria a further argument against the view recently advanced that a small and contracted irritable bladder is the cause of enuresis. we do, of course, meet with cases of irritable bladder often enough, but the complaint is then not of incontinence, but always of the discomfort of having to rise so frequently for micturition. to deprive the child of fluid, to wake her many times at night, to tilt the foot of the bed, are devices which may help in the hands of some one who is confident of his ability to cure the condition and can communicate the confidence to the child. carried out hopelessly and pessimistically by a tired and exasperated mother, they are well calculated to strengthen the hold which the obsession has on the child, so that often we meet with a mother who rightly enough maintains that the more she wakes the child, the oftener the bed is wet, till she wonders where it all comes from. the treatment of enuresis to be successful must be conducted through and by means of the grown-up persons who have the control of the children. to stop the development of enuresis in early infancy we must intervene to prevent the concentration of the child's mind on the difficulty. during the time when control is ordinarily developed, in the second and third year, judicious management of the child is essential. the emphasis should be laid upon successes, not upon failures. for every child his reputation will sway in the balance for a time. he must be helped and encouraged to self-confidence, not rendered diffident or self-conscious. if the case is well established before it comes under our notice, the mother, the nurse, the schoolmaster, or whoever is responsible for the child's management, must understand clearly the nature of the trouble. the suggestion acting on the child's mind must be altered, and self-confidence restored. the child must learn to see that the thing is not so desperately tragic. he should be told that the trouble always gets well, and that it only goes on now because he is worried about it and keeps thinking of it. if the whole environment of the child is bad, so that such a change of suggestion is not possible, and if enuresis is but one of many symptoms of mental or moral instability, it may be necessary to remove the child and place him under the influence of some one else. sometimes the prescription of a rubber urinal, which the child can slip on at night, is directly curative. a public school boy, who was about to be sent away from school for this failing, fortified by the possession of this apparatus, wrote six months later to say that he knew now that it must be all worry that caused the trouble, because with the urinal in position he had not once had the incontinence. in inveterate cases hypnotic suggestion is always, i think, successful. it is obvious, however, that in many cases there are objections to its use. often enuresis is evidence that the child's home environment has been at fault, and that his mental and moral development has been retarded. it is the management which must be modified or the home, if necessary, changed. hypnotic suggestion will make this one symptom disappear promptly enough, but it will rather perpetuate than combat the cause--that undue susceptibility to suggestion, which is characteristic alike of the little child and of many older neuropathic persons. chapter vii toys, books, and amusements any one who has an opportunity of watching little children must have observed that they are happiest and most contented when playing alone. the education of the little child is carried on by means of games and toys. handling the various objects which we give him, imparting movement to them, transferring them from hand to hand and from one situation to another, he learns dexterity and precision of movement, and in the process hand and brain grow in power. when at play, his whole energies should be absorbed to the exclusion of everything else. he will often be oblivious to everything that is going on around him, intent only on the purpose of the moment. in order to permit this fervour of self-education it is necessary that the child should be accustomed to playing alone, and it is well, if only for convenience' sake, that he should be accustomed to playing in a room by himself. something is wrong if the child cannot be left for a few moments without breaking into tears or displaying bad temper. engrossed in his own tasks, he should be content to leave his nurse to move in and out of the room without protest. if this fault has appeared and the child cannot be left alone, our whole educational system is undermined, and play will be profitless and over-exciting, because it demands the constant participation of grown-up people. as a preliminary to all improvement in the management of a nervous child, we must see to it that he becomes accustomed to being alone. we must so arrange his nursery that he can do no damage to himself. scissors and matches must not be left lying about, and a fireguard must be fixed in position so that it cannot be disturbed. then, disregarding his protests, the nurse must leave him to himself, at first only for a moment or two, re-entering the room in a matter-of-fact way without speaking to him, and again leaving it. soon he will learn that a temporary separation does not mean that we have abandoned him for all time. then the period of absence can be gradually lengthened till all difficulty disappears. once his attention is removed from the grown-up people who mean so much to him, his natural impulse to explore and experiment with his playthings will show itself. those toys are best which are neither elaborate nor expensive. for a little child a small box containing a miscellaneous collection of wooden or metal objects, none of them small enough to be in danger of being swallowed, forms the material for which his soul craves. everything else in the room may be out of his reach. a dozen times he will empty the box and then replace each object in turn. he will arrange them in every possible combination, and then sweep the whole away to start afresh. at eighteen months of age observation and imitative capacity will have made more complex pursuits possible. as a rule the objects which are most prized and which have most educative value are those which lend themselves best to the actions with which alone the child is familiar. hence the supreme importance of the doll and the doll's perambulator. the doll will be treated exactly as the child is treated by the nurse. it will be washed, and dressed, and weighed, and put to bed in faithful reproduction of what the child has daily experienced. dusting, and sweeping, and laying the table will be exactly copied. if a child has no opportunity of being familiar with horses, if he has not seen them fed, and watered, and groomed, and harnessed, he may not find any great satisfaction in a toy horse, or pay much attention to it, no matter how costly or realistic it may be. in the third year more precise tasks, such as stringing beads, drawing, and painting, will play their part, while at the same time the increased imaginative powers will give attraction to toy soldiers or a toy tea-service. playing at shop, robbers, and rafts are developments of still later growth. in the child's games we recognise the instinct of imitation--playing with dolls, sweeping and dusting, playing at shop or visitors; the instinct of constructiveness--making mud pies and sand castles, drawing or whittling a stick; and the instinct of experiment--letting objects fall, rattling, hammering, taking to pieces. all this activity must be encouraged, never unduly repressed or destroyed. but whatever form it takes, the bulk of the play must be carried on without the intervention of grown-up persons, or it will lose its educative value and prove too exacting. if grown-up people attempt to take part, the child will lose interest in the play and turn his attention to them. children differ very much in their attitude towards books. one child quite early in the second year will be happy poring over picture books, while another will seldom glance at the contents and finds pleasure only in turning over the pages, opening and shutting them, and carrying them from place to place. such differences are natural enough and foreshadow perhaps the permanent characteristics that divide men and women, and produce in later life men of thought and men of action, women who are marthas and women who are marys. nevertheless, we should bear in mind that there is danger in a training that is too one sided, and that books and toys have both their part to play in developing the powers of the child. all the activities of the child should be used in as varied a way as possible. the eye is but one doorway to knowledge and understanding, the ear is another, the hand a third. from pictures an imaginative child will derive very strong impressions, and mothers should be careful in their choice. it is foolish to confuse the growth of æsthetic perceptions by presenting children with books which depict children as grotesquely ugly beings with goggle eyes and heads like rubber balls. children love animals and endow them with all their own reasoning attributes, and in stories of the home life of rabbits, and bears, and squirrels they take a pure delight. books of the "struwwelpeter" type are less to be recommended. the faults which they are intended to eradicate become peculiarly attractive from much familiarity. a little boy of two and a half who resolutely refused all food for some days was in the end detected to be playing the part of that augustus, once so chubby and fat, who reduced himself to a skeleton, saying, "take the nasty soup away; i don't want any soup to-day." tales of naughty children who meet with a distressing fate may either frighten the child unduly, or else produce in a child of inquiring mind the desire to brave his fate and put the matter to the test. pictures should not be terrifying or horrible. ogres devouring children are out of place as subjects for pictures and may cause night-terrors. children should be taught to be careful of books and toys. the indestructible book, generally falsely so called, is often responsible for the immediate dissolution of all others less protected which come to hand. the sympathy which little children have with the sufferings of all inanimate objects and their habit of endowing them with their own sensations may be made of use in teaching them care and gentleness. they are naturally prone to sympathise with the doll that has been crushed or the book that has been torn. they will learn very easily to be kind to a pet animal and to be solicitous for its feelings, and the lesson so learnt will be applied to inanimate objects as well. there is, however, another side to the question. it is true that if the child is not to be over-stimulated upon the psychical side, we must see to it that his play, for the most part, is not dependent upon the participation of grown-up persons. in practice this excessive stimulation is the common fault with which we meet. there are few children in well-to-do homes, with loving mothers and devoted nurses, who suffer from too little mothering and nursing. too many show signs of too much. to observe the opposite fault we must seek the infants and children who for a long time are inmates of institutions, orphanages, infirmaries, hospitals, and so forth. in such surroundings the mental life of the child may languish. his physical wants are cared for, but there the matter ends. in a rigid routine he is washed and fed, but he may not be talked to or played with or stimulated in any way. his day is spent passively lying in his cot, unnoticed and unnoticing. i have seen a poor child of three years just released from such a life, and after eighteen months returned to his mother, unable to talk and almost unable to walk, crying pitifully at the novelty and strangeness of the noisy life to which he had returned, worried by contact with the other children, and without any desire or power to occupy himself in the home. for an hour in the day mothers may devote themselves wholeheartedly to the children, and if they set them romping till they are tired out, so much the better. in the garden or in an airy room with the windows open, a game with a ball or a toy balloon, or a game of hide-and-seek, will be all to the good, and the children may climb and be rolled over and swung about to their heart's content. with an only child, especially with a child whose home is in town, and whose outings are limited to a sedate airing in the park, such free play is especially necessary. it may help more than anything else to quiet restless minds and tempers that are on edge all day long from excessive repression. on the other hand, those forms of entertainment which are known as "children's parties" are generally fruitful of ill results, at any rate with nervous and highly-strung children. sometimes they entail a postponement of the usual bedtime, and nearly always they involve over-heated and crowded rooms. perverse custom has decreed that these gatherings shall take place most commonly in the winter, when dark and cold add nothing to the pleasure and a great deal to the risk of infection which must always attend the crowding of susceptible children together in a confined space with faulty ventilation. there is clearly on the score of health much less objection to summer garden parties for children, but these for some reason are less the vogue. as a rule parties are not enjoyed by nervous children. there is intense excitement in anticipation, and when at length the moment arrives, there is apt to be disillusion. either the excitement of the child may pass all bounds and end in tears and so-called naughtiness, or the unfamiliar surroundings may leave him distrait with a strange sense of unreality and unhappiness. it is not always fair to blame the want of wisdom in his hostess's choice of eatables, if the excited and overstimulated child fails in the work of digestion and returns to the nursery to suffer the reaction, with pains and much sickness. the same arguments may be urged against taking little children to the theatre. the nerve strain is apt to be out of proportion to the enjoyment gained. if children must go to theatres and parties, the treat should be kept secret from them until the moment of its realisation, in order that the period of mental excitement should be contracted as much as possible, and grown-up people should be advised to treat the whole expedition in a matter-of-fact sort of way that does nothing to add to the excitement or increase the risk of subsequent disillusion. chapter viii nervousness in early infancy we may now pass back to consider the nervous system of the child in infancy. there, too, from the moment of birth there are clearly-marked differences between individuals. the newborn baby has a personality of his own, and mothers will note with astonishment and delight how strongly marked variations in conduct and behaviour may be from the first. one baby is pleased and contented, another is fidgety, restless, and enterprising. at birth the baby wakes from his long sleep to find his environment completely changed. within the uterus he lies in unconsciousness because no ordinary stimulus from the outer world can reach him to exert its effect. he lies immersed in fluid, which, obeying the laws of physics, exercises a pressure which is uniformly distributed over all points of his body. no sound reaches him, and no light. after birth all this is suddenly changed. the sense of new points of pressure breaks in upon his consciousness. cold air strikes upon his skin. loud sounds and bright lights evoke a characteristic response. a placid child who inherits a relatively obtuse nervous organisation will be but little upset by this sudden and radical change in the nature of his environment. his brain is readily but healthily tired by the new sensations which stream in from all sides, and he falls straight away into a sleep from which he rouses himself at intervals only under the impulse of the new sensation of hunger. babies of nervous inheritance, on the other hand, will show clearly by the violence of the response provoked that their nervous system is easily stimulated and exhausted. they will wriggle and squirm for hours together, emitting the same constant reflex cry. the whole body will start convulsively at a sudden touch or a loud sound which would evoke no response from a more stolid infant. the sleeplessness and crying exhaust the baby, rendering the nervous system more and more irritable, while the sensation of hunger which is delayed in other children by twelve hours or more of deep sleep appears early and is of extreme intensity. we must see to it that sense stimuli are reduced to the lowest possible level. true, we cannot again restore the child to a bath of warm fluid, of the same temperature as his body, where he can be free from irksome pressure and from all sensations of sound and light, but we can so arrange matters that he is not disturbed by loud sounds and bright lights, and that he is not moved more than is necessary. sudden unexpected movements are especially harmful. jogging him up and down, patting him on the back, expostulation, and entreaties are all out of place and do all the harm in the world. the first bath should be as expeditious as possible, and above all the baby must not be chilled by tedious exposure. cold irritates his nervous system more than anything else, unless it be excessive warmth. in preserving the proper temperature so that we do not render the child restless by excess of heat or by excess of cold, we too-civilised people have made our own difficulties. we have exaggerated the completeness of the sudden separation of mother and child which nature decrees. it is the function of all mother animals to approximate the unstable temperature of the newly born to their own by the close contact of their bodies, which provide just the proper heat. labour is nowadays so complicated and exhausting a process for mothers that, all things considered, we are wise in completing the separation of mother and child and in removing the baby to his own cot. but the difficulty remains, and we must arrange that any artificial heating needed is constant and of proper degree. if the baby is very restless and irritable, too wide awake and too conscious of his surroundings, the all-important task of getting him to the breast and getting him to draw the milk into the breast is apt to be difficult. his sucking is a purely reflex and involuntary act. it can be produced by anything which gently presses down the tongue, and a finger placed in the proper position will provoke the movement without the child's consciousness being aroused. the placid child whose mind is at rest will suck well and strongly. if, on the other hand, the brain is too much stimulated and the child is restless and irritable, the reflex act of suction is inhibited, and it is a difficult matter to get the child to the breast. he is too eager, mouthing, and gulping, and spluttering. or sometimes his mental sufferings seem too much for his appetite, and though wide awake and crying loudly, he refuses to grasp the nipple, turning his head away and wriggling blindly hither and thither. this effect of mental unrest on the newborn infant is often disastrous, because it is one of the common causes of the failure of women to nurse their children. this is not the place to sketch in detail a scheme for the proper technique of breast nursing, a matter which is much misunderstood at the present day. it will be enough shortly to say that an efficient supply of milk depends upon the complete and regular emptying of the breast. the breasts of all mothers will secrete milk if strong and vigorous suction is applied to the nipple by the child. if anything interferes with suction, the milk does not appear or, if it has appeared, it rapidly declines in amount. the mother's part is to a great extent a passive one, provided that she can supply one essential--a nipple that is large enough for the child to grasp properly. within wide limits what the mother eats or drinks, whether she be robust or whether she has always been something of an invalid, matters not at all. a frail woman may naturally not be able to stand the strain of nursing for many months, but that is not here the point in question. we are dealing only with the establishment of lactation and with the milk supply of the early days and weeks which is of such vital importance for the child. if the mother is ill, if, for example, she has consumption, we may separate her from the child in the interests of both; but if this is not done, she will continue to secrete milk for a time as readily as if she were in perfect health, and the breasts of many a dying woman are to be seen full of milk. mothers are too apt to attribute the disappointment of a complete failure to nurse to some weakness or want of robustness in their own health. this is never the reason of the failure, and the fault, if the mother has a well-formed nipple, is generally to be found in some disturbance in the child. prematurity, with extreme somnolence, breathlessness from respiratory disease, nasal catarrh, which hinders breathing through the nose, infections of all sorts, are common causes of this failure to suck effectively. but perhaps the most common cause of all is the inhibition from nervous unrest of that reflex act of sucking which works so well in the placid and quiet child. it is a point to which too little attention is paid, and mothers and the books which mothers read commonly neglect the nervous system of the child and devote themselves to such considerations as the relative merits of two-hourly and four-hourly feedings--important points in their way, but less important than this. the matter is complicated in two other ways. in the first place, the nervous baby, just because he is so active and wakeful and restless, is apt rapidly to lose weight and to have an increased need for food. the restlessness is generally attributed to hunger, and this is true, because hunger is soon added to the other sensations from which he suffers, and like them is unduly acute. it is difficult not to give way and to provide artificial food from the bottle. yet if we do so we must face the fact that these restless little mortals are quicker to form habits than most, and once they have tasted a bottle that flows easily without hard suction, they will often obstinately refuse the ungrateful task of sucking at a breast which has not yet begun to secrete readily. the suction that is devoted to the bottle is removed from the breast, and the natural delay in the coming in of the milk is increased indefinitely. at the worst, the supply of milk fails almost at its first appearance. we must devote our attention to quieting the nervous unrest by removing all unnecessary sensory stimulation from the baby. he must be in a warm cot, in a warm, well-aired, darkened, and silent room, and the necessary handling must be reduced to a minimum. sometimes sound sleep will come for the first time if he is placed gently in his mother's bed, close to her warm body. if he is apt to bungle at the breast from eagerness and restlessness, it is not wise always to choose the moment when he has roused himself into a passion of crying to attempt the difficult task. so far as is possible he should be carried to the breast when he is drowsy and sleepy, not when he is crying furiously, and then the reflex sucking act may proceed undisturbed. in the second place, we must guard against the ill effect which the ceaseless crying of these nervous babies has upon the mother. she may be so exhausted by the labour that her nerves are all on edge, and she grows apprehensive and frightened over all manner of little things. the tired mother is apt to fear that she will have no milk, and her agitation grows with each failure on the part of the child. now the first secretion of milk is very closely dependent upon the nervous system of the mother. we have said that within wide limits her physical condition is of less importance, but her peace of mind is essential. and so it is wise for some part of the day to keep the nervous baby out of hearing of the mother, and so far as possible to choose moments when the child is quiet to put him to the breast. a nurse with a confident, hopeful manner will effect most; a fussy, over-anxious, or despondent attitude will do untold harm. we shall sometimes fail if the nervous unrest is very obstinate either in mother or in child, but we shall fail less often if we diagnose the cause correctly in the cases we are considering. lastly, it is possible to control the condition in both mother and child by the careful use of bromide or chloral. it is not, of course, suggested that these drugs should be given freely or as a routine to every hungry baby wailing for the breast, or that we can hope to combat or ward off an inherited neuropathy by a few doses of a sedative. there are, however, not a few babies in whom there develops soon after birth a sort of vicious circle. they can suck efficiently and digest without pain only when they sleep soundly. if they are put to the breast after much crying and restlessness, each meal is followed by flatulence, colic, and renewed crying. the only effective treatment is to secure sleep and to carry a slumbering or drowsy infant to the breast. then the sucking reflex comes to its own again, the breast is drained steadily and well, and digestion proceeds thereafter without disturbance and during a further spell of sleep. two or three times in the day we may be forced, as meal-time approaches, to cut short the restlessness of the child by giving a teaspoonful of the following mixture: pot. brom., grs. ii. [2 grains] chloral hydrate, gr. i. [1 grain] syrup, m x. [10 minims] aq. menth. pip., ad 3 i. [1 dram] after this has been taken the child should be laid down for a quarter of an hour until soundly asleep. then very gently he can be carried to his mother and the nipple inserted. if in this way a few days of sound sleep and less disturbed digestion can be secured, the difficulty will in most cases permanently be overcome. the steadier suction and more efficient emptying of the breast will promote a freer flow of milk, and the deeper and more prolonged sleep will lower greatly the needs of the child for food. most of the babies who show this fault are thin, meagre, and fidgety, and with some increase of muscular tone. the head is held up well, the limbs are stiff, the hands clenched, the abdomen retracted, with the outline of the recti muscles unusually prominent. if we can relax this exaggerated state of nervous tension, if we can help them to become fatter and to put on weight, the dyspepsia will disappear with the other symptoms. it is a question still to be answered whether the rare conditions of pyloric spasm and pyloric hypertrophic stenosis are not further developments of the same disturbance. certainly these grave complications appear most commonly in infants with a pronounced nervous inheritance, and, as might be expected, they are more commonly found in private practice than among the hospital classes. in passing, we may note that there are babies who exhibit the opposite fault, and in whom the contrary regimen must be instituted. premature children, children born in a very poor state of nutrition, and children born with great difficulty, so that they are exhausted by the violence of their passage into the world, are apt to show the opposite fault of extreme somnolence. they are so little stimulated by their surroundings, and they sleep so profoundly, that the sucking reflex is not aroused. put to the breast they continue to slumber, or after a few half-hearted sucking movements relapse into sleep. we must rouse such children by moving them about and stirring them to wakefulness before we put them to the breast. once the child has been got to the breast, once the milk has become firmly established, we have overcome the first great difficulty which besets us in the management of nervous little babies, but it is by no means the last. restlessness and continual crying must be combated or digestion suffers, and may show itself in a peculiar form of explosive vomiting, which betokens the reflex excitability and unrest of the stomach. the sense of taste is as acute as all other sensations. if the child is bottle-fed, the slightest change in diet is resented because of the unfamiliar taste, and the whole may promptly be rejected. the tendency to dyspeptic symptoms is apt to lead to much unwise changing of the diet, and everything tried falls in turn into disrepute, until perhaps all rational diets are abandoned, and some mixture of very faulty construction, because of its temporary or accidental success, becomes permanently adopted--a mixture perhaps so deficient in some necessary constituent that, if it is persisted with, permanent damage to the growth of the child results. we must pay less attention to changes of diet and explore our management of the child to try and find how we can make his environment more restful. it is wise to accustom a nervous child from a very early age to take a little water or fruit juice from a spoon every day. otherwise when breast-feeding or bottle-feeding is abandoned one may meet with the most formidable resistance. infants of a few months can be easily taught; the resistance of a child of nine months or a year may be difficult to overcome. the difficulty of weaning from the breast recurs with great constancy in nervous children. by this time the influence of environment has become clearly apparent. the child is often enough already master of the situation, and is conscious of his power. such children will sometimes prefer to starve for days together, obstinately opposing all attempts to get them to drink from a spoon, a cup, or even a bottle. when this happens, sometimes the only effective way is to change the environment and to send the baby to a grandmother or an aunt, where in new surroundings and with new attendants the resistance which was so strong at home may completely disappear. when weaning is resented, and difficulties of this sort arise, it is clear that the mother, whose breast is close at hand, is at a great disadvantage in combating the child's opposition. for nervous infants, alas! broken sleep is the rule. what, then, is to be done? it is astonishing to me that any one who has studied the behaviour of only a few of these nervous and restless infants should uphold the teaching that the crying of the young infant is a bad habit, and that the mother who is truly wise must neglect the cry and leave him to learn the uselessness of his appeals. it is true that the youngest child readily contracts habits good or bad. either he will learn the habit of sleep or the habit of crying. mercifully the inclination of the majority is towards sleep. but to encourage habits of restlessness and crying there is no surer way than to follow this bad advice and to permit the child to cry till he is utterly exhausted in body and in mind. it is unwise _always_ to rock a baby to sleep; it is also unwise to allow him to scream himself into a state of hysteria. a quiet, darkened room, the steady pressure of the mother's hand in some rhythmical movement, will often quiet an incipient storm. the longer he cries, the more trouble it is to soothe him. sleep provokes sleep, so that often we find restlessness and sound sleep alternating in a sort of cycle, a good week perhaps following a bad one. the nurse who is quick to cut short a storm of crying and to soothe the child again to sleep is helping him to form habits of sleep. the nurse who leaves him to cry, believing that in time he will of his own accord recognise the futility of his behaviour, is making him form habits of crying. a rigid routine in sleep is a good thing, but the routine belongs to the baby, not to the nurse. the child must be educated to sleep, not taught to cry. a baby has but little power of altering his position when it becomes strained or uncomfortable. he cannot turn over and nestle down into a new posture. if we watch him wake, the first stirring may be very gradual, and in a moment he may fall again to sleep. a few minutes later he stirs again more strongly, and is wider awake and for longer. it may only be after a third waking, by a summation of stimuli, that he is finally roused and breaks into loud crying. the nurse who is on the watch, who, sleeping beside him, wakes at the slightest sound and is quick to turn him over and settle him into a new position of rest, will probably report in the morning that the baby has had a good night. the nurse who lets the child grow wide awake and start crying loudly, will spend perhaps many hours before quiet is again restored. of the voluntary, purposive crying of infants a little older i am not here speaking. infants in the second six months are quite capable of establishing a "tyranny of tears" and feeling their power. fortunately it requires no great experience to distinguish one from the other, and to adopt for each the appropriate treatment. again, in elementary teaching upon the management of infants stress is laid, rightly enough, upon the importance of regularity in the times of feeding, and on the observance in this respect also of a very strict routine. but in the case of the very nervous infant a certain latitude should be allowed to an experienced nurse or mother. we may wreck everything by a blind adhesion to a too rigid scheme, which may demand that we leave the child to scream for an hour before his meal, or that, when at length he has fallen into a sound sleep after hours of wakefulness, we should proceed to wake him. symptoms of dyspepsia which are due to continued nervous excitement demand treatment which is very different from that which would be appropriate to dyspepsia which is due to other causes, such as overfeeding or unsuitable feeding. the temporary restriction of food, which is commonly ordered in dyspepsia from these causes, is very badly supported by the nervous infant. hunger invariably increases the unrest, and the unrest increases the dyspepsia. the difficulties of managing a nervous infant are very real, and call for the most exemplary patience on the part of the mother and the clearest insight into the nature of the disturbance. chapter ix management in later childhood in the early days in the nursery the actions of the infant, for the most part, follow passively the traction exercised by nurses and mothers, sometimes consciously, but more often unconsciously. we have now to consider a period when the child becomes possessed of a driving force of his own, and moves in this direction or that of his own volition. in this new intellectual movement through life he will not avoid tumbles. he will feel the restraints of his environment pressing upon him on all sides, and he will often come violently in contact with rigid rules and conventions to which he must learn to yield. from time to time we read in the papers of some terrible accident in a picture-palace, or in a theatre. although there has been no fire, there has been a cry of fire, and in the panic which ensues lives are lost from the crowding and crushing. yet all the time the doors have stood wide open, and through them an orderly exit might have been conducted had reason not given place to unreason. it is the task of those responsible for the children's education to guide them without wild struggling along the paths of well-regulated conduct towards the desired goal, influenced not by the emotions of the moment, but only by reason and a sense of right; not ignorant of the difficulties to be met, but practised and equipped to overcome them. it is easy thus to state in general terms the objects of education, and the need for discipline. to apply these principles to the individual is a task, the immeasurable difficulty of which we are only beginning to appreciate with the failure of thirty years of compulsory education before us. a recent writer[2] gives it as his opinion that the aim of education is to equip a child with ideals, and that this task should not be difficult, because the lower savages successfully subject all the members of their tribe to the most ruthless discipline. their lives, he says, "are lived in fear, in restraint, in submission, in suffering, subject to galling, unreasoning, unnecessary, arbitrary prohibitions and taboos, and to customary duties equally galling, unreasoning, unnecessary, and arbitrary. they endure painful mutilations, they submit to painful sacrifices.... how are these wild, unstable, wayward, impulsive, passionate natures brought to submit to such a rigorous and cruel discipline? by education; by the inculcation from infancy of these ideals. in these ideals they have been brought up, and to them they cling with the utmost tenacity." one might as well contend that it was easy to teach all men to live the self-denying life of earnest christians because some savage tribe was successful in maintaining among its members a universal and orthodox worship of idols. the ideals set before the child are too high and too complex to be inculcated by physical force, or even by force of public opinion. a rigid discipline, with many stripes and with terrible threats of a still worse punishment in the world to come, was the almost invariable lot of children until the last century was well advanced. yet has this drastic treatment of young children fulfilled its purpose? were the men of fifty years ago better conducted and more controlled than the men of to-day? in any one family did a greater proportion turn out well? is it not true that at least among the educated classes the relaxation of nursery and schoolroom discipline which the last fifty years has seen has been justified by its results? is it not true that the childhood of our grandmothers was often lived "in fear, in restraint, in submission, in suffering subject to galling, unreasoning, unnecessary, arbitrary prohibitions and taboos, and to customary duties equally galling, unreasoning, unnecessary, and arbitrary." and though perhaps the grandmothers of most of us may not have been much the worse for all this discipline, is it not true that of the little brothers who shared the nursery with them a surprising number broke straightway into dissipation when the parental restraints were removed? if we are to teach a child to be gentle to the weak it is not wise to beat him. the qualities which we wish him to possess are not more subtle than the means by which we must aid him to their possession. [footnote 2: _the principles of rational education_, by dr. c.a. mercier.] education comprises physical, mental, and moral training. in earlier times physical strength and the power to fight well, alone were prized and were the chief objects to be gained in the education of youth. later, under the stress of intellectual competition for success in life, mental acquirements have come to occupy the first place. we are only now learning to lay emphasis upon the supreme need for moral training. not that it is possible to separate the sum of education into its constituent parts, and to regard each as distinct from the others. that many men of great intellectual activity, and many men pre-eminent for their moral qualities have harboured a great brain or a noble character in a weakly or deformed body, forms no argument to disprove the general rule that a healthy, vigorous physique is the only sure foundation upon which to build a highly developed intellect and a stable temperament. in childhood the intimate connection between vigour of mind and vigour of body is almost always clearly shown. a child with rickets, unable to exercise his body in free play, as a rule shows a flabbiness of mind in keeping with his useless muscles and yielding bones. such children talk late, are infantile in their habits and ways of thought, and are more emotional and unstable than healthy children of the same age. the connection between bodily ailments and instability of nervous control is even more clearly seen in the frequent combination of rheumatism and chorea. a very high proportion of older children suffering from the graver neuroses, such as chorea, syncopal attacks, phobias, tics, and so forth, show defective physical development. scoliosis, lordosis, knock-knee, flat foot, pigeon chest, albuminuria, cold and cyanosed extremities, are the rule rather than the exception. if the body of the child is developed to the greatest perfection of which it is capable we shall not often find a too sensitive nervous system. the boy of fine physique may have many faults. he may be bad-tempered or untruthful or selfish, but such faults as he has are as a rule more primitive in type, more readily traced to their causes, and more easy to eradicate than the faults which spring from that timidity, instability, and moral flabbiness which has so often developed in the lax delicate child reared softly in mind and body. physical training children thrive best in the healthy open-air life of the country, and if there is any tendency to nervous disturbances the need for this becomes insistent. physical training, further, includes the manual education of the child. the system of child-training advocated by dr. montessori is based upon the cultivation of tactile sensations and the development of manual dexterity. exercises such as she has devised have an immediate effect in calming the nervous system and in changing the restless or irritable child into a self-restrained and eager worker. lord macaulay, whose phenomenal memory as a child has become proverbial, was so extraordinarily unhandy that throughout life he had considerable difficulty in putting on his gloves, while he had such trouble with shaving that on his return from india there were found in his luggage some fifty razors, none of which retained any edge, and nearly as many strops which had been cut to pieces in his irritated and ineffectual efforts. if we teach a child manual dexterity it is an advantage to him, because manual dexterity is seldom associated with restlessness and irritability of mind. to excel in some handicraft not only bespeaks the possession of self-control, it helps directly to cultivate it. the teaching of froebel and montessori holds good after nursery days are over. mental training mental training enables the child to retain facts in his memory, to obtain information from as many sources as possible, to understand and piece them together, and finally to reach fresh conclusions from previously acquired data. so far as is possible the teacher must satisfy the natural desire to know the reason of things. it must be his endeavour to prevent the child from accepting any argument which he has not fully understood, and which, as a result, he is able not to reconstruct but only to repeat. mental work which is slovenly and perfunctory is as harmful to the child's education as mechanical work which is bungled and ineffective. taking advantage of his natural aptitudes, his interest should be developed and extended in every way possible. tasks which are accomplished without enthusiasm are labour expended in vain, because the knowledge so acquired is not assimilated and adds nothing to the child's mental growth. there should be no sharp differentiation between work and play. moral training moral training depends upon the force of example rather than of precept. parents must be scrupulously just and truthful to the child, for his quick perception will detect the slightest deceit, and the evil impression made on his mind may be lasting. they must confidently expect conduct from him of a high moral standard, and be careful at this early age to avoid the common fault of giving a dog a bad name. if it is said on all sides that a child has an uncontrollable temper, is an inveterate grumbler, is lacking in all power of concentration, or has a tendency to deceit, it is likely that the child will act up to his reputation. he comes in time to regard this failing of his as part of himself just as much as is the colour of his hair or the length of his legs. it may be said of a schoolboy that he shows no aptitude for his work. term by term the same report is brought home from school, and each serves only to confirm the boy in his belief that this failing is part of his nature, and that no effort of his own can correct it. if one subject only has escaped the condemnation of his master, then it may be to that study alone that he returns with zest and enjoyment. spendthrift sons are manufactured by those fathers who many times a day proclaim that the boy has no notion of the value of money. and so with children! parents must take it for granted that they will display all the virtues they desire in them. they must trust to their honour always to speak the truth, and always to do their best in work or play whether they are with them or not. again and again the children will fail and their patience will be tried to the utmost. they must explain how serious is the fault, and for the time being their trust may have to be removed; but with the promise of amendment it must again be fully restored and the lapse completely forgotten. if the child feels he is not trusted he ceases to make any effort, and lapse will succeed lapse with increasing frequency. in efforts at moral training there is often too great an emphasis laid upon negative virtues. it is wrong to do this: to do that is forbidden. children cannot progress by merely avoiding faults any more than a man may claim to be an agreeable companion at table because he does not eat peas with a knife or drink with his mouth full. there must be a constant effort to achieve some positive good, to acquire knowledge, to do service, to take thought for others, to discipline self, and the parent will get the best result who is comparatively blind to failure but quick to encourage effort and to appreciate success. when the child knows well that he is doing wrong, exhortation and expostulation are usually of little avail if repeated too often, and serious talks should only take place at long intervals. we know how effective the so-called "therapeutic conversation" may be in helping some overwrought and nervously exhausted man or woman to regain peace of mind and self-control. after an intimate conversation with a medical man who knows how to draw from the patient a free expression of the doubts, anxieties, and fears which are obsessing him, many a patient feels as though he had awakened in that instant from a nightmare, and passes from the consulting-room to find his troubles become of little account. not a few patients return to be reassured once more, and derive new strength on each occasion. yet visits such as these must be infrequent or they will lose their power. now, just as the physician is well aware that his intervention if too frequently repeated will lose its effect, so the parent must be chary of too frequent an appeal to the moral sense of the child. at long intervals opportunity may be taken with all seriousness to set before the child ideals of conduct, to-speak to him of the meaning of character and of self-discipline, and of the standards by which we judge a man or woman to be weak and despicable, or strong and to be admired. the effect of such an intimate conversation, never repeated, may persist throughout life. constantly reiterated appeals, on the other hand, do more harm than good. to tell a child daily that he is "breaking mother's heart," or that he is "disappointing his father," is to debase the moral appeal and deprive it of its strength. for everyday use it is best to cultivate a manner which can indicate to the child that he is for the moment unpopular, but which at the same time denies to the small sinner the interest of attempting his own defence. on the other hand, should the child be reasonably in doubt as to the nature of his offence we must spare no trouble in explaining it to him. punishment will be most effective when the child is convinced that he is rightly convicted. if it is to act as a real deterrent, he must agree to be punished--a frame of mind which, if it can be produced, may be welcomed as a sure sign that training is proceeding along the right lines. by physical training, mental training, and moral training the child's character is formed and self-discipline is developed. with the child of neuropathic disposition and inheritance matters may not proceed so smoothly. reasoning and conduct may be alike faulty, and the nervous disturbances may even cause detriment to the physical health. not that the nervous child requires an environment different from that of the normal child. the difficulties which the parents will encounter and the problems which must be solved differ not in kind but in degree. an error of environment which is without effect in the normal child may be sufficient to produce disastrous results in the neuropathic. it must be granted that there are some unfortunate children in whom the moral sense remains absent and cannot be developed--children who steal and lie, who seem destitute of natural affection, or who appear to delight in acts of cruelty. these moral degenerates need not be considered here. serious errors of conduct, however, in children who are not degenerate or imbecile, frequently arise directly from faults of management and can be controlled by correcting these faults. suppose, for example, that a child is found to have taken money not his own. the action of the parents faced with this difficulty and disappointment will determine to a great extent whether the incident is productive of permanent damage to the child's character. the peculiar circumstances of each case must be considered. for example, the parent must bear in mind the relation in which children stand to all property. the child possesses nothing of his own; everything belongs in reality to his father and mother, but of all things necessary for him he has the free and unquestioned use. unless his attention has been specially directed to the conception of ownership and the nature of theft, he may not have reasoned very closely on the matter at all. very probably he knows that it is wrong to take what is not given him, but he does not regard helping himself to some dainty from a cupboard as more than an act of disobedience to authority. he may have imbibed no ideas which place the abstraction of money from a purse belonging to his parents on a different plane, and which have taught him to regard such an action as especially dishonourable and criminal. finally, a child who, undetected, has more than once taken money belonging to his father and mother, may pass without much thought to steal from a visitor or a servant. to deal with such a case effectively, to ensure that it shall never happen again, requires much insight. if the father, shocked beyond measure to find his son an incipient criminal, differing in his guilt in no way from boys who are sent to reformatories as bad characters, convinces the child that although he did not realise it, he has shown himself unworthy of any further trust, untold harm will be done. almost certainly the child will act in the future according to the suggestions which are thus implanted in his mind. if the household eyes him askance as a thief, if confidence is withdrawn from him, he sees himself as others see him and will react to the suggestions by repeating the offence. the seriousness of what he has done should be explained to him, and after due punishment he must be restored completely and ostentatiously to absolute trust. only by showing confidence in him can we hope to do away with the dangers of the whole incident. to inculcate good habits and encourage good behaviour we must let the child build up his own reputation for these virtues. it need not make him priggish or self-satisfied if parents let him understand that they take pride in seeing him practise and develop the virtue they aim at. for example, it is desired above all that he should always speak the truth. then they must ostentatiously attach to him the reputation of truthfulness and show their pride in his possessing it. if he falls from grace they must remember that he is still a child, and that if that reputation is lightly taken from him and he is accused of a permanent tendency towards untruthfulness, he is left hopeless and resigned to evil. let any mother make the experiment of presenting to her child in this way a reputation for some particular virtue. for example, if an older child shows too great a tendency to tease and interfere with the younger children, let the mother seize the first opportunity which presents itself to applaud some action in which he has shown consideration for the others. let her comment more than once in the next few days on how careful and gentle the older child is becoming in his behaviour to the little ones, and in a little the suggestion will begin to act until the transformation is complete. if, on the other hand, the mother adopts the opposite course and rebukes the child for habitual unkindness, she will be apt to find unkindness persisted in. the criminal records of the nation show too often the truth of the saying that "once a thief always a thief." deprived of his good repute, man loses his chief protection against evil and his incentive to good. the inability of a child--and especially of a nervous and sensitive child--to form conceptions of his own individuality except from ideas derived from the suggestions of others, gives us the key to our management of him and to our control of his conduct. he has, as a rule, a marvellously quick perception of our own estimate of him, and unconsciously is influenced by it in his conception of his own personality, and in all his actions. parents must believe in his inherent virtue in spite of all lapses. if they despair it cannot be hid from the child. he knows it intuitively and despairs also. it is then that they call him incorrigible. if it happens that one parent becomes estranged from the child, despairs of all improvement, and sees in all his conduct the natural result of an inborn disposition to evil, while the other parent holds to the opinion that the child's nature is good, and to the belief that all will come right, then often enough the child's conduct shows the effect of these opposite influences. in contact with the first he steadily deteriorates, affording proof after proof that judgment against him has been rightly pronounced. in contact with the other, though his character and conduct are bound to suffer from such an unhappy experience, he yet shows the best side of his nature and keeps alive the conviction that he is not all bad. the force of suggestion is still powerful to control conduct and determine character in later childhood. the impetus given by the parents in this way is only gradually replaced by the driving power of his own self-respect--a self-respect based upon self-analysis in the light of the greater experience he has acquired. chapter x nervousness in older children in older children the line which separates naughtiness, fractiousness, and restlessness from definite neuropathy begins to be more marked. the nature of the young child, taking its colour from its surroundings, is sensitive, mobile, and inconstant. with every year that passes, the normal child loses something of this impressionable and fluid quality. with increasing experience and with a growing power to argue from ascertained facts, character becomes formed, and if tempered by discipline will come to present a more and more unyielding surface to environment, until finally it becomes set into the stability of adult age. we may perhaps, with some approach to truth, look upon the adult neurotic as one whose character retains something of the impressionable quality of childhood throughout life, so that, to the last, environment influences conduct more than is natural. all the emotions of neurotic persons are exaggerated. disappointments over trifles cause serious upsets; grief becomes overmastering. violent and perhaps ill-conceived affection for individuals is apt to be followed by bitter dislike and angry quarrelling. on the physical side, sense perception is abnormally acute, and many sensations which do not usually rise up into consciousness at all become a source of almost intolerable suffering. to these most unhappy people summer is too hot and winter too cold; fresh air is an uncomfortable draught, while too close an atmosphere produces symptoms of impending suffocation. in some neurotics there is an excessive interest in all the processes of the life of the body, and when attention is once attracted to that which usually proceeds unconsciously, symptoms of discomfort are apt to arise. thus so simple an act as swallowing may become difficult, or for the time being impossible. to breathe properly and without a sense of suffocation may seem to require the sustained attention of the patient; or again, the voice may be suddenly lost. more commonly, perhaps, neuropathy exhibits itself in an undue tendency to show signs of fatigue upon exertion of any sort, mental or physical. sustained interest in any pursuit or task becomes impossible. nameless fears and unaccountable sensations of dread establish themselves suddenly and without warning, and may be accompanied on the physical side by palpitation, flushing, headache, or acute digestive disturbances. all these manifestations are best controlled by selecting a suitable environment, and as a rule the character of the environment is determined by the temperament and disposition of those who live in close contact with the patient. like the tiny children with whom we have dealt so far, the behaviour of neuropathic persons is subject wholly to the direction of stronger and more dominant natures. with faulty management at the hands of those around them, no matter how loving and patient these may be, the conduct of the neurotic tends to become abnormal. in children beyond earliest infancy we recognise a gradual approach to the conditions of adult life. fractiousness and naughtiness, ungovernable fits of temper, inconsolable weeping and inexplicable fears should disappear with early childhood even if management has not been perfect. if they persist to older childhood we shall find in an increasing percentage of cases evidence of definite neuropathic tendencies which urgently call for investigation and for a precise appreciation of the nature of the abnormality. it may be that the only effective treatment is that which we recognise as essential in the grosser mental disturbances--removal from the surroundings in which the abnormal conduct has had free play, and separation from the relatives whose anxiety and alarm cannot be hidden. in young nervous children fear is the most prominent psychical symptom. the children are afraid of everything strange with which they come in contact. they are afraid of animals, of a strange face, or an unfamiliar room. older children usually manage to control themselves, suppress their tears, and prevent themselves from crying out, but it is nevertheless easy to detect the struggle. often we find those distressing attacks to which the name "night-terrors" has been given. the child wakes with a cry,--usually soon after he has gone to sleep,--sits up in bed and shows signs of extreme terror, gazing at some object of his dreams with wide-open startled eyes, begging his nurse or mother to keep off the black dog, or the man, or whatever the vision may be. even after the light is turned up and the child has been comforted, the terror continues, and half an hour may elapse before he becomes quiet and can be persuaded to go back to bed. in the morning as a rule he remembers nothing at all. phobias of all sorts are common in nervous children, and result from a morbid exaggeration of the instinct for self-preservation. some cannot bear to look from a height, others grow confused and frightened in a crowd; dread of travelling, of being in an enclosed space such as a church or a schoolroom, or of handling sharp objects may develop into a constant obsession. i have known a little girl who was seized with violent fear whenever her father or mother was absent from the house, and she would stand for hours at the window in an agony of terror lest some harm should have befallen them. as if with some strange notion of propitiating the powers of darkness these children will often constantly perform some action and will refuse to be happy until they have done so. the same little girl who suffered such torments of anxiety in her parents' absence would always refuse to go to bed unless she had stood in turn on all the doormats on the staircase of her home. other children feel themselves forced to utter certain words or to go through certain rhythmical movements. they fully understand that the fear in their mind is irrational and devoid of foundation, but they are unable to expel it. often it is hugged as a jealous secret, so that the childish suffering is only revealed to others years afterwards, when adult age has brought freedom from it. we will do well to try by skilful questioning to gain an insight into the mental processes of a child when we find him showing an uncontrollable desire to touch lamp-posts or to stand in certain positions; or when he develops an excessive fear of getting dirty, or is constantly washing his hands to purify them from some fancied contamination. the treatment of all these symptoms calls for much insight. the child's confidence must be completely secured, and he must be encouraged to tell of all his sensations and of the reasons which prompt his actions. the nervous child has a horror of appearing unlike other children, and will suffer in silence. if his troubles are brought into the light of day with kindness and sympathy they will melt before his eyes. even night-terrors are, as a rule, determined by the suppressed fears of his waking hours. if they are provoked by his experiences at school, by the fear of punishment or by dismay at a task that has proved beyond his powers, he should be taken away from school for the time being. night-terrors are said to be aggravated by nasal obstruction due to adenoid vegetations. clothing at night should be light and porous, and particular attention should be paid to the need for free ventilation. we have spoken in an earlier chapter of the trouble sometimes experienced in inducing a nervous child to go to sleep. in older children insomnia is common enough. even when sleep comes it may be light and broken, as though the child slept just below the surface of consciousness and did not descend into the depths of sound and tranquil slumber. we have often noticed how different is the estimate of the patient from that of the nurse as to the number of hours of sleep during the night. the sick man maintains that he has hardly slept at all, whilst the nurse, drawing us aside, whispers in our ear that he has slept most of the night. in estimating sleep we have to consider not only its duration, but also its depth, and the patient who denies that he has slept at all has lain perhaps half the night with an active restless brain betwixt sleep and wakefulness. often enough when he comes to consider in the morning the problems that vexed his soul at midnight, he is quite unable to recall their nature, and recognises them as the airy stuff that dreams are made of. although in a sense asleep he may have retained a half-consciousness of his surroundings and a sense of despair at the continued absence of a sounder sleep. with nervous children we are apt to find sleep which is of little depth and which constantly shows evidence of a too-active brain. the body is tossed to and fro, words are muttered, and the respiration is hurried and with a change in rhythm, because there is no depth of anæsthesia. the body still responds to the impulses of the too-active brain. from the nature of his dream--as shown by chance words overheard--we may sometimes gather hints to help us to find where the elements of unrest in his daily life lie. sleep-walking is only a further stage in this same disorder of sleep, in which the dream has become so vivid that it is translated into motor action. if a child begins to suffer from active sleeplessness we must not make the mistake of urging him to sleep. he is no more capable than we are ourselves of achieving sleep by an effort of will power. to urge him to sleep is likely to cause him to keep awake because we direct his attention to the difficulty and make him fear that sleep will not come. if he understands that all that he needs is rest, he will probably fall asleep without further trouble. day-dreams also may become abnormal, and tell of an unduly nervous temperament. any one who watches a little child at play will realise the strength of his power of imagination. the story of red riding hood told by the nursery fire excites in the mind of the child an unquestioning belief which is never granted in later life to the most elaborate efforts of the theatre. all this imaginative force is natural for the child. it becomes abnormal only when things seen and acts performed in imagination are so vivid as to produce the impression of actual occurrences, and when the child is so under the sway of his day-dreams that he fails to realise the difference between pretence and reality. imagination which keeps in touch with reality by means of books and dolls and toys is natural enough. not so imagination which leads to communion with unseen familiars or to acts of violence due to the organisation of "conspiracies" or "robber bands" amongst schoolboys. if evidence of abnormal imagination appears, the child must be kept in close touch with reality. we must give him interesting and rational occupation, such as drawing, painting, the making of collections of all sorts, gardening, manual work, and so forth. in older children we must especially supervise the reading. in many nervous children we find a faulty contact with environment, so that instead of becoming interested in the thousand-and-one happenings of everyday life and experiences, they become introspective and self-conscious. as a result, sensations of all sorts, which are commonly insufficient to arouse the conscious mind, attract attention and, rising into consciousness, occupy the interest to the exclusion of everything else. the conscious mind is not capable of being occupied by more than one thing at a time. if attention is concentrated upon external matters, bodily sensations, even extreme pain, may pass altogether unnoticed. the mohawk, lord macaulay tells us, hardly feels the scalping-knife as he shouts his death song. the soldier in the excitement of battle is often bereft of all sense of pain. on the other hand, the patient who is morbidly self-conscious becomes oblivious of his surroundings while he suffers intensely from sensations which are usually not appreciated at all. self-conscious children will complain much of breathlessness and a sense of suffocation, of headache, of palpitation, of intolerable itching, of the pressure of clothing, or of flushing and a sense of heat. excessive introspection influences their conduct in many ways. at children's parties, for example, they will be found wandering about unhappy, dazed and unable to feel the reality of the surroundings which afford such joy to the others; or they may be anxious to join in play, but finding themselves called upon to take their turn are apt to stand helplessly inactive, or to burst into tears. at school, though they may be really quick to learn, they will often be found oblivious of all that has gone on around them, not from stupidity, but from inability to dissociate their thoughts from themselves and to concentrate attention upon the matter in hand. in such a case we must aim at developing the child's interest to the exclusion of this morbid introspection. taking advantage of his individual aptitude, we must strengthen his hold upon externals in every way possible, and we must explain to him the nature of his failing and teach him that his salvation lies in cultivating his capacity for paying attention to things around him and developing an interest in suitable occupations. fainting fits are not uncommon amongst nervous children from about the sixth year onwards, and are apt to give rise to an unwarranted suspicion of epilepsy. in other cases fears have been aroused that the heart may be diseased. in children who faint habitually the nervous control of the circulation is deficient. we notice that when they are tired by play, or when they are suffering from the reaction that follows excitement of any sort, the face is apt to become pale, and dark lines may appear under the eyes. yet there may be no true anæmia present: it is only that the skin is poorly supplied with blood for the moment. after a little rest in bed, or under the influence of a new excitement, the colour returns, and the tired look vanishes. if children of this type are made to stand motionless for any length of time, and if at the same time there is nothing to attract their interest or attention--a combination of circumstances which unhappily is sometimes to be found during early morning prayers at school--the want of tone in the blood vessels may leave the brain so anaemic that fainting follows. the first fainting attack is a considerable misfortune, because the fear of a recurrence is a potent cause of a repetition. standing upright with the body at rest and the mind vacant, the circulation stagnates, the boy's mind is attracted by the suggestion, he fears that he will faint as he has done before, and he faints. schoolmasters are well aware that if one or two boys faint in chapel and are carried out, the trouble may grow to the proportion of a veritable epidemic. it is important that this habit of fainting should be combated not only by general means to improve the tone of the body and circulation, but also by taking care that the child understands the nature of the fainting fit, and the part which association of ideas plays in producing it. disease of the heart seldom gives rise to fainting. the same vasomotor instability which shows itself in the tendency to syncopal attacks is apparent in many other ways. sudden sensations of heat and of flushing, equally sudden attacks of pallor, coldness of the extremities, abundant perspiration,--raising in the mind of the anxious mother the fear of consumption,--and excessive diuresis are common accompaniments. a further group of symptoms is provided by the extreme sensibility of the digestive apparatus. dyspepsia, hyperaesthesia of the intestinal tract, viscero-motor atonies and spasms, and anomalies of the secretions, whether specific like that of the gastric juice or indifferent like that of the nasal, pharyngeal, gastric, and intestinal mucus, are all of common occurrence. whenever the nervous child is subjected to any exhausting experience, any excitement, pleasurable or the reverse, or any undue exertion, whether mental or physical, one may note the subsequent gastro-intestinal derangement, including even a coating of the tongue. the slightest deviation from the usual diet, the most trivial fatigue, a chill of the body, even a change in the temperature of the food may set loose the most extreme reactions in the gastro-intestinal tract--motor, sensory, or secretory. it is not an accident that so often the mucous diarrhoea, which may have afflicted an excitable child in london for many months, and which a visit to the seaside, with all its healthy activities, may seem to have completely cured, relapses within a day or two of the return to the restricted environment and uninteresting routine of life in london. the child who was happy and busy and at peace with himself, at play in the open air, resents the sudden cessation of all this, and the nervous unrest returns. to attempt treatment by dietetic restrictions alone is to deal only with a symptom. the gastro-intestinal reactions are so violent that the parents are generally voluble on the subject of the many foods which cannot be taken and the few which are not suspect. to prescribe rigid tables of diet is to add to the alarm of the mother, and to sustain her in the belief that the child is in daily danger of being poisoned by a variety of common articles of diet. only by lowering the excitability of the nervous system, by occupying the mind and giving strength to the child's powers of control can we effectively combat the hyperaesthesia. if necessary the personnel of the management of the child will have to be altered. there may be no other way to achieve certain and rapid improvement in a condition which is causing grave danger to the child and very genuine distress and suffering to the parents. a violent reaction to intoxications of all sorts is a further stigma of nervous instability. sudden and even inexplicable rises of temperature are frequent complaints, and the constitutional effects of even trivial local infections are apt to be disproportionately great. fatigue is easily induced and is exhibited in all varieties of activity--mental, physical, or visceral. mental work may produce fatigue with extreme readiness even although the quality of the work may remain of a high standard. to darwin and to zola work for more than three hours daily was an impossibility, and yet their work done under these restrictions excites all men's admiration. the palpitation and breathlessness which follows upon trivial exertion, such as climbing a flight of stairs, is a good example of visceral fatigue. among adult neuropaths we recognise the harm which may be done by unwise speeches on the part of relatives, or still more on the part of doctors. a chance word from a doctor or nurse off their guard for the moment will implant in the minds of many such a person the unyielding conviction that he or she is suffering from some gastric complaint, from some cardiac affection, or from some constriction of the bowel. it may take the united force of many doctors to uproot this pathological doubt which was implanted so easily and so carelessly. the medical student is notoriously prone to recognise in himself the symptoms of ailments which he hears discussed. little children, too, are apt to suffer in the same way. how much illness could be avoided if mothers would cease to erect some single manifestation of insufficient nervous control into a local disorder which becomes an object of anxiety to the child and to the whole household. undue liability to fatigue, irritability, instability, lack of control over the emotions, extreme suggestibility, prompt and exaggerated reactions to toxins of all sorts, excessive vasomotor reactions and anomalies of secretion, weakness of the gastro-intestinal apparatus--these, and many other symptoms, are of everyday occurrence in the nervous child. to discuss them more fully would be to pass too far from our nursery studies into a consideration of psychological medicine. chapter xi nervousness and physique it has already been said that symptoms of nervousness are often accompanied by faults in the physical development of the child. the defects may assume so many forms as to make any attempt at description very difficult. nevertheless, certain types of physical defect present themselves with sufficient frequency, in combination with neurosis, to merit a detailed description. for example, we recognise a type of nervous child which is marked by a persistence into later childhood of certain infantile characteristics of the build and shape of body. further, we meet with a group characterised by a special want of tone in the skeletal muscles, by lordosis, by postural albuminuria, and by abdominal and intestinal disturbances of various sorts. we recognise also the rheumatic type of child with a tendency to chorea, and in contrast to this a type with listlessness, immobility, and katatonia. lastly, in a few children, in boys as well as in girls, we may meet with cases of hysteria.[3] [footnote 3: if we accept as hysterical all symptoms which are produced by suggestion and which can be removed by suggestion, we may correctly speak of a physiological hysteria of childhood, which includes a very large number of the symptoms discussed. the term is used here in its older more limited sense.] (1) a group with persistence of certain infantile characteristics during the first year or eighteen months of life, the rounded infantile shape of body persists. the limbs are short and thick, the cheeks full and rounded, the thorax and pelvis are small, the abdomen relatively large and full. the great adipose deposit in the subcutaneous tissue serves as a depôt in which water is stored in large amounts. in the healthy child of normal development by the end of the second year a great change has taken place. the shape of the body has become more like that of an adult in miniature. the limbs have grown longer and slimmer. the thorax and pelvis have developed so as to produce relatively a diminution in the size of the abdomen. the body fat is still considerable, but no longer completely obliterates the bony prominences of the skeleton. delay in this change, in this putting aside of the infantile habit of body, is commonly associated with a corresponding backwardness in the mental development. such children walk late, talk late, learn late to feed themselves, to bite, and to chew effectively. watery and fat, they carry with them into later childhood the infantile susceptibility to catarrhal infections of the lung, bowel, skin, etc., and they are apt to suffer, in consequence, from a succession of pyrexial attacks. nasal catarrh, bronchitis, otitis media, enteritis, eczema, urticaria papulata, are apt to follow each other in turn, giving rise in many cases to a persistent enlargement of the corresponding lymphatic glands. the effect upon the different tissues of the body of these repeated infections is very various. we are probably not wrong in attributing the failure to develop and the persistently infantile appearance to a prejudicial effect upon the various ductless glands in the body. the condition is associated with an excessive retention of fluid in the body, secondary in all probability to alterations in the concentration and distribution of the saline constituents of the body. a rapid excretion of salts may be followed by a correspondingly speedy dehydration of the body, a retention of salts by a sudden increase of weight. the parathyroid glands are probably closely concerned in regulating the retention and excretion of salts, and especially of calcium, a circumstance which becomes of significance when we remember how frequently rickety changes, tetany, and other convulsive seizures form part of the clinical picture which we are now considering. while it is difficult to determine the effect of repeated infections upon the functions of the endocrine glands, we have clear evidence of the deleterious influence upon almost all the tissues of the body, the functioning of which it is more easy to estimate. for example, the cells of the skin and of the mucous membranes which happen to be visible to the eye show clear evidence of diminished vitality and increased vulnerability. physiological stimuli, incapable of producing any visible reaction in healthy children, habitually determine widely spread and persistent inflammatory reactions. for example, the licking movements of the tongue at the corners of the mouth produce the little unhealthy fissures which the french call _perlèche_. the physiological stimulus of the erupting tooth is capable of causing a painful irritation of the gum, so that the child is said to suffer from teething, accompanied, it may be, and the association is significant, by "teething convulsions." the irritation of the urine produces rawness and excoriation of the skin of the prepuce, contact with intestinal contents not in themselves very abnormal, an intractable dermatitis of the buttocks or a persistent diarrhoea and enteral catarrh. improvement in the general health, the result of the cessation for the time being of the recurrent infections, perhaps consequent upon improved hygienic conditions, always determines the rapid disappearance of all these accompaniments of the general diminution of tissue vitality. the muscular system and the bones are commonly also involved, so that rickety changes are often found in these infantile and watery children. in early childhood the processes of calcification and decalcification proceed side by side and with great rapidity, and in health there is always a balance on the side of the constructive process. in the children whom we are now considering, saturated as they are, from time to time, with the toxins resulting from repeated infection, ossification may be so interfered with as to cause softening and bending, with the evolution of a state of rickets. between bone and muscle, too, we find a close relationship. we do not find powerful muscles with softened bone, nor flabby muscle with rigid and well-formed bone. in the nervous system, the conditions are somewhat different. in skin, in bone, and in muscle new cell elements are constantly being formed, and the life of the individual cell is relatively short. in the nervous system, on the other hand, the individual cells are long lived. their life-history may even be coterminous with that of the individual, and if destroyed they are not replaced. nevertheless, they do not escape undamaged in the general disturbance. in a deprivation of calcium we have, in all probability, the explanation of the increased irritability of peripheral nerves and of the tendency to convulsive seizures of all sorts which is a common accompaniment of the condition. convulsions, laryngismus stridulus, tetany, or carpopedal spasm are all frequently met with. in crying, the children hold their breath to the point of producing extreme cyanosis, ending, as the spasm relaxes, with a crowing inspiration, which resembles and yet differs in tone from both the whoop of whooping-cough and the crowing inspiration of croup. apart, however, from this tendency to convulsive seizures the nervous system of these children is abnormal. as a rule they are excitable, and develop late the power to control their emotions. lagging behind in physical development and in the capacity to interest themselves in the pursuits of normal children, their emotional state remains that of a much younger child. in the infant classes at schools they are recognised as dullards, learning slowly, speaking badly, and lacking co-ordination in all muscular movements. the clinical picture so depicted is encountered with extreme frequency among the children of the poor in our large cities. to find a name for the condition is no easy matter. to call it "rickets" is to place an undue emphasis upon the bony changes which, though common, are by no means invariable. elsewhere i have suggested the name status catarrhalis, on an analogy with the name status lymphaticus, which in the post-mortem room is used to describe the secondary overgrowth of lymphatic tissue which is found in these catarrhal children. in the present connection it is of interest to us to note how commonly the nervous system is involved in the general picture and the frequency both of convulsive disorders and of neuropathy. the nervous symptoms of both sorts are to be allayed only by improving the general hygiene of the child and raising its resistance against infection. a sufficiency of fresh air and of sunlight, and a management which encourages independence of action in the child, are both necessary. the diet is of the first importance. it should be sufficient, and no more than sufficient, to cover the physiological needs of the child for food. the majority of these children have enormous appetites, and excess of food, and especially of carbohydrate food, plays some part in the production of the disturbance. we must guard against overfeeding, against want of air and want of exercise, and against those errors of management described in previous chapters, which produce the maximum of disturbance in this type of child. (2) a group with muscular atrophy, lordosis, and postural albuminuria at an older age, in children from the fifth year onwards, a second type of physical defect associated with pronounced nervous disturbance presents itself with some frequency. the body is thin and badly nourished, and the muscular system especially poorly developed and very lax in tone. the most striking feature is the extreme lordosis, accompanied usually by a secondary and compensatory curve in the cervico-dorsal region, so that the shoulders are rounded, with the head poked forward. viewed from in front the abdomen is seen to be prominent, overhanging the symphysis pubis, while the shoulders have receded far backwards. the scapulæ have been dragged apart, as though by the weight of the dependent arms, with eversion of their vertebral borders and lowering of the points of the shoulders. the position which they adopt is that into which the body falls when it ceases to be braced by strong muscular support. the muscular system is here so weakly developed and so toneless that the posture is determined by the bony structure and its ligamentous attachments. the lordosis resembles the similar deformity which develops in cases of primary myopathy, when the spinal muscles have undergone complete atrophy. as in myopathy the movements are very uncertain. the children are apt to fall heavily when the centre of gravity is suddenly displaced, because their upright posture is maintained by balancing the trunk upon the support of the pelvis. the frequency and severity of the falls which these children suffer is a common complaint of the mother. the faulty posture is often associated with slight albuminuria. its appearance is very capricious, but it is dependent to a great extent upon the assumption of the erect posture. there has been much discussion as to its explanation. it has been argued that the lordosis itself produces the albuminuria by mechanical compression of the renal vein, and it is said that albuminuria can be produced, even in the prone position, by placing the child in a plaster jacket applied so as to maintain the position of lordosis. other observers, however, have not obtained this result. it seems most likely that the albuminuria is due to defective tone in the vasomotor musculature, comparable in every way to the defective tone in the muscles of the skeleton. we have often further evidence of vasomotor weakness. fainting attacks are so common as to be the rule rather than the exception. again, mothers are likely to complain of the child's pallor and of dark lines under the eyes, especially after exertion or in the reaction which follows excitement of any sort. as a rule a blood count will not show any very striking evidence of true anæmia. the pallor is of vasomotor origin, determined by faults in the distribution of the blood from vasomotor weakness and not by deficient blood formation. circulatory and vasomotor disturbance probably also accounts for the dyspeptic pains and vomiting which commonly accompany any emotional excitement, or follow any unusual exertion or fatiguing experience. constipation is a common, and mucous diarrhoea an occasional, symptom. the abdomen is often pigmented. the hands and feet are usually cold and cyanosed. the extreme nervousness of the children is the point upon which most stress may be laid in the present connection. the association of albuminuria with neurosis in childhood has been noticed by many observers. the gastric and intestinal symptoms are especially characteristic. if the condition of the children is not materially improved, and if the symptoms, both of the physical defect and of the nervous disturbance, are not cut short, we may predict that in adult age their lives will be made miserable by a variety of abdominal symptoms dependent both on the vasomotor disturbance and upon the accompanying neurosis. now that surgery forms so large a part of our therapeutic proceedings, they may not reach middle life without being submitted to one or more surgical operations. with good management both on the physical side and on the moral or psychological side they can be made into strong and useful members of society. the treatment of these cases may be summed up as follows: _(a)_ we must search for any source of infection, a source which is often to be found in the condition of the tonsils. enucleation may then be indicated as the first step in treatment. _(b)_ massage and gymnastic exercises calculated to improve the muscular tone, while every effort is made to secure for the child as perfect hygiene in the environment as possible. _(c)_ the stimulating effect of cold douches is often very evident in improving the vasomotor tone. these children, however, will not stand well the abstraction of heat from their thin and chilly little bodies, so that it is a good plan before the colder douche to immerse the child in a hot bath and to return again to the bath momentarily afterwards. with these precautions children will often enjoy a cold spray, the temperature of which may be constantly lowered as they become used to it. prolonged hot bathing has a correspondingly prejudicial effect. _(d)_ we must be on the watch to prevent the development of further postural deformities, such as scoliosis. if a child of strong muscular tone and good physique habitually adopts some posture, curled up, it may be, in some favourite easy-chair, there is little likelihood that its constant assumption will produce deformity. when the muscular system is lax and weak, on the other hand, deformity such as scoliosis is very readily caused. it is important, for example, to see that the child does not habitually incline to one side in reading or writing. when there is little energy for free and energetic play the children are apt to become great bookworms. if there is shortsightedness, the dangers are correspondingly increased. a special chair may be made with a well-fitting back and the seat a little tilted upwards so as to throw the child's trunk on to the support of the back. lastly, a desk, the height of which can be regulated at will, can be swung into the proper position. the child, sitting straight and square, with the weight supported by the foot-rest and back as well as by the seat of the chair, should be taught to write with an upright hand, avoiding the slope which leads to sitting sideways with the left shoulder lowered. (e) malt extract, cod liver oil, parrish's food, and other tonics may be of undoubted service. (3) rheumatism and chorea it is certain that there is a close association between rheumatism in childhood and the common nervous affection known as chorea. we are still ignorant of the precise nature of the infection which we know as rheumatism. there is much to suggest that in rheumatism we have to deal only with a further stage in those catarrhal infections to which so much infantile ill-health is to be attributed, and that endocarditis and arthritis, when they arise, signalise the entry of these catarrhal, non-pyogenic organisms into the blood stream, overcoming at last the barrier of lymphoid tissue which has hypertrophied to oppose their passage. certainly the connection of rheumatism with catarrhal infections of the mucous membranes and adenoid enlargements of all sorts is a close one. whatever its nature, the rheumatic infection in childhood is more lasting and chronic than in adult life. rheumatism in childhood is not manifested by acute and short-lived attacks of great severity so much as by a long-continued succession of symptoms of a subacute nature, a transient arthritis, perhaps, succeeding an attack of sore throat with torticollis, to be followed by carditis, to be followed again by another attack of tonsillitis. and so the cycle of symptoms revolves. in most cases the child grows thin and weak; in most cases he becomes restless, irritable, and unhappy; often there is definite chorea. of this cerebral irritability chorea is the expression. in adults, chorea is perhaps more obviously associated with mental stress of all sorts and with states of excitement and agitation. in the case of little children it is often only the mother who really appreciates how radical an alteration the child's whole nature has undergone, and how great the element of nervous overstrain has been before the chorea has appeared. of the treatment of chorea there is no need to speak. it is purely symptomatic. isolation, best perhaps away from home, as might be expected, gives the best results. if there are pronounced rheumatic symptoms, the salicylates will be needed; if there is anæmia, arsenic and iron; if there is sleeplessness and great restlessness, bromides or chloral. hypnotism is often almost instantly successful, but, apart from hypnosis, curative suggestions proceeding from the attendants form the principal means at our disposal. (4) exhaustion and katatonia a large number of children, in convalescence from infective disorders, when the nutrition of the body has fallen to a low ebb, show as evidence of cerebral exhaustion a group of symptoms which in a sense are the reverse of those which characterise cerebral irritation and chorea. the healthy child is a creature of free movement. the children we are now considering will sit for a long time motionless. the expression of their faces is fixed, immobile, and melancholy. if the arm or leg is raised it will be held thus outstretched without any attempt to restore it to a more natural position of rest for minutes at a time. the posture and expression remind us at once of the katatonia which is symptomatic of dementia præcox and other stuporose and melancholiac conditions in adult life. symptoms of this sort are especially common in children with intestinal and alimentary disturbances of great chronicity. the symptom is so frequently met with that it is strange that it should have attracted so little attention as compared with the contrasting condition of chorea. and yet it is of more serious significance, more difficult to overcome, and with a greater danger that permanent symptoms of neurasthenia will result. in early childhood a careful dietetic régime, suitable hygienic surroundings, and a stimulating psychical atmosphere will often effect great improvement. as in chorea, however, relapses are frequent, and there are cases which for some unexplained reason are peculiarly resistant to all remedial influences. (5) hysteria in hysteria, in contrast to the types previously described, the infective element may be completely absent. except in some special features of minor importance the symptoms of hysteria do not differ from those of adults, and, as in adult age, the condition of hysteria may be present although the physical development may be perfect. we cannot here speak of any physical characteristics which are associated with the nervous symptoms. the third or fourth year represents the age limit, below which hysterical symptoms do not appear. thereafter they may be occasionally met with, with increasing frequency. at first, in the earlier years of childhood, there is no preponderance in the female sex. as puberty approaches, girls suffer more than boys. it may be said to be characteristic of hysteria in childhood that its symptoms are less complex and varied than in adult life. the naive imagination of the child is content with some single symptom, and is less apt to meet the physician half-way when he looks for the so-called stigmata. similarly mono-symptomatic hysteria is characteristic of oases occurring in the uneducated or peasant class. in children, hysterical pain, hysterical contractures or palsies, mutism, and aphonia are the most usual symptoms. hysterical deafness, blindness, and dysphagia are manifestations of great rarity in childhood. chapter xii the nervous child in sickness in time of sickness the management of the nervous child becomes very difficult. restlessness and opposition may reach such a pitch that it may be almost impossible to confine the patient to bed or to carry out the simplest treatment. sometimes days may elapse before the sick-nurse who is installed to take the place of the child's usual attendant is able to approach the cot or do any service to the child without provoking a paroxysm of screaming. in such a case any systematic examination is often out of the question, with the result that the diagnosis may be delayed or rendered impossible. there is only one reassuring feature of a situation, which arises only in nurseries in which the management of the children is at fault; the doctor has learned from experience that this pronounced opposition of the child to himself, to the nurse, and even to the mother, is of itself a reassuring sign, indicating, as a rule, that the condition is not one of grave danger or extreme severity. when the child is more seriously ill, opposition almost always disappears, and the child lies before us limp and passive. only with approaching recovery or convalescence does his spirit return and renewed opposition show itself. extreme nervousness in childhood carries with it a certain liability towards what is known as "delicacy of constitution." the sensitiveness of the children is so great that they react with striking symptoms to disturbances so trivial that they would hardly incommode the child of more stable nervous constitution. for example, a simple cold in the head, or a sore throat, may cause a convulsion or a condition of nervous irritability which may even arouse the suspicion that meningitis is present. or, again, a little pharyngeal irritation which would ordinarily be incapable of disturbing sleep may be sufficient to keep the child wide awake all night with persistent and violent coughing. the little irritating papules of nettlerash from which many children suffer are commonly disregarded by busy, happy children during the day, and even at night hardly suffice to cause disturbance. the nervous child, on the other hand, will scratch them again and again till they bleed, tearing at them with his nails, and making deep and painful sores. the temperature is commonly unstable and readily elevated. moreover, feverishness from whatever cause is often accompanied by an active delirium, which is apt to occasion unnecessary alarm. this symptom of delirium is always a manifestation of an excitable temperament. i remember being called to see a young woman who was thought to be suffering from acute mania. examination showed that she was suffering from pneumonia in the early stages. it was only later that we discovered that she had always been of an unstable nervous temperament, and had been in an asylum some years before. those of us who are fortunate in possessing a placid temperament and have developed a high degree of self-control are not likely to show delirium as a prominent symptom should we fall ill with fever; just as we should not struggle and scream too violently when we "come round" from having gas at the dentist's. looked at from this point of view, it is natural for all children to become delirious readily, and this tendency is peculiarly marked in those who are unduly nervous. as a consequence of this extreme sensitiveness, the nervous child is likely to suffer more than others from a succession of comparatively trifling ailments and disturbances. the delicacy of the child has, in this sense, a real existence, and is not confined to the imagination of over-anxious and apprehensive parents. no doubt the nervous mother of an only child does worry unnecessarily, and is far too prone to feed her fears by the daily use of the thermometer or the weighing-machine; but her friends who are happy in the possession of numerous and placid children are not justified in laying the whole blame upon her too great solicitude. children who are members of large families, whose nervous systems have been strengthened by contact with their brothers and sisters, are not habitually upset by trifles, and suffer even serious illnesses with symptoms of less severity. nervous children, and only children, on the other hand, show the opposite extreme. nevertheless, the mother of a nervous and delicate child--a child, that is to say, who, even if he is not permanently an invalid, nevertheless never seems quite well and lacks the robustness of other children--should realise clearly how much of this sensitiveness is due to the atmosphere of unrest and too great solicitude which surrounds him. it is a matter of universal experience that excess of care for only children has a depressing influence which affects their character, their physical constitution, and their entire vitality. at all costs we must hide our own anxieties from the child, and we must treat his illnesses in as matter-of-fact a way as possible. when illness comes, his daily routine should be interrupted as little as possible. in dealing with nervous children, it is often better to lay aside treatment altogether rather than to carry out a variety of therapeutic procedures which have the effect of concentrating the child's mind upon his symptoms. when we grown-up people are sick, we often find a great deal of comfort in submitting ourselves to some form of treatment. we have great faith, we say, in this remedy or in that. it is _our_ remedy, a _nostrum_. the physician knows well that the opportunities which are presented to him of intervening effectually to cut short the processes of disease by the use of specific cures are not very numerous, and that often enough the justification for his prescription is the soothing effect which it may exercise upon the mind of the patient, who, believing either in the physician or in his remedy, finds confidence and patience till recovery ensues. as a rule this form of consolation is denied to little children. they have no belief in the efficacy of the remedies which are applied with such vigour and persistence. indeed, it is not the child, but his anxious mother, who finds comfort in the thought that everything possible has been done. therefore, a prescription must be written and changed almost daily, the child's chest must be anointed with oil, and the air of the sick-room made heavy with some aromatic substance for inhalation, and all this when the disturbance is of itself unimportant, and owes its severity only to the undue sensitiveness of the child's nervous system. the very name of illness should be banished from such nurseries. everything should be done to reassure the child and to make light of his symptoms, and we can keep the most scrupulous watch over his health without allowing him to perceive at all that our eye is on him. with older children the evil results of suggestions, unconsciously conveyed to them by the apprehension of their parents, become very obvious. the visit of the doctor, to whom in the child's hearing all the symptoms are related, is often followed by an aggravation which is apt to be attributed to his well-meant prescription. the harm done by examinations, which are specially calculated to appeal to the child's imagination, as, for instance, an x-ray examination, is often clearly apparent. i remember a schoolboy of thirteen who was sent to me because he had constantly complained of severe abdominal pain. he was a nervous child with a habit spasm, the son of a highly neurotic father and an overanxious mother. an x-ray examination was made, but showed nothing amiss. the child's interest and preoccupation in the examination was painfully obvious. that night his restraint broke down altogether, and he screamed with pain, declaring that it had become insupportable. younger children, less imaginative but equally perverse, noticing how anxiously their mothers view their symptoms, will often make complaint merely to attract attention and to excite expressions of pity or condolence. sometimes they will enforce their will by an appeal to their symptoms. i have had a little patient of no more than thirteen months of age who suffered severely and for a long time from eczema, and who in this way used his affliction to ensure that he got his own way. if he was not given what he wanted immediately he would fall to scratching, with an expression upon his face which could not be mistaken. to him, poor child, the grown-up people around seemed possessed of but one desire--to stop his scratching; and he had learnt that if he showed himself determined to scratch they would give way on every other point. the ill-effects of departing too readily from ordinary nursery routine on account of a little illness, and of adopting straightway a variety of measures of treatment, is well shown in cases of asthma in children. the asthmatic child is almost always of a highly nervous temperament, and often passionate and ungovernable. often the most effective treatment of an attack, which usually comes on some hours after going to bed, is to make little of it, to talk naturally and calmly to the child, to turn on the light, and to allow him, if he will, to busy himself with toys or books. to be seized with panic, to send post-haste for the doctor, to carry the patient to the open window, to burn strong-smelling vapours, and so forth, not only is apt to prolong the nervous spasm on this occasion, but makes it likely that a strong impression will be left in his mind which by auto-suggestion will provoke another attack shortly. with nervous children a seeming neglect is the best treatment of all trivial disorders. meanwhile we can redouble our efforts to remedy defects in management, and to obtain an environment which will gradually lower the heightened nervous irritability. when the illness is of a more serious nature, as has been said, the restlessness as a rule promptly disappears. in each case it must be decided whether it is best for the child to be nursed by his mother and his own nurse, or by a sick-nurse. in the latter event the ordinary nurse and the mother should absent themselves from the sick-room as much as possible. often the firm routine of the hospital nurse is all that is wanted to obtain rest. less often, the child will be quiet with his own nurse, and quite unmanageable with a stranger. there is, however, another side to the question. the relation of neurosis in childhood to infection of the body is complex. i have said that with the nervous child a trivial infection may produce symptoms disproportionately severe. persistent and serious infection, however, is capable of producing nervous symptoms even in children who were not before nervous, and we must recognise that prolonged infection makes a favourable soil for neuroses of all sorts. the frequency with which st. vitus's dance accompanies rheumatism in childhood forms a good example of this tendency. the child who, from time to time, complains of the transient joint pains which are called "growing pains," and who is found by the doctor to be suffering from subacute rheumatism, is commonly restless, fretful, and nervous. appetite, memory, and the power of sustained attention become impaired. often there is excessive emotional display, with, perhaps, unexplained bursts of weeping. the child is readily frightened, and when sooner or later the restless, jerky movements of st. vitus's dance appear, the usual explanation is that some shock has been experienced, that the child has seen a street accident, has been alarmed by a big dog jumping on her, or by a man who followed her--shocks which would have been incapable of causing disturbance, and which would have passed almost unappreciated had not the soil been prepared by the persistent rheumatic infection. the management of the nervous child whose physical health remains comparatively good is difficult enough, but these difficulties are increased many times when the physical health seriously fails. to steer a steady course which shall avoid neglecting what is dangerous if neglected, and overemphasising what is dangerous if over-emphasised, calls for a great deal of wisdom on the part both of the mother and her doctor. chapter xiii nervous children and education on sexual matters in this chapter i approach with diffidence a subject which is rightly enough occupying a great deal of attention at the present time: the instruction of our children in the nature, meaning, and purpose of sexual processes. it is a subject filled with difficulties. every parent would wish to avoid offending the sense of modesty which is the possession of every well-trained child, and finds it difficult to escape the feeling that discussion on such matters may do more harm than good. there is certainly some risk at the present time that, putting reticence on one side, we may be carried too far in the opposite direction. the evils which result from keeping children in ignorance are well appreciated. we have yet to determine the effect upon them of the very frank and free exposure of the subject which is recommended by many modern writers. nevertheless, it must be granted that it is not right to allow the boy or girl to approach adolescence without some knowledge of sex and the processes of reproduction. if nothing is said on such subjects, which in the nature of things are bound to excite a lively interest and curiosity in the minds of older children, evil results are apt to follow. because parents have never mentioned these subjects to their child, they must not conclude that he is ignorant of all knowledge concerning them. it is not unlikely that the question has often occupied his thoughts, and that his speculations have led him to conclusions which are, on the whole, true, although perhaps incorrect in matters of detail. most children, unable to ask their mother or father direct questions upon matters which they feel instinctively are taboo, have pieced together, from their reading and observation, a faulty theory of sexual life. the pursuit of such knowledge, in secret, is not a healthy occupation for the child. his parents' silence has given him the feeling that the unexplored land is forbidden ground. in satisfying his curiosity he is most certainly fulfilling an uncontrollable impulse, but he has been forced to be secretive, and to look upon the information he has acquired as a guilty secret. so far even the best of children will go upon, the dangerous path. if training has been good, and if the child has responded well to it, he will go no further. though he can hardly be expected to refrain from constructing theories and from testing them in the light of any chance information which may come his way, he will instinctively feel that the subject is one best left alone. he will not talk of it with other boys--not even with those who are older than himself and whose superior knowledge in all other matters he is accustomed to respect. we need not be surprised, however, that the majority of children do not attain to this high standard of conduct, and that the interest and excitement of exploring the unknown and the forbidden proves too great. children will consult with each other about such matters, and knowledge of evil may spread rapidly from the older to the younger. in some schools, as is well known, there may grow up with deplorable facility an unhealthy interest in sexual matters. on the surface of school life all may seem fair enough, but beneath, hidden from all recognised authority, lies much that is unspeakable. if the boy has not been taught to have clean thoughts upon matters which are essentially clean, if he has not learned to know evil that he may avoid it, he may not escape great harm. the fault in us which kept him in ignorance will recoil upon our own heads. he will maintain the barrier which was erected in the first place by our own unhappy reticence, and we may find it a hard task to penetrate behind it and prevent his constant return to secret thoughts and imaginings or secret habits and practices. certain physiological processes come to have for him an unclean flavour which is yet perniciously attractive. he knows little of the real meaning of sexual processes or of the great purpose for which they are designed. it is only that an unhealthy interest becomes attached to all subjects which are scrupulously avoided in general conversation. in secret he develops a wrong attitude to all these matters. oliver wendell holmes[4] tells us that in religion certain words and ideas become "polarised," that is to say, charged with forces of powerful suggestion, and must be "depolarised." [footnote 4: _the professor at the breakfast table_, oliver wendell holmes.] * * * * * "i don't know what you mean by 'depolarising' an idea, said the divinity-student. "i will tell you, i said. when a given symbol which represents a thought has lain for a certain length of time in the mind, it undergoes a change like that which rest in a certain position gives to iron. it becomes magnetic in its relations--it is traversed by strange forces which did not belong to it. the word, and consequently the idea it represents, is polarised. "the religious currency of mankind, in thought, in speech, and in print, consists entirely of polarised words. borrow one of these from another language and religion, and you will find it leaves all its magnetism behind it. take that famous word, o'm, of the hindoo mythology. even a priest cannot pronounce it without sin; and a holy pundit would shut his ears and run away from you in horror, if you should say it aloud. what do you care for o'm? if you wanted to get the pundit to look at his religion fairly, you must first depolarise this and all similar words for him. the argument for and against new translations of the bible really turns on this. scepticism is afraid to trust its truths in depolarised words, and so cries out against a new translation. i think, myself, if every idea our book contains could be shelled out of its old symbol and put into a new, clean, unmagnetic word, we should have some chance of reading it as philosophers, or wisdom-lovers, ought to read it--which we do not and cannot now, any more than a hindoo can read the 'gayatri' as a fair man and lover of truth should do." * * * * * now in the minds of many boys and some girls certain words and ideas connected with certain physiological processes become polarised. it is the parents' duty to depolarise them. it is a task which cannot well be deputed to others; nor can much help be derived from books, though many have been written with the object of initiating children into the mysteries of sex. no one but a parent is likely to be on sufficiently intimate terms with the child to enable the subject to be approached without restraint or awkwardness, and no book can adapt itself to the varying needs of individual children. an exposition in cold print, or a single formal lecture on the subject, is apt to do more harm than good. i have seen instructions to parents to deliver themselves of set speeches, examples of which are given, which seem to me well calculated to repel and frighten the nervous child. still more dangerous is the advice to make sexual hygiene a subject for class study. the task requires that parents should be upon very intimate terms with their children, and on suitable occasions, when this feeling of intimacy is strong, children should be encouraged to speak freely and to ask for explanations. by a judicious use of such opportunities piece by piece the whole may be unfolded. in order that the child may approach the subject in the proper spirit we may stimulate interest by a few lessons in natural history. a child of eight or ten years of age is not too young to learn a little of the outlines of anatomy and physiology. if he is told a few bald facts about the skeleton, about the circulation and the processes of digestion such as any parent can teach at the cost of a few hours' study of a handbook, this will lead naturally enough, in later lessons, to a similar talk upon the excretory organs, reproduction, and the anatomy and processes of sex, suitable to the individual. to achieve "depolarisation," there is nothing more efficacious than the frankness and explicitness of scientific statement, however elementary. later a little knowledge of botany and zoology will enable a parent to sketch briefly the outlines of fertilisation and reproduction. the child may grasp the conception that the life of all individual plants and animals is directed towards the single aim of continuing the species. he can be told how the bee carries the male pollen to the female flower, how all living things habitually conjugate, the lowest in the scale of development as well as the highest, and how the fertilised egg becomes the embryo which is hatched by the mother or born of her. as the child grows older and understands more and more of these natural processes an opportunity can be used to make the presentation of the subject more personal. he can be told that during childhood his own sexual processes have been undeveloped, but that as he grows older they will awake. that with their awakening in adolescence new temptations to self-indulgence in thought or action may assail him, but that these temptations are delayed by the wisdom of nature until his understanding has grown and his man's strength of character has developed. a high ideal of purity should be set before boy and girl alike, and the conception of sex from the beginning should be associated in their minds with the high purpose to which some day it may be put. before the boy goes to a boarding-school he should have imbibed from his father the desire for moral cleanliness, the knowledge of good and of evil, and a cordial dislike for everything that is sensual, self-indulgent, or nasty. talks on such subjects should be very infrequent, but i believe that, if "depolarisation" is to be achieved, they must be repeated every now and then during later childhood and in adolescence. to attempt to impart all this interesting information in a single constrained and awkward interview is to court failure, or at least to run the risk that the explanation is not fully understood, so that the child is mystified, or even offended in his sense of propriety. i have dwelt at some length upon this question of sex education, because it is one of especial difficulty when we have to deal with a child of nervous inheritance, or with a child in whom symptoms of neurosis have developed in a faulty home environment. misconduct in sexual matters is a sign of deficient nervous and moral control, and when the conduct in other respects is ill-regulated, the development of sexual processes must be watched with some anxiety. there are those who see a still more intimate relationship between errors of conduct or symptoms of neurosis in childhood and the sexual instincts. it is perhaps necessary here briefly to refer to the teaching of sigmund freud of vienna, because his views have attracted a great deal of attention in this country and have become familiar to a great part of the reading public. freud believes that the origin of many abnormal mental states and of the disturbances of conduct which are dependent upon them is to be traced back to forgotten experiences, the recollection of which has faded from the conscious mind, but which are still capable of exerting an indirect influence. he regards the process of forgetting, not as merely a passive fading of mental impressions, but as an active process of repression, by which the experience, and especially the unpleasant experience, is thrust and kept out of consciousness. there thus arises a mental conflict between the forces of repression and the forces which tend to obtrude the recollection into consciousness, and at times the energy engendered in this conflict escapes from the censorship of the repressing forces and finds vent in the production of abnormal mental states or disorders of conduct. thus to take a simple example, a business man who has had a trying day at the office, on returning home in the evening may succeed in thrusting out of his consciousness the thought of his disappointments and worries, yet the disturbance in his mind may show itself in quarrels with his wife or complaints of the quality of the cooking at dinner. freud has called attention to the part which the suppressed and long-forgotten experiences of early childhood play in the production of neuroses of all sorts at a later date, and he has laid especial emphasis on sexual experiences as peculiarly fruitful causes of such disturbances. those who have embraced freud's teaching have gone even farther than he in this direction, and by psycho-analysis--that is to say, by attempting in intimate conversation to arouse the dormant memory and lay bare the buried complex, the suppression of which has produced the conflict in the mind of the sufferer--will seldom fail to discover the influence of sexual forces and sexual attractions which, while capable of causing disorders of mind and of conduct, show themselves only obscurely and indirectly, as, for example, in dreams or in symbolic form. so far as the nervous disorders of children are concerned, much that is written to-day upon the influence of repressed sexual experiences may be dismissed as grotesque and untrue. the conclusions to which the psycho-analyst is habitually led, and which he puts forward with such confidence, can be convincing only to those who have replaced the study of childhood by the study of the writings of freud and his school. thus it is common enough to find a mother complaining that her child of two or three years of age is bitterly jealous of the new baby who has come to share with him his mother's love and attention. according to the views of freud, we are to recognise in this jealousy an exhibition of the sexual instincts of the older child, who scents a possible rival for the affections of his mother. even if we give to the term sexual the widest possible meaning, it is difficult for a close observer of children to detect any truth in this conclusion. the behaviour of the older child to the newly born will be determined mainly by the attitude adopted by the grown-up persons around him and by the unconscious suggestions which his impressionable mind receives from them. if the mother is fearful of what may happen, and refuses to leave the children alone, she will find it hard to hide from the older child her conviction that danger is to be apprehended from him. if this suggestion acts upon his mind, and if the reputation that he is jealous of the new baby becomes attached to him, he will assuredly not fail to act up to it, and her daily conduct will appear to prove the justness of his mother's apprehension. fortunately, mothers are commonly able to divest themselves of such fears as these. the older child is brought freely to the baby to admire him, to bestow caresses on him, and to speak to him in the very tones of his elders. in a few days his reputation is established, that he is "so fond of the baby," and to this reputation too he faithfully conforms. we have seen in an earlier chapter that constantly and ostentatiously to oppose a child's will is to produce a counter-opposition which because of its persistence and vigour appears to have behind it the strongest possible concentration of mind and power of will. yet if we cease to oppose, the counter-opposition which appeared so formidable at once dissolves, and the difficulty is at an end. we took as an example the child's apparent determination to approach as near as possible to the fire, the one place in the room which our fear of accident forbids him. the difficulty with the new baby is but another example of the same tendency. if he does not know that the ground is forbidden, if we do not concentrate his attention on the prohibition, he will show no particular desire to approach it. his apparent jealousy of his little brother is the result not of the rivalry of sex, but of bad management. again, it is occasionally a subject of complaint that children will apparently dislike their father, that they will shrink from him or burst into tears whenever he approaches them. there is no need to see in this the child's jealousy of the father as a rival in the affections of his mother, which is the explanation proffered by the school of freud. every action and every occupation of the child during the whole day can be made a pleasure or a pain to him, according to the attitude of his nurse and mother towards it. eating and drinking should be pleasant and are normally pleasant. the same forces which are sufficient to make every meal-time a signal for struggling and tears, are sufficient to produce this dislike, apparently so invincible, to the father of his being. although the nervous troubles of infancy are not commonly due, as freud and his numerous followers would have us believe, to suppressed sexual desires or experiences, it is clear that in the sensitive mind of the child the reception of a severe shock may have effects long after the memory of it has disappeared from consciousness. in a medical journal there was recently recounted the case of an officer of the r.a.m.c. who all his life had suffered from claustrophobia--the fear of being shut up in a closed space. by skilful questioning, the remembrance of a terrifying incident in his childhood was regained. as a child of five he had been shut in a passage in a strange house by the accidental banging to of a door, unable to escape from the attentions of a growling dog. a complete cure was said to follow upon the discovery that in this incident lay the origin of the phobia. nevertheless, observation would lead me to lay the greater stress not upon any one particular shocking or terrifying experience, but upon the attitude of parents and nurses in focusing the child's attention upon the danger, and in sapping his confidence by showing their own apprehensions and communicating them to him. as a method of treatment for neuroses of childhood, psycho-analysis is not only unsuccessful, it has dangers and produces ill effects which far outweigh any advantage which may be gained from it. there can be no doubt that freud has exaggerated the part which sexual impulses play in causing neurosis. it will be sufficient for us to recognise that for the nervous child the sexual life has especial dangers, and we should redouble our efforts to prevent his ideas on the subject becoming "polarised." for the child whose environment has been well regulated and who has developed strength of character, self-control, and self-respect, there need be no fear. chapter xiv the nervous child and school at the onset of puberty childhood comes to an end, and the period of adolescence begins. into these further stages of development it is not proposed to enter, but it may be well to consider a question which is apt to present itself for answer at this period: "should the boy, or girl, of nervous temperament, or whose development up to this point has been accompanied by symptoms of nervous disorder, be sent to a boarding-school?" so long as the child remains at home the home environment is the force which alone is concerned in moulding his character. we have seen how plastic the young child is, how imitative, how suggestible, how prone to form habits good or bad. the diversity of type shown by the homes is reflected in the diversity of character and conduct exhibited by the children. the home is the culture medium, and in no two homes is its composition the same. for each child home influence remains to a great extent unchanged, and in great part unchangeable. its action upon the child is constant and long sustained. hence, it is not surprising that the growth of his character and powers is commonly unequal. at one point we may find a good crop of virtues, at another a barren tract; and the home influences which have ripened the one and blighted the other are calculated by the lapse of time to increase the contrast rather than to diminish it. i suppose it is for this reason that the custom of sending children to boarding-schools has so firm a hold among us. the boarding-school forms an environment selected to correct the inequalities which result from the special action upon the child of individual homes. the life of a boy in one of our large public schools is well calculated to act as a corrective in this way not only by reason of its ordered routine and discipline, but still more because it is affected, perhaps for the first time, by the strong force of public opinion. it is the strength of this public opinion which gives to our public schools their peculiar character and produces their peculiar effects. that which the schoolboy most despises is what he calls "bad form," and he bows down and worships an idol he himself has set up, the name of which is "good form." public opinion forms the code of morals observed in the school. the standard set is commonly not so high as to be very difficult of attainment. it demands many good qualities. to lie, to sneak, to tell tales, to bully, to "put on side," are bad form. in some respects the definition of what is virtuous may be a little hazy. thus it may be wrong to cheat to gain a prize, but to copy from one's neighbour only so much as will enable one to pass muster and escape condemnation is no great sin. in short, good form demands that a boy should have all the social virtues: that he should be a good fellow, easy to live with, and possessed of a high sense of public spirit--good qualities certainly, though perhaps not those which help to make the reformers or martyrs of this world. the school life is the life of the herd, and to be successful in it the boy must mingle with the herd, not break from it or shun it. good form--if we came to analyse the conception that underlies it--consists only in a close approximation to the standard pattern; bad form, in any deviation from it. it is this similarity of type and community of ideals which makes it so easy for most public-school boys to get on well with one another. when in after life they are thrown among a set of men who know nothing of their conception of good form, and whose training has been on completely different lines, there may be a corresponding difficulty. now what is true of public-school life is of course also true of the larger life after schooldays are over for which all education is a preparation. these qualities of sociability and good sportsmanship will stand a man in good stead throughout life. even the most ardent and active spirit will benefit by being subjected for some years to this steady pressure of public opinion. the most part will learn from it good sense, consideration for others, and self-control. as they pass from the lower forms to the higher in the school they will learn too to support authority without doing injustice, and to bring the weight of public opinion to bear upon others. and to all this training many a man owes his happiness in after life--a happiness which he could not have secured if his character had been moulded only by the environment of his home, or by the home in combination with the less-powerful corrective of a day school. for the nervous child the passage from home to school life may involve considerable mental strain. he may be morbidly self-conscious and timid, or, unknown to himself--because he has as yet no power of self-analysis and has no opportunities of comparing himself with others--he may have developed certain eccentricities. in most cases the plunge into school life will be taken well enough; in a few the little vessel will not right itself, and proves permanently unseaworthy. no doubt as a rule a private school will have preceded the public school, and this gradation should make the entrance to the public school a lesser ordeal. but it often happens that it is just in the case of the nervous child that this intermediate stage has been omitted, and that his thirteenth birthday finds him still in the home circle. if the boy's father has first-hand knowledge of life in the lower forms of public schools, his experience may enable him to form some estimate of the effect of school life upon the nervous system of his son. it is when parents or guardians have no such experience of their own to guide them that mistakes are most liable to be made. i can myself remember the unhappy state of some solitary and eccentric schoolfellows of mine who aroused the resentment of "the herd" by their behaviour or opinions. if it is clear that the boy has a peculiar temperament and is likely to suffer in this way, some _via media_ must be found. the home has failed so that he must leave home and come under the influence of some one who understands the nature of the difficulty and can adapt the boy to school life. a change of environment of this sort as a preliminary to the public school is often all that is needed. if his age permits, every effort should be made in this way to obtain for the nervous child who has developed peculiarities or faults the benefits of a public-school education. some types of nervous children will show immediate improvement when they go to school. the boy who is passionate and disobedient, and whose parents cannot control him, is best at school. boys who, from being much with grown-up people, have become too precocious and have acquired the habits and tastes of their elders, will dislike school at first, but it will do them good. their fault shows that they are quick to learn and sensitive to the influences of others, and they will soon adapt themselves to their new surroundings. boys who are dreamy and imaginative, who early adopt a "specialist" attitude towards life, who, however ignorant they may be of everything else, cultivate a reputation for omniscience in some particular subject, such as egyptology, astronomy, or the construction of battleships, are usually nervous boys whose symptoms will disappear at school. where undue timidity, phobia, or habit spasm is present, the question is more difficult to decide. every individual case must be studied as a whole, and our object should be not unnecessarily to deprive the boy of the wholesome training of public-school life. there are parents who from sheer ignorance add to the difficulties which the boy encounters in going to school. failure to appreciate very small points may cause unnecessary suffering. to be the only boy in the school to wear combinations is not a distinction that any new boy craves, however strong his nerves may be. a friend of mine still relates with feeling how, twenty years ago, he arrived at school with shirts which _buttoned_ at the neck! at night when every one else in the dormitory was asleep he sat for hours on his bed, miserable beyond words, removing the buttons and doing his best in the dark to bore buttonholes which would admit what every other boy in the school had--a collar stud. with girls perhaps this question of fitness for school life does not arise in so urgent a way. girls are usually older when they go to school, and girls' schools are perhaps less terrifying and more like home. there is, however, one important point which should be borne in mind. the date of the onset of puberty varies much in both sexes. if the boy grows to a great hulking fellow at fourteen, and even displays a desire secretly to borrow his father's razor, he is at no particular disadvantage as compared with his fellows. he is so much bigger and stronger than the others that he may thereby early enjoy the distinction of playing at "big side," or of getting a place in the school eleven. he is probably much envied by those of the same age who, with the aid of their youthful aspect, can still occasionally extract compensation by inducing the railway company to let them travel to school at half fare. but with girls it is different. many at fourteen or fifteen are children still; some are grown up, with the tastes, feelings, and attraction of maturity. those who have developed fastest are often, for that very reason, kept backward in school learning. often they are nervously the least stable. now that large schools for girls on the model of our public schools are become the fashion, such precociously developed and nervously unstable girls are apt to find themselves in the very uncongenial society of little girls of twelve or thirteen. the elder girls commonly hold aloof, while mistresses are apt to view this precocious development with disapproval, and to attempt to retard what cannot be retarded by insisting that the young woman has remained a child. i remember being called in consultation by a surgeon who had been asked to operate for appendicitis upon a girl of fourteen. i found a tall, well-grown girl, with an appearance and manner that made her look four years older. i could find no signs of appendicitis, but i learned from her that she had been for three months at a large girls' school, and that in a few days' time her second term was due to begin. as we became friends, she agreed that her appendicitis and her resolve not to return to school, where she was unhappy, were but different ways of saying the same thing. she was an only child who had travelled a great deal with her parents, had found her interests in their pursuits, and had grown backward in school work. the little girls with whom she was expected to associate seemed to her mere children. the elder girls did not want her friendship, and snubbed her. i prescribed a change to a small boarding-school with only a few girls, where age differences would not matter so much, and where she could make friends with girls older than herself, though not more mature. into their school life we need not follow the children. happily the time is past when schoolmasters and schoolmistresses were incapable of understanding their charges, and confounded nervous exhaustion with stupidity or timidity with incapacity. and so we come back to the point from which we started: the nervous infant, restless, wriggling, and constantly crying! the nervous child, unstable, suggestible, passionate, and full of nameless fears! the nervous schoolboy or schoolgirl prone to self-analysis, subject-conscious, and easily exhausted! and how many and how various are the manifestations of this temperament! refusal of food, refusal of sleep, negativism, irritability, and violent fits of temper, vomiting, diarrhoea, morbid flushing and blushing, habit spasms, phobias--all controlled not by reproof or by medicine, but by good management and a clear understanding of their nature. the hygiene of the child's mind is as important as the hygiene of his body, and both are studies proper for the doctor. neuropathy and an unsound, nervous organisation are often enough legacies from the nervous disorders of childhood. index abdomen, prominent abdominal symptoms of neurosis accent, local, facility with which acquired acetone, in breath and urine during cyclic vomiting acidosis, accompanying cyclic vomiting action, imitativeness of liberty of, in early childhood activities in the nursery not to be restrained without intervention of grown-up people wonderful nature of adenoid vegetations, night-terrors aggravated by removal of, in treatment of enuresis adolescence, and education on sexual matters adults, child in relation to the society of æsthetic sense, in early childhood affection, in the child air hunger, in cyclic vomiting air swallowing, habitual action of albuminuria, associated with faulty posture cause of, in neuropaths allimentary disturbances, symptom of alkali, in treatment of cyclic vomiting anæmia, of neuropaths anorexia nervosa a case illustrating apnoea, fatal cases of following burst of crying twitching of facial muscles in appetite, emotional states affecting loss of, case illustrating causes and characteristics treatment means of stimulating nature of the sensation of apprehension, causes of growth of neuroses in atmosphere of artificial feeding aspirin asthma, treatment of attention, child's love of attracting examples of authority, delight in defying over-exercise of, by parents, results of babies. _see_ newborn baby backward development signs of "bad form" bad habits bath, baby's first experience of bed, dislike of how overcome efforts to resist preparation for bedroom, airing and temperature of bedtime management at bed wetting. _see_ enuresis behaviour. _see_ conduct bladder, hydrostatic distension of, for enuresis boarding-schools, object of bodily ailments, and instability of nervous control, connection between _see also_ disorders body, and mind, development of development of environment influencing effect of mind on gradual alterations in the shape of infantile characteristics in later childhood bone, and muscle, changes in, in infantile children books, child's attitude towards educative value of kinds most suitable brachial nerve, pressure causing tetany breast-feeding, best time for causes of failure in observations on _see also_ lactation breath-holding action during fatal cases of phenomena of bromides, administration of to newborn baby cajoling, futility of calcium bromide, in treatment of spasms calcium metabolism, disturbance of care, ill effects of excess of carpo-pedal spasm catarrhal infections connection of rheumatism with, 155 cerebral anæmia cerebral circulation, stagnation of cerebral exhaustion. _see_ mental exhaustion cerebral functions, rapid growth of unstable in the child _see also_ mental character, formation of during school life home influence in the development of ideals of, how inculcated children's parties, disadvantages of chloral, administration of to newborn baby in treatment of spasms chorea, and rheumatism, association between symptom of cerebral irritability treatment of chvostek's sign, characteristics and nature of circulation, cerebral, stagnation of nervous control of claustrophobia clothing, kind suitable new, child's delight in coaxing, futility of cold douches, improving vasomotor tone coldness of extremities conduct, control of, factors in errors of, and sexual instincts control of correction of due to faults of management in neuropathic children excessive introspection influencing ideals of, how inculcated influence of environment on influenced by suggestion mother's influence on of neuropaths perverse suggestion in the control of constipation, mental causes of negativism in perversion of suggestion a common cause of suggestion in relation to constitution, delicacy of convulsions, fatal cases of generalised convulsive disorders cough, nervous counter-opposition, child's opposition growing with crying, constant formation of habit of in emotional and excitable children management of mechanism of phenomena of purposeful cyclic or periodic vomiting. _see_ vomiting day-dreams, indicating nervous temperament deceit defæcation, inhibition of painful delicacy of constitution delirium, tendency to depolarisation of ideas depression, recurrence of periods of dexterity, lack of manual, advantages of toys developing diaphragm, spasm of diarrhoea, mucous diet, likes and dislikes for articles of opposition to of newborn child, changes in _see also_ food digestion, emotional states affecting digestive disorders, mental causes of digestive neuroses digestive system, symptoms of extreme sensibility of dirt eating discipline in later childhood in the school misdirected efforts at enforcing severe, effects of dishonesty disobedience, growth of habit of personality and perverse attitude of reproof and coaxing causing disorders, ætiology of associated with neurosis common environment as cause and cure of of neuropaths treatment of trifling diuresis, excessive doll, child's care of, an example of imitativeness educative value of douches, cold, improving vasomotor tone dover's powder dreams, nature of, indicating nature of mental unrest drugs, in sleeplessness ductless glands, in relation to infantile characteristics dullards dyspepsia, complications of course and effects of mental aspects of nervous symptoms of symptoms in newborn infant treatment early childhood, care during impulse of opposition in love of power in early childhood, nervousness in reasoning power in three common neuroses of toys, books, and amusements in _see also_ newborn baby education, aim of by games and toys on sexual matters educative value, of books, games, and toys emotional states, appetite affected by causing spasm management of of neurotics, exaggeration of physical disturbances due to producing laryngismus stridulus emotional storms endocrine glands enuresis, causal factors in characteristics and peculiarities of condition of urine during mental aspects of mistakes in treatment of perversion of suggestion as cause of removal of tonsils in treatment, essentials in hypnotic suggestion in methods of environment, body moulded and shaped by change of, beneficial effects of effect in developing child's powers effect on common disorders errors of, and neuropathic children essentials of faulty contact with, in neuropathic children for neuropaths influence on conduct in later childhood influence on mental processes influence on personality irritating nature of the adult mind in of the home, reflected in the child of school life stimulus of susceptibility to influences of epilepsy, cyclical character of evil, inborn disposition to excitable children, management of exercise, sleep in relation to exhaustion. _see_ mental exhaustion expostulation, frequent, bad effects of _see also_ reproof expressions, to attract attention facial muscles, twitching of associated with apnoea fæces, incontinence of fainting fits, cause and characteristics control of of neuropaths fatigue, mental, physical, and visceral fats, lowered tolerance to faults, correction of not corrected by too frequent reproof fear, causes of phenomena of prominent psychical symptom of neuropathic children treatment of feeding, artificial factors in of newborn infant, regularity in fertilisation, method of imparting knowledge of food, force of suggestion in relation to healthy desire for likes and dislikes for how overcome phenomena of the desire of refusal of nervous causes of persistent, factors encouraging suggestion in relation to treatment of force and cajoling, futility of freud, teaching of functional disturbances, in combination with organic disease gait, peculiarity of games, educative value of gastric disturbances gastric juice, psychic secretion of gastric symptoms, of neurosis gastro-intestinal derangement, causes of environment as cause and cure of gentleness, inculcation of girls' schools glottis, spasm of, strong emotion causing "good form" grasping habit, reproof in relation to growing pains habit spasms, age of appearance of cause of definition of examples of spread of suggestion in relation to treatment of habits, regulation of suggestion in relation to habitual actions, infant's pleasure in mental unrest in relation to of the parent, reproduction in the child varieties and characteristics habitual wakefulness hands, control of movement of expressionless happiness and contentment, of child when playing alone headache, periodic. _see_ migraine heat and cold, newborn baby in relation to heat and flushing, sudden sensations of heredity, and temperament and type of child nervous disorders in relation to home influence, in development of character reflected in the child hunger, of the newborn baby hypnotic suggestion, in treatment of enuresis hypnotics hysteria, age of appearance of suggestion in relation to symptoms of hysterical girls, characteristics of ideals, inculcation of ideas, polarisation and depolarisation of illness. _see_ sickness imagination, abnormal, correction of child's stories and tales in relation to developed by toys imitativeness, age at which apparent extent of illustration of lack of of action of speech tell-tale child an illustration of incontinence of urine incorrigible children infantile characteristics, ductless glands in relation to nervous system in relation to infective disorders, convalescence from producing nervous symptoms relation of neurosis to inflammatory reactions insomnia. _see_ sleeplessness intellect, compared with physique intelligence, in early childhood intestinal disturbance of neurosis symptom of intoxications, violent reaction to introspection, and neuropathic children excessive, evidences of influencing conduct irritation, child to be free from joint pains kindergarten school, artificial symbolism of kindness, inculcation of lactation, care of child during care of mother during causes of failure in establishment of tongue-tie in relation to laryngismus stridulus. _see_ breath-holding later childhood, infantile characteristics in management in mental backwardness in likes and dislikes lordosis and neurosis producing albuminuria manual dexterity, advantages of massage, improving tone of muscles medicines, sensitiveness to melancholy children mental aspects, of digestive disorders of enuresis of management in early childhood mental backwardness, and infantile characteristics in later childhood mental disturbances, cyclical character of indicating neuropathic tendencies irregularities of sleep due to psycho-analysis of mental exhaustion, during convalescence from infective disorders easily produced in nervous children mental irritability, chorea a symptom of mental life of the child mental power, active before beginning of speech in early childhood mental processes, development of age at which most apparent in later childhood effect of unconscious suggestions on heredity in relation to influence of environment on mental training compared with physical training objects and advantages of mental unrest, avoidance of crying in relation to digestive disturbances due to growth of neuroses in atmosphere of habitual actions in relation to in the adult in the child negativism due to of newborn infant, effects of _see also_ nervous unrest micturition, functional disorder of negativism in regulation of _see also_ enuresis migraine, periodic vomiting associated with symptom of nervous exhaustion mind, and body, development of effect on the body vigour of, in relation to that of body money, theft of montessori system of training moral degeneracy moral standard of school life moral training importance and effects of negative virtues and objects and advantages of parents' responsibilities in morals, public opinion forming code of morbid introspection mothers, ability and inability to manage children attitude in regard to temperament of child care of, during lactation conduct of child influenced by inability to understand nature of child's disorders influence of, on tone and manner of speech mental environment of child created by personality of relation to the child motionless children mouth, habit of conveying everything to, cause of movements, precision of purposive, development of self-command of muscular atrophy, and neurosis muscular system, changes in infantile children weak development of muscular tone, how improved myopathy, primary nasal obstruction and failure of lactation night-terrors aggravated by natural history, sexual matters taught by naughtiness, child's delight in naughty, use of the term negative virtues, and moral training negativism, cause of characteristics factors developing in constipation in micturition spirit of treatment of want of sleep depending on nerve centres, controlling movement, development of nervous control, instability of, connection between bodily ailments and nervous cough nervous disorders, and psycho-analysis common, causes, characteristics, and treatment frequency of nervous exhaustion, cyclic vomiting and migraine symptoms of nervous instability, stigma of nervous system, abnormal in children in relation to cyclic vomiting increased irritability of infantile characteristics of nervous unrest, environment in relation to factors increasing manifestations of recurrence of periods of symptoms of _see also_ mental unrest nervous vomiting. _see_ vomiting nervousness, and digestive disorders and neuropathy in early infancy in older children parents' attitude causing nettlerash neurasthenia neuropathic children, common symptoms of conduct of faulty contact with environment in fear the prominent symptom of introspection and self-consciousness of management of training of neuropathic tendencies, evidence of, in older children neuropaths, adult faulty management in child life leading to phenomena of phobias of selection of suitable environment for symptoms of neuroses, and psycho-analysis association of albuminuria with constipation frequently due to examination of growth in atmosphere of unrest and apprehension relation of, to infection of the body treatment of neurotics, and physique characteristics exaggeration of emotions of newborn baby, administration of sedatives to artificial feeding of breast feeding of case of effect of mental unrest on first impressions of formation of habits of sleep and crying in heat and cold in relation to hunger of induction of the sucking movements of of nervous inheritance personality of prevention of restlessness and crying reduction of sense stimuli in reflex action of sucking in sense of taste of symptoms of dyspepsia in times of feeding weaning of night-terrors, aggravation of, causes of of neuropathic children nursery, activities in, child's interest in importance of child's being alone in observations in nursery life, advantages of nursery psycho-therapeutics nurses, ability and inability to manage children influence of, on tone and manner of speech mental environment of child created by personality of nursing, during sickness of the newborn infant obedience and perverse pleasure growth of obsession of bed wetting opposition and counter-opposition during sickness force of, factors influencing development habit of impulse of love of, in early childhood to food organic disturbance, in combination with functional trouble pain, frequent loss of sense of, in neuropaths pallor sudden attacks of palpitation, example of visceral fatigue parathyroid glands, function of parents, and children, conflict between and silence on sexual matters habitual actions of, reproduced in the child mental attitude of, in relation to conduct over-exercise of authority by, results of responsibilities in moral training of child suggestions unconsciously conveyed by, evil results of parties, disadvantages of patient, temperament of, physician in relation to pelvis, development of peripheral nerves, increase in irritability and conductivity of personal adornment, delight in personality, and disobedience child's own conception of environment influencing in early childhood of newborn baby perspiration, abundant, sudden attacks of, 141 phobias, characteristics and varieties frequency of treatment of physical defects, accompanying neurosis physical disturbances, due to emotion physical exercise, lack of, causing want of sleep physical fatigue, easily produced in nervous children physical phenomena of neuropaths physical training, objects and advantages of physician, and the temperament of his patient examination by diagnosis by difficulties of physique, intellect compared with pica and dirt eating picture books, educative value of kinds most suitable play, happiness of child during in the nursery with grown-up persons pleasure, sense of, in early childhood polarisation of ideas postural albuminuria posture, faulty prevention of power, child's love of precision of movement, development of psycho-analysis, dangers of observations on public schools, character and effects of punishment, deserved and undeserved frequent, disadvantages of observations on purity, inculcation of high ideals of, purposive movements, earliest, cause of encouragement of pyloric spasm pyrexia, organic disease in relation to rational hygiene reasoning power, active before advent of speech factors influencing development of regulation of habits repression, by older children of younger reproduction, method of imparting knowledge of reproof, cases in which useless causing disobedience effects of extreme sensitiveness to perverse pleasure of too frequent repetition of, futility of restlessness, during sickness rewards, use and dangers of rheumatism, and chorea, association between characteristics in childhood subacute treatment of rickets, mental and intellectual condition in in infantile children occurrence with spasmophilia right and wrong, appreciation of, in early childhood round shoulders st. vitus's dance salts, excretion of school life, and sexual matters moral standard of moral training and moulding of character during of boys of girls schools, public, character and effects of scoliosis, prevention of secretions, anomalies of self, child's conception of self-conscious children, complaints of self-consciousness, of neuropathic children self-discipline, development of self-education, in the nursery self-feeding self-preservation, morbid instinct of self-sacrifice, not to be expected in early childhood sensations, acuteness of bodily, of neuropaths sense perception, of neuropaths sense stimuli, cultivation of perception of in newborn babies sexual matters, education on method of errors of conduct and parents' silence in regard to psycho-analysis in relation to school life in relation to sickness evil effects of suggestions unconsciously conveyed by parents during management during nurse and mother during opposition during temperature during therapeutic measures in therapeutic procedures concentrating child's mind on his symptoms sleep, estimation of the amount of force of suggestion in relation to formation of habit of light and broken, cause of of newborn infant sound, beneficial effects of sleeping attire sleeplessness, breaking of the habit of causes and characteristics drugs in in older children lack of physical exercise causing suggestion in relation to treatment of sleep-walking snatching, habit of spasmophilia ætiology of drugs in treatment of occurrence of rickets with spasms, control of fatal speech, beginnings of facility with which local accent is acquired imitativeness of infant's reasoning power present before advent of influence of nurses and mothers on tone and manner of spinal deformity, prevention of spinal muscles, atrophy of spoon feeding status catarrhalis status lymphaticus story-telling sucking movements, of newborn child, induction of _see also_ lactation suggestion, and habit spasms appetite in relation to bed wetting in relation to bodily habits in relation to characteristics conduct influenced by constipation in relation to effect on mental processes food in relation to force of, on child's mind hysteria in relation to perverse influence of bad habits due to causing constipation want of sleep depending upon refusal of food in relation to sleep in relation to susceptibility to unconsciously conveyed by parents, evil results of suicide suspicions, aroused in the child syncopal attacks, causes and characteristics tactile sensation. _see_ touch taste, perversion of sensations of how controlled sense of, in newborn infant teething convulsions tell-tale child, characteristics temperament, diversity of heredity and mother's attitude in relation to of the patient, physician in relation to temperature, during sickness inexplicable rises in terror, causes, of tetany, liability to, in increased irritability of nervous system pressure to brachial nerve causing theatres, disadvantages of theft therapeutic conversation thigh rubbing, avoidance of characteristics habitual action of thorax, development of thumb sucking persistence of the habit tongue-tie, in relation to lactation tonics tonsils, removal of, in treatment of enuresis touch, sense of, cultivation of early development of organs with greatest development of toys, child's interest in educative value of kind most suitable training, early, importance and object of trousseau's sign, nature and production of truthfulness inculcation of twitching of facial muscles tyranny of tears unkindness, habitual, of children to others untruthfulness over-exercise of authority encouraging urine, condition in enuresis incontinence of, methods of treatment _see also_ enuresis increased secretion of irritation of vasomotor instability conditions indicating in neuropaths vasomotor tone, how improved virtuous, definition of the term visceral fatigue, easily produced in nervous children vocabulary voice, tone of voluntary movements, development of cerebral centres controlling vomiting, cyclic ætiology of age at which it occurs case illustrating causes and characteristics class of child affected by condition of the child during frequency of attacks migraine in association with nervous system in relation to treatment of waking states weaning, difficulty in will, strength of, absence in childhood work and play, differentiation between writing, correct posture during transcriber's notes the following typographical errors were corrected: page 4: 'sensisive' changed to 'sensitive'. page 48: 'self-abnegnatio'n changed to 'self-abnegation'. page 61: fixed 'and and'. page 125: 'acount' changed to 'account'. first page of index (191): 'ullimentary' changed to 'allimentary'; also 'ilstrating' channged to 'illustrating'. this file was produced from images generously made available by the canadian institute for historical microreproductions. advice to a mother on the management of her children and on the treatment on the moment of some of their more pressing illnesses and accidents by pye henry chavasse, fellow of the royal college of surgeons of england, fellow of the obstetrical society of london, formerly president of queen's college medico-chirurgical society, birmingham. "lo, children and the fruit of the womb are an heritage and gift that cometh of the lord." preface. this book has been translated into french, into german, into polish, and into tamil (one of the languages of india); it has been extensively published in america; and is well-known wherever the english language is spoken. the twelfth edition--consisting of twenty thousand copies--being exhausted in less than three years, the thirteenth edition is now published. one or two fresh questions have been asked and answered, and two or three new paragraphs have i been added. pye henry chavasse. 214, hagley road, edgbaston, birmingham, _june_, 1878. contents. part i--infancy. preliminary conversation ablution management of the navel navel rupture--groin rupture clothing diet vaccination and re-vaccination dentition exercise sleep the bladder and the bowels ailments, disease, etc. concluding remarks on infancy part ii--childhood ablution clothing diet the nursery exercise amusements education sleep second dentition disease, etc. warm baths warm external applications accidents part iii--boyhood and girlhood ablution, etc. management of the hair clothing diet air and exercise amusements education household work for girls choice of profession or trade sleep on the teeth and gums prevention of disease, etc. concluding remarks index advice to a mother. part i.--infancy _infant and suckling._--i. samuel _a rose with all its sweetest leaves yet folded._--byron. _man's breathing miniature!_--coleridge. preliminary conversation 1. _i wish to consult you on many subjects appertaining to the management and the care of children; will you favour me with your advice and counsel_? i shall be happy to accede to your request, and to give you the fruits of my experience in the clearest manner i am able, and in the simplest language i can command--freed from all technicalities. i will endeavour to guide you in the management of the health of your offspring;--i will describe to you the _symptoms_ of the diseases of children;--i will warn you of approaching danger, in order that you may promptly apply for medical assistance before disease has gained too firm a footing;--i will give you the _treatment_ on the moment; of some of their more pressing illnesses--when medical aid cannot at once be procured, and where delay may be death;--i will instruct you, in case of accidents, on the _immediate_ employment of remedies--where procrastination may be dangerous;--i will tell you how a sick child should be nursed, and how a sick-room ought to be managed;--i i will use my best energy to banish injurious practices from the nursery;--i will treat of the means to prevent disease where it be possible;--i will show you the way to preserve the health of the healthy,--and how to strengthen the delicate;--and will strive to make a medical man's task more agreeable to himself,--and more beneficial to his patient,--by dispelling errors and prejudices, and by proving the importance of your _strictly_ adhering to his rules. if i can accomplish any of these objects, i shall be amply repaid by the pleasing satisfaction that i have been of some little service to the rising generation. 2. _then you consider it important that i should be made acquainted with, and be well informed upon, the subjects you have just named_? certainly! i deem it to be your imperative duty to _study_ the subjects well. the proper management of children is a vital question,--a mother's question,--and the most important that can be brought under the consideration of a parent; and, strange to say, it is one that has been more neglected than any other. how many mothers undertake--the responsible management of children without previous instruction, or without forethought; they undertake it, as though it may be learned either by intuition or by instinct, or by affection. the consequence is, that frequently they are in a sea of trouble and uncertainty, tossing about without either rule or compass; until, too often, their hopes and treasures are shipwrecked and lost. the care and management, and consequently the health and future well-doing of the child, principally devolve upon the mother, "for it is the mother after all that has most to do with the making or marring of the man." [footnote: _good words_, dr w. lindsay alexander, march 1861.] dr guthrie justly remarks that--"moses might have never been the man he was unless he had been nursed by his own mother. how many celebrated men have owed their greatness and their goodness to a mother's training!" napoleon owed much to his mother. "'the fate of a child,' said napoleon, 'is always the work of his mother;' and this extraordinary man took pleasure in repeating, that to his mother he owed his elevation. all history confirms this opinion..." the character of the mother influences the children more than that of the father, because it is more exposed to their daily, hourly observation.--_woman's mission_. i am not overstating the importance of the subject in hand when i say, that a child is the most valuable treasure in the world, that "he is the precious gift of god," that he is the source of a mother's greatest and purest enjoyment, that he is the strongest bond of affection between her and her husband, and that "a babe in a house is a well-spring of pleasure, a messenger of peace and love."--_tupper_, i have, in the writing of the following pages, had one object constantly in view--namely, health- "that salt of life, which does to all a relish give, its standing pleasure, and intrinsic wealth, the body's virtue, and the soul's good fortune--health." if the following pages insist on the importance of one of a mother's duties more than another it is this,--_that the mother herself look well into everything appertaining to the management of her own child_. blessed is that mother among mothers of whom it can be said, that "she hath done what she could" for her child--for his welfare, for his happiness, for his health! for if a mother hath not "done what she could for her child"--mentally, morally, and physically--woe betide the unfortunate little creature;--better had it been for him had he never been born! ablution 3. _is a new-born infant, for the first time, to be washed in warm or in cold water_? it is not an uncommon plan to use _cold_ water from the first, under the impression of its strengthening the child. this appears to be a cruel and barbarous practice, and is likely to have a contrary tendency. moreover, it frequently produces either inflammation of the eyes, or stuffing of the nose, or inflammation of the lungs, or looseness of the bowels. although i do not approve of _cold_ water, we ought not to run into an opposite extreme, as _hot_ water would weaken and enervate the babe, and thus would predispose him to disease. luke warm _rain_ water will be the best to wash him with. this, if it be summer, should have its temperature gradually lowered, until it be quite cold, if it be winter, a _dash_ of warm water ought still to be added, to take oft the chill [footnote: a nursery basin (wedgwoode make is considered the best), holding either six or eight quarts of water, and which will be sufficiently large to hold the whole body of the child. the baton is generally fitted into a wooden frame which will raise it to a convenient height for the washing of the baby.] (by thermometer = 90 to 92 degrees.) it will be necessary to use soap--castile soap being the best for the purpose--it being less irritating to the skin than the ordinary soap. care should be taken that it does not get into the eyes, as it may produce either inflammation or smarting of those organs. if the skin be delicate, or if there be any excoriation or "breaking-out" on the skin, then glycerine soap, instead of the castile soap, ought to be used. 4. _at what age do you recommend a mother to commence washing her infant either in the tub, or in the nursery basin_? as soon as the navel string comes away [footnote: sir charles locock strongly recommends that an infant should be washed _in a tub_ from the very commencement. he says,--"all those that i superintend _begin_ with a tub."--_letter to the author_.] do not be afraid of water,--and that in plenty,--as it is one of the best strengtheners to a child's constitution. how many infants suffer, for the want of water from excoriation! 5. _which do you prefer--flannel or sponge--to wash a child with_? a piece of flannel is, for the first part of the washing very useful--that is to say, to use with the soap, and to loosen the dirt and the perspiration; but for the finishing-up process, a sponge--a large sponge--is superior to flannel, to wash all away, and to complete the bathing. a sponge cleanses and gets into all the nooks, corners, and crevices of the skin. besides, sponge, to finish up with, is softer and more agreeable to the tender skin of a babe than flannel. moreover, a sponge holds more water than flannel, and thus enables you to stream the water more effectually over him. a large sponge will act like a miniature shower bath, and will thus brace and strengthen him. 6. _to prevent a new-born babe from catching cold, is it necessary to wash his head with brandy_? it is _not necessary_. the idea that it will prevent cold is erroneous, as the rapid evaporation of heat which the brandy causes is more likely to give than to prevent cold. 7. _ought that tenacious, paste like substance, adhering to the skin of a new-born babe, to be washed off at the first dressing_? it should, provided it be done with a soft sponge and with care. if there be any difficulty in removing the substance, gently rub it, by means of a flannel, [footnote: mrs baines (who has written so much and so well on the management of children), in a _letter_ to the author, recommends flannel to be used in the _first_ washing of an infant, which flannel ought afterwards to be burned; and that the sponge should be only used to complete the process, to clear off what the flannel had already loosened. she also recommends that every child should have his own sponge, each of which should have a particular distinguishing mark upon it, as she considers the promiscuous use of the same sponge to be a frequent cause of _ophthalmia_ (inflammation of the eyes). the sponges cannot be kept too clean.] either with a little lard, or fresh butter, or sweet-oil. after the parts have been well smeared and gently rubbed with the lard, or oil, or butter, let all be washed off together, and be thoroughly cleansed away, by means of a sponge and soap and warm water, and then, to complete the process, gently put him in for a minute or two in his tub. if this paste like substance be allowed to remain on the skin, it might produce either an excoriation, or a "breaking-out" besides, it is impossible, if that tenacious substance be allowed to remain on it, for the skin to perform its proper functions. 8. _have you any general observations to make on the washing of a new-born infant_? a babe ought, every morning of his life, to be thoroughly washed from head to foot, and this can only be properly done by putting him bodily either into a tub or into a bath, or into a large nursery basin, half filled with water. the head, before placing him in the bath, should be first wetted (but not dried), then immediately put him into the water, and, with a piece of flannel well soaked, cleanse his whole body, particularly his arm pits, between his thighs, his groins, and his hams, then take a large sponge in hand, and allow the water from it, well filled, to stream all over the body, particularly over his back and loins. let this advice be well observed, and you will find the plan most strengthening to your child. the skin must, after every bath, be thoroughly but quickly dried with warm, dry, soft towels, first enveloping the child in one, and then gently absorbing the moisture with the towel, not roughly scrubbing and rubbing his tender skin as though a horse were being rubbed down. the ears must, after each ablution, be carefully and well dried with a soft dry napkin, inattention to this advice has sometimes caused a gathering in the ear--a painful and distressing complaint, and at other times it has produced deafness. directly after the infant is dried, all the parts that are at all likely to be chafed ought to be well powdered. after he is well dried and powdered, the chest, the back, the bowels, and the limbs should be gently rubbed, taking care not to expose him unnecessarily during such friction. he ought to be partially washed every evening, indeed it may be necessary to use a sponge and a little warm water frequently during the day, namely, each time after the bowels have been relieved. _cleanliness is one of the grand incentives to health_, and therefore cannot be too strongly insisted upon. if more attention were paid to this subject, children would be more exempt from chafings, "breakings-out," and consequent suffering, than they at present are. after the second month, if the babe be delicate, the addition of two handfuls of table-salt to the water he is washed with in the morning will tend to brace and strengthen him. with regard to the best powder to dust an infant with, there is nothing better for general use than starch--the old fashioned starch _made of wheaten flour_--reduced by means of a pestle and mortar to a fine powder, or violet powder, which is nothing more than finely powdered starch scented, and which may be procured of any respectable chemist. some others are in the habit of using white lead, but as this is a poison, it ought _on no account_ to be resorted to. 9. _if the parts about the groin and fundament be excoriated, what is then the best application_? after sponging the parts with tepid _rain water_, holding him over his tub, and allowing the water from a well filled sponge to stream over the parts, and then drying them with a soft napkin (not rubbing, but gently dabbing with the napkin), there is nothing better than dusting the parts frequently with finely powdered native carbonate of zinc-calamine powder. the best way of using this powder is, tying up a little of it in a piece of muslin, and then gently dabbing the parts with it. remember excoriations are generally owing to the want of water,--to the want of an abundance of water. an infant who is every morning well soused and well swilled with water seldom suffers either from excoriations, or from any other of the numerous skin diseases. cleanliness, then, is the grand preventative of, and the best remedy for excoriations. naaman the syrian was ordered "to wash and be clean," and he was healed, "and his flesh came again like unto the flesh of a little child and he was clean." this was, of course, a miracle; but how often does water, without any special intervention, act miraculously both in preventing and in curing skin diseases! an infant's clothes, napkins especially, ought never to be washed with soda; the washing of napkins with soda is apt to produce excoriations and breakings-out. "as washerwomen often deny that they use soda, it can be easily detected by simply soaking a clean white napkin in fresh water and then tasting the water; if it be brackish and salt, soda has been employed." [footnote: communicated by sir charles locock to the author.] 10. _who is the proper person to wash and dress the babe_? the monthly nurse, as long as she is in attendance; but afterwards the mother, unless she should happen to have an experienced, sensible, thoughtful nurse, which, unfortunately, is seldom the case. [footnote: "the princess of wales might have been seen on thursday taking an airing in a brougham in hyde park with her baby--the future king of england--on her lap, without a nurse, and accompanied only by mrs brace. the princess seems a very pattern of mothers, and it is whispered among the ladies of the court that every evening the mother of this young gentleman may be seen in a flannel dress, in order that she may properly wash and put on baby's night clothes, and see him safely in bed. it is a pretty subject for a picture."--_pall mall gazette_.] 11. _what is the best kind of apron for a mother, or for a nurse, to wear, while washing the infant_? flannel--a good, thick, soft flannel, usually called bathcoating--apron, made long and full, and which of course ought to be well dried every time before it is used. 12. _perhaps you will kindly recapitulate, and give me further advice on the subject of the ablution of my babe_. let him by all means, then, as soon as the navel-string has separated from the body, be bathed either in his tub, or in his bath, or in his large nursery-basin, for if he is to be strong and hearty, in the water every morning he must go. the water ought to be slightly warmer than new milk. it us dangerous for him to remain for a long period in his bath, this, of course, holds good in a ten fold degree if the child have either a cold or pain in his bowels. take care that, immediately after he comes out of his tub, he is well dried with warm towels. it is well to let him have his bath the first thing in the morning, and before he has been put to the breast, let him be washed before he has his breakfast, it will refresh him and give him an appetite. besides, he ought to have his morning ablution on an empty stomach, or it may interfere with digestion, and might produce sickness and pain. in putting him in his tub, let his head be the first part washed. we all know, that in bathing in the sea, now much better we can bear the water if we first wet our head, if we do not do so, we feel shivering and starved and miserable. let there be no dawdling in the washing, let it be quickly over. when he is thoroughly dried with warm _dry_ towels, let him be well rubbed with the warm hand of the mother or of the nurse. as i previously recommended, while drying him and while rubbing him, let him repose and kick and stretch either on the warm flannel apron, or else on a small blanket placed on the lap. one bathing in the tub, and that in the morning, is sufficient, and better than night and morning. during the day, as i before observed, he may, after the action either of his bowels or of his bladder, require several spongings of lukewarm water, _for cleanliness is a grand incentive to health and comeliness_. remember it is absolutely necessary to every child from his earliest babyhood to have a bath, to be immersed every morning of his life in the water. this advice, unless in cases of severe illness, admits of no exception. water to the body--to the whole body--is a necessity of life, of health, and of happiness, it wards off disease, it brace? the nerves, it hardens the frame, it is the finest tonic in the world. oh, if every mother would follow to the very letter this counsel how much misery, how much ill-health might then be averted! management of the navel. 13. _should the navel-string be wrapped in singed rag_? there is nothing better than a piece of fine old linen rag, _unsinged_; when singed, it frequently irritates the infant's skin. 14. _how ought the navel-string to be wrapped in the rag_? take a piece of soft linen rag, about three inches wide and four inches long, and wrap it neatly round the navel string, in the same manner you would around a cut finger, and then, to keep on the rag, tie it with a few rounds of whity-brown thread. the navel-string thus covered should, pointing upwards, be placed on the belly of the child, and must be secured in its place by means of a flannel belly-band. 15. _if after the navel-string has been secured, bleeding should (in the absence of the medical man) occur, how must it be restrained_? the nurse or the attendant ought immediately to take off the rag, and tightly, with a ligature composed of four or five whity-brown threads, retie the navel-string; and to make assurance doubly sure, after once tying it, she should pass the threads a second time around the navel-string, and tie it again; and after carefully ascertaining that it no longer bleeds, fasten it up in the rag as before. bleeding of the navel-string rarely occurs, yet, if it should do so--the medical man not being at hand--the child's after-health, or even his life, may, if the above directions be not adopted, be endangered. 16. _when does the navel-string separate from the child_? from five days to a week after birth; in some cases not until ten days or a fortnight, or even, in rare cases, not until three weeks. 17. _if the navel-string does not at the end of a week came away, ought any means to be used to cause the separation_? certainly not, it ought always to be allowed to drop off, which, when in a fit state, it will readily do. meddling with the navel string has frequently cost the babe a great deal of suffering, and in some cases even his life. 18. _the navel is sometimes a little sore, after the navel-string comes away, what ought then to be done_? a little simple cerate should be spread on lint, and be applied every morning to the part affected, and a white-bread poultice, every night, until it is quite healed. navel rupture--groin rupture. 19. _what are the causes of a rupture of the navel? what ought to be done? can it be cured_? (1) a rupture of the navel is sometimes occasioned by a meddlesome nurse. she is very anxious to cause the navel-string to separate from the infant's body, more especially when it is longer in coming away than usual. she, therefore, before it is in a fit state to drop off, forces it away. (2) the rapture, at another time, is occasioned by the child incessantly crying. a mother, then, should always bear in mind, that a rupture of the navel is often caused by much crying, and that it occasions much crying, indeed, it is a frequent cause of incessant crying. a child, therefore, who, without any assignable cause, is constantly crying, should have his navel carefully examined. a rupture of the navel ought always to be treated early--the earlier the better. ruptures of the navel can only be _cured_ in infancy and in childhood. if it be allowed to run on until adult age, a _cure_ is impossible. palliative means can then only be adopted. the best treatment is a burgundy pitch plaster, spread on a soft piece of wash leather, about the size of the top of a tumbler, with a properly-adjusted pad (made from the plaster) fastened on the centre of the plaster, which will effectually keep up the rupture, and in a few weeks will cure it. it will be necessary, from time to time, to renew the plaster until the cure be effected. these plasters will be found both more efficacious and pleasant than either truss or bandage; which latter appliances sometimes gall, and do more harm than they do good. 20. _if an infant have a groin-rupture (an inguinal rupture), can that also be cured_? certainly, if, soon after birth, it be properly attended to. consult a medical man, and he will supply you with a well-fitting truss, _which will eventually cure him_. if the truss be properly made (under the direction of an experienced surgeon) by a skilful surgical-instrument maker, a beautiful, nicely-fitting truss will be supplied, which will take the proper and exact curve of the lower part of the infant's belly, and will thus keep on without using any under-strap whatever--a great desideratum, as these under-straps are so constantly wetted and soiled as to endanger the patient constantly catching cold. but if this under-strap is to be superseded, the truss must be made exactly to fit the child--to fit him like a ribbon; which is a difficult thing to accomplish unless it be fashioned by a skilful workman. it is only lately that these trusses have been made without under-straps. formerly the under-straps were indispensable necessaries. these groin-ruptures require great attention and supervision, as the rupture (the bowel) must, before putting on the truss be cautiously and thoroughly returned into the belly; and much care should be used to prevent the chafing and galling of the tender skin of the babe, which an ill-fitting truss would be sure to occasion. but if care and skill be bestowed on the case, a perfect cure might in due time be ensured. the truss must not be discontinued, until a _perfect_ cure be effected. let me strongly urge you to see that my advice is carried out to the very letter, as a groin-rupture can only be _cured_ in infancy and in childhood. if it be allowed to ran on, unattended to, until adult age, he will be obliged to wear a truss _all his life_, which would be a great annoyance and a perpetual irritation to him. clothing. 21. _is it necessary to have a flannel cap in readiness to put on as soon as the babe is born_? sir charles locock considers that a flannel cap is _not_ necessary, and asserts that all his best nurses have long discarded flannel caps. sir charles states that since the discontinuance of flannel caps infants have not been more liable to inflammation of the eyes. such authority is, in my opinion, conclusive. my advice, therefore, to you is, discontinue by all means the use of flannel caps. 22. _what kind of a belly-band do you recommend--a flannel or a calico one_? i prefer flannel, for two reasons--first, on account of its keeping the child's bowels comfortably warm; and secondly, because of its not chilling him (and thus endangering cold, &c.) when he wets himself. the belly-band ought to be moderately, but not tightly applied, as, if tightly applied, it would interfere with the necessary movement of the bowels. 23. _when should the belly-band be discontinued_? when the child is two or three months old. the best way of leaving it off is to tear a strip off daily for a few mornings, and then to leave it off altogether. "nurses who take charge of an infant when the monthly nurse leaves, are frequently in the habit of at once leaving off the belly-band, which often leads to ruptures when the child cries or strains. it is far wiser to retain it too long than too short a time; and when a child catches whooping-cough, whilst still very young, it is safer to resume the belly-band." [footnote: communicated by sir charles locock to the author.] 24. _have you any remarks to make on the clothing of on infant_? a babe's clothing ought to be light, warm, loose, and free from pins. (1.) _it should be light_, without being too airy. many infant's clothes are both too long and too cumbersome. it is really painful to see how some poor little babies are weighed down with a weight of clothes. they may be said to "bear the burden," and that a heavy one, from the very commencement of their lives! how absurd, too, the practice of making them wear _long_ clothes. clothes to cover a child's feet, and even a little beyond, may be desirable; but for clothes, when the infant is carried about, to reach to the ground, is foolish and cruel in the extreme. i have seen a delicate baby almost ready to faint under the infliction. (2.) _it should be warm_, without being too warm. the parts that ought to be kept warm are the chest, the bowels, and the feet. if the infant be delicate, especially if he be subject to inflammation of the lungs, he ought to wear a fine flannel, instead of his usual shirts, which should be changed as frequently. (3.) _the dress should be loose_, so as to prevent any pressure upon the blood-vessels, which would otherwise impede the circulation, and thus hinder a proper development of the parts. it ought to be loose about the chest and waist, so that the lungs and the heart may have free play. it should be loose about the stomach, so that digestion may not be impeded; it ought to be loose about the bowels, in order that the spiral motion of the intestines may not be interfered with--hence the importance of putting on a belly-band moderately slack; it should be loose about the sleeves, so that the blood may course, without let or hindrance, through the arteries and veins; it ought to be loose, then, everywhere, for nature delights in freedom from restraint, and will resent, sooner or later, any interference. oh, that a mother would take common sense, and not custom, as her guide! (4.) _as few pins_ should be used in the dressing of a baby as possible. inattention to this advice has caused many a little sufferer to be thrown into convulsions. the generality of mothers use no pins in the dressing of their children; they tack every part that requires fastening with a needle and thread. they do not even use pins to fasten the baby's diapers. they make the diapers with loops and tapes, and thus altogether supersede the use of pins in the dressing of an infant. the plan is a good one, takes very little extra time, and deserves to be universally adopted. if pins be used for the diapers, they ought to be the patent safety pins. 25. _is there any necessity for a nurse being particular in airing an infant's clothes before they are put on? if she were less particular, would it not make him more hardy_? a nurse cannot be too particular on this head. a babe's clothes ought to be well aired the day before they are put on, as they should _not_ be put on warm from the fire. it is well, where it can be done, to let him have clean clothes daily. where this cannot be afforded, the clothes, as soon as they are taken off at night, ought to be well aired, so as to free them from the perspiration, and that they may be ready to put on the following morning. it is truly nonsensical to endeavour to harden a child, or any one else, by putting on damp clothes! 26. _what is your opinion of caps for an infant_? the head ought to be kept cool; caps, therefore, are unnecessary. if caps be used at all, they should only be worn for the first month in summer, or for the first two or three months in winter. if a babe take to caps, it requires care in leaving them off, or he will catch cold. when you are about discontinuing them, put a thinner and a thinner one on, every time they are changed, until you leave them off altogether. but remember, my opinion is, that a child is better _without_ caps; they only heat his head, cause undue perspiration, and thus make him more liable to catch cold. if a babe does not wear a cap in the day, it is not at all necessary that he should wear one at night. he will sleep more comfortably without one, and it will be better for his health. moreover, night-caps injure both the thickness and beauty of the hair. 27. _have you any remarks to make on the clothing of an infant, when, in the winter time, he is sent out for exercise_? be sure that he is well wrapped up. he ought to have under his cloak a knitted worsted spencer, which should button behind, and if the weather be very cold, a shawl over all, and, provided it be dry above, and the wind be not in the east or in the north-east, he may then brave the weather. he will then come from his walk refreshed and strengthened, for cold air is an invigorating tonic. in a subsequent conversation i will indicate the proper age at which a child should be first sent out to take exercise in the open air. 28. _at what age ought an infant "to be shortened?"_ this, of course, will depend upon the season. in the summer, the right time "for shortening a babe," as it is called, is at the end of two months, in the winter, at the end of three months. but if the right time for "shortening" a child should happen to be in the spring, let it be deferred until the end of may. the english springs are very trying and treacherous, and sometimes, in april the weather is almost as cold, and the wind as biting as in winter. it is treacherous, for the sun is hot, and the wind, which is at this time of the year frequently easterly, is keen and cutting i should far prefer "to shorten" a child in the winter than in the early spring. diet 29. _are you an advocate for putting a baby to the breast soon after birth, or for waiting, as many do, until the third day_? the infant ought to be put to the bosom soon after birth, the interest, both of the mother and of the child demands it. it will be advisable to wait three or four hours, that the mother may recover from her fatigue, and, then, the babe must be put to the breast. if this be done, he will generally take the nipple with avidity. it might be said, at so early a period that there is no milk in the bosom; but such is not usually the case. there generally is a _little_ from the very beginning, which acts on the baby's bowels like a dose of purgative medicine, and appears to be intended by nature to cleanse the system. but, provided there be no milk at first, the very act of sucking not only gives the child a notion, but, at the same time, causes a draught (as it is usually called) in the breast, and enables the milk to flow easily. of course, if there be no milk in the bosom--the babe having been applied once or twice to determine the fact--then you must wait for a few hours before applying him again to the nipple, that is to say, until the milk be secreted. an infant, who, for two or three days, is kept from the breast, and who is fed upon gruel, generally becomes feeble, and frequently, at the end of that time, will not take the nipple at all. besides, there is a thick cream (similar to the biestings of a cow), which, if not drawn out by the child, may cause inflammation and gathering of the bosom, and, consequently, great suffering to the mother. moreover, placing him _early_ to the breast, moderates the severity of the mother's after pains, and lessens the risk of her flooding. a new-born babe must _not_ have gruel given to him, as it disorders the bowels, causes a disinclination to suck, and thus makes him feeble. 30. _if an infant show any disinclination to suck, or if he appear unable to apply his tongue to the nipple, what ought to be done_? immediately call the attention of the medical man to the fact, in order that he may ascertain whether he be tongue-tied. if he be, the simple operation of dividing the bridle of the tongue will remedy the defect, and will cause him to take the nipple with ease and comfort. 31. _provided there be not milk at first, what ought then to be done_? wait with patience; the child (if the mother have no milk) will not, for at least twelve hours, require artificial food. in the generality of instances, then, artificial food is not at all necessary; but if it should be needed, one-third of new milk and two-thirds of warm water, slightly sweetened with loaf sugar (or with brown sugar, if the babe's bowels have not been opened), should be given, in small quantities at a time, every four hours, until the milk be secreted, and then it must be discontinued. the infant ought to be put to the nipple every four hours, but not oftener, until he be able to find nourishment. if after the application of the child for a few times, he is unable to find nourishment, then it will be necessary to wait until the milk be secreted. as soon as it is secreted, he must be applied with great regularity, _alternately_ to each breast. i say _alternately_ to each breast. _this is most important advice_. sometimes a child, for some inexplicable reason, prefers one breast to the other, and the mother, to save a little contention, concedes the point, and allows him to have his own way. and what is frequently the consequence?--a gathered breast! we frequently hear of a babe having no notion of sucking. this "no notion" may generally be traced to bad management, to stuffing him with food, and thus giving him a disinclination to take the nipple at all. 32. _how often should a mother suckle her infant_? a mother generally suckles her baby too often, having him almost constantly at the breast. this practice is injurious both to parent and to child. the stomach requires repose as much as any other part of the body; and how can it have if it be constantly loaded with breast-milk? for the first month, he ought to be suckled, about every hour and a half; for the second month, every two hours,--gradually increasing, as he becomes older, the distance of time between, until at length he has it about every four hours. if a baby were suckled at stated periods, he would only look for the bosom at those times, and be satisfied. a mother is frequently in the habit of giving the child the breast every time he cries, regardless of the cause. the cause too frequently is that he has been too often suckled--his stomach has been overloaded, the little fellow is consequently in pain, and he gives utterance to it by cries. how absurd is such a practice! we may as well endeavour to put out a fire by feeding it with fuel. an infant ought to be accustomed to regularity in everything, in times for sucking, for sleeping, &c. no children thrive so well as those who are thus early taught. 33. _where the mother is moderately strong, do you advise that the infant should have any other food than the breast_? artificial food must not, for the first five or six months, be given, if the parent be _moderately_ strong, of course, if she be feeble, a _little_ food will be necessary. many delicate women enjoy better health whilst ambling than at any other period of their lives. it may be well, where artificial food, in addition to the mother's own milk, is needed, and before giving any farinaceous food whatever (for farinaceous food until a child is six or seven months old is injurious), to give, through a feeding bottle, every night and morning, in addition to the mother's breast of milk, the following _milk-water-and sugar-of milk food_- fresh milk, from one cow, warm water, of each a quarter of a pint, sugar of milk one tea spoonful the sugar of milk should first be dissolved in the warm water, and then the fresh milk _unboiled_ should be mixed with it. the sweetening of the above food with sugar-of-milk, instead of with lump sugar, makes the food more to resemble the mother's own milk. the infant will not, probably, at first take more than half of the above quantity at a time, even if he does so much as that but still the above are the proper proportions, and as he grows older, he will require the whole of it at a meal. 34. _what food, when a babe is six or seven months old, is the best substitute for a mother's milk?_ the food that suits one infant will not agree with another. (1) the one that i have found the most generally useful, is made as follows--boil the crumb of bread for two hours in water, taking particular care that it does not burn, then add only a _little_ lump-sugar (or _brown_ sugar, if the bowels be costive), to make it palatable. when he is six or seven months old, mix a little new milk--the milk of one cow--with it gradually as he becomes older, increasing the quantity until it be nearly all milk, there being only enough water to boil the bread, the milk should be poured boiling hot on the bread. sometimes the two milks--the mother's and the cow's milk--do not agree, when such is the case, let the milk be left out, both in this and in the foods following, and let the food be made with water, instead of with milk and water. in other respects, until the child is weaned, let it be made as above directed, when he is weaned, good fresh cow's milk must, as previously recommended, be used. (2) or cut thin slices of bread into a basin, cover the bread with _cold_ water, place it in an oven for two hours to bake, take it out, beat the bread up with a fork, and then slightly sweeten it. this is an excellent food. (3) if the above should not agree with the infant (although, if properly made, they almost invariably do), "tous les-mois" may be given. [footnote: "tous les mois" is the starch obtained from the tuberous roots of various species of _canna_, and is imported from the west indies. it is very similar to arrow root. i suppose it is called "tous les-mois," as it is good to be eaten all the year round.](4) or robb's biscuits, as it is "among the best bread compounds made out of wheat-flour, and is almost always readily digested."--_routh_. (5) another good food is the following--take about a pound of flour put it in a cloth, tie it up tightly, place it a saucepanful of water, and let it boil for four or five hours, then take it out, peel off the outer rind, and the inside will be found quite dry, which grate. (6) another way of preparing an infant's food, is to bake flour--biscuit flour--in a slow oven, until it be of a light fawn colour. baked flour ought after it is baked, to be reduced, by means of a rolling pin, to a fine powder, and should then be kept in a covered tin, ready for use. (7) an excellent food for a baby is baked crumbs of bread. the manner of preparing it is as follows--crumb some bread on a plate, put it a little distance from the fire to dry. when dry, rub the crumbs in a mortar, and reduce them to a fine powder, then pass them through a sieve. having done which, put the crumbs of bread into a slow oven, and let them bake until they be of a light fawn colour. a small quantity either of the boiled, or of the baked flour, or of the baked crumb of bread, ought to be made into food, in the same way as gruel is made, and should then be slightly sweetened, according to the state of the bowels, either with lump or with brown sugar. (8) baked flour sometimes produces constipation, when such is the case, mr. appleton, of budleigh salterton, devon, wisely recommends a mixture of baked flour, and prepared oatmeal, [footnote: if there is any difficulty in obtaining _prepared_ oatmeal, robinson's scotch oatmeal will answer equally as well.] in the proportion of two of the former and one of the latter. he says--"to avoid the constipating effects, i have always had mixed, before baking, one part of prepared oatmeal with two parts of flour, this compound i have found both nourishing, and regulating to the bowels. one table-spoonful of it, mixed with a quarter of a pint of milk, or milk and water, when well boiled, flavoured and sweetened with white sugar, produces a thick, nourishing, and delicious food for infants or invalids." he goes on to remark--"i know of no food, after repeated trials, that can be so strongly recommended by the profession to all mothers in the rearing of their infants, without or with the aid of the breasts, at the same time relieving them of much draining and dragging whilst nursing with an insufficiency of milk, as baked flour and oatmeal." [footnote: _british medical journal_, dec 18, 1858] (9) a ninth food may be made with "farinaceous food for infants, prepared by hards of dartford". if hard's farinaceous food produces costiveness--as it sometimes does--let it be mixed either with equal parts or with one third of robinson's scotch oatmeal. the mixture of the two together makes a splendid food for a baby. (10) a tenth, and an excellent one, may be made with rusks, boiled for an hour in water, which ought then to be well beaten up, by means of a fork, and slightly sweetened with lump sugar. great care should be taken to select good rusks, as few articles vary so much in quality. (11) an eleventh is--the top crust of a baker's loaf, boiled for an hour in water, and then moderately sweetened with lump sugar. if, at any time, the child's bowels should be costive, _raw_ must be substituted for _lump_ sugar. (12) another capital food for an infant is that made by lemann's biscuit powder. [footnote: lemann's biscuit powder cannot be too strongly recommended--it is of the finest quality, and may be obtained of lemann, threadneedle street, london. an extended and an extensive experience confirms me still more in the good opinion i have of this food.] (13) or, brown and polson's patent corn flour will be found suitable. francatelli, the queen's cook, in his recent valuable work, gives the following formula for making it--"to one dessert-spoonful of brown and polson, mixed with a wineglassful of cold water, add half a pint of boiling water, stir over the fire for five minutes, sweeten lightly, and feed the baby, but if the infant is being brought up by the hand, this food should then be mixed with milk--not otherwise." (14) a fourteenth is neaves' farinaceous food for infants, which is a really good article of diet for a babe, it is not so binding to the bowels as many of the farinaceous foods are, which is a great recommendation. (15) the following is a good and nourishing food for a baby:--soak for an hour, some _best_ rice in cold water; strain, and add fresh water to the rice; then let it simmer till it will pulp through a sieve; put the pulp and the water in a saucepan, with a lump or two of sugar, and again let it simmer for a quarter of an hour; a portion of this should be mixed with one-third of fresh milk, so as to make it of the consistence of good cream. this is an excellent food for weak bowels. when the baby is six or seven months old, new milk should be added to any of the above articles of food, in a similar way to that recommended for boiled bread. (16.) for a delicate infant, lentil powder, better known as du barry's "ravalenta arabica," is invaluable. it ought to be made into food, with new milk, in the same way that arrow-root is made, and should be moderately sweetened with loaf-sugar. whatever food is selected ought to be given by means of a nursing bottle. if a child's bowels be relaxed and weak, or if the motions be offensive, the milk _must_ be boiled, but not otherwise. the following (17) is a good food when an infant's bowels are weak and relaxed:--"into five large spoonfuls of the purest water, rub smooth one dessert-spoonful of fine flour. set over the fire five spoonfuls of new milk, and put two bits of sugar into it; the moment it boils, pour it into the flour and water, and stir it over a slow fire twenty minutes." where there is much emaciation, i have found (18) genuine arrow-root [footnote: genuine arrow-root, of first-rate quality, and at a reasonable price, may be obtained of h. m. plumbe, arrow-root merchant, 8 alie place. great alie street. aldgate, london, e.] a very valuable article of food for an infant, as it contains a great deal of starch, which starch helps to form fat and to evolve caloric (heat)--both of which a poor emaciated chilly child stands so much in need of. it must be made with equal parts of water and of good fresh milk, and ought to be slightly sweetened with loaf sugar; a small pinch of table salt should be added to it. arrow-root will not, as milk will, give bone and muscle; but it will give--what is very needful to a delicate child--fat and warmth. arrow-root, as it is principally composed of starch, comes under the same category as cream, butter, sugar, oil, and fat. arrowroot, then, should always be given with new milk (mixed with one-half of water); it will then fulfil, to perfection, the exigencies of nourishing, of warming, and fattening the child's body. new milk, composed in due proportions as it is, of cream and of skim milk--the very acme of perfection--is the only food, _which of itself alone,_ will nourish and warm and fatten. it is, for a child, _par excellence,_ the food of foods! arrow-root, and all other farinaceous foods are, for a child, only supplemental to milk--new milk being, for the young, the staple food of all other kinds of foods whatever. but bear in mind, _and let there be no mistake about it,_ that farinaceous food, be it what it may, until the child be six or seven months old, until, indeed, he _begin_ to cut his teeth, is not suitable for a child; until then, _the milk-water-salt-and-sugar food_ (see page 29) is usually, if he be a dry-nursed child, the best artificial food for him. i have given you a large and well-tried infant's dietary to chose from, as it is sometimes difficult to fix on one that will suit; but, remember, if you find one of the above to agree, keep to it, as a babe requires a simplicity in food--a child a greater variety. let me, in this place, insist upon the necessity of great care and attention being observed in the preparation of any of the above articles of diet. a babe's stomach is very delicate, and will revolt at either ill-made, or lumpy, or burnt food. great care ought to be observed as to the cleanliness of the cooking utensils. the above directions require the strict supervision of the mother. broths have been recommended, but, for my own part, i think that, for a _young_ infant, they are objectionable; they are apt to turn acid on the stomach, and to cause flatulence and sickness, they, sometimes, disorder the bowels and induce griping and purging. whatever artificial food is used ought to be given by means of a bottle, not only as it is a more natural way than any other of feeding a baby, as it causes him to suck as though he were drawing it from the mother's breasts, but as the act of sucking causes the salivary glands to press out their contents, which materially assist digestion. moreover, it seems to satisfy and comfort him more than it otherwise would do. one of the best, if not _the best_ feeding bottle i have yet seen, is that made by morgan brothers, 21 bow lane, london. it is called "the anglo-french feeding bottle" s maw, of 11 aldersgate street, london, has also brought out an excellent one--"the fountain infant's feeding bottle" another good one is "mather's infant's feeding bottle" either of these three will answer the purpose admirably. i cannot speak in terms too highly of these valuable inventions. the food ought to be of the consistence of good cream, and should be made fresh and fresh. it ought to be given milk warm. attention must be paid to the cleanliness of the vessel, and care should be taken that the milk be that of one cow, [footnote: i consider it to be of immense importance to the infant, that the milk be had from one cow. a writer in the _medical times and gazette_ speaking on this subject, makes the following sensible remarks--"i do not know if a practice common among french ladies when they do not nurse, has obtained the attention among ourselves which it seems to me to deserve. when the infant is to be fed with cow milk that from various cows is submitted to examination by the medical man and if possible, tried on some child, and when the milk of any cow has been chosen, no other milk is ever suffered to enter the child's lips for a french lady would as soon offer to her infant's mouth the breasts of half a dozen wet-nurses in the day, as mix together the milk of various cows, which must differ, even as the animals themselves, in its constituent qualities. great attention is also paid to the pasture, or other food of the cow thus appropriated."] and that it be new and of good quality, for if not it will turn acid and sour, and disorder the stomach, and will thus cause either flatulence or looseness of the bowels, or perhaps convulsions. the only way to be sure of having it from _one_ cow, is (if you have not a cow of your own), to have the milk from a _respectable_ cow keeper, and to have it brought to your house in a can of your own (the london milk cans being the best for the purpose). the better plan is to have two cans, and to have the milk fresh and fresh every night and morning. the cans, after each time of using, ought to be scalded out, and, once a week the can should be filled with _cold_ water, and the water should be allowed to remain in it until the can be again required. very little sugar should be used in the food, as much sugar weakens the digestion. a small pinch of table-salt ought to be added to whatever food is given, as "the best savour is salt." salt is most wholesome--it strengthens and assists digestion, prevents the formation of worms, and, in small quantities, may with advantage be given (if artificial food be used) to the youngest baby. 35. _where it is found to be absolutely necessary to give an infant artificial food_ whilst suckling, _how often ought he to be fed_? not oftener than twice during the twenty four hours, and then only in _small_ quantities at a time, as the stomach requires rest, and at the same time, can manage to digest a little food better than it can a great deal. let me again urge upon you the importance, if it be at all practicable, of keeping the child _entirely_ to the breast for the first five or six months of his existence. remember there is no _real_ substitute for a mother's milk, there is no food so well adapted to his stomach, there is no diet equal to it in developing muscle, in making bone, or in producing that beautiful plump rounded contour of the limbs, there is nothing like a mother's milk _alone_ in making a child contented and happy, in laying the foundation of a healthy constitution, in preparing the body for a long life, in giving him tone to resist disease, or in causing him to cut his teeth easily and well, in short, _the mothers milk is the greatest temporal blessing an infant can possess_. as a general rule, therefore, when the child and the mother are tolerably strong, he is better _without artificial_ food until he have attained the age of three or four months, then, it will usually be necessary to feed him with _the milk-water-and-sugar-of milk food_ (see p 19) twice a day, so as gradually to prepare him to be weaned (if possible) at the end of nine months. the food mentioned in the foregoing conversation will, when he is six or seven months old, be the best for him. 36. _when the mother is not able to suckle her infant herself, what ought to be done_? it must first be ascertained, _beyond all doubt_, that a mother is not able to suckle her own child many delicate ladies do suckle their infants with advantage, not only to their offspring, but to themselves. "i will maintain," says steele, "that the mother grows stronger by it, and will have her health better than she would have otherwise she will find it the greatest cure, and preservative for the vapours [nervousness] and future miscarriages, much beyond any other remedy whatsoever her children will be like giants, whereas otherwise they are but living shadows, and like unripe fruit, and certainly if a woman is strong enough to bring forth a child, she is beyond all doubt strong enough to nurse it afterwards." many mothers are never so well as when they are nursing, besides, suckling prevents a lady from becoming pregnant so frequently as she otherwise would. this, if she be delicate, is an important consideration, and more especially if she be subject to miscarry. the effects of miscarriage are far more weakening than those of suckling. a hireling, let her be ever so well inclined, can never have the affection and unceasing assiduity of a mother, and, therefore, cannot perform the duties of suckling with equal advantage to the baby. the number of children who die under five years of age is enormous--many of them from the want of the mother's milk. there is a regular "parental baby-slaughter"--"a massacre of the innocents"-constantly going on in england, in consequence of infants being thus deprived of their proper nutriment and just dues! the mortality from this cause is frightful, chiefly occurring among rich people who are either too grand, or, from luxury, too delicate to perform such duties; poor married women, as a rule, nurse their own children, and, in consequence reap their reward. if it be ascertained, _past all doubt_, that a mother cannot suckle her child, then, if the circumstances of the parents will allow--and they ought to strain a point to accomplish it--a healthy wet-nurse should be procured, as, of course, the food which nature has supplied is far, very far superior to any invented by art. never bring up a baby, then, if you can possibly avoid it, on _artificial_ food. remember, as i proved in a former conversation, there is in early infancy no _real_ substitute for either a mother's or a wet-nurse's milk. it is impossible to imitate the admirable and subtle chemistry of nature. the law of nature is, that a baby, for the first few months of his existence, shall be brought up by the breast, and nature's law cannot be broken with impunity. [footnote: for further reasons why artificial food is not desirable, at an early period of infancy, see answer to 35th question, page 26.] it will be imperatively necessary then- "to give to nature what is nature's due." again, in case of a severe illness occurring during the first nine months of a child's life, what a comfort either the mother's or the wet-nurse's milk is to him! it often determines whether he shall live or die. but if a wet-nurse cannot fill the place of a mother, then asses' milk will be found the best substitute, as it approaches nearer, in composition, than any other animal's, to human milk; but it is both difficult and expensive to obtain. the next best substitute is goats' milk. either the one or the other ought to be milked fresh and fresh, when wanted, and should be given by means of a feeding-bottle. asses' milk is more suitable for a _delicate_ infant, and goats' milk for a _strong_ one. if neither asses' milk nor goats' milk can be procured, then the following _milk-water-salt-and-sugar food_, from the very commencement, should be given; and as i was the author of the formula, [footnote: it first appeared in print in the 4th edition of _advice to a mother_, 1852.] i beg to designate it as--_rye chavasse's milk food_:- new milk, the produce of one _healthy_ cow; warm water, of each, equal parts; table salt, a few grains--a small pinch; lump sugar, a sufficient quantity, to slightly sweeten it. the milk itself ought not to be heated over the fire, [footnote: it now and then happens that if the milk be not boiled, the motions of an infant are offensive; _when such is the case_, let the milk be boiled, but not otherwise.] but should, as above directed, be warmed by the water; it must, morning and evening, be had fresh and fresh. the milk and water should be of the same temperature as the mother's milk, that is to say, at about ninety degrees fahrenheit. it ought to be given by means of either morgan's, or maw's, or mather's feeding-bottle, [footnote: see answer to question 24, page 24.] and care must be taken to _scald_ the bottle out twice a day, for if attention be not paid to this point, the delicate stomach of an infant is soon disordered. the milk should, as he grows older, be gradually increased and the water decreased, until two-thirds of milk and one-third of water be used; but remember, that either _much_ or _little_ water must _always_ be given with the milk. the above is my old form, and which i have for many years used with great success. where the above food does not agree (and no food except a healthy mother's own milk does _invariably_ agree) i occasionally substitute sugar-of milt for the lump sugar, in the proportion of a tea spoonful of sugar-of milk to every half pint of food. if your child bring up his food, and if the ejected matter be sour-smelling, i should advise you to leave out the sugar-of milk altogether, and simply to let the child live, for a few days, on milk and water alone, the milk being of _one_ cow, and in the proportion of two-thirds to one-third of _warm_ water--not _hot_ water, the milk should not be scalded with _hot_ water, as it injures its properties, besides, it is only necessary to give the child his food with the chill just off. the above food, where the stomach is disordered, is an admirable one, and will often set the child to rights without giving him any medicine whatever. moreover, there is plenty of nourishment in it to make the babe thrive, for after all it is the milk that is the important ingredient in all the foods of infants, they can live on it, and on it alone, and thrive amazingly. mothers sometimes say to me, that farinaceous food makes their babes flatulent, and that my food (_pye chavasse's milk food_) has not that effect. the reason of farinaceous food making babes, until they have _commenced_ cutting their teeth, "windy" is, that the starch of the farinaceous food (and all farinaceous foods contain more or less of starch) is not digested, and is not, as it ought to be, converted by the saliva into sugar [footnote: see pye chavasse's _counsel to a mother_, 3d edition.] hence "wind" is generated, and pain and convulsions often follow in the train. the great desideratum, in devising an infant's formula for food, is to make it, until he be nine months old, to resemble as much as possible, a mother's own milk, and which my formula, as nearly as is practicable, does resemble hence its success and popularity. as soon as a child begins to cut his teeth the case is altered, and _farinaceous food, with milk and with water_, becomes an absolute necessity. i wish, then, to call your especial attention to the following-facts, for they are facts--farinaceous foods, _of all kinds_, before a child _commences_ cutting his teeth (which is when he is about six or seven months old) are worse than useless--they are, positively, injurious, they are, during the early period of infant life, perfectly indigestible, and may bring on--which they frequently do-convulsions. a babe fed on farinaceous food alone would certainly die of starvation, for, "up to six or seven months of age, infants have not the power of digesting farinaceous or fibrinous substances"--dr letheby on _food_. a babe's salivary glands, until he be six or seven months old, does not secrete its proper fluid--namely, ptyalin, and consequently the starch of the farinaceous food--and all farinaceous food contains starch--is not converted into dextrine and grape-sugar, and is, therefore, perfectly indigestible and useless--nay, injurious to an infant, and may bring on pain and convulsions, and even death, hence, the giving of farinaceous food, until a child be six or seven months old, is one and the principal cause of the frightful infant mortality at the present time existing in england, and which is a disgrace to any civilized land! in passing, allow me to urge you never to stuff a babe--never to overload his little stomach with food, it is far more desirable to give him a little not enough, than to give him a little too much. many a poor child has been, like a young bird, killed with stuffing. if a child be at the breast, and at the breast alone, there is no fear of his taking too much, but if he be brought up on artificial food, there is great fear of his over loading his stomach. stuffing a child brings on vomiting and bowel-complaints, and a host of other diseases which now it would be tedious to enumerate. let me, then, urge you on no account, to over load the stomach of a little child. there will, then, in many cases, be quite sufficient nourishment in the above. i have known some robust infants brought up on it, and on it along, without a particle of farinaceous food, or of any other food, in any shape or form whatever. but if it should not agree with the child, or if there should not be sufficient nourishment in it, then the food recommended in answer to no. 34 question ought to be given, with this only difference--a little new milk must from the beginning be added, and should be gradually increased, until nearly all milk be used. the milk, as a general rule, ought to be _unboiled_; but if it purge violently, or if it cause offensive motions--which it sometimes does--then it must be boiled. the moment the milk boils up, it should be taken off the fire. food ought for the first month to be given about every two hours; for the second month, about every three hours; lengthening the space of time as the baby advances in age. a mother must be careful not to over-feed a child, as over-feeding is a prolific source of disease. let it be thoroughly understood, and let there be no mistake about it, that a babe during the first nine months of his life, must have--it is absolutely necessary for his very existence--milk of some kind, as the staple and principal article of his diet, either mother's, wet-nurse's, or asses', or goats', or cow's milk. 37. _how would you choose a wet-nurse_? i would inquire particularly into the state of her health; whether she be of a healthy family, of a consumptive habit, or if she or any of her family have laboured under "king's evil;" ascertaining if there be any seams or swellings about her neck; any eruptions or blotches upon her skin; if she has a plentiful breast of milk, and if it be of good quality [footnote: "it should be thin, and of a bluish-white colour, sweet to the taste, and when allowed to stand, should throw up a considerable quantity of cream,"--_maxell and evenson on the diseases of children_.] (which may readily be ascertained by milking a little into a glass); if she has good nipples, sufficiently long for the baby to hold; that they be not sore; and if her own child be of the same, or nearly of the same age, as the one you wish her to nurse. ascertain, whether she menstruate during suckling; if she does, the milk is not so good and nourishing, and you had better decline taking her. [footnote: sir charles locock considers that a woman who menstruates during lactation is objectionable as a wet-nurse, and "that as a mother with her first child is more liable to that objection, that a second or third child's mother is more eligible than a first"--_letter to the author_.] assure yourself that her own babe is strong and healthy that he be free from a sore mouth, and from a "breaking-out" of the skin. indeed, if it be possible to procure such a wet-nurse, she ought to be from the country, of ruddy complexion, of clear skin, and of between twenty and five-and-twenty years of age, an the milk will then be fresh, pure, and nourishing. i consider it to be of great importance that the infant of the wet-nurse should be, as nearly as possible, of the same age as your own, as the milk varies in quality according to the age of the child. for instance, during the commencement of suckling, the milk is thick and creamy, similar to the biestings of a cow, which, if given to a babe of a few months old, would cause derangement of the stomach and bowels. after the first few days, the appearance of the milk changes; it becomes of a bluish-white colour, and contains less nourishment. the milk gradually becomes more and more nourishing as the infant becomes older and requires more support. in selecting a wet-nurse for a very small and feeble babe, you must carefully ascertain that the nipples of the wet-nurse are good and soft, and yet not very large. if they be very large, the child's mouth being very small, he may not be able to hold them. you must note, too, whether the milk flows readily from the nipple into the child's mouth; if it does not, he may not have strength to draw it, and he would soon die of starvation. the only way of ascertaining whether the infant really draws the milk from the nipple, can be done by examining the mouth of the child _immediately_ after his taking the breast, and seeing for yourself whether there be actually milk, or not, in his mouth. very feeble new-born babes sometimes cannot take the bosom, be the nipples and the breasts ever so good, and although maw's nipple-shield and glass tube had been tried. in such a case, cow's milk-water-sugar-and-salt, as recommended at page 29, must be given in small quantities at a time--from two to four tea-spoonfuls--but frequently; if the child be awake, every hour, or every half hour, both night and day, until he be able to take the breast. if, then, a puny, feeble babe is only able to take but little at a time, and that little by tea-spoonfuls, he must have little and often, in order that "many a little might make a mickle." i have known many puny, delicate children who had not strength to hold the nipple in their mouths, but who could take milk and water (as above recommended) by tea-spoonfuls only at a time, with steady perseverance, and giving it every half hour or hour (according to the quantity swallowed), at length be able to take the breast, and eventually become strong and hearty children; but such cases require unwearied watching, perseverance, and care. bear in mind, then, that the smaller the quantity of the milk and water given at a time, the oftener must it be administered, as, of course, the babe must have a certain quantity of food to sustain life. 38. _what ought to be the diet either of a wet-nurse, or of a mother, who is suckling_? it is a common practice to cram a wet-nurse with food, and to give her strong ale to drink, to make good nourishment and plentiful milk! this practice is absurd; for it either, by making the nurse feverish, makes the milk more sparing than usual, or it causes the milk to be gross and unwholesome. on the other hand, we must not run into an opposite extreme. the mother, or the wet-nurse, by using those means most conducive to her own health, will best advance the interest of her little charge. a wet-nurse, ought to live somewhat in the following way:--let her for breakfast have black tea, with one or two slices of cold meat, if her appetite demand it, but not otherwise. it is customary for a wet-nurse to make a hearty luncheon; of this i do not approve. if she feel either faint or low at eleven o'clock, let her have either a tumbler of porter, or of mild fresh ale, with a piece of dry toast soaked in it. she ought not to dine later than half-past one or two o'clock; she should eat, for dinner, either mutton or beef, with either mealy potatoes, or asparagus, or french beans, or secale, or turnips, or broccoli, or cauliflower, and stale bread. rich pastry, soups, gravies, high-seasoned dishes, salted meats, greens, and cabbage, must one and all be carefully avoided; as they only tend to disorder the stomach, and thus to deteriorate the milk. it is a common remark, that "a mother who is suckling may eat anything." i do not agree with this opinion. can impure or improper food make pure and proper milk, or can impure and improper milk make good blood for an infant, and thus good health? the wet-nurse ought to take with her dinner a moderate quantity of either sound porter, or of mild (but not old or strong) ale. tea should be taken at half past five or six o'clock; supper at nine, which should consist either of a slice or two of cold meat, or of cheese if she prefer it, with half a pint of porter or of mild ale; occasionally a basin of gruel may with advantage be substituted. hot and late suppers are prejudicial to the mother, or to the wet-nurse, and, consequently, to the child. the wet-nurse ought to be in bed every night by ten o'clock. it might be said, that i have been too minute and particular in my rules for a wet-nurse; but when it is considered of what importance good milk is to the well-doing of an infant, in making him strong and robust, not only now, but as he grows up to manhood, i shall, i trust, be excused for my prolixity. 39. _have you any more hints to offer with regard to the management of a wet-nurse_? a wet-nurse is frequently allowed to remain in bed until a late hour in the morning, and during the day to continue in the house, as if she were a fixture! how is it possible that any one, under such treatment, can continue healthy! a wet nurse ought to rise early, and, if the weather and season will permit, take a walk, which will give her an appetite for breakfast, and will make a good meal for her little charge. this, of course, cannot, during the winter mouths, be done; but even then, she ought, some part of the day, to take every opportunity of walking out; indeed, in the summer time she should live half the day in the open air. she ought strictly to avoid crowded rooms; her mind should be kept calm and unruffled, as nothing disorders the milk so much as passion, and other violent emotions of the mind; a fretful temper is very injurious, on which account you should, in choosing your wet-nurse, endeavour to procure one of a mild, calm, and placid disposition. [footnote: "'the child is poisoned.' 'poisoned! by whom?' 'by you. you have been fretting.' 'nay, indeed, mother. how can i help fretting!' 'don't tell me, margaret. a nursing mother has no business to fret. she must turn her mind away from her grief to the comfort that lies in her lap. know you not that the child pines if the mother vexes herself?'"--_the cloister and the hearth_. by charles reade.] a wet-nurse ought never to be allowed to dose her little charge either with godfrey's cordial, or with dalby's carminative, or with syrup of white poppies, or with medicine of any kind whatever. let her thoroughly understand this, and let there be no mistake in the matter. do not for one moment allow your children's health to be tampered and trifled with. a baby's health is too precious to be doctored, to be experimented upon, and to be ruined by an ignorant person. 40. _have the goodness to state at what age a child ought to be weaned_? this, of course, must depend both upon the strength of the child, and upon the health of the parent; on an average, nine months is the proper time. if the mother be delicate, it may be found necessary to wean the infant at six months; or if he be weak, or labouring under any disease, it may be well to continue suckling him for twelve months; but after that time, the breast will do him more harm than good, and will, moreover, injure the mother's health, and may, if she be so predisposed, excite consumption. 41. _how would you recommend a mother to act when, she weans her child_? she ought, as the word signifies, do it gradually--that is to say, she should, by degrees, give him less and less of the breast, and more and more of artificial food; at length, she must only suckle him at night; and lastly, it would be well for the mother either to send him away, or to leave him at home, and, for a few days, to go away herself. a good plan is, for the nurse-maid to have a half-pint bottle of new milk--which has been previously boiled [footnote: the previous boiling of the milk will prevent the warmth of the bed turning the milk sour, which it otherwise would do.]--in the bed, so as to give a little to him in lieu of the breast. the warmth of the body will keep the milk of a proper temperature, and will supersede the use of lamps, of candle-frames, and of other troublesome contrivances. 42. _while a mother is weaning her infant, and after she have weaned him, what ought to be his diet_? any one of the foods recommended in answer to question 34. 43. _if a child be suffering severely from "wind," is there any objection to the addition of a small quantity either of gin or of peppermint to his food to disperse it_? it is a murderous practice to add either gin or peppermint of the shops (which is oil of peppermint dissolved in spirits) to his food. many children have, by such a practice, been made puny and delicate, and have gradually dropped into an untimely grave. an infant who is kept, for the first five or six months, _entirely_ to the breast--more especially if the mother be careful in her own diet--seldom suffers from "wind;" those, on the contrary, who have much or improper food, [footnote: for the first five or six months never, if you can possibly avoid it, give artificial food to an infant who is sucking. there is nothing, in the generality of cases, that agrees, for the first few months, like the mother's milk _alone_.] suffer severely. care in feeding, then, is the grand preventative of "wind;" but if, notwithstanding all your precautions, the child be troubled with flatulence, the remedies recommended under the head of flatulence will generally answer the purpose. 44. _have you any remarks to make on sugar for sweetening a baby's food_? a _small_ quantity of sugar in an infant's food is requisite, sugar being nourishing and fattening, and making cow's milk to resemble somewhat, in its properties human milk; but, bear in mind, _it must be used sparingly._ _much_ sugar cloys the stomach, weakens the digestion, produces acidity, sour belchings, and wind:- "things sweet to taste, prove in digestion sour." _shakspeare._ if a babe's bowels be either regular or relaxed, _lump_ sugar is the best for the purpose of sweetening his food; if his bowels are inclined to be costive, _raw_ sugar ought to be substituted for lump sugar, as _raw_ sugar acts on a young babe as an aperient, and, in the generality of cases, is far preferable to physicking him with opening medicine. an infant's bowels, whenever it be practicable (and it generally is), ought to be regulated by a judicious dietary rather than by physic. vaccination and re-vaccination. 45. _are you an advocate for vaccination_? certainly. i consider it to be one of the greatest blessings ever conferred upon mankind. small-pox, before vaccination was adopted, ravaged the country like a plague, and carried off thousands annually; and those who did escape with their lives were frequently made loathsome and disgusting objects by it. even inoculation (which is cutting for the small-pox) was attended with danger, more especially to the unprotected--as it caused the disease to spread like wildfire, and thus it carried off immense numbers. vaccination is one, and an important cause of our increasing population; small-pox, in olden times, decimated the country. 46. _but vaccination does not always protect a child from, small-pox_? i grant you that it does not _always_ protect him, _neither does inoculation_; but when he is vaccinated, if he take the infection, he is seldom pitted, and very rarely dies, and the disease assumes a comparatively mild form. there are a few, very few fatal cases recorded after vaccination, and these may be considered as only exceptions to the general rule; and, possibly, some of these may be traced to the arm, when the child was vaccinated, not having taken proper effect. if children, and adults were _re-vaccinated_,--say every seven years after the first vaccination,--depend upon it, even these rare cases would not occur, and in a short time small-pox would be known only by name. 47. _do you consider it, then, the imperative duty of a mother, in every case, to have, after the lapse of every seven years, her children re-vaccinated_? i decidedly do: it would be an excellent plan for _every_ person, once every seven years to be re-vaccinated, and even oftener, if small-pox be rife in the neighbourhood. vaccination, however frequently performed, can never do the slightest harm, and might do inestimable good. small-pox is both a pest and a disgrace, and ought to be constantly fought and battled with, until it be banished (which it may readily be) the kingdom. i say that small-pox is a pest; it is worse than the plague, for if not kept in subjection, it is more general--sparing neither young nor old, rich nor poor, and commits greater ravages than the plague ever did. small-pox is a disgrace: it is a disgrace to any civilised land, as there is no necessity for its presence, if cow-pox were properly and frequently performed, small-pox would be unknown. cow-pox is a weapon to conquer small-pox and to drive it ignominiously from the field. my firm belief, then, is, that if _every_ person were, _every seven years_, duly and properly vaccinated, small-pox might be utterly exterminated; but as long as there are such lax notions on the subject, and such gross negligence, the disease will always be rampant, for the poison of small-pox never slumbers nor sleeps, but requires the utmost diligence to eradicate it. the great dr jenner, the discoverer of cow-pox as a preventative of small-pox, strongly advocated the absolute necessity of _every_ person being re-vaccinated once every seven years, or even, oftener, if there was an epidemic of small-pox in the neighbourhood. 48. _are you not likely to catch not only the cow-pox, but any other disease that the child has from whom the matter is taken_? the same objection holds good in cutting for small pox (inoculation)--only in a ten-fold degree--small-pox being such a disgusting complaint. inoculated small-pox frequently produced and left behind inveterate "breakings-out," scars, cicatrices, and indentations of the skin, sore eyes, blindness, loss of eyelashes, scrofula, deafness--indeed, a long catalogue of loathsome diseases. a medical man, of course, will be careful to take the cow-pox matter from a healthy child. 49. _would it not be well to take the matter direct from the cow_? if a doctor be careful--which, of course, he will be--to take the matter from a healthy child, and from a well-formed vesicle, i consider it better than taking it _direct_ from the cow, for the following reasons:--the cow-pox lymph, taken direct from the cow, produces much more violent symptoms than after it has passed through several persons; indeed, in some cases, it has produced effects as severe as cutting for the small-pox, besides, it has caused, in many cases, violent inflammation and even sloughing of the arm. there are also several kinds of _spurious_ cow-pox to which the cow is subject, and which would be likely to be mistaken for the _real_ lymph. again, if even the _genuine_ matter were not taken from the cow _exactly_ at the proper time, it would he deprived of its protecting power. 50. _at what age do you recommend an infant to be first vaccinated_? when he is two months old, as the sooner he is protected the better. moreover, the older he is the greater will be the difficulty in making him submit to the operation, and in preventing his arm from being rubbed, thus endangering the breaking of the vesicles, and thereby interfering with its effects. if small-pox be prevalent in the neighbourhood, he may, with perfect safety, be vaccinated at the month's end; indeed if the small-pox be near at hand, he _must_ be vaccinated, regardless of his age, and regardless of everything else, for small-pox spares neither the young nor the old, and if a new-born babe should unfortunately catch the disease, he will most likely die, as at his tender age he would not have strength to battle with such a formidable enemy. "a case, in the general lying-in-hospital, lambeth, of small-pox occurred in a woman a few days after her admission, and the birth of her child. her own child was vaccinated when only four days old, and all the other infants in the house varying from one day to a fortnight and more. all took the vaccination; and the woman's own child, which suckled her and slept with her; and all escaped the small pox." [footnote: communicated by sir charles locock to the author.] 51. _do you consider that taking of matter from a child's arm weakens the effect of vaccination on the system_? certainly not, provided it has taken effect in more than one place. the arm is frequently much inflamed, and vaccinating other children from it abates the inflammation, and thus affords relief. _it is always well to leave one vesicle undisturbed_. 52. _if the infant have any "breaking out" upon the skin, ought that to be a reason for deferring the vaccination_? it should, as two skin diseases cannot well go on together; hence the cow-pox might not take, or, if it did, might not have its proper effect in preventing small-pox. "it is essential that the vaccine bud or germ have a congenial soil, uncontaminated by another poison, which, like a weed, might choke its healthy growth."--_dendy_. the moment the skin be free from the breaking-out, he must be vaccinated. a trifling skin affection, like red gum, unless it be severe, ought not, at the proper age to prevent vaccination. if small-pox be rife in the neighbourhood, the child _must_ be vaccinated, regardless of any "breaking-out" on the skin. 53. _does vaccination make a child poorly_? at about the fifth day after vaccination, and for three or four days, he is generally a little feverish; the mouth is slightly hot, and he delights to have the nipple in his mouth. he does not rest so well at night; he is rather cross and irritable; and, sometimes, has a slight bowel-complaint. the arm, about the ninth or tenth day, is usually much inflamed--that is to say it is, for an inch or two or more around the vesicles, red, hot, swollen, and continues in this state for a day or two, at the end of which time the inflammation gradually subsides. it might be well to state that the above slight symptoms are desirable, as it proves that the vaccination has had a proper effect on his system, and that, consequently, he is more likely to be thoroughly protected from any risk of catching small-pox. 54. _do you approve, either during or after vaccination, of giving medicine, more especially if he be a little feverish_? no, as it would be likely to work off some of its effects, and thus would rob the cow-pox of its efficacy on the system. i do not like to interfere with vaccination _in any way whatever_ (except, at the proper time, to take a little matter from the arm), but to allow the pock to have full power upon his constitution. what do you give the medicine for? if the matter that is put into the arm be healthy, what need is there of physic! and if the matter be not of good quality, i am quite sure that no physic will make it so! look, therefore, at the case in whatever way you like, physic after vaccination is _not_ necessary; but, on the contrary, hurtful. if the vaccination produce slight feverish attack, it will, without the administration of a particle of medicine, subside in two or three days. 55. _have you any directions to give respecting the arm after vaccination_? the only precaution necessary is to take care that the arm be not rubbed; otherwise the vesicles may be prematurely broken, and the efficacy of the vaccination may be lessened. the sleeve, in vaccination, ought to be large and soft, and should not be tied up. the tying up of a sleeve makes it hard, and is much more likely to rub the vesicles than if it were put on the usual way. 56. _if the arm, after vaccination, be much inflamed, what ought to be done_? smear frequently, by means of a feather or a camel's hair brush, a little cream on the inflamed part. this simple remedy will afford great comfort and relief. 57. _have the goodness to describe the proper appearance, after the falling-off of the scab of the arm_? it might be well to remark, that the scabs ought always to be allowed to fall off of themselves. they must not, on any account, be picked or meddled with. with regard to the proper appearance of the arm, after the falling-off of the scab, "a perfect vaccine scar should be of small size, circular, and marked with radiations and indentations."-_gregory_. dentition 58. _at what time does dentition commence_? the period at which it commences is uncertain. it may, as a rule, be said that a babe begins to cut his teeth at seven months old. some have cut teeth at three months; indeed, there are instances on record of infants having been born with teeth. king richard the third is said to have been an example. shakspeare notices it thus:- "york.--marry, they say my uncle grew so fast, that he could gnaw a crust at two hours old. 'twas full two years ere i could get a tooth, grandam, this would have been a biting jest." when a babe is born with teeth, they generally drop out. on the other hand, teething, in some children does not commence until they are a year and a half or two years old, and, in rare cases, not until they are three years old. there are cases recorded of adults who have never cut any teeth. an instance of the kind came under my own observation. dentition has been known to occur in old age. a case is recorded by m. carre, in the _gazette medicale de paris_ (sept 15, 1860), of an old lady, aged eighty-five, who cut several teeth after attaining that age! 59. _what is the number of the first set of teeth, and in what order do they generally appear_? the first or temporary set consists of twenty. the first set of teeth are usually cut in pairs. "i may say that nearly invariably the order is--1st, the lower front incissors [cutting teeth], then the upper front, then the _upper_ two lateral incissors, and that not uncommonly a double tooth is cut before the two _lower_ laterals; but at all events the lower laterals come 7th and 8th, and, not 5th and 6th, as nearly all books on the subject testify." [footnote: sir charles locock in a _letter_ to the author.] then the first grinders, in the lower jaw, afterwards the first upper grinders, then the lower corner-pointed or canine teeth, after which the upper corner or eye-teeth, then the second grinders in the lower jaw, and lastly, the second grinders of the upper jaw. they do not, of course, always appear in this rotation. nothing is more uncertain than the order of teething. a child seldom cuts his second grinders until after he is two years old. _he is, usually, from the time they first appear, two years in cutting the first set of teeth_. as a rule, therefore, a child of two years old has sixteen, and one of two years and a half old, twenty teeth. 60. _if an infant be feverish or irritable, or otherwise poorly, and if the gums be hot, swollen, and tender, are you an advocate for their being lanced_? certainly; by doing so he will, in the generality of instances, be almost instantly relieved. 61. _but it has been stated that lancing the gums hardens them_? this is a mistake--it has a contrary effect. it is a well-known fact, that a part which has been divided gives way much more readily than one which has not been cut. again, the tooth is bound down by a tight membrane, which, if not released by lancing, frequently brings on convulsions. if the symptoms be urgent, it may be necessary from time to time to repeat the lancing. it would, of course, be the height of folly to lance the gums unless they be hot and swollen, and unless the tooth, or the teeth, be near at hand. it is not to be considered a panacea for every baby's ill, although, in those cases where the lancing of the gums is indicated, the beneficial effect is sometimes almost magical. 62. _how ought the lancing of a child's gums to be performed_? the proper person, of course, to lance his gums is a medical man. but if, perchance, you should be miles away and be out of the reach of one, it would be well for you to know how the operation ought to be performed. well, then, let him lie on the nurse's lap upon his back, and let the nurse take hold of his hands in order that he may not interfere with the operation. then, _if it be the upper gum_ that requires lancing, you ought to go to the head of the child, looking over, as it were, and into his mouth, and should steady the gum with the index finger of your left hand; then, you should take hold of the gum-lancet with your right hand--holding as if it were a table-knife at dinner--and cut firmly along the inflamed and swollen gum and down to the tooth, until the edge of the gum-lancet grates on the tooth. each incision ought to extend along the ridge of the gum to about the extent of each expected tooth. _if it be the lower gum_ that requires lancing, you must go to the side of the child, and should steady the outside of the jaw with the fingers of the left hand, and the gum with the left thumb, and then you should perform the operation as before directed. although the lancing of the gums, to make it intelligible to a non-professional person, requires a long description, it is, in point of fact, a simple affair, is soon performed, and gives but little pain. 63. _if teething cause convulsions, what ought to be done_? the first thing to be done (after sending for a medical man) is to freely dash water upon the face, and to sponge the head with cold water, and as soon as warm water can be procured, to put him into a warm bath [footnote: for the precautions to be used in putting a child into a warm bath, see the answer to question on "warm baths."] of 98 degrees fahrenheit. if a thermometer be not at hand, [footnote: no family, where there are young children, should be without fahrenheit's thermometer.] you must plunge your own elbow into the water: a comfortable heat for your elbow will be the proper heat for the infant. he must remain in the bath for a quarter of an hour, or until the fit be at an end. the body must, after coming out of the bath, be wiped with warm and dry and coarse towels; he ought then to be placed in a warm blanket. the gums must be lanced, and cold water should be applied to the head. an enema, composed of table salt, of olive oil, and warm oatmeal gruel--in the proportion of one table-spoonful of salt, of one of oil, and a tea-cupful of gruel--ought then to be administered, and should, until the bowels have been well opened, be repeated every quarter of an hour; as soon as he comes to himself a dose of aperient medicine ought to be given. it may be well, for the comfort of a mother, to state that a child in convulsions is perfectly insensible to all pain whatever; indeed, a return to consciousness speedily puts convulsions to the rout. 64. _a nurse is in the habit of giving a child, who is teething, either coral, or ivory, to bite: do you approve of the plan_? i think it a bad practice to give him any hard, unyielding substance, as it tends to harden the gums, and, by so doing, causes the teeth to come through with greater difficulty. i have found softer substances, such as either a piece of wax taper, or an india-rubber ring, or a piece of the best bridle leather, or a crust of bread, of great service. if a piece of crust be given as a gum-stick, he must, while biting it, be well watched, or by accident he might loosen a large piece of it, which might choke him. the pressure of any of these excites a more rapid absorption of the gum, and thus causes the tooth to come through more easily and quickly. 65. _have you any objection to my baby, when he is cutting his teeth, sucking his thumb_? certainly not: the thumb is the best gum-stick in the world:--it is convenient; it is handy (in every sense of the word): it is of the right size, and of the proper consistence, neither too hard nor too soft; there is no danger, as of some artificial gum-sticks, of its being swallowed, and thus of its choking the child. the sucking of the thumb causes the salivary glands to pour out their contents, and thus not only to moisten the dry mouth, but assist the digestion; the pressure of the thumb eases, while the teeth are "breeding," the pain and irritation of the gums, and helps, when the teeth are sufficiently advanced, to bring them through the gums. sucking of the thumb will often make a cross infant contended and happy, and will frequently induce a restless babe to fall into a sweet refreshing sleep. truly may the thumb be called a baby's comfort. by all means, then, let your child suck his thumb whenever he likes, and as long as he chooses to do so. there is a charming, bewitching little picture of a babe sucking his thumb in kingsley's _water babies_, which i heartily commend to your favourable notice and study. 66. _but if an infant be allowed to suck his thumb, will it not be likely to become a habit, and stick to him for years--until, indeed, he become a big boy_? after he have cut the whole of his first set of teeth, that is to say, when he is about two years and a half old, he might, if it be likely to become a habit, be readily cured by the following method, namely, by making a paste of aloes and water, and smearing it upon his thumb. one or two dressings will suffice as after just tasting the bitter aloes he will take a disgust to his former enjoyment, and the habit will at once be broken. many persons i know have an objection to children sucking their thumbs, as for instance,- "perhaps it's as well to keep children from plums, and from pears in the season, and sucking their thumbs." [footnote: _ingoldsby legends_.] my reply is,- p'rhaps 'tis as well to keep children from pears; the pain they might cause, is oft follow'd by tears; 'tis certainly well to keep them from plums; but certainly not from sucking their thumbs! if a babe suck his thumb 'tis an ease to his gum; a comfort; a boon; a calmer of grief; a friend in his need--affording relief; a solace; a good; a soother of pain; a composer to sleep; a charm; and a gain. 'tis handy, at once, to his sweet mouth to glide; when done with, drops gently down by his side; 'tis fix'd, like an anchor, while the babe sleeps. and the mother, with joy, her still vigil keeps. 67. _a child who is teething dribbles, and thereby wets his chest, which frequently causes him to catch cold; what had better be done_? have in readiness to put on several _flannel_ dribbling bibs, so that they may be changed as often as they become wet; or, if he dribble _very much_, the oiled silk dribbling-bibs, instead of the flannel ones, may be used, and which may be procured at any baby-linen ware house. 68. _do you approve of giving a child, during teething, much fruit_? no; unless it be a few ripe strawberries or raspberries, or a roasted apple, or the juice of five or six grapes--taking care that he does not swallow either the seeds or the skin--or the insides of ripe gooseberries, or an orange. such fruits, if the bowels be in a costive state, will be particularly useful. all stone fruit, _raw_ apples or pears, ought to be carefully avoided, as they not only disorder the stomach and the bowels,--causing convulsions, gripings, &c.,--but they have the effect of weakening the bowels, and thus of engendering worms. 69. _is a child, during teething, more subject to disease, and, if so, to what complaints, and in what manner may they be prevented_? the teeth are a fruitful source of suffering and of disease; and are, with truth, styled "our first and our last plagues." dentition is the most important period of a child's life, and is the exciting cause of many infantile diseases; during this period, therefore, he requires constant and careful watching. when we consider how the teeth elongate and enlarge in his gums, pressing on the nerves and on the surrounding parts, and thus how frequently they produce pain, irritation, and inflammation; when we further contemplate what sympathy there is in the nervous system, and how susceptible the young are to pain, no surprise can be felt, at the immense disturbance, and the consequent suffering and danger frequently experienced by children while cutting their _first_ set of teeth. the complaints or the diseases induced by dentition are numberless, affecting almost every organ of the body,--the _brain_, occasioning convulsions, water on the brain, &c.; the _lungs_, producing congestion, inflammation, cough, &c.; the _stomach_, exciting sickness, flatulence, acidity, &c,; the _bowels_, inducing griping, at one time costiveness, and at another time purging; the _skin_, causing "breakings-out." to prevent these diseases, means ought to be used to invigorate a child's constitution by plain, wholesome food, as recommended under the article of diet; by exercise and fresh air; [footnote: the young of animals seldom suffer from cutting their teeth--and what is the reason? because they live in the open air, and take plenty of exercise; while children are frequently cooped up in close rooms, and are not allowed the free use of their limbs. the value of fresh air is well exemplified in the registrar-general's report for 1843; he says that in 1,000,000 deaths, from all diseases, 616 occur in the town from teething while 120 only take place in the country from the same cause.] by allowing him, weather permitting, to be out of doors a great part of every day; by lancing the gums when they get red, hot, and swollen; by attention to the bowels, and if he suffer more than usual, by keeping them rather in a relaxed state by any simple aperient, such as either castor oil, or magnesia and rhubarb, &c.; and, let me add, by attention to his temper: many children are made feverish and ill by petting and spoiling them. on this subject i cannot do better than refer you to an excellent little work entitled abbot's _mother of home_, wherein the author proves the great importance of _early_ training. 70. _have the goodness to describe the symptoms and the treatment of painful dentition_? painful dentition may be divided into two forms--(1) the mild; and (2) the severe. in the _mild_ form the child is peevish and fretful, and puts his fingers, and everything within reach, to his mouth, he likes to have his gums rubbed, and takes the breast with avidity, indeed it seems a greater comfort to him than ever. there is generally a considerable flow of saliva, and he has frequently a more loose state of bowels than is his wont. now, with regard to the more _severe_ form of painful dentition--the gums are red, swollen, and hot, and he cannot without expressing pain bear to have them touched, hence, if he be at the breast, he is constantly loosing the nipple. there is dryness of the mouth, although before there had been a great flow of saliva. he is feverish, restless, and starts in his sleep. his face is flashed. his head is heavy and hot. he is sometimes convulsed. [footnote: see answer to question 63.] he is frequently violently griped and purged, and suffers severely from flatulence. he is predisposed to many and severe diseases. the _treatment,_ of the _mild_ form, consists of friction, of the gum with the finger, with a little "soothing syrup," as recommended by sir charles locock, [footnote: soothing syrup--some of them probably contain opiates, but a perfectly safe and useful one is a little nitrate of potass in syrup of roses--one scruple to half an ounce.--_communicated by sir charles locock to the author._ this 'soothing syrup' is not intended to be given us a mixture but to be used as an application to rub the gums with. it may be well to state that it is a perfectly harmless remedy even if a little of it were swallowed by mistake.] a tepid bath of about 92 degrees fahrenheit, every night at bed time, attention to diet and to bowels, fresh air and exercise. for the mild form, the above plan will usually be all that is required. if he dribble, and the bowels be relaxed, so much the better. the flow of saliva and the increased action of the bowels afford relief, and therefore must not be interfered with. in the _mild_ form, lancing of the gums is not desirable. the gums ought not to be lanced, unless the teeth be near at hand, and unless the gums be red, hot, and swollen. in the _severe_ form a medical man should be consulted early, as more energetic remedies will be demanded; that is to say, the gums will require to be freely lanced, warm baths to be used, and medicines to be given, to ward off mischief from the head, from the chest, and from the stomach. if you are living in the town, and your baby suffers much from teething, take him into the country. it is wonderful what change of air to the country will often do, in relieving a child who is painfully cutting his teeth. the number of deaths in london, from teething, is frightful; it is in the country comparatively trifling. 71. _should an infant be purged during teething or indeed, during any other time, do you approve of either absorbent or astringent medicines to restrain it_? certainly not. i should look upon, the relaxation as an effort of nature to relieve itself. a child is never purged without a cause; that cause, in the generality of instances, is the presence of either some undigested food, or acidity, or depraved motions, that want a vent. the better plan is, in such a case, to give a dose of aperient medicine, such as either castor oil, or magnesia and rhubarb; and thus work it off. if we lock up the bowels, we confine the enemy, and thus produce mischief. [footnote: i should put this in capitals, it is so important and is often mistaken.--c. locock.] if he be purged more than usual, attention should be paid to the diet--if it be absolutely necessary to give him artificial food while suckling--and care must be taken not to overload the stomach. 72. _a child is subject to a slight cough during dentition--called by nurses "tooth-cough"--which a parent would not consider of sufficient importance to consult a doctor about: pray tell me, is there any objection to a mother giving her child a small quantity either of syrup of white poppies, or of paregoric, to ease it_? a cough is an effort of nature to bring up any secretion from the lining membrane of the lungs, or from the bronchial tubes, hence it ought not to be interfered with. i have known the administration of syrup of white poppies, or of paregoric, to stop the cough, and thereby to prevent the expulsion of the phlegm, and thus to produce either inflammation of the lungs, or bronchitis. moreover, both paregoric and syrup of white poppies are, for a young child, dangerous medicines (unless administered by a judicious medical man), and _ought never to be given by a mother_. in the month of april 1844, i was sent for, in great haste, to an infant, aged seventeen months, who was labouring under convulsions and extreme drowsiness, from the injudicious administration of paregoric, which had been given to him to ease a cough. by the prompt administration of an emetic he was saved. 73. _a child, who is teething, is subject to a "breaking-out," more especially behind the ears--which is most disfiguring, and frequently very annoying what would you recommend_? i would apply no external application to cure it, as i should look upon it as an effort of the constitution to relieve itself, and should expect, if the "breaking-out" were repelled, that either convulsions, or bronchitis, or inflammation of the lungs, or water on the brain, would be the consequence. the only plan i should adopt would be, to be more careful in his diet, to give him less meat (if he be old enough to eat animal food), and to give him, once or twice a week, a few doses of mild aperient medicine, and, if the irritation from the "breaking-out" be great, to bathe it, occasionally, either with a little warm milk and water, or with rose water. exercise. 74. _do you recommend exercise in the open air for a baby? and if so, how soon after birth_? i am a great advocate for his having exercise in the open air. "the infant in arms makes known its desire for fresh air, by restlessness, it cries, for it cannot speak its wants, is taken abroad and is quiet." the age at which he ought to commence taking exercise will, of course, depend upon the season and upon the weather. if it be summer, and the weather be fine, he should he carried in the open air, a week or a fortnight after birth, but if it be winter, he ought not on any account to be taken out under the month, and not even then, unless the weather be mild for the season, and it be the middle of the day. at the end of two months he should breathe the open air more frequently. and after the expiration of three months, he ought to be carried out _every day_, even if it be wet under foot, provided it be fine above, and the wind be neither in an easterly nor in a north-easterly direction. by doing so we shall make him strong and hearty, and give the skin that mottled appearance which is so characteristic of health. he must, of course, be well clothed. i cannot help expressing my disapprobation of the practice of smothering up an infant's face with a handkerchief, with a veil or with any other covering, when he is taken out into the air. if his face be so muffled up, he may as well remain at home, as under such circumstances, it is impossible for him to receive any benefit from the invigorating effects of the fresh air. 75. _can you devise any method to induce a babe himself to take exercise_? he must be encouraged to use muscular exertion, and, for this purpose, he ought to be frequently laid either upon a rug, or carpet, or the floor. he will then stretch his limbs and kick about with perfect glee. it is a pretty sight, to see a little fellow kicking and sprawling on the floor. he crows with delight and thoroughly enjoys himself. it strengthens his back, it enables him to stretch his limbs, and to use his muscles, and is one of the best kinds of exercise a very young child can take. while going through his performances his diaper, if he wear one, should be unfastened, in order that he might go through his exercises untrammelled. by adopting the above plan, the babe quietly enjoys himself--his brain is not over excited by it; this is an important consideration, for both mothers and nurses are apt to rouse, and excite very young children to their manifest detriment. a babe requires rest, and not excitement. how wrong it is, then, for either a mother or a nurse to be exciting and rousing a new born babe. it is most injurious and weakening to his brain. in the early period of his existence his time ought to be almost entirely spent in sleeping and in sucking! 76. _do you approve of tossing an infant much about_? i have seen, a child tossed nearly to the ceiling! can anything be more cruel or absurd! violent tossing of a young babe ought never to be allowed, it only frightens him, and has been known to bring on convulsions. he should be gently moved up and down (not tossed), such exercises causes a proper circulation of the blood, promotes digestion, and soothes to sleep. he must always be kept quiet immediately after taking the breast, if he be tossed _directly_ afterwards, it interferes with his digestion, and is likely to produce sickness. sleep 77. _ought the infant's sleeping apartment to be kept warm_? the lying-in room is generally kept too warm, its heat being, in many instances, more that of an oven than of a room. such a place is most unhealthy, and is fraught with danger both to the mother and the baby. we are not, of course, to run into an opposite extreme, but are to keep the chamber at a moderate and comfortable temperature. the door ought occasionally to be left ajar, in order the more effectually to change the air and thus to make it more pure and sweet. a new born babe, then, ought to be kept comfortably warm, but not very warm. it is folly in the extreme to attempt to harden a very young child either by allowing him, in the winter time, to be in a bedroom without a fire, or by dipping him in _cold_ water, or by keeping him with scant clothing on his bed. the temperature of a bedroom, in the winter time, should be, as nearly as possible, at 60 deg. fahr. although the room should be comfortably warm, it ought from time to time to be properly ventilated. an unventilated room soon becomes foul, and, therefore, unhealthy. how many in this world, both children and adults, are "poisoned with their own breaths!" an infant should not be allowed to look at the glare either of a fire or of a lighted candle, as the glare tends to weaken the sight, and sometimes brings on an inflammation of the eyes. in speaking to, and in noticing a baby, you ought always to stand _before_, and not _behind_ him, or it might make him squint. 78. _ought a babe to lie alone from the first_? certainly not: at first--say, for the first few months--he requires the warmth of another person's body, especially in the winter; but care must be taken not to overlay him, as many infants, from carelessness in this particular, have lost their lives. after the first few months he had better lie alone, on a horse-hair mattress. 79. _do you approve of rocking an infant to sleep_? i do not. if the rules of health be observed, he will sleep both soundly and sweetly without rocking; if they be not, the rocking might cause him to fall into a feverish, disturbed slumber, but not into a refreshing, calm sleep. besides, if you once take to that habit, he will not go to sleep without it. 80. _then don't you approve of a rocking-chair, and of rockers to the cradle_? certainly not: a rocking-chair, or rockers to the cradle, may be useful to a lazy nurse or mother, and may induce a child to sleep, but that restlessly, when he does not need sleep, or when he is wet and uncomfortable, and requires "changing;" but will not cause him to have that sweet and gentle and exquisite slumber so characteristic of a baby who has no artificial appliances to make him sleep. no! rockers are perfectly unnecessary, and the sooner they are banished the nursery the better will it be for the infant community. i do not know a more wearisome and monotonous sound than the everlasting rockings to and fro in some nurseries, they are often accompanied by a dolorous lullaby from the nurse, which adds much to the misery and depressing influence of the performance. 81. _while the infant is asleep, do you advise the head of the crib to be covered with a handkerchief, to shade his eyes from the light, and, if it be summer time, to keep off the flies_? if the head of the crib be covered, the babe cannot breathe freely, the air within the crib becomes contaminated, and thus the lungs cannot properly perform their functions. if his sleep is to be refreshing, he must breathe pure air. i do not even approve of a head to a crib. a child is frequently allowed to sleep on a bed with the curtains drawn completely close, as though it were dangerous for a breath of air to blow upon him [footnote: i have somewhere read that if a cage containing a canary, be suspended at night within a bed where a person is sleeping, and the curtains be drawn closely around, that the bird will, in the morning, in all probability, be found dead!] this practice is most injurious. an infant must have the full benefit of the air of the room, indeed, the bed room door ought to be frequently left ajar, so that the air of the apartment may be changed, taking care, of course, not to expose him to a draught. if the flies, while he is asleep, annoy him, let a net veil be thrown over his face, as he can readily breathe through net, but not through a handkerchief. 82. _have you any suggestions to offer as to the way a babe should be dressed when he is put down to sleep_? whenever he be put down to sleep, be more than usually particular that his dress be loose in every part, be careful that there be neither strings nor bands, to cramp him. let him, then, during repose, be more than ordinarily free and unrestrained- "if, whilst in cradled rest your infant sleeps. your watchful eyes unceasing vigil keeps lest cramping bonds his pliant limbs constrain, and cause defects that manhood may retain." 83. _is it a good sign for a young child to sleep much_? a babe who sleeps a great deal thrives much more than one who does not. i have known many children, who were born [footnote: it may be interesting to a mother to know the average weight of new born infants. there is a paper on the subject in the _medical circular_ (april 10, 1861) and which has been abridged in _braithwaite's retrospect of medicine_ (july and december 1861). the following are extracts--"dr. e. von siebold presents a table of the weights of 3000 infants (1586 male and 1414 female) weighed immediately after birth. from this table (for which we have not space) it results that by far the greater number of the children, 2215 weighed between 6 and 8 lbs. from 5 3/4 to 6 lbs. the number rose from 99 to 268, and from 8 to 8 1/4 lbs. they fell from 226 to 67, and never rose again at any weight to 100. from 8 3/4 to 9 1/2 lbs. they sank from 61 to 8, rising however at 9 1/2 lbs. to 21. only six weighed 10 lbs., one 10 3/4 lbs. and two 11 lbs. the author has never but once met with a child weighing 11 lbs. the most frequent weight in the 3000 was 7 lbs, numbering 426. it is a remarkable fact, that until the weight of 7 lbs the female infants exceeded the males in number, the latter thenceforward predominating. from these statements, and those of various other authors here quoted, the conclusion may be drawn that the normal weight of a mature new born infant is not less than six nor more than 8 lbs., the average weight being 6 1/2 or 7 lbs., the smaller number referring to female and the higher to male infants."] small and delicate, but who slept the greatest part of their time, become strong and healthy. on the other hand, i have known those who were born large and strong, yet who slept but little, become weak and unhealthy. the common practice of a nurse allowing a baby to sleep upon her lap is a bad one, and ought never to be countenanced. he sleeps cooler, more comfortably, and soundly in his crib. the younger an infant is the more he generally sleeps, so that during the early months he is seldom awake, and then only to take the breast. 84. _how is it that much sleep causes a young child to thrive so well_? if there be pain in any part of the body, or if any of the functions be not properly performed, he sleeps but little. on the contrary, if there be exemption from pain, and if there be a due performance of all the functions, he sleeps a great deal, and thus the body becomes refreshed and invigorated. 85. _as much sleep is of such advantage, if an infant sleep but little, would you advise composing medicine to be given to him_? certainly not. the practice of giving composing medicine to a young child cannot he too strongly reprobated. if he does not sleep enough, the mother ought to ascertain if the bowels be in a proper state, whether they be sufficiently opened, that the motions be of a good colour--namely, a bright yellow, inclining to orange colour--and free from slime or from bad smell. an occasional dose of rhubarb and magnesia is frequently the best composing medicine he can take. 86. _we often hear of coroner's inquests upon infants who have been found dead in bed--accidentally overlaid what is usually the cause_? suffocation, produced either by ignorance, or by carelessness. from _ignorance_ in mothers, in their not knowing the common laws of life, and the vital importance of free and unrestricted respiration, not only when babies are up and about, but when they are in bed and asleep. from _carelessness_, in their allowing young and thoughtless servants to have the charge of infants at night, more especially as young girls are usually heavy sleepers, and are thus too much overpowered with sleep to attend to their necessary duties. a foolish mother sometimes goes to sleep while allowing her child to continue sucking. the unconscious babe, after a tune, looses the nipple, and buries his head in the bed-clothes. she awakes in the morning, finding, to her horror, a corpse by her side, with his nose flattened, and a frothy fluid, tinged with, blood, exuding from his lips. a mother ought, therefore, never to go to sleep until her child have finished sucking. _the following are a few rules to prevent an infant from being accidentally overlaid_--(1.) let your baby while asleep have plenty of room in the bed. (2.) do not allow him to be too near to you; or if he he unavoidably near you (from the small size of the bed), let his face be turned to the opposite side. (3.) let him lie fairly either on his side, or on his back. (4.) be careful to ascertain that his mouth be not covered with the bed-clothes; and, (5.) do not smother his face with clothes, as a plentiful supply of pure air is as necessary when he is awake, or even more so, than when he is asleep. (6.) never let him lie low in the bed. (7.) let there be _no_ pillow near the one his head is resting on, lest he roll to it, and thus bury his head in it remember, a young child has neither the strength nor the sense to get out of danger; and, if he unfortunately either turn on his face, or bury his head in a pillow that is near, the chances are that he will be suffocated, more especially as these accidents usually occur at night, when the mother, or the nurse, is fast asleep. (8.) never intrust him at night to a young and thoughtless servant. the bladder and the bowels of an infant. 87. _have you any hints to offer respecting the bowels and the bladder of an infant during the first three months of his existence_? a mother ought daily to satisfy herself as to the state of the bladder and the bowels of her child. she herself should inspect the motions, and see that they are of a proper colour (bright-yellow, inclining to orange), and consistence (that of thick gruel), that they are neither slimy, nor curdled, nor green; if they should be either the one or the other, it is a proof that she herself has, in all probability, been imprudent in her diet, and that it will be necessary for the future that she be more careful both in what she eats and in what she drinks. she ought, moreover, to satisfy herself that the urine does not smell strongly, that it does not stain the diapers, and that he makes a sufficient quantity. a frequent cause of a child crying is, he is wet, and uncomfortable, and wants drying and changing, and the only way he has of informing his mother of the fact is by crying lustily, and thus telling her in most expressive language of her thoughtlessness and carelessness. 88. _how soon may an infant dispense with diapers_? a babe of three months and upwards, ought to be held out, at least, a dozen times during the twenty-four hours; if such a plan were adopted, diapers might at the end of three months be dispensed with--a great _desideratum_-and he would be inducted into clean habits--a blessing to himself, and a comfort to all around, and a great saving of dresses and of furniture. "teach your children to be clean. a dirty child is the mother's disgrace," [footnote: hints on household management, by mrs c. l. balfour.] truer words were never written,--a dirty child is the mother's disgrace. ailments, disease, etc. 89. _a new born babe frequently has a collection of mucus in the air passages, causing him to wheeze: is it a dangerous symptom_? no, not if it occur _immediately_ after birth; as soon as the bowels have been opened, it generally leaves him, or even before, if he give a good cry, which as soon as he is born he usually does. if there be any mucus either within or about the mouth, impeding breathing, it must with a soft handkerchief be removed. 90. _is it advisable, as soon as an infant is born, to give him medicine_? it is now proved that the giving of medicine to a babe _immediately_ after birth is unnecessary, nay, that it is hurtful--that is, provided he be early put to the breast, as the mother's _first_ milk is generally sufficient to open the bowels. sir charles locock [footnote: in a _letter_ to the author.] makes the following sensible remarks on this subject:--"i used to limit any aperient to a new-born infant to those which had not the first milk, and who had wet nurses, whose milk was, of course, some weeks old, but for many years i have never allowed any aperient at all to any new born infant, and i am satisfied it is the safest and the wisest plan." the advice of sir charles locock--_to give no aperient to a new-born infant_--is most valuable, and ought to be strictly followed. by adopting his recommendation, much after misery might be averted. if a new born babe's bowels be costive, rather than give him an aperient, try the effect of a little moist sugar, dissolved in a little water, that is to say, dissolve half a tea-spoonful of pure unadulterated _raw_ sugar in a tea-spoonful of warm water and administer it to him, if in four hours it should not operate, repeat the dose. butter and raw sugar is a popular remedy, and is sometimes used by a nurse to open the bowels of a new born babe, and where there is costiveness, answers the purpose exceedingly well, and is far superior to castor oil. try by all means to do, if possible, without a particle of opening medicine. if you once begin to give aperients, you will have frequently to repeat them. opening physic leads to opening physic, until at length his stomach and bowels will become a physic shop! let me, then, emphatically say, avoid, if possible, giving a new born babe a drop or a gram of opening medicine. if from the first you refrain from giving an aperient, he seldom requires one afterwards. it is the _first_ step, in this as in all other things, that is so important to take. if a new-born babe have _not_ for twelve hours made water, the medical man ought to be informed of it, in order that he may inquire into the matter, and apply the proper remedies. be particular in attending to these directions, or evil consequences will inevitably ensue. 91. _some persons say, that new-born female infants have milk in their bosoms, and that it is necessary to squeeze them, and apply plasters to disperse the milk_. the idea of there being real milk in a baby's breast is doubtful, the squeezing of the bosom is barbarous, and the application of plasters is useless. "without actually saying," says sir charles locock, "there is milk secreted in the breasts of infants, there is undoubtedly not rarely considerable swelling of the breasts both in _female_ and _male_ infants, and on squeezing them a serous fluid oozes out. i agree with you that the nurses should never be allowed to squeeze them, but be ordered to leave them alone." [footnote: _letter_ to the author.] 92. _have the goodness to mention the slight ailments which are not of sufficient importance to demand the assistance of a medical man_? i deem it well to make the distinction between _serious_ and _slight_ ailments, i am addressing a mother. with regard to serious ailments, i do not think myself justified, except in certain _urgent_ cases, in instructing a parent to deal with them. it might be well to make a mother acquainted with the _symptoms_, but not with the _treatment_, in order that she might lose no time in calling in medical aid. this i hope to have the pleasure of doing in future conversations. _serious diseases, with a few exceptions_, and which i will indicate in subsequent conversations, ought never to be treated by a parent, not even in the _early_ stages, for it is in the early stages that the most good can generally be done. it is utterly impossible for any one who is not trained to the medical profession to understand a _serious_ disease in all its bearings, and thereby to treat it satisfactorily. there are some exceptions to these remarks. it will be seen in future conversations that sir charles locock considers that a mother ought to be made acquainted with the _treatment_ of _some_ of the more _serious_ diseases, where delay in obtaining _immediate_ medical assistance might be death. i bow to his superior judgment, and have supplied the deficiency in subsequent conversations. the ailments and the diseases of infants, such as may, in the absence of the doctor, be treated by a parent, are the following:--chafings, convulsions, costivenesa, flatulence, gripings, hiccup, looseness of the bowels (diarrhoea), dysentery, nettle-rash, red-gum, stuffing of the nose, sickness, thrush. in all these complaints i will tell you--_what to do_, and--_what not to do_. 93. _what are the causes and the treatment of chafing_? the want of water: inattention and want of cleanliness are the usual causes of chafing. _what to do._--the chafed parts ought to be well and thoroughly sponged with tepid _rain_ water--allowing the water from a well-filled sponge to stream over them,--and, afterwards, they should be thoroughly, but tenderly, dried with a soft towel, and then be dusted, either with finely-powdered starch, made of wheaten flour, or with violet powder, or with finely-powdered native carbonate of zinc, or they should be bathed with finely-powdered fuller's-earth and tepid water. if, in a few days, the parts be not healed discontinue the above treatment, and use the following application:--beat up well together the whites of two eggs, then add, drop by drop, two table-spoonfuls of brandy. when well mixed, put it into a bottle and cork it up. before using it let the excoriated parts be gently bathed with luke-warm rain water, and, with a soft napkin, be tenderly dried; then, by means of a camel's hair brush, apply the above liniment, having first shaken the bottle. but bear in mind, after all that can be said and done, _that there is nothing in these cases like water_--there is nothing like keeping the parts clean, and the only way of thoroughly effecting this object is _by putting him every morning into his tub_. _what not to do_.--do not apply white lead, as it is a poison. do not be afraid of using _plenty_ of water, as cleanliness is one of the most important items of the treatment. 94. _what are the causes of convulsions of an infant_? stuffing him, in the early months of his existence, _with food_, the mother having plenty of breast milk the while, the constant physicking of child by his own mother, teething, hooping-cough, when attacking a very young baby. i never knew a case of convulsions occur--say for the first four months--(except in very young infants labouring under hooping-cough), where children lived on the breast-milk alone, and where they were _not_ frequently quacked by their mothers. for the treatment of the convulsions from teething, see page 46. _what to do_ in a case of convulsions which has been caused by feeding an infant either with too much or with _artificial_ food. give him, every ten minutes, a tea-spoonful of ipecacuanha wine, until free vomiting be excited then put him into a warm bath (see warm baths), and when he comes out of it administer to him a tea-spoonful of castor oil, and repeat it every four hours, until the bowels be well opened. _what not to do_--do not for at least a month after the fit, give him artificial food, but keep him entirely to the breast. do not apply leeches to the head. _what to do in a case of convulsions from hooping cough_--there is nothing better than dashing cold water on the face, and immersing him in a warm bath of 98 degrees fahr. if he be about his teeth, and they be plaguing him, let the gums be both freely and frequently lanced. convulsions seldom occur in hooping-cough, unless the child be either very young or exceedingly delicate. convulsions attending an attack of hooping-cough make it a _serious_ complication, and requires the assiduous and skilful attention of a judicious medical man. _what not to do in such a case_--do not apply leeches, the babe requires additional strength, and not to be robbed of it, and do not attempt to treat the case yourself. 95. _what are the best remedies for the costiveness of an infant_? i strongly object to the frequent administration of opening medicine, as the repetition of it increases the mischief to a tenfold degree. _what to do_.--if a babe, after the first few months, were held out, and if, at regular intervals, he were put upon his chair, costiveness would not so much prevail. it is wonderful how soon the bowels, in the generality of cases, by this simple plan, may be brought into a regular state. besides, it inducts an infant into clean habits, i know many careful mothers who have accustomed their children, after the first three months, to do without diapers altogether. it causes at first a little trouble, but that trouble is amply repaid by the good consequences that ensue; among which must be named the dispensing with such encumbrances as diapers. diapers frequently chafe, irritate, and gall the tender skin of a baby. but they cannot of course, at an early age be dispensed with, unless a mother have great judgment, sense, tact, and perseverance, to bring her little charge into the habit of having his bowels relieved and his bladder emptied every time he is either held out or put upon his chair. before giving an infant a particle of aperient medicine, try, if the bowels are costive, the effect of a little _raw_ sugar and water, either half a tea-spoonful of raw sugar dissolved in a tea-spoonful or two of water, or give him, out of your fingers, half a tea-spoonful of raw sugar to eat. i mean by _raw_ sugar, not the white, but the pure and unadulterated sugar, and which you can only procure from a respectable grocer. if you are wise, you will defer as long as you can giving an aperient. if you once begin, and continue it for a while, opening medicine becomes a dire necessity, and then woe betide the poor unfortunate child. or, give a third of a tea-spoonful of honey, early in the morning, occasionally. or administer a warm water enema--a tablespoonful, or more, by means of a 2 oz. india rubber enema bottle. _what not to do_.--there are two preparations of mercury i wish to warn you against administering of your own accord, viz.--(1) calomel, and a milder preparation called (2) grey-powder (mercury with chalk). it is a common practice in this country to give calomel, on account of the readiness with which it can be administered it being small in quantity, and nearly tasteless. grey powder also, is, with many mothers, a favourite in the nursery. it is a medicine of immense power--either for good or for evil, in certain cases it is very valuable, but in others, and in the great majority, it is very detrimental. this practice, then, of a mother giving mercury, whether in the form either of calomel or of grey powder, cannot be too strongly reprobated, as the frequent administration either of the one or of the other weakens the body, predisposes it to cold, and frequently excites king's-evil--a disease too common in this country. calomel and grey-powder, then, ought never to be administered unless ordered by a medical man. syrup of buckthorn and jalap are also frequently given, but they are griping medicines for a baby, and ought to be banished from the nursery. the frequent repetition of opening medicines, then, in any shape or form, very much interferes with digestion, they must, therefore, be given as seldom as possible. let me, at the risk of wearying you, again urge the importance of your avoiding, as much as possible, giving a babe purgative medicines. they irritate beyond measure the tender bowels of an infant, and only make him more costive afterwards, they interfere with his digestion, and are liable to give him cold. a mother who is always, of her own accord, quacking her child with opening physic, is laying up for her unfortunate offspring a debilitated constitution--a miserable existence. for further information on this important subject see the 3d edition of _counsel to a mother (being the companion volume of advice to a mother)_, on the great importance of desisting from irritating, from injuring, and from making still more costive, the obstinate bowels of a costive child,--by the administration of opening medicine,--however gentle and well-selected the aperients might be. oh, that the above advice could be heard, and be acted upon, through the length and the breadth of the land, how much misery and mischief would then be averted! 96. _are there any means of preventing the costiveness of an infant_? if greater care were paid to the rules of health, such as attention to diet, exercise in the open air, thorough ablution of the _whole_ body--more especially when he is being washed--causing the water, from a large and well-filled sponge, to stream over the lower part of his bowels; the regular habit of causing him, at stated periods, to be held out, whether he want or not, that he may solicit a stool. if all these rules were observed, costiveness would not so frequently prevail, and one of the miseries of the nursery would be done away with. some mothers are frequently dosing their poor unfortunate babes either with magnesia to cool them, or with castor oil to heal their bowels! oh, the folly of such practices! the frequent repetition of magnesia, instead of cooling an infant, makes him feverish and irritable. the constant administration of castor oil, instead of healing the bowels, wounds them beyond measure. no! it would be a blessed thing if a babe could be brought up without giving ham a particle of opening medicine; his bowels would then act naturally and well: but then, as i have just now remarked, a mother, must be particular in attending to nature's medicines--to fresh air, to exercise, to diet, to thorough ablution, &c. until that time comes, poor unfortunate babies must be, occasionally, dosed with an aperient. 97. _what are the causes of, and remedies for, flatulence_? flatulence most frequently occurs in those infants who live on _artificial_ food, especially if they be over-fed. i therefore beg to refer you to the precautions i have given, when speaking of the importance of keeping a child for the first five or six months _entirely_ to the breast; and, if that be not practicable, of the times of feeding, and of the _best_ kinds of artificial food, and of those which are least likely to cause "wind." _what to do._--notwithstanding these precautions, if the babe should still suffer, "one of the best and safest remedies for flatulence is sal volatile,--a tea-spoonful of a solution of one drachm to an ounce and a half of water" [footnote: sir charles locock, in a _letter_ to the author since sir charles did me the honour of sending me, for publication, the above prescription for flatulence, a new "british pharmacopoeia" has been published in which the sal volatile is much increased in strength it is therefore necessary to lessen the sal volatile in the above prescription one half--that is to say, a tea spoonful of the solution of _half_ a drachm to an ounce and a half of water.] or, a little dill or aniseed may be added to the food--half a tea-spoonful of dill water or, take twelve drops of oil of dill, and two lumps of sugar, rub them well in a mortar together, then add, drop by drop, three table-spoonfuls of spring water, let it be preserved in a bottle for use. a tea-spoonful of this, first shaking the vial, may be added to each quantity of food. or, three tea-spoonfuls of bruised caraway-seeds may be boiled for ten minutes in a tea-cupful of water, and then strained. one or two tea-spoonfuls of the caraway tea may be added to each quantity of his food, or a dose of rhubarb and magnesia may occasionally be given. opodeldoc, or warm olive oil, well rubbed, for a quarter of an hour at a time, by means of the warm hand, over the bowels, will frequently give relief. turning the child over on his bowels, so that they may press on the nurses' lap, will often afford great comfort. a warm bath (where he is suffering severely) generally gives _immediate_ ease in flatulence, it acts as a fomentation to the bowels. but after all, a dose of mild aperient medicine, when the babe is suffering severely, is often the best remedy for "wind." remember, at all times, prevention, whenever it be--and how frequently it is--possible, is better than cure. _what not to do_--"godfrey's cordial," "infants' preservative," and "dalby's carminative," are sometimes given in flatulence, but as most of these quack medicines contain, in one form or another, either opium or poppy, and as opium and poppy are both dangerous remedies for children, all quack medicines must be banished the nursery. syrup of poppies is another remedy which is often given by a nurse to afford relief for flatulence; but let me urge upon you the importance for banishing it from the nursery. it has (when given by unprofessional persons) caused the untimely end of thousands of children. the medical journals and the newspapers teem with cases of deaths from mothers incautiously giving syrup of poppies to ease pain and to procure sleep. 98. _what are the symptoms, the causes, and the treatment of "gripings" of an infant_? _the symptoms._--the child draws up his legs; screams violently; if put to the nipple to comfort him, he turns away from it and cries bitterly; he strains, as though he were having a stool; if he have a motion, it will be slimy, curdled, and perhaps green. if, in addition to the above symptoms, he pass a large quantity of watery fluid from his bowels, the case becomes one of _watery gripes_, and requires the immediate attention of a doctor. the _causes_ of "gripings" or "gripes" may proceed either from the infant or from the mother. if from the child, it is generally owing either to improper food or to over-feeding; if from the mother, it may be traced to her having taken either greens, or port, or tart beer, or sour porter, or pickles, or drastic purgatives. _what to do._--the _treatment_, of course, must depend upon the cause. if it arise from over-feeding, i would advise a dose of castor oil to be given, and warm fomentations to be applied to the bowels, and the mother, or the nurse, to be more careful for the future. if it proceed from improper food, a dose or two of magnesia and rhubarb in a little dill water, made palatable with simple syrup. [footnote: take of--powdered turkey rhubarb, half a scruple; carbonate of magnesia, one scruple; simple syrup, three drachms; dill water, eight drachms; make a mixture, one or two tea-spoonfuls (according to the age of the child) to be taken every four boors, until relief be obtained--first shaking the bottle.) if it arise from a mother's imprudence in eating trash, or from her taking violent medicine, a warm bath, a warm bath, indeed, let the cause of "griping" be what it may, usually affords instant relief. another excellent remedy is the following--soak a piece of new flannel, folded into two or three thicknesses, in warm water, wring it tolerably dry, and apply as hot as the child can comfortably bear it to the bowels, then wrap him in a warm, dry blanket, and keep him, for at least half an hour, enveloped in it. under the above treatment, he will generally soon fall into a sweet sleep, and awake quite refreshed. _what not to do_--do not give opiates, astringents, chalk, or any quack medicine whatever. if a child suffer from a mother's folly in her eating improper food, it will be cruel in the extreme for him a _second_ time to be tormented from the same cause. 99. _what occasions hiccup, and what is its treatment_? hiccup is of such a trifling nature as hardly to require interference. it may generally be traced to over feeding. should it be severe, four or five grains of calcined magnesia, with a little syrup and aniseed water, and attention to feeding are all that will be necessary. 100. _will you describe the symptoms of infantile diarrhoea_? infantile diarrhoea, or _cholera infantum_, is one of the most frequent and serious of infantile diseases, and carries off, during the year, more children than any other complaint whatever a knowledge of the symptoms, therefore, is quite necessary for a mother to know, in order that she may, at the proper tune, call in efficient medical aid. it will be well, before describing the symptoms, to tell you how many motions a young infant ought to have a day, their colour, consistence, and smell. well, then, he should have from three to six motions in the twenty four hours, the colour ought to be a bright yellow, inclining to orange, the consistence should be that of thick gruel; indeed, his motion, if healthy, ought to be somewhat of the colour (but a little more orange-tinted) and of the consistence of mustard made for the table; it should be nearly, if not quite, devoid of smell; it ought to have a faint and peculiar, but not a strong disagreeable odour. if it have a strong and disagreeable smell, the child is not well, and the case should be investigated, more especially if there be either curds or lumps in the motions; these latter symptoms denote that the food has not been properly digested. now, suppose a child should have a slight bowel complaint--that is to say, that he has six or eight motions during the twenty-four hours,--and that the stools are of a thinner consistence than what i have described,--provided, at the same time, that he be not griped, that he have no pain, and have not lost his desire for the breast:--what ought to be done?_nothing_. a slight looseness of the bowels should _never_ be interfered with,--it is often an effort of nature to relieve itself of some vitiated motion that wanted a vent--or to act as a diversion, by relieving the irritation of the gums. even if he be not cutting his teeth, he may be "breeding" them--that is to say, the teeth may be forming in his gums, and may cause almost as much, irritation as though he were actually cutting them. hence, you see the immense good a slight "looseness of the bowels" may cause. i think that i have now proved to you the danger of interfering in such a case, and that i have shown you, the folly and the mischief of at once giving astringents--such as godfrey's cordial, dalby's carminative, &c.--to relieve a _slight_ relaxation. a moderate "looseness of the bowels," then, is often a safety-valve, and you may, with as much propriety, close the safety-valve of a steam engine, as stop a moderate "looseness of the bowels!" now, if the infant, instead of having from three to six motions, should have more than double the latter number; if they be more watery; if they become slimy and green, or green in part and curdled; if they should have an unpleasant smell; if he be sick, cross, restless, fidgety, and poorly; if every time he have a motion he be griped and in pain, we should then say that he is labouring under diarrhoea; then, it will be necessary to give a little medicine, which i will indicate in a subsequent conversation. should there be both blood and slime mixed with the stool, the case becomes more serious; still, with proper care, relief can generally be quickly obtained. if the evacuations--instead of being stool--are merely blood and slime, and the child strain frequently and violently, endeavouring thus, but in vain, to relieve himself, crying at each effort, the case assumes the character of dysentery. [footnote: see symptoms and treatment of dysentery.] if there be a mixture of blood, slime, and stool from the bowels, the case would be called dysenteric-diarrhoea. the latter case requires great skill and judgment on the part of a medical men, and great attention and implicit obedience from the mother and the nurse. i merely mention these diseases in order to warn you of their importance, and of the necessity of strictly attending to a doctor's orders. 101. _what are the causes of diarrhoea--"looseness of the bowels?"_ improper food; overfeeding; teething; cold; the mother's milk from various causes disagreeing, namely, from her being out of health, from her eating unsuitable food, from her taking improper and drastic purgatives, or from her suckling her child when she is pregnant. of course, if any of these causes are in operation, they ought, if possible, to be remedied, or medicine to the babe will be of little avail. 102. _what is the treatment of diarrhoea_? _what to do._--if the case be _slight_, and has lasted two or three days (do not interfere by giving medicine at first), and if the cause, as it probably is, be some acidity or vitiated stool that wants a vent, and thus endeavours to obtain one by purging, the best treatment is, to assist nature by giving either a dose of castor oil, or a moderate one of rhubarb and magnesia, [footnote: for a rhubarb and magnesia mixture prescription, see page 71 (_note_).] and thus to work off the enemy. after the enemy has been worked off, either by the castor oil, or by the magnesia and rhubarb, the purging will, in all probability, cease; but if the relaxation still continue, that is to say, for three or four days--then, if medical advice cannot be procured, the following mixture should be given:- take of--aromatic powder of chalk and opium, ten grains; oil of dill, five drops; simple syrup, three drachms; water, nine drachms; make a mixture, [footnote: let the mixture be made by a chemist.] half a tea-spoonful to be given to an infant of six months and under, and one tea-spoonful to a child above that age, every four hours--first shaking the bottle. if the babe be at the breast, he ought, for a few days, to be kept _entirely_ to it. the mother should be most particular in her own diet. _what not to do._--the mother must neither take greens, nor cabbage, nor raw fruit, nor pastry, nor beer; indeed, while the diarrhoea of her babe continues, she had better abstain from wine, as well as from fermented liquors. the child, if at the breast, ought _not_, while the diarrhoea continues, to have any artificial food. he must neither be dosed with grey-powder (a favourite, but highly improper remedy, in these cases), nor with any quack medicines, such as dalby's carminative or godfrey's cordial. 103. _what are the symptoms of dysentery_? dysentery frequently arises from a neglected diarrhoea. it is more dangerous than diarrhoea, as it is of an inflammatory character; and as, unfortunately, it frequently attacks a delicate child, requires skilful handling; hence the care and experience required in treating a case of dysentery. well, then, what are the symptoms? the infant, in all probability, has had an attack of diarrhoea--bowel complaint as it is called--for several days; he having had a dozen or two of motions, many of them slimy and frothy, like "frog-spawn," during the twenty-four hours. suddenly the character of the motion changes,--from being principally stool, it becomes almost entirely blood and mucus; he is dreadfully griped, which causes him to strain violently, as though his inside would come away every time he has a motion,--screaming and twisting about, evidently being in the greatest pain, drawing his legs up to his belly and writhing in agony. sickness and vomiting are always present, which still more robs him of his little remaining strength, and prevents the repair of his system. now, look at his face! it is the very picture of distress. suppose he has been a plump, healthy little fellow, you will see his face, in a few days, become old-looking, care-worn, haggard, and pinched. day and night the enemy tracks him (unless proper remedies be administered); no sleep, or if he sleep, he is, every few minutes, roused. it is heart-rending to have to attend a bad case of dysentery in a child,--the writhing, the screaming, the frequent vomiting, the pitiful look, the rapid wasting and exhaustion, make it more distressing to witness than almost any other disease a doctor attends. 104. _can anything be done to relieve such a case_? yes. a judicious medical man will do a great deal. but, suppose that yon are not able to procure one, i will tell you _what to do_ and _what not to do_. _what to do_.--if the child be at the breast, keep him to it, and let him have nothing else for dysentery is frequently caused by improper feeding. if your milk be not good, or it be scanty, _instantly_ procure a healthy wet-nurse. _lose not a moment;_ for in dysentery, moments are precious. but, suppose that you have no milk, and that no wet-nurse can be procured: what then? feed him entirely on cow's milk--the milk of _one_ healthy cow; let the milk be unboiled, and be fresh from the cow. give it in small quantities at a time, and frequently, so that it may be retained on the stomach. if a table-spoonful of the milk make him sick, give him a dessert-spoonful; if a dessert-spoonful cause sickness, let him only have a tea-spoonful at a time, and let it be repeated every quarter of an hour. but, remember, in such a case the breast milk--the breast milk alone--is incomparably superior to any other milk or to any other food whatever. if he be a year old, and weaned, then feed him, as above recommended, on the cow's milk. if there be extreme exhaustion and debility, let fifteen drops of brandy be added to each table-spoonful of new milk, and let it be given every half hour. now with regard to medicine. i approach this part of the treatment with some degree of reluctance,--for dysentery is a case requiring opium--and opium i never like a mother of her own accord to administer. but suppose a medical man cannot be procured in time, the mother must then prescribe, or the child will die! _what then is to be done?_ sir charles locock considers "that, in severe dysentery, especially where there is sickness, there is no remedy equal to pure calomel, in a full dose without opium." [footnote: communicated by sir charles locock to the author.] therefore, at the very _onset_ of the disease, let from three to five grains (according to the age of the patient) of calomel, mixed with an equal quantity of powdered white sugar, be put dry on the tongue. in three hours after let the following mixture be administered:- take of--compound powder of ipecacuanha, five grains; ipecacuanha wine, one drachm; simple syrup, three drachms; cinnamon water, nine drachms; to make a mixture, a tea-spoonful to be given every three or four hours, first _well_ shaking the bottle. supposing he cannot retain the mixture--the stomach rejecting it as soon as swallowed--what then? give the opium, mixed with small doses of mercury with chalk and sugar, in the form of powder, and put one of the powders _dry_ on the tongue, every three hours:- take of--powdered opium, half a grain; mercury with chalk, nine grains; sugar of milk, twenty-four grains; mix well in a mortar, and divide into twelve powders. now, suppose the dysentery has for several days persisted, and that, during that time, nothing but mucus and blood--that no real stool--has come from the bowels, then a combination of castor oil and opium [footnote: my friend, the late dr baly, who had made dysentery his particular study, considered the combination of opium and castor oil very valuable in dysentery.] ought, instead of the medicine recommended above, to be given:- take of--mucilage of gum acacia, three drachms; simple syrup, three drachms; tincture of opium, ten drops (_not_ minims); castor oil, two drachms; cinnamon water, four drachms: make a mixture. a tea spoonful to be taken every four hours, first _well_ shaking the bottle. a warm bath, at the commencement of the disease, is very efficacious; but it must be given at the _commencement_. if he has had dysentery for a day or two, he will be too weak to have a warm bath; then, instead of the bath, try the following:--wrap him in a blanket, which has been previously wrung out of hot water; over which envelope him in a _dry_ blanket. keep him in this hot, damp blanket for half an hour; then take him out, put on his nightgown and place him in bed, which has been, if it be winter time, previously warmed. the above "blanket treatment" will frequently give great relief, and will sometimes cause him to fall into a sweet sleep. a flannel bag, filled with hot powdered table salt, made hot in the oven, applied to the bowels, will afford much comfort. _what not to do_.--do not give aperients unless it be, as before advised, the castor oil guarded with the opium; do not stuff him with artificial food; do not fail to send for a judicious and an experienced medical man; for, remember, it requires a skilful doctor to treat a case of dysentery, more especially in a child. 105. _what are the symptoms, the causes and the treatment of nettle-rash_? nettle-rash consists of several irregular, raised wheals, red at the base, and white on the summit, on different parts of the body; _but it seldom attacks the face_. it is not contagious, and it may occur at all ages and many times. it comes and goes, remaining only a short time in a place. it puts on very much the appearance of the child having been stung by nettles--hence its name. it produces great heat, itching, and irritation, sometimes to such a degree as to make him feverish, sick, and fretful. he is generally worse when he is warm in bed, or when the surface of his body is suddenly exposed to the air. rubbing the skin, too, always aggravates the itching and the tingling, and brings out a fresh crop. the _cause_ of nettle-rash may commonly be traced to improper feeding; although, occasionally, it proceeds from teething. _what to do_.--it is a complaint of no danger, and readily gives way to a mild aperient, and to attention to diet. there is nothing better to relieve the irritation of the skin than a warm bath. if it be a severe attack of nettle-rash, by all means call in a medical man. _what not to do_.--do not apply cold applications to his skin, and do not wash him (while the rash is out) in quite _cold_ water. do not allow him to be in a draught, but let him be in a well-ventilated room. if he be old enough to eat meat, keep it from him for a few days, and let him live on milk and farinaceous diet. avoid strong purgatives, and calomel, and grey-powder. 106. _what are the symptoms and the treatment of red-gum_? red-gum, tooth-rash, red-gown, is usually owing to irritation from teething; not always from the cutting but from the evolution--the "breeding," of the teeth. it is also sometimes owing to unhealthy stools irritating the bowels, and showing itself, by sympathy, on the skin. red-gum consists of several small papulae, or pimples, about the size of pins' heads, and may be known from measles--the only disease for which it is at all likely to be mistaken--by its being unattended by symptoms of cold, such as sneezing, running, and redness of the eyes, &c., and by the patches _not_ assuming a crescentic--half-moon shape; red-gum, in short, may readily he known by the child's health being unaffected, unless, indeed, there be a great crop of pimples; then there will be slight feverishness. _what to do_.--little need be done. if there be a good deal of irritation, a mild aperient should be given. the child ought to be kept moderately, but not very warm. _what not to do_.--draughts of air, or cold should be carefully avoided; as, by sending the eruption suddenly in, either convulsions or disordered bowels might be produced. do not dose him with grey-powder. 107. _how would you prevent "stuffing of the nose" in a new-born babe_? rubbing a little tallow on the bridge of the nose is the old-fashioned remedy, and answers the purpose. it ought to be applied every evening just before putting him to bed. if the "stuffing" be severe, dip a sponge in hot water, as hot as he can comfortably bear; ascertain that it be not too hot, by previously applying it to your own face, and then put it for a few minutes to the bridge of his nose. as soon as the hard mucus is within reach, it should be carefully removed. 108. _do you consider sickness injurious to an infant_? many thriving babies are, after taking the breast, frequently sick; still we cannot look upon sickness otherwise than as an index of either a disordered or of an overloaded stomach. if the child be sick, and yet be thriving, it is a proof that he overloads his stomach. a mother, then, must not allow him to suck so much, at a time. she should, until he retain all he takes, lessen the quantity of milk. if he be sick and does _not_ thrive, the mother should notice if the milk he throws up has a sour smell; if it have, she must first of all look to her own health; she ought to ascertain if her own stomach be out of order; for if such be the case, it is impossible for her to make good milk. she should observe whether in the morning her own tongue be furred and dry; whether she have a disagreeable taste in her mouth, or pains at her stomach, or heart-burn, or flatulence. if she have all, or any of these symptoms, the mystery is explained why he is sick and does not thrive. she ought then to seek advice, and a medical man will soon put her stomach into good order; and, by so doing, will, at the same time, benefit her child. but if the mother be in the enjoyment of good health, she must then look to the babe himself, and ascertain if he be cutting his teeth; if the gums require lancing; if the secretions from the bowels be proper both in quantity and in quality; and, if he have had _artificial_ food--it being absolutely necessary to give such food--whether it agree with him. _what to do_.--in the first place, if the gums be red, hot, and swollen, let them be lanced; in the second, if the secretion from the bowels be either unhealthy or scanty, give him a dose of aperient medicine, such as caster oil, or the following:--take two or three grains of powdered turkey rhubarb, three grains of pure carbonate of magnesia, and one grain of aromatic powder--mix. the powder to be taken at bed-time, mixed in a tea-spoonful of sugar and water, and which should, if necessary, be repeated the following night. in the third place, if the food he be taking does not agree with him, change it (_vide_ answer to question 33). give it in smaller quantities at a time, and not so frequently; or what will be better still, if it be possible, keep him, for a while, entirely to the breast. _what not to do_.--do not let him overload his stomach either with breast milk, or with _artificial food_. let the mother avoid, until his sickness be relieved, greens, cabbage, and all other green vegetables. 109. _what are the causes, the symptoms, the prevention, and the cure of thrush_? the thrush is a frequent disease of an infant, and is often brought on either by stuffing or by giving him improper food. a child brought up _entirely_, for the first three or four months, on the breast, seldom suffers from this complaint. the thrush consists of several irregular, roundish, white specks on the lips, the tongue, the inside and the angles of the mouth, giving the parts affected the appearance of curds and whey having been smeared upon them. the mouth is hot and painful, and he is afraid to suck; the moment the nipple is put to his mouth he begins to cry. the thrush, sometimes, although but rarely, runs through the whole of the alimentary canal. it should be borne in mind that nearly every child, who is sucking, has his or her tongue white or "frosted," as it is sometimes called. the thrush may be mild or very severe. now with regard to what to do.--as the thrush is generally owing to improper and to artificial feeding, _if the child be at the breast_, keep him, for a time, entirely to it. do not let him be always sucking, as that will not only fret his month, but will likewise irritate and make sore the mother's nipple. _if he be not at the breast_, but has been weaned, then keep him for a few days entirely to a milk diet--to the milk of one cow--either boiled, if it be hot weather, to keep it sweet; or unboiled, in cool weather--fresh as it comes from the cow, mixed with warm water. the best medicine is the old-fashioned one of borax, a combination of powdered lump-sugar and borax being a good one for the purpose: the powdered lump-sugar increases the efficacy, and the cleansing properties of the borax; it tends, moreover, to make it more palatable.- take of--borax, half a drachm; lump sugar, two scruples; to be well mixed together, and made into twelve powders. one of the powders to be put dry on the tongue every four hours. the best _local_ remedy is honey of borax, which ought to be smeared frequently, by means of the finger, on the parts affected. thorough ventilation of the apartment must be observed; and great cleanliness of the vessels containing the milk should be insisted upon. in a bad case of thrush, change of air to the country is most desirable; the effect is sometimes, in such cases, truly magical. if the thrush be brought on either by too much or by improper food; in the first case of course, a mother must lessen the quantity; and, in the second, she should be more careful in her selection. _what not to do_.--do not use either a calf's teat or wash leather for the feeding-bottle; fortunately, since the invention of india-rubber teats, they are now nearly exploded; they were, in olden times, fruitful causes of thrush. do not mind the trouble of ascertaining that the cooking-vessels connected with the baby's food are perfectly clean and sweet. do not leave the purity and the goodness of the cow's milk (it being absolutely necessary to feed him on artificial food) to be judged either by the milk-man, or by the nurse, but taste and prove it yourself. do not keep the milk in a warm place, but either in the dairy or in the cellar; and, if it be summer time, let the jug holding the milk be put in a crock containing lumps of ice. do not use milk that has been milked longer than twelve hours, but if practicable, have it milked direct from the cow, and use it _immediately_--let it be really and truly fresh and genuine milk. when the disease is _severe_, it may require more active treatment--such as a dose of calomel; _which medicine must never be given unless it be either under the direction of a medical man, or unless it be in an extreme case,--such as dysentery_; [footnote: see the treatment of dysentery.] therefore, the mother had better seek advice. in a _severe_ case of thrush, where the complaint has been brought on by _artificial_ feeding--the babe not having the advantage of the mother's milk--it is really surprising how rapidly a wet-nurse--if the case has not been too long deferred--will effect a cure, where all other means have been tried and have failed. the effect has been truly magical! in a severe case of thrush pure air and thorough ventilation are essential to recovery. 110. _is anything to be learned from the cry of an infant_? a babe can only express his wants and his necessities by a cry; he can only tell his aches and his pains by a cry; it is the only language of babyhood; it is the most ancient of all languages; it is the language known by our earliest progenitors; it is, if listened to aright, a very expressive language, although it is only but the language of a cry- "soft infancy, that nothing canst but cry."--_shakspeare_. there is, then, a language in the cry of an infant, which to a mother is the most interesting of all languages, and which a thoughtful medical man can well interpret. the cry of a child, to an experienced doctor, is, each and all, a distract sound, and is as expressive as the notes of the gamut. the cry of passion, for instance, is a furious cry; the cry of sleepiness is a drowsy cry; the cry of grief is a sobbing cry; the cry of an infant when roused from sleep is a shrill cry; the cry of hunger is very characteristic,--it is unaccompanied with tears, and is a wailing cry; the cry of teething is a fretful cry; the cry of pain tells to the practised ear the part of pain; the cry of ear-ache is short, sharp, piercing, and decisive, the head being moved about from side to side, and the little hand being often put up to the affected side of the head; the cry of bowel-ache is also expressive,--the cry is not so piercing as from ear-ache, and is an interrupted, straining cry, accompanied with a drawing-up of the legs to the belly; the cry of bronchitis is a gruff and phlegmatic cry; the cry of inflammation of the lungs is more a moan than a cry; the cry of croup is hoarse, and rough, and ringing, and is so characteristic that it may truly be called "the croupy cry;" the cry of inflammation of the membranes of the brain is a piercing shriek--a danger signal--most painful to hear; the cry of a child recovering from a severe illness is a cross, and wayward, and tearful cry; he may truly be said to be in a quarrelsome mood; he bursts out, without rhyme or reason, into a passionate flood of tears--into "a tempest of tears:" tears are always, in a severe illness, to be looked upon as a good omen, as a "the tears that heal and bless"--_h. bonar_. tears, when a child is dangerously ill, are rarely, if ever, seen; a cry, at night, for light--a frequent cause of a babe crying--is a restless cry:- "an infant--crying in the night; an infant crying for the light: and with no language hat a cry."--_tennyson_. 111. _if an infant be delicate, have you any objection to his having either veal or mutton broth, to strengthen him_? broths seldom agree with a babe at the breast i have known them produce sickness, disorder the bowels, and create fever. i recommend you, therefore, not to make the attempt. although broth and beef-tea, when taken by the mouth, will seldom agree with an infant at the breast, yet, when used as an enema, and in small quantities, so that they may be retained, i have frequently found them to be of great benefit, they have in some instances appeared to have snatched delicate children from the brink of the grave. 112. _my baby's ankles are very weak: what do you advise to strengthen them_? if his ankles be weak, let them every morning be bathed, after the completion of his morning's ablution, for fire minutes each time, with bay-salt and water, a small handful of bay-salt dissolved in a quart of rain water (with the chill of the water off in the winter, and of its proper temperature in the summer time); then let them be dried; after the drying, let the ankles he well rubbed with the following liniment:- take of--oil of rosemary, three drachms; liniment of camphor, thirteen drachms: to make a liniment do not let him be put on his feet early; but allow him to crawl, and sprawl, and kick about the floor, until his body and his ankles become strong. do not, on any account, without having competent advice on the subject, use iron instruments, or mechanical supports of any kind: the ankles are generally, by such artificial supports, made worse, in consequence of the pressure causing a further dwindling away and enfeebling of the ligaments of the ankles, already wasted and weakened. let him wear shoes with straps over the insteps to keep them on, and not boots: boots will only, by wasting the ligaments, increase the weakness of the ankles. 113. _sometimes there is a difficulty in restraining the bleeding of leech bites. what is the best method_? the difficulty in these cases generally arises from the improper method of performing it. for example--a mother endeavours to stop the haemorrhage by loading the part with rag; the more the bites discharge, the more rag she applies. at the same time, the child probably is in a room with a, large fire, with two or three candles, with the doors closed, and with perhaps a dozen people in the apartment, whom the mother has, in her fright, sent for. this practice is strongly reprehensible. if the bleeding cannot be stopped,--in the first place, the fire most be extinguished, the door and windows should be thrown open, and the room ought to be cleared of persons, with the exception of one, or, at the most, two; and every rag should be removed. "stopping of leech bites.--the simplest and most certain way, till the proper assistance is obtained, is the pressure of the finger, with nothing intervening. it _cannot_ bleed through that." [footnote: sir charles locock, in a _letter_ to the author.] many babies, by excessive loss of blood from leech bites, have lost their lives from a mother not knowing how to act, and also from the medical man either living at a distance, or not being at hand. fortunately for the infantile community, leeches are now very seldom ordered by doctors. 114. _supposing a baby to be poorly, have you any advice to give to his mother as to her own management_? she must endeavour to calm her feelings or her milk will be disordered, and she will thus materially increase his illness. if he be labouring under any inflammatory disorder, she ought to refrain from the taking of beer, wine, and spirits, and from all stimulating food; otherwise, she will feed his disease. before concluding the first part of my subject--the management of infancy--let me again urge upon you the importance--the paramount importance--if you wish your babe to be strong and hearty,--of giving him as little opening physic as possible. the best physic for him is nature's physic--fresh air, and exercise, and simplicity of living. a mother who is herself always drugging her child, can only do good to two persons--the doctor and the druggist! if an infant from his birth be properly managed,--if he have an abundance of fresh air for his lungs,--if he have plenty of exercise for his muscles (by allowing him to kick and sprawl on the floor),--if he have a good swilling and sousing of water for his skin,--if, during the _early_ months of his life, he have nothing but the mother's milk for his stomach,--he will require very little medicine--the less the better! he does not want his stomach to be made into a doctor's shop! the grand thing is not to take every opportunity of administering physic, but of using every means of with-holding it! and if physic be necessary, not to doctor him yourself, unless it be in extreme and urgent cases (which in preceding and succeeding conversations i either have or will indicate), but to employ an experienced medical man. a babe who is always, without rhyme or reason, being physicked, is sure to be puny, delicate, and unhealthy, and is ready at any moment to drop into an untimely grave! i will maintain that a healthy child _never_ requires drugging with opening physic, and that costiveness is brought on by bad management. aperient medicines to a healthy child are so much poison! _let me impress the above remarks on every mother's mind;_ for it is a subject of vital importance. never, then, give a purgative to a healthy child; for, if he be properly managed, he will never require one. if you once begin to give aperients, you will find a difficulty discontinuing them. finally, i will only say with _punch_,--"don't" concluding remarks on infancy. 115. in concluding the first part of our subject--infancy--i beg to remark: there are four things essentially necessary to a babe's well-doing, namely, (1) plenty of water for his skin; (2) plenty of fresh genuine milk mixed with water for his stomach (of course, giving him only his mother's milk during the first six, eight, or nine months of his existence); (3) plenty of pure air for his lungs; (4) plenty of sleep for his brain: these are the four grand essentials for an infant; without an abundance of one and all of them, perfect health is utterly impossible! perfect health! the greatest earthly blessing, and more to be coveted than ought else beside! there is not a more charming sight in the universe than the beaming face of a perfectly healthy babe,- "his are the joys of nature, his the smile, the cherub smile, of innocence and health."--_knox._ part ii. childhood. _the child is father of the man_.--wordsworth. _bairns are blessings_--shakespeare. _these are my jewels!_--cornella. ablution. 116. _at twelve months old, do you still recommend a child to be_ put in his tub _to be washed_? certainly i do, as i have previously recommended at page 6, in order that his skin may be well and thoroughly cleansed. if it be summer time, the water should be used cold; if it be winter, a dash of warm must be added, so that it may be of the temperature of new milk: but do not, on any account use _very warm_ water. the head must be washed (but not dried) before he be placed in a tub, then, putting him in the tub (containing the necessary quantity of water, and washing him as previously recommended), [footnote: see infancy-ablution, page 6.] a large sponge should be filled with the water and squeezed over his head, so that the water may stream over the whole surface of his body. a jugful of water should, just before taking him out of his bath, be poured over and down his loins; all this ought rapidly to be done, and he must be quickly dried with soft towels, and then expeditiously dressed. for the washing of your child i would recommend you to use castile soap in preference to any other; it is more pure, and less irritating, and hence does not injure the texture of the skin. take care that the soap does not get into his eyes, or it might produce irritation and smarting. 117. _some mothers object to a child's standing in the water._ if the head be wetted before he be placed in the tub, and if he be washed as above directed, there can be no valid objection to it. he must not be allowed to remain in his tab more than five minutes. 118. _does not washing the child's head, every morning, make him more liable to catch cold, and does it not tend to weaken his sight_? it does neither the one nor the other; on the contrary, it prevents cold, and strengthens his sight; it cleanses his scalp, prevents scurf, and, by that means, causes a more beautiful bead of hair. the head, after each washing, ought, with a soft brush, to be well brushed, but should not be combed. the brushing causes a healthy circulation of the scalp; but combing the hair makes the head scurfy, and pulls out the hair by the roots. 119. _if the head, notwithstanding the washing, be scurfy, what should be done_? after the head has been well dried, let a little cocoa-nut oil be well rubbed, for five minutes each time, into the roots of the hair, and, afterwards, let the head be well brushed, but not combed. the fine-tooth comb will cause a greater accumulation of scurf, and will scratch and injure the scalp. 120. _do you recommend a child to be washed_ in his tub _every night and morning_? no; once a day is quite sufficient; in the morning in preference to the evening; unless he be poorly, then, evening instead of morning; as, immediately after he has been washed and dried, he can be put to bed. 121. _ought a child to be placed in his tub whilst he is in a state of perspiration_? not whilst he is perspiring _violently,_ or the perspiration might he checked suddenly, and ill consequences would ensue; _nor ought he to be put in his tub when he is cold,_ or his blood would be chilled, and would be sent from the skin to some internal vital part, and thus would be likely to light up inflammation--probably of the lungs. his skin, when he is placed in his bath, ought to be moderately and comfortably warm; neither too hot nor too cold. 122. _when the child is a year old, do you recommend cold or warm water to be used_? if it be winter, a little warm water ought to be added, so as to raise the temperature to that of new milk. as the summer advances, less and less warm water is required, so that, at length, none is needed. 123. _if a child be delicate, do you recommend anything to be added to the water which may tend to brace and strengthen him_? either a handful of table-salt, or half a handful of bay-salt, or of tidman's sea-salt, should be previously dissolved in a quart jug of _cold_ water; then, just before taking the child out of his morning bath, let the above be poured over and down the back and loins of the child--holding the jug, while pouring its contents on the back, a foot distant from the child, in order that it might act as a kind of douche bath. 124. _do you recommend the child, after he has been dried with the towel, to be rubbed with the hand_? i do; as friction encourages the cutaneous circulation, and causes the skin to perform its functions properly, thus preventing the perspiration (which is one of the impurities of the body) from being sent inwardly either to the lungs or to other parts. the back, the chest, the bowels, and the limbs are the parts that ought to be well rubbed. clothing 125. _have you any remarks to make on the clothing of a child_? children, boys and girls, especially if they be delicate, ought always to wear high dresses up to their necks. the exposure of the upper part of the chest (if the child be weakly) is dangerous. it is in the _upper_ part of the lungs, in the region of the collar bones, that consumption first shows itself. the clothing of a child, more especially about the chest, should be large and full in every part, and be free from tight strings, so that the circulation of the blood may not be impeded, and that there may be plenty of room for the fall development of the rapidly-growing body. his frock, or tonic, ought to be of woollen material--warm, light, and porous, in order that the perspiration may rapidly evaporate. the practice of some mothers in allowing their children to wear tight bands round their waists, and tight clothes, is truly reprehensible. _tight_ bands or _tight_ belts around the waist of a child are very injurious to health; they crib in the chest, and thus interfere with the rising and the falling of the ribs--so essential to breathing. _tight_ hats ought never to be worn; by interfering with the circulation they cause headaches. nature delights in freedom, and resents interference! 126. _what parts of the body in particular ought to be kept warm_? the chest, the bowels, and the feet, should be kept comfortably warm. we must guard against an opposite extreme, and not keep them too hot. the head alone should be kept cool, on which account i do not approve either of night or of day caps. 127. _what are the best kinds of hat for a child_? the best covering for the head, when he is out and about, is a loose-fitting straw hat, which will allow the perspiration to escape. it should have a broad rim, to screen the eyes. a sun-shade, that is to say, a sea-side hat--a hat made of cotton--with a wide brim to keep off the sun, is also an excellent hat for a child; it is very light, and allows a free escape of the perspiration. it can be bought, ready made, at a baby-linen warehouse. a knitted or crocheted woollen hat, with woollen rosettes to keep the ears warm, and which may be procured at any baby-linen warehouse, makes a nice and comfortable winter's hat for a child. it is also a good hat for him to wear while performing a long journey. the colour chosen is generally scarlet and white, which, in cold weather, gives it a warm and comfortable appearance. it is an abominable practice to cover a child's head with beaver or with felt, or with any thick impervious material it is a well-ascertained fact, that beaver and silk hats cause men to suffer from headache, and to lose their hair--the reason being, that the perspiration cannot possibly escape through them. now, if the perspiration cannot escape, dangerous, or at all events injurious, consequences must ensue, as it is well known that the skin is a breathing apparatus, and that it will not with impunity bear interference. neither a child nor any one else should be permitted to be in the glare of the son without his hat. if he be allowed, he is likely to have a sun-stroke, which might either at once kill him, or might make him an idiot for the remainder of his life; which latter would be the worse alternative of the two. 128. _have you, any remarks to make on keeping a child's hands and legs warm when in the winter time he it carried out_? when a child either walks or is carried out in wintry weather, be sure and see that both his hands and legs are well protected from the cold. there is nothing for this purpose like woollen gloves, and woollen stockings coming up over the knees. 129. _do you approve of a child wearing a flannel nightgown_? he frequently throws the clothes off him, and has occasion to be taken up in the night, and if he have not a flannel gown on, is likely to catch cold; on which account i recommend it to be worn. the usual calico night-gown should be worn _under_ it. 130. _do you advise a child to be lightly clad, in order that he may be hardened thereby_? i should fear that such a plan, instead of hardening, would be likely to produce a contrary effect. it is an ascertained fact that more children of the poor, who are thus lightly clad, die, than of those who are properly defended from the cold. again, what holds good with a young plant is equally applicable to a young child; and we all know that it is ridiculous to think of unnecessarily exposing a tender plant to harden it. if it were thus exposed, it would wither and die. 131. _if a child be delicate, if he have a cold body, or a languid circulation, or if he be predisposed to inflammation of the lungs, do you approve of his wearing flannel instead of linen shirts_? i do; as flannel tends to keep the body at an equal temperature, thus obviating the effects of the sudden changes of the weather, and promotes by gentle friction the cutaneous circulation, thus warming the cold body, and giving an impetus to the languid circulation, and preventing an undue quantity of blood from being sent to the lungs, either to light up or to feed inflammation _fine_ flannel, of course, ought to be worn, which should be changed as frequently as the usual shirts. if a child have had an attack either of bronchitis or of inflammation of the lungs, or if he have just recovered from scarlet fever, by all means, if he have not previously worn flannel, _instantly_ let him begin to do so, and let him, _next_ to the skin, wear a flannel waistcoat. _this is important advice, and ought not to be disregarded_. _scarlet_ flannel is now much used instead of _white_ flannel; and as scarlet flannel has a more comfortable appearance, and does not shrink so much in washing, it may be substituted for the white. 132. _have you any remarks to make on the shoes and stockings of a child? and on the right way of cutting the toe-nails_? he ought, daring the winter, to wear lamb's wool stockings that will reach _above_ the knees, and _thick_ calico drawers that will reach a few inches _below_ the knees; as it is of the utmost importance to keep the lower extremities comfortably warm. it is really painful to see how many mothers expose the bare legs of their little ones to the frosty air, even in the depths of winter. be sure and see that the boots and shoes of your child be sound and whole; for if they be not so, they will let in the damp, and if the damp, disease and perhaps death. "if the poor would take better care of their children's feet half the infantile mortality would disappear. it only costs twopence to put a piece of thick felt or cork into the bottom of a boot or shoe, and the difference is often between that and a doctors bill, with, perhaps, the undertaker's besides."--_daily telegraph_, garters ought not to be worn, as they impede the circulation, waste the muscles, and interfere with walking. the stocking may be secured in its place by means of a loop and tape, which should be fastened to a part of the dress. let me urge upon you the importance of not allowing your child to wear _tight_ shoes; they cripple the feet, causing the joints of the toes, which ought to have free play, and which should assist in walking, to be, in a manner, useless; they produce corns and bunions, and interfere with the proper circulation of the foot. a shoe ought to be made according to the shape of the foot--rights and lefts are therefore desirable. the toe-part of the shoe must be made broad, so as to allow plenty of room for the toes to expand, and that one toe cannot overlap another. be sure, then, that there be no pinching and no pressure. in the article of shoes you ought to be particular and liberal; pay attention to having nicely fitting ones, and let them be made of soft leather, and throw them on one side the moment they are too small. it is poor economy, indeed, because a pair of shoes be not worn out, to run the risk of incurring the above evil consequences. _shoes are far preferable to boots:_ boots weaken instead of strengthen the ankle. the ankle and instep require free play, and ought not to be hampered by boots. moreover, boots, by undue pressure, decidedly waste away the ligaments of the ankle. boots act on the ankles in a similar way that stays do on the waist--they do mischief by pressure. boots waste away the ligaments of the ankle; stays waste away the muscles of the back and chest; and thus, in both cases, do irreparable mischief. a shoe for a child ought to be made with a narrow strap over the instep, and with button and button-hole; if it be not made in this way, the shoe will not keep on the foot. it is a grievous state of things, that in the nineteenth century there are but few shoemakers who know how to make a shoe! the shoe is made not to fit a real foot, but a fashionable imaginary one! the poor unfortunate toes are in consequence screwed up as in a vice! let me strongly urge you to be particular that the sock, or stocking, fits nicely--that it is neither too small nor too large; if it be too small, it binds up the toes unmercifully, and makes one toe to ride over the other, and thus renders the toes perfectly useless in walking; if it be too large, it is necessary to lap a portion of the sock, or stocking, either under or over the toes, which thus presses unduly upon them, and gives pain and annoyance. it should be borne in mind, that if the toes have full play, they, as it were, grasp the ground, and greatly assist in locomotion--which, of course, if they are cramped up, they cannot possibly do. be careful, too, that the toe-part of the sock, or stocking, be not pointed; let it be made square in order to give room to the toes. "at this helpless period of life, the delicately feeble, outspreading toes are wedged into a narrow-toed stocking, often so short as to double in the toes, diminishing the length of the rapidly growing foot! it is next, perhaps, tightly laced into a boot of less interior dimensions than itself; when the poor little creature is left to sprawl about with a limping, stumping gait, thus learning to walk as it best can, under circumstances the most cruel and torturing imaginable." [footnote: _the foot and its covering_, second edition. by james dowie. london: 1872. i beg to call a mother's especial attention to this valuable little book: it is written by an earnest intelligent man, by one who has studied the subject in all its bearings, and by one who is himself a shoemaker.] it is impossible for either a stocking, or a shoe, to fit nicely unless the toe-nails be kept in proper order. now, in cutting the toe-nails, there is, as in everything else, a right and a wrong way. the _right_ way of cutting a toe-nail is to cut it straight--in a straight line. the _wrong_ way is to cut the corners of the nail--to round the nail as it is called. this cutting the corners of the nails often makes work for the surgeon, as i myself can testify; it frequently produces "growing-in" of the nail, which sometimes necessitates the removal of either the nail, or a portion of it. 133. _at what time of the year should a child leave off his winter clothing_? a mother ought not to leave off her children's winter clothing until the spring be far advanced: it is far better to be on the safe side, and to allow the winter clothes to be worn until the end of may. the old adage is very good, and should be borne in mind:- "button to chin till may be in; ne'er cast a clout till may be out." 134. _have you any general remarks to make on the present fashion of dressing children_? the present fashion is absurd. children are frequently dressed like mountebanks, with feathers and furbelows and finery; the boys go bare-legged; the little girls are dressed like women, with their stuck-out petticoats, crinolines, and low dresses! their poor little waists are drawn in tight, so that they can scarcely breathe; their dresses are very low and short, the consequence is, that a great part of the chest is exposed to our variable climate; their legs are bare down to their thin socks, or if they be clothed, they are only covered with gossamer drawers; while their feet are encased in tight shoes of paper thickness! dress! dress! dress! is made with them, at a tender age, and when first impressions are the strongest, a most important consideration. they are thus rendered vain and frivolous, and are taught to consider dress "as the one thing needful" and if they live to be women--which the present fashion is likely frequently to prevent--what are they? silly, simpering, delicate, lack-a-daisical nonentities; dress being their amusement, their occupation, their conversation, their everything, their thoughts by day and their dreams by night! truly they are melancholy objects to behold! let children be dressed as children, not as men and women. let them be taught that dress is quite a secondary consideration. let health, and not fashion, be the first, and we shall then have, with god's blessing, blooming children, who will, in time, be the pride and strength of dear old england! diet. 135. _at twelve months old, have you any objection to a child having any other food besides that you mentioned in answer to the 34th question_? there is no objection to his _occasionally_ having, for dinner, either a mealy, _mashed_ potato and gravy, or a few crumbs of bread and gravy. rice-pudding or batter-pudding may, for a change, be given; but remember, the food recommended in a former conversation is what, until he be eighteen months old, must be principally taken. during the early months of infancy--say, for the first six or seven--if artificial food be given at all, it should be administered by means of a feeding-bottle. after that time, either a spoon, or a nursing boat, will be preferable. the food as he becomes older, ought to be made more solid. 136. _at_ eighteen _months old, have you any objection to a child having meat_? he ought not to have meat until he have several teeth to chew it with. if he has most of his teeth--which he very likely at this age will have--there is no objection to his taking a small slice either of mutton, or occasionally of roast beef, which should be well cut into very small pieces, and mixed with a mealy _mashed_ potato, and a few crumbs of bread and gravy; either _every_ day, if he be delicate, or every _other_ day, if he be a gross or a fast-feeding child. it may be well, in the generality of cases, for the first few months to give him meat _every other_ day, and either potato or gravy, or rice or suet-pudding or batter-pudding on the alternate days; indeed, i think so highly of rice, of suet, and of batter-puddings, and of other farinaceous puddings, that i should advise you to let him have either the one or the other even on those days that he has meat--giving it him _after_ his meat. but remember, if he have meat _and_ pudding, the meat ought to be given sparingly. if he be gorged with food, it makes him irritable, cross, and stupid; at one time, clogging up his bowels, and producing constipation; at another, disordering his liver, and causing either clay-coloured stools--denoting a _deficiency_ of bile, or dark and offensive motions--telling of _vitiated_ bile; while, in a third case, cramming him with food might bring on convulsions. 137. _as you are to partial to puddings for a child, which do you consider the best for him_? he ought, every day, to have a pudding for his dinner--either rice, arrow-root, sago, tapioca, suet-pudding, batter-pudding, or yorkshire-pudding, mixed with crumbs of bread and gravy--free from grease. a well boiled suet-pudding, with plenty of suet in it, is one of the best puddings he can have; it is, in point of fact, meat and farinaceous food combined, and is equal to, and will oftentimes prevent the giving of, cod-liver oil; before cod-liver oil came into vogue, suet boiled in milk was _the_ remedy for a delicate child. he may, occasionally, have fruit-pudding, provided the pastry be both plain and light. the objection to fruit pies and puddings is, that the pastry is often too rich for the delicate stomach of a child; there is so objection, certainly not, to the fruit--cooked fruit being, for a child, most wholesome; if, therefore, fruit puddings and pies be eaten, the pastry part ought to be quite plain. there is, in "murray's modern cookery book," an excellent suggestion, which i will take the liberty of quoting, and of strongly urging my fair reader to carry into practice:--"_to prepare fruit for children, a far more wholesome way than in pies and puddings_, is to put apples sliced, or plums, currants, gooseberries, &c., into a stone jar; and sprinkle among them as much lisbon sugar as necessary. set the jar on an oven or on a hearth, with a tea-cupful of water to prevent the fruit from burning; or put the jar into a saucepan of water, till its contents be perfectly done. slices of bread or some rice may be put into the jar, to eat with the fruit." _jam_--such as strawberry, raspberry, gooseberry--_is most wholesome for a child_, and ought occasionally to be given, in lieu of sugar, with the rice, with the batter, and with the other puddings. marmalade, too, is very wholesome. puddings ought to be given _after_ and not _before_ his meat and vegetables; if you give him pudding before his meat, he might refuse to eat meat altogether. by adopting the plan of giving puddings _every_ day, your child will require _less_ animal food; _much_ meat is injurious to a young child. but do not run into an opposite extreme: a _little_ meat ought, every day, to be given, _provided he has cut the whole of his first set of teeth_; until then, meat every _other_ day will be often enough. 138. _as soon as a child has cut the whole of his first set of teeth, what ought to be his diet?--what should be his breakfast_? he can, then, have nothing better, where it agrees, than scalding hot new milk poured on sliced bread, with a slice or two of bread and butter to eat with it. butter, in moderation, is nourishing, fattening, and wholesome. moreover, butter tends to keep the bowels regular. these facts should be borne in mind, as some mothers foolishly keep their children from butter, declaring it to be too rich for their children's stomachs! new milk should be used in preference either to cream or to skim-milk. cream, as a rule, is too rich for the delicate stomach of a child, and skim-milk is too poor when robbed of the butter which the cream contains. but give cream and water, where new milk (as is _occasionally_ the case) does not agree; but never give skim-milk. _skim_-milk (among other evils) produces costiveness, and necessitates the frequent administration of aperients. cream, on the other hand, regulates and tends to open the bowels. although i am not, as a rule, so partial to cream as i am to good genuine fresh milk, yet i have found, in cases of great debility, more especially where a child is much exhausted by some inflammatory disease, such as inflammation of the lungs, the following food most serviceable:--beat up, by means of a fork, the yolk of an egg, then mix, little by little, half a tea-cupful of very weak _black_ tea, sweeten with one lump of sugar, and add a table-spoonful of cream. let the above, by tea-spoonfuls at a time be frequently given. the above food is only to be administered until the exhaustion be removed, and is not to supersede the milk diet, which must, at stated periods, be given, as i have recommended in answers to previous and subsequent questions. when a child has costive bowels, there is nothing better for his breakfast than well-made and well-boiled oatmeal stir-about, which ought to be eaten with milk fresh from the cow. scotch children scarcely take anything else, and a finer race is not in existence; and, as for physic, many of them do not even know either the taste or the smell of it! you win find robinson's pure scotch oatmeal (sold in packets) to be very pure, and sweet, and good. stir-about is truly said to be- "the halesome parritch, chief of scotia's food."--_burns._ cadbury's cocoa essence, made with equal parts of boiling water and fresh milk, slightly sweetened with lump sugar, is an admirable food for a delicate child. bread and butter should be eaten with it. 139. _have you any remarks to make on cow's milk as an article of food_? cow's milk is a valuable, indeed, an indispensable article of diet, for the young; it is most nourishing, wholesome, and digestible. the finest and the healthiest children are those who, for the first four or five years of their lives, are fed _principally_ upon it. milk ought then to be their staple food. no child, as a rule, can live, or, if he live, can be healthy, unless milk be the staple article of his diet. there is no substitute for milk. to prove the fattening and strengthening qualities of milk, look only at a young calf who lives on milk, and on milk alone! he is a samson in strength, and is "as fat as butter;" and all young things if they are in health are fat! milk, then, contains every ingredient to build up the body, which is more than can be said of any other known substance besides. a child may live entirely, and grow, and become both healthy and strong, on milk and on milk alone, as it contains every constituent of the human body. a child cannot "live by bread alone," but he might on milk alone! milk is animal and vegetable--it is meat and bread--it is food and drink--it is a fluid, but as soon as it reaches the stomach it becomes a solid [footnote: how is milk in the making of cheese, converted into curds? by rennet. what is rennet? the juice of a calf's maw or stomach. the moment the milk enters the human maw or stomach, the juice of the stomach converts it into curds--into solid food, just as readily as when it enters a calfs maw or stomach, and much more readily than by rennet, as the _fresh_ juice is stronger than the _stale_. an ignorant mother often complains that because, when her child is sick, the milk curdles, that it is a proof that it does not agree with him! if, at those times, it did _not_ curdle, it would, indeed, prove that his stomach was in a wretchedly weak state; she would then have abundant cause to be anxious.]--solid food; it is the most important and valuable article of diet for a child in existence. it is a glorious food for the young, and must never, on any account whatever, in any case be dispensed with. "considering that milk contains in itself most of the constituents of a perfect diet, and is capable of maintaining life in infancy without the aid of any other substance, it is marvellous that the consumption of it is practically limited to so small a class; and not only so, but that in sick-rooms, where the patient is surrounded with every luxury, arrow-root, and other compounds containing much less nutriment, should so often be preferred to it."--_the times._ do not let me be misunderstood. i do not mean to say, but that the mixing of farinaceous food--such as lemann's biscuit powder, robb's biscuit, hard's farinaceous food, brown and polson's corn flour, and the like, with the milk, is an improvement, in some cases--a great improvement; but still i maintain that a child might live and thrive, and that for a lengthened period, on milk--and on milk alone! a dog will live and fatten for six weeks on milk alone; while he will starve and die in a shorter period on strong beef-tea alone! it is a grievous sin for a milkman to adulterate milk. how many a poor infant has fallen a victim to that crime!--for crime it may be truly called. it is folly in the extreme for a mother to bate a milkman down in the price of his milk; if she does, the milk is sure to be either of inferior quality, or adulterated, or diluted with water; and woe betide the poor unfortunate child if it be either the one or the other! the only way to insure good milk is, to go to a respectable cow-keeper, and let him be made to thoroughly understand the importance of your child having _genuine_ milk, and that you are then willing to pay a fair remunerative price for it. rest assured, that if you have to pay one penny or even twopence a quart more for _genuine_ milk, it is one of the best investments that you ever have made, or that you are ever likely to make in this world! cheap and inferior milk might well be called cheap and nasty; for inferior or adulterated milk is the very essence, the conglomeration of nastiness; and, moreover, is very poisonous to a child's stomach. one and the principal reason why so many children are rickety and scrofulous, is the horrid stuff called milk that is usually given to them. it is a crying evil, and demands a thorough investigation and reformation, and the individual interference of every parent. limited liability companies are the order of the day; it would really be not a bad speculation if one were formed in every large town, in order to insure good, genuine, and undiluted milk. _young_ children, as a rule, are allowed to eat too much meat. it is a mistaken notion of a mother that they require so much animal food. if more milk were given and less meat, they would he healthier, and would not be so predisposed to disease, especially to diseases of debility, and to skin-disease. i should strongly recommend you, then, to be extravagant in your milk score. each child ought, in the twenty-four hours, to take at least a quart of good, fresh, new milk. it should, of course, be given in various ways,--as bread and milk, rice-puddings, milk and differents kinds of farinaceous food, stir-about, plain milk, cold milk, hot milk, any way, and every way, that will please his palate, and that will induce him to take an abundant supply of it. the "advice" i have just given you is of paramount importance, and demands your most earnest attention. there would be very few rickety children in the world if my "counsel" were followed out to the very letter. 140. _but suppose my child will not take milk, he having an aversion to it, what ought then to be done_? boil the milk, and sweeten it to suit his palate. after he has been accustomed to it for a while, he will then, probably, like milk. gradually reduce the sugar, until at length it be dispensed with. a child will often take milk this way, whereas he will not otherwise touch it. if a child will not drink milk, he _must_ eat meat; it is absolutely necessary that he should have either the one or the other; and, if he have cut nearly all his teeth, he ought to have both meat and milk--the former in moderation, the latter in abundance. 141. _supposing milk should not agree with my child, what must then be done_? milk, either boiled or unboiled, almost always agrees with a child. if it does not, it must be looked upon as the exception, and not as the rule. i would, in such a case, advise one-eighth of lime water to be added to seven-eighths of new milk--that is to say, two table-spoonfuls of lime water should be mixed with half a pint of new milk. 142. _can you tell me of a way to prevent milk, in hot weather, from turning sour_? let the jug of milk be put into a crock, containing ice--wenham lake is the best--either in the dairy or in the cellar. the ice may at any time, be procured of a respectable fishmonger, and should be kept, wrapped either in flannel or in blanket, in a cool place, until it be wanted. 143. _can you tell me why the children of the rich suffer so much more from costiveness than do the children of the poor_? the principal reason is that the children of the rich drink milk without water, while the children of the poor drink water without, or with very little, milk--milk being binding, and water opening to the bowels. be sure then, and bear in mind, _as this is most important advice_, to see that water is mixed with all the milk that is given to your child. the combination of milk and water for a child is a glorious compound--strengthening, fattening, refreshing, and regulating to the bowels, and thus doing away with that disgraceful proceeding so common in nurseries, of everlastingly physicking, irritating and irreparably injuring the tender bowels of a child. my opinion is, that aperients, as a rule, are quite unnecessary, and should only be given in severe illness, and under the direction of a judicious medical man. how much misery, and injury, might be averted if milk were always given to a child in combination with water! aperients, by repetition, unlike water, increase the mischief tenfold, and cork them up most effectually; so that the bowels, in time, will not act without them! a mother before she gives an aperient to her child should ponder well upon what i have said upon the subject, it being a vital question, affecting, as it does, the well-being and the well-doing of her child. 144. _but, if a child's bowels be very costive, what is to be done to relieve them_? do not give him a grain or a drop of opening medicine, but in lieu thereof, administer, by means of a 6 oz. india-rubber enema bottle, half a tea-cup or a tea-cupful, according to the age of the child, [footnote: for a babe, from birth until he be two years old, one, two, or three table-spoonfuls of warm water will be sufficient, and a 2 oz. enema bottle will be the proper size for the purpose of administering it.] of warm water; now this will effectually open the bowels, without confining them afterwards, which opening physic would most assuredly do! 145. _is it necessary to give a child luncheon_? if he want anything to eat between breakfast and dinner let him have a piece of dry bread; and if he have eaten very heartily at dinner, and, like oliver twist, "asks for more!" give him, to satisfy his craving, a piece of _dry_ bread. he will never eat more of that than will do him good, and yet he will take sufficient to satisfy his hunger, which is very important. 146. _what ought now to be his dinner_? he should now have meat, either mutton or beef, daily, which must be cut up very small, and should be mixed with mealy, _mashed_ potato and gravy. he ought _always_ to be accustomed to eat salt with his dinner. let a mother see that this advice is followed, or evil consequences will inevitably ensue. let him be closely watched, to ascertain that he well masticates his food, and that he does not eat too quickly; for young children are apt to bolt their food. 147. _have you any objection to pork for a change_? i have a great objection to it for the young. it is a rich, gross, and therefore unwholesome food for the delicate stomach of a child. i have known it, in several instances, produce violent pain, sickness, purging, and convulsions. if a child be fed much, upon such meat, it will be likely to produce "breakings-out" on the skin. in fine, his blood will put on the same character as the food he is fed with. moreover, pork might be considered a _strong meat_, and "_strong_ meat and _strong_ drink can only be taken by _strong_ men." 148. _do you approve of veal for a child_? my objection to pork was, that it was rich and gross; this does not apply to veal; but the objection to it is, that it is more difficult of digestion that either mutton or beef; indeed, all young meats are harder of digestion than meats of maturity; thus mutton is more digestible than lamb, and beef than veal. 149. _do you disapprove of salted and boiled beef for a child_? if beef be _much_ salted it is hard of digestion, and therefore ought not to be given to him; but if it have been but _slightly_ salted, then for a change there will be no objection to a little. there is no necessity in the _winter_ time to _salt_ meat intended for boiling; then boiled _unsalted_ meat makes a nice change for a child's dinner. salt, of course, _must_ with the unsalted meat be eaten. 150. _but suppose there is nothing on the table that a child may with impunity eat_? he should then have either a grilled mutton chop, or a lightly-boiled egg; indeed, the latter, at any time, makes an excellent change. there is great nourishment in an egg; it will not only strengthen the frame, but it will give animal heat as well: these two qualities of an egg are most valuable; indeed, essential for the due performance of health: many articles of food contain the one qualification, but not the other: hence the egg is admirably suitable for a child's _occasional_ dinner. 151. _are potatoes an unwholesome food for a child_? new ones are; but old potatoes well cooked and mealy, are the best vegetable he can have. they ought to be _well mashed_, as i have known lumps of potatoes cause convulsions. 152. _do you approve of any other vegetables for a child_? occasionally: either asparagus or broccoli, or cauliflower, or turnips, or french beans, which latter should be cut up fine, may with advantage be given. green peas may occasionally be given, provided they be thoroughly well boiled, and mashed with the knife on the plate. underdone and unmashed peas are not fit for a child's stomach: there is nothing more difficult of digestion than underdone peas. it is important, too, to mash them, even if they be well done, as a child generally bolts peas whole; and they pass through the alimentary canal without being in the least digested. 153. _might not a mother be too particular in dieting her child_? certainly not. if blood can be too pure and too good she might! when we take into account that the food we eat is converted into blood; that if the food be good the blood is good; and that if the food be improper or impure, the blood is impure likewise; and, moreover, when we know that every part of the body is built up by the blood, we cannot be considered to be too particular in making our selection of food. besides if indigestible or improper food be taken into the stomach, the blood will not only be made impure, but the stomach and the bowels will be disordered. do not let me be misunderstood: i am no advocate for a child having the same food one day as another-certainly not. let there be variety, but let it be _wholesome_ variety. variety in a child's (not in infant's) food is necessary. if he were fed, day after day, on mutton, his stomach would, at length be brought into that state, that in time it would not properly digest any other meat, and a miserable existence would be the result. 154. _what ought a child to drink with his dinner_? toast and water, or, if he prefer it, plain spring water. let him have as much as he likes. if you give him water to drink, there is no fear of his taking too much; nature will tell him when he has had enough. be careful of the quality of the water, and the source from which you procure it. if the water be _hard_--provided it be free from organic matter--so much the better. [footnote: see the _third_ edition of _counsel to a mother_, under the head of "hard or soft water as a beverage!"] spring water from a moderately deep well is the best. if it come from a land spring, it is apt, indeed, is almost sure to be contaminated by drains, &c.; which is a frequent cause of fevers, of diphtheria, of asiatic cholera, and of other blood poisons. guard against the drinking water being contaminated with lead; never, therefore, allow the water to be collected in leaden cisterns, as it sometimes is if the water be obtained from water-works companies. lead pumps, for the same reason, ought never to be used for drinking purposes. paralysis, constipation, lead colic, dropping of the wrist, wasting of the ball of the thumb, loss of memory, and broken and ruined health, might result from neglect of this advice. the drinking fountains are a great boon to poor children, as water and plenty of it, is one of the chief necessaries of their existence; and, unfortunately, at their own homes they are not, oftentimes, able to obtain a sufficient supply. moreover, drinking fountains are the best advocates for temperance. some parents are in the habit of giving their children beer with their dinners--making them live as they live themselves! this practice is truly absurd, and fraught with great danger! not only so, but it is inducing a child to be fond of that which in after life might be his bane and curse! no good end can be obtained by it; it will _not_ strengthen so young a child; it will on the contrary, create fever, and will thereby weaken him; it will act injuriously upon his delicate, nervous, and vascular systems, and by means of producing inflammation either of the brain or of its membranes, might thus cause water on the brain (a disease to which young children are subject), or it might induce inflammation of the lungs. 155. _what ought a child who has cut his teeth to have for his supper_? the same that he has for breakfast. he should sup at six o'clock. 156. _have you any general remarks to make on a child's meals_? i recommended a great sameness in an _infant's_ diet; but a _child's_ meals, his dinners especially, ought to be much varied. for instance, do not let him have day after day mutton; but ring the changes on mutton, beef, poultry, game, and even occasionally fish--sole or cod. not only let there be a change of meat, but let there be a change in the manner of cooking it; let the meat sometimes be roasted; let it at other times be boiled. i have known a mother who has prided herself as being experienced in these matters, feed her child, day after day, on mutton chops! such a proceeding is most injurious to him, as after a while his unfortunate stomach will digest nothing but mutton chops, and, in time, not even those! with regard to vegetables, potatoes--_mashed_ potatoes--ought to be his staple vegetable; but, every now and then, cauliflower, asparagus, turnips, and french beans, should be given. with respect to puddings, vary them; rice, one day; suet, another; batter, a third; tapioca, a fourth; or, even occasionally, he might have either apple or gooseberry or rhubarb pudding--provided the pastry be plain and light. it is an excellent plan, as i have before remarked, to let her child eat jam--such as strawberry, raspberry, or gooseberry--and that without stint, either with rice or with batter puddings. _variety of diet_, then, is _good for a child:_ it will give him muscle, bone, and sinew; and, what is very important, it will tend to regulate his bowels, and it will thus prevent the necessity of giving him aperients. but do not stuff a child--do not press him, as is the wont of some mothers, to eat more than he feels inclined. on the contrary, if you think that he is eating too much--that he is overloading his stomach--and if he should ask for more, then, instead of giving him either more meat or more pudding, give him a piece of dry bread. by doing so, you may rest assured that he will not eat more than is absolutely good for him. 157. _if a child be delicate, is there any objection to a little wine, such as cowslip or tent, to strengthen him_? wine ought not to be given to a child unless it be ordered by a medical man; it is even more injurious than beer. wine, beer, and spirits, principally owe their strength to the alcohol they contain; indeed, nearly _all_ wines are _fortified_ (as it is called) with brandy. brandy contains a large quantity of alcohol, more than any other liquor, namely 55.3 per cent. if, therefore, you give wine, it is, in point of fact, giving diluted brandy--diluted alcohol; and alcohol acts, unless it be used as a medicine, and under skilful medical advice, as a poison to a child. 158. _suppose a child suddenly to lose his appetite? is any notice to be taken of it_? if he cannot eat well, depend upon it, there is something wrong about the system. if he be teething, let a mother look well to his gums, and satisfy herself that they do not require lancing. if they be red, hot, and swollen, send for a medical man, that he may scarify them. if his gums be not inflamed, and no tooth appears near, let her look well to the state of his bowels; let her ascertain that they be sufficiently opened, and that the stools be of a proper consistence, colour, and smell. if they be neither the one nor the other, give a dose of aperient medicine, which will generally put all to rights. if the gums be cool, and the bowels be right, and his appetite continue bad, call in medical aid. a child asking for something to eat, is frequently, in a severe illness, the first favourable symptom; we may generally then prognosticate that all will soon be well again. if a child refuse his food, neither coax nor tempt him to eat: as food without an appetite will do him more harm than it will do him good; it may produce either sickness, bowel-complaint, or fever. depend upon it, there is always a cause for a want of appetite;--perhaps his stomach has been over-worked, and requires repose; or his bowels are loaded, and nature wishes to take time to use up the old material;--there might be fever lurking in his system; nature stops the supplies, and thus endeavours, by not giving it food to work with, to nip it in the bud;--there might be inflammation; food would then be improper, as it would only add fuel to the fire; let, therefore, the cause be either an overworked stomach, over-loaded bowels, fever, or inflammation, food would be injurious. kind nature if we will but listen to her voice, will tell us when to eat, and when to refrain. 159. _when a child is four or five years old, have you any objection to his drinking tea_? some parents are in the habit of giving their children strong (and frequently green) tea. this practice is most hurtful. it acts injuriously upon their delicate, nervous system, and thus weakens their whole frame. if milk does not agree, a cup of very weak tea, that is to say, water with a dash of _black_ tea in it, with a table-spoonful of cream, may be substituted for milk; but a mother must never give tea where milk agrees. 160. _have you any objection to a child occasionally having either cakes or sweetmeats_? i consider them as so much slow poison. such things both cloy and weaken the stomach, and thereby take away the appetite, and thus debilitate the frame. moreover "sweetmeats are coloured with poisonous pigments." a mother, surely, is not aware, that when she is giving her child sugar confectionery she is, in many cases, administering a deadly poison to him? "we beg to direct the attention of our readers to the report of the analytical sanitary commission, contained in the _lancet_ of the present week (dec. 18, 1858), on the pigments employed in colouring articles of sugar confectionery. from this report it appears that metallic pigments of a highly dangerous and even poisonous character, containing chromic acid, lead, copper, mercury, and arsenic, are commonly used in the colouring of such articles." if a child be never allowed to eat cakes and sweetmeats, he will consider a piece of dry bread a luxury, and will eat it with the greatest relish. 161. _is bakers' or is home-made bread the most wholesome for a child_? bakers' bread is certainly the lightest; and, if we could depend upon its being unadulterated, would, from its lightness, be the most wholesome; but as we cannot always depend upon bakers' bread, home-made bread, as a rule should be preferred. if it be at all heavy, a child must not be allowed to partake of it; a baker's loaf ought then to be sent for, and continued to be eaten until light home-made bread can be procured. heavy bread is most indigestible. he must not be allowed to eat bread until it be two or three days old. if it be a week old, in cold weather, it will be the more wholesome. 162. _do you approve either of caraway seeds or of currants in bread or in cakes--the former to disperse wind, the latter to open the bowels_? there is nothing better than plain bread: the caraway-seeds generally pass through the bowels undigested, and thus might irritate, and might produce, instead of disperse wind. [footnote: although caraway seeds _whole_ are unwholesome, yet caraway tea, made as recommended in a previous conversation, is an excellent remedy to disperse wind.] some mothers put currants in cakes, with a view of opening the bowels of their children; but they only open them by disordering them. 163. _my child has an antipathy to certain articles of diet: what would you advise to be done_? a child's antipathy to certain articles of diet should be respected: it is a sin and a shame to force him to eat what he has a great dislike to: a child, for instance, sometimes dislikes the fat of meat, underdone meat, the skin off boiled milk and off rice-pudding. why should he not have his likes and dislikes as well as "children of a larger growth?" besides, there is an idiosyncrasy--a peculiarity of the constitution in some children--and nature oftentimes especially points out what is good and what is bad for them individually, and we are not to fly in the face of nature. "what is one man's meat is another man's poison." if a child be forced to eat what he dislikes, it will most likely not only make him sick, but will disorder his stomach and bowels; food, if it is really to do him good, must be eaten by him with a relish, and not with disgust and aversion. some mothers, who are strict disciplinarians, pride themselves on compelling their children to eat whatever they choose to give them! such children are to be pitied! 164. _when ought a child to commence to dine with his parents_? as soon as he be old enough to sit up at the table, provided the father and mother either dine or lunch in the middle of the day. "i always prefer having children about me at meal tines. i think it makes them little gentlemen and gentlewomen in a manner that nothing else will."--_christian's mistake_. the nursery. 165. _save you any remarks to make on the selection, the ventilation, the warming, the temperature, and the arrangements of a nursery? and have you any further observations to offer conducive to the well-doing of my child_? the nursery ought to be the largest and the most airy room in the house. in the town, if it be in the topmost story (provided the apartment be large and airy) so much the better, as the air will then be purer. the architect, in the building of a house, ought to be particularly directed to pay attention to the space, the loftiness, the ventilation, the light, the warming, and the conveniences of a nursery. a bath-room attached to it will be of great importance and benefit to the health of a child. it will be advantageous to have a water-closet near at hand, which should be well supplied with water, be well drained, and be well ventilated. if this be not practicable, the evacuations ought to be removed as soon as they are passed. it is a filthy and an idle habit of a nurse-maid to allow a motion to remain for any length of time in the room. the ventilation of a nursery is of paramount importance. there ought to be a constant supply of fresh pure air in the apartment. but how few nurseries have fresh, pure air! many nurseries are nearly hermetically sealed--the windows are seldom, if ever, opened; the doors are religiously closed; and, in summer time, the chimneys are carefully stuffed up, so that a breath of air is not allowed to enter! the consequences are, the poor unfortunate children "are poisoned by their own breaths," and are made so delicate that they are constantly catching cold; indeed, it might be said that they are labouring under chronic catarrhs, all arising from nature's laws being set at defiance. the windows ought to be large, and should be made to freely open both top and bottom. whenever the child is out of the nursery, the windows ought to be thrown wide open; indeed, when he is in it, if the weather be fine, the upper sash should be a little lowered. a child should be encouraged to change the room, frequently, in order that it may be freely ventilated; for good air is as necessary to his health as wholesome food, and air cannot be good if it be not frequently changed. if you wish to have a strong and healthy child, ponder over and follow this advice. i have to enter my protest against the use of a stove in a nursery. i consider a gas stove _without a chimney_ to be an abomination, most destructive to human life. there is nothing like the old-fashioned open fire-place with a good-sized chimney, so that it may not only carry off the smoke, but also the impure air of the room. be strict in not allowing your child either to touch or to play with fire; frightful accidents have occurred from mothers and nurses being on these points lax. the nursery ought to have a large fire-guard, to go all round the hearth, and which should be sufficiently high to prevent a child from climbing over. not only must the nursery have a guard, but every room where he is allowed to go should he furnished with one on the bars. moreover, it will be advisable to have a guard in every room where a fire is burning, to prevent ladies from being burned. fortunately for them, preposterous crinolines are out of fashion: when they were in fashion, death from burning was of every-day occurrence; indeed, lady-burning was then to be considered one of the institutions of our land! a nursery is usually kept too hot; the temperature in the winter time ought _not to exceed_ 60 degrees fahrenheit a _good_ thermometer should be considered an indispensable requisite to a nursery. a child in a hot, close nursery is bathed in perspiration; if he leave the room to go to one of lower temperature, the pores of his skin are suddenly closed, and either a severe cold or an inflammation of the lungs, or an attack of bronchitis, is likely to ensue. moreover, the child is both weakened and enervated by the heat, and thus readily falls a prey to disease. a child ought never to be permitted to sit with his back to the fire; if he be allowed, it weakens the spine, and thus his whole frame; it causes a rash of blood to the head and face, and predisposes him to catch cold. let a nurse make a point of opening the nursery window every time that she and her little charge leave the nursery, if her absence be only for half an hour. the mother herself ought to see that this advice is followed, pure air is so essential to the well-being of a child. pure air and pure water, and let me add, pure milk, are for a child the grand and principal requirements of health. look well to the drainage of your house and neighbourhood. a child is very susceptible to the influence of bad drainage. bad drains are fruitful sources of scarlet fever, of diphtheria, of diarrhoea, &c. "it is sad to be reminded that, whatever evils threaten the health of population, whether from pollutions of water or of air,--whether from bad drainage or overcrowding, they fall heaviest upon the most innocent victims--upon children of tender years. their delicate frames are infinitely more sensitive than the hardened constitutions of adults, and the breath of poison, or the chill of hardships, easily blights their tender life."--_the times._ a nursery floor ought not to be _washed_ oftener than once a week; and then the child or children should, until it be dry, be sent into another room. during the drying of the floor, the windows must, of course, be thrown _wide_ open. the constant _wetting_ of a nursery is a frequent source of illness among children. the floor ought, of course, to be kept clean; but this may be done by the servant thoroughly sweeping the room out every morning before her little charge makes his appearance. do not have your nursery wall covered with green paper-hangings. green paper-hangings contain large quantities of arsenic--arsenite of copper (scheele's green)--which, i need scarcely say, is a virulent poison, and which flies about the room in the form of powder. there is frequently enough poison on the walls of a room to destroy a whole neigbourhood. there is another great objection to having your nursery walls covered with _green_ paper-hangings; if any of the paper should become loose from the walls, a little child is very apt to play with it, and to put it, as he does every thing else, to his mouth. this is not an imaginary state of things, as four children in one family have just lost their lives from sucking green paper-hangings. green dresses, as they are coloured with a preparation of arsenic, are equally as dangerous as green paper-hangings; a child ought, therefore, never to wear a green dress. "it may be interesting to some of our readers," says _land and water_, "to know that the new green, so fashionable for ladies' dresses, is just as dangerous in its nature as the green wall-paper, about which so much was written some time since. it is prepared with a large quantity of arsenic; and we have been assured by several of the leading dressmakers, that the workwomen employed in making up dresses of this colour are seriously affected with all the symptoms of arsenical poisoning. let our lady friends take care." children's toys are frequently painted of a green colour with arsenite of copper, and are consequently, highly dangerous for him to play with. the best toy for a child is a box of _unpainted_ wooden bricks, which is a constant source of amusement to him. if you have your nursery walls hung with paintings and engravings, let them be of good quality. the horrid daubs and bad engravings that usually disfigure nursery walls, are enough to ruin the taste of a child, and to make him take a disgust to drawing, which would be a misfortune. a fine engraving and a good painting expand and elevate his mind. we all know that first impressions are the most vivid and the most lasting. a taste in early life for everything refined and beautiful purifies his mind, cultivates his intellect, keeps him from low company, and makes him grow up a gentleman! lucifer matches, in case of sudden illness, should, both in the nursery and in the bedroom, be always in readiness; but they must be carefully placed out of the reach of children, as lucifer matches are a deadly poison. many inquests have been held on children who have, from having sucked them, been poisoned by them. 166. _have you any observation to make on the light of a nursery_? let the window, or what is better, the windows, of a nursery be very large, so as to thoroughly light up every nook and corner of the room, as there is nothing more conducive to the health of a child than an abundance of light in the dwelling. a room cannot, then, be too light. the windows of a nursery are generally too small. a child requires as much light as a plant. gardeners are well aware of the great importance of light in the construction of their greenhouses, and yet a child, who requires it as much, and is of much greater importance, is cooped up in dark rooms! the windows of a nursery ought not only to be frequently opened to let in fresh air, but should be _frequently cleaned_, to let in plenty of light and of sunshine, as nothing is so cheering and beneficial to a child as an abundance of light and sunshine! _with regard to the best artificial light for a nursery._--the air of a nursery cannot be too pure; i therefore do not advise you to have gas in it, as gas in burning gives off quantities of carbonic acid and sulphuretted hydrogen, which vitiate the air. the paraffine lamp, too, makes a room very hot and close. there is no better light for a nursery than either price's patent candles or the old-fashioned tallow-candle. let a child's _home_ he the happiest _house_ to him in the world; and to be happy he must be merry, and all around him should be merry and cheerful; and he ought to have an abundance of playthings, to help on the merriment. if he have a dismal nurse, and a dismal home, he may as well be incarcerated in a prison, and be attended by a gaoler. it is sad enough to see dismal, doleful men and women, but it is a truly lamentable and unnatural sight to see a doleful child! the young ought to be as playful and as full of innocent mischief as a kitten. there will be quite time enough in after years for sorrow and for sadness. bright colours, plenty of light, _clean_ windows (mind this, if you please), an abundance of _good_-coloured prints, and toys without number, are the proper furnishings of a nursery. nursery! why, the very name tells you what it ought to be--the home of childhood--the most important room in the house,--a room that will greatly tend to stamp the character of your child for the remainder of his life. 167. _have you any more hints to offer conducive to the well-doing of my child_? you cannot be too particular in the choice of those who are in constant attendance upon him. you yourself, of course, must be his _head-nurse_--you only require some one to take the drudgery off your hands! you ought to be particularly careful in the selection of his nurse. she should be steady, lively, truthful, and good tempered; and must be free from any natural imperfection, such as squinting, stammering, &c., for a child is such an imitative creature that he is likely to acquire that defect, which in the nurse is natural. "children, like babies, are quick at 'taking notice.' what they see they mark, and what they mark they are very prone to copy."--_the times_. she ought not to be very young, or she may be thoughtless, careless, and giggling. you have no right to set a child to mind a child; it would be like the blind leading the blind. no! a child is too precious a treasure to be entrusted to the care and keeping of a young girl. many a child has been ruined for life by a careless young nurse dropping him and injuring his spine. a nurse ought to be both strong and active, in order that her little charge may have plenty of good nursing; for it requires great strength in the arms to carry a heavy child for the space of an hour or two at a stretch, in the open air; and such is absolutely necessary, and is the only way to make him strong, and to cause him to cut his teeth easily, and at the same time to regulate his bowels; a noise, therefore, most be strong and active, and not mind hard, work, for hard work it is; but, after she is accustomed to it, pleasant notwithstanding. never should a nurse be allowed to wear a mask, nor to dress up and paint herself as a ghost, or as any other frightful object. a child is naturally timid and full of fears, and what would not make the slightest impression upon a grown-up person might throw a child into fits- "the sleeping, and the dead, are but as pictures: 'tis the age of childhood that fears a painted devil."--_shakspeare_. never should she be permitted to tell her little charge frightful stories of ghosts and hobgoblins; if this be allowed, the child's disposition will become timid and wavering, and may continue so for the remainder of his life. if a little fellow were not terrified by such stories, the darkness would not frighten him more than the light. moreover, the mind thus filled with fear, acts upon the body, and injures the health. a child must never be placed in a dark cellar, nor frightened by tales of rats, &c. instances are related of fear thus induced impairing the intellect for life; and there are numerous examples of sudden fright causing a dangerous and even a fatal illness. _night-terrors_.--this frightening of a child by a silly nurse frequently brings on night-terrors. he wakes up suddenly, soon after going to sleep, frightened and terrified; screaming violently, and declaring that he has seen either some ghost, or thief, or some object that the silly nurse had been previously in the day describing, who is come for him to take him away. the little fellow is the very picture of terror and alarm; he hides his face in his mother's bosom, the perspiration streams down him, and it is some time before he can be pacified--when, at length, he falls into a troubled feverish slumber, to awake in the morning unrefreshed. night after night these terrors harass him, until his health materially suffers, and his young life becomes miserable looking forward with dread to the approach of darkness. _treatment of night terrors_.--if they have been brought on by the folly of the nurse, discharge her at once, and be careful to select a more discreet one. when the child retires to rest, leave a candle burning, and let it burn all night, sit with him until he be asleep, and take care, in case he should rouse up in one of his night-terrors, that either yourself or some kind person be near at hand. do not scold him for being frightened--he cannot help it, but soothe him, calm him, fondle him, take him into your arms and let him feel that he has some one to rest upon, to defend and to protect him. it is frequently in these cases necessary before he can be cared to let him have change of air and change of scene. let him live, in the day time, a great part of the day in the open air. a nurse maid should never, on any account whatever, be allowed to whip a child. "does ever any man or woman remember the feeling of being 'whipped' as a child, the fierce anger, the insupportable ignominy, the longing for revenge, which blotted out all thought of contrition for the fault or rebellion against the punishment? with this recollection on their own parts, i can hardly suppose any parents venturing to inflict it, much less allowing its infliction by another under any circumstances whatever. a nurse-maid or domestic of any sort, once discovered to have lifted up her hand against a child, ought to meet instant severe rebuke, and on a repetition of the offence instant dismissal." [footnote: _a woman's thoughts about women_.] i have seen in the winter tune a lazy nurse sit before the fire with a child on her lap, rubbing his cold feet just before putting him to his bed. now, this is not the way to warm his feet. the right method is to let him romp and run either about the room, or the landing, or the hall--this will effectually warm them, but, of course, it will entail a little extra trouble on the nurse, as she will have to use a little exertion to induce him to do so, and this extra trouble a lazy nurse will not relish. warming the feet before the fire will give the little fellow chilblains, and will make him when he is in bed more chilly. the only way for him to have a good romp before he goes to bed, is for the mother to join in the game. she may rest assured, that if she does so, her child will not be the only one to benefit by it. she herself will find it of marvellous benefit to her own health; it will warm her own feet, it will be almost sure to insure her a good night, and will make her feel so light and buoyant as almost to fancy that she is a girl again! well, then, let every child, before going to bed, hold a high court of revelry, let him have an hour--the children's hour--devoted to romp, to dance, to shout, to sing, to riot, and to play, and let him be the master of the revels- "between the dark and the daylight, when the night is beginning to lower, comes a pause in the day's occupation, which is known as the children's hour." _longfellow_. let a child be employed--take an interest in his employment, let him fancy that he is useful--_and he is useful_, he is laying in a stock of health. he is much more usefully employed than many other grown-up children are! a child should be happy; he must, in every way, be made happy; everything ought to be done to conduce to his happiness, to give him joy, gladness, and pleasure. happy he should be, as happy as the day is long. kindness should be lavished upon him. make a child understand that you love him; prove it in your actions--these are better than words; look after his little pleasures--join in his little sports; let him never hear a morose word--it would rankle in his breast, take deep root, and in due time bring forth bitter fruit. love! let love be his pole-star; let it be the guide and the rule of all you do and all you say unto him. let your face, as well as your tongue speak love. let your hands be ever ready to minister to his pleasures and to his play. "blessed be the hand that prepares a pleasure for a child, for there is no saying when and where it may again bloom forth. does not almost everybody remember some kind-hearted man who showed him a kindness in the dulcet days of childhood? the writer of this recollects himself, at this moment, a bare-footed lad, standing at the wooden fence of a poor little garden in his native village, while, with longing eyes, he gazed on the flowers which were blooming there quietly in the brightness of the sabbath morning. the possessor came from his little cottage. he was a wood-cutter by trade, and spent the whole week at work in the woods. he had come into the garden to gather flowers to stick in his coat when he went to church. he saw the boy, and breaking off the most beautiful of his carnations (it was streaked with red and white), he gave it to him. neither the giver nor the receiver spoke a word, and with bounding steps the hoy ran home. and now, here, at a vast distance from that home, after so many events of so many years, the feeling of gratitude which agitated the breast of the boy, expressed itself on paper. the carnation has long since faded, but it now bloometh afresh."--_douglas jerrold_. the hearty ringing laugh of a child is sweet music to the ear. there are three most joyous sounds in nature--the hum of a bee, the purr of a cat, and the laugh of a child. they tell of peace, of happiness, and of contentment, and make one for a while forget that there is so much misery in the world. a man who dislikes children is unnatural, he has no "milk of human kindness" in him; he should be shunned. give me, for a friend, a man- "who takes the children on his knee, and winds their curls, about his hand."--_tennyson_. 168. _if a child be peevish, and apparently in good health, have you any plan to propose to allay his irritability_? a child's troubles are soon over--his tears are soon dried; "nothing dries sooner than a tear"--if not prolonged by improper management- "the tear down childhood's check that flows is like the dew-drop on the rose; when next the summer breeze comes by, and waves the bush, the flower is dry."--_scott_. never allow a child to be teased; it spoils his temper. if he be in a cross humour take no notice of it, but divert his attention to some pleasing object. this may be done without spoiling him. do not combat bad temper with bad temper--noise with noise. be firm, be kind, be gentle, [footnote: "but we were gentle among you, even as a women cherisheth her children."--1 thess. ii. 7.] be loving, speak quietly, smile tenderly, and embrace him fondly, but _insist upon implicit obedience_, and you will have, with god's blessing, a happy child- "when a little child is weak from fever passing by, or wearied out with restlessness don't scold him if he cry. tell him some pretty story- don't read it from a book; he likes to watch you while you speak, and take in every look. or sometimes singing gently- a little song may please, with quiet and amusing words, and tune that flows with ease. or if he is impatient, perhaps from time to time a simple hymn may suit the best, in short and easy rhyme. the measured verses flowing in accents clear and mild, may blend into his troubled thought, and soothe the little child. but let the words be simple, and suited to his mind, and loving, that his weary heart a resting-place may find."--_household verses_. speak, _gently_ to a child; speak _gently_ to all; but more especially speak _gently_ to a child. "a gentle voice is an excellent thing in a woman," and is a jewel of great price, and is one of the concomitants of _perfect_ lady. let the hinges of your disposition be well oiled. "'i have a dear friend. he was one of those well-oiled dispositions which turn upon the hinges of the world without creaking.' would to heaven there were more of them! how many there are who never turn upon the hinges of this world without a grinding that sets the teeth of a whole household on edge! and somehow or other it has been the evil fate of many of the best spirits to be so circumstanced; both men and women, to whom life is 'sweet habitude of being,' which has gone far to reconcile them to solitude as far less intolerable! to these especially the creakings of those said rough hinges of the world is one continued torture, for they are all too finely strung; and the oft-recurring grind jars the whole sentient frame, mars the beautiful lyre, and makes cruel discord in a soul of music. how much of sadness there is in such thoughts! seems there not a past in some lives, to which it is impossible ever to become reconciled!"--_life's problems_. pleasant words ought always to be spoken to a child; there must be neither snarling, nor snapping, nor snubbing, nor loud contention towards him. if there be it will ruin his temper and disposition, and will make him hard and harsh, morose and disagreeable. do not always be telling your child how wicked he is; what a naughty boy he is; that god will never love him, and all the rest of such twaddle and blatant inanity! do not, in point of fact, bully him, as many poor little fellows are bullied! it will ruin him if you do; it will make him in after years either a coward or a tyrant. such conversations, like constant droppings of water, will make an impression, and will cause him to feel that it is of no use to try to be good--that he is hopelessly wicked! instead of such language, give him confidence in himself; rather find out his good points and dwell upon them; praise him where and whenever you can; and make him feel that, by perseverance and god's blessing, he will make a good man. speak truthfully to your child; if you once deceive him, he will not believe you for the future. not only so, but if you are truthful yourself you are likely to make him truthful--like begets like. there is something beautiful in truth! a lying child is an abomination! sir walter scott says "that he taught his son to ride, to shoot, and to tell the truth" archdeacon hare asserts "that purity is the feminine, truth the masculine of honour." as soon as a child can speak he should be made to lisp the noble words of truth, and to love it, and to abhor a lie! what a beautiful character he will then make! blessed is the child that can say,- "parental cares watched o'er my growing youth, and early stamped it with the love of truth." _leadbeater papers._ have no favourites, show no partiality; for the young are very jealous, sharp-sighted, and quick-witted, and take a dislike to the petted one. do not rouse the old adam in them. let children be taught to be "kindly affectioned one to another with brotherly love;" let them be encouraged to share each other's toys and playthings, and to banish selfishness. attend to a child's _little_ pleasures. it is the _little_ pleasures of a child that constitute his happiness. great pleasures to him and to us all (as a favourite author remarks) come but seldom, and are the exceptions, and not the rule. let a child he nurtured in love. "it will be seen," says the author of _john halifax_, "that i hold this law of kindness as the alpha and omega of education. i once asked one, in his own house, a father in everything but the name, his authority unquestioned, his least word held in reverence, his smallest wish obeyed--'how did you ever manage to bring up these children?' he said: '_by love_.'" let every word and action prove that you love your children. enter into all their little pursuits and pleasures. join them in their play, and be a "child again!" if they are curious, do not check their curiosity; but rather encourage it; for they have a great deal--as we all have--to learn, and how can they know if they are not taught? you may depend upon it the knowledge they obtain from observation is far superior to that obtained from books. let all you teach them, let all you do, and let all you say bear the stamp of love. "endeavour, from first to last, in your intercourse with your children, to let it bear the impress of _love_. it is not enough that you _feel_ affection towards your children--that you are devoted to their interests; you must show in your manner the fondness of your hearts towards them. young minds cannot appreciate great sacrifices made for them; they judge their parents by the words and deeds of every-day life. they are won by _little_ kindnesses, and alienated by _little_ acts of neglect or impatience. one complaint unnoticed, one appeal unheeded, one lawful request arbitrarily refused, will be remembered by your little ones more than a thousand acts of the most devoted affection."--_the protoplast_. a placid, well-regulated temper is very conducive to health. a disordered, or an over-loaded stomach, is a frequent cause of peevishness. appropriate treatment in such a case will, of course, be necessary. 169. _my child stammers: can you tell me the cause, and can you suggest a remedy_? a child who stammers is generally "nervous," quick, and impulsive. his ideas flow too rapidly for speech. he is "nervous;" hence, when he is alone, and with those he loves, he oftentimes speaks fluently and well; he stammers more both when he is tired and when he is out of health--when the nerves are either weak or exhausted. he is emotional: when he is either in a passion or in excitement, either of joy or of grief, he can scarcely speak--"he stammers all over." he is impulsive: he often stammers in consequence. he is in too great a hurry to bring out his words; they do not flow in proper sequence: hence his words are broken and disjointed. stammering, of course, might be owing either to some organic defect, such as from defective palate, or from defective brain, then nothing will cure him; or it might be owing to "nervous" causes--to "irregular nervous action," then a cure might, with care and perseverance, be usually effected. in all cases of stammering of a child, let both the palate of his mouth and the bridle of his tongue be carefully examined, to see that neither the palate be defective, nor the bridle of the tongue be too short--that he be not tongue-tied. _now, with regard to treatment._--make him speak slowly and deliberately: let him form each word, without clipping or chopping; let him be made, when you are alone with him, to exercise himself in elocution. if he speak quickly, stop him in his mid-career, and make him, quietly and deliberately, go through the sentence again and again, until he has mastered the difficulty; teach him to collect his thoughts, and to weigh each word ere he give it utterance; practise him in singing little hymns and songs for children; this you will find a valuable help in the cure. a stammerer seldom stutters when he sings. when he sings, he has a full knowledge of the words, and is obliged to keep in time--to sing neither too fast nor too slow. besides, he sings in a different key to his speaking voice. many professors for the treatment of stammering cure their patients by practising lessons of a sing-song character. never jeer him for stammering, nor turn him to ridicule; if you do, it will make him ten times worse; but be patient and gentle with him, and endeavour to give him confidence, and encourage him to speak to you as quietly, as gently, and deliberately as you speak to him; tell him not to speak, until he has arranged his thoughts and chosen his words; let him do nothing in a hurry. demosthenes was said, in his youth, to have stammered fearfully, and to have cured himself by his own prescription, namely, by putting a pebble in his mouth, and declaiming, frequently, slowly quietly, and deliberately, on the sea-shore--the fishes alone being his audience,-until at length he cured himself, and charmed the world with his eloquence and with his elocution. he is held up, to this very day, as the personification and as the model of an orator. his patience, perseverance, and practice ought, by all who either are, or are, interested in a stammerer, to be borne in mind and followed. 170. _do you approve of a carpet in a nursery_? no, unless it be a small piece for a child to roll upon. a carpet harbours dirt and dust, which dust is constantly floating about the atmosphere, and thus making it impure for him to breathe. the truth of this may be easily ascertained by entering a darkened room, where a ray of sunshine is struggling through a crevice in the shutters. if the floor of a nursery must be covered, let drugget be laid down, and this may every morning be taken up and shaken. the less furniture a nursery contains the better, for much furniture obstructs the free circulation of the air, and, moreover, prevents a child from taking proper play and exercise in the room--an abundance of which are absolutely necessary for his health. 171. _supposing there is not a fire in the nursery grate, ought the chimney to be stopped to prevent a draught in the room_? certainly not. i consider the use of a chimney to be two-fold--first, to carry off the smoke, and secondly (which is of quite as much importance), to ventilate the room, by carrying off the impure air, loaded as it is with carbonic acid gas--the refuse of respiration. the chimney, therefore, should never, either winter or summer, be allowed for one moment to be stopped. this is important advice, and requires the strict supervision of every mother, as servants will, if they have the chance, stop all chimneys that have no fires in the grates. exercise. 172. _do you approve, during the summer months, of sending a child out before breakfast_? i do, when the weather will permit, and provided the wind be neither in an easterly nor in a north-easterly direction; indeed, _he can scarcely be too much in the open air_. he must not be allowed to stand about draughts or about entries, and the only way to prevent him doing so is for the mother herself to accompany the nurse. she will then kill two birds with one stone, as she will, by doing so, benefit her own as well as her child's health. 173. _ought a child to be early put on his feet to walk_? no: let him learn to walk himself. he ought to be put upon a carpet; and it will be found that when he is strong enough, he will hold by a chair, and will stand alone: when he can do so, and attempts to walk, he should then be supported. you must, on first putting him upon his feet, be guided by his own wishes. he will, as soon as he is strong enough to walk, have the inclination to do so. when he has the inclination and the strength it will be folly to restrain him; if he have neither the inclination nor the strength, it will be absurd to urge him on. rely, therefore, to a certain extent, upon the inclination of the child himself. self-reliance cannot be too early taught him, and, indeed, every one else. in the generality of instances, however, a child is put on his feet too soon, and the bones, at that tender age, being very flexible, bend, causing bowed and bandy-legs; and the knees, being weak, approximate too closely together, and thus they become knock-kneed. this advice of _not_ putting a child _early_ on his feet, i must strongly insist on, as many mothers are so ridiculously ambitious that their young ones should walk early--that they should walk before other children of their acquaintance have attempted--that they have frequently caused the above lamentable deformities; which is a standing reproach to them during the rest of their lives. 174. _do you approve of perambulators_? i do not, for two reasons:--first, because when a child is strong enough, he had better walk as much as he will; and, secondly, the motion is not so good, and the muscles are not so much put into action, and consequently cannot be so well developed, as when he is earned. a perambulator is very apt to make a child stoop, and to make him both crooked and round-shouldered. he is cramped by being so long in one position. it is painful to notice a babe of a few months old in one of these newfangled carriages. his little head is bobbing about first on one side and then on the other--at one moment it is dropping on his chest, the next it is forcibly jolted behind: he looks, and doubtless feels, wretched and uncomfortable. again, these perambulators are dangerous in crowded thoroughfares. they are a public nuisance, inasmuch as they are wheeled against and between people's legs, and are a fruitful source of the breaking of shins, of the spraining of ankles, of the crushing of corns, and of the ruffling of the tempers of the foot-passengers who unfortunately come within their reach; while, in all probability, the gaping nurses are staring another way, and every way indeed but the right, more especially if there be a redcoat in the path! besides, in very cold weather, or in a very young infant, the warmth of the nurse's body, while he is being carried, helps to keep him warm, he himself being naturally cold. in point of fact, the child, while being borne in the nurse's arms, reposes on the nurse, warm and supported, as though he were in a nest! while, on the other hand, if he be in a perambulator, he is cold and unsupported, looking the very picture of misery, seeking everywhere for test and comfort, and finding none! a nurse's arm, then, is the only proper carriage for a _young_ child to take exercise on. she ought to change about, first carrying frim on the one arm, and then on the other. nursing him on one arm only might give his body a twist on one side, and thus might cause deformity. when he is old enough to walk, and is able properly to support the weight of his own neck and back, then there will be no objection, provided it be not in a crowded thoroughfare, to his riding occasionally in a perambulator; but when he is older still, and can sit either a donkey or a pony, such exercise will be far more beneficial, and will afford him much greater pleasure. 175. _supposing it to be wet under foot, but dry above, do you then approve of sending a child out_? if the wind be neither in the east nor the north-east, and if the air be not damp, let him be well wrapped up and be sent out. if he be labouring under an inflammation of the lungs, however slight, or if he be just recovering from one, it would, of coarse, be highly improper. in the management of a child, we must take care neither to coddle nor to expose him unnecessarily, as both are dangerous. never send a child out to walk in a fog; he will, if you do, be almost sure to catch cold. it would be much safer to send him out in rain than in fog, though neither the one nor the other would be desirable. 176. _how many times a day in fine weather ought a child to be sent out_? let him be sent out as often as it be possible. if a child lived more in the open air than he is wont to do, he would neither be so susceptible of disease, nor would he suffer so much from teething, nor from catching cold. 177. _supposing the day to be wet, what exercise would you then recommend_? the child ought to run either about a large room, or about the hall; and if it does not rain violently, you should put on his hat and throw up the window, taking care while the window is open that he does not stand still. a wet day is the day for him to hold his high court of revelry, and "to make him as happy as the day is long." do not on any account allow him to sit any length of time at a table, amusing himself with books, &c.; let him be active and stirring, that his blood may freely circulate as it ought to do, and that his muscles may be well developed. i would rather see him actively engaged in mischief than sitting still, doing nothing! he ought to be put on the carpet, and should then be tumbled and rolled about, to make the blood bound merrily through, the, vessels, to stir up the liver, to promote digestion, and to open the bowels. the misfortune of it is, the present race of nurses are so encumbered with long dresses, and so screwed in with tight stays (aping their betters), that they are not able to stoop properly, and thus to have a good game of romps with their little charges. "doing nothing is doing ill" is as true a saying as was ever spoken. 178. _supposing it to be winter, and the weather to be very cold, would you still send a child out_? decidedly, provided he be well wrapped up. the cold will brace and strengthen him. cold weather is the finest tonic in the world. in frosty weather, the roads being slippery, when you send him out to walk, put a pair of large old woollen stockings over his boots or shoes. this will not only keep his feet and his legs warm, but it will prevent him from falling down and hurting himself. while thus equipped, he may even walk on a slide of ice without falling down! a child, in the winter time, requires, to keep him warm, plenty of flannel and plenty of food, plenty of fresh and genuine milk, and plenty of water in his tub to wash and bathe him in a morning, plenty of exercise and plenty of play, and then he may brave the frosty air. it is the coddled, the half-washed, and the half-starved child (half-washed and half-starved from either the mother's ignorance or from the mother's timidity), that is the chilly starveling,--catching cold at every breath of wind, and every time he either walks or is carried out,--a puny, skinny, scraggy, scare-crow, more dead than alive, and more fit for his grave than for the rough world he will have to struggle in! if the above advice be strictly followed, a child may be sent out in the coldest weather, even- "when icicles hang by the wall, and dick, the shepherd, blows his nail; and tom bears logs into the hall, and milk comes frozen home in pail." _shakspeare_. amusements. 179. _have you any remarks to make on the amusements of a child_? let the amusements of a child be as much as possible out of doors; let him spend the greater part of every day in the open air; let him exert himself as much as he please, his feelings will tell him when to rest and when to begin again; let him be what nature intended mm to be--a happy, laughing, joyous child. do not let him be always poring over books:- "books! 'tis a dull and endless strife, come, hear the woodland linnet! how sweet his music! on my life, there's more of wisdom in it. and hark! how blithe the throstle sings! he, too, is no mean preacher: come forth into the light of things,- let nature be your teacher. she has a world of ready wealth, our minds and hearts to bless,- spontaneous wisdom breathed by health, truth breathed by cheerfulness. one impulse from a vernal wood may teach you more of man, of moral evil and of good, than, all the sagea can."--_wordsworth._ he ought to be encouraged to engage in those sports wherein the greatest number of muscles are brought into play. for instance, to play at ball, or hoop, or football, to play at horses, to run to certain distances and back; and, if a girl, to amuse herself with a skipping rope, such, being excellent exercise- "by sports like these are all their cares beguiled, the sports of children satisfy the child."--_goldsmith._ every child, where it be practicable, should have a small plot of ground to cultivate, that he may dig and delve in, and make dirt-pies if he choose. children now-a-days, unfortunately, are not allowed to soil their hands and their fine clothes. for my own part, i dislike such model children; let a child be natural--let him, as far as is possible, choose his own sports. do not be always interfering with his pursuits, and be finding fault with him. remember, what may be amusing to you may be distasteful to him. i do not, of course, mean but that you should constantly have a watchful eye over him; yet do not let him see that he is under restraint or surveillance; if you do, you will never discover his true character and inclinations. not only so, but do not dim the bright sunshine of his early life by constantly checking and thwarting him, tupper beautifully says- "and check not a child in his merriment,- should not his morning be sunny?" when, therefore, he is either in the nursery or in the play-ground, let him shout and riot and romp about as much as he please. his lungs and his muscles want developing, and his nerves require strengthening; and how can such be accomplished unless you allow them to be developed and strengthened by natural means? the nursery is a child's own domain; it is his castle, and he should be lord paramount therein. if he choose to blow a whistle, or to spring a rattle, or to make any other hideous noise, which to him is sweet music, he should be allowed, without let or hindrance, to do so. if any members of the family have weak nerves, let them keep at a respectful distance. a child who never gets into mischief must be either sly, or delicate, or idiotic; indeed, the system of many persons, in bringing up children, is likely to make them either the one or the other. the present plan of training children is nearly all work (books), and very little play. play, and plenty of it, is necessary to the very existence of a child. a boy not partial to mischief, innocent mischief, and play, is unnatural; he is a man before his time, he is a nuisance, he is disagreeable to himself and to every one around. he is generally a sneak, and a little humbug. girls, at the present time, are made clever simpletons; their brains are worked with useless knowledge, which totally unfits them for every-day duties. their muscles are allowed to be idle, which makes them limp and flabby. the want of proper exercise ruins the complexion, and their faces become of the colour of a tallow candle! and precious wives and mothers they make when they do grow up! grow up, did i say? they grow all manner of ways, and are as crooked as crooked sticks! what an unnatural thing it is to confine a child several hours a day to his lessons; why, you might as well put a colt in harness, and make him work for his living! a child is made for play; his roguish little eye, his lithe figure, his antics, and his drollery, all point out that he is cut out for play--that it is as necessary to his existence as the food he eats, and as the air he breathes! a child ought not to be allowed to have playthings with which he can injure either himself or others, such as toy-swords, toy-cannons, toy-paint-boxes, knives, bows and arrows, hammers, chisels, saws, &c. he will not only be likely to injure himself and others, but will make sad havoc on furniture, house, and other property. fun, frolic, and play ought, in all innocent ways, to be encouraged; but wilful mischief and dangerous games ought, by every means, to be discountenanced. this advice is frequently much needed, as children prefer to have and delight in dangerous toys, and often coax and persuade weak and indulgent mothers to gratify their wishes. _painted_ toys are, many of them, highly dangerous, those painted _green_ especially, as the colour generally consists of scheele's green--arsenite of copper. children's paint-boxes are very dangerous toys for a child to play with; many of the paints are poisonous, containing arsenic, lead, gamboge, &c, and a child, when painting, is apt to put the brush into his mouth, to absorb the superabundant fluid. of all the colours, the _green_ paint is the most dangerous, as it is frequently composed of arsenite of copper--arsenic and copper--two deadly poisons. there are some paint-boxes warranted not to contain a particle of poison of any kind these ought, for a child, to be chosen by a mother. but, remember, although he ought not to be allowed to have poison paint-boxes and poison painted toys, _he must have an abundance of toys,_ such as the white wood toys--brewers' drays, millers' waggons, boxes of wooden bricks, &c. the noah's ark is one of the most amusing and instructive toys for a child. "those fashioned out of brown, unpainted pine-wood by the clever carvers of nuremberg or the black forest are the best, i think, not only because they are the most spirited, but because they will survive a good deal of knocking about and can be sucked with impunity from the first dawn of recollection, children are thus familiarised with the forms of natural objects, and may be well up in natural history before they have mastered the abc" [footnote: from an excellent article _about toys,_ by j hamilton fyfe in _good words_ for december 1862.] parents often make sunday a day of gloom; to this i much object. of all the days in the week, sunday should be the most cheerful and pleasant. it is considered by our church a festival, and a glorious festival it ought to be made, and one on which our heavenly father wishes to see all his children happy and full of innocent joy. let sunday, then, be made a cheerful, joyous, innocently happy day, and not, as it frequently is, the most miserable and dismal in the week. it is my firm conviction that many men have been made irreligious by the ridiculously strict and dismal way they were compelled, as children, to spend their sundays. you can no more make a child religious by gloomy asceticism, than yon can make people good by act of parliament. one of the great follies of the present age is, children's parties, where they are allowed to be dressed up like grown-up women, stuck out in petticoats, and encouraged to eat rich cake and pastry, and to drink wine, and to sit up late at night! there is something disgusting and demoralising in all this. their pure minds are blighted by it. do not let me be misunderstood: there is not the least objection, but, on the contrary, great advantage, for friends' children to meet friends' children; but then let them be treated as children, and not as men and women! 180. _do you approve of public play-grounds for children_? it would be well, in every village, and in the outskirts of every town, if a large plot of ground were set apart for children to play in, and to go through regular gymnastic exercises. play is absolutely necessary to a child's very existence, as much as food and sleep; but in many parts of england where is he to have it? playgrounds and play are the best schools we have; they teach a great deal not taught elsewhere; they give lessons in health, which is the grandest wealth that can be bestowed--"for health is wealth;" they prepare the soil for the future schoolmaster; they clear the brain, and thus the intellect, they strengthen the muscles; they make the blood course merrily through the arteries; they bestow healthy food for the lungs; they give an appetite; they make a child, in due time, become every inch a man! play-grounds and play are one of the finest institutions we possess. what would our large public schools be without their play and cricket grounds? they would be shorn of half their splendour and their usefulness! there is so much talk now-a-days about _useful_ knowledge, that the importance of play and play-grounds is likely to be forgotten. i cannot help thinking however, that a better state of things is dawning. "it seems to be found out that in our zeal for useful knowledge, that knowledge is found to be not the least useful which treat boys as active, stirring, aspiring, and ready." [footnote: _the saturday review_, december 13, 1862.] 181. _do you approve of infant schools_? i do, if the arrangements be such that health is preferred before learning. [footnote: "according to aristotle, more care should be taken of the body than of the mind for the first seven years; strict attention to diet be enforced, &c. . . . . . the eye and ear of the child should be most watchfully and severely guarded against contamination of every kind, and unrestrained communication with servants be strictly prevented. even his amusements should be under due regulation, and rendered as interesting and intellectual as possible."--the rev john williams, in his _life and actions of alexander the great_] let children be only confined for three or four hours a day, and let what little they learn be taught as an amusement rather than as a labour. a play-ground ought to be attached to an infant school; where, in fine weather, for every half-hour they spend in-doors, they should spend one in the open air; and, in wet weather, they ought to have, in lieu of the play-ground, a large room to romp, and shout, and riot in. to develop the different organs, muscles, and other parts of the body, children require fresh air, a free use of their lungs, active exercise, and their bodies to be thrown into all manner of attitudes. let a child mope in a corner, and he will become stupid and sickly. the march of intellect, as it is called, or rather the double quick march of intellect, as it should be called, has stolen a march upon health. only allow the march of intellect and the march of health to take equal strides, and then we shall have "_mens sana in corpore sano_" (a sound mind in a sound body). in the education of a young child, it is better to instruct him by illustration, by pictures, and by encouraging observation on things around and about him, than by books. it is surprising how much, without endangering his health, may be taught in this way. in educating your child, be careful to instil and to form good habits--they will then stick to him for life. children at the present day are too highly educated--their brains are over-taxed, and thus weakened. the consequence is, that as they grow up to manhood, if they grow up at all, they become fools! _children_ are now taught what formerly _youths_ were taught. the chord of a child's life is ofttimes snapped asunder in consequence of over education:- "screw not the cord too sharply, lest it snap"--_tennyson_. you should treat a child as you would a young colt. think only at first of strengthening his body. let him have a perfectly free, happy life, plenty of food to eat, abundance of air to breathe, and no work to do; there is plenty of time to think of his learning--of giving him brain work. it will come sadly too soon; but do not make him old before his time. 182. _at what age do you advise my child to begin his course of education--to have his regular lessons_? in the name of the prophet,--figs! fiddlesticks! about courses of education and regular lessons for a child! you may as well ask me when he, a child, is to begin hebrew, the sanscrit, and mathematics! let him have a course of education in play; let him go through regular lessons in foot-ball, bandy, playing at tic, hares and hounds, and such like excellent and really useful and health-giving lessons. begin his lessons! begin brain work, and make an idiot of him! oh! for shame, ye mothers! you who pretend to love your children so much, and to tax, otherwise to injure, irreparably to injure their brains, and thus their intellects and their health, and to shorten their very days. and all for what? to make prodigies of them! forsooth! to make fools of them in the end, 183. _well, then, as you have such a great objection to a child commencing his education early in life, at what age may he, with safety, commence his lessons? and which do you prefer--home or school education_? home is far preferable to a school education. he is, if at home, under your own _immediate_ observation, and is not liable to be contaminated by naughty children; for, in every school, there is necessarily a great mixture of the good and of the bad; and a child, unfortunately, is more likely to be led by the bad than by the good. moreover, if he be educated at home, the mother can see that his brain is not over-worked. at school the brain is apt to be over-worked, and the stomach and the muscles to be under-worked. remember, as above stated, _the brain must have but very little work until the child be seven years old;_ impress this advice upon your memory, and let no foolish ambition to make your child a clever child allow you, for one moment, to swerve from this advice. build up a strong, healthy body, and in due time the brain will bear a _moderate_ amount of intellectual labour. as i have given _you_ so much advice, permit me, for one moment, to address a word to the father of your child:-let me advise you, then, mr. _pater familias_, to be careful how you converse, what language you use, while in the company of your child. bear in mind, a child is very observant, and thinks much, weighs well, and seldom forgets all you say and all you do! let no hasty word, then, and more especially no oath, or no impious language, ever pass your lips, if your child be within hearing. it is, of course, at all times wicked to swear; but it is heinously and unpardonably sinful to swear in the presence of your child! "childhood is like a mirror, catching and reflecting images. one impious or profane thought, uttered by a parent's lip, may operate upon the young heart like a careless spray of water thrown upon polished steel, staining it with rust, which no after scouring can efface." never talk secrete before a child--"little pitchers have long ears;" if you do, and he disclose your secrets--as most likely he will--and thus make mischief, it will be cruel to scold him; you will, for your imprudence, have yourself only to blame. be most careful, then, in the presence of your child, of what you say, and of whom you speak. this advice, if followed, might save a great deal of annoyance and vexation. 184. _are you an advocate for a child being taught singing?_ i am: i consider singing a part of his education. singing expands the walls of his chest, strengthens and invigorates his lungs, gives sweetness to his voice, improves his pronunciation, and is a great pleasure and amusement to him. sleep. 185. _do you approve of a child sleeping on a_ feather _bed_? a _feather_ bed enervates his body, and, if he be so predisposed, causes rickets, and makes him crooked. a horse-hair mattress is the best for a child to lie on. the pillow, too, should be made of horse-hair. a _feather_ pillow often causes the bead to be bathed in perspiration, thus enervating the child, and making him liable to catch cold. if he be at all rickety, if he be weak in the neck, if he be inclined to stoop, or if he be at all crooked, let him, by all means, lie without a pillow. 186. _do you recommend a child, in the middle of the day, to be put to sleep_? let him be put on his mattress _awake_, that he may sleep for a couple of hours before dinner, then he will rise both refreshed and strengthened for the remainder of the day. i said, let him be put down _awake_. he might, for the first few times, cry, but, by perseverance, he will without any difficulty fall to sleep. the practice of sleeping before dinner ought to be continued until he be three years old, and, if he can be prevailed upon, even longer. for if he do not have sleep in the middle of the day, he will all the afternoon and the evening be cross; and when he does go to bed, he will probably be too tired to sleep, or his nerves having been exhausted by the long wakefulness, he will fall into a troubled, broken slumber, and not into that sweet, soft, gentle repose, so characteristic of healthy, happy childhood! 187. _at what hour ought a child to be put to bed in the evening_? at six in the winter, and at seven o'clock in the summer. _regularity_ ought to be observed, _as regularity is very conducive to health._ it is a reprehensible practice to keep a child up until nine or ten o'clock at night. if this be done, he will, before his time, become old, and the seeds of disease will be sown, as soon as he can run, let him be encouraged, for half an hour before he goes to bed, to race either about the hall, or the landing, or a large room, which will be the best means of warming his feet, of preventing chilblains, and of making him sleep soundly. 188. _have you any directions to give me at to the placing of my child in his bed_? if a child lie alone, place him fairly on his aide in the middle of the bed; if it be winter time, see that his arms and hands be covered with the bed-clothes; if it be summer, his hands might be allowed to be outside the clothes. in putting him down to sleep, you should ascertain that his face be not covered with the bedclothes; if it be, he will he poisoned with his own breath--the breath constantly giving off carbonic acid gas; which gas must, if his face be smothered in the clothes; be breathed--carbonic acid gas being highly poisonous. you can readily prove the existence of carbonic and gas in the breathing, by simply breathing into a little lime-water; after breathing for a few seconds into it, a white film will form on the top; the carbonic acid gas from the breath unites with the lime of the lime-water and the product of the white film is carbonate of lime. 189. _do you advise a bedroom to be darkened at night_? certainly: a child sleeps sounder and sweeter in a dark than in a light room. there is nothing better for the purpose of darkening a bedroom, than venetian blinds. remember, then, a well-ventilated, but a darkened, chamber at night. the cot or the crib ought _not_ to face the window, "as the light is best behind." [footnote: sir charles locock in a letter to the author. ] 190. _which is the beat position for a child when sleeping--on his back, or on his side_? his side: he ought to be accustomed to change about on the right side one night, on the left another; and occasionally, for a change, he should lie on his back. by adopting this plan, you will not only improve his figure, but likewise his health. lying, night after night, in one position, would be likely to make him crooked. 191. _do you advise, in the winter time, that there should be a fire in the night nursery_? certainly not, unless the weather be intensely cold. i dislike fires in bedrooms, especially for children; they are very enervating, and make a child liable to catch cold. cold weather is very bracing, particularly at night "generally speaking," says the _siecle_, "during winter, apartments are too much heated. the temperature in them ought not to exceed 16 deg. centigrade (59 deg. fahrenheit); and even in periods of great cold scientific men declare that 12 deg. or 14 deg. had better not be exceeded. in the wards of hospitals, and in the chambers of the sick, care is taken not to have greater heat than 15 deg.. clerks in offices, and other persons of sedentary occupations, when rooms in which they sit are too much heated, are liable to cerebral [brain] congestion and to pulmonary [lung] complaints. in bedrooms, and particularly those of children, the temperature ought to be maintained rather low; it is even prudent only rarely to make fires in them, especially during the night" if "a cold stable make a healthy horse," i am quite sure that a moderately cold and well-ventilated bedroom helps to make a healthy child. but, still, in the winter time, if the weather be biting cold, a _little_ fire in the bedroom grate is desirable. in bringing up children, we must never run into extremes--the coddling system and the hardening system are both to be deprecated; the coddling system will make the strong child weakly, while the hardening system will probably kill a delicate one. a child's bed ought, of course, to be comfortably clothed with blankets--i say blankets, as they are much superior to coverlids; the perspiration will more readily pass through a blanket than a coverlid. a _thick_ coverlid ought never to be used; there is nothing better, for a child's bed, than the old-fashioned patchwork coverlid, as the perspiration will easily escape through it. 192. _should a child be washed and dressed_ as soon as he awake _in the morning_? he ought, if he awake in anything like reasonable time; for if he doze after he be once awake, such slumber does him more harm than good. he should be up every morning as soon as it is light if, as a child, he be taught to rise early, it will make him an early riser for life, and will tend greatly to prolong both his existence and his happiness. _never awake a child from his sleep_ to dress him, to give him medicine, or for any other purpose; _let him always sleep as long as he can;_ but the moment he awakes let him be held out, and then let him be washed and dressed, and do not wait, as many a silly nurse does, until he have wet his bed, until his blood be chilled, and until he be cross, miserable, and uncomfortable! how many babes are made ill by such foolish practices! the moment he leaves his bed, turn back to the fullest extent the clothes, in order that they may be thoroughly ventilated and sweetened. they ought to be exposed to the air for at least an hour before the bed be made. as soon as he leaves his room, be it winter or summer, throw open the windows. 193. _ought a child to lie alone_? he should, after he is weaned. he will rest more comfortably, and his sleep will be more refreshing. 194. _supposing a child should not sleep well, what ought to be done? would you give him a dose of composing medicine_? certainly not. try the effects of exercise. exercise in the open air is the best composing medicine in the world. let the little fellow be well tired out, and there will be little fear of his not sleeping. 195. _have you any further observations to make on the subject of sleep_? send a child joyful to bed. do not, if you can possibly help it, let him go to bed crying. let the last impressions he has at night be of his happy home, and of his loving father and mother and let his last thoughts be those of joy and gladness. he will sleep all the sounder if he be sent to bed in such a frame of mind, and he will be more refreshed and nourished in the morning by his sleep. 196. _what are the usual causes of a child walking in his sleep, and what measures during such times, ought to be adopted to prevent his injuring himself_? a disordered stomach, in a child of nervous temperament, or worms, are usually the causes. the means to be adopted to prevent his throwing himself out of the window, are to have bars to his chamber present, and if that be not practicable, to have either nails or screws driven into the window sash to allow the window to open only for a sufficient space for ventilation, and to have a screw window fastening, in order that he cannot, without difficulty, open the window, to have a trusty person to sleep in his room, who should have directions given not to rouse him from his sleep, but to gently lead him back to his bed, which may frequently be done without awaking him, and to consult a medical man, who will adopt means to destroy the worms, to put his stomach into order, to brace his nerves, and to strengthen his general system. a trip to the coast and sea bathing, in such a case, is often of great service. second dentition. 197. _when does a child commence to cut his second set of teeth_? generally at seven years old. he _begins to cut_ them at about that time: but it should be borne in mind (so wonderful are the works of god) that the _second_ crop of teeth, _in embryo_, is actually bred and formed from the very commencement of his life, _under_ the first tier of teeth, but which remain in abeyance for years, and do not come into play until the _first_ teeth, having done their duty, loosen and fall out, and thus make room for the more numerous, larger, stronger, and more permanent teeth, which latter have to last for the remainder of his existence. the _first_ set is sometimes cut with a great deal of difficulty, and produces various diseases; the _second_, or permanent teeth, come easily, and are unaccompanied with any disorder. the following is the process:--one after another of the _first_ set gradually loosen, and either drop out, or with little pain are readily pulled out; under these, the _second_--the permanent--teeth make their appearance, and fill up the vacant spaces. the fang of the tooth that has dropped out is nearly all absorbed or eaten away, leaving little more than the crown. the _first_ set consists of twenty; the _second_ (including the wise-teeth, which are not, generally cut until after the the age of twenty-seven) consists of thirty-two. i would recommend you to pay particular attention to the teeth of your children; for, besides their being ornamental, their regularity and soundness are of great importance to the present as well as to the future health of your offspring. if there be any irregularity in the appearance of the _second_ set, lose no time in consulting an experienced and respectable dentist. on disease, etc. 198. _do you think it important that i should be made acquainted with the symptoms of the serious diseases of children_? certainly i am not advocating the doctrine of a mother _treating serious_ diseases; far from it, it is not her province, except in certain cases of extreme urgency, where a medical man cannot be procured, and where delay might be death; but i do insist upon the necessity of her knowing the _symptoms_ of disease. my belief is, that if parents were better informed on such subjects, many children's lives might be saved, much suffering averted, and sorrow spared. the fact is, the knowledge of the symptoms of disease is, to a mother, almost a sealed book. if she were better acquainted with these matters, how much more useful would she be in a sick-room, and how much more readily would she enter into the plans and views of the medical man! by her knowledge of the symptoms, and by having his advice in time, she would nip disease in the bud, and the fight might end in favour of life, for "sickness is just a fight between life and death."--_geo. m'donald._ it is really lamentable to contemplate the amount of ignorance that still exists among mothers in all that appertains to the diseases of children; although, fortunately, they are beginning to see and to feel the importance of gaining instruction on such subjects; but the light is only dawning. a writer of the _medical times and gazette_ makes the following remarks, which somewhat bear on the subject in question. he observes--"in spite of the knowledge and clear views possessed by the profession on all that concerns the management of children, no fact is more palpable than that the most grievous ignorance and incompetency prevail respecting it among the public. we want some means of making popular the knowledge which is now almost restricted to medical men, or, at most, to the well-educated classes." in the earlier editions of this work i did not give the _treatment_ of any serious diseases, however urgent. in the eight last editions, i have been induced, for reasons i will presently state, to give the _treatment_ of some of the more urgent _serious_ diseases, when a medical man cannot instantly be procured, and where delay might be death. sir charles locock, who has taken a kind interest in this little work, has given me valid reasons why a mother should be so enlightened. the following extracts are from a letter which i received from sir charles on the subject, and which he has courteously allowed me to publish. he says,--"as an old physician of some experience in complaints of infants and children, i may perhaps be allowed to suggest that in a future edition you should add a few words on the actual treatment of some of the more urgent infantile diseases. it is very right to caution parents against superseding the doctor, and attempting to manage serious illness themselves, but your advice, with very small exceptions, always being 'to lose no tune in sending for a medical man,' much valuable and often irremediable time may be lost _when a medical man is not to be had_. take, for instance, a case of croup there are no directions given at all, except to send for a medical man, and always to keep medicines in the house which he may have directed. but how can this apply to a first attack? you state that a first attack is generally the worst. but why is it so? simply because it often occurs when the parents do not recognise it, and it is allowed to get a worse point than in subsequent attacks, when they are thoroughly alive to it. as the very best remedy, and often the only essential one, if given early, is a full emetic, surely it is better that you should give some directions as to this in a future edition, and i can speak from my own experience when i say that an emetic, _given in time_, and repeated to free vomiting, will cut short _any_ case of croup. in nine cases out of ten the attack takes place in the evening or early night, and when vomiting is effected the dinner of that day is brought up nearly undigested, and the seventy of the symptoms at once cut short. whenever any remedy is valuable, the more by its being administered _in time_, it is surely wiser to give directions as to its use, although, as a general rule, it is much better to advise the sending for medical advice." the above reasons, coming from such a learned and experienced physician as sir charles locock, are conclusive, and have decided me to comply with his advice, to enlighten a mother on the _treatment_ of some of the more urgent diseases of infants and of children. in a subsequent letter addressed to myself, sir charles has given me the names of those _urgent_ diseases, which he considers may be treated by a mother "where a medical man cannot be procured quickly, or not at all." they are croup: inflammation of the lungs; diptheria; dysentry; diarrhoea; hooping cough, in its various stages; and shivering fit. sir charles sums up his letter to me by saying, "such a book ought to be made as complete as possible, and the objections to medical treatment being so explained as to induce mothers to try to avoid medical men is not so serious as that of leaving them without any guide in those instances where every delay is dangerous, and yet where medical assistance is not to be obtained or not to be had quickly." in addition to the above i shall give you the _treatment_ of bronchitis, measles, and scarlet fever. bronchitis is one of the most common diseases incidental to childhood, and, with judicious treatment, is, in the absence of the medical man, readily managed by a sensible mother. measles is very submissive to treatment. scarlet fever, _if it be not malignant_, and, _if it be not complicated with diphtheric-croup_, and if certain rules be strictly followed, is also equally amenable to treatment. i have been fortunate in treating scarlet fever, and i therefore think it desirable to enter fully into the _treatment_ of a disease which is looked upon by many parents, and, according to the usual mode of treatment, with just cause, with great consternation and dread. by giving my plan of treatment, fully and simply, and without the slightest reservation, i am fully persuaded, through god's blessing, that i may be the humble means of saving the lives of numbers of children. the diseases that might be treated by a mother, in the absence of a medical man, will form the subject of future conversations. i think it right to promise that in all the prescriptions for a child i have for the use of a mother given, i have endeavoured to make them as simple as possible, and have, whenever practicable, avoided to recommend powerful drugs. complicated prescriptions and powerful medicines might, as a rule, to be seldom given; and when they are, should only be administered by a judicious medical man: a child requiring much more care and gentleness in his treatment than an adult: indeed, i often think it would be better to leave a child to nature rather than to give him powerful and large doses of medicines. a remedy--calomel, for instance--has frequently done more mischief than the disease itself; and the misfortune of it is, the mischief from that drug has oftentimes been permanent, while the complaint might, if left alone, have only been temporary. 199. _at what age does water in the brain usually occur, and how is a mother to know that her child is about to labour under that disease_? water on the brain is, as a rule, a disease of childhood: after a child is seven years old it is comparatively rare. it more frequently attacks delicate children--children who have been dry nursed (especially if they have been improperly fed), or who have been suckled too long, or who have had consumptive mothers, or who have suffered severely from toothing, or who are naturally of a feeble constitution. water on the brain sometimes follows an attack of inflammation of the lungs, more especially if depressing measures (such as excessive leeching and the administration of emetic tartar) have been adopted. it occasionally follows in the train of contagious eruptive diseases, such as either small-pox or scarlatina. we may divide the symptoms of water on the brain into two stages. the first--the premonitory stage--which lasts for or five days, in which medical aid might be of great avail: the second--the stage of drowsiness and of coma--which usually ends in death. i shall dwell on the first--the premonitory stage--in order that a mother may see the importance without loss of time of calling in a medical man:-if her child be feverish and irritable, if his stomach be disordered, if he have urgent vomitings, if he have a foul breath, if his appetite be capricious and bad, if his nights be disturbed (screaming out in his sleep), if his bowels be disordered, more especially if they be constipated, if he be more than usually excited, if his eye gleam with unusual brilliancy, if his tongue run faster than it is wont, if his cheek be flushed and his head be hot, and if he be constantly putting his hand to his head; there is cause for suspicion. if to these symptoms be added, a more than usual carelessness in tumbling about, in hitching his foot in the carpet, or in dragging one foot after the other; if, too, he has complained of darting, shooting, lancinating pains in his head, it may then be known that the _first_ stage of inflammation (the forerunner of water on the brain) either has taken, or is about taking place. remember no time ought to be lost in obtaining medical aid; for the _commencement_ of the disease is the golden opportunity, when life might probably be saved. 200. _at what age, and in what neighbourhood, is a child most liable to croup, and when is a mother to know that it is about to take place_? it is unusual for a child until he be twelve months old to have croup: but, from that time until the age of two years, he is more liable to it than at any other period. the liability after two years, gradually, until he be ten years old, lessens, after which time it is rare. a child is more liable to croup in a low and damp, than in a high and dry neighbourhood; indeed, in some situations, croup is almost an unknown disease; while in others it is only too well understood. croup is more likely to prevail when the wind is either easterly or north-easterly. there is no disease that requires more prompt treatment than croup, and none that creeps on more insidiously. the child at first seems to be labouring under a slight cold, and is troubled with a little _dry_ cough, he is hot and fretful, and hoarse when he cries. hoarseness is one of the earliest symptoms of croup, and it should be borne in mind that a young child, unless he be going to have croup, is seldom hoarse, if, therefore, your child be hoarse, he should be carefully watched, in order that, as soon as croup be detected, not a moment be lost in applying the proper remedies. his voice at length becomes gruff, he breathes as though it were through muslin, and the cough becomes crowing. these three symptoms prove that the disease is now fully formed. these latter symptoms sometimes come on without any previous warning, the little fellow going to bed apparently quite well, until the mother is awakened, perplexed and frightened, in the middle of the night, by finding him labouring under the characteristic cough and the other symptoms of croup. if she delay either to send for assistance, _or if proper medicines be not instantly given_, in a few hours it will probably be of no avail, and in a day or two the little sufferer will be a corpse. when once a child has had croup the after attacks are generally milder. if he has once had an attack of croup, i should advise you always to have in the house medicine--a 4 oz. bottle of ipecacuanha wine, to fly to at a moments notice, [footnote: in case of a sudden attack of croup, _instantly_ give a teaspoonful of ipecacuanha wine, and repeat it every fire minutes natal free vomiting be excited.] but never omit, where practicable, in a case of croup, whether the case be severe or mild to send _immediately_ for medical aid. there is no disease in which time is more precious than in croup, and where the delay of an hour may decide either for life or for death. 201. _but suppose a medical man is not immediately to be procured, what then am i to do? more especially, as you say, that delay might be death_? _what to do_.--i never, in my life, lost a child with croup with catarrhal croup where i was called in at the _commencement_ of the disease, and where my plans were carried out to the very letter. let me begin by saying, look well to the goodness and purity of the medicine, for the life of your child may depend upon the medicine being genuine. what medicine! _ipecacuanha wine!_ at the earliest dawn of the disease give a few spoonful of ipecacuanha wine every five minutes, until free vomiting be exerted. in croup, then, before he be safe, free vomiting _must_ be established, and that without loss of time. if, _after_ the expiration of an hour, the ipecacuanha wine (having given during that hour one or two tea-spoonfuls of it every five minutes) be not sufficiently powerful for the purpose--although it generally is so--(_if the ipecacuanha wine be good_)--then let the following mixture be substituted- take of--powdered ipecacuanha, one scruple, wine of ipecacuanha, one ounce and a half make a mixture. one or two tea spoonfuls to be given every five minutes, until free vomiting be excited, first well shaking the bottle. after the vomiting, place the child for a quarter of an hour in a warm bath. [footnote: see "warm baths"--directions and precautions to be observed.] when out of the bath give him small doses of ipecacuanha wine every two or three hours. the following is a palatable form for the mixture- take of--wine of ipecacuanha, three drachms; simple syrup, three drachms, water, six drachms make a mixture. a tea-spoonful to be taken every two or three hours. but remember the emetic which is given at _first_ is _pure ipecacuanha wine, without a drop of either water or of syrup._ a large sponge dipped out of very hot water, and applied to the throat, and frequently renewed, oftentimes affords great relief in croup, and ought during the time the emetic is being administered in all cases to be adopted. if it be a _severe_ case of croup, and does not in the course of two hours yield to the free exhibition of the ipecacuanha emetic, apply a narrow strip of _smith's tela vesicularia_ to the throat, prepared in the same way as for a case of inflammation of the lungs (see the conversation on the _treatment_ of inflammation of the lungs). with this only difference, let it be a narrower strip, only one-half the width there recommended, and apply it to the throat instead of to the chest. if a child has a very short, fat neck, there may not be room for the _tela_, then you ought to apply it to the _upper_ part of the chest--just under the collar-bones. let it be understood, the the _tela vesicularia_ is not a severe remedy, that the _tela_ produces very little pain--not nearly so much as the application of leeches; although, in its action, it is much more beneficial, and is not nearly so weakening to the system. keep the child from all stimulants; let him live on a low diet, such as milk and water, toast and water, arrowroot, &c.; and let the room be, if practicable, at a temperate heat--60 deg. fahrenheit, and be well ventilated. so you see that the _treatment_ of croup is very simple, and the the plan might be carried out by an intelligent mother. notwithstanding which, it is your duty, where practicable, to send, at the very _onset_ of the disease, for a medical man. let me again reiterate that, if your child is to be saved, the _ipecacuanha wine must be genuine and good_. this can only be effected by having the medicine from a highly respectable chemist. again, if ever your child has had croup, let me again urge you _always_ to have in the house a 4 oz. bottle of ipecacuanha wine, that you may resort to at a moment's notice, in case there be the slightest return of the disease. ipecacuanha wine, unfortunately, is not a medicine that keeps well, therefore, every three or four months a fresh bottle ought to be procured, either from a medical man or from a chemist. as long as the ipecacuanha wine remains _clear_, it is good; but as soon as it becomes _turbid_, it is bad, and ought to be replaced by a fresh supply. an intelligent correspondent of mine makes the following valuable remarks on the preservation of ipecacuanha wine:--"now, i know that there are some medicines and chemical preparations which, though they spoil rapidly when at all exposed to the air, yet will keep perfectly good for an indefinite time if hermetically sealed up in a _perfectly full_ bottle. if so, would it not be a valuable suggestion if the apothecaries' hall, or some other london firm of _undoubted_ reliability, would put up 1 oz. phials of ipecacuanha wine of guaranteed purity, sealed up so as to keep good so long as unopened, and sent out in sealed packages, with the guarantee of their name. by their keeping a few such ounce bottles in an unopened state in one's house, one might rely in being ready for any emergency. if you think this suggestion worth notice, and could induce some first-rate house to carry it out, and mention the fact in a subsequent edition of your book, you would, i think, be adding another most valuable item to an already invaluable book." the above suggestion of preserving ipecacuanha wine in ounce bottles, quite full, and hermetically sealed, is a very good one. the best way of hermetically sealing the bottle would be, to cut the cork level with the lip of the bottle, and to cover the cork with sealing-wax, in the same manner wine merchants serve some kinds of their wines, and then to lay the bottles on their sides in sawdust in the cellar. i have no doubt, if such a plan were adopted, the ipecacuanha wine would for a length of time keep good. of course, if the wine of ipecacuanha be procured from the apothecaries' hall company, london (as suggested by my correspondent), there can be no question as to the genuineness of the article. _what not to do_--do not give emetic tartar, do not apply leeches, do not keep the room very warm, do not give stimulants, do not omit to have always in the house either a 4 oz. bottle, or three or four 1 oz. bottles, of ipecacuanha wine. 202. _i have heard child crowing mentioned as a formidable disease, would you describe the symptoms_? child-crowing, or spasm of the glottis, or _spurious croup_, as it is sometimes called, is occasionally mistaken for _genuine croup_. it is a more frequent disorder than the latter, and requires a different plan of treatment child crowing is a disease that invariably occurs only during dentition, and is _most perilous_, indeed, painful dentition is _the_ cause--_the_ only cause--of child crowing. but, if a child labouring under it can fortunately escape suffocation until he have cut the whole of his first set of teeth--twenty--he is then safe. child-crowing comes on in paroxysms. the breathing during the intervals is quite natural--indeed, the child appears perfectly well, hence, the dangerous nature of the disease is either overlooked, or is lightly thought of, until perhaps a paroxysm worse than common takes place, and the little patient dies of suffocation, overwhelming the mother with terror, with confusion, and dismay. the _symptoms_ in a paroxysm of child-crowing are as follows--the child suddenly loses and fights for his breath, and in doing so, makes a noise very much like that of crowing, hence the name child-crowing. the face during the paroxysm becomes bluish or livid. in a favourable case, after either a few seconds, or even, in some instances, a minute, and a frightful straggle to breathe, he regains his breath, and is, until another paroxysm occurs, perfectly well. in an unfavourable case, the upper part (chink) of the windpipe--the glottis--remains for a minute or two closed, and the child, not being able to breathe, drops a corpse in his nurse's arms! many children, who are said, to have died of fits, hare really died of child-crowing. child-crowing is very apt to cause convulsions, which complication, of course, adds very much to the danger. such a complication requires the constant supervision of an experienced and skilful medical man. i have entered thus rather fully into the subject, as nearly every life might be saved, if a mother knew the nature and the treatment of the complaint, and of the _great necessity during the paroxysm of prompt and proper measures_. for, too frequently, before a medical man has had time to arrive, the child has breathed his last, the parent himself being perfectly ignorant of the necessary treatment; hence the vital importance of the subject, and the paramount necessity of imparting such information, in a _popular_ style, in conversations of this kind. 203. _what treatment, then, during a paroxysm of child-crowing should you advise_? the first thing, of course, to be done, is to send _immediately_ for a medical man. have a plentiful supply of cold and of hot water always at hand, ready at a moment's notice for use. the instant the paroxysm is upon the child, plentifully and perseveringly dash _cold_ water upon his head and face. put his foot and legs in _hot_ salt, mustard, and water; and, if necessary, place him up to his neck in a hot bath, still dashing water upon his face and head. if he does not quickly come round, sharply smack his back and buttocks. in every severe paroxysm of child-crowing, put your fore-finger down the throat of the child, and pull his tongue forward. this plan of pulling the tongue forward opens the epiglottis (the lid of the glottis), and thus admits air (which is so sorely needed) into the glottis and into the lungs, and thus staves off impending suffocation. if this plan were generally known and adopted, many precious lives might be saved. [footnote: an intelligent correspondent first drew my attention to the efficacy of pulling forward the tongue in every severe paroxysm of child-crowing.] there is nothing more frightfully agonising to a mother's feelings than to see her child strangled,--as it were,--before her eyes, by a paroxysm of child crowing. as soon as a medical man arrives, he will lose no time in thoroughly lancing the gums, and in applying other appropriate remedies. great care and attention ought, during the intervals, to be paid to his diet. if the child be breathing a smoky, close atmosphere, he should be immediately removed to a pure one. in this disease, indeed, there is no remedy equal to a change of air--to a dry, bracing neighbourhood. change of air, even if it be winter, is the best remedy, either to the coast or to a healthy mountainous district. i am indebted to mr roberton of manchester (who has paid great attention to this disease, and who has written a valuable essay on the subject [footnote: see the end of the volume of "physiology and diseases of women," &c. churchill, 1851.]) for the knowledge of this fact. where, in a case of this kind, it is not practicable to send a child _from_ home, then let him be sent out of doors the greater part of every day; let him, in point of fact, almost live in the open air. i am quite sure, from an extensive experience, that in this disease, fresh air, and plenty of it, is the best and principal remedy. cold sponging of the body too is useful. mr roberton, who, at my request, has kindly given me the benefit of his extensive experience in child-crowing, considers that there is no remedy, in this complaint, equal to fresh air--to dry cold winds--that the little patient ought, in fact, nearly to live, during the day, out of doors, whether the wind be in the east or in the north-east, whether it be biting cold or otherwise, provided it be dry and bracing, for "if the air be dry, the colder the better,"--taking care, of course, that he be well wrapped up. mr roberton, moreover, advises that the child should be sent away at once from home, either to a bracing sea-side place, such as blackpool or fleetwood; or to a mountainous district, such as buxton. as the subject is so important, let me recapitulate: the gums ought, from time to time, to be well lanced, in order to remove the irritation of painful dentition--painful dentition being the real cause of the disease. cold sponging should be used twice or thrice daily. the diet should be carefully attended to (see dietary of child); and everything conducive to health should (as recommended in these conversations) be observed. but, remember, after all that can be said about the treatment, there is nothing like change of air, of fresh air, of cold, dry pure air, and of plenty of it--the more the little fellow can inhale, during the day, the better it will be for him, it will be far better than any drug contained in the pharmacopoeia. i have dwelt on this subject at some length--it being a most important one--as, if the above advice were more generally known and followed, nearly every child, labouring under this complaint, would be saved; while now, as coroners' inquests abundantly testify, the disease carries off yearly an immense number of victims. 204. _when is a mother to know that a cough is not a "tooth cough" but one of the symptoms of inflammation of the lungs_? if the child has had a shivering fit; if his skin be very hot and very dry; if his lips be parched; if there be great thirst; if his cheeks be flushed; if he be dull and heavy, wishing to be quiet in his cot or crib; if his appetite be diminished; if his tongue be furred; if his mouth be _burning_ hot and dry; [footnote: if you put your finger into the mouth of a child labouring under inflammation of the lungs, it is like putting your finger into a hot apple pie, the heat is so great.] if his urine be scanty and high-coloured, staining the napkin or the linen; _if his breathing be short, panting, hurried, and oppressed; if there be a hard dry cough, and if his skin be burning hot;_--then there is no doubt that inflammation of the lungs has taken place. no time should be lost in sending for medical aid; indeed, the _hot, dry mouth and skin, and short, hurried breathing_ would be sufficient cause for your procuring _immediate_ assistance. if inflammation of the lungs were properly treated at the _onset_, a child would scarcely ever be lost by that disease. i say this advisedly, for in my own practice, _provided i am called in early, and if my plans are strictly carried out_, i scarcely ever lose a child from inflammation of the lungs. you may ask--what are your plans? i will tell you, in case _you cannot promptly obtain medical advice,_ as delay might be death! _the treatment of inflammation of the lungs, what to do._--keep the child to one room, to his bedroom, and to his bed. let the chamber be properly ventilated. if the weather be cool, let a small fire be in the grate; otherwise, he is better without a fire. let him live on low diet, such as weak black tea, milk and water (in equal quantities), and toast and water, thin oatmeal gruel, arrow-root, and such like simple beverages, and give him the following mixture:- take of--wine of ipecacuanha, three drachms; simple syrup, three drachms; water, six drachms; make a mixture. a tea-spoonful of the mixture to be taken every four hours. be careful that you go to a respectable chemist, in order _that the totality of the ipecacuanha wine may be good, as the child's life may depend upon it._ if the medicine produce sickness, so much the better; continue it regularly until the short, oppressed, and hurried breathing has subsided, and has become natural. if the attack be very severe, in addition to the above medicine, at once apply a blister, not the common blister, but _smith's tela vesicatoria_ [footnote: manufactured by t. & h. smith, chemists, edinburgh, and may be procured of southalls, chemists, birmingham.]--a quarter of a sheet. if the child be a year old, the blister ought to be kept on for three hours, and then a piece of dry, soft linen rag should be applied for another three hours. at the end of which time--six hours--there will be a beautiful blister, which must then, with a pair of scissors, be cut, to let out the water, and then let the blister be dressed, night and morning, with simple cerate spread on lint. if the little patient be more than one year, say two years old, let the tela remain on for five hours, and the dry linen rag for five hours more, before the blister, as above recommended, be cut and dressed. if in a day or two the inflammation still continue violent, let another tela vesicatoria be applied, not over the old blister, but let a narrow strip of it be applied on each side of the old blister, and managed in the same manner as before directed. _i cannot speak too highly of smith's tela vesicatoria._ it has, in my hands, through god's blessing, saved the lives of scores of children. it is far, very far, superior to the old fashioned blistering plaster. it seldom, if the above rules be strictly observed, fails to rise, it gives much less pain than the common blister, when it has had the desired effect, it readily heals, which cannot always be said of the common fly blister, more especially with children. my sheet anchors, then, in the inflammation of the lungs of children are, ipecacuanha wine and smith's _tela vesicatoria_. let the greatest care, as i before advised, be observed in obtaining the ipecacuanha wine genuine and good. this can be only depended upon by having the medicine from a highly respectable chemist, ipecacuanha wine, when genuine and good, is, in many children's diseases, is one of the most valuable of medincies. _what, in a case of inflammation of the lungs, not to do_--do not, on any account, apply leeches. they draw out the life of the child, but not his disease. avoid--_emphatically let me say so_--giving emetic tartar it is one of the most lowering and death-dealing medicines that can be administered either to an infant or to a child! if you wish to try the effect of it, take a dose yourself, and i am quite sure that you will then never be inclined to poison a child with such an abominable preparation! in olden times--many, many years ago--i myself gave it in inflammation of the lungs, and lost many children! since leaving it off, the recoveries of patients by the ipecacuanha treatment, combined with the external application of smith's _tela vesicatoria_, have been in many cases marvellous. avoid broths and wine, and all stimulants. do _not_ put the child into a warm bath, it only oppresses the already oppressed breathing. moreover, after he is out of the bath, it causes a larger quantity of blood to rush back to the lungs and to the bronchial tubes, and thus feeds the inflammation. do not, by a large fire, keep the temperature of the room high. a small fire, in the winter time, encourages ventilation, and in such a case does good. when the little patient is on the mother's or on the nurse's lap, do not burden him either with a _heavy_ blanket or with a _thick_ shawl. either a _thin_ child's blanket, or a _thin_ woollen shawl, in addition to his usual nightgown, is all the clothing necessary. 205. _is bronchitis a more frequent disease than inflammation of the lungs? which is the most dangerous? what are the symptoms of bronchitis_? bronchitis is a much more frequent disease than inflammation of the lungs, indeed, it is one of the most common complaints both of infants and of children, while inflammation of the lungs is comparatively a rare disease. bronchitis is not nearly such a dangerous disease as inflammation of the lungs. _the symptoms_--the child for the first few days labours under symptoms of a heavy cold, he has not his usual spirits. in two or three days, instead of the cold leaving him, it becomes more confirmed, he is now really poorly, fretful, and feverish, his breathing becomes rather hurried and oppressed, his cough is hard and dry, and loud, he wheezes, and if you put your ear to his naked back, between his shoulder blades, you will hear the wheezing more distinctly. if at the breast, he does not suck with his usual avidity; the cough, notwithstanding the breast is a great comfort to him, compels him frequently to loose the nipple; his urine is scanty, and rather high-coloured, staining the napkin, and smelling strongly. he is generally worse at night. well, then, remember if the child be feverish, if he have symptoms of a heavy cold, if he have an oppression of breathing, if he wheeze, and if he have a tight, dry, noisy cough, you may be satisfied that he has an attack of bronchitis. 206. _how can i distinguish between bronchitis and inflammation of the lungs_? in bronchitis the skin is warm, but moist; in inflammation of the lungs it is hot and dry: in bronchitis the mouth is warmer than usual, but moist; in inflammation of the lungs it is burning hot: in bronchitis the breathing is rather hurried, and attended with wheezing; in inflammation of the lungs it is very short and panting, and is unaccompanied with wheezing, although occasionally a very slight crackling sound might be heard: in bronchitis the cough is long and noisy; in inflammation of the lungs it is short and feeble: in bronchitis the child is cross and fretful; in inflammation of the lungs he is dull and heavy, and his countenance denotes distress. we have sometimes a combination of bronchitis and of inflammation of the lungs, an attack of the latter following the former. then the symptoms will be modified, and will partake of the character of the two diseases. 207. _how would you treat a case of bronchitis_? if a medical man cannot be procured, i will tell you _what to do_: confine the child to his bedroom, and if very ill, to his bed. if it be winter time, have a little fire in the grate, but be sure that the temperature of the chamber be not above 60 degrees fahrenheit, and let the room be properly ventilated, which may be effected by occasionally leaving the door a little ajar. let him lie either _outside_ the bed or on a sofa, if he be very ill, _inside_ the bed, with a sheet and a blanket only to cover him, but no thick coverlid. if he be allowed to be on the lap, it only heats him and makes him restless. if he will not lie on the bed, let him rest on a pillow placed on the lap, the pillow will cause him to lie cooler, and will more comfortably rest his weaned body. if he be at the breast, keep him to it, let him have no artificial food, unless, if he be thirsty a little toast and water. if he be weaned, let him have either milk and water, arrow root made with equal parts of milk and water, toast and water, barley water, or weak black tea, with plenty of new milk in it, &c., but, until the inflammation have subsided, neither broth nor beef tea. now, with regard to medicine, the best medicine is ipecacuanha wine, given in large doses, so as to produce constant nausea. the ipecacuanha abates fever, acts on the skin, loosens the cough, and, in point of fact, in the majority of cases, will rapidly effect a cure. i have in a preceding conversation given you a prescription for the ipecacuanha wine mixture. let a tea-spoonful of the mixture be taken every four hours. if in a day or two he be no better, but worse, by all means continue the mixture, whether it produce sickness or otherwise, and put on the chest a _tela vesicatoria_, a quarter of a sheet. the ipecacuanha wine and the tela vesicatoria are my sheet anchors in the bronchitis, both of infants and of children. they rarely, even in very severe cases, fail to effect a cure, provided the tela vesicatorina be properly applied, and the ipecacuanha wine be genuine and of good quality. if there be any difficulty in procuring _good_ ipecacuanha wine, the ipecacuanha may be given in powder instead of the wine the following is a pleasant form- take of--powder of ipecacuanha, twelve grains white sugar thirty six grains mix well together and divide into twelve powders. one of the powders to be put dry on the tongue every four hours. the ipecacuanha powder will keep better than the wine--an important consideration to those living in country places, nevertheless, if the wine can be procured fresh and good, i far prefer the wine to the powder. when the bronchitis has disappeared, the diet ought gradually to be improved--rice, sago, tapioca, and light batter-pudding, &c.; and, in a few days, either a little chicken or a mutton chop, mixed with a well-mashed potato and crumb of bread, should be given. but let the improvement in his diet be gradual, or the inflammation might return. _what not to do_.--do not apply leeches. do not give either emetic tartar or antimonial wine, which is emetic tartar dissolved in wine. do not administer either paregoric or syrup of poppies, either of which would stop the cough, and would thus prevent the expulsion of the phlegm. any fool can stop a cough, but it requires a wise man to rectify the mischief. a cough is an effort of nature to bring up the phlegm, which would otherwise accumulate, and in the end cause death. again, therefore, let me urge upon you the immense importance of _not_ stopping the cough of a child. the ipecacuanha wine will, by loosening the phlegm, loosen the cough, which is the only right way to get rid of a cough. let what i have now said be impressed deeply upon your memory, as thousands of children in england are annually destroyed by having their coughs stopped. avoid, until the bronchitis be relieved, giving him broths, and meat, and stimulants of all kinds. for further observations on _what not to do_ in bronchitis, i beg to refer you to a previous conversation we had on _what not to do_ in inflammation of the lungs. that which is injurious in the one case is equally so in the other. 208. _what are the symptoms of diphtheria, or, as it is sometimes called, boulogne sore-throat_? this terrible disease, although by many considered to be a new complaint, is, in point of fact, of very ancient origin. homer, and hippocrates, the father of physic, have both described it. diphtheria first appeared in england in the beginning of the year 1857, since which time it has never totally left our shores. _the symptoms_--the little patient, before the disease really shows itself, feels poorly, and is "out of sorts." a shivering fit, though not severe, may generally be noticed. there is heaviness, and slight headache, principally over the eyes. sometimes, but not always, there is a mild attack of delirium at night the next day he complains of slight difficulty of swallowing. if old enough, he will complain of constriction about the swallow. on examining the throat, the tonsils will be found to be swollen and redder--more darkly red than usual. slight specks will be noticed on the tonsils. in a day or two an exudation will cover them, the back of the swallow, the palate, the tongue, and sometimes the inside of the cheeks and of the nostrils. this exudation of lymph gradually increases until it becomes a regular membrane, which puts on the appearance of leather, hence its name diphtheria. this membrane peels off in pieces, and if the child be old and strong enough he will sometimes spit it up in quantities, the membrane again and again rapidly forming as before. the discharges from the throat are occasionally, but not always, offensive. there is danger of croup from the extension of the membrane into the wind pipe. the glands about the neck and under the jaw are generally much swollen, the skin is rather cold and clammy, the urine is scanty and usually pale, the bowels at first are frequently relaxed. this diarrhoea may, or may not, cease as the disease advances. the child is now in a perilous condition, and it becomes a battle between his constitution and the disease. if, unfortunately, as is too often the case--diphtheria being more likely to attack the weakly--the child be very delicate, there is but slight hope of recovery. the danger of the disease is not always to be measured by the state of the throat. sometimes, when the patient appears to be getting well, a sudden change for the worse rapidly carries him off. hence the importance of great caution, in such cases, in giving an opinion as to ultimate recovery. i have said enough to prove the terrible nature of the disease, and to show the necessity of calling in, at the earliest period of the symptoms, an experienced and skilful medical man. 209. _is diphtheria contagious_? _decidedly_. therefore, when practicable, the rest of the children ought instantly to be removed to a distance. i say _children_, for it is emphatically a disease of childhood. when adults have it, it is the exception and not the rule: "thus it will be seen, in the account given of the boulogne epidemic, that of 366 deaths from this cause, 341 occurred amongst children under ten years of age. in the lincolnshire epidemic, in the autumn of 1858, all the deaths at horncastle, 25 in number, occurred amongst children under twelve years of age." [footnote: _diphtheria_: by ernest hart. a valuable pamphlet on the subject. dr wade of birmingham has also written an interesting and useful monograph on diphtheria. i am indebted to the above authors for much valuable information.] 210. _what are the causes of diphtheria_? bad and imperfect drainage; [footnote: "now all my carefully conducted inquiries induce me to believe that the disease comes from drain-poison. all the cases into which i could fully inquire, have brought conviction to my mind that there is a direct law of sequence in some peculiar conditions of atmosphere between diphtheria and bad drainage; and, if this be proved by subsequent investigations, we may be able to prevent a disease which, in too many cases, our known remedies cannot cure."--w. carr, esq., blackheath, _british medical journal_, december 7, 1861.] want of ventilation; overflowing privies; low neighbourhoods in the vicinity of rivers; stagnant waters; indeed, everything that vitiates the air, and thus depresses the system, more especially if the weather be close and muggy; poor and, improper food; and last, though not least, contagion. bear in mind, too, that a delicate child is much more predisposed to the disease than a strong one. 211. _what is the treatment of diptheria_? _what to do_--examine well into the ventilation, for as diphtheria is frequently caused by deficient ventilation, the best remedy is thorough ventilation. look well both to the drains and to the privies, and see that the drains from the water-closets and from the privies do not in any way contaminate the pump-water. if the drains be defective or the privies be full, the disease in your child will be generated, fed, and fostered. not only so, but the disease will spread in your family and all around you. keep the child to his bedroom and to his bed. for the first two or three days, while the fever runs high, put him on a low diet, such as milk, tea, arrow root, &c. apply to his throat every four hours a warm barm and oatmeal poultice. if he be old enough to have the knowledge to use a gargle, the following will be found serviceable- take of--permanganate of potash, pure, four grams, water eight ounces to make a gargle or, take of--powdered alum, one drachm, simple syrup one ounce, water, seven ounces to make a gargle the best medicine for the first few days of the attack, is the following mixture- take of--chlorate of potash two drachms, boiling water seven ounces syrup of red poppy one ounce to make a mixture. a table spoonful to be taken every four hours. or the chlorate of potash might be given in the form of powder- take of--chlorate of potash two scruples, lump sugar one drachm mix and divide into eight powders. one to be put into a dry tea spoon and then placed on the tongue every three hours, these powders are very useful in diphtheria; they are very cleansing to the tongue and throat. if they produce much smarting as where the mouth is very sore they sometimes do, let the patient, after taking one, drink plentifully of milk, indeed i have known these powders induce a patient to take nourishment, in the form of milk, which he otherwise would not have done, and thus to have saved him from dying of starvation, which, before taking the powders, there was every probability of his doing. an extensive experience has demonstrated to me the great value of these powders in diphtheria, but they must be put on the tongue dry. as soon as the skin has lost its preternatural heat, beef tea and chicken broth ought to be given. or if great prostration should supervene, in addition to the beef tea, port wine, a table spoonful every four hours, should be administered. if the child be cold, and there be great sinking of the vital powers, brandy and water should be substituted for the port wine. remember, in ordinary cases, port wine and brandy are not necessary, _but in cases of extreme exhaustion_ they are most valuable. as soon as the great heat of the skin has abated and the debility has set in, one of the following mixtures will be found useful- take of--wine of iron, one ounce and a half, sample syrup, one ounce, water, three ounces and a half to make a mixture. a table spoonful to be taken every four hours. or, take of--tincture of perchloride of iron, one drachm simple syrup, one ounce, water, three ounces to make a mixture. a table spoonful to be taken three times a day. if the disease should travel downwards, it will cause all the symptoms of croup, then it must be treated as croup, with this only difference, that a blister (_tela vesicatoria_) must _not_ be applied, or the blistered surface may be attacked by the membrane of diphtheria, which may either cause death or hasten that catastrophe. in every other respect treat the case as croup, by giving an emetic, a tea spoonful of ipecacuanha wine every five minutes, until free vomiting be excited, and then administer smaller doses of ipecacuanha wine every two or three hours, as i recommended when conversing with you on the treatment of croup. _what not to do_--do not, on any account, apply either leeches or a blister. if the latter be applied, it is almost sure to be covered with the membrane of diphtheria, similar to that inside of the mouth and of the throat, which would be a serious complication. do not give either calomel or emetic tartar. do not depress the system by aperients, for diphtheria is an awfully depressing complaint of itself, the patient, in point of fact, is labouring under the depressing effects of poison, for the blood has been poisoned either by the drinking water being contaminated by faecal matter from either a privy or from a water-closet, by some horrid drain, by proximity to a pig-sty, by an overflowing privy, especially if vegetable matter be rotting at the same time in it, by bad ventilation, or by contagion. diphtheria may generally be traced either to the one or to the other of the above causes, therefore let me urgently entreat you to look well into all these matters, and thus to stay the pestilence! diphtheria might long remain in a neighbourhood if active measures be not used to exterminate it. 212. _have the goodness to describe the symptoms of measles_? measles commences with symptoms of a common cold, the patient is at first chilly, then hot and feverish, he has a running at the nose, sneezing, watering, and redness of the eyes, headache, drowsiness, a hoarse and peculiar ringing cough, which nurses call "measle-cough," and difficulty of breathing. these symptoms usually last three days before the eruption appears, on the fourth it (the eruption) generally makes its appearance, and continues for four days and then disappears, lasting altogether, from the commencement of the symptoms of cold to the decline of the eruption, seven days. it is important to bear in mind that the eruption consists of _crescent-shaped--half moon-shaped--patches_, that they usually appear first about the face and the neck, in which places they are the best marked; then on the body and on the arms; and, lastly, on the legs, and that they are slightly raised above the surface of the skin. the face is swollen, more especially the eye-lids which are sometimes for a few days closed. well, then, remember, _the running at the nose, the, sneezing, the peculiar hoarse cough, and the half-moon-shaped patches_, are the leading features of the disease, and point out for a certainty that it is measles. 213. _what constitutes the principal danger in measles_? the affection of the chest. the mucous or lining membrane of the bronchial tubes is always more or less inflamed, and the lungs themselves are sometimes affected. 214. _do you recommend "surfeit water" and saffron tea to throw out the eruption in measles_? certainly not. the only way to throw out the eruption, as it is called, is to keep the body comfortably warm, and to give the beverages ordered by the medical man, with the chill off. "surfeit water," saffron tea, and remedies of that class, are hot and stimulating. the only effect they can have, will be to increase the fever and the inflammation--to add fuel to the fire. 215. _what is the treatment of measles_? _what to do_.--the child ought to be confined both to his room and to his bed, the room being kept comfortably warm; therefore, if it be winter time, there should be a small fire in the grate; in the summer time, a fire would be improper. the child must not be exposed to draughts; notwithstanding, from time to time, the door ought to be left a little ajar in order to change the air of the apartment; for proper ventilation, let the disease be what it may, is absolutely necessary. let the child, for the first few days, be kept on a low diet, such as on milk and water, arrow-root, bread and butter, &c. if the attack be mild, that is to say, if the breathing be not much affected (for in measles it always is more or less affected), and if there be not much wheezing, the acidulated infusion of roses' mixture [footnote: see page 178] will be all that is necessary. but suppose that the breathing is short, and that there is a great wheezing, then instead of giving him the mixture just advised, give him a tea-spoonful of a mixture composed of ipecacuanha wine, syrup, and water, [footnote: see page 161] every four hours. and if, on the following day, the breathing and the wheezing be not relieved in addition to the ipecacuanha mixture, apply a tola vesicatoria, as advised under the head of inflammation of the lungs. when the child is convalescing, batter puddings, rice, and sago puddings, in addition to the milk, bread and butter, &c, should be given, and, a few days later, chicken, mutton chops, &c. the child ought not, even in a mild case of measles, and in favourable weather to be allowed to leave the house under a fortnight, or it might bring on an attack of bronchitis. _what not to do_--do not give either "surfeit water" or wine. do not apply leeches to the chest. do not expose the child to the cold air. do not keep the bed room very hot, but comfortably warm. do not let the child leave the house, even under favourable circumstances, under a fortnight. do not, while the eruption is out, give aperients. do not, "to ease the cough," administer either emetic tartar or paregoric--the former drug is awfully depressing, the latter will stop the cough, and will thus prevent the expulsion of the phlegm. 216. _what is the difference between scarlatina and scarlet fever_? they are indeed one and the same disease, scarlatina being the latin for scarlet fever. but, in a _popular_ sense, when the disease is mild, it is usually called scarlatina. the latter term does not sound so formidable to the ears either of patients or of parents. 217. _will you describe the symptoms of scarlet fever_? the patient is generally chilly, languid, drowsy, feverish, and poorly for two days before the eruption appears. at the end of the second day, the characteristic, bright scarlet efflorescence, somewhat similar to the colour of a boiled lobster, usually first shows itself. the scarlet appearance is not confined to the skin; but the tongue, the throat, and the whites of the eyes put on the same appearance; with this only difference, that on the tongue and on the throat the scarlet is much darker; and, as dr elliotson accurately describes it,--"the tongue looks as if it had been slightly sprinkled with cayenne pepper;" the tongue, at other times, looks like a strawberry; when it does, it is called "the strawberry tongue." the eruption usually declines on the fifth, and is generally indistinct on the sixth day; on the seventh it has completely faded away. there is usually, after the first few days, great itching on the surface of the body. the skin, at the end of the week, begins to peel and to dust off, making it look as though meal had been sprinkled upon it. there are three forms of scarlet fever;--the one where the throat is little, if at all, affected, and this is a mild form of the disease; the second, which is generally, especially at night, attended with delirium, where the throat is _much_ affected, being often greatly inflamed and ulcerated; and the third (which is, except in certain unhealthy districts, comparatively rare, and which is very dangerous), the malignant form. 218. _would it be well to give a little cooling, opening physic as soon as a child begins to sicken for scarlet fever_? _on no account whatever._ aperient medicines are, in my opinion, highly improper and dangerous both before and during the period of the eruption. it is my firm conviction, that the administration of opening medicine, at such times, is one of the principal causes of scarlet fever being so frequently fatal. this is, of course, more applicable to the poor, and to those who are unable to procure a skilful medical man. 219. _what constitutes the principal danger in scarlet fever_? the affection of the throat, the administration of opening medicine during the first ten days, and a peculiar disease of the kidneys ending in _anasarca_ (dropsy), on which account, the medical man ought, when practicable, to be sent for at the onset, that no time may be lost in applying _proper_ remedies. when scarlet fever is complicated--as it sometimes is--with diphtheria, the diphtheric membrane is very apt to travel into the wind-pipe, and thus to cause diphtheric croup, it is almost sure, when such is the case, to end in death. when a child dies from such a complication, the death might truly be said to be owing to the diphtheric croup, and not to the scarlet fever, for if the diphtheric croup had not occurred, the child would, in all probability, have been saved. the deaths from diphtheria are generally from diphtheric croup, if there be no croup, there is, as a rule, frequent recovery. 220. _how would you distinguish between scarlet fever and measles_? measles commences with symptoms of a common cold, scarlet fever does not. measles has a _peculiar hoarse_ cough, scarlet fever has not. the eruption of measles is in patches of a half moon shape, and is slightly raised above the skin, the eruption of scarlet fever is _not_ raised above the skin at all, and is one continued mass. the colour of the eruption is much more vivid in scarlet fever than in measles. the chest is the part principally affected in measles, and the throat in scarlet fever. there is an excellent method of determining, for a certainty, whether the eruption be that of scarlatina or otherwise. i myself have, in several instances, ascertained the truth of it--"for several years m bouchut has remarked in the eruptions of scarlatina a curious phenomenon, which serves to distinguish this eruption from that of measles, erythema, erysipelas &c., a phenomenon essentially vital, and which is connected with the excessive contractability of the capillaries. the phenomenon in question is a _white line_, which can be produced at pleasure by drawing the back of the nail along the skin where the eruption, is situated. on drawing the nail, or the extremity of a hard body (such as a pen-holder), along the eruption, the skin is observed to grow pale, and to present a white trace, which remains for one or two minutes, or longer, and then disappears. in this way the diagnosis of the disease may be very distinctly written on the skin; the word 'scarlatina' disappears as the eruption regains its uniform tint."--_edinburgh medical journal._ 221. _is it of so much importance, then, to distinguish between scarlet fever and measles_? it is of great importance, as in measles the patient ought to be kept _moderately_ warm, and the drinks should be given with the chill off; while in scarlet fever the patient ought to be kept cool--indeed, for the first few days, _cold_--and the beverages, such as spring-water, toast and water, &c., should be administered quite cold. 222. _do you believe in "hybrid" scarlet fever--that is to say, in a cross between scarlet fever and measles_? i never in my life saw a case of "hybrid" scarlet fever--nor do i believe in it. scarlet fever and measles are both blood poisons, each one being perfectly separate and distinct from the other. "hybrid" scarlet fever is, in my opinion, an utter impossibility. in olden times, when the symptoms of diseases were not so well and carefully distinguished as now, scarlet fever and measles were constantly confounded one with the other, and was frequently said to be "hybrid"--a cross between measles and scarlet fever--to the patient's great detriment and danger, the two diseases being as distinct and separate as their treatment-and management ought to be. 223. _what is the treatment of scarlet fever?_ [footnote: on the 4th of march 1856, i had the honour to read a _paper on the treatment of scarlet fever_ before the members of queens college medico-chirugical society, birmingham--which _paper_ was afterwards published in the _association journal_ (march 15 1856) and in braithwaite's _retrospect of medicine_ (january--june, 1856) and in rankings _half yearly abstract of the medical sciences_ (july--december, 1856), besides in other publications. moreover the _paper_ was translated into german, and published in _canstatts jahresbericht_, iv 456, 1859] _what to do_--pray pay attention to my rules, and carry out my directions to the letter--i can then promise, _that if the scarlet fever be neither malignant nor complicated with diphtheria_, the plan i am about to advise will, with god's blessing, be usually successful. what is the first thing to be done? send the child to bed, throw open the windows, be it winter or summer, and have a thorough ventilation, for the bedroom must be kept cool, i may say cold. do not be afraid of fresh air, for fresh air, for the first few days, is essential to recovery. _fresh air, and plenty of it, in scarlet fever, is the best doctor_ a child can have let these words be written legibly on your mind. [footnote: in the _times_ of sept 4, 1863, is the following copied from the _bridgewater mercury_-gross superstition--in one of the streets of taunton, there resides a man and his wife who have the care of a child this child was attacked with scarlatina, and to all appearance death was inevitable. a jury of matrons was as it were empanelled, and to prevent the child 'dying hard' all the doors in the house all the drawers, all the boxes all the cupboards were thrown wide open, the keys taken out and the body of the child placed under a beam, whereby a sure, certain, and easy passage into eternity could be secured. watchers held their vigils throughout the weary night, and in the morning the child, to the surprise of all, did not die, and is now gradually recovering. these old women--this jury of matrons--stumbled on the right remedy, "all the doors in the house....were thrown vide open," and thus they thoroughly ventilated the apartment. what was the consequence? the child who, just before the opening of the doors, had all the appearances "that death was inevitable," as soon as fresh air was let in showed symptoms of recovery, "and in the morning the child, to the surprise of all, did not die, and is now gradually recovering." there is nothing wonderful--there is nothing surprising to my mind--in all this. ventilation--thorough ventilation--is the grand remedy for scarlatina! oh, that there were in scarlet fever cases a good many such old women's--such a "jury of matrons'"--remedies! we should not then be horrified, as we now are, at the fearful records of death, which the returns of the registrar general disclose!] if the weather be either intensely cold, or very damp, there is no objection to a small fire in the grate provided there be, at the same time, air--an abundance of fresh air--admitted into the room. take down the curtains of the bed, remove the valances. if it be summer time, let the child be only covered with a sheet. if it be winter time, in addition to the sheet, he should have one blanket over him. now for the throat--the best _external_ application is a barm and oatmeal poultice how ought it to be made, and how applied? put half a tea-cupful of barm into a saucepan, put it on the fire to boil; as soon as it boils, take it off the fire, and stir oatmeal into it, until it be of the consistence of a nice soft poultice; then place it on a rag, and apply it to the throat, carefully fasten it on with a bandage, two or three turns of the bandage going round the throat, and two or three over the crown of the head, so as nicely to apply the poultice where it is wanted--that is to say, to cover the tonsils. tack the bandage: do not pin it. let the poultice be changed three times a day. the best medicine is the acidulated infusion of roses, sweetened with syrup:- take of--dilated sulphuric acid, half a drachm; simple syrup, one ounce and a half; acid infusion of roses, four ounces and a half: to make a mixture. a table-spoonful to be taken every four hours. it is grateful and refreshing, it is pleasant to take, it abates fever and thirst, it cleanses the throat and tongue of mucus, and is peculiarly efficacious in scarlet fever; as soon as the fever is abated it gives an appetite. my belief is that the sulphuric acid in the mixture is a specific in scarlet fever, as much as quinine is in ague, and sulphur in itch. i have reason to say so, for, in numerous cases i have seen its immense value. now, with regard to food.--if the child be at the breast, keep him entirely to it. if he be weaned, and under two years old, give him milk and water, and cold water to drink. if he be older, give him toast and water, and plain water from the pump, as much as he chooses; let it be quite cold--the colder the better. weak black tea, or thin gruel, may be given, but not caring, unless he be an infant at the breast, if he take nothing but _cold_ water. if the child be two years old and upwards, roasted apples with sugar, and grapes, will be very refreshing, and will tend to cleanse both the mouth and the throat avoid broths and stimulants. when the appetite returns, you may consider the patient to be safe. the diet ought now to be gradually improved. bread and butter, milk and water, and arrowroot made with equal parts of new milk and water, should for the first two or three days be given. then a light batter or rice pudding may be added, and in a few days, either a little chicken or a mutton chop. the essential remedies, then, in scarlet fever, are, for the first few days--(1) plenty of fresh air and ventilation, (2) plenty of cold water to drink, (3) barm poultices to the throat, and (4) the acidulated infusion of roses mixture as a medicine. now, then, comes very important advice. after the first few days, probably five or six, sometimes as early as the fourth day--_watch carefully and warily, and note the time, the skin will suddenly become cool_, the child will say that he feels chilly; then is the time you must now change your tactics--_instantly close the windows and put extra clothing_, a blanket or two, on his bed. a flannel nightgown should, until the dead skin have peeled off, be now worn next to the skin, when the flannel nightgown should be discontinued. the patient ought ever after to wear, in the day time, a flannel waistcoat. [footnote: on the importance--the vital importance--of the wearing of flannel next to the skin, see "flannel waistcoats."] his drinks must now be given with the chill off; he ought to have a warm cup of tea, and gradually his diet should, as i have previously advised, be improved. there is one important caution i wish to impress upon you,--_do not give opening medicine during the time the eruption is out_. in all probability the bowels will be opened: if so, all well and good; but do not, on any account, for the first ten days, use artificial means to open them. it is my firm conviction that the administration of purgatives in scarlet fever is a fruitful source of dropsy, of disease, and death. when we take into consideration the sympathy there is between the skin and the mucous membrane, i think that we should pause before giving irritating medicines, such as purgatives. the irritation of aperients on the mucous membrane may cause the poison of the skin disease (for scarlet fever is a blood-poison) to be driven internally to the kidneys, to the throat, to the pericardium (bag of the heart), or to the brain. you may say, do you not purge if the bowels be not open for a week? i say emphatically, no! i consider my great success in the treatment of scarlet fever to be partly owing to my avoidance of aperients during the first ten days of the child's illness. if the bowels, after the ten days, be not properly opened, a dose or two of syrup of senna should be given: that is to say, one or two tea-spoonfuls should be administered early in the morning, and should, if the first dose does not operate, be repeated in four hours. in a subsequent conversation, i shall strongly urge you not to allow your child, when convalescent, to leave the house under at least a month from the commencement of the illness; i, therefore, beg to refer you to that conversation, and hope that you will give it your best and earnest consideration! during the last twenty years i have never had dropsy from scarlet fever, and i attribute it entirely to the plan i have just recommended, and in not allowing my patients to leave the house under the month--until, in fact, the skin that had peeled off has been renewed. let me now sum up the plan i adopt, and which i beg leave to designate as--pye chavasse's fresh air treatment of scarlet fever:-1. thorough ventilation, a cool room, and scant clothes on the bed, for the first five or six days. 2. a change of temperature of the skin to be carefully regarded. as soon as the skin is cool, closing the windows, and putting additional clothing on the bed. 3. the acidulated infusion of hoses with syrup is _the_ medicine for scarlet fever. 4. purgatives to be religiously avoided for the first ten days at least, and even afterwards, unless there be absolute necessity. 5. leeches, blisters, emetics, cold and tepid spongings, and painting the tonsils with caustic, inadmissible in scarlet fever. 6. a strict antiphlogistic (low) diet for the first few days, during which time cold water to be given _ad libitum_. 7. the patient not to leave the house in the summer under the month; in the winter, under six weeks. _what not to do._--do not, then, apply either leeches or blisters to the throat; do not paint the tonsils with caustic; do not give aperients; do not, on any account, give either calomel or emetic tartar; do not, for the first few days of the illness, be afraid of _cold air_ to the skin, and of cold water as a beverage; do not, emphatically let me say, _do not_ let the child leave the house for at least a month from the commencement of the illness. my firm conviction is, that purgatives, emetics, and blisters, by depressing the patient, sometimes cause ordinary scarlet fever to degenerate into malignant scarlet fever. i am aware that some of our first authorities advocate a different plan to mine. they recommend purgatives, which i may say, in scarlet fever, are my dread and abhorrence. they advise cold and tepid spongings--a plan which i think dangerous, as it will probably drive the disease internally. blisters, too, have been prescribed; these i consider weakening, injurious, and barbarous, and likely still more to inflame the already inflamed skin. they recommend leeches to the throat, which i am convinced, by depressing the patient, will lessen the chance of his battling against the disease, and will increase the ulceration of the tonsils. again, the patient has not too much blood; the blood is only poisoned. i look upon scarlet fever as a specific poison of the blood, and one which will be eliminated from the system, _not_ by bleeding, _not_ by purgatives, _not_ by emetics but by a constant supply of fresh and cool air, by the acid treatment, by cold water as a beverage, and for the first few days by a strict antiphlogistic (low) diet. sydenham says that scarlet fever is oftentimes "fatal through the officiousness of the doctor." i conscientiously believe that a truer remark was never made; and that, under a different system to the usual one adopted, scarlet fever would not be so much dreaded. [footnote: if any of my medical brethren should do me the honour to read these pages, let me entreat them to try my plan of treating scarlet fever, as my success has been great. i have given full and minute particulars, in order that they and mothers (if mothers cannot obtain medical advice) may give my plan a fair and impartial trial. my only stipulations are that they must _begin_ with my treatment, and _not mix_ any other with it, and carry out my plan to the very letter. i then, with god's blessing, provided the cases be neither malignant nor complicated with diphtheria, shall not fear the result. if any of my _confreres_ have tried my plan of treatment of scarlet fever--and i have reason to know that many have--i should feel grateful to them if they would favour me with their opinion as to its efficacy. address--"pye chavasse, 214 hagley road, birmingham."] dr budd, of bristol, recommends, in the _british medical journal_, that the body, including the scalp, of a scarlet fever patient, should, after about the fourth day, be anointed, every night and morning, with camphorated oil; this anointing to be continued until the patient is able to take a warm bath and use disinfectant soap: this application will not only be very agreeable to the patient's feelings, as there is usually great irritation and itching of the skin, but it will, likewise, be an important means of preventing the dead skin, which is highly infectious, and which comes off partly in flakes and partly floats about the air as dust, from infecting other persons. the plan is an excellent one, and cannot be too strongly recommended. if the case be a combination of scarlet fever and of diphtheria, as it unfortunately now frequently is, let it be treated as a case of diphtheria. 224. _i have heard of a case of scarlet fever, where the child, before the eruption showed itself, was suddenly struck prostrate, cold, and almost pulseless: what, in such a case, are the symptoms, and what immediate treatment do you advise_? there is an _exceptional_ case of scarlet fever, which now and then occurs, and which requires _exceptional_ and prompt treatment, or death will quickly ensue. we will suppose a case: one of the number, where nearly all the other children of a family are labouring under scarlet fever, is quite well, when suddenly--in a few hours, or even, in some cases, in an hour--utter prostration sets in, he is very cold, and is almost pulseless, and is nearly insensible--comatose. having sent instantly for a judicious medical man, apply, until he arrives, hot bottles, hot bricks, hot bags of salt to the patient's feet and legs and back, wrap him in hot blankets, close the window, and give him hot brandy and water--a tablespoonful of brandy to half a tumblerful of hot water--give it him by teaspoonfuls, continuously--to keep him alive; when he is warm and restored to consciousness, the eruption will probably show itself, and he will become hot and feverish; then your tactics must, at once, be changed, and my fresh air treatment, and the rest of the plan i have before advised must in all its integrity, be carried out. we sometimes hear of a child, before the eruption comes out and within twenty-four hours of the attack, dying of scarlet fever. when such be the case it is probably owing to low vitality of the system--to utter prostration--he is struck down, as though for death, and if the plan be not adopted of, for a few hours, keeping him alive by heat, and by stimulants, until, indeed, the eruption comes out, he will never rally again, but will die from scarlet fever poisoning and from utter exhaustion. these cases are comparatively rare, but they do, from time to time, occur, and, when they do, they demand exceptional and prompt and energetic means to save them from ending in almost immediate and certain death. "to be forewarned is to be forearmed." [footnote: i have been reminded of this _exceptional_ case of scarlet fever by a most intelligent and valued patient of mine, who had a child afflicted as above described, and whose child was saved from almost certain death, by a somewhat similar plan of treatment as advised in the text.] 225. _how soon ought a child to be allowed to leave the house after an attack of scarlet fever_? he must not be allowed to go out for at least a month from the commencement of the attack, in the summer, and six weeks in the winter; and not even then without the express permission of a medical man. it might be said that this is an unreasonable recommendation: but when it is considered that the whole of the skin generally desquamates, or peels off, and consequently leaves the surface of the body exposed to cold, which cold flies to the kidneys, producing a peculiar and serious disease in them, ending in dropsy, this warning will not be deemed unreasonable. scarlet fever dropsy, which is really a _formidable disease, generally arises from, the carelessness, the ignorance, and the thoughtlessness of parents in allowing a child to leave the house before the new skin be properly formed and hardened._ prevention is always better than cure. thus far with regard to the danger to the child himself. now, if you please, let me show you the risk of contagion that you inflict upon families, in allowing your child to mix with others before a month at least has elapsed. bear in mind, a case is quite as contagious, if not more so, while the skin is peeling off, as it was before. thus, in ten days or a fortnight, there is as much risk of contagion as at the _beginning_ of the disease, and when the fever is at its height. at the conclusion of the month, the old skin has generally all peeled off, and the new skin has taken its place; consequently there will then be less fear of contagion to others. but the contagion of scarlet fever is so subtle and so uncertain in its duration, that it is impossible to fix the exact time when it ceases. let me most earnestly implore you to ponder well on the above important facts. if these remarks should be the means of saving only one child from death, or from broken health, my labour will not have been in vain. 226. _what means do you advise to purify a house, clothes, and furniture, from the contagion of scarlet fever_? let every room in the house, together with its contents, and clothing and dresses that cannot be washed, be well fumigated with sulphur--taking care the while to close both windows and door; let every room be _lime-washed_ and then be white-washed; if the contagion have been virulent, let every bedroom be freshly papered (the walls having been previously stripped of the old paper and then lime-washed); let the bed, the holsters, the pillows, and the mattresses be cleansed and purified; let the blankets and coverlids be thoroughly washed, and then let them be exposed to the open air--if taken into a field so much the better; let the rooms be well scoured; let the windows, top and bottom, be thrown wide open; let the drains be carefully examined; let the pump water be scrutinised, to see that it be not contaminated by faecal matter, either from the water-closet, from the privy, from the pig-stye, or from the stable; let privies be emptied of their contents--_remember this is most important advice_--then put, into the empty places, either lime and powdered charcoal or carbolic acid, for it is a well ascertained fact that it is frequently impossible to rid a house of the infection of scarlet fever without adopting such a course. "in st george's, southwark, the medical officer reports that scarlatina 'has raged fatally, almost exclusively where privy or drain, smells are to be perceived in the houses.'" [footnote: _quarterly report of the board of health_ upon sickness in the metropolis.] let the children, who have not had, or who do not appear to be sickening for scarlet fever, be sent away from home--if to a farm house so much the better. indeed, leave no stone unturned, no means untried, to exterminate the disease from the house and from the neighbourhood. remember the young are more prone to catch contagious diseases than adults; for "in the morn and liquid dew of youth contagious blastments are most imminent."--_shakspeare_. 227. _have you any further observations to offer on the precautions to be taken against the spread of scarlet fever_? great care should be taken to separate the healthy from the infected. the nurses selected for attending scarlet fever patients should be those who have previously had scarlet fever themselves. dirty linen should be removed at once, and be put into boiling water. very little furniture should be in the room of a scarlet fever patient--the less the better--it only obstructs the circulation of the air, and harbours the scarlet fever poison. the most scrupulous attention to cleanliness should, in these cases, be observed. a patient who has recovered from scarlet fever, and before he mixes with healthy people, should, for three or four consecutive mornings, have a warm bath, and well wash himself, while in the bath, with soap; he will, by adopting this plan, get rid of the dead skin, and thus remove the infected particles of the disease. if scarlet fever should appear in a school, the school must for a time be broken up, in order that the disease might be stamped out there must be no half measures where such a fearful disease is in question. a house containing scarlet fever patients should, by parents, be avoided as the plague; it is a folly at any time to put one's head into the lion's mouth! chloralum and carbolic acid, and chloride of lime, and condy's fluid, are each and all good disinfectants; but not one is to be compared to perfect cleanliness and to an abundance of fresh and pure air--the last of which may truly _par excellence_ be called god's disinfectant! either a table-spoonful of chloralum, or two tea-spoonfuls of carbolic acid, or two tea-spoonfuls of condy's fluid, or a tea-spoonful of chloride of lime in a pint of water, are useful to sprinkle the soiled handkerchiefs as soon as they be done with, and before the be washed, to put in the _pot-de-chambre_, and to keep in saucers about the room; but, remember, as i have said before, and cannot repeat too often, there is no preventative like the air of heaven, which should be allowed to permeate and circulate freely through the apartment and through the house: air, air, air is the best disinfectant, curative, and preventative of scarlet fever in the world! i could only wish that my _treatment of scarlet fever_ were, in all its integrity, more generally adopted; if it were, i am quite sure that thousands of children would annually be saved from broken health and from death. time still further convinces me that my treatment is based on truth as i have every year additional proofs of its value and of its success; but error and prejudice are unfortunately ever at work, striving all they can to defeat truth and common sense. one of my principal remedies in the treatment of scarlet fever is an abundance of fresh air; but many people prefer their own miserable complicated inventions to god's grand and yet simple remedies--they pretend that they know better than the mighty framer of the universe! 228. _will you describe the symptoms of chicken pox_? it is occasionally, but not always, ushered in with a slight shivering fit; the eruption shows itself in about twenty-four hours from the child first appearing poorly. it is a vesicular [footnote: _vesicles_. small elevations of the cuticle, covering a fluid which is generally clear and colourless at first, but afterwards whitish and opaque, or pearly.--_watson_.] disease. the eruption comes out in the form of small pimples, and principally attacks the scalp, the neck, the back, the chest, and the shoulders, but rarely the face; while in small-pox the face is generally the part most affected. the next day these pimples fill with water, and thus become vesicles; on the third day they are at maturity. the vesicles are quite separate and distinct from each other. there is a slight redness around each of them. fresh ones, whilst the others are dying away, make their appearance. chicken-pox is usually attended with a slight itching of the skin; when the vesicles are scratched the fluid escapes, and leaves hard pearl-like substances, which, in a few days, disappear. chicken-pox never leaves pit marks behind. it is a child's complaint; adults scarcely, if ever, have it. 229. _is there any danger in chicken-pox; and what treatment do you advise_? it is not at all a dangerous, but, on the contrary, a trivial complaint. it lasts only a few days, and requires but little medicine. the patient ought, for three or four days, to keep the house, and should abstain from animal food. on the sixth day, but not until then, a dose or two of a mild aperient is all that will be required. 230. _is chicken-pox infectious_? there is a diversity of opinion on this head, but one thing is certain--it cannot be communicated by inoculation. 231. _what are the symptoms of modified small-pox_? the modified small-pox--that is to say, small-pox that has been robbed of its virulence by the patient having been either already vaccinated, or by his having had a previous attack of small-pox--is ushered in with severe symptoms, with symptoms almost as severe as though the patient had not been already somewhat protected either by vaccination or by the previous attack of small-pox--that is to say, he has a shivering fit, great depression of spirits and debility, _malaise_, sickness, headache, and occasionally delirium. after the above symptoms have lasted about three days, the eruption shows itself. the immense value of the previous vaccination, or the previous attack of small-pox, now comes into play. in a case of _unprotected_ small-pox, the appearance of the eruption _aggravates_ all the above symptoms, and the danger begins; while in the _modified_ small-pox, the moment the eruption shows itself the patient feels better, and, as a rule, rapidly recovers. the eruption, of _modified_ small-pox varies materially from the eruption of the _unprotected_ small-pox. the former eruption assumes a varied character, and is composed, first, of vesicles (containing water); and, secondly, of pustules (containing matter), each of which pustules has a depression in the centre; and, thirdly, of several red pimples without either water or matter in them, and which sometimes assume a livid appearance. these "breakings-out" generally show themselves more upon the wrist, and sometimes up one or both of the nostrils. while in the latter disease--the _unprotected_ small-pox--the "breaking-out" is composed entirely of pustules containing matter, and which pustules are more on the face than on any other part of the body. there is generally a peculiar smell in both diseases--an odour once smelt never to be forgotten. now, there is one most important remark i have to make,--the _modified small-pox is contagious_. this ought to be borne in mind, as a person labouring under the disease must, if there be children in the house, either be sent away himself, or else the children ought to be banished both the house and the neighbourhood. another important piece of advice is,--let _all_ in the house--children and adults, one and all--be vaccinated, even if any or all have been previously vaccinated. _treatment_.--let the patient keep his room, and if he be very ill, his bed. let the chamber be well ventilated. if it be winter time, a small fire in the grate will encourage ventilation. if it be summer, a fire is out of the question; indeed, in such a case, the window-sash ought to be opened, as thorough ventilation is an important requisite of cure, both in small-pox and in _modified_ small-pox. while the eruption is out, do not on any account give aperient medicine. in ten days from the commencement of the illness a mild aperient may be given. the best medicine in these cases is, the sweetened acidulated infusion of roses, [footnote: see page 178] which ought to be given from the commencement of the disease, and should be continued until the fever be abated. for the first few days, as long as the fever lasts, the patient ought not to be allowed either meat or broth, but should be kept on a low diet, such as on gruel, arrow-root, milk-puddings, &c. as soon as the fever is abated he ought gradually to resume his usual diet. when he is convalescent, it is well, where practicable, that he should have change of air for a month. 232. _how would you distinguish between modified small-pox and chicken-pox_? modified small-pox may readily be distinguished from chicken-pox, by the former disease being, notwithstanding its modification, much more severe and the fever much more intense before the eruption shows itself than chicken-pox; indeed, in chicken-pox there is little or no fever either before or after the eruption; by the former disease--the modified small-pox--consisting _partly_ of pustules (containing matter), each pustule having a depression in the centre, and the favourite localities of the pustules being the wrists and the inside of the nostrils; while, in the chicken-pox, the eruption consists of vesicles (containing water), and _not_ pustules (containing matter), and the vesicles having neither a depression in the centre, nor having any particular partiality to attack either the wrists or the inside of the nose. in modified small-pox each pustule is, as in unprotected small-pox, inflamed at the base; while in chicken-pox there is only very slight redness around each vesicle. the vesicles in chicken-pox are small--much smaller than the pustules in modified small-pox. 233. _is hooping-cough an inflammatory disease_? hooping-cough in itself is not inflammatory, it is purely spasmodic; but it is generally accompanied with more or less of bronchitis-inflammation of the mucous membrane of the bronchial tubes--on which account it is necessary, _in all cases_ of hooping-cough, to consult a medical man, that he may watch the progress of the disease and nip inflammation in the bud. 234. _will you have the goodness to give the symptoms, and a brief history of, hooping-cough_? hooping-cough is emphatically a disease of the young; it is rare for adults to have it; if they do, they usually suffer more severely than children. a child seldom has it but once in his life. it is highly contagious, and therefore frequently runs through a whole family of children, giving much annoyance, anxiety, and trouble to the mother and the nurses; hence hooping-cough is much dreaded by them. it is amenable to treatment. spring and summer are the best seasons of the year for the disease to occur. this complaint usually lasts from six to twelve weeks--sometimes for a much longer period, more especially if proper means are not employed to relieve it. hooping-cough commences as a common cold and cough. the cough, for ten days or a fortnight, increases in intensity; at about which time it puts on the characteristic "hoop." the attack of cough comes on in paroxysms. in a paroxysm, the child coughs so long and so violently, and _expires_ so much air from the lungs without _inspiring_ any, that at times he appears nearly suffocated and exhausted; the veins of his neck swell; his face is nearly purple; his eyes, with the tremendous exertion, almost seem to start from their sockets; at length there is a sudden _inspiration_ of air through the contracted chink of the upper part of the wind-pipe--the glottis--causing the peculiar "hoop;" and after a little more coughing, he brings up some glairy mucus from the chest; and sometimes, by vomiting, food from the stomach; he is at once relieved, until the next paroxysm occur, when the same process is repeated, the child during the intervals, in a favourable case, appearing quite well, and after the cough is over, instantly returning either to his play or to his food. generally, after a paroxysm he is hungry, unless, indeed, there be severe inflammation either of the chest or of the lungs. sickness, as i before remarked, frequently accompanies hooping-cough; when it does, it might be looked upon as a good sign. the child usually knows when an attack is coming on; he dreads it, and therefore tries to prevent it; he sometimes partially succeeds; but, if he does, it only makes the attack, when it does come, more severe. all causes of irritation and excitement ought, as much as possible, to be avoided, as passion is apt to bring on a severe paroxysm. a new-born babe--an infant of one or two months old--commonly escapes the infection; but if, at that tender age, he unfortunately catch hooping-cough, it is likely to fare harder with him than if he were older--the younger the child, the greater the risk. but still, in such a case, do not despair, as i have known numerous instances of new-born infants, with judicious care, recover perfectly from the attack, and thrive after it as though nothing of the kind had ever happened. a new-born babe, labouring under hooping-cough, is liable to convulsions, which is in this disease one, indeed the great, source of danger. a child, too, who is teething, and labouring under the disease, is also liable to convulsions. when the patient is convalescing, care ought to be taken that he does not catch cold, or the "hoop" might return. hooping-cough may either precede, attend, or follow an attack of measle. 235. _what is the treatment of hooping-cough_? we will divide the hooping-cough into three stages, and treat each stage separately, _what to do.--in the first stage_, the commencement of hooping-cough: for the first ten days give the ipecacuanha wine mixture, [footnote: for the prescription of the ipecacuanha wine mixture, see page 161.] a tea-spoonful three times a day. if the child be not weaned, keep him entirely to the breast, if he be weaned, to a milk and farinaceous diet. confine him for the first ten days to the house, more especially if the hooping-cough be attended, as it usually is, with more or less bronchitis. but take care that the rooms be well ventilated; for good air is essential to the cure. if the bronchitis attending the hooping-cough be severe, confine him to his bed, and treat him as though it were simply a case of bronchitis. [footnote: for the treatment of bronchitis, see answer to 207th question.] _in the second stage_, discontinue the ipecacuanha mixture, and give dr gibb's remedy--namely, nitric acid--which i have found to be an efficacious and valuable one in hooping-cough:- take of--diluted nitric acid, two drachms; compound tincture of cardamons, half a drachm; simple syrup, three ounces; water, two ounces and a half: make a mixture. one or two tea-spoonfuls, or a table-spoonful, according to the age of the child--one tea-spoonful for an infant of six months, and two tea-spoonfuls for a child of twelve months, and one table-spoonful for a child of two years, every four hours, first shaking the bottle. let the spine and the chest be well rubbed every night and morning either with roche's embrocation, or with the following stimulating liniment (first shaking the bottle):- take of--oil of cloves, one drachm; oil of amber, two drachms; camphorated oil, nine drachms: make a liniment. let him wear a broad band of new flannel, which should extend round from his chest to his back, and which ought to be changed every night and morning, in order that it may be dried before putting on again. to keep it in its place it should be fastened by means of tapes and with shoulder-straps. the diet ought now to be improved--he should gradually return to his usual food; and, weather permitting, should almost live in the open air--fresh air being, in such a case, one of the finest medicines. _in the third stage_, that is to say, when the complaint has lasted a month, if by that time the child is not well, there is nothing like change of air to a high, dry, healthy, country place. continue the nitric acid mixture, and either the embrocation or the liniment to the back and the chest, and let him continue to almost live in the open air, and be sure that he does not discontinue wearing the flannel until he be quite cured, and then let it be left off by degrees. if the hooping-cough have caused debility, give him cod-liver oil--a tea-spoonful twice or three times a day, giving it him on a full stomach, after his meals. but, remember, after the first three or four weeks, change of air, and plenty of it, is for hooping-cough the grand remedy. _what not to do_.--"do not apply leeches to the chest, for i would rather put blood into a child labouring under hooping-cough than take it out of him--hooping-cough is quite weakening enough to the system of itself without robbing him of his life's blood; do not, on any account whatever, administer either emetic tartar or antimonial wine; do not give either paregoric or syrup of white poppies; do not drug him either with calomel or with grey-powder; do not dose him with quack medicine; do not give him stimulants, but rather give him plenty of nourishment, such as milk and farinaceous food, but _no_ stimulants; do not be afraid, after the first week or two, of his having fresh air, and plenty of it--for fresh, pure air is the grand remedy, after all that can be said and done, in hooping-cough. although occasionally we find that, if the child to labouring under hooping-cough, and is breathing a pure country air, and is not getting well so rapidly as we could wish, change of air to a smoky gas-laden town will sometimes quickly effect a cure; indeed, some persons go so far as to say that the _best_ remedy for an _obstinate_ case of hooping-cough is, for the child to live, the great part of every day, in gas-works!" 236. _what is to be done during a paroxysm of hooping-cough_? if the child be old enough, let him stand up; but if he be either too young or too feeble, raise his head, and bend his body a little forward; then support his back with one hand, and the forehead with the other. let the mucus, the moment it be within reach, be wiped with a soft handkerchief out of his mouth. 237. _in an obstinate case of hooping-cough, what is the best remedy_? change of air, provided there be no active inflammation, to any healthy spot. a farm-house, in a high, dry, and salubrious neighbourhood, is as good a place as can be chosen. if, in a short time, he be not quite well, take him to the sea-side: the sea breezes will often, as if by magic, drive away the disease. 238. _suppose my child should have a shivering fit, is it to be looked upon as an important symptom_? certainly. nearly all _serious_ illnesses commence with a shivering fit: severe colds, influenza, inflammations of different organs, scarlet fever, measles, small-pox, and very many other diseases, begin in this way. if, therefore, your child should ever have a shivering fit, _instantly_ send for a medical man, as delay might be dangerous. a few hours of judicious treatment, at the commencement of an illness, is frequently of more avail than days and weeks, nay months, of treatment, when disease has gained a firm footing. a _serious_ disease often steals on insidiously, and we have perhaps only the shivering fit, which might be but a _slight_ one, to tell us of its approach. a _trifling_ ailment, too, by neglecting the premonitory symptom, which, at first might only be indicated by a _slight_ shivering fit, will sometimes become a mortal disorder:- "the little rift within the lute, that by-and-by will make the music mute, and ever widening slowly silence all." [footnote: the above extract from tennyson is, in my humble opinion, one of the most beautiful pieces of poetry in the english language. it is a perfect gem, and a volume in itself, so truthful, so exquisite, so full of the most valuable reflections; for instance--(1.) "the little rift within the lute,"--the little tubercle within the lung "that by-and-by will make the music mute, and ever widening slowly silence all," and the patient eventually dies of consumption. (2.) the little rent--the little rift of a very minute vessel in the brain, produces an attack of apoplexy, and the patient dies. (3.) each and all of us, in one form or another, sooner or later, will have "the little rift within the lute." but why give more illustrations?--a little reflection will bring numerous examples to my fair reader's memory.] 239. _in case of a shivering fit, perhaps you will tell me what to do_? _instantly_ have the bed warmed, and put the child to bed. apply either a hot bottle or a hot brick, wrapped in flannel, to the soles of his feet. put an extra blanket on his bed, and give him a cup of hot tea. as soon as the shivering fit is over, and he has become hot, gradually lessen the _extra_ quantity of clothes on his bed, and take away the hot bottle or the hot brick from his feet. _what not to do_.--do not give either brandy or wine, as inflammation of some organ might be about taking place. do not administer opening medicine, as there might be some "breaking out" cooling out on the skin, and an aperient might check it. 240. _my child, apparently otherwise healthy, screams out in the night violently in his sleep, and nothing for a time will pacify him: what is likely to be the cause, and what is the treatment_? the causes of these violent screamings in the night are various. at one time, they proceed from teething; at another, from worms; sometimes, from night-mare; occasionally, from either disordered stomach or bowels. each of the above causes will, of course, require a different plan of procedure; it will, therefore, be necessary to consult a medical man on the subject, who will soon, with appropriate treatment, be able to relieve him. 241. _have the goodness to describe the complaint of children called mumps_. the mumps, inflammation of the "parotid" gland, is commonly ushered in with a slight feverish attack. after a short time, a swelling, of stony hardness, is noticed before and under the ear, which swelling extends along the neck towards the chin. this lump is exceedingly painful, and continues painful and swollen for four or five days. at the end of which time it gradually disappears, leaving not a trace behind. the swelling of mumps never gathers. it may affect one or both sides of the face. it seldom occurs but once in a lifetime. it is contagious, and has been known to run through a whole family or school; but it is not dangerous, unless, which is rarely the case, it leaves the "parotid" gland, and migrates either to the head, to the breast, or to the testicle. 242. _what is the treatment of mumps_? foment the swelling, four or five times a day, with a flannel wrung out of hot camomile and poppy-head decoction; [footnote: four poppy-heads and four ounces of camomile blows to be boiled in four pints of water for half an hour, and then strained to make the decoction.] and apply, every night, a barm and oatmeal poultice to the swollen gland or glands. debar, for a few days, the little patient from taking meat and broth, and let him live on bread and milk, light puddings, and arrow-root. keep him in a well-ventilated room, and shut him out from the company of his brothers, his sisters, and young companions. give him a little mild, aperient medicine. of course, if there be the slightest symptom of migration to any other part or parts, instantly call in a medical man. 243. _what is the treatment of a boil_? one of the best applications is a burgundy-pitch plaster spread on a soft piece of wash leather. let a chemist spread a plaster, about the size of the hand; and, from this piece, cut small plasters, the size of a shilling or a florin (according to the dimensions of the boil), which snip around and apply to the part. put a fresh one on daily. this plaster will soon cause the boil to break; when it does break, squeeze out the contents--the core and the matter--and then apply one of the plasters as before, which, until the boil be well, renew every day. the old-fashioned remedy for a boil--namely, common yellow soap and brown-sugar, is a capital one for the purpose. it is made with equal parts of brown sugar and of shredded yellow soap, and mixed by means of a table-knife on a plate, with a few drops of water, until it be all well blended together, and of the consistence of thick paste; it should then be spread either on a piece of wash-leather, or on thick linen, and applied to the boil, and kept in its place by means either of a bandage or of a folded handkerchief; and should he removed once or twice a day. this is an excellent application for a boil--soothing, comforting, and drawing--and will soon effect a cure. a paste of honey and flour, spread on linen rag, is another popular and good application for a boil. _if the boils should arise from the child being in a delicate state of health_, give him cod-liver oil, meat once a day, and an abundance of milk and farinaceous food. let him have plenty of fresh air, exercise, and play. _if the boil should arise from gross and improper feeding_, then keep him for a time from meat, and let him live principally on a milk and farinaceous diet. _if the child be fat and gross_, cod-liver oil would he improper; a mild aperient, such as rhubarb and magnesia, would then be the best medicine. 244. _what are the symptoms of ear-ache_? a young child screaming shrilly, violently, and continuously, is oftentimes owing to ear-ache; carefully, therefore, examine each ear, and ascertain if there be any discharge; if there be, the mystery is explained. screaming from ear-ache may be distinguished from the screaming from bowel-ache by the former (ear-ache) being more continuous--indeed, being one continued scream, and from the child putting his hand to his head; while, in the latter (bowel-ache), the pain is more of a coming and of a going character, and he draws up his legs to his bowels. again, in the former (ear-ache), the secretions from the bowels are natural; while, in the latter (bowel-ache), the secretions from the bowels are usually depraved, and probably offensive. but a careful examination of the ear will generally at once decide the nature of the case. 213. _what is the best remedy for ear-ache_? apply to the ear a small flannel bag, filled with hot salt--as hot as can be comfortably borne, or foment the ear with a flannel wrung out of hot camomile and poppy head decoction. a roasted onion, inclosed in muslin applied to the ear, is an old-fashioned and favourite remedy, and may, if the bag of hot salt, or if the hot fomentation do not relieve, be tried. put into the ear, but not very far, a small piece of cotton wool, moistened with warm olive oil. taking care that the wool is always removed before a fresh piece be substituted, as if it be allowed to remain in any length of time, it may produce a discharge from the ear. avoid all _cold_ applications. if the ear-ache be severe, keep the little fellow at home, in a room of equal temperature, but well-ventilated, and give him, for a day or two, no meat. if a discharge from the ear should either accompany or follow the ear-ache, _more especially if the discharge be offensive_, instantly call in a medical man, or deafness for life may be the result. a knitted or crotcheted hat, with woollen rosettes over the ears, is, in the winter time, an excellent hat for a child subject to ear-ache. the hat may be procured at any baby-linen warehouse. 246. _what are the causes and the treatment of discharges from the ear_? cold, measles, scarlet fever, healing up of "breakings out" behind the ear; pellets of cotton wool, which had been put in the ear, and had been forgotten to be removed, are the usual causes of discharges from the ear. it generally commences with ear-ache. the _treatment_ consists in keeping the parts clean, by syringing the ear every morning with warm water, by attention to food--keeping the child principally upon a milk and a farmaceous diet, and by change of air--more especially to the coast. if change of air be not practicable, great attention should be paid to ventilation. as i have before advised, in all cases of discharge from the ear call in a medical man, as a little judicious medicine is advisable--indeed, essential; and it may be necessary to syringe the ear with lotions, instead of with warm water; and, of course, it is only a doctor who has actually seen the patient who can decide these matters, and what is best to be done in each case. 247. _what is the treatment of a "stye" on the eye-lid_? bathe the eye frequently with warm milk and water, and apply, every night at bedtime, a warm white-bread poultice. no medicine is required; but, if the child be gross, keep him for a few days from meat, and let him live on bread and milk and farinaceous puddings. 248. _if a child have large bowels, what would you recommend as likely to reduce their size_? it ought to be borne in mind, that the bowels of a child are larger in proportion than those of an adult. but, if they be actually larger than they ought to be, let them be well rubbed for a quarter of an hour at a time night and morning, with soap liniment, and then apply a broad flannel belt. "a broad flannel belt worn night and day, firm but not tight, is very serviceable." [footnote: sir charles locock, in a _letter_ to the author.] the child ought to be prevented from drinking as much as he has been in the habit of doing; let him be encouraged to exercise himself well in the open air; and let strict regard be paid to his diet. 249. _what are the best aperients for a child_? if it be _actually_ necessary to give him opening medicine, one or two tea-spoonfuls of syrup of senna, repeated, if necessary, in four hours, will generally answer the purpose; or, for a change, one or two tea-spoonfuls of castor oil may be substituted. lenitive electuary (compound confection of senna) is another excellent aperient for the young, it being mild in its operation, and pleasant to take; a child fancying it is nothing more than jam, and which it much resembles both in appearance and in taste. the dose is half or one tea-spoonful early in the morning occasionally. senna is an admirable aperient for a child, and is a safe one, which is more than can be said of many others. it is worthy of note that "the taste of senna may be concealed by sweeting the infusion, [footnote: infusion of senna may be procured of any respectable druggist. it will take about one or two table-spoonfuls, or even more, of the infusion (according to the age of the child, and the obstinacy of the bowels), to act as an aperient. of course, you yourself will be able, from time to time, as the need arises, to add the milk and the sugar, and thus to make it palatable. it ought to be given warm, so as the more to resemble tea.] adding milk, and drinking as ordinary tea, which, when thus prepared, it much resembles" [footnote: _waring's manual of practical therapeutics._] honey, too, is a nice aperient for a child--a tea-spoonful ought to be given either by itself, or spread on a slice of bread. some mothers are in the habit of giving their children jalap gingerbread. i do not approve of it, as jalap is a drastic, griping purgative; besides, jalap is very nasty to take--nothing will make it palatable. fluid magnesia--solution of carbonate of magnesia--is a good aperient for a child; and, as it has very little taste, is readily given, more especially if made palatable by the addition either of a little syrup or of brown sugar. the advantages which it has over the old solid form are, that it is colourless and nearly tasteless, and never forms concretions in the bowels, as the _solid_ magnesia, if persevered in for any length of time, sometimes does. a child of two or three years old may take one or two table-spoonfuls of the fluid; either by itself or in his food, repeating it every four hours until the bowels be open. when the child is old enough to drink the draught off _immediately_, the addition of one or two tea-spoonfuls of lemon juice to each dose of the fluid magnesia, makes a pleasant effervescing draught, and increases its efficacy as an aperient. bran-bread [footnote: one-part of bran to three parts of flour, mixed together and made into bread.] and _treacle_ will frequently open the bowels; and as treacle is wholesome, it may be substituted for butter when the bowels are inclined to be costive. a roasted apple, eaten with _raw_ sugar, is another excellent mild aperient for a child. milk gruel--that is to say, milk thickened with oatmeal--forms an excellent food for him, and often keeps his bowels regular, and thus (_which is a very important consideration_) supersedes the necessity of giving him an aperient. an orange (taking care he does not eat the peel or the pulp), or a fig after dinner, or a few muscatel raisins, will frequently regulate the bowels. stewed prunes is another admirable remedy for the costiveness of a child. the manner of stewing them is as follows:--put a pound of prunes in a brown jar, add two table-spoonfuls of _raw_ sugar, then cover the prunes and the sugar with cold water; place them in the oven, and let them stew for four hours. a child should every morning eat half a dozen or a dozen of them, until the bowels be relieved, taking care that he does not swallow the stones. stewed prunes may be given in treacle--treacle increasing the aperient properties of the prunes. a suppository is a mild and ready way of opening the bowels of a child. when he is two or three years old and upwards, a _candle_ suppository is better than a _soap_ suppository. the way of preparing it is as follows:--cut a piece of dip-tallow candle--the length of three inches--and insert it as you would a clyster pipe, about two inches up the fundament, allowing the remaining inch to be in sight, and there let the suppository remain until the bowels be opened. another excellent method of opening a child's bowels is by means of an enema of warm water,--from half a tea-cupful to a tea-cupful, or even more, according to the age of the child. i cannot speak too highly of this plan as a remedy for costiveness, as it entirely, in the generality of cases, prevents the necessity of administering a particle of aperient medicine by the mouth. the fact of its doing so stamps it as a most valuable remedy--opening physic being, as a rule, most objectionable, and injurious to a child's bowels. bear this fact--for it is a fact--in mind and let it be always remembered. 450. _what are the most frequent causes of protrusion of the lower-bowel_? the too common and reprehensible practice of a parent administering frequent aperients, especially calomel and jalap, to her child. another cause, is allowing him to remain for a quarter of an hour or more at a time on his chair; this induces him to strain, and to force the gut down. 251. _what are the remedies_? if the protrusion of the bowel have been brought on by the abase of aperients, abstain, for the future from giving them; but if medicine be absolutely required, give the mildest--such as either syrup of senna or castor oil--_and the less of those the better._ if the _external_ application of a purgative will have the desired effects it will in such cases, be better than the _internal_ administration of aperients. castor oil used as a liniment is a good one for the purpose. let the bowels be well rubbed, every night and morning, for five minutes at a time with the oil. a wet compress to the bowels will frequently open them, and will thus do away with the necessity of giving an aperient--_a most important consideration_. fold a napkin in six thicknesses, soak it in _cold_ water, and apply it to the bowels; over which put either a thin covering or sheet of gutta-percha, or a piece of oiled-silk; keep it in its place with a broad flannel roller; and let it remain on the bowels for three or four hours, or until they be opened. try what diet will do, as opening the bowels by a regulated diet is far preferable to the giving of aperients. let him have either bran-bread or robinson's patent groats, or robinson's pure scotch oatmeal made into gruel with new milk, or du barry's arabica revalenta, or a slice of huntly and palmer's lump gingerbread. let him eat stewed prunes, stewed rhubarb, roasted apples, strawberries, raspberries, the inside of grapes and gooseberries, figs, &c. give him early every morning a draught of _cold_ water. let me, again, urge you _not_ to give aperients in these cases, or in any case, unless you are absolutely compelled. by following my advice you will save yourself an immense deal of trouble, and your child a long catalogue of misery. again, i say, look well into the matter, and whenever it be practicable avoid purgatives. now, with regard to the best manner of returning the bowel, lay the child upon the bed on his face and bowels, with his hips a little raised; then smear lard on the forefinger of your right hand (taking care that the nail be cut close), and gently with, your fore-finger press the bowel into its proper place. remember, if the above methods be observed, you cannot do the slightest injury to the bowel; and the sooner it be returned, the better it will be for the child; for if the bowel be allowed to remain long down, it may slough or mortify, and death may ensue. the nurse, every time he has a motion, must see that the bowel does not come down, and if it does, she ought instantly to return it. moreover, the nurse should be careful _not_ to allow the child to remain on his chair more than two or three minutes at a time. another excellent remedy for the protrusion of the lower bowel, is to use every morning a cold salt and water sitz bath. there need not be more than a depth of three inches of water in the bath; a small handful of table salt should be dissolved in the water; a dash of warm water in the winter time must be added, to take off the extreme chill; and the child ought not to be allowed to sit in the bath for more than one minute, or whilst the mother can count a hundred; taking care, the while, to throw either a square of flannel or a small shawl over his shoulders. the sitz bath ought to be continued for months, or until the complaint be removed. i cannot speak in too high praise of these baths. 252. _do you advise me, every spring and fall, to give my child brimstone to purify and sweeten his blood, and as a preventive medicine_? certainly not; if you wish to take away his appetite, and to weaken and depress him, give brimstone! brimstone is not a remedy fit for a child's stomach. the principal use and value of brimstone is as an external application in itch, and as an internal remedy, mixed with other laxatives, in piles--piles being a complaint of adults. in olden times poor unfortunate children were dosed, every spring and fall, with brimstone and treacle to sweeten their blood! fortunately for the present race, there is not so much of that folly practised, but still there is room for improvement. to dose a _healthy_ child with physic is the grossest absurdity. no, the less physic a delicate child has the better it will be for him, but physic to a healthy child is downright poison! and brimstone of all medicines! it is both weakening and depressing to the system, and by opening the pores of the skin and by relaxing the bowels, is likely to give cold, and thus to make a healthy, a sickly child. sweeten his blood! it is more likely to weaken his blood, and thus to make his blood impure! blood is not made pure by drugs, but by nature's medicine; by exercise, by pure air, by wholesome diet, by sleep in a well-ventilated apartment, by regular and thorough ablution. brimstone a preventive medicine! preventive medicine--and brimstone especially in the guise of a preventive medicine--is "a mockery, a delusion, and a snare." 253. _when a child is delicate, and his body, without any assignable cause, is gradually wasting away, and the stomach rejects all food that is taken, what plan can be adopted likely to support his strength, and thus probably be the means of saving his life_? i have seen, in such a case, great benefit to arise from half a tea-cupful of either strong mutton-broth or of strong beef-tea, used as an enema every four hours. [footnote: an enema apparatus is an important requisite in every nursery; it may be procured of any respectable surgical instrument maker. the india-rubber enema bottle is, for a child's use, a great improvement on the old syringe, as it is not so likely to get out of order, and, moreover, is more easily used.] it should be administered slowly, in order that it may remain in the bowel. if the child be sinking, either a dessert-spoonful of brandy, or half a wine-glassful of port wine, ought to be added to each enema. the above plan ought only to be adopted if there be _no_ diarrhoea. if there be diarrhoea, an enema must _not_ be used. then, provided there be great wasting away, and extreme exhaustion, and other remedies having failed, it would be advisable to give, by the mouth, _raw_ beef of the finest quality, which ought to be taken from the hip bone, and should be shredded very fine. all fat and skin must be carefully removed. one or two tea-spoonfuls (according to the age of the child) ought to be given every four hours. the giving of _raw_ meat to children in exhaustive diseases, such as excessive long-standing diarrhoea, was introduced into practice by a russian physician, a professor wiesse of st petersburg. it certainly is, in these cases, a most valuable remedy, and has frequently been the means of snatching such patients from the jaws of death. children usually take raw meat with avidity and with a relish. 254. _if a child be naturally delicate, what plan would you recommend to strengthen him_? i should advise strict attention to the rules above mentioned, and _change of air_--more especially, if it be possible, to the coast. change of air, sometimes, upon a delicate child, acts like magic, and may restore him to health when all other means have failed. if a girl be delicate, "carry her off to the farm, there to undergo the discipline of new milk, brown bread, early hours, no lessons, and romps in the hay-field."--_blackwood_. this advice is, of course, equally applicable for a delicate boy, as delicate boys and delicate girls ought to be treated alike. unfortunately in these very enlightened days there is too great a distinction made in the respective management and treatment of boys and girls. the best medicines for a delicate child will be the wine of iron and cod-liver oil. give them combined in the manner i shall advise when speaking of the treatment of rickets. in diseases of long standing, and that resist the usual remedies, there is nothing like _change of air_. hippocrates, the father of medicine, says- "in longis morbis solum mutare." (in tedious diseases to change the place of residence.) a child who, in the winter, is always catching cold, whose life during half of the year is one continued catarrh, who is in consequence, likely, if he grow up at all, to grow up a confirmed invalid, ought, during the winter months, to seek another clime; and if the parents can afford the expense, they should at the beginning of october, cause him to bend his steps to the south of europe--mentone being as good a place as they could probably fix upon. 255. _do you approve of sea bathing for a delicate young child_? no: he is frequently so frightened by it that the alarm would do him more harm than the bathing would do him good. the better plan would be to have him every morning well sponged, especially his back and loins, with sea water; and to have him as much as possible carried on the beach, in order that he may inhale the sea breezes. when he be older, and is not frightened at being dipped, sea bathing will be very beneficial to him. if bathing is to do good, either to an adult or to a child, it must be anticipated with pleasure, and neither with dread nor with distaste. 256. _what is the best method for administering medicine to a child_? if he be old enough, appeal to his reason; for, if a mother endeavour to deceive her child, and he detect her, he will for the future suspect her. if he be too young to be reasoned with, then, if he will not take his medicine, he must be compelled. lay him across your knees, let both his hands and his nose be tightly held, and then, by means of the patent medicine-spoon, or, if that be not at hand, by either a tea or a dessert-spoon, pour the medicine down his throat, and he will be obliged to swallow it. it may be said that this is a cruel procedure; but it is the only way to compel an unruly child to take physic, and is much less cruel than running the risk of his dying from the medicine not having been administered. [footnote: if any of my medical brethren should perchance read these conversations, i respectfully and earnestly recommend them to take more pains in making medicines for children pleasant and palatable. i am convinced that, in the generality of instances, provided a little more care and thought were bestowed on the subject, it may be done; and what an amount of both trouble and annoyance it would save! it is really painful to witness the struggles and cries of a child when _nauseous_ medicine is to be given; the passion and excitement often do more harm than the medicine does good.] 257. _ought a sick child to be roused from his sleep to give him physic, when it is time for him to take it_? on no account, as sleep, being a natural restorative, must not be interfered with. a mother cannot be too particular in administering the medicine, at stated periods, whilst he is awake. 258. _have you any remarks to make on the management of a sick-room, and have you any directions to give on the nursing of a child_? in sickness select a large and lofty room; if in the town, the back of the house will be preferable--in order to keep the patient free from noise and bustle--as a sick-chamber cannot be kept too quiet. be sure that there be a chimney in the room--as there ought to be in _every_ room in the house--and that it be not stopped, as it will help to carry off the impure air of the apartment. keep the chamber _well ventilated_, by, from time to time, opening the window. the air of the apartment cannot be too pure; therefore, let the evacuations from the bowels be instantly removed, either to a distant part of the house, or to an out-house or to the cellar, as it might be necessary to keep them for the medical man's inspection. before using either the night-commode, or the _pot-de-chambre_, let a little water, to the depth of one or two inches, be put in the pan, or _pot_; in order to sweeten the motion, and to prevent the faecal matter from adhering to the vessel. let there be frequent change of linen, as in sickness it is even more necessary than in health, more especially if the complaint be fever. in an attack of fever, clean sheets ought, every other day, to be put on the bed; clean body-linen every day. a frequent change of linen in sickness is most refreshing. if the complaint be fever, a fire in the grate will not be necessary. should it be a case either of inflammation of the lungs or of the chest, a small fire in the winter time is desirable, keeping the temperature of the room as nearly as possible at 60 degrees fahrenheit. bear in mind that a large fire in a sick-room cannot be too strongly condemned; for if there be fever--and there are scarcely any complaints without--a large fire only increases it. small fires, in cases either of inflammation of the lungs or of the chest, in the winter time, encourage ventilation of the apartment, and thus carry off impure air. if it be summer time, of course fires would be improper. a thermometer is an indispensable requisite in a sick-room. in fever, free and thorough ventilation is of vital importance, more especially in scarlet fever; then a patient cannot have too much air; in scarlet fever, for the first few days the windows, be it winter or summer, must to the widest extent be opened. the fear of the patient catching cold by doing so is one of the numerous prejudices and baseless fears that haunt the nursery, and the sooner it is exploded the better it will he for human life. the valances and bed-curtains ought to be removed, and there should be as little furniture in the room as possible. if it be a case of measles, it will be necessary to adopt a different course; then the windows ought not to be opened, but the door must from time to time be left ajar. in a case of measles, if it be winter time, a _small_ fire in the room will be necessary. in inflammation of the lungs or of the chest, the windows should not be opened, but the door ought occasionally to be left unfastened, in order to change the air and to make it pure. remember, then, that ventilation, either by open window or by open door, is in all diseases most necessary. ventilation is one of the best friends a doctor has. in fever, do not load the bed with clothes; in the summer a sheet is sufficient, in winter a sheet and a blanket. in fever, do not be afraid of allowing the patient plenty either of cold water or of cold toast and water; nature will tell him when he has had enough. in measles, let the chill be taken off the toast and water. in _croup_, have always ready a plentiful supply of hot water, in case a warm bath might he required. in _child-crowing_, have always in the sick-room a supply of cold water, ready at a moment's notice to dash upon the face. in fever, do not let the little patient lie on the lap; he will rest more comfortably on a horse-hair mattress in his crib or cot. if he have pain in the bowels, the lap is most agreeable to him; the warmth of the body, either of the mother or of the nurse, soothes him; besides, if he be on the lap, he can be turned on his stomach and on his bowels, which, often affords him great relief and comfort. if he be much emaciated, when he is nursed, place a pillow upon the lap and let him lie upon it. in _head affections_, darken the room with a _green_ calico blind; keep the chamber more than usually quiet; let what little talking is necessary be carried on in whispers, but the less of that the better; and in _head affections_, never allow smelling salts to be applied to the nose, as they only increase the flow of blood to the head, and consequently do harm. it is often a good sign for a child, who is seriously ill, to suddenly become cross. it is then he begins to feel his weakness and to give vent to his feelings. "children are almost always cross when recovering from an illness, however patient they may have been during its severest moments, and the phenomenon is not by any means confined to children."--geo. mcdonald. a sick child must _not_ be stuffed with _much_ food at a time. he will take either a table-spoonful of new milk or a table-spoonful of chicken broth every half hour with greater advantage than a tea-cupful of either the one or the other every four hours, which large quantity would very probably be rejected from his stomach, and may cause the unfortunately treated child to die of starvation! if a sick child be peevish, attract his attention either by a toy or by an ornament; if he be cross, win him over to good humour by love, affection, and caresses, but let it be done gently and without noise. do not let visitors see him; they will only excite, distract, and irritate him, and help to consume the oxygen of the atmosphere, and thus rob the air of its exhilarating health-giving qualities and purity; a sick-room, therefore, is not a proper place, either for visitors or for gossips. in selecting a sick-nurse, let her be gentle, patient, cheerful, quiet, and kind, but firm withal; she ought to be neither old nor young: if she be old she is often garrulous and prejudiced, and thinks too much of her trouble; if she he young, she is frequently thoughtless and noisy; therefore choose a middle-aged woman. do not let there be in the sick-room more than, besides the mother, one efficient nurse; a greater number can he of no service--they will only be in each other's way, and will distract the patient. let stillness, especially if the head be the part affected, reign in a sick-room. creaking shoes [footnote: nurses at these times ought to wear slippers, and not shoes. the best slippers in sick-rooms are those manufactured by the north british rubber company, edinburgh; they enable nurses to walk in them about the room without causing the slightest noise; indeed, they might truly be called "the noiseless slipper," a great desideratum in such cases, more especially in all head affections of children. if the above slippers cannot readily be obtained, then list slippers--soles and all bring made of list--will answer the purpose equally as well.] and rustling silk dresses ought not to be worn in sick-chambers--they are quite out of place there. if the child be asleep, or if he be dozing, perfect stillness must he enjoined, not even a whisper should be heard:- "in the sick-room be calm, more gently and with care. lest any jar or sudden noise, come sharply unaware. you cannot tell the harm. the mischief it may bring, to wake the sick one suddenly, besides the suffering. the broken sleep excites fresh pain, increased distress; the quiet slumber undisturb'd soothes pain and restlessness. sleep is the gift of god: oh! bear these words at heart, 'he giveth his beloved sleep,' and gently do thy part." [footnote: _household verses on health and happiness._ london: jarrold and sons. a most delightful little volume.] if there be other children, let them be removed to a distant part of the house; or, if the disease be of an infectious nature, let them be sent away from home altogether. in all illnesses--and bear in mind the following is most important advice--a child must be encouraged to try and make water, whether he ask or not, at least four times during the twenty-four hours; and at any other time, if he express the slightest inclination to do so. i have known a little fellow to hold his water, to his great detriment, for twelve hours, because either the mother bad in her trouble forgotten to inquire, or the child himself was either too ill or too indolent to make the attempt. see that the medical man's directions are, to the very letter, carried out. do not fancy that you know better than he does, otherwise you have no business to employ him. let him, then, have your implicit confidence and your exact obedience. what _you_ may consider to be a trifling matter, may frequently be of the utmost importance, and may sometimes decide whether the case shall end either in life or death! _lice_.--it is not very poetical, as many of the grim facts of every-day life are not, but, unlike a great deal of poetry, it is unfortunately too true that after a severe and dangerous illness, especially after a bad attack of fever, a child's head frequently becomes infested with vermin--with lice. it therefore behoves a mother herself to thoroughly examine, by means of a fine-tooth comb, [footnote: which fine-tooth comb ought not to be used at any other time except for the purpose of examination, as the constant use of a fine-tooth comb would scratch the scalp, and would encourage a quantity of scurf to accumulate.] her child's head, in order to satisfy her mind that there be no vermin there. as soon as he be well enough, he ought to resume his regular ablutions--that is to say, that he must go again regularly into his tub, and have his head every morning thoroughly washed with soap and water. a mother ought to be particular in seeing that the nurse washes the hair-brush at least once every week; if she does not do so, the dirty brush which had during the illness been used, might contain the "nits"--the eggs of the lice--and would thus propagate the vermin, as they will, when on the head of the child, soon hatch. if there be already lice on the head, in addition to the regular washing every morning with the soap and water, and after the head has been thoroughly dried, let the hair be well and plentifully dressed with camphorated oil--the oil being allowed to remain on until the next washing on the following morning. lice cannot live in oil (more especially if, as in camphorated oil, camphor be dissolved in it), and as the camphorated oil will not, in the slightest degree, injure the hair, it is the best application that can be used. but as soon as the vermin have disappeared, let the oil be discontinued, as the _natural oil_ of the hair is, at other times, the only oil that is required on the head. the "nit"--the egg of the louse--might be distinguished from scurf (although to the _naked_ eye it is very much like it in appearance) by the former fastening firmly on one of the hairs as a barnacle would on a rock, and by it not being readily brushed off as scurf would, which latter (scurf) is always loose. 259. _my child, in the summer time, is much tormented with fleas: what are the best remedies_? a small muslin bag, filled with camphor, placed in the cot or bed, will drive fleas away. each flea-bite should, from time to time, be dressed by means of a camel's hair brush, with a drop or two of spirit of camphor; an ounce bottle of which ought, for the purpose, to be procured from a chemist. camphor is also an excellent remedy to prevent bugs from biting. bugs and fleas have a horror of camphor; and well they might, for it is death to them! there is a famous remedy for the destruction of fleas manufactured in france, entitled "_la poudre insecticide,_" which, although perfectly harmless to the human economy, is utterly destructive to fleas. bugs are best destroyed either by creosote or by oil of turpentine: the places they do love to congregate in should be well saturated by means of a brush, with the creosote or with the oil of turpentine. a few dressings will effectually destroy both them and their young ones. 260. _is not the pulse a great sign either of health or of disease_? it is, and every mother should have a general idea of what the pulse of children of different ages should be both in health and in disease. "every person should know how to ascertain the state of the pulse in health; then, by comparing it with what it is when he is ailing, he may have some idea of the urgency of his case. parents should know the healthy pulse of each child, since now and then a person is born with a peculiarly slow or fast pulse, and the very case in hand may be of such peculiarity. an infant's pulse is 140, a child of seven about 80, and from 20 to 60 years it is 70 beats a minute, declining to 60 at fourscore. a healthful grown person beats 70 times in a minute, declining to 60 at fourscore. at 60, if the pulse always exceeds 70, there is a disease; the machine working itself out, there is a fever or inflammation somewhere, and the body is feeding on itself, as in consumption, when the pulse is quick." 261. _suppose a child to have had an attack either of inflammation of the lungs or of bronchitis, and to be much predisposed to a return: what precautions would you take to prevent either the one or the other for the future_? i would recommend him to wear fine flannel instead of lawn shirts; to wear good lamb's-wool stockings _above the knees_, and good, strong, dry shoes to his feet; to live, weather permitting, a great part of every day in the open air; to strengthen his system by good nourishing food--by an abundance of both milk and meat (the former especially); to send him, in the autumn, for a couple of months, to the sea-side; to administer to him, from time to time, cod-liver oil; in short, to think only of his health, and to let learning, until he be stronger, be left alone. i also advise either table salt or bay salt, or tidman's sea salt, to be added to the water in which the child is washed with in the morning, in a similar manner as recommended in answer to a previous question. 262. _then do you not advise such a child to be confined within doors_? if any inflammation be present, or if he have but just recovered from one, it would be improper to send him into the open air, but not otherwise, as the fresh air would be a likely means of strengthening the lungs, and thereby of preventing an attack of inflammation for the future. besides, the more a child is coddled within doors, the more likely will he be to catch cold, and to renew the inflammation. if the weather be cold, yet neither wet nor damp, he ought to be sent out, but let him be well clothed; and the nurse should have strict injunctions _not_ to stand about entries or in any draughts--indeed, not to stand about at all, but to keep walking about all the time she is in the open air. unless you have a trustworthy nurse, it will be well for you either to accompany her in her walk with your child, or merely to allow her to walk with him in the garden, as you can then keep your eye upon both of them. 263. _if a child be either chicken-breasted, or if he be narrow-chested, are there any means of expanding and of strengthening his chest_? learning ought to be put out of the question, attention must be paid to his health alone, or consumption will probably mark him as its own! let him live as much as possible in the open air; if it be country, so much the better. let him rise early in the morning, and let him go to bed betimes; and if he be old enough to use the dumb-bells, or what is better, an india-rubber chest-expander, he should do so daily. he ought also to be encouraged to use two short sticks, similar to, but heavier than, a policeman's staff, and to go, every morning, through regular exercises with them. as soon as he is old enough, let him have lessons from a drill-sergeant and from a dancing master. let him be made both to walk and to sit upright, and let him be kept as much as possible upon a milk diet, [footnote: where milk does not agree, it may generally be made to do so by the addition of one part of lime water to seven parts of new milk. moreover, the lime will be of service in hardening his bones, and, in these cases, the bones require hardening.] and give him as much as he can eat of fresh meat every day. cod liver oil, a tea-spoonful or a dessert-spoonful, according to his age, twice a day, is serviceable in these cases. stimulants ought to be carefully avoided. in short, let every means be used to nourish, to strengthen, and invigorate the system, without, at the same time, creating fever. such a child should be a child of nature, he ought almost to live in the open air, and throw his books to the winds. of what use is learning without health? in such a case as this you cannot have both. 264. _if a child be round-shouldered, or if either of his shoulder-blades have "grown out," what had better be done_? many children have either round shoulders, or have their shoulder blades grown out, or have their spines twisted, from growing too fast, from being allowed to slouch in their gait, and from not having sufficient nourishing food, such as meat and milk, to support them while the rapid growth of childhood is going on. if your child be affected as above described, nourish him well on milk and on farinaceous food, and on meat once a day, but let milk be his staple diet; he ought, during the twenty four hours, to take two or three pints of new milk. he should almost live in the open air, and must have plenty of play. if you can so contrive it, let him live in the country. when tired, let him lie, for half an hour, two or three times daily, flat on his back on the carpet. let him rest at night on a horse-hair mattress, and not on a feather bed. let him have every morning, if it be summer, a thorough cold water ablution, if it be winter, let the water be made tepid. let either two handfuls of table salt or a handful of bay salt be dissolved in the water. let the salt and water stream well over his shoulders and down his back and loins. let him be well dried with a moderately coarse towel, and then let his back be well rubbed, and his shoulders be thrown back-exercising them much in the same manner as in skipping, for five or ten minutes at a time. skipping, by-the-by, is of great use in these cases, whether the child be either a boy or a girl-using, of course, the rope backwards, and not forwards. let books be utterly discarded until his shoulders have become strong, and thus no longer round, and his shoulder-blades have become straight. it is a painful sight to see a child stoop like an old man. let him have, twice daily, a tea-spoonful or a dessert-spoonful (according to his age) of cod-liver oil, giving it him on a full and not on an empty stomach. when he is old enough, let the drill-sergeant give him regular lessons, and let the dancing-master be put in requisition. let him go through regular gymnastic exercises, provided they are not of a violent character. but, bear in mind, let there be in these cases no mechanical restraints--no shoulder-straps, no abominable stays. make him straight by natural means--by making him strong. mechanical means would only, by weakening and wasting the muscles, increase the mischief, and thus the deformity. in this world of ours there is too much reliance placed on artificial, and too little on natural means of cure. 265. _what are the causes of bow legs in a child; and what is the treatment_? weakness of constitution, poor and insufficient nourishment, and putting a child, more especially a fat and heavy one, on his legs too early. _treatment._--nourishing food, such as an abundance of milk, and, if he be old enough, of meat; iron medicines; cod-liver-oil; thorough ablution, every morning of the whole body; an abundance of exercise, either on pony, or on donkey, or in carriage, but not, until his legs be stronger, on foot. if they are much bowed, it will be necessary to consult an experienced surgeon. 266. _if a child, while asleep, "wet his bed" is there any method of preventing him from doing so_? let him be held out just before he himself goes to bed, and again when the family retires to rest. if, at the time, he be asleep, he will become so accustomed to it, that he will, without awaking, make water. he ought to be made to lie on his side; for, if he be put on his back, the urine will rest upon an irritable part of the bladder, and, if he be inclined to wet his bed, he will not be able to avoid doing so. he must not be allowed to drink much with his meals, especially with his supper. wetting the bed is an infirmity with some children--they cannot help it. it is, therefore, cruel to scold and chastise them for it. occasionally, however, wetting the bed arises from idleness; in which case, of course, a little wholesome correction might be necessary. water-proof bed-sheeting--one yard by three-quarters of a yard--will effectually preserve the bed from being wetted, and ought always, on these occasions, to be used. a mother ought, every morning, to ascertain for herself, whether a child have wet his bed; if he have, and if, unfortunately, the water-proof cloth have not been used, the mattress, sheets, and blankets must be instantly taken to the kitchen fire and be properly dried. inattention to the above has frequently caused a child to suffer either from cold, from a fever, or from an inflammation; not only so, but, if they be not dried, he is wallowing in filth and in an offensive effluvium. if both mother and nurse were more attentive to their duties--in frequently holding a child out, whether he ask or not--a child wetting his bed would be the exception, and not, as it frequently is, the rule. if a child be dirty, you may depend upon it, the right persons to blame are the mother and the nurse, and not the child! 267. _if a child should catch small-pox, what are the best means to prevent pitting_? he ought to be desired neither to pick nor to rub the pustules. if he be too young to attend to these directions, his hands must be secured in bags (just large enough to hold them), which bags should he fastened round the wrists. the nails must be cut very close. cream smeared, by means of a feather, frequently in the day, on the pustules, affords great comfort and benefit. tripe liquor (without salt) has, for the same purpose, been strongly recommended. i myself, in several cases, have tried it, and with the happiest results. it is most soothing, comforting, and healing to the skin. 268. _can you, tell me of any plan to prevent chilblaine, or, if a child be suffering from them, to cure them_? _first, then, the way to prevent them._--let a child, who is subject to them, wear, in the winter time, a square piece of wash-leather over the toes, a pair of warm lamb's-wool stockings, and good shoes; but, above all, let him be encouraged to run about the house as much as possible, especially before going to bed; and on no account allow him either to warm has feet before the fire, or to bathe them in hot water. if the feet be cold, and the child be too young to take exercise, then let them be well rubbed with the warm hand. if adults suffer from chilblains, i have found friction, night and morning, with horse-hail flesh-gloves, the best means of preventing them. _secondly, the way to cure them._--if they be unbroken: the old-fashioned remedy of onion and salt is one of the best of remedies. cut an onion in two; take one-half of it, dip it in table salt and well rub, for two or three minutes, the chilblain with it. the onion and salt is a famous remedy to relieve that intolerable itching which sometimes accompanies chilblains: then let them be covered with a piece of lint, over which a piece of wash-leather should be placed. _if they be broken_, let a piece of lint be spread with spermaceti-cerate, and be applied, every morning, to the part, and let a white-bread poultice be used every night. 269. _during the winter time my child's hands, legs, &c., chap very much; what ought i to do_? let a tea-cupful of bran be tied up in a muslin bag, and be put, over the night, into either a large water-can or jug of _rain_ water; [footnote: _rain_ water ought _always_ to be used in the washing of a child; pump water is likely to chap the skin, and to make it both rough and irritable.] and let this water from the can or jug be the water he is to be washed with on the following morning, and every morning until the chaps be cured. as often as water is withdrawn, either from the water-can or from the jog, let fresh rain water take its place, in order that the bran may be constantly soaking in it. the bran in the bag should be renewed about twice a week. take particular care to dry the skin well every time he be washed; then, after each ablution, as well as every night at bed-time, rub a piece of deer's suet over the parts affected: a few dressings will perform a cure. the deer's suet may be bought at any of the shops where venison is sold. another excellent remedy is glycerine, [footnote: glycerine prepared by price's patent candle company is by far the best. sometimes, if the child's skin be very irritable, the glycerine requires diluting with water--say, two ounces of glycerine to be mixed in a bottle with four ounces of rain water--the bottle to be well shaken just before using it.] which should be smeared, by means of the finger or by a camel's hair brush, on the parts affected, two or three times a day. if the child be very young, it might be necessary to dilute the glycerine with rose-water; fill a small bottle one-third with glycerine, and fill up the remaining two-thuds of the bottle with rose-water--shaking the bottle every time just before using it. the best soap to use for chapped hands is the glycerine soap: no other being required. 270. _what is the best remedy for chapped lips_? cold-cream (which may be procured of any respectable chemist) is an excellent application for _chapped lips_. it ought, by means of the finger, to be frequently smeared on the parts affected. 271. _have the goodness to inform me of the different varieties of worms that infest a child's bowels_? principally three--1, the tape-worm; 2, the long round-worm; and 3, the most frequent of all, the common thread or maw-worm. the tape-worm infests the whole course of the bowels, both small and large: the long round-worm, principally the small bowels, occasionally the stomach; it sometimes crawls out of the child's mouth, causing alarm to the mother; there is, of course, no danger in its doing so: the common thread-worm or maw-worm infests the rectum or fundament. 272. _what are the causes of worms_? the causes of worms are: weak bowels; bad and improper food, such as unripe, unsound, or uncooked fruit, and much green vegetables; pork, especially underdone pork; [footnote: one frequent, if not the most frequent, cause of tape-worm is the eating of pork, more especially if it be underdone. _underdone_ pork is the most unwholesome food that can he eaten, and is the most frequent cause of tape-worm known. _underdone_ beef also gives tape-worm; let the meat, therefore, be well and properly cooked. these facts ought to be borne in mind, as prevention is always better than cure.] an abundance of sweets; the neglecting of giving salt in the food. 273. _what are the symptoms and the treatment of worms_? _the symptoms_ of worms are--emaciation; itching and picking of the nose; a dark mark under the eyes; grating, during sleep, of the teeth; starting in the sleep; foul breath; furred tongue; uncertain appetite--sometimes voracious, at other times bad, the little patient sitting down very hungry to his dinner, and before scarcely tasting a mouthful, the appetite vanishing; large bowels; colicky pains of the bowels; slimy motions; itching of the fundament. tape-worm and round-worm, more especially the former, are apt, in children, to produce convulsions. tape-worm is very weakening to the constitution, and usually causes great emaciation and general ill-health; the sooner, therefore, it is expelled from the bowels the better it will be for the patient. many of the obscure diseases of children arise from worms. in all doubtful cases, therefore, this fact should be borne in mind, in order that a thorough investigation may be instituted. with regard to _treatment_, a medical man ought, of course, to be consulted. he will soon use means both to dislodge them, and to prevent a future recurrence of them. let me caution a mother never to give her child patent medicines for the destruction of worms. there is one favourite quack powder, which is composed principally of large doses of calomel, and which is quite as likely to destroy the patient as the worms! no, if your child have worms, put him under the care of a judicious medical man, who will soon expel them, without, at the same tune, injuring health or constitution! 274. _how may worms be prevented from infesting a child's bowels_? worms generally infest _weak_ bowels; hence, the moment a child becomes strong worms cease to exist. the reason why a child is so subject to them is owing to the improper food which is usually given to him. when he be stuffed with unsound and with unripe fruits, with much sweets, with rich puddings, and with pastry, and when he is oftentimes allowed to eat his meat _without_ salt, and to _bolt_ his food without chewing it, is there any wonder that he should suffer from worms? the way to prevent them is to avoid such things, and, at the same time, to give him plenty of salt to his _fresh_ and well-cooked meat. salt strengthens and assists digestion, and is absolutely necessary to the human economy. salt is emphatically a worm destroyer. the truth of this statement may be readily tested by sprinkling a little salt on the common earth-worm. "what a comfort and real requisite to human life is salt! it enters into the constituents of the human blood, and to do without it is wholly impossible."--_the grocer_. to do without it is wholly impossible! these are true words. look well to it, therefore, ye mothers, and beware of the consequences of neglecting such advice, and see for yourselves that your children regularly eat salt with their food. if they neglect eating salt with their food, they _must of necessity have worms_, and worms that will eventually injure them, and make them miserable. all food, then, should be "flavoured with salt;" _flavoured_, that is to say, salt should be used in each and every kind of food--_not in excess, but in moderation_. 275. _you have a great objection to the frequent administration of aperient medicines to a child: can you advise any method to prevent their use_? although we can scarcely call constipation a disease, yet it sometimes leads to disease. the frequent giving of aperients only adds to the stubbornness of the bowels. i have generally found a draught, early every morning, of _cold_ pump water, the eating either of huntley and palmer's loaf ginger-bread, or of oatmeal gingerbread, a variety of animal and vegetable food, ripe sound fruit, muscatel raisins, a fig, or an orange after dinner, and, when he be old enough, _coffee_ and milk instead of _tea_ and milk, to have the desired effect, more especially if, for a time, aperients be studiously avoided. 276. _have you any remarks to make on rickets_? rickets is owing to a want of a sufficient quantity of earthy matter in the bones; hence the bones bend and twist, and lose their shape, causing deformity. rickets generally begins to show itself between the first and second years of a child's life. such children are generally late in cutting their teeth, and when the teeth do come they are bad, deficient of enamel, discoloured, and readily decay. a rickety child is generally stunted in stature; he has a large head, with overhanging forehead, or what nurses call a watery-head-shaped forehead. the fontanelles, or openings of the head, as they are called, are a long time in closing. a rickety child is usually talented; his brain seems to thrive at the expense of his general health. his breast-bone projects out, and the sides of his chest are flattened; hence he becomes what is called chicken-breasted or pigeon-breasted; his spine is usually twisted, so that he is quite awry, and, in a bad case, he is hump-backed; the ribs, from the twisted spine, on one side bulge out; he is round-shouldered; the long bones of his body, being soft, bend; he is bow-legged, knock-kneed, and weak-ankled. rickets are of various degrees of intensity, the humpbacked being among the worst there are many mild forms of rickets; weak ankles, knocked-knees, bowed-legs, chicken-breasts, being among the latter number. many a child, who is not exactly hump-backed, is very round-shouldered, which latter is also a mild species of rickets. show me a child that is rickety, and i can generally prove that it is owing to poor living, more especially to poor milk. if milk were always genuine, and if a child had an abundance of it, my belief is that rickets would be a very rare disease. the importance of genuine milk is of national importance. we cannot have a race of strong men and women unless, as children, they have had a good and plentiful supply of milk. it is utterly impossible. milk might well be considered one of the necessaries of a child's existence. genuine, fresh milk, then, is one of the grand preventatives, as well as one of the best remedies, for rickets. many a child would not now have to swallow quantities of cod-liver oil if previously he had imbibed quantities of good genuine milk. an insufficient and a poor supply of milk in childhood sows the seeds of many diseases, and death often gathers the fruit. can it be wondered at, when there is so much poor and nasty milk in england, that rickets in one shape or another is so prevalent? when will mothers arouse from their slumbers, rub their eyes, and see clearly the importance of the subject? when will they know that all the symptoms of rickets i have just enumerated _usually_ proceed from the want of nourishment, more especially from the want of genuine, and of an abundance of, milk? there are, of, course, other means of warding off rickets besides an abundance of nourishing food, such as thorough ablution, plenty of air, exercise, play, and sunshine; but of all these splendid remedies, nourishment stands at the top of the list. i do not mean to say that rickets _always_ proceeds from poorness of living--from poor milk. it sometimes arises from scrofula, and is an inheritance of one or of both the parents. rickety children, if not both carefully watched and managed, frequently, when they become youths, die of consumption. a mother, who has for some time neglected the advice i have just given, will often find, to her grievous cost, that the mischief has, past remedy, been done, and that it is now "too late!--too late!" 277. _how may a child be prevented from becoming rickety? or, if he be rickety, how ought he to be treated_? if a child be predisposed to be rickety, or if he be actually rickety, attend to the following rules:-let him live well, on good nourishing diet, such as on tender rump-steaks, cut very fine, and mixed with mashed potatoes, crumb of bread, and with the gravy of the meat. let him have, as i have before advised, an abundance of good new milk--a quart or three pints during every twenty-four hours. let him have milk in every form--as milk gruel, du barry's arabica revalenta made with milk, batter and rice puddings, suet puddings, bread and milk, etc. _to harden the bones_, let lime water be added to the milk (a table-spoonful to each tea-cupful of milk.) let him have a good supply of fresh, pure, dry air. he must almost live in the open air--the country, if practicable, in preference to the town, and the coast in summer and autumn. sea bathing and sea breezes are often, in these cases, of inestimable value. he ought not, at an early age, to be allowed to bear his weight upon his legs. he must sleep on a horse-hair mattress, and not on a feather bed. he should use every morning cold baths in the summer and tepid baths in the winter, with bay salt (a handful) dissolved in the water. friction with the hand must, for half an hour at a time, every night and morning, be sedulously applied to the back and to the limbs. it is wonderful how much good in these cases friction does. strict attention ought to be paid to the rules of health as laid down in these conversations. whatever is conducive to the general health is preventive and curative of rickets. books, if he be old enough to read them, should be thrown aside; health, and health alone, must be the one grand object. the best medicines in these cases are a combination of cod-liver oil and the wine of iron, given in the following manner:--put a tea-spoonful of wine of iron into a wine-glass, half fill the glass with water, sweeten it with a lump or two of sugar, then let a tea-spoonful of cod-liver oil swim on the top; let the child drink it all down together, twice or three times a day. an hour after a meal is the _best_ time to give the medicine, as both iron and cod-liver oil sit better on a _full_ than on an _empty_ stomach. the child in a short time will become fond of the above medicine, and will be sorry when it is discontinued. a case of rickets requires great patience and steady perseverance; let, therefore, the above plan have a fair and long-continued trial, and i can then promise that there will be every probability that great benefit will be derived from it. 278. _if a child be subject to a scabby eruption about the mouth, what is the best local application_? leave it to nature. do not, on any account, apply any local application to heal it; if you do, you may produce injury; you may either bring on an attack of inflammation, or you may throw him into convulsions. no! this "breaking-out" is frequently a safety-valve, and must not therefore be needlessly interfered with. should the eruption be severe, reduce the child's diet; keep him from butter, from gravy, and from fat meat, or, indeed, for a few days from meat altogether; and give him mild aperient medicine; but, above all things, do not quack him either with calomel or with grey-powder. 279. _will you have the goodness to describe the eruption on the face and on the head of a young child, called milk-crust or running scall_? milk-crust is a complaint of very young children--of those who are cutting their teeth--and, as it is a nasty looking complaint, and frequently gives a mother a great deal of trouble, of anxiety, and annoyance, it will be well that you should know its symptoms, its causes, and its probable duration. _symptoms_.--when a child is about nine months or a year old, small pimples are apt to break out around the ears, on the forehead, and on the head. these pimples at length become vesicles (that is to say, they contain water), which run into one large one, break, and form a nasty dirty-looking yellowish, and sometimes greenish, scab, which scab is moist, indeed, sometimes quite wet, and gives out a disagreeable odour, and which is sometimes so large on the head as actually to form a skullcap, and so extensive on the face as to form a mask. these, i am happy to say, are rare cases. the child's beauty is, of, course, for a time completely destroyed, and not only his beauty, but his good temper; for as the eruption causes great irritation and itching, he is constantly clawing himself, and crying with annoyance the great part of the day, and sometimes also of the night--the eruption preventing him from sleeping. it is not contagious, and soon after he has cut the whole of his first set of teeth it will get well, provided it has not been improperly interfered with. _causes_.--irritation from teething; stuffing him with overmuch meat, thus producing a humour, which nature tries to get rid of by throwing it out on the surface of the body; the safest place she could fix on for the purpose; hence the folly and danger of giving medicines and applying _external_ applications to drive the eruption in. "diseased nature oftentimes breaks forth in strange eruptions," and cures herself in this way, if she be not too much interfered with, and if the eruption be not driven in by injudicious treatment. i have known in such cases disastrous consequences to follow over-officiousness and meddlesomeness. nature is trying all she can to drive the humour out, while some wiseacres are doing all they can to drive the humour in. _duration_.--as milk-crust is a tedious affair, and will require a variety of treatment, it will be necessary to consult an experienced medical man; and although he will be able to afford great relief, the child will not, in all probability, be quite free from the eruption until he have cut the whole of his first set of teeth--until he be upwards of two years and a half old--when, with judicious and careful treatment, it will gradually disappear, and eventually leave not a trace behind. it will be far better to leave the case alone--to get well of itself--rather than to try to cure the complaint either by outward applications or by strong internal medicines; "the remedy is often worse than the disease," of this i am quite convinced. 280. _have you any advice to give me as to my conduct towards my medical man_? give him your entire confidence. be truthful and be candid with him. tell him the truth, the whole truth, and nothing but the truth. have no reservations; give him, as near as you can, a plain, unvarnished statement of the symptoms of the disease. do not magnify, and do not make too light of any of them. be prepared to state the exact time the child first showed symptoms of illness. if he have had a shivering fit, however slight, do not fail to tell your medical man of it. note the state of the skin; if there be a "breaking-out"--be it ever so trifling--let it be pointed out to him. make yourself acquainted with the quantity and with the appearance of the urine, taking care to have a little of it saved, in case the doctor may wish to see and examine it. take notice of the state of the motions--their number during the twenty-four hours, their colour, their smell, and their consistence, keeping one for his inspection. never leave any of these questions to be answered by a servant; a mother is the proper person to give the necessary and truthful answers, which answers frequently decide the fate of the patient. bear in mind, then, a mother's untiring care and love, attention and truthfulness, frequently decide whether, in a serious illness, the little fellow shall live or die! fearful responsibility! a medical man has arduous duties to perform; smooth, therefore, his path as much as you can, and you will be amply repaid by the increased good he will be able to do your child. strictly obey a doctor's orders--in diet, in medicine, in everything. never throw obstacles in his way. never omit any of his suggestions; for, depend upon it that if he be a sensible man, directions, however slight, ought never to be neglected; bear in mind, with a judicious medical man, "that nothing walks with aimless feet."--_tennyson_. if the case be severe, requiring a second opinion, never of your own accord call in a physician, without first consulting and advising with your own medical man. it would be an act of great discourtesy to do so. inattention to the foregoing advice has frequently caused injury to the patient, and heart-burnings and ill-will among doctors. speak, in the presence of your child, with respect and kindness of your medical man, so that the former may look upon the latter as a friend--as one who will strive, with god's blessing, to relieve his pain and suffering. remember the increased power of doing good the doctor will have if the child be induced to like, instead of dislike, him. not only be careful that you yourself speak before your child, respectfully and kindly of the medical man, but see that your domestics do so likewise; and take care that they are never allowed to frighten your child, as many silly servants do, by saying that they will send for the doctor, who will either give him nasty medicine, or will perform some cruel operation upon him. a nurse-maid should, then, never for one moment be permitted to make a doctor an object of terror or of dislike to a child. send, whenever it be practicable, for your doctor _early_ in the morning, as he will then make his arrangements accordingly, and can by daylight better ascertain the nature of the complaint, more especially if it be a skin disease. it is utterly impossible for him to form a correct opinion of the nature of a "breaking-out" either by gas or by candle light. if the illness come on at night, particularly if it be ushered in either with a severe shivering, or with any other urgent symptom, no time should be lost, be it night or day, in sending for him, "a little fire is quietly trodden out, which, being sufier'd, rivers cannot quench." _shakespeare_. warm baths 281. _have the goodness to mention the complaints of a child for which warm baths are useful_. 1. convulsions; 2. pains in the bowels, known by, the child drawing up his legs, screaming violently, etc.; 3. restlessness from teething; 4. flatulence. the warm bath acts as a fomentation to the stomach and the bowels, and gives ease where the usual remedies do not rapidly relieve. 282. _will you mention the precautions, and the rules to be observed in gutting a child info a warm bath_? carefully ascertain before he be immersed in the bath that the water be neither too hot nor too cold. carelessness, or over-anxiety to put him in the water as quickly as possible, has frequently, from his being immersed in the bath when the water was too hot, caused him great pain and suffering. from 96 to 98 degrees of fahrenheit is the proper temperature of a warm bath. if it be necessary to add fresh warm water, let him be either removed the while, or let it not be put in when very hot; for if boiling water be added to increase the heat of the bath, it naturally ascends, and may scald him. again, let the fresh water be put in at as great a distance from him as possible. the usual time for him to remain in a bath is a quarter of an hour or twenty minutes. let the chest and the bowels be rubbed with the hand while he is in the bath. let him be immersed in the bath as high up as the neck, taking care that he be the while supported under the armpits, and that his head be also rested. as soon as he comes out of the bath, he ought to be carefully but quickly rubbed dry; and if it be necessary to keep up the action on the skin, he should be put to bed, between the blankets; or if the desired relief has been obtained, between the sheets, which ought to have been previously warmed, where, most likely, he will fall into a sweet refreshing sleep. warm external applications. 283. _in case of a child suffering pain either in his stomach or in his bowels, or in case he has a feverish cold, can you tell me of the best way of applying heat to them_? in pain either of the stomach or of the bowels, there is nothing usually affords greater or speedier relief than the _external_ application of heat the following are four different methods of applying heat:--1. a bag of hot salt--that is to say, powdered table-salt--put either into the oven or into a frying-pan over the fire, and thus made hot, and placed in a flannel bag, and then applied, as the case may be, either to the stomach or to the bowels. hot salt is an excellent remedy for these pains. 2. an india-robber hot-water bottle, [footnote: every house where there are children ought to have one of these india-rubber hot-water bottles. it may be procured at any respectable vulcanised india-rubber warehouse.] half filled with hot water--it need not be boiling--applied to the stomach or to the bowels, will afford great comfort 3. another and an excellent remedy for these cases is a hot bran poultice. the way to make it is as follows:--stir bran into a vessel containing either a pint or a quart (according to size of poultice required) of boiling water, until it be the consistence of a nice soft poultice, then put into a flannel bag and apply it to the part affected. when cool, dip it from time to time in _hot_ water. 4. in case a child has a feverish cold, especially if it be attended, as it sometimes is, with pains in the bowels, the following is a good external application.--take a yard of flannel, fold it in three widths, then dip it in very hot water, wring it out tolerably dry, and apply it evenly and neatly round and round the bowels; over this, and to keep it in its place, and to keep in the moisture, put on a _dry_ flannel bandage, four yards long and four inches wide. if it be put on at bed-time, it ought to remain on all night. where there are children, it is desirable to have the yard of flannel and the flannel bandage in readiness, and then a mother will be prepared for emergencies. either the one or the other, then, of the above applications will usually, in pains of the stomach and bowels, afford great relief. there is one great advantage of the _external_ application of heat--it can never do harm; if there be inflammation, it will do good; if there be either cramps or spasms of the stomach, it will be serviceable; if there be colic, it will be one of the best remedies that can be used; if it be a feverish cold, by throwing the child into a perspiration, it will be beneficial. it is well for a mother to know how to make a white bread poultice; and as the celebrated abernethy was noted for his poultices, i will give you his directions, and in his very words:--"scald out a basin, for you can never make a good poultice unless you have perfectly boiling water, then, having put in some hot water, throw in coarsely crumbled bread, and cover it with a plate. when the bread has soaked up as much water as it will imbibe, drain off the remaining water, and there will be left a light pulp. spread it a third of an inch thick on folded linen, and apply it when of the temperature of a warm bath. it may be said that this poultice will be very inconvenient if there be no lard in it, for it will soon get dry; but this is the very thing you want, and it can easily be moistened by dropping warm water on it, whilst a greasy poultice will be moist, but not wet."--_south's household surgery_. accidents. 284. _supposing a child to cut his finger, what is the best application_? there is nothing better than tying it up with rag in its blood, as nothing is more healing than blood. do not wash the blood away, but apply the rag at once, taking care that no foreign substance be left in the wound. if there be either glass or dirt in it, it will of course be necessary to bathe the cut in warm water, to get rid of it before the rag be applied. some mothers use either salt or fryar's balsam, or turpentine, to a fresh wound; these plans are cruel and unnecessary, and frequently make the cut difficult to heal. if it bleed immoderately, sponge the wound freely with cold water. if it be a severe cut, surgical aid, of course, will be required. 285. _if a child receive a blow, causing a bruise, what had better be done_? immediately smear a small lump of _fresh_ butter on the part affected, and renew it every few minutes for two or three hours; this is an old-fashioned, but a very good remedy. olive oil may--if _fresh_ butter be not at hand--be used, or soak a piece of brown-paper in one third of french brandy and two-thirds of water, and immediately apply it to the part; when dry renew it. either of these simple plans--the butter plan is the best--will generally prevent both swelling and disfiguration. a "_black eye_."--if a child, or indeed any one else, receive a blow over the eye, which is likely to cause a "black eye," there is no remedy superior to, nor more likely to prevent one, than well buttering the parts for two or three inches around the eye with fresh butter, renewing it every few minutes for the space of an hour or two; if such be well and perseveringly done, the disagreeable appearance of a "black eye" will in all probability be prevented. a capital remedy for a "black eye" is the arnica lotion,- take of--tincture of arnica, one ounce; water, seven ounces; to make a lotion. the eye to be bathed by means of a soft piece of linen rag, with this lotion frequently; and, between times, let a piece of linen rag, wetted in the lotion, be applied: to the eye, and be fastened in its place by means of a bandage. the white lily leaf, soaked in brandy, is another excellent remedy for the bruises of a child. gather the white lily blossoms when in full bloom, and put them in a wide-mouthed bottle of brandy, cork the bottle, and it will then always be ready for use. apply a leaf to the part affected, and bind it on either with a bandage or with a handkerchief. the white lily root sliced is another valuable external application for bruises. 286. _if a child fall upon his head and be stunned, what ought to be done_? if he fall upon his head and be stunned, he will look deadly pale, very much as if he had fainted. he will in a few minutes, in all probability, regain his consciousness. sickness frequently supervenes, which makes the case more serious, it being a proof that injury, more or less severe, has been done to the brain; send, therefore, instantly for a medical man. in the meantime, loosen both his collar and neckerchief, lay him flat on his back, sprinkle cold water upon his face, open the windows so as to admit plenty of fresh air, and do not let people crowd round him, nor shout at him, as some do, to make him speak. while he is in an unconscious state, do not on any account whatever allow a drop of blood to be taken from him, either by leeches or from the arm-venesection; if you do, he will probably never rally, but will most likely "sleep the sleep that knows not breaking." 287. _a nurse sometimes drops an infant and injures his back; what ought to be done_? instantly send for a surgeon; omitting to have proper advice in such a case has frequently made a child a cripple for life. a nurse frequently, when she has dropped her little charge, is afraid to tell her mistress; the consequences might then be deplorable. if ever a child scream violently without any assignable cause, and the mother is not able for some time to pacify him, the safer plan is that she send for a doctor, in order that he might strip and carefully examine him; much after misery might often be averted if this plan were more frequently followed. 288. _have you any remarks to make and directions to give on accidental poisoning by lotions, by liniments, etc_? it is a culpable practice of either a mother or nurse to leave _external_ applications within the reach of a child. it is also highly improper to put a mixture and an _external_ application (such as a lotion or a liniment) on the same tray or on the same mantel-piece. many liniments contain large quantities of opium, a tea-spoonful of which would be likely to cause the death of a child. "hartshorn and oil," too, has frequently been swallowed by children, and in several instances has caused death. many lotions contain sugar of lead, which is also poisonous. there is not, fortunately, generally sufficient lead in the lotion to cause death; but if there be not enough to cause death, there may be more than enough to make the child very poorly. all these accidents occur from disgraceful carelessness. a mother or a nurse ought _always_, before administering a dose of medicine to a child, to read the label on the bottle; by adopting this simple plan many serious accidents and much after misery might be averted. again, i say, let every lotion, every liniment, and indeed everything for external use, be either locked up or be put out of the way, and far away from all medicine that is given by the mouth. this advice admits of no exception. if your child have swallowed a portion of a liniment containing opium, instantly send for a medical man. in the meantime force a strong mustard emetic (composed of two tea-spoonfuls of flour of mustard, mixed in half a tea-cupful of warm water) down his throat. encourage the vomiting by afterwards forcing him to swallow warm water. tickle the throat either with your finger or with a feather. souse him alternately in hot and then in a cold bath. dash cold water on his head and face. throw open the windows. walk him about in the open air. rouse him by slapping him, by pinching him, and by shouting to him; rouse him, indeed, by every means in your power, for if you allow him to go to sleep, it will, in all probability, be the sleep that knows no waking! if a child have swallowed "hartshorn and oil," force him to drink vinegar and water, lemon-juice and water sweetened with sugar, barley water, and thin gruel. if he have swallowed a lead lotion, give him a mustard emetic, and then vinegar and water, sweetened either with honey or with sugar, to drink. 289. _are not lucifer matches poisonous_? certainly, they are very poisonous; it is, therefore, desirable that they should be put out of the reach of children. a mother ought to be very strict with servants on this head. moreover, lucifer matches are not only poisonous but dangerous, as a child might set himself on fire with them. a case bearing on the subject has just come under my own observation. a little boy three years old, was left alone for two or three minutes, during which time he obtained possession of a lucifer match, and struck a light by striking the match against the wall. instantly there was a blaze. fortunately for him, in his fright, he threw the match on the floor. his mother at this moment entered the room. if his clothes had taken fire, which they might have done, had he not have thrown the match away, or if his mother had not been so near at hand, he would, in all probability, have either been severely burned or have been burned to death. 290. _if a child's clothes take fire, what ought to be done to extinguished them_? lay him on the floor, then roll him either in the rug, or in the carpet, or in the door-mat, or in any thick article of dress you may either have on, or have at hand--if it be woollen, so much the better; or, throw him down, and roll him over and over on the floor, as, by excluding the atmospheric air, the flame will go out:--hence the importance of a mother cultivating presence of mind. if parents were better prepared for such emergencies, such horrid disfigurations and frightful deaths would be less frequent. you ought to have a proper fire-guard before the nursery grate, and should be strict in not allowing your child to play with fire. if he still persevere in playing with it, when he has been repeatedly cautioned not to do so, he should be punished for his temerity. if anything would justify corporal chastisement, it would surely be such an act of disobedience. there are only two acts of disobedience that i would flog a child for--namely, the playing with fire and the telling of a lie! if after various warnings and wholesome corrections he still persist, it would be well to let him slightly taste the pain of his doing so, either by holding his hand for a moment very near the fire, or by allowing him to slightly touch either the hot bar of the grate or the flame of the candle. take my word for it the above plan, will effectually cure him--he will never do it again. it would be well for the children of the poor to have pinafores made either of woollen or of stuff materials. the dreadful deaths from burning, which so often occur in winter, too frequently arise from _cotton_ pinafores first taking fire. [footnote: it has been computed that upwards of 1000 children are annually burned to death by accident in england.] if all dresses after being washed, and just before being dried, were, for a short time, soaked in a solution of tungstate of soda, such clothes, when dried, would, be perfectly fire-proof. tangstate of soda may be used either with or without starch; but full directions for the using of it will, at the time of purchase, be given by the chemist. 291. _is a burn more dangerous than a scald_? a burn is generally more serious than a scald. burns and scalds are more dangerous on the body, especially on the chest, than either on the face or on the extremities. the younger the child, the greater the danger. scalds both of the mouth and the throat, from a child drinking boiling water from the spout of a tea-kettle, are most dangerous. a poor person's child is, from the unavoidable absence of the mother, sometimes shut up in the kitchen by himself, and being very thirsty, and no other water being at hand, he is tempted, in his ignorance, to drink from the tea-kettle: if the water be unfortunately boiling, it will most likely prove to him to be a fatal draught! 292. _what are the best immediate applications to a scald or to a burn_? there is nothing more efficacious than flour. it ought to be thickly applied over the part affected, and should be kept in its place either with a rag and a bandage, or with, strips of old linen. if this be done, almost instantaneous relief will be experienced, and the burn or the scald, if superficial, will soon be well. the advantage of flour as a remedy, is this, that it is always at hand. i have seen some extensive bums and scalds cured by the above simple plan. another excellent remedy is, cottonwool of superior quality, purposely made for surgeons. the burn or the scald ought to be enveloped in it; layer after layer should be applied until it be several inches thick. the cotton-wool must not be removed for several days. these two remedies, flour and cotton-wool, may be used in conjunction; that is to say, the flour may be thickly applied to the scald or to the burn, and the cotton wool over all. prepared lard--that is to say, lard without salt [footnote: if there be no other lard in the house but lard _with_ salt, the salt may be readily removed by washing the lard in cold water. prepared lard--that is to say, lard _without_ salt--can, at any moment, be procured from the nearest druggist in the neighbourhood]--is an admirable remedy for burns and for scalds. the advantages of lard are,--(1.) it is almost always at hand; (2.) it is very cooling, soothing, and unirritating to the part, and it gives almost immediate freedom from pain; (3.) it effectually protects and sheathes the burn or the scald from the air; (4.) it is readily and easily applied: all that has to be done is to spread the lard either on pieces of old linen rag, or on lint, and then to apply them smoothly to the parts affected, keeping them in their places by means of bandages--which bandages may be readily made from either old linen or calico shirts. dr john packard, of philadelphia, was the first to bring this remedy for burns and scalds before the public--he having tried it in numerous instances, and with the happiest results. i myself have, for many years been in the habit of prescribing lard as a dressing for blisters, and with the best effects. i generally advise equal parts of prepared lard and of spermaceti-cerate to be blended together to make an ointment. the spermaceti-cerate gives a little more consistence to the lard, which, in warm weather especially, is a great advantage. another valuable remedy for burns is "carron-oil;" which is made by mixing equal parts of linseed-oil and lime-water in a bottle, and shaking it up before using it. cold applications, such as cold water, cold vinegar and water, and cold lotions, are most injurious, and, in many cases, even dangerous. scraped potatoes, sliced cucumber, salt, and spirits of turpentine, have all been recommended; but, in my practice, nothing has been so efficacious as the remedies above enumerated. do not wash the wound, and do not dress it more frequently than every _other_ day. if there be much discharge, let it be gently sopped up with soft old linen rag; but do not, _on any_ account, let the burn be rubbed or roughly handled. i am convinced that, in the majority of cases, wounds are too frequently dressed, and that the washing of wounds prevents the healing of them. "it is a great mistake," said ambrose pare, "to dress ulcers too often, and to wipe their surfaces clean, for thereby we not only remove the useless excrement, which is the mud or sanies of ulcers, but also the matter which forms the flesh. consequently, for these reasons, ulcers should not be dressed too often." it is nature, and not the surgeon, that really cures the wound, and it is done, like all nature's works, principally in secret, by degrees, and by patience, and resents much interference. the seldom-dressing of a wound and patience are, then, two of the best remedies for effecting a cure. shakspeare, who seemed to know surgery, as he did almost everything else beside was quite cognisant of the fact:- "how poor are they, that have not patience what wound did ever heal, but by degrees" the burn or the scald may, after the first two days, if severe, require different dressings; but, if it be severe, the child ought of course to be immediately placed under the care of a surgeon. if the scald be either on the leg or on the foot, a common practice is to take the shoe and the stocking off; in this operation the skin is also at the same time very apt to be removed. now, both the shoe and the stocking ought to be slit up, and thus be taken off, so that neither unnecessary pain nor mischief may be caused. 293. _if a bit of quick-lime should accidentally enter the eye of my child, what ought to be done_? instantly, but tenderly remove, either by means of a camel's hair brush, or by a small spill of paper, any bit of lime that may adhere to the ball of the eye, or that may be within the eye or on the eye-lashes; then well bathe the eye (allowing a portion to enter it) with vinegar and water-one part of vinegar to three parts of water, that is to say, a quarter fill a clean half-pint medicine bottle with vinegar, and then fill it up with spring water, and it will be ready for use. let the eye be bathed for at least a quarter of an hour with, it the vinegar will neutralise the lime, and will rob it of its burning properties. having bathed the eye with vinegar and water for a quarter of an hour, bathe it for another quarter of an hour simply with a little warm water, after which, drop into the eye two or three drops of the best sweet-oil, put on an eye-shade made of three thicknesses of linen rag, covered with green silk, and then do nothing more until the doctor arrive. if the above rules be not _promptly_ and _properly_ followed out, the child may irreparably lose his eyesight; hence the necessity of conversations of this kind, to tell a mother, provided _immediate_ assistance cannot be obtained, what ought _instantly_ to be done; for moments, in such a case, are precious. while doing all that i have just recommended, let a surgeon be sent for, as a smart attack of inflammation, of the eye is very apt to follow the burn of lime; but which inflammation will, provided the _previous_ directions have been _promptly_ and _efficiently_ followed out, with appropriate treatment, soon subside. the above accident is apt to occur to a child who is standing near a building when the slacking of quicklime is going on, and where portions of lime in the form of powder are flying about the air. it would be well not to allow a child to stand about such places, as prevention is always better than cure. _quicklime_ is sometimes called _caustic-lime_--it well deserves its name, for it is a _burning-lime_, and if proper means be not promptly used, will soon burn away the sight. 294. _if any other foreign substance should enter the eye, what is the best method of removing it_? if there be grit, or sand, or dust, or particle of coal, or gnat, or a hair, or an eye-lash in the eye, it ought to be tenderly removed by a small tightly-folded paper spill, holding down the lower lid with the fore-finger of the left hand the while; and the eye, if inflamed, should be frequently bathed with warm milk and water; but generally as soon as the cause is removed the effect will cease, and after treatment will be unnecessary. if a particle of metal be sticking on the cornea of the eye, as it sometimes does, it will require the skilled hand of a surgeon to remove it. any foreign substance, however minute, in the eye, is very painful; but a piece of burning lime is excruciating. shakspeare gives a graphic description of the pain from the presence of any foreign substance, however small, in the eye:- "oh heaven!--that there were but a mote in yours, a grain, a dust, a gnat, a wand'ring hair, any annoyance in that precious sense! then, feeling what small things are boist'rous there, your vile intent must needs seem horrible." 295. _what ought to be done in a case of choking_? how often does a hungry little child, if not carefully watched, fill his mouth so full, and swallow lumps of food in such hot haste, as to choke himself- "with eager feeding, food doth choke the feeder" _shakespeare._ _treatment_.-instantly put your finger into the throat and feel if the substance be within reach; if it be food, force it down, and thus liberate the breathing; should it be a hard substance, endeavour to hook it out; if you cannot reach it, give a good smart blow or two with the flat of the hand on the back; or, as recommended by contributor to the _lancet_, on the chest, taking care to "seize the little patient, and place him between your knees side ways, and in this or some other manner to _compress the abdomen_ [the belly], otherwise the power of the blow will be lost by the yielding of the abdominal parieties [walls of the belly], and the respiratory effort will not be produced." if that does not have the desired effect, tickle the throat with your finger, so as to ensure immediate vomiting, and the subsequent ejection of the offending substance. 296. _should my child be bitten by a dog supposed to be mad, what ought to be done_? instantly well rub for the space of five or ten _seconds_--seconds, _not_ minutes--a stick of nitrate of silver (lunar-caustic) into the wound. the stick of lunar-caustic should be pointed, like a cedar pencil for writing, in order the more thoroughly to enter the wound. [footnote: a stick of pointed nitrate of silver, in a case, ready for use, may be procured of any respectable chemist.] this, if properly done directly after the bite, will effectually prevent hydrophobia. the nitrate of silver acts not only as a caustic to the part, but it appears effectually to neutralise the poison, and thus, by making the virus perfectly innocuous, is a complete antidote. if it be either the lip, or the parts near the eye, or the wrist, that have been bitten, it is far preferable to apply the caustic than to cut the part out; as the former is neither so formidable, nor so dangerous, nor so disfiguring as the latter, and yet it is equally as efficacious. i am indebted to the late mr youatt, the celebrated veterinary surgeon, for this valuable antidote or remedy for the _prevention_ of the most horrible, heart-rending, and incurable disease known. mr youatt had an immense practice among, dogs as well as among horses. he was a keen observer of disease, and a dear lover of his profession, and he had paid great attention to rabies-dog-madness. he and his assistants had been repeatedly bitten by rabid dogs; but knowing that he was in possession of an infallible preventive remedy, he never dreaded the wounds inflicted either upon himself or upon his assistants. mr youatt never knew lunar-caustic, if properly and _immediately_ applied, to fail. it is, of course, only a preventive. if hydrophobia be once developed in the human system, no antidote has ever yet, for this fell and intractable disease, been found. while walking the london hospitals, upwards of forty years ago, i received an invitation from mr youatt to attend a lecture on rabies--dog-madness. he had, during the lecture, a dog present labouring under _incipient_ madness. in a day or two after the lecture, he requested me and other students to call at his infirmary and see the dog, as the disease was at that time fully developed. we did so, and found the poor animal raving mad--frothing at the mouth, and snapping at the iron bars of his prison. i was particularly struck with a peculiar brilliancy and wildness of the dog's eyes. he seemed as though, with affright and consternation, he beheld objects unseen by all around. it was pitiful to witness his frightened and anxious countenance. death soon closed the scene! i have thought it my duty to bring the value of lunar-caustic as a preventive of hydrophobia prominently before your notice, and to pay a tribute of respect to the memory of mr youatt--a man of talent and of genius. never kill a dog supposed to be mad who has bitten either a child, or any one else, until it has, past all doubt, been ascertained whether he be really mad or not. he ought, of course, to be tied up; and be carefully watched, and be prevented the while from biting any one else. the dog by all means should be allowed to live at least for some weeks, as the fact of his remaining well will be the best guarantee that there is no fear of the bitten child having caught hydrophobia. there is a foolish prejudice abroad, that a dog, be he mad or not, who has bitten a person ought to be _immediately_ destroyed; that although the dog be not at the time mad, but should at a future period become so, the person who had been bitten when the dog was _not_ mad, would, when the dog became mad, have hydrophobia! it seems almost absurd to bring the subject forward; but the opinion is so very general and deep-rooted, that i think it well to declare that there is not the slightest foundation of truth in it, but that it is a ridiculous fallacy! a cat sometimes goes mad, and its bite may cause hydrophobia; indeed, the bite of a mad cat is more dangerous than the bite of a mad dog. a bite from a mad cat ought to be treated precisely in the same manner-namely, with the lunar-caustic--as for a mad dog. hydrophobia was by our forefathers graphically called _water-fright_: it was well named, for the horror of swallowing water is, by an hydrophobic patient, most intense, and is _the_ leading symptom of this fell and incurable disease. a bite either from a dog or from a cat _who is not mad_, from a cat especially, is often venomous and difficult to heal. the best application is, _immediately_ to apply a large hot white bread poultice to the part, and to renew it every four hours; and, if there be much pain in the wound, to well foment the part, every time before applying the poultice, with a hot camomile and poppy-head fomentation. scratches of a cat are best treated by smearing, and that freely and continuously for an hour, and then afterwards at longer intervals, fresh butter on the part affected. if fresh butter be not at hand, fresh lard--that is to say, lard _without_ salt--will answer the purpose. if the pain of the scratch be very intense, foment the part affected with hot water, and then apply a hot white bread poultice, which should be frequently renewed. 297. _what are the best remedies in ease of a sting from either a bee or a wasp_? extract the sting, if it have been left behind, either by means of the pair of dressing forceps, or by the pressure of the hollow of a small key--a watch-key will answer the purpose; then, the blue-bag (which is used in washing) moistened with water, should be applied to the part; or a few drops of solution of potash, [footnote: which may be instantly procured of a druggist.] or "apply moist snuff or tobacco, rubbing it well in," [footnote: a bee-master. _the times_, july 28,1864.] and renew from time to time either of them: if either of these be not at hand, either honey, or treacle, or fresh butter, will answer the purpose. should there be much swelling or inflammation, foment the part with hot water, and then apply hot bread poultice, and renew it frequently. in eating apricots, or peaches, or other fruit, they ought beforehand to be carefully examined, in order to ascertain that no wasp is lurking in them; otherwise, it may sting the throat, and serious consequences will ensue. 298. _if a child receive a fall, causing the skin to be grazed, can you tell me of a good application_? you will find gummed paper an excellent remedy: the way of preparing it is as follows:--apply evenly, by means of a small brush, thick mucilage of gum-arabic to cap-paper; hang it up to dry, and keep it ready for use. when wanted, cut a portion as large as may be requisite, then moisten it with your tongue, in the same manner you would a postage stamp, and apply it to the grazed part. it may be removed when necessary by simply wetting it with water. the part in two or three days will be well. there is usually a margin of gummed paper sold with postage stamps; this will answer the purpose equally well. if the gummed paper be not at hand, then frequently, for the space of an hour or two, smear the part affected with fresh butter. 299. _in case of a child swallowing by mistake either laudanum, or paregoric, or godfrey's cordial, or any other preparation of opium, what ought to be done_? give, as _quickly as possible_, a strong mustard emetic; that is to say, mix two tea-spoonfuls of flour of mustard in half a tea-cupful of water, and force it down his throat. if free vomiting be not induced, tickle the upper part of the swallow with a feather, drench the little patient's stomach with large quantities of warm water. as soon as it can be obtained from the druggist, give him the following emetic draught- take of--sulphate of zinc, one scruple; simple syrup, one drachm. distilled water, seven drachms; to make a draught. smack his buttocks and his back, walk him, or lead him, or carry him about in the fresh air, shake him by the shoulders, pat his hair, tickle his nostrils, shout and holler in his ears, plunge him into a warm bath and then into a cold bath alternately. well sponge his head and face with cold water, dash cold water on his head, face, and neck, and do not, on any account, until the effects of the opiate are gone off, allow him to go to sleep, if you do, he will never wake again! while doing all those things, of course, you ought to lose no time in sending for a medical man. 300. _have you any observation to make on parent's allowing the deadly nightshade (atropa belladonna) to grow in their gardens_? i wish to caution you not on any account to allow the belladonna--the deadly nightshade--to grow in your garden. the whole plant--root, leaves, and berries--is poisonous and the berries, being attractive to the eye, are very alluring to children. 301. _what is the treatment of poisoning by belladonna_? instantly send for a medical man, but, in the mean time, give an emetic-a mustard emetic--mix two teaspoonfuls of flour of mustard in half a tea-cupful of warm water, and force it down the child's throat then drench him with warm water, and tickle the upper part of his swallow either with a feather or with the finger, to make him sick as the grand remedy is an emetic to bring up the offending cause. if the emetic has not acted sufficiently, the medical man when he arrives may deem it necessary to use the stomach pump, but remember not a moment must be lost, for moments are precious in a case of belladonna poisoning, in giving a mustard emetic, and repeating it again and again until the enemy be dislodged. dash cold water upon his head and face; the best way of doing which is by means of a large sponge, holding his head and his face over a wash-hand basin, half filled with cold water, and filling the sponge from the basin, and squeezing it over his head and face, allowing the water to continuously stream over them for an hour or two, or until the effects of the poison have passed away. this sponging of the head and face is very useful in poisoning by opium, as well as in poisoning by belladonna; indeed, the treatment of poisoning by the one is very similar to the treatment of poisoning by the other. i, therefore, for the further treatment of poisoning by belladonna, beg to refer you to a previous conversation, on the treatment of poisoning by opium. 302. _should a child put either a pea or a bead, or any other foreign substance, up the nose, what ought to be done_? do not attempt to extract it yourself, or you might push it further in, but send instantly for a surgeon, who will readily remove it, either with a pair of forceps, or by means of a bent probe, or with a director. if it be a pea, and it be allowed for any length of time to remain in, it will swell, and will thus become difficult to extract, and may produce great irritation and inflammation. a child ought not to be allowed to play with peas or with beads (unless the beads are on a string), as he is apt, for amusement, to push them up his nose. 303. _if a child have put either a pea, a bean, a bead, a cherry-stone, or any other smooth substance, into his ear, what ought to be done to remove it_? turn his head on one side, in order to let the ear with the pea or the bead in it be undermost, then give with the flat of your hand two or three sharp, sudden slaps or boxes on the other, or _upper_most ear, and most likely the offending substance will drop out. poking at the ear will, in the majority of cases, only send the substance further in, and will make it more difficult (if the above simple plan does not succeed) for the medical man to remove. the surgeon will, in all probability, syringe the ear; therefore have a supply of warm water in readiness for him, in order that no time may be lost. 304. _if an earwig or any other living thing, should get into the ear of a child, what ought to be done_? lay the child on his side, the affected ear being uppermost, and fill the ear, from a tea-spoon, with either water or sweet oil. the water or oil will carry the living thing, whatever it be, out of the ear, and the child is at once relieved. 305. _if a child swallow a piece of broken glass, what ought to be done_? avoid purgatives, as the free action on the bowels would be likely to force the spiculae of glass into the mucous membrane of the bowels, and thus would wound them, and might cause ulceration, and even death. "the object of treatment will be to allow them to pass through the intestines well enveloped by the other contents of the tube, and for this purpose a solid, farinaceous diet should be ordered, and purgatives scrupulously avoided."--_shaw's medical remembrancer_, by hutchinson. 306. _if a child swallow a pin, what should be done_? treat him as for broken glass. give him no aperients, or it might, in action, force the pin into the bowel. i have known more than one instance where a child, after swallowing a pin, to have, voided it in his motion. 307. _if a child swallow a coin of any kind, is danger likely, to ensue, and what ought to be done_? there is, as a rule, no danger. a dose or two of castor oil will be all that is usually necessary. the evacuations ought to be carefully examined until the coin be discovered. i once knew a child swallow a pennypiece, and pass it in his stool. 308. _if a child, while playing with a small coin (such as either a threepenny or a fourpenny piece), or any other substance, should toss it into his mouth, and inadvertently allow it to enter the windpipe, what ought to be done_? take hold of him by the legs, allowing his head to hang downwards; then give him with the palm of your hand several sharp blows on his back, and you may have the good fortune to see the coin coughed out of his mouth. of course, if this plan does not succeed, send instantly, for a medical man. 309. _how can a mother prevent her child from having an accident_? by strict supervision over frim on her own part, and by not permitting her child to be left to the tender mercies of servants; by not allowing him to play with fire, to swing over banisters, and to have knives and playthings of a dangerous character; to keep all poisonous articles and cutting instruments out of his reach; and, above all and before all, insisting, lovingly, affectionately, but firmly, upon implicit obedience. accidents generally arise from one of three causes, namely, either from wilful disobedience, or from gross carelessness, or from downright folly. i quite agree with davenant, that they do not arise from chance- "if we consider accident, and how, repugnant unto sense, it pays desert with bad event, we shall disparage providence." part iii. boyhood and girlhood. _just at the age 'twixt boy and youth when thought is speech and speech is truth_--scott _'tis with him e'en standing water. between man and boy_--shakespeare _standing with reluctant feet, where the brook and river meet, womanhood and childhood fleet_--longfellow ablution, etc. 310. _have you any remarks to make on the ablution of boys and girls_? how is it that a mother thinks it absolutely necessary (which it really is) that her babe's _whole_ body should, every morning, be washed; and yet who does not deem it needful that her girl or boy, of twelve years old, should go through the process of daily and _thorough_ ablution? if the one case be necessary, sure i am that the other is equally if not more needful. thorough ablution of the body every morning at least is essential to health. i maintain that no one can be in the enjoyment of perfect health who does not keep his skin--the whole of his skin--clean. in the absence of cleanliness, a pellicle forms on the skin which engenders disease. moreover, a person who does not keep his skin clean is more susceptible of contracting contagious disease, such as small-pox, typhus fever, cholera, diphtheria, scarlet fever, etc. thorough ablution of the body is a grand requisite of i maintain that no one can be perfectly healthy unless he thoroughly wash his body--the whole of his body; if filth accumulate which, if not washed off, it is sure to do, disease must, as a matter of course, follow. besides, ablution is a delightful process; it makes one feel fresh and sweet, and young and healthy; it makes the young look handsome, and the old look young! thorough ablution might truly be said both to renovate and to rejuvenise! a scrupulously clean skin is one of the grand distinctive characteristics both of a lady and of a gentleman, dirty people are not only a nuisance to themselves, but to all around; they are not only a nuisance but a danger, as their dirty bodies are apt to carry from place to place contagious diseases. it is important that parts that are covered should be kept cleaner than parts exposed to the air, as dirt is more apt to fester in dark places; besides, parts exposed to the air have the advantage of the air's sweetening properties; air acts as a bath, and purifies the skin amazingly. it is desirable to commence a complete system of washing early in life, as it then becomes a second nature, and cannot afterwards be dispensed with. one accustomed to the luxury of his morning ablution, if anything prevented him from taking it, would feel most uncomfortable; he would as soon think of dispensing with his breakfast as with his bath. every boy, every girl, and every adult, ought each to have either a room or a dressing-room to himself or to herself, in order that he or she might strip to the skin and thoroughly wash themselves; no one can wash properly and effectually without doing so. now, for the paraphernalia required for the process--(1.) a large nursery basin, one that will hold six or eight quarts of water (wedgwood's make being considered the best); (2.) a piece of coarse flannel, a yard long and half a yard wide; (3.) a large sponge; (4.) a tablet either of the best yellow or of curd soap; (5.) two towels-one being a diaper, and the other a turkish rubber. now, as to the manner of performing ablution. you ought to fill the basin three parts full with _rain_ water, then, having well-soaped and cleansed your hands, re-soap them, dip your head and face into the water, then with the soaped hands well rub and wash your head, face, neck, chest, and armpits; having done which, take the wetted sponge, and go over all the parts previously travelled over by the soaped hands; then fold the flannel, as you would a neck-kerchief, and dip it in the water, then throw it, as you would a skipping-rope, over your shoulders and move it a few times from right to left and from left to right, and up and down, and then across the back and loins; having done which, dip the sponge in the water, and holding your head over the water, let the water stream from the sponge a time or two over your head, neck, and face. dip your head and face in the water, then put your hands and arms (as far as they will go) into the water, holding them there while you can count thirty. having reduced the quantity of water to a third of a basinful, place the basin on the floor, and sit (while you can count fifty) in the water; then put one foot at a time in the water, and quickly rub, with soaped hands, up and down your leg, over the foot, and pass your thumb between each toe (this latter procedure tends to keep away soft corns); then take the sponge, filled with water, and squeeze it over your leg and foot, from the knee downwards,--then serve your other leg and foot in the same way. by adopting the above plan, the whole of the body will, every morning, be thoroughly washed. a little warm water might at first, and during the winter time, be added, to take off the chill; but the sooner quite cold water is used the better. the body ought to be quickly dried (taking care to wipe between each toe), first with the diaper, and then with the turkish rubber. in drying your back and loins, you ought to throw as you would a skipping-rope, the turkish rubber over your shoulders, and move it a few times front side to side, until the parts be dry. although the above description is necessarily prolix, the washing itself ought to be very expeditiously performed; there should be no dawdling over it, otherwise the body will become chilled, and harm instead of good will be the result. if due dispatch be used, the whole of the body might, according to the above method, be thoroughly washed and dried in the space of ten minutes. a boy ought to wash his head, as above directed, every morning, a girl, who has much hair, once a week, with soap and water, with flannel and sponge. the hair, if not frequently washed, is very dirty, and nothing is more repulsive than a dirty head! it might be said, "why do you go into particulars? why dwell so much upon minutiae? every one, without being told, knows how to wash himself!" i reply, "that very few people do know how to wash themselves properly; it is a misfortune that they do not--they would be healthier and happier and sweeter if they did!" 311. _have you any remarks to make on boys and girls learning to swim_? let me strongly urge you to let your sons and daughters be _early_ taught to swim. swimming is a glorious exercise--one of the best that can be taken; it expands the chest; it promotes digestion; it develops the muscles, and brings into action some muscles that in any other form of exercise are but seldom brought into play; it strengthens and braces the whole frame, and thus makes the swimmer resist the liability of catching cold; it gives both boys and girls courage, energy, and self-reliance,--splendid qualities in this rough world of ours. swimming is oftentimes the means of saving human life; this of itself would be a great recommendation of its value. it is a delightful amusement; to breast the waves is as exhilarating to the spirits as clearing on horse-back a five-barred gate. the art of learning to swim is quite as necessary to be learned by a girl as by a boy; the former has similar muscles, lungs, and other organs to develop as the latter. it is very desirable that in large towns swimming-baths for ladies should be instituted. swimming ought, then, to be a part and parcel of the education of every boy and of every girl. swimming does not always agree. this sometimes arises from a person being quite cold before he plunges into the water. many people have an idea that they ought to go into the water while their bodies are in a cool state. now this is a mistaken notion, and is likely to produce dangerous consequences. the skin ought to be comfortably warm, neither very hot nor very cold, and then the bather will receive every advantage that cold bathing can produce, if he go into the bath whilst the body is cold, the blood becomes chilled, and is driven to internal parts, and thus mischief is frequently produced. a boy, after using cold bathing, ought, if it _agree_ with him, to experience a pleasing glow over the whole surface of his body, his spirits and appetite should be increased, and he ought to feel stronger; but if it _disagree_ with him, a chilliness and coldness, a lassitude and a depression of spirits, will be the result; the face will be pale and the features will be pinched, and, in some instances, the lips and the nails will become blue; all these are signs that _cold_ bathing is injurious, and, therefore, that it ought on no account to be persevered in, unless these symptoms have hitherto proceeded from his going into the bath whilst he was quite cold. he may, previously to entering the bath, warm himself by walking briskly for a few minutes. where cold, sea water bathing does not agree, _warm_ sea bathing should be substituted. 312. _which do you prefer--sea bathing or fresh water bathing_? sea bathing. sea bathing is incomparably superior to fresh water bathing; the salt water is far more refreshing and invigorating; the battling with the waves is more exciting; the sea breezes, blowing on the nude body, breathes (for the skin is a breathing apparatus) health and strength into the frame, and comeliness into the face; the sea water and the sea breezes are splendid cosmetics; the salt water is one of the finest applications, both for strengthening the roots and brightening the colour of the hair, provided grease and pomatum have not been previously used. 313. _have you any directions to give as to the time and the seasons, and the best mode of sea bathing_? summer and autumn are the best seasons of the year for cold sea bathing--august and september being the best months. to prepare the skin for the cold sea bathing, it would be well, before taking a dip in the sea, to have on the previous day a warm salt water bath. it is injurious, and even dangerous, to bathe _immediately_ after a _full_ meal; the best time to bathe is about two hours after breakfast-that is to say, at about eleven or twelve o'clock in the forenoon. the bather as soon as he enters the water, ought _instantly_ to wet his head; this may be done either by his jumping at once from the machine into the water, or, if he have not the courage to do so, by plunging his head without loss of time _completely_ under the water. he should remain in the water about a quarter of an hour, but never longer than half an hour. many bathers by remaining a long time in the water do themselves great injury. if sea bathing be found to be invigorating-and how often to the delicate it has proved to be truly magical--a patient may bathe once every day, but on no account oftener. if he be not strong, he had better, at first, bathe only every other day, or even only twice a week. the bather, after leaving the machine, ought for half an hour to take a brisk walk in order to promote a reaction, and thus to cause a free circulation of the blood. 314. _do you think a tepid bath [footnote: a tepid bath from 62 to 96 degrees of, fahrenheit.] may be more safely used_? a tepid bath may be taken at almost any time, and a bather may remain longer in one, with safety, than in a cold bath. 315. _do you approve of warm bathing_? a warm, bath [footnote: a warm bath from 97 to 100 degrees of fahrenheit] may with advantage be occasionally used--say, once a week. a warm bath cleanses the skin more effectually than either a cold or a tepid bath; but, as it is more relaxing, ought not to be employed so often as either of them. a person should not continue longer than ten minutes in a warm bath. once a week, as a rule is quite often enough for a warm bath; and it would be an excellent plan if every boy and girl and adult would make a practice of having one regularly every week, unless any special reason should arise to forbid its use. 316. _but does not warm bathing, by relaxing the pores of the skin, cause a person to catch cold if he expose himself to the air immediately afterwards_? there is, on this point, a great deal of misconception and unnecessary fear. a person, _immediately_ after using a warm bath, should take proper precautions--that is to say, he must not expose himself to draughts, neither ought he to wash himself in _cold_ water, nor should he, _immediately_ after taking one, drink _cold_ water. but he may follow his usual exercise or employment, provided the weather be fine, and the wind be neither in the east nor the north-east. every house of any pretension ought to have a bathroom. nothing would be more conducive to health than regular systematic bathing. a hot and cold bath, a sitz bath, and a shower bath--each and all in their turn--are grand requisites to preserve and procure health. if the house cannot boast of a bath-room, then the corporation baths (which nearly every large town possesses) ought to be liberally patronised. management of the hair 317. _what is the best application for the hair_? a sponge and _cold_ water, and two good hair-brushes. avoid grease, pomatum, bandoline, and all abominations of that kind. there is a natural oil of the hair, which is far superior to either rowland's macassar oil or any other oil! the best scent for the hair is an occasional dressing of soap and water; the best beautifier of the hair is a downright thorough good brushing with two good hair brushes! again, i say, _avoid grease of all kinds to the hair_. "and as for woman's hair, don't plaster it with scented and sour grease, or with any grease; it has an oil of its own. and don't tie up your hair tight, and make it like a cap of iron over your skull. and why are your ears covered? you hear all the worse, and they are not the cleaner. besides, the ear is beautiful in itself, and plays its own part in the concert of the features." [footnote: _health._ by john brown, m.d.] if the hair cannot, without some application, be kept tidy, then a little castor oil, scented, might, by means of an old tooth-brush, be used to smooth it; castor oil is, for the purpose, one of the most simple and harmless of dressings; but, as i said before, the hair's own natural oil cannot be equalled, far less surpassed! if the hair fall off, the castor oil, scented with a few drops either of otto of roses or of essence of bergamot, is a good remedy to prevent its doing so; a little of it ought, night and morning, to be well rubbed into the roots of the hair. cocoa-nut oil is another excellent application for the falling off of the hair, and can never do harm, which is more than can be said of many vaunted remedies for the hair! clothing. 318. _do you approve of a boy wearing flannel next to the skin?_ england is so variable a climate, and the changes from heat to cold, and from dryness to moisture of the atmosphere, are so sudden, that some means are required to guard against their effects. flannel, as it is a bad conductor of heat, prevents the sudden changes from affecting the body, and thus is a great preservative against cold. flannel is as necessary in the summer as in the winter time; indeed, we are more likely both to sit and to stand in draughts in the summer than in the winter; and thus we are more liable to become chilled and to catch cold. woollen shirts are now much worn; they are very comfortable and beneficial to health. moreover, they simplify the dress, as they supersede the necessity of wearing either both flannel and linen, or flannel and calico shirts. 319. _flannel sometimes produces great irritation of the skin: what ought to be done to prevent it_? have a moderately fine flannel, and persevere in its use; the skin in a few days will bear it comfortably. the angola and wove-silk waistcoats have been recommended as substitutes, but there is nothing equal to the old-fashioned welsh flannel. 320. _if a boy have delicate lungs, do you approve of his wearing a prepared hare-skin over the chest_? i do not: the chest may be kept too warm as well as too cold. the hare-skin heats the chest too much, and thereby promotes a violent perspiration; which, by his going into the cold air, may become suddenly checked, and may thus produce mischief. if the chest be delicate, there is nothing like flannel to ward off colds. 321. _after an attack of rheumatic fever, what extra clothing do you advise_? in the case of a boy, or a girl, just recovering from a severe attack of rheumatic fever, flannel next the skin ought always, winter and summer, to be worn--flannel drawers as well as a flannel vest. 322. _have you any remarks to make on boys' waistcoats_? fashion in this, as in most other instances, is at direct variance with common sense. it would seem that fashion was intended to make work for the doctor, and to swell the bills of mortality! it might be asked, what part of the chest, in particular, ought to be kept warm? the upper part needs it most. it is in the _upper_ part of the lungs that tubercles (consumption) usually first make their appearance; and is it not preposterous to have such parts, in particular, kept cool? double-breasted waistcoats cannot be too strongly recommended for _delicate_ youths, and for all men who have _weak_ chests. 323. _have you any directions to give respecting the shoes and the stockings_? the shoes for winter should be moderately thick and waterproof. if boys and girls be delicate, they ought to have double soles to their shoes, with a piece of bladder between each sole, or the inner sole may be made of cork; either of the above plans will make the soles of boots and shoes completely water-proof. in wet or dirty weather india-rubber over-shoes are useful, as they keep the _upper_ as well as the _under_ leathers perfectly dry. the socks, or stockings, for winter, ought to be either lambs-wool or worsted; it is absurd to wear _cotton_ socks or stockings all the year round. i should advise a boy to wear socks not stockings, as he will then be able to dispense with garters. garters, as i have remarked in a previous conversation, are injurious--they not only interfere with the circulation of the blood, but also, by pressure, injure the bones, and thus the shape of the legs. boys and girls cannot be too particular in keeping their feet warm and dry, as cold wet feet are one of the most frequent exciting causes of bronchitis, of sore throats, and of consumption. 324. _when should a girl begin to wear stays_? she ought never to wear them. 325. _do not stays strengthen the body_? no; on the contrary, they weaken it (1.) _they, weaken the muscles_. the pressure upon them causes them to waste; so that, in the end, a girl cannot do without them, as the stays are then obliged to perform the duty of the wasted muscles. (2.) _they weaken the lungs_ by interfering with their functions. every inspiration is accompanied by a movement of the ribs. if this movement be impeded, the functions of the lungs are impeded likewise, and, consequently, disease is likely to follow, and either difficulty of breathing, or cough, or consumption, may ensue. (3) _they weaken the heart's action_, and thus frequently produce palpitation, and, perhaps, eventually, organic or incurable disease of the heart (4) _they weaken the digestion_, by pushing down the stomach and the liver, and by compressing the latter, and thus induce indigestion, flatulence, and liver-disease. [footnote: several years ago, while prosecuting my anatomical studies in london university college dissecting rooms, on opening a young women, i discovered an immense indentation of the liver large enough to admit a rolling pin, produced by tight lacing!] (5) _they weaken the bowels_, by impeding their proper peristaltic (spiral) motion, and thus might produce either constipation or a rupture. is it not presumptuous to imagine that man can improve upon god's works, and that if more support had been required, the almighty would not have given it?- "god never made his work for man to mend"--_dryden._ 326. _have you any remarks to make on female dress_? there is a perfect disregard of health in everything appertaining to fashion. parts that ought to be kept warm, remain unclothed, the _upper_ portion of the chest, most prone to tubercles (consumption), is completely exposed, the feet, great inlets to cold, are covered with thin stockings, and with shoes as thin as paper. parts that should have full play are cramped and hampered, the chest is cribbed in with stays, the feet with _tight_ shoes,--hence causing deformity, and preventing a free circulation of blood. the mind, that ought to be calm and unruffled, is kept in a constant state of excitement by balls, and concerts, and plays. mind and body sympathise with each other, and disease is the consequence. night is turned into day, and a delicate girl leaves the heated ball room, decked out in her airy finery, to breathe the damp and cold air of night. she goes to bed, but, for the first few hours, she is too much excited to sleep, towards morning, when the air is pure and invigorating, and, when to breathe it, would be to inhale health and life, she falls into a feverish slumber, and wakes not until noon-day. oh, that a mother should be so blinded and so infatuated! 327. _have you any observations to make on a girl wearing a green dress_? it is injurious to wear a green dress, if the colour have been imparted to it by means of _scheele's green_, which is arsenite of copper--a deadly poison. i have known the arsenic to fly off from a _green_ dress in the form of powder, and to produce, in consequence, ill-health. gas-light green is a lovely green, and free from all danger, and is fortunately superseding the scheele's green both in dresses and in worsted work. i should advise my fair reader, when she selects green as her colour, always to choose the gas-light green, and to wear and to use for worsted work no other green besides, unless it be imperial green. diet. 328. _which is the more wholesome, coffee or tea, where milk does not agree, for a youth's breakfast_? coffee, provided it be made properly, and provided the boy or the girl take a great deal of out-door exercise; if a youth be much confined within doors, black tea is preferable to coffee. the usual practice of making coffee is to boil it, to get out the strength! but the fact is, the process of boiling boils the strength away; it drives off that aromatic, grateful principle, so wholesome to the stomach, and so exhilarating to the spirits; and, in lieu of which, extracts its dregs and impurities, which are both heavy and difficult of digestion. the coffee ought, if practicable, to be _freshly_ ground every morning, in order that you may be quite sure that it be perfectly genuine, and that none of the aroma of the coffee has flown off from long exposure to the atmosphere. if a youth's bowels be inclined to be costive, coffee is preferable to tea for breakfast, as coffee tends to keep the bowels regular. fresh milk ought always to be added to the coffee in the proportion of half coffee and half new milk. if coffee does not agree, then _black_ tea should be substituted, which ought to be taken with plenty of fresh milk in it. milk may be frequently given in tea, when it otherwise would disagree. when a youth is delicate, it is an excellent plan to give him, every morning before he leaves his bed, a tumblerful of _new_ milk. the draught of milk, of course, is not in any way to interfere with his regular breakfast. 329. _do you approve of a boy eating meat with his breakfast_? this will depend upon the exercise he uses. if he have had a good walk or run before breakfast, or if he intend, after breakfast, to take plenty of athletic out-door exercise, meat, or a rasher or two of bacon, may, with advantage, be eaten; but not otherwise. 330. _what is the best dinner for a youth_? fresh mutton or beef, a variety of vegetables, and a farinaceous pudding. it is a bad practice to allow him to dine, exclusively, either on a fruit pudding, or on any other pudding, or on pastry. unless he be ill, he must, if he is to be healthy, strong, and courageous, eat meat every day of his life. "all courageous animals are carnivorous, and greater courage is to be expected in a people, such as the english, whose food is strong and hearty, than in the half-starved commonalty of other countries."--sir w. temple. let him be debarred from rich soups and from high-seasoned dishes, which only disorder the stomach and inflame the blood. it is a mistake to give a boy or a girl broth or soup, in lieu of meat for dinner; the stomach takes such slops in a discontented way, and is not at all satisfied. it may be well, occasionally, to give a youth with his dinner, _in addition to his meat_, either good soup or good broth not highly seasoned, made of good _meat_ stock. but after all that can be said on the subject, a plain joint of meat, either roast or boiled, is far superior for health and strength than either soup or broth, let it be ever so good or so well made. he should be desired to take plenty of time over his dinner, so that he may be able to chew his food well, and thus that it may be reduced to an impalpable mass, and be well mixed with the saliva,--which the action of the jaws will cause to be secreted--before it passes into the stomach. if such were usually the case, the stomach would not have double duty to perform, and a boy would not so frequently lay the foundation of indigestion, etc., which may embitter, and even make miserable, his after-life. meat, plain pudding, vegetables, bread, and hunger for sauce (which exercise will readily give), is the best, and, indeed, should be, as a rule, the only dinner he should have. a youth ought not to dine later than two o'clock. 331. _do you consider broths and soups wholesome_? the stomach can digest solid much more readily than it can liquid food; on which account the dinner, specified above, is far preferable to one either of broth or of soup. fluids in large quantities too much dilute the gastric juice, and over-distend the stomach, and hence weaken it, and thus produce indigestion: indeed, it might truly be said that the stomach often takes broths and soups in a grumbling way! 332. _do you approve of a boy drinking beer with his dinner_? there is no objection to a little good, mild table-beer, but _strong_ ale ought never to be allowed. it is, indeed, questionable whether a boy, unless he take unusual exercise, requires anything but water with his meals. 333. _do you approve of a youth, more especially if he be weakly, having a glass or two of wine after dinner_? i disapprove of it: his young blood does not require to be inflamed, and his sensitive nerves excited, with wine; and, if he he delicate, i should be sorry to endeavour to strengthen him by giving him such an inflammable fluid. if he be weakly, he is more predisposed to put on either fever or inflammation of some organ; and, being thus predisposed, wine would be likely to excite either the one or the other of them into action. "wine and youth are fire upon fire."--_fielding._ a parent ought on no account to allow a boy to touch spirits, however much diluted; they are, to the young, still more deadly in their effects than wine. 334. _have you any objection to a youth drinking tea_? not at all, provided it be not _green_ tea, that it be not made strong, and that it have plenty of milk in it. green tea is apt to make people nervous, and boys and girls ought not even to know what it is to be nervous. 335. _do you object to supper for a youth_? meat suppers are highly prejudicial. if he be hungry (and if he have been much in the open air, he is almost sure to be), a piece of bread and cheese, or of bread and butter, with a draught either of new milk or of table beer, will form the best supper he can have. he ought not to sup later than eight o'clock. 336. _do you approve of a boy having anything between meals_? i do not; let him have four meals a day, and he will require nothing in the intervals. it is a mistaken notion that "little and often is best," the stomach requires rest as much as, or perhaps more than (for it is frequently sadly over-worked) any other part of the body. i do not mean that he is to have "_much_ and seldom:" moderation, in everything, is to be observed. give him as much as a growing boy requires (_and that is a great deal_), but do not let him eat gluttonously, as many indulgent parents encourage their children to do. intemperance in eating cannot be too strongly condemned. 337. _have you any objection to a boy having pocket money_? it is a bad practice to allow a boy _much_ pocket money; if he be so allowed, he will be loading his stomach with sweets, fruit, and pastry, and thus his stomach will become cloyed and disordered, and the keen appetite, so characteristic of youth, will be blunted, and ill-health will ensue. "in a public education, boys early learn intemperance, and if the parents and friends would give them less money upon their usual visits, it would be much to their advantage, since it may justly be said that a great part of their disorders arise from surfeit, '_plus occidit gula quam gladius_' (gluttony kills more than the sword)."--_goldsmith._ how true is the saying that "many people dig their graves with their teeth." you may depend upon it that more die from stuffing than from starvation! there would be little for doctors to do if there were not so much stuffing and imbibing of strong drinks going on in the world! air and exercise. 338. _have you any remarks to make on fresh air and exercise for boys and girls_? girls and boys, especially the former, are too much confined within doors. it is imperatively necessary, if you wish them to be strong and healthy, that they should have plenty of fresh air and exercise; remember, i mean fresh air--country air, not the close air of a town. by exercise, i mean the free unrestrained use of their limbs. girls, in this respect, are unfortunately worse off than boys, although they have similar muscles to develop, similar lungs that require fresh air, and similar nerves to be braced and strengthened. it is not considered lady-like to be natural--all then: movements must be measured by rule and compass! the reason why so many young girls of the present day are so sallow, under-sized, and ill-shaped, is for the want of air and exercise. after a time the want of air and exercise, by causing ill health, makes them slothful and indolent-it is a trouble for them to move from their chairs! respiration, digestion, and a proper action of the bowels, imperatively demand fresh air and exercise. ill health will inevitably ensue if boys and girls are cooped up a great part of the day in a close room. a distinguished writer of the present day says: "the children of the very poor are always out and about. in this respect they are an example to those careful mammas who keep their children, the whole day long, in their chairs, reading, writing, ciphering, drawing, practising music lessons, doing crotchet work, or anything, in fact, except running about in spite of the sunshine always peeping in and inviting them out of doors; and who, in the due course of time, are surprised to find their children growing up with incurable heart, head, lung, or stomach complaints." 339. _what is the lest exercise for a youth_? walking or running: provided either of them be not carried to fatigue,--the slightest approach to it should warn a youth to desist from carrying it further. walking exercise is not sufficiently insisted upon. a boy or a girl, to be in the enjoyment of good health, ought to walk at least ten miles every day. i do not mean ten miles at a stretch, but at different times of the day. some young ladies think it an awfully long walk if they manage a couple of miles! how can they, with such exercise, expect to be well? how can their muscles be developed? how can their nerves be braced? how can their spines be strengthened and be straight? how can their blood course merrily through their blood-vessels? how can their chests expand and be strong? why, it is impossible! ill health must be the penalty of such indolence, for nature will not be trifled with! walking exercise, then, is the finest exercise that can be taken, and must be taken, and that without stint, if boys and girls are to be strong and well! the advantage of our climate is, that there is not a day in the whole year that walking exercise cannot be enjoyed. i use the term enjoyed advisedly. the roads may, of course, be dirty; but what of that a good thick pair of boots will be the remedy. do then, let me entreat you, insist upon your--girls and boys taking plenty of exercise; let them almost live in the open air! do not coddle them; this is a rough; world of ours, and they must rough it; they must be knocked about a great deal, and the knocks will do them, good. poor youths who are, as it were, tied to their mother's apron strings, are much to be pitied; they are usually puny and delicate, and effeminate, and utterly deficient of self-reliance. 340. _do you approve of--horse or pony exercise for boys and girls_? most certainly i do; but still it ought not to supersede walking. horse or pony exercise is very beneficial, and cannot be too strongly recommended. one great advantage for those living in towns, which it has over walking, is, that a person may go further into the country, and thus be enabled to breathe a purer and more healthy atmosphere. again, it is a much more amusing exercise than walking, and this, for the young, is a great consideration indeed. horse exercise is for both boys and girls a splendid exercise; it improves the figure, it gives grace to the movements, it strengthens the chest, it braces the muscles, and gives to the character energy and courage. both boys and girls ought to be early taught to ride. there is nothing that gives more pleasure to the young than riding either on a pony or on a horse, and for younger children, even on that despised, although useful animal, a donkey. exercise, taken with pleasure, is doubly beneficial. if girls were to ride more on horseback than they now do, we should hear less of crooked spines and of round shoulders, of chlorosis and of hysteria, and of other numerous diseases of that class, owing, generally, to debility and to mismanagement. those ladies who "affect the saddle" are usually much healthier, stronger, and straighter than those who either never or but seldom ride on horseback. siding on horseback is both an exercise and an amusement, and is peculiarly suitable for the fair sex, more especially as their modes of exercise are somewhat limited, ladies being excluded from following many games, such as cricket, and foot-ball, both of which are practised, with such zest and benefit, by the rougher sex. 341. _do you approve of carriage exercise_? there is no muscular exertion in carriage exercise; its principal advantage is, that it enables a person to have a change of air, which may be purer than the one he is in the habit of breathing. but, whether it be so or not, change of air frequently does good, even, if the air be not so pure. carriage exercise, therefore, does only partial good, and ought never to supersede either walking or horse exercise. 342. _what is the best time of the day, for the taking of exercise_? in the summer time, early in the morning and before breakfast, as "cool morning air exhilarates young blood like wine." if a boy cannot take exercise upon an empty stomach, let him have a slice of bread and a draught of milk. when he returns home he will be able to do justice to his breakfast. in fine weather he cannot take too much exercise, provided it be not carried to fatigue. 343. _what is the best time for him to keep quiet_? he ought not to take exercise immediately after--say for half an hour after--a hearty meal, or it will be likely to interfere with his digestion. amusements. 344. _what amusements do you recommend for a boy as being most beneficial to health_? manly games--such as rowing, skating, cricket, quoits, foot-ball, rackets, single-stick, bandy, bowls, skittles, and all gymnastic exercises. such games bring the muscles into proper action, and thus cause them to be fully developed. they expand and strengthen the chest; they cause a due circulation of the blood, making it to bound merrily through the blood-vessels, and thus to diffuse health and happiness in its course. another excellent amusement for boys, is the brandishing of clubs. they ought to be made in the form of a constable's staff, but should be much larger and heavier. the manner of handling them is so graphically described by addison that i cannot do better than transcribe it--"when i was some years younger than i am at present, i used to employ myself in a more laborious diversion, which i learned from a latin treatise of exercises that is written with great erudition; it is there called the [greek: skiomachia] or the fighting with a man's own shadow, and consists in the brandishing of two short sticks grasped in each hand, and loaded with plugs of lead at either end. this opens the chest, exercises the limbs, and gives a man all the pleasure of boxing without the blows. i could wish that several learned men would lay out that time which they employ in controversies and disputes about nothing, in this method of fighting with their own shadows. it might conduce very much to evaporate the spleen which makes them uneasy to the public as well as to themselves." another capital, healthful game is single-stick, which makes a boy "to gain an upright and elastic carriage, and to learn the use of his limbs."--_h. kingsley_. single-stick may be taught by any drill-sergeant in the neighbourhood. do everything to make a boy strong. remember, "the glory of young men is their strength." if games were more patronised in youth, so many miserable, nervous, useless creatures would not abound. let a boy or girl, then, have plenty of play; let half of his or her time be spent in play. there ought to be a gymnasium established in every town of the kingdom. the gymnasium, the cricket ground, and the swimming bath, are among our finest establishments, and should be patronised accordingly. first of all, by an abundance of exercise and fresh air make your boys and girls strong, and then, in due time, they will be ready and be able to have their minds properly cultivated. unfortunately, in this enlightened age, we commence at the wrong end--we put the cart before the horse--we begin by cultivating the mind, and we leave the body to be taken care of afterwards; the results are, broken health, precocious, stunted, crooked, and deformed youths, and premature decay. one great advantage of gymnastic exercise is, it makes the chest expand, it fills the lungs with air, and by doing so strengthens them amazingly, and wards off many diseases. the lungs are not sufficiently exercised and expanded; boys and girls, girls especially, do not as a rule half fill their lungs with air; now air to the lungs is food to the lungs, and portions of the lungs have not half their proper food, and in consequence suffer. it is very desirable that every boy and girl should, every day of his or her life, and for a quarter of an hour at least each time, go through a regular _breathing exercise_--that is to say, should be made to stand upright, throw back the shoulders, and the while alternately and regularly fully fill and fully empty the lungs of air. if this plan were daily followed, the chest and lungs would be wonderfully invigorated, and the whole body benefited. 345. _is playing the flute, blowing the bugle, or any other wind instrument, injurious to health_? decidedly so: the lungs and the windpipe are brought into unnatural action by them. if a boy be of a consumptive habit, this will, of course, hold good with tenfold force. if a youth must be musical let him be taught singing, as that, provided the lungs be not diseased, will be beneficial. 346. _what amusements do you recommend for a girl_? archery, skipping, horse exercise, croquet, the hand-swing, the fly-pole, skating, and dancing, are among the best. archery expands the chest, throws back the shoulders, thus improving the figure, and develops the muscles. skipping is exceedingly good exercise for a girl, every part of the body being put into action by it horse exercise is splendid for a girl; it improves the figure amazingly--it is most exhilarating and amusing; moreover, it gives her courage and makes her self-reliant croquet develops and improves the muscles of the arms, beautifies the complexion, strengthens the back, and throws out the chest. croquet is for girls and women what cricket is for boys and men--a glorious game. croquet has improved both the health and the happiness of womankind more than any game ever before invented. croquet, in the bright sunshine, with the winds of heaven blowing about the players, is not like a ball in a stifling hot ball-room, with gas-lights poisoning the air. croquet is a more sensible amusement than dancing; it brings the intellect as well as the muscles into play. the man who invented croquet has deserved greater glory, and has done more good to his species, than many philosophers whose names are emblazoned in story. hand-swing is a capital exercise for a girl, the whole of the body is thrown into action by it, and the spine, the shoulders, and the shoulder-blades, are especially benefited. the fly-pole, too, is good exercise for the whole of the muscles of the body, especially of the legs and the arms. skating is for a girl excellent exercise, and is as exhilarating as a glass of champagne, but will do her far more good! skating improves the figure, and makes a girl balance and carry herself upright and well; it is a most becoming exercise for her, and is much in every way to be commended. moreover, skating gives a girl courage and self-reliance. dancing, followed as a rational amusement, causes a free circulation of the blood, and provided it does not induce her to sit up late at night, is most beneficial. 347. _if dancing be so beneficial why are balls such fruitful sources of coughs, of cold, and consumptions_? on many accounts. they induce young ladies to sit up late at night; they cause them to dress more lightly than they are accustomed to do; and thus thinly clad, they leave their homes while the weather is perhaps piercingly cold, to plunge into a suffocating, hot ballroom, made doubly injurious by the immense number of lights, which consume the oxygen intended for the due performance of the healthy functions of the lungs. their partners, the brilliancy of the scene, and the music, excite their nerves to undue and thus to unnatural, action, and what is the consequence? fatigue, weakness, hysterics, and extreme depression follow. they leave the heated ball-room when the morning has far advanced, to breathe the bitterly cold and frequently damp air of a winter's night, and what is the result? hundreds die of consumption, who might otherwise have lived. ought there not, then, to be a distinction between a ball at midnight and a dance in the evening? 348. _but still, would you have a girl brought up to forego the pleasure of a ball_? if a parent prefer her so-called pleasures to her health, certainly not; to such a mother i do not address myself. 349. _have you any remarks to make on singing, or on reading aloud_? before a mother allows her daughter to take lessons in singing, she should ascertain that there be no actual disease of the lungs, for if there be, it will probably excite it into action; but if no disease exist, singing or reading aloud is very conducive to health. public singers are seldom known to die of consumption. singing expands the chest, improves the pronunciation, enriches the voice for conversation, strengthens the lungs, and wards off many of their diseases. 350. _do you approve of corporal punishments in schools_? i do not. i consider it to be decidedly injurious both to body and mind. is it not painful to witness the pale cheeks and the dejected looks of those boys who are often flogged? if their tempers are mild, their spirits are broken; if their dispositions are at all obstinate, they become hardened and wilful, and are made little better than brutes. [footnote: "i would have given him, captain fleming, had he been my son," quoth old pearson the elder, "such's good sound drubbing as he never would have forgotten--never!" "pooh! pooh! my good sir. don't tell me. never saw flogging in the navy do good. kept down brutes; never made a man yet."--dr norman macleod in _good words_, may 1861.] a boy who is often flogged loses that noble ingenuousness and fine sensibility so characteristic of youth. he looks upon his school as his prison, and his master as his gaoler, and as he grows up to manhood, hates and despises the man who has flogged him. corporal punishment is revolting, disgusting, and demoralising to the boy; and is degrading to the schoolmaster as a man and as a christian, if schoolmasters must flog, let them flog their own sons. if they must ruin the tempers, the dispositions, and the constitution of boys, they have more right to practise upon their own than on other people's children! oh! that parents would raise--and that without any uncertain sound--their voices against such abominations, and the detestable cane would soon be banished the school-room! "i am confident that no boy," says addison, "who will not be allured by letters without blows, will never be brought to anything with them. a great or good mind must necessarily be the worse for such indignities; and it is a sad change to lose of its virtue for the improvement of its knowledge. no one has gone through what they call a great school, but must have remembered to have seen children of excellent and ingenuous natures (as have afterwards appeared in their manhood). i say, no man has passed through this way of education but must have seen an ingenuous creature expiring with shame, with pale looks, beseeching sorrow, and silent tears, throw up its honest sighs, and kneel on its tender knees to an inexorable blockhead, to be forgiven the false quantity of a word in making a latin verse. the child is punished, and the next day he commits a like crime, and so a third, with the same consequence. i would fain ask any reasonable man whether this lad, in the simplicity of his native innocence, full of shame, and capable of any impression from that grace of soul, was not fitter for any purpose in this life than after that spark of virtue is extinguished in him, though he is able to write twenty verses in an evening?" how often is corporal punishment resorted to at school because the master is in a passion, and he vents his rage upon the poor school-boy's unfortunate back! oh! the mistaken notion that flogging will make a bad-behaved boy a good boy; it has the contrary effect. "'i dunno how 'tis, sir,' said an old farm labourer, in reply to a question from his clergyman respecting the bad behaviour of his children, 'i dunno how 'tis; i beats 'em till they're black and blue, and when they won't kneel down to pray i knocks 'em down, and yet they ain't good.'"--_the birmingham journal._ in an excellent article in _temple bar_(november 1864) on flogging in the army, the following sensible remarks occur:--"in nearly a quarter of a century's experience with soldiers, the writer has always, and without a single exception, found flogging makes a good man bad, and a bad man worse." with equal truth it may be said that, without a single exception, flogging makes a good boy bad, and a bad boy worse. how many men owe their ferocity to the canings they received when school-boys! the early floggings hardened and soured them, and blunted their sensibility. dr arnold of rugby, one of the best schoolmasters that england ever produced, seldom caned a boy--not more than once or twice during the half year; but when he did cane him, he charged for the use of the cane each time in the bill, in order that the parents might know how many times their son had been punished. at some of our public schools now-a-days, a boy is caned as many times in a morning as the worthy doctor would have caned him during the whole half year; but then, the doctor treated the boys as gentlemen, and trusted much to their honour; but now many schoolmasters trust much to fear, little to honour, and treat them as brute beasts. it might be said that the discipline of a school cannot be maintained unless the boys be frequently caned, that it must be either caning or expulsion. i deny these assertions. dr arnold was able to conduct his school with honour to himself, and with immense benefit to the rising generation, without either frequent canings or expulsions. the humane plan, however, requires at first both trouble and patience; and trouble some schoolmasters do not like, and patience they do not possess; the use of the cane is quick, sharp, decisive, and at the time effective. if caning be ever necessary, which it might occasionally be, for the telling of lies for instance, or for gross immorality, let the head master himself be the only one to perform the operation, but let him not be allowed to delegate it to others. a law ought in all public schools to be in force to that effect. high time that something were done to abate such disgraceful practices. never should a schoolmaster, or any one else, be allowed, _on any pretence whatever_, to strike a boy upon his head. boxing of the ears has sometimes caused laceration of the drum of the ear, and consequent partial deafness for life. boxing of the ears injures the brain, and therefore the intellect. it might be said, that i am travelling out of my province in making remarks on corporal chastisement in schools? but, with deference, i reply that i am strictly in the path of duty. my office is to inform you of everything that is detrimental to your children's health and happiness; and corporal punishment is assuredly most injurious both to their health and happiness. it is the bounden duty of every man, and especially of every medical man, to lift up his voice against the abominable, disgusting, and degrading system of flogging, and to warn parents of the danger and the mischief of sending boys to those schools where flogging is, except in rare and flagrant cases, permitted. 351. _have you any observations to make on the selection, of a female boarding-school_? home education, where it be practicable, is far preferable to sending a girl to school; as _at_ home, her health, her morals, and her household duties, can be attended to much more effectually than _from_ home. moreover, it is a serious injury to a girl, in more ways than one, to separate her from her own brothers: they very much lose their affection for each other, and mutual companionship (so delightful and beneficial between brothers and sisters) is severed. if home education be not practicable, great care must be taken in making choice of a school. boarding school education requires great reformation. accomplishments, superficial acquirements, and brain-work, are the order of the day; health is very little studied. you ought, in the education of your daughters, to remember that they, in a few years, will be the wives and the mothers of england; and, if they have not health and strength, and a proper knowledge of household duties to sustain their characters, what useless, listless wives and mothers they will make! remember, then, the body, and not the mind, ought, in early life, to be principally cultivated and strengthened, and that the growing brain will not bear, with impunity, much book learning. the brain of a school-girl is frequently injured by getting up voluminous questions by rote, that are not of the slightest use or benefit to her, or to any one else. instead of this ridiculous system, educate a girl to be useful and self-reliant. "from babyhood they are given to understand that helplessness is feminine and beautiful; helpfulness, except in certain received forms of manifestation, unwomanly and ugly. the boys may do a thousand things which are 'not proper for little girls.'"--_a woman's thoughts about women_. from her twelfth to her seventeenth year, is the most important epoch of a girl's existence, as regards her future health, and consequently, in a great measure, her future happiness; and one, in which, more than at any other period of her life, she requires a plentiful supply of fresh air, exercise, recreation, a variety of innocent amusements, and an abundance of good nourishment--more especially of fresh meat; if therefore you have determined on sending your girl to school, you must ascertain that the pupils have as much plain wholesome nourishing food as they can eat, [footnote: if a girl have an _abundance_ of good nourishment, the schoolmistress must, of coarse, be remunerated for the necessary and costly expense; and how can this be done on the paltry sum charged at _cheap_ boarding schools? it is utterly impossible! and what are we to expect from poor and insufficient nourishment to a fast-growing girl, and at the time of life, remember, when she requires an _extra_ quantity of good sustaining, supporting food? a poor girl, from such treatment, becomes either consumptive or broken down in constitution, and from which she never recovers, but drags on a miserable existence.] that the school be situated in a healthy spot, that it be well-drained, that there be a large play-ground attached to it, that the young people are allowed plenty of exercise in the open air--indeed, that at least one-third of the day is spent there in croquet, skipping, archery, battle-dore and shuttlecock, gardening, walking, running, &c. take care that the school-rooms are well-ventilated, that they are not over-crowded, and that the pupils are allowed chairs to sit upon, and not those abominations--forms and stools. if you wish to try the effect of them upon yourselves, sit for a couple of hours without stirring upon a form or upon a stool, and, take my word for it, you will insist that forms and stools be banished for ever from the schoolroom. assure yourself that the pupils are compelled to rise early in the morning, and that they retire early to rest; that each young lady has a separate bed [footnote: a horse-hair mattress should always be preferred to a feather-bed. it is not only better for the health, but it improves the figure] and that many are not allowed to sleep in the same room, and that the apartments are large and well-ventilated. in fine, their health and their morals ought to be preferred far above all their accomplishments. 352. _they use, in some schools, straight-backed chairs to make a girl sit upright, and to give strength to her back: do you approve of them_? certainly not: the natural and the graceful curve of the back is not the curve of a straight-backed chair. straight-backed chairs are instruments of torture, and are more likely to make a girl crooked than to make her straight. sir astley cooper ridiculed straight-backed chairs, and well he might. it is always well for a mother to try, for some considerable time, such ridiculous inventions upon herself before she experiments upon her unfortunate daughter. the position is most unnatural. i do not approve of a girl lounging and lolling on a sofa; but, if she be tired and wants to rest herself, let her, like any other reasonable being, sit upon a comfortable ordinary chair. if you want her to be straight, let her be made strong; and if she is to be strong, she must use plenty of exercise and exertion, such as drilling, dancing, skipping, archery, croquet, hand-swinging, horse-exercise, swimming, bowls, etc. this is the plan to make her back straight and her muscles strong. why should we bring up a girl differently from a boy? muscular exercises, gymnastic performances, and health-giving exertion, are unladylike, forsooth! household work for girls. 353. _do you recommend household work as a means of health for my daughter_? decidedly: whatever you do, do not make a fine lady of her, or she will become puny and delicate, listless, and miserable. a girl, let her station be what it might, ought, as soon as she be old enough, to make her own bed. there is no better exercise to expand the figure and to beautify the shape than is bed-making. let her make tidy her own room. let her use her hands and her arms. let her, to a great extent, be self-reliant, and let her wait upon herself. there is nothing vulgar in her being useful. let me ask, of what use are many girls of the present day? they are utterly useless. are they happy? no, for the want of employment, they are miserable--i mean bodily employment, household work. many girls, now-a-days, unfortunately, are made to look upon a pretty face, dress, and accomplishments, as the only things needed! and, when they do become women and wives--if ever they do become women and wives--what miserable lackadaisical wives, and what senseless, useless mothers they will make! choice of profession or trade. 354. _what profession or trade would you recommend a boy of a delicate or of a consumptive habit to follow_? if a youth be delicate, it is a common practice among parents either to put him to some light in-door trade, or, if they can afford it, to one of the learned professions. such a practice is absurd, and fraught with danger. the close confinement of an in-door trade is highly prejudicial to health. the hard reading requisite to fit a man to fill, for instance, the sacred office, only increases delicacy of constitution. the stooping at a desk, in an attorney's office, is most trying to the chest. the harass, the anxiety, the disturbed nights, the interrupted meals, and the intense study necessary to fit a man for the medical profession, is still more dangerous to health than either law, divinity, or any in-door trade. "sir walter scott says of the country surgeon, that he is worse fed and harder wrought than any one else in the parish, except it be his fiorse."--_brown's horoe subsecivoe._ a modern writer, speaking of the life of a medical man, observes, "there is no career which so rapidly wears away the powers of life, because there is no other which requires a greater activity of mind and body. he has to bear the changes of weather, continued fatigue, irregularity in his meals, and broken rest; to live in the midst of miasma and contagion. if in the country, he has to traverse considerable distances on horseback, exposed to wind and storm; to brave all dangers to go to the relief of suffering humanity. a fearful truth for medical men has been established by the table of mortality of dr. caspar, published in the _british review_. of 1000 members of the medical profession, 600 died before their sixty-second year; whilst of persons leading a quiet life--such as agriculturists or theologians--the mortality is only 347. if we take 100 individuals of each of these classes, 43 theologians, 40 agriculturists, 35 clerks, 32 soldiers, will reach their seventieth year; of 100 professors of the healing art, 24 only will reach that age. they are the sign-posts to health; they can show the road to old age, but rarely tread it themselves." if a boy, therefore, be of a delicate or of a consumptive habit, an out-door calling should be advised, such as that of a farmer, of a tanner, or a land-surveyor; but, if he be of an inferior station of society, the trade of a butcher may be recommended. tanners and butchers are seldom known to die of consumption. i cannot refrain from reprobating the too common practice among parents of bringing up their boys to the professions. the anxieties and the heartaches which they undergo if they do not succeed (and how can many of them succeed when there is such a superabundance of candidates?) materially injure their health. "i very much wonder," says addison, "at the humour of parents, who will not rather choose to place their sons in a way of life where an honest industry cannot but thrive, than in stations where the greatest probity, learning, and good sense, may miscarry. how many men are country curates, that might have made themselves aldermen of london by a right improvement of a smaller sum of money than what is usually laid out upon a learned education? a sober, frugal person, of slender parts and a slow apprehension, might have thrived in trade, though he starves upon physic; as a man would be well enough pleased to buy silks of one whom he could not venture to feel his pulse. vagellius is careful, studious, and obliging, but withal a little thick-skulled; he has not a single client, but might have had abundance of customers. the misfortune is that parents take a liking to a particular profession, and therefore desire their sons may be of it; whereas, in so great an affair of life, they should consider the genius and abilities of their children more than their own inclinations. it is the great advantage of a trading nation, that there are very few in it so dull and heavy who may not be placed in stations of life which may give them an opportunity of making their fortunes. a well-regulated commerce is not, like law, physic, or divinity, to be overstocked with hands; but, on the contrary, flourishes by multitudes, and gives employment to all its professors. fleets of merchantmen are so many squadrons of floating shops, that vend our wares and manufactures in all the markets of the world, and find out chapmen under both the tropics." 355. _then, do you recommend a delicate youth to be brought up either to a profession or to a trade_? decidedly; there is nothing so injurious for a delicate boy, or for anyone else, as idleness. work, in moderation, enlivens the spirits, braces the nerves, and gives tone to the muscles, and thus strengthens the constitution. of all miserable people, the idle boy, or the idle man, is the most miserable! if you be poor, of course you will bring him up to some calling; but if you be rich, and your boy be delicate (if he be not actually in a consumption), you will, if you are wise, still bring him up to some trade or profession. you will, otherwise, be making a rod for your own as well as for your son's back. oh, what a blessed thing is work! 356. _have you any remarks to make on the sleep of boys and girls_? sleeping-rooms, are, generally, the smallest in the house, whereas, for health's sake, they ought to be the largest if it be impossible to have a _large_ bedroom, i should advise a parent to have a dozen or twenty holes (each about the size of a florin) bored with a centre-bit in the upper part of the chamber door, and the same number of holes in the lower part of the door, so as constantly to admit a free current of air from the passages. if this cannot readily be done, then let the bedroom door be left ajar all night, a door chain being on the door to prevent intrusion; and, in the summer time, during the night, let the window-sash, to the extent of about two or three inches, be left open. if there be a dressing-room next to the bedroom, it will be well to have the dressing-room window, instead of the bedroom window, open at night. the dressing-room door will regulate the quantity of air to be admitted into the bedroom, opening it either little or much, as the weather might be cold or otherwise. _fresh air during deep is indispensable to health._--if a bedroom be close, the sleep, instead of being calm and refreshing, is broken and disturbed; and the boy, when he awakes in the morning, feels more fatigued than when he retired to rest. if sleep is to be refreshing, the air, then, must be pure, and free from carbonic acid gas, which, is constantly being evolved from the lungs. if sleep is to be health-giving, the lungs ought to have their proper food--oxygen, and not to be cheated by giving them instead a poison--carbonic acid gas. it would be well for each boy to have a separate room to himself, and each girl a separate room to herself. if two boys are obliged, from the smallness of the house, to sleep in one room, and if two girls, from the same cause, are compelled to occupy the same chamber, by all means let each one have a _separate_ bed to himself and to herself, as it is so much more healthy and expedient for both boy and girl to sleep alone. the roof of the bed should be left open--that is to say, the top of the bedstead ought not to be covered with bed furniture, but should be open to the ceiling, in order to encourage a free ventilation of air. a bed-curtain may be allowed on the side of the bed where there are windy currents of air; otherwise bed-curtains and valances ought on no account to be allowed. they prevent a free circulation of the air. a youth should sleep on a horse-hair mattress. such mattresses greatly improve the figure and strengthen the frame. during the day time, provided it does not rain, the windows must be thrown wide open, and, directly after he has risen from bed, the clothes ought to be thrown entirely back, in order that they may become, before the bed be made, well ventilated and purified by the air- "do yon wish to be healthy?- then keep the home sweet, as soon as you're up shake each blanket and sheet. leave the beds to get fresh on the close crowded floor let the wind sweep right through- open window and door the bad air will rush out as the good air comes in, just as goodness is stronger and better than sin. do this, it's soon done, in the fresh morning air, it will lighten your labour and lessen your care you are weary--no wonder, there's weight and there's gloom hanging heavily round in each over full room. be sure all the trouble is profit and gain for there's head ache and heart-ache, and fever and pain hovering round, settling down in the closeness and heat let the wind sweep right through till the air's fresh and sweet, and more cheerful you'll feel through the toil of the day, more refreshed you'll awake when the night's paved away" [footnote: _household verses on health and happiness_ london. jarrold and sons. every mother should read these _verses_.] plants and flowers ought not to be allowed to remain in a chamber at night. experiments have proved that plants and flowers take up, in the day-time, carbonic acid gas (the refuse of respiration), and give off oxygen (a gas so necessary and beneficial to health), but give out, in the night season, a poisonous exhalation. early rising cannot be too strongly insisted upon; nothing is more conducive to health and thus to long life. a youth is frequently allowed to spend the early part of the morning in bed, breathing the impure atmosphere of a bedroom, when he should be up and about, inhaling the balmy and health-giving breezes of the morning:- "rise with the lark, and with the lark to bed: the breath of night's destructive to the hue of ev'ry flower that blows. go to the field, and ask the humble daisy why it sleeps soon as the sun departs? why close the eyes of blossoms infinite long ere the moon her oriental veil puts off? think why, nor let the sweetest blossom nature boasts be thus exposed to night's unkindly damp. well may it droop, and all its freshness lose, compell'd to taste the rank and pois'nous steam of midnight theatre and morning ball gire to repose the solemn hour she claims; and from the forehead of the morning steal the sweet occasion. oh! there is a charm which morning has, that gives the brow of age, a smack of youth, and makes the lip of youth shed perfume exquisite. expect it not ye who till noon upon a down-bed lie, indulging feverish sleep."--_hurdis_. if early rising be commenced in childhood it becomes a habit, and will then probably be continued through life. a boy ought on no account to be roused from his sleep; but, as soon as he be awake in the morning, he should be encouraged to rise. dozing--that state between sleeping and waking--is injurious; it enervates both body and mind, and is as detrimental to health as dram drinking! but if he rise early he must go to bed betimes; it is a bad practice to keep him up until the family retire to rest. he ought, winter and summer, to seek his pillow by nine o'clock, and should rise as soon as he awake in the morning. let me urge upon a parent the great importance of _not_ allowing the chimney of any bedroom, or of any room in the house, to be stopped, as many are in the habit of doing to prevent, as _they_ call it, a draught, but to prevent, as _i_ should call it, health. 357. _how many hours of deep ought a boy to have_? this, of course, will depend upon the exercise he takes: but, on an average, he should have every night at least eight hours. it is a mistaken notion that a boy does _better_ with _little_ sleep. infants, children, and youths require more than those who are further advanced in years; hence old people can frequently do with little sleep. this may in a measure be accounted for from the quantity of exercise the young take. another reason may be, the young have neither racking pain, nor hidden sorrow, nor carking care, to keep them awake; while, on the contrary, the old have frequently, the one, the other, or all:- "care keeps his watch on every old man's eye, and where care lodges, sleep will never lie."--_shakspeare_. on the teeth and the gums. 358. _what are the beet means of keeping the teeth and the gums in a healthy state_? i would recommend the teeth and the gums to be well brushed with warm salt and water, in the proportion of one large tea-spoonful of, salt to a tumbler of water. i was induced to try the above plan by the recommendation of an american writer--_todd_. the salt and water should be used _every night_. the following is an excellent tooth-powder:- take of--finely-powder peruvian bark; '' prepared coral; '' prepared chalk; '' myrrh, of each half an ounce '' orris root, a quarter of an ounce: mix them well together in a mortar, and preserve the powder in a wide mouthed stoppered bottle. the teeth ought to be well brushed with the above tooth-powder every morning. if the teeth be much decayed, and if, in consequence, the breath be offensive, two ounces of finely-powdered charcoal well mixed with the above ingredients will be found a valuable addition. some persons clean their teeth every morning with soap; if soap be used it ought to be castile soap; and if the teeth be not white and clean, castile soap is an excellent cleanser of the teeth, and may be used in lieu of the tooth powder as before recommended. there are few persons who brush their teeth properly. i will tell you the right way. first of all procure a tooth brush of the best make, and of rather hard bristles, to enable it to penetrate into all the nooks and corners of the teeth; then, having put a small quantity of warm water into your mouth, letting the principal of it escape into the basin, dip your brush in warm water, and if you are about using castile soap, rub the brush on a cake of the soap, and then well brush your teeth, first upwards and then downwards, then from side to side--from right to left, and from left to right--then the backs of the teeth, then apply the brush to the tops of the crowns of the teeth both of the upper and of the lower jaw,--so that _every_ part of each tooth, including the gums, may in turn be well cleansed and be well brushed. be not afraid of using the brush; a good brushing and dressing will do the teeth and the gums an immensity of good; it will make the breath sweet, and will preserve the teeth sound and good. after using the brush the mouth must, of course, be well rinsed out with warm water. the finest get of teeth i ever saw m my life belonged to a middle-aged gentleman; the teeth had neither spot nor blemish, they were like beautiful pearls. he never had toothache in his life, and did not know what toothache meant! he brushed his teeth, every morning, with soap and water, in the manner i have previously recommended. i can only say to you--go and do likewise! camphor ought never to be used as an ingredient of tooth-powder, it makes the teeth brittle. camphor certainly has the effect of making the teeth, for a time, look very white; but it is an evanescent beauty. tartar is apt to accumulate between and around the teeth; it is better in such a case not to remove it by sealing instruments, but to adopt the plan recommended by dr richardson, namely, to well brush the teeth with pure vinegar and water. prevention of disease, etc 359. _if a boy or a girl show great precocity of intellect, is any organ likely to become affected_? a greater quantity of arterial blood is sent to the brain of those who are prematurely talented, and hence it becomes more than ordinarily developed. such advantages are not unmixed with danger; this same arterial blood may exite and feed inflammation, and either convulsions, or water on the brain, or insanity, or, at last, idiocy may follow. how proud a mother is in having a precocious child! how little is she aware that precocity is frequently an indication of disease! 360. _how can danger in such a case be warded off_? it behoves a parent, if her son be precocious, to restrain him--to send him to a quiet country place, free from the excitement of the town; and when he is sent to school, to give directions to the master that he is not on any account to tax his intellect (for a master is apt, if he have a clever boy, to urge him forward); and to keep him from those institutions where a spirit of rivalry is maintained, and where the brain is thus kept in a state of constant excitement. medals and prizes are well enough for those who have moderate abilities, but dangerous, indeed, to those who have brilliant ones. an over-worked precocious brain is apt to cause the death of the owner; and if it does not do so, it in too many instances injures the brain irreparably, and the possessor of such an organ, from being one of the most intellectual of children becomes one of the most commonplace of men. let me urge you, if you have a precocious child, to give, and that before it be too late, the subject in question your best consideration. 361. _are precocious boys in their general health usually strong or delicate_? delicate: nature seems to have given a delicate body to compensate for the advantages of a talented mind. a precocious youth is predisposed to consumption, more so than to any other disease. the hard study which he frequently undergoes excites the disease into action. it is not desirable, therefore, to have a precocious child. a writer in "eraser's magazine" speaks very much to the purpose when he says, "give us intellectual beef rather than intellectual veal." 362. _what habit of body is most predisposed to scrofula_? he or she who has a moist, cold, fair, delicate and almost transparent skin, large prominent blue eyes, protuberant forehead, light-brown or auburn hair, rosy cheeks, pouting lips, milk-white teeth, long neck, high shoulders, small, flat, and contracted chest, tumid bowels, large joints, thin limbs, and flabby muscles, is the person, most predisposed to scrofula. the disease is not entirely confined to the above; sometimes she or he who has black hair, dark eyes and complexion, is subject to it, but yet, far less frequently than the former. it is a remarkable fact that the most talented are the most prone to scrofula, and being thus clever their intellects are too often cultivated at the expense of their health. in infancy and childhood, either water on the brain or mesenteric disease; in youth, pulmonary consumption is frequently their doom: they are like shining meteors; their life is short, but brilliant. 363. _how may scrofula be warded off_? strict attention to the roles of health is the means to prevent scrofula. books, unless as an amusement, ought to be discarded. the patient must almost live in the open air, and his residence should be a healthy country place, where the air is dry and bracing; if it be at a farm-house, in a salubrious neighbourhood, so much the better. in selecting a house for a patient predisposed to scrofula, _good pure water should be an important requisite;_ indeed for every one who values his health. early rising in such a case is most beneficial. wine, spirits, and all fermented liquors ought to be avoided. beef-steaks and mutton-chops in abundance, and plenty of milk and of farinaceous food--such as rice, sago, arrowroot, &c., should be his diet. scrofula, if the above rules be strictly and perseveringly followed, may be warded off; but there must be no half measures, no trying to serve two masters--to cultivate at the same time the health and the intellect. the brain, until the body becomes strong, must _not_ be taxed. "you may prevent scrofula by care, but that some children are originally predisposed to the disease there cannot be the least doubt, and in such cases the education and the habits of youth should be so directed as to ward off a complaint, the effects of which are so frequently fatal."--_sir astley cooper on scrofula_. 364. _but suppose the disease to be already formed, what must then be done_? the plan recommended above must still be pursued, not by fits and starts, but steadily and continuously, for it is a complaint that requires a vast deal of patience and great perseverance. warm and cold sea-bathing in such a case are generally most beneficial. in a patient with confirmed scrofula it will of course be necessary to consult a skilful and experienced doctor. but do not allow without a second opinion any plan to be adopted that will weaken the system, which is already too much depressed. no, rather build up the body by good nourishing diet (as previously recommended), by cod-liver oil, by a dry bracing atmosphere, such as, either brighton, or ramsgate, or llandudno; or if the lungs be delicate, by a more sheltered coast, such as, either st leonards or torquay. let no active purging, no-mercurials, no violent, desperate remedies be allowed. if the patient cannot be cured _without_ them, i am positive that he will not be cured _with_ them. but do not despair; many scrofulous patients are cured by time and by judicious treatment but if desperate remedies are to be used, the poor patient had better by jar be left to nature: "let me fall now into the hand of the lord; for very great are his mercies; but let me not fall into the hand of man."--_chronicles_. 365. _have you any remarks to make on a girl stooping_? a girl ought never to be allowed to stoop: stooping spoils the figure, weakens the chest, and interferes with the digestion. if she cannot help stooping, you may depend upon it that she is in bad health, and that a medical man ought to be consulted. as soon as her health is improved the dancing-master should be put in requisition, and calisthenic and gymnastic exercises should be resorted to. horse exercise and swimming in such a case are very beneficial the girl should live well, on good nourishing diet, and not be too closely confined either to the house or to her lessons. she ought during the night to lie on a horsehair mattress, and during the day, for two or three hours, flat on, her back on a reclining board. stooping, if neglected, is very likely to lead to consumption. 366. _if a boy be round-shouldered and slouching in his gait, what ought to be done_? let him be drilled; there is nothing more likely to benefit him than drilling. you never see a soldier round-shouldered nor slouching in his gait he walks every inch like a man. look at the difference in appearance between a country bumpkin and a soldier! it is the drilling that makes the difference: "oh, for a drill-sergeant to teach them to stand upright, and to turn out their toes, and to get rid of that slouching, hulking gait, which gives such a look of clumsiness and stupidity!" [footnote: a. k, h. b., _fraser's magazine_, october 1861.] 367. _my daughter has grown out of shape, she has grown on one ride, her spine is not straight, and her ribs bulge out more on the one side than on the other; what is the cause, and can anything be done to remedy the deformity_? the causes of this lateral curvature of the spine, and consequent bulging out of the ribs that you have just now described, arise either from delicacy of constitution, from the want of proper exercise, from too much learning, or from too little play, or from not sufficient or proper nourishment for a rapidly-growing body. i am happy to say that such a case, by judicious treatment, can generally be cured--namely, by gymnastic exercises, such as the hand-swing, the fly-pole, the patent parlour gymnasium, the chest-expander, the skipping rope, the swimming bath; all sorts of out-door games, such as croquet, archery, &c.; by plenty of good nourishment, by making her a child of nature, by letting her almost live in the open air, and by throwing books to the winds. but let me strongly urge you not, unless ordered by an experienced surgeon, to allow any mechanical restraints or appliances to be used. if she be made strong, the muscles themselves will pull both the spine and the ribs into their proper places, more especially if judicious games and exercises (as i have before advised), and other treatment of a strengthening and bracing nature, which a medical man will indicate to you, be enjoined. mechanical appliances will, if not judiciously applied, and in a proper case, waste away the muscles, and will thus increase the mischief; if they cause the ribs to be pushed in in one place, they will bulge them out in another, until, instead of being one, there will be a series of deformities. no, the giving of strength and the judicious exercising of the muscles are, for a lateral curvature of the spine and the consequent bulging out of one side of the ribs, the proper remedies, and, in the majority of cases, are most effectual, and quite sufficient for the purpose. i think it well to strongly impress upon a mother's mind the great importance of early treatment. if the above advice be followed, every curvature in the beginning might be cured. cases of several years' standing might, with judicious treatment, be wonderfully relieved. bear in mind, then, that if the girl is to be made straight, she is first of all to be made strong; the latter, together with the proper exercises of the muscles, will lead to the former; and the _earlier_ a medical man takes it in hand, the more rapid, the more certain, and the more effectual will be the cure. an inveterate, long-continued, and neglected case of curvature of the spine and bulging out of the ribs on one side might require mechanical appliances, but such a case can only be decided on by an experienced surgeon, who ought always, _in the first place_, to be consulted. 368. _is a slight spitting of blood to be looked upon as a dangerous symptom_? spitting of blood is always to be looked upon with suspicion; even when a youth appears, in other respects, to be in good health, it is frequently the forerunner of consumption. it might be said that, by mentioning the fact, i am unnecessarily alarming a parent, but it would be a false kindness if i did not do so:- "i most be cruel, only to be kind."--_shakspeare_. let me ask, when is consumption to be cured? is it at the onset, or is it when it is confirmed? if a mother had been more generally aware that spitting of blood was frequently the forerunner of consumption, she would, in the management of her offspring, have taken greater precautions; she would have, made everything give way to the preservation of their health; and, in many instances, she would have been amply repaid by having the lives of her children spared to her. we frequently hear of patients, in _confirmed_ consumption, being sent to mentone, to madeira, and to other foreign parts. can anything be more cruel or absurd? if there be any disease that requires the comforts of home--and truly may an englishman's dwelling be called _home!_--and good nursing more than another, it is consumption. 369. _what it the death-rate of consumption in england? at what age does consumption most frequently occur? are girls more liable to it than boys? what are the symptoms of this disease_? it is asserted, on good authority, that there always are in england, 78,000 cases of consumption, and that the yearly death-rate of this fell disease alone is 39,000! consumption more frequently shows itself between the ages of fourteen and twenty-one: after then, the liability to the disease gradually diminishes, until, at the age of forty-five, it becomes comparatively rare. boys are more prone to this complaint than girls. some of the most important symptoms of pulmonary consumption are indicated by the stethoscope; but, as i am addressing a mother, it would, of course, be quite out of place to treat of such signs in conversations of this kind. the symptoms it might be well for a parent to recognise, in order that she may seek aid early, i will presently describe. it is perfectly hopeless to expect to cure consumption unless advice be sought at the _onset_, as the only effectual good in this disease is to be done _at first_. it might be well to state that consumption creeps on insidiously. one of the earliest symptoms of this dreadful scourge is a slight, dry, short cough, attended with tickling and irritation at the top of the throat. this cough generally occurs in the morning; but, after some time, comes on at night, and gradually throughout the day and the night. frequently during the early stage of the disease _a slight spitting of blood occurs_. now, this is a most dangerous symptom; indeed, i may go so far as to say that, as a rule, it is almost a sure sign that the patient is in the _first_ stage of a consumption. there is usually hoarseness, not constant, but coming on if the patient be tired, or towards the evening; there is also a sense of lassitude and depression, shortness of breath, a feeling of being quickly wearied--more especially on the slightest exertion. the hair of a consumptive person usually falls off, and what little remains is weak and poor; the joints of the fingers become enlarged, or clubbed as it is sometimes called; the patient loses flesh, and, after some time, night sweats make their appearance: then we may know that hectic fever has commenced. hectic begins with chilliness, which is soon followed by flushings of the face, and by burning heat of the hands and the feet, especially of the palms and the soles. this is soon succeeded by perspirations. the patient has generally, during the day, two decided paroxysms of hectic fever--the one at noon, which lasts above five hours; the other in the evening, which is more severe, and ends in violent perspirations, which perspirations continue the whole night through. he may, during the day, have several attacks of hectic flushes of the face, especially after eating; at one moment he complains of being too hot, and rushes to the cool air; the next moment he is too cold, and almost scorches himself by sitting too near the fire. whenever the circumscribed hectic flush is on the cheek, it looks as though the cheek had been painted with vermilion, then is the time when the palms of the hands are burning hot. crabbe, in the following lines, graphically describes the hectic flush:- "when his thin cheek assumed a deadly hue, and all the rose to one small spot withdrew: they call'd it hectic; 'twas a fiery flush, more fix'd and deeper than the maiden blush." the expectoration at first is merely mucus, but after a time it assumes a characteristic appearance; it has a roundish, flocculent, woolly form, each portion of phlegm keeping, as it were, distinct; and if the expectoration be stirred in water, it has a milk-like appearance. the patient is commonly harassed by frequent bowel complaints, which rob him of what little strength he has left. the feet and ankles swell. the perspiration, as before remarked, comes on in the evening, continues all night--more especially towards morning, and while the patient is asleep; during the time he is awake, even at night, he seldom sweats much. the thrush generally shows itself towards the close of the disease, attacking the tongue, the tonsils, and the soft palate, and _is a sure harbinger of approaching death_. emaciation rapidly sets in. if we consider the immense engines of destruction at work-viz., the-colliquative (melting) sweats, the violent bowel complaints, the vital parts that are affected, the harassing cough, the profuse expectoration, the hectic fever, the distressing exertion of struggling to breathe--we cannot be surprised that "consumption had hung out her red flag of no surrender," and that death soon closes the scene. in girls, provided they have been previously regular, menstruation gradually declines, and then entirely disappears. 370. _what are the causes of consumption_? the _predisposing_ causes of consumption are the tuberculous habit of body, hereditary predisposition, narrow or contracted chest, deformed spine, delicacy of constitution, bad and scanty diet, or food containing but little nourishment, impure air, close in-door confinement in schools, in shops, and in factories, ill-ventilated apartments, dissipation, late hours, over-taxing with book-learning the growing brain, thus producing debility, want of proper out-door exercises and amusements, tight lacing; indeed, anything and everything, that either will debilitate the constitution, or will interfere with, or will impede, the proper action of the lungs, will be the predisposing causes of this fearful and lamentable disease. an ill, poor, and insufficient diet is the mother of many diseases, and especially of consumption: "whatsoever was the father of a disease, an ill diet was the mother." the most common _exciting_ causes of consumption are slighted colds, neglected inflammation of the chest, long continuance of influenza, sleeping in damp beds, allowing wet clothes to dry on the body, unhealthy employments--such as needle-grinding, pearl button making etc. 371. _supposing a youth to have spitting of blood, what precautions would you take to prevent it from ending in consumption_? let his health be the first consideration; throw books to the winds; if he be at school, take him away; if he be in trade, cancel his indentures; if he be in the town, send him to a sheltered healthy spot in the country, or to the south coast; as, for instance, either to st leonards-on-sea, to torquay, or to the isle of wight. i should be particular in his clothing, taking especial care to keep his chest and feet warm. if he did not already wear flannel waistcoats, let it be winter or summer, i should recommend him immediately to do so: if it be winter, i should advise him also to take to _flannel_ drawers. the feet must be carefully attended to; they ought to be kept both warm and dry, the slightest dampness of either shoes or stockings should cause them to be immediately changed. if a boy, he ought to wear double-breasted waistcoats; if a girl, high dresses. the diet must be nutritious and generous; he should be encouraged to eat plentifully of beef and mutton. there is nothing better for breakfast, where it agree, than milk; indeed, it may be frequently made to agree by previously boiling it. good home-brewed ale or sound porter ought, in moderation, to be taken. wine and spirits must on no account be allowed. i caution parents in this particular, as many have an idea that wine, in such cases, is strengthening, and that _rum_ and milk is a good thing either to cure or to prevent a cough! if it be summer, let him be much in the open air, avoiding the evening and the night air. if it be winter, he should, unless the weather be mild for the season, keep within doors. particular attention ought to be paid to the point the wind is in, as he should not be allowed to go out if it is either in the north, in the east, or in the north-east; the latter is more especially dangerous. if it be spring, and the weather be favourable, or summer or autumn, change of air, more especially to the south-coast--to the isle of wight, for instance-would be desirable; indeed, in a case of spitting of blood, i know of no remedy so likely to ward off that formidable, and, generally, intractable complaint--consumption--as change of air. the beginning of the autumn is, of course, the beat season for visiting the coast. it would be advisable, at the commencement of october, to send him either to italy, to the south of france--to mentone [footnote: see _winter and spring on the shores of the mediterranean_, by j. henry bennet, m.d., london: churchill.]--or to the mild parts of england--more especially either to hastings, or to torquay, or to the isle of wight--to winter. but remember, if he be actually in a _confirmed_ consumption, i would not on any account whatever let him leave his home; as then the comforts of home will far, very far, out-weigh any benefit of change of air. 372. _suppose a youth to be much predisposed to a sore throat, what precautions ought he to take to ward off future attacks_? he must use every morning thorough ablution of the body, beginning cautiously; that is to say, commencing with the neck one morning, then by degrees, morning after morning, sponging a larger surface, until the whole of the body be sponged. the chill at first must be taken off the water; gradually the temperature ought to be lowered until the water be quite cold, taking care to rub the body thoroughly dry with a coarse towel--a turkish rubber being the best for the purpose. he ought to bathe his throat externally every night and morning with luke-warm salt and water, the temperature of which must be gradually reduced until at length no warm water be added. he should gargle his throat either with barm, vinegar, and sage tea, [footnote: a wine-glassful of barm, a wine-glassful of vinegar, and the remainder sage tea, to make a half-pint bottle of gargle.] or with salt and water--two tea-spoonfuls of table salt dissolved in a tumbler of water. he ought to harden himself by taking plenty of exercise in the open air. he must, as much as possible, avoid either sitting or standing in a draught, if he be in one, he should face it. he ought to keep his feet warm and dry. he should take as little aperient medicine as possible, avoiding especially both calomel and blue pill. as he grows up to manhood he ought to allow his beard to grow, as such would be a natural covering for his throat. i have known great benefit to arise from this simple plan. the fashion is now to wear the beard, not to use the razor at all, and a sensible fashion i consider it to be. the finest respirator in the world is the beard. the beard is not only good for sore throats, but for weak chests. the wearing of the beard is a splendid innovation, it saves no end of trouble, is very beneficial to health, and is a great improvement "to the human face divine." 373. _have you any remarks to make on the almost universal habit of boys and of very young men smoking_? i am not now called upon to give an opinion of the effects of tobacco smoking on the middle-aged and on the aged. i am addressing a mother as to the desirability of her sons, when boys, being allowed to smoke. i consider tobacco smoking one of the most injurious and deadly habits a boy or young man can indulge in. it contracts the chest and weakens the lungs, thus predisposing to consumption. it impairs the stomach, thus producing indigestion. it debilitates the brain and nervous system, thus inducing epileptic fits and nervous depression. it stunts the growth, and is one cause of the present race of pigmies. it makes the young lazy and disinclined for work. it is one of the greatest curses of the present day. the following cases prove, more than any argument can prove, the dangerous and deplorable effects of a boy smoking. i copy the first case from _public opinion_. "the _france_ mentions the following fact as a proof of the evil consequences of smoking for boys--'a pupil in one of the colleges, only twelve years of age, was some tune since seized with epileptic fits, which became worse and worse in spite of all the remedies employed. at last it was discovered that the lad had been for two years past secretly indulging in the weed. effectual means were adopted to prevent his obtaining tobacco, and he soon recovered.'" the other case occurred about fifteen years ago in my own practice. the patient was a youth of nineteen. he was an inveterate smoker. from being a bright intelligent lad, he was becoming idiotic, and epileptic fits were supervening. i painted to him, in vivid colours, the horrors of his case, and assured him that if he still persisted in his bad practices, he would soon become a drivelling idiot! i at length, after some trouble and contention, prevailed upon him to desist from smoking altogether. he rapidly lost all epileptic symptoms, his face soon resumed its wonted intelligence, and his mind asserted its former power. he remains well to this day, and is now a married man with a family. 374. _what are the best methods to restrain a violent bleeding from the nose_? do not, unless it be violent, interfere with a bleeding from the nose. a bleeding from the nose is frequently an effort of nature to relieve itself, and therefore, unless it be likely to weaken the patient, ought not to be restrained. if it be necessary to restrain the bleeding, press firmly, for a few minutes, the nose between the finger and the thumb; this alone will often stop the bleeding; if it should not, then try what bathing the nose and the forehead and the nape of the neck with water quite cold from the pump, will do. if that does not succeed, try the old-fashioned remedy of putting a cold large door-key down the back. if these plans fail, try the effects either of powdered alum or of powdered matico, used after the fashion of snuff--a pinch or two either of the one or of the other, or of both, should be sniffed up the bleeding nostril. if these should not answer the purpose, although they almost invariably will, apply a large lump of ice to the nape of the neck, and put a small piece of ice into the patient's mouth for him to suck. if these methods do not succeed, plunge the hand and the fore-arm into cold water, keep them in for a few minutes, then take them out, and either hold, or let be held up, the arms and the hands high above the head: this plan has frequently succeeded when others have failed. let the room he kept cool, throw open the windows, and do not have many in the room to crowd around the patient. doubtless dr richardson's local anaesthetic--the ether spray--playing for a few seconds to a minute _on_ the nose and _up_ the bleeding nostril, would act most beneficially in a severe case of this kind, and would, before resorting to the disagreeable operation of plugging the nose, deserve a trial. i respectfully submit this suggestion to my medical brethren. the ether--rectified ether--used for the spray ought to be perfectly pure, and of the specific gravity of 0.723. if the above treatment does not soon succeed, send for a medical man, as more active means, such as plugging of the nostrils--_which, is not done unless in extreme cases_--might be necessary. but before plugging of the nose is resorted to, it will be well to try the effects of a cold solution of alum:- take of--powdered alum, one drachm; water, half a pint: to make a lotion. a little of the lotion should be put into the palm of the hand and sniffed up the bleeding nostril; or, if that does not succeed, some of the lotion ought, by means of a syringe, to be syringed up the nose. 375. _in case of a young lady fainting, what had better be done_? lay her flat upon her back, taking care that the head be as low as, or lower than, the body; throw open the-windows, do not crowd around her, [footnote: shakspeare knew the great importance of not crowding around a patient who has fainted. he says- "so play the foolish throngs with one that swoons; come all to help him, and so stop the air by which he should revive."] unloosen her dress as quickly as possible; ascertain if she have been guilty of tight-lacing--for fainting is sometimes produced by that reprehensible practice. apply smelling salts to her nostrils; if they be not at hand, burn a piece of rag under her nose; dash cold water upon her face; throw open the window; fan her; and do not, as is generally done, crowd round her, and thus prevent a free circulation of air. as soon as she can swallow, give her either a draught of _cold_ water or a glass of wine, or a tea-spoonful of sal-volatile in a wine-glassful of water. _to prevent fainting for the future._--i would recommend early hours; country air and exercise; the stays, if worn at all, to be worn slack; attention to diet; avoidance of wine, beer, spirits, excitement, and fashionable amusements. sometimes the cause of a young lady fainting, is either a disordered stomach, or a constipated state of the bowels. if the fainting have been caused by _disordered stomach_, it may be necessary to stop the supplies, and give the stomach, for a day or two, but little to do; a fast will frequently prevent the necessity of giving medicine. of course, if the stomach be _much_ disordered, it will be desirable to consult a medical man. if your daughter's fainting have originated from a _costive state of the bowels_ (another frequent cause of fainting), i beg to refer you to a subsequent conversation, in which i will give you a list of remedies for the prevention and the treatment of constipation. a young lady's fainting occasionally arises from debility--from downright weakness of the constitution; then the best remedies will be, change of air to the coast, good nourishing diet, and the following strengthening mixture: take of--tincture of perchloride of iron, two drachms; tincture of calumba, six drachms; distilled water, seven ounces: two table-spoonfuls of this mixture to be taken three times a day. or for a change, the following:- take of--wine of iron, one ounce and a half distilled water, six ounces and a half to make a mixture. two table spoonfuls to be taken three times a day. iron medicines ought always to be taken _after_ instead of _before_ a meal. the best times of the day for taking either of the above mixtures will be eleven o'clock, four o'clock, and seven o'clock. 376. _you had a great objection to a mother administering calomel either to an infant or to a child, have you the same objection to a boy or a girl taking it when he or she requires an aperient_? equally as great. it is my firm belief that the frequent use, or rather the abuse, of calomel and of other preparations of mercury, is often a source of liver disease and an exciter of scrofula. it is a medicine of great value in some diseases, when given by a _judicious_ medical man, but, at the same time, it is a drag of great danger when either given indiscriminately, or when too often prescribed. i will grant that in liver diseases it frequently gives temporary relief, but when a patient has once commenced the regular use of it, he cannot do without it, until, at length, the _functional_ ends in _organic_ disease of the liver. the use of calomel predisposes to cold, and thus frequently brings on either inflammation or consumption. family aperient pills ought never to contain, in any form whatever, a particle of mercury. 377. _will you give me a list of remedies for the prevention and for the cure of constipation_? if you find it necessary to give your son or daughter an aperient, the mildest should be selected, for instance, an agreeable and effectual one, is an electuary composed of the following ingredients- take of--beat alexandria senna, powdered, one ounce best figs, two ounces, best raisins (stoned), two ounces, all chopped very fine. the size of a nutmeg or two to be eaten, either early in the morning or at bedtime. or, one or two tea-spoonfuls of compound confection. of senna (lenitive electuary) may occasionally, early in the morning, be taken. or, for a change, a tea-spoonful of henry's magnesia, in half a tumblerful of warm water. if this should not be sufficiently active, a tea-spoonful of epsom salts should be given with the magnesia. a seidlitz powder forms another safe and mild aperient, or one or two compound rhubarb pills may be given at bed time. the following prescription for a pill, where an aperient is absolutely necessary, is a mild, gentle, and effective one for the purpose- take of--extract of socotrine aloes, eight grains, compound extract of colocynth, forty-eight grains, hard soap, twenty four grains, treacle, a sufficient quantity to make twenty four pills. one or two to be taken at bedtime occasionally. but, after all, the best opening medicines are--cold ablutions every morning of the whole body, attention to diet, variety of food, bran-bread, grapes, stewed prunes, french plums, muscatel raisins, figs, fruit both cooked and raw--if it be ripe and sound, oatmeal porridge, lentil powder, in the form of du barry's arabica revalenta, vegetables of all kinds, especially spinach, exercise in the open air, early rising, daily visiting the water-closet at a certain hour--there is nothing keeps the bowels open so regularly and well as establishing the habit of visiting the water-closet at a certain hour every morning, and the other rules of health specified in these conversations. if more attention were paid to these points, poor school boys and school girls would not be compelled to swallow such nauseous and disgusting messes as they usually do to their aversion and injury. should these plans not succeed (although in the majority of cases, with patience and perseverance, they will) i would advise an enema once or twice a week, either simply of warm water, or of one made of gruel, table-salt, and olive-oil, in the proportion of two table-spoonfuls of salt, two of oil, and a pint of warm gruel, which a boy may administer to himself, or a girl to herself, by means of a proper enema apparatus. hydropathy is oftentimes very serviceable in preventing and in curing costiveness; and as it will sometimes prevent the necessity of administering medicine, it is both a boon and a blessing. "hydropathy also supplies us with various remedies for constipation. from the simple glass of cold water, taken early in the morning, to the various douches and sea-baths, a long list of useful appliances might be made out, among which we may mention the 'wet compresses' worn for three hours over the abdomen [bowels], with a gutta percha covering." i have here a word or two to say to a mother who is always physicking her family. it is an unnatural thing to be constantly dosing either a child, or any one else, with medicine. one would suppose that some people were only sent into the world to be physicked! if more care were paid to the rules of health, very little medicine would be required! this is a hold assertion; but i am confident that it is a true one. it is a strange admission for a medical man to make, but, nevertheless, my convictions compel me to avow it. 378. _what is the reason girls are so subject to costiveness_? the principal reason why girls suffer more from costiveness than boys, is that their habits are more sedentary; as the best opening medicines in the world are an abundance of exercise, of muscular exertion, and of fresh air. unfortunately, poor girls in this enlightened age must be engaged, sitting all the while, several hours every day at fancy work, the piano, and other accomplishments; they, consequently, have little time for exercise of any kind. the bowels, as a matter of course, become constipated; they are, therefore, dosed with pills, with black draughts, with brimstone and treacle--oh! the abomination! --and with medicines of that class, almost _ad infinitum_. what is the consequence? opening medicines, by constant repetition, lose their effects, and, therefore, require to be made stronger and still stronger, until at length, the strongest will scarcely act at all, and the poor unfortunate girl, when she becomes a woman, _if she ever does become one_, is spiritless, heavy, doll, and listless, requiring daily doses of physic, until she almost lives on medicine! all this misery and wretchedness proceed from nature's laws having been set at defiance, from _artificial_ means taking the place of _natural_ ones--from a mother adopting as her rule and guide fashion and folly, rather than reason and common sense. when will a mother awake from her folly and stupidity? this is strong language to address to a lady, but it is not stronger than the subject demands. mothers of england do, let me entreat you, ponder well upon what i have said. do rescue your girls from the bondage of fashion and of folly, which is worse than the bondage of the egyptian task masters, for the israelites did, in making bricks without straw, work m the open air--"so the people were scattered abroad throughout all the land of egypt to gather stubble instead of straw," but your girls, many of them, at least, have no work, either in the house or in the open air--they have no exercise whatever. they are poor, drawling, dawdling, miserable nonentities, with muscles, for the want of proper exercise, like ribands, and with faces, for the lack of fresh air, as white as a sheet of paper. what a host of charming girls are yearly sacrificed at the shrine of fashion and of folly. another, and a frequent cause of costiveness, is the bad habit of disobeying the call of having the bowels opened. the moment there is the slightest inclination to relieve the bowels, _instantly_ it ought to be attended to, or serious results will follow. let me urge a mother to instil into her daughter's mind the importance of this advice. 379. _young people are subject to pimples on the face, what is the remedy_? these hard red pimples (acne--"the grub pimple") are a common and an obstinate affection of the skin, affecting the forehead, the temples, the nose, the chin, and the cheeks, occasionally attacking the neck, the shoulders, the back, and the chest; and as they more frequently affect the young, from the age of 15 to 35, and are disfiguring, they cause much annoyance. "these pimples are so well known by most persons as scarcely to need description; they are conical, red, and hard; after a while, they become white, and yellow at the point, then discharge a thick, yellow-coloured matter, mingled with a whitish substance, and become covered by a hard brown scab, and lastly, disappear very slowly, sometimes very imperfectly, and often leaving an ugly scar behind them. to these symptoms are not unfrequently added considerable pain, and always much unsightliness. when these little cones have the black head of a 'grub' at their point, they constitute the variety termed _spotted acne_. these latter often remain stationary for months, without increasing or becoming red; but when they inflame, they are in nowise different in their course from the common kind."--_wilson on healthy skin_. i find, in these cases, great benefit to be derived from bathing the face, night and morning, with strong salt and water--a table-spoonful of table-salt to a tea-cupful of water; by paying attention to the bowels; by living on plain, wholesome, nourishing food; and by taking a great of out-door exercise. sea-bathing, in these cases, is often very beneficial. grubs and worms have a mortal antipathy to salt. 380. _what is the cause of a gum-boil_? a decayed root of a tooth, which causes inflammation and abscess of the gum, which abscess breaks, and thus becomes a gum-boil. 381. _what is the treatment of a gum-boil_? foment the outside of the face with a hot camomile and poppy head fomentation, [footnote: four poppy heads and four ounces of camomile blows to be boiled in four pints of water for half an hoar, and then to be strained to make the fomentation.] and apply to the gum-boil, between the cheek and the gum, a small white bread and milk poultice, [footnote: cut a piece of bread, about the size of the little finger-without breaking it into crumb--pour boiling hot milk upon it, cover it over, and let it stand for five minutes, then apply the soaked bread over the gum-boil, letting it rest between the cheek and the gum.] which renew frequently. as soon as the gum-boil has become quiet, _by all means_ have the affected tooth extracted, or it might cause disease, and consequently serious injury of the jaw; and whenever the patient catches cold there will be a renewal of the inflammation, of the abscess, and of the gum-boil, and, as a matter of course, renewed pain, trouble, and annoyance. moreover, decayed fangs of teeth often cause the breath to be offensive. 382. _what is the best remedy for a corn_? the best remedy for a _hard corn_ is to remove it. the usual method of cutting, or of paring a corn away, is erroneous. the following is the right way--cut with a _sharp_ pair of pointed scissors around the circumference of the corn. work gradually round and round and towards the centre. when you have for some considerable distance well loosened the edges, you can either with your fingers or with a pair of forceps generally remove the corn bodily, and that without pain and without the loss of any blood: this plan of treating a corn i can recommend to you as being most effectual. if the corn be properly and wholly removed it will leave a small cavity or round hole in the centre, where the blood-vessels and the nerve of the corn--vulgarly called the root--really were, and which, in point of fact, constituted the very existence or the essence of the corn. moreover, if the corn be entirely removed, you will, without giving yourself the slightest pain, be able to squeeze the part affected between your finger and thumb. _hard corns_ on the sole of the foot and on the sides of the foot are best treated by filing--by filing them with a sharp cutting file (flat on one side and convex on the other) neither too coarse nor too fine in the cutting. the corn ought, once every day, to be filed, and should daily be continued until you experience a slight pain, which tells you that the end of the corn is approaching. many cases of _hard corn_ that have resisted every other plan of treatment, have been _entirely_ cured by means of the file. one great advantage of the file is, it cannot possibly do any harm, and may be used by a timid person--by one who would not readily submit to any cutting instrument being applied to the corn. the file, if properly used, is an effectual remedy for a _hard_ corn on the sole of the foot. i myself have seen the value of it in several cases, particularly in one case, that of an old gentleman of ninety five, who had had a corn on the sole of his foot for upwards of half a century, and which had resisted numerous, indeed almost innumerable remedies, at length i recommended the file, and after a few applications entire relief was obtained, and the corn was completely eradicated. the corns between the toes are called _soft corns_. a _soft corn_ is quickly removed by the strong acetic acid--acid. acetic fort--which ought to be applied to the corn every night by means of a camel's hair brush. the toes should be kept asunder for a few minutes, in order that the acid may soak in, then apply between the toes a small piece of cotton wool. galbanum plaster spread either on wash leather, or on what is better, on an old white kid glove, has been, in one of our medical journals, strongly recommended as a corn plaster, it certainly is an admirable one, and when the corn is between the toes is sometimes most comfortable--affording immense relief. corns are like the little worries of life--very teazing and troublesome a good remedy for a corn--which the galbanum plaster undoubtedly is-is therefore worth knowing. _hard corns_, then, on the sole and on the side of the foot are best treated by the file, _hard corns_ on the toes by the scissors, and _soft corns_ between the toes either by the strong acetic acid or by the galbanum plaster. in the generality of cases the plans recommended above, if properly performed, will effect a cure, but if the corn, from pressure or from any other cause, should return, remove it again, and proceed as before directed. if the corn have been caused either by tight or by ill fitting shoes, the only way to prevent a recurrence is, of course, to have the shoes, properly made by a clever shoemaker--by one who thoroughly understands his business, and who will have a pair of lasts made purposely for the feet. [footnote: as long as fashion instead of common sense is followed in the making of both boots and shoes, men and women will, as a matter of course, suffer from corns. it has, often struck me as singular, when all the professions and trades are so overstocked, that there should be, as there is in every large town, such a want of chiropodists (corn-cutters)--of respectable chiropodists--of men who would charge a _fixed_ sum for every visit the patient may make, for instance to every working man a shilling, and to every gentleman half-a-crown or five shillings for _each_ sitting, and not for _each_ corn (which latter system is a most unsatisfactory way of doing business). i am quite sure that of such a plan were adopted, every town of any size in the kingdom would employee regularly one chiropodist at least. however we might dislike some few of the american customs, we may copy them with advantage in this particular--namely, in having a regular staff of chiropodists both in civil and in military life.] the german method of making boots and shoes is a capital one for the prevention of corns, as the boots and shoes are made, scientifically to fit a _real_ and not an _ideal_ foot. one of the best preventatives of as well as of the best remedies for corns, especially of soft corns between the toes, is washing the feet every morning as recommended in a previous conversation, [footnote: youth--ablution, page 250.] taking especial care to wash with the thumb, and afterwards to wipe with the towel between each toe. 383. _what are the best remedies to destroy a wart_? pure nitric acid, [footnote: a very small quantity of pure nitric acid--just a drain at the bottom of a stoppered bottle--is all that is needed, and which may be procured of a chemist.] carefully applied to the wart by means of a small stick of cedar wood--a camel's hair pencil-holder--every other day, will soon destroy it. care must be taken that the acid does not touch the healthy skin, or it will act as a caustic to it. the nitric acid should be preserved in a stoppered bottle and must be put out of the reach of children. glacial acetic acid is another excellent destroyer of warts: it should, by means of a camel's hair brush, be applied to each wart, every night just before going to bed. the warts will, after a few applications, completely disappear. 384. _what is the best remedy for tender feet, for sweaty feet, and for smelling feet_? cold water: bathing the feet in cold water, beginning with tepid water; but gradually from day to day reducing the warm until the water be quite cold. a large nursery-basin one-third full of water, ought to be placed on the floor, and one foot at a time should be put in the water, washing the while with a sponge the foot, and with the thumb between each toe. each foot should remain in the water about half a minute. the feet ought, after each washing, to be well dried, taking care to dry with the towel between each toe. the above process must be repeated at least once every day--every morning, and if the annoyance be great, every night as well. a clean pair of stockings ought in these cases to be put on daily, as perfect cleanliness is absolutely necessary both to afford relief and to effect a cure. if the feet be tender, or if there be either bunions, or corns, the shoes and the boots made according to the german method (which are fashioned according to the actual shape of the foot) should alone be worn. 385. _what are the causes of so many young ladies of the present day being weak, nervous, and unhappy_? the principal causes are--ignorance of the laws of health, nature's laws being set at nought by fashion and by folly, by want of fresh air and exercise, by want of occupation, and by want of self-reliance. weak, nervous, and unhappy! well they might be! what have they to make them strong and happy? have they work to do to brace the muscles? have they occupation--useful, active occupation--to make them happy? no! they have neither the one nor the other! 386. what diseases are girls most subject to? the diseases peculiar to girls are--chlorosis--green-sickness--and hysterics. 387. what are the usual causes of chlorosis? chlorosis is caused by torpor and debility of the whole frame, especially of the womb. it is generally produced by scanty or by improper food, by the want of air and of exercise, and by too close application within doors. here we have the same tale over again--close application within doors, and the want of fresh air and of exercise. when will the eyes of a mother he opened, to this important subject?--the most important that can engage her attention! 388. what is the usual age for chlorosis to occur and what are the symptoms? chlorosis more frequently attacks girls from fifteen to twenty years of age; although unmarried women, much older, occasionally have it. i say _unmarried_, for, as a rule, it is a complaint of the _single_. the patient, first of all, complains of being languid, tired, and out of spirits; she is fatigued with the slightest exertion; she has usually palpitation of the heart (so as to make her fancy that she has a disease of that organ, which, in all probability, she has not); she has shortness of breath, and a short dry cough; her face is flabby and pale; her complexion gradually assumes a yellowish or greenish hue--hence the name of chlorosis; there is a dark, livid circle around her eyes; her lips lose their colour, and become almost white; her tongue is generally white and pasty, her appetite is bad, and is frequently depraved--the patient often preferring chalk, slate pencil, cinder, and even dirt, to the daintiest food, indigestion frequently attends chlorosis, she has usually pains over the short-ribs, on the _left_ side, she suffers greatly from "wind"--is frequently nearly choken by it, her bowels are generally costive, and the stools are unhealthy, she has pains in her hips, loins, and back, and her feet and ankles are oftentimes swollen. _the menstrual discharge is either suspended or very partially performed_, if the latter, it is usually almost colourless. hysterical fits not unfrequently occur during an attack of chlorosis. 389. _how may chlorosis be prevented_? if health were more and fashion were less studied, chlorosis would not be such a frequent complaint. this disease generally takes its rise from mismanagement--from nature's laws having been set at defiance. i have heard a silly mother express an opinion that it is not _genteel_ for a girl to eat _heartily!_ such language is perfectly absurd and cruel. how often, too, a weak mother declares that a healthy, blooming girl looks like a milk maid! it would be well if she did! how true and sad it is, that "a pale, delicate face, and clear eyes, indicative of consumption, are the fashionable _desiderata_ at present for complexion."--_dublin university magazine._ a growing girl requires _plenty_ of _good_ nourishment--as much as her appetite demands, and if she have it not, she will become either chlorotic, or consumptive, or delicate. besides, _the greatest beautifier in the world is health_, therefore, by a mother studying the health of her daughter, she will, at the same time, adorn her body with, beauty! i am sorry to say that too many parents think more of the beauty than of the health of their girls. sad and lamentable infatuation! nathaniel hawthorne--a distinguished american--gives a graphic description of a delicate young lady. he says--"she is one of those delicate nervous young creatures not uncommon in new england, and whom i suppose to have become what we find them by the gradually refining away of the physical system among young women. some philosophers choose to glorify this habit of body by terming it spiritual, but in my opinion, it is rather the effect of unwholesome food, bad air, lack of out-door exercise, and neglect of bathing, on the part of these damsels and their female progenitors, all resulting in a kind of hereditary dyspepsia." nathaniel hawthorne was right. such ladies, when he wrote, were not uncommon, but within the last two or three years, to their great credit be it spoken, "a change has come o'er the spirit of their dreams," and they are wonderfully improved in health, for, with all reverence be it spoken, "god helps them who help themselves," and they have helped themselves by attending to the rales of health--"the women of america are growing more and more handsome every year for just this reason. they are growing rounder of chest, fuller of limb, gaining, substance and development in every direction. whatever may be urged to the contrary we believe this to be a demonstrable fact. when the rising generation of american girls once begin to wear thick shoes, to take much exercise in the open air, to skate, to play at croquet, and to affect the saddle, it not only begins to grow more wise but more healthful, and which must follow as the night the day--more beautiful"--_the round table_. if a young girl had plenty-of wholesome meat, varied from day to day, either plain roast or boiled, and neither stewed, nor hashed, nor highly seasoned for the stomach, if she has had an abundance of fresh air for her lungs, if she had plenty of active exercise, such as skipping, dancing, running, riding, swimming, for her muscles, if her clothing were warm and loose, and adapted to the season, if her mind were more occupied with active _useful_ occupation, such as household work, than at present, and if she were kept calm and untroubled from the hurly-burly and excitement of fashionable life--chlorosis would almost be an unknown disease. it is a complaint of rare occurrence with country girls, but of great frequency with fine city ladies. 390. _what treatment should you advise_? the treatment which would prevent should be adopted when the complaint first makes its appearance. if the above means do not quickly remove it, the mother must then apply to a medical man, and he will give medicines _which will soon have the desired effect_. chlorosis is very amenable to treatment. if the disease be allowed for any length of time to run on, it may produce either organic--incurable--disease of the heart, or consumption or indigestion, or confirmed ill-health. 391. _at what period of life is a lady most prone in hysterics, and what are the symptoms_? the time of life when hysterics occur is generally from the age of fifteen to fifty. hysterics come on by paroxysms--hence they are called hysterical fits. a patient, just before an attack, is low-spirited; crying without a cause; she is "nervous," as it is called; she has flushings of the face; she is at other times very pale; she has shortness of breath and occasional palpitations of the heart; her appetite is usually bad; she passes quantities of colourless limpid urine, having the appearance of pump water; she is much troubled with flatulence in her bowels, and, in consequence, she feels bloated and uncomfortable. the "wind" at length rises upwards towards the stomach, and still upwards to the throat, giving her the sensation of a ball stopping her breathing, and producing a feeling of suffocation. the sensation of a ball in the throat (_globus hystericus_) is the commencement of the fit. she now becomes _partially_ insensible, although she seldom loses _complete_ consciousness. her face becomes flushed, her nostrils dilated, her head thrown back, and her stomach and bowels enormously distended with "wind." after a short time she throws her arms and her legs about convulsively, she beats her breast, tears her hair and clothes, laughs boisterously and screams violently; at other times she makes a peculiar noise; sometimes she sobs and her face is much distorted. at length she brings up enormous quantities of wind; after a time she bursts into a violent flood of tears, and then gradually comes to herself. as soon as the fit is at an end she generally passes enormous quantities of colourless limpid urine. she might, in a short time, fall into another attack similar to the above. when she comes to herself she feels exhausted and tired, and usually complains of a slight headache, and of great soreness of the body and limbs. she seldom remembers what has occurred during the fit. hysterics are sometimes frightful to witness, but, in themselves, are not at all dangerous. hysterics--an hysterical fit--is sometimes styled hysterical passion. shakspeare, in one of his plays, calls it _hysterica passio_- "oh how this, mother, swells up toward my heart! _hysterica passio!_" sir walter scott graphically describes an attack--"the hysterical passion that impels tears is a terrible violence--a sort of throttling sensation--then succeeded by a state of dreaming stupidity" 392. _what are the causes of hysterics_? delicate health, chlorosis, improper and not sufficiently nourishing food, grief, anxiety, excitement of the mind, closely confined rooms, want of exercise, indigestion, flatulence and tight-lacing, are the causes which usually produce hysterics. hysterics are frequently feigned, indeed, oftener than any other complaint, and even a genuine case is usually much aggravated by a patient herself giving way to them. 393. _what do you recommend an hysterical lady to do_? to improve her health by proper management, to rise early and to take a walk, that she may breathe pure and wholesome air,--indeed, she ought to live nearly half her time in the open air, exercising herself with walking, skipping, etc., to employ her mind with botany, croquet, archery, or with any out-door amusement, to confine herself to plain, wholesome, nourishing food, to avoid tight lacing; to eschew fashionable amusements; and, above all, not to give way to her feelings, but, if she feel an attack approaching, to rouse herself. _if the fit be upon her_, the better plan is, to banish all the _male_ sex from the room, and not even to have many women about her, and for those around to loosen her dress; to lay her in the centre of the room, flat upon the ground, with a pillow under her head, to remove combs and pins and brooches from her person; to dash cold water upon her face; to apply cloths, or a large sponge wetted in cold water, to her head; to throw open the window, and then to leave her to herself; or, at all events, to leave her with only one _female_ friend or attendant. if such be done, she will soon come round; but what is the usual practice? if a girl be in hysterics, the whole house, and perhaps the neighbourhood, is roused; the room is crowded to suffocation; fears are openly expressed by those around that she is in a dangerous state; she hears what they say, and her hysterics are increased ten-fold. 394. _have you any remarks to make on a patient recovering from a severe illness_? there is something charming and delightful in the feelings of a patient recovering from a severe illness: it is like a new birth: it is almost worth the pain and anguish of having been ill to feel quite well again: everything around and about him wears a charming aspect--a roseate hue: the appetite for food returns with pristine vigour; the viands, be they ever so homely, never tasted before so deliciously sweet; and a draught of water from the spring has the flavour of ambrosial nectar: the convalescent treads the ground as though he were on the ambient air; and the earth to him for a while is paradise: the very act of living is a joy and gladness:- "see the wretch that long has tost on the thorny bed of pain again repair his vigour lost and walk and run again. the meanest flow'ret of the vale, the amplest note that swells the gale, the common air, the earth, the skies, to him are opening paradise."--_grey_ * * * * * concluding remarks if this book is to be of use to mothers and to the rising generation, as i humbly hope and trust that it has been, and that it will be still more abundantly, it ought not to be listlessly read, merely as a novel or as any other piece of fiction; but it must be thoughtfully and carefully studied, until its contents, in all its bearings, be completely mastered and understood. * * * * * in conclusion: i beg to thank you for the courtesy, confidence, and attention i have received at your hands; and to express a hope that my advice, through god's blessing, may not have been given in vain; but that it may be--one among many--an humble instrument for improving the race of our children--england's priceless treasures! o, that the time may come, and may not be far distant, "that our sons may grow up as the young plants, and that our daughters may be as the polished corners of the temple!" index. ablution of a child of an infant of a youth thorough, of boy and girl accidents of children how to prevent acne, symptoms and treatment of advice to a mother if her infant be poorly to _mr pater familias_ ailments, the distinction between between _serious_ and _slight_ of infants air and exercise for youth the importance of good the necessity of fresh, and changing the airing an infant's clothes alternately to each breast american ladies amusements for a child for a boy for a girl ankles, weak antipathies of a child aperients for a child for an infant for a new-born babe for a youth danger of frequent appeal to mothers appetite, on a child losing his applications, hot apron, washing archery arnold, dr, on corporal punishment arrow-root for an infant artificial food for an infant at breast asses' milk babes should kick on floor babe's clothing babe himself taking exercise babyhood, the language of baby daughter baked crumb of bread for an infant flour for an infant bakers' and home made bread bathing after _full_ meal baths, cold, tepid, and warm warm, as a remedy for flatulence beard, best respirator bed, on placing child in beds, feather purification of bed-rooms, the ventilation of cool large a plan to ventilate bee, the sting of beef, salted or boiled beer, on giving child belladonna, poisoning by belly-band, best kind when to discontinue beverage for a child "black-eye," remedies for bladder and bowels of an infant bleeding from navel, how to restrain of nose blood, spitting of blows and bruises boarding schools for females on cheap (note) boiled bread for infants' food flour for infants' food boils, the treatment of boots and shoes bottles, the best nursing boulogne sore-throat bow-legs bowels, large, of children looseness of protrusion of lower regulation of, by diet boys should be made strong brain, water on the bran to soften water bran poultices breakfast of a child of a youth breast on early putting an infant to breathing exercise brimstone and treacle brown and polson's corn flour bronchitis, the treatment of broth for infants for a new born infant and soup brothers and sisters bruises, remedies for bullying a child burns and scalds butter, wholesome cadbury's cocoa essence calomel, the danger of a mother prescribing the ill effects of camphor makes teeth brittle caning a boy caps, flannel care in preparation of food carpets in nurseries carriage exercise carron oil in burns castor oil to heal the bowels cat, bites and scratches of a "chafings" of infants, the treatment of chairs, straight backed change of air linen in sickness chapped hands, legs, &c lips chest, keeping warm the upper part of the "chicken breasted" and narrow breasted children pox chilblains child should dine with parents "child-crowing" the treatment of a paroxysm of children's hour parties chimneys, on the stopping of chiropodists (_note_) chloralum as a disinfectant chlorosis and green sickness not in rural districts choking, what to be done in a case of _cholera infantum_ cisterns, best kind of clothes, on airing an infant's the ill effects of tight clothing of children of infants during winter of youths coffee as an aperient and tea coin, on the swallowing of a cold bed-room healthy cold, a feverish on child always catching feet, method to warm concluding remarks on infancy conclusion constipation, prevention and cure of consumption attacks the _upper_ part of the lungs the age at which it usually appears causes of death rate importance of early consulting a medical man in spitting of blood in symptoms of consumptive patient, the treatment of a convulsions of children cause insensibility from hooping-cough no pain in cooked fruit for child corns corn plaster, an excellent coroners inquests on infants corporal punishment at schools costiveness of infants, the means to prevent remedies for the reason why so prevalent in weak children cough, the danger of stopping a cow, the importance of having the milk from one pox lymph direct from heifer from healthy child cream and egg, 200 and water for babe crinoline and burning of ladles crib, covering head of croquet for girls crossness in a sick child croup the treatment of cry of infant cure, artificial and natural "curious phenomenon" in scarlet fever cut finger, the application for dancing, and skipping danger of constantly giving physic delicate child, plan to strengthen a dentition lancing of gums second painful diarrhoea of infants treatment of diet of a child who has cut his teeth of children of a dry nursed child of infants on a mother being particular in attending to variety of for child of youth dietary in infants dieting a child dinner for a child youth diphtheria symptoms, causes, and treatment of dirty child diseased nature and strange eruptions diseases of children girls infants obscure the prevention of produced by tight lacing symptoms of _serious_ disinfectants in scarlet fever doctor on early calling in dog the bide of a doleful child don't dowle on _the foot and its covering_ drainage dress, female of a child while asleep of a babe, child, and youth dresses, high for delicate child dressing babe for sleep dribbling bibs drinking fountains dropping child, danger of dry nursed children, the best food for "dusting powder" for infants dysentery, symptoms and treatment of ear, discharges from removal of a pea or bead from ear-ache, treatment of wig in ear early rising education of children infant schools home, the best for girls education, modern for youth eggs for children electuary of figs emetic tarter dangerous for child eneme apparatus (_note_) of warm water engravings in nurseries eruptions about the mouth excorations applications for best remedy for exercise best composing medicine during teething for children in wet weather on violently tossing infants horse and pony an infant himself taking in very cold weather in wet weather for youth eve, substances in faecal matter in pump-water fainting from constipation from debility from disordered stomach falling-off of hair falls on the head farinaceous food give _babes_ wind fash on dangerous effects of strictly attending to the present, of dressing children fashionable _desiderata_ for complexion favouritism feeding bottles infants, proper times for at breast new born babe with gruel feet smelling sweating tender female dress fire, on a child playing with danger of back to in night nursery the manner of extinguishing, if clothes be on guards fire-proof, making dresses flannel cap for babe night-gowns shifts for a delicate child waistcoats to wash child with flatulence, remedies for fleas, to drive away flute, bugle and other wind-instruments fly pole fog, on sending a child out in folly, of giving physic after vaccination food, artificial, during snacking care in preparing infant's for dry-nursed infants for infants who are sucking formula, for milk, water, salt, and sugar friction after ablation frightening a child fruit as an aperient during teething garters impede circulation gently speak to child gin or pepperment in infant's food giving joy to a child glass, a child swallowing broken gluttony glycerine goats' milk _godfrey's cordial_ poisoning by treatment grazed skin green dresses poisonous paper hangings for nurseries peas as a vegetable "gripings" for infants groin rupture "gross superstition," "grub-pimple" gums, the lancing of the gum-bod, cause and treatment gum-sticks, the best gymnasium, value of hair, the best application for falling off making tidy management of half-washed and half starved child hand-swing happiness to a child happy child hard's farinaceous food hardening of children's constitutions of infants hartehorn, on swallowing hats for a child, the best kind hawthorn, nathaniel, on american ladies head, fall upon heat, external application of hectic flush, description of hiccups of infants hints conducive to the well-doing of a child home of childhood--the nursery hooping-cough obstinate treatment of horse exercise for boys or girls and pony exercise hot-water bag or bottle household work for girls hurdle on early rising hydrophobia _hysterica passio_ hysterics ice, on the value of illness, recovery from importance of our subject india-rubber hot-water bottle ingoldsby legend on thumb-sucking infants should be encouraged to use exertion infant schools ipecacuantis wine, preservation of joyful to bed, on sending child ladies "affecting the saddle" laudanum, poisoning by laugh of a child law, physic, and divinity leaden cisterns learning without health leech bites, the way to restrain bleeding from lessons for child lice in head after illness light, best artificial, for nursery the importance of, to health lightly clad child lime in the eye to harden the bones lime-water and milk "looseness of the the bowels" the treatment love of children lucifer-matches the poisonous effects of luncheon for a child lungs, inflammation of precautions to symptoms of treatment of lying lips of a child mad dog, the bite of description of magnesia to cool a child management of child's mother's question massacre of innocents mattresses, horse-hair, best for child may, the month of meals, a child's measles and scarlet fever treatment of meat, daily, on giving raw in long-standing diarrhoea in exhaustive diseases when a child should commence taking meddlesome treatment medical man, a mother's treatment towards medicine, the best way of administering on giving new-born infants on making palatable (_note_) menstruating female during suckling mercury, on the danger of parents giving milk, on the importance of having it from one cow bad, very nasty for babe indispensable in every form or meat, or both a plan to make a child take sugar of, and water the value of, for children unboiled a way to prevent, turning sour -crust mismanaged baby modified small-pox and chicken-pox mother fretting, injurious to infant a foolish of many diseases mother's and cow's milk, on mixing health during suckling influence motions, healthy, of babe mumps naaman, the syrian napkins, when to dispense with nature's physic navel, management of the rupture of sore -string separation of neaves' farinaceous food nervous and unhappy young ladies nettle-rash new-born infants and aperients when feeble night-commode night-terrors nose, removal of foreign substances from bleeding from, means to restrain nurse, on the choice of a a lazy strong and active young, not desirable for the sick nursery-basin of a sick child a child's own domain selection, warming, ventilation, arrangements of on the light of a must be airy observations, further windows to be often opened nursing-bottles, the best opium, a case of poisoning by the danger of administering to infants the treatment of poisoning by over-education over-lying a child pain, convulsions, and death paint-boxes dangerous as toys parental baby-slaughter parritch, the halesome peevishness of a child, the plan to allay perambulators physicking a child, on the frequent pies and puddings pimples on the face, treatment of pin, on a child swallowing pins, in dressing of babe play, a course of education in play-grounds for children and play pleasant words to a child poisoning, accidental by the breath poppy-syrup pork an improper meat for children position of a sleeping child potatoes for children poultice, a white-bread powder, "dusting" _precocity of intellect_ precocious youths, the health of prescriptions for a child princess of wales and her baby (note) professions and trades proper person to wash an infant prunes, the best way of stewing profession or trade, choice of, for delicate youth delicate youth should be brought up to puddings for children pals of child pye chavasse's fresh air treatment of scarlet fever milk food quack medicines quacking an infant quick lime in eye rain water recapitulation of ablution red gum respiration, products of poisonous rest, the best time for a child to retire to re-vaccination, importance of every seven years recommended by jenner revalenta arabica rheumatic fever, flannel vest and drawers ribs, bulging out of rice, prepared as an infant's food rich children _richardson, dr, ether spray_ rickets various degrees of roberton on child-crowing rocking-chairs, and rockers to cradle, rocking infants to sleep rooms ill effects, of dark round shoulders round worm running scall rupture rusks sallowness, cause of in young girls salt water and fresh water should be added to an infants food bag of hot necessary to human life salt-and water ablations for a delicate child for teeth and gums meats for children scalds and burns of mouth scarlatina scarlet-fever and diphtheria the contagion of the danger of giving aperients in the dropsy of fresh air treatment of hybrid management of child after and measles, the importance of distinguishing between the principal danger of purification of house after treatment of utter prostration in schools, female boarding public screaming in sleep scrofula prevention of scurfy head sea-bathing and fresh-water bathing for a young child secrets, talking, before child senna as an aperient shivering fit, importance of attending to a treatment of shoes, _plan to waterproof_ preferable to boots sound and whole and stockings for children and youths the ill effects of tight "shortening" an infant shoulder-blades "growing out" sick child, the nursing of a not to be staffed with food sick-room, management of, sickness of infants singing and reading aloud beneficial to a child single-stick sitting with back to fire sitz-bath for protrusion of bowels skating for boys and girls skin, grazed sleep of children sleep, infant's in middle of day beneficial much, necessary for infants temperature of an infant's bedroom during right time of putting a child to putting infants to of youth -walker sleeping on lap -rooms, importance of well-ventilating sleepless child slippers, the best for sick-room (_note_) small-pox a pest and disgrace modified when in neighborhood, to prevent pitting of smoking, on a boy smothering of infants, the cause socks and stockings for a child soda, ill effects of washing clothes with sounds, joyful soups and broths speak gently to a child spencer, a knitted worsted spines, distorted spine, injury to curvature of twisted spirits, deadly effects of, to the young spitting of blood precautions spurious croup stammering, cause of cure of stays, the ill effects of stillness of sick-room sting of bee or wasp stir-about and milk stockings and shoes stooping in a girl stopping of chimneys stoves in nursery strawberry-tongue stuffing a sick child with food a babe "stuffing of the nose" of infants stunning of a child "stye," treatment of substitute for mother's milk sucking of thumb suckling, the proper times of suet pudding sugar for infants confectionery -of-milk _raw_, as an aperient sun-stroke sunday supper for a child and for a youth surfeit water and saffron tea sweet things and sour digestion sweetmeats and cakes swimming, on boys and girls symptoms of serious diseases tape-worm taste for things refined tea, on giving a child green, the ill effects of teeth, attention to, importance of child should not have meat till he have cut several the diet of a child who has cut all his and gums right way of brushing appearance and number of _first_ set of _second_ set of second crop of teething causing convulsions eruptions from frequent cause of sickness fruitful source of disease purging during restlessness from second symptoms and treatment of painful in town or country temperature and ventilation of a nursery of a warm-bath thread-worm throats, sore, precautions to prevent thrush, cause, symptoms, prevention and cure of thumb best gum-stick tight bands, belts, and hats tight-lacing, the ill effects of times for suckling an infant tobacco-smoking for boys cases illustrating the danger of toe-nails, the right way of cutting, tongue-tied, an infant "tooth-cough," tooth-powder, an excellent top-crust of bread as infant's food tossing an infant tous-les-mois toys, children's painted with arsenic trade or profession for delicate youth, treatment of a delicate child of some urgent serious diseases troubles of child truth, the love of tub, commencement of washing infant in tubbing a child tumbling and rolling of a child vaccination appearance of scab arm after giving medicine after, making babe poorly veal for a child vegetables for a child ventilation, and stopping of chimneys and sleep of a nursery violet-powder walking, on the early, of infants exercise, value in his sleep, a child warm-bathe for children external applications warts washing of boys and girls washing a child an infant a new-born infant's head with brandy washing a nursery floor wasp, the sting of a water, on the importance of good, on the brain closet, on going regularly to, cold and warm for ablution, hard for drinking -fright pure, essential to health to whole of skin weaned child, the diet of a weaning, proper time and manner of weather, on a child almost living in the air in flue on the sending a child out in wet weight of new-born infants (_note_) wet flannel application wet-nurse diet of for feeble babe management of "wetting the bed" during sleep wheezing of a new-born infant white lily leaf for bruises "wind," babe suffering from windows of a nursery wind pipe, foreign substance in wine and youth wine for children and youths winter clothing woolen garments worms quick medicines for transcriber's notes: seven typographical errors have been corrected: page 8, "15" changed to "18" (see fig. 18) page 208, "5" changed to "7" (see fig. 7) page 281, "does" changed to "dose" (give a big dose of castor oil) page 306, "he" changed to "be" (which should be covered with a single thickness) page 348, "iself" changed to "itself" (than by the bite itself) page 362, "dioxid" changed to "dioxide" (harmless substances as water and carbon dioxide) page 435, "ecezmatous" changed to "eczematous" (to keep the eczematous skin area moist) [illustration] the mother and her child by william s. sadler, m. d. professor of therapeutics, the post-graduate medical school of chicago; director of the chicago institute of physiologic therapeutics; fellow of the american medical association; member of the chicago medical society; the illinois state medical society; the american association for the advancement of science, etc. and lena k. sadler, m. d. associate director of the chicago institute of physiologic therapeutics; fellow of the american medical association; member of the chicago medical society; the medical women's club of chicago; national congress of mothers and parent-teacher association; the chicago woman's club, etc. _illustrated_ [illustration] toronto mcclelland, goodchild & stewart chicago: a. c. mcclurg & co. 1916 copyright a. c. mcclurg & co. 1916 * * * * * published august, 1916 * * * * * _copyrighted in great britain_ w. f. hall printing company, chicago to "billy" who, because of his unconscious contributions to its practical features, should be regarded as a co-author, this volume is affectionately dedicated by his parents the authors preface for many years the call for a book on the mother and her child has come to us from patients, from the public, and now from our publishers--and this volume represents our efforts to supply this demand. the larger part of the work was originally written by dr. lena k. sadler, with certain chapters by dr. william s. sadler, but in the revision and re-arrangement of the manuscript so much work was done by each on the contributions of the other, that it was deemed best to bring the book out under joint authorship. the book is divided into three principal parts: part i, dealing with the experience of pregnancy from the beginning of expectancy to the convalescence of labor: part ii, dealing with the infant from its first day of life up to the weaning time; part iii, taking up the problems of the nursery from the weaning to the important period of adolescence. the advice given in this work is that which we have tried out by experience--both as parents and physicians--and we pass it on to mothers, fathers, and nurses with the belief that it will be of help in their efforts at practical and scientific "child culture." we believe, also, that the expectant mother will be aided and encouraged in bearing the burdens which are common to motherhood by the advice and instruction offered. while we have drawn from our own professional and personal experience in the preparation of this book, we have also drawn freely from the present-day literature dealing with the subjects treated, and desire to acknowledge our indebtedness to the various writers and authorities. we now jointly send forth the volume on its mission, as a contribution toward lightening the task and inspiring the efforts of those mothers, nurses, and others who honor us by a perusal of its pages. william s. sadler. lena k. sadler. _chicago_, 1916. contents * * * * * part i the mother chapter page i the expectant mother 1 ii story of the unborn child 7 iii birthmarks and prenatal influence 14 iv the hygiene of pregnancy 21 v complications of pregnancy 35 vi toxemia and its symptoms 47 vii preparations for the natal day 53 viii the day of labor 63 ix twilight sleep and painless labor 71 x sunrise slumber and nitrous oxid 84 xi the convalescing mother 93 part ii the baby xii baby's early days 103 xiii the nursery 114 xiv why babies cry 123 xv the nursing mother and her babe 133 xvi the bottle-fed baby 147 xvii milk sanitation 156 xviii home modification of milk 165 xix the feeding problem 177 xx baby's bath and toilet 190 xxi baby's clothing 202 xxii fresh air, outings, and sleep 213 xxiii baby hygiene 222 xxiv growth and development 232 part iii the child xxv the sick child 251 xxvi baby's sick room 266 xxvii digestive disorders 274 xxviii contagious diseases 285 xxix respiratory diseases 300 xxx the nervous child 308 xxxi nervous diseases 323 xxxii skin troubles 333 xxxiii deformities and chronic disorders 341 xxxiv accidents and emergencies 348 xxxv diet and nutrition 360 xxxvi caretakers and governesses 370 xxxvii the power of positive suggestions 380 xxxviii play and recreation 390 xxxix the puny child 400 xl teaching truth 405 appendix 427 index 449 illustrations the mother and her child _frontispiece_ figure page 1 steps in early development 10 2 the "expectant" costume 23 3 the photophore 43 4 taking the blood pressure 48 5 breast binder 59 6 how to hold the baby 110 7 making the sleeping blanket 117 8 in the sleeping blanket 118 9 homemade ice box 149 10 heating the bottle 151 11 a sanitary dairy 158 12 articles needed for baby's feeding 167 13 supporting the baby for the bath 194 14 developmental changes 240 15 the cooling enema 290 16 x ray showing tuberculosis of the lung 346 17 father and mother corn and morning glory 406 part i the mother the mother and her child * * * * * part i the mother * * * * * chapter i the expectant mother there can be no grander, more noble, or higher calling for a healthy, sound-minded woman than to become the mother of children. she may be the colaborer of the business man, the overworked housewife of the tiller of the soil, the colleague of the professional man, or the wife of the leisure man of wealth; nevertheless, in every normal woman in every station of life there lurks the conscious or sub-conscious maternal instinct. sooner or later the mother-soul yearns and cries out for the touch of baby fingers, and for that maternal joy that comes to a woman when she clasps to her breast the precious form of her own babe. motherhood the highest calling motherhood is by far woman's highest and noblest profession. science, art, and careers dwindle into insignificance when we attempt to compare them with motherhood. and to attain this high profession, to reach this manifest "goal of destiny," women are seeking everywhere to obtain the best information, and the highest instruction regarding "mothercraft," "babyhood," and "child culture." in an indiana town not long ago, at the close of a lecture, a small, intellectual-appearing mother came forward, and, tenderly placing her tiny and emaciated infant in my arms, said: "o doctor! can you help me feed my helpless babe? i'm sure it is going to die. nothing seems to help it. my father is the banker in this town. i graduated from high school and he sent me to ann arbor, and there i toiled untiringly for four years and obtained my degree of b. a. i have gone as far as i could--spent thousands of dollars of my unselfish father's money--but i find myself totally ignorant of my own child's necessities. i cannot even provide her food. o doctor! can't something be done for young women to preparé them for motherhood?" mothercraft preparation the time will come when our high and normal schools will provide adequate courses for the preparation of the young woman for her highest profession, motherhood. this young mother, who had reached the goal of bachelor of arts, found to her sorrow that she was entirely deficient in her education and training regarding the duties and responsibilities of a mother. in every school of the higher branches of education that train young women in their late teens there should be a chair of mothercraft, providing practical lectures on baby hygiene, dress, bathing, and the general care of infants, and giving instruction in the rudiments of simple bottle-feeding, together with the caloric values of milk, gruels, and other ingredients which enter into the preparation of a baby's food. young women would most enthusiastically enroll for such classes, and as years passed and marriage came and children to the home, imagine the gratitude that would flood the souls of the young mothers who were fortunate enough to have attended schools where the chairs of motherhood prepared them for these new duties and responsibilities. early medical supervision just as soon as it is known that a baby is coming into the home, the expectant mother should engage the best doctor she can afford. she should make frequent calls at his office and intelligently carry out the instruction concerning water drinking, exercise, diet, etc. twenty-four hour specimens of urine should be frequently saved and taken to the physician for examination. in these days the blood-pressure is closely observed, together with approaching headaches and other evidences of possible kidney complications. the early recognition of these dangers is accompanied by the immediate employment of appropriate sweating procedures and other measures designed to promote the elimination of body poisons. thus science is able effectively to stay the progress of the high blood-pressure of former days, and which was so often followed by eclampsia--uremic poisoning. in these days of careful urine analysis, expertly administered anaesthetics, and up-to-date hospital confinements, the average intelligent woman may enter into pregnancy quite free from the oldtime fears, whose only rewards were grief and cankering care. all fear of childbirth and all dread of maternal duties and sacrifices do not in the least lessen the necessary unpleasantness associated with normal labor. it lies in the choice of every expectant mother to journey through the months of pregnancy with dissatisfaction and resentment or with joy and serenity. "the child will be born and laid in your arms to be fed, cared for, and reared, whether you weep or smile through the months of waiting." the resentful mother a little woman came into our office the day of this writing, saying: "doctor, i'm just as mad as i can be; i don't want to be pregnant, i just hate the idea." as i smiled upon this girl-wife of nineteen, i drew from my desk a sheet of paper and slowly wrote down these words for the head of a column: "got a mad on," and for the head of another, "got a glad on;" and then we quickly set to work carefully to tabulate all the results that having a "mad on" would bring. we found to her dismay that its harvest would be sadness of the heart, husband unhappy, work unbearable, while all church duties as well as social functions would be sadly marred. then, just as carefully, we tabulated the benefits that would follow having a "glad on." her face broke into a smile; she laughed, and as she left the office she assured me that she would accept nature's decree, make the best of her lot, and thus wisely align herself with the normal life demands of old mother nature. this view of her experience, she came to see, would bring the greatest amount of happiness to both herself and husband. she left me, declaring that she was just "wild for a baby;" and there is still echoing in my ears her parting words: "i'm leaving you, oh, such a happy girl! and i'm going home to harold a happy and contented expectant mother." there often enters on the exit of a discontented and resentful expectant mother, a woman, very much alone in the world--perhaps a bachelor maid or a barren wife, who, as she sits in the office, bitterly weeps and wails over her state of loneliness or sterility; and so we are led to realize that discontentment is the lot of many women; and we are sometimes led to regret that ours is not the power to take from her that hath and give to her that hath not. early signs of pregnancy among the first questions an expectant mother asks is: "what are early signs of pregnancy?" the answer briefly is: 1. cessation of menstruation. 2. changes in the breast. 3. morning sickness. 4. disturbances in urination. menstruation may be interrupted by other causes than pregnancy, but the missing of the second or third periods usually indicates pregnancy. accompanying the cessation of menstruation, changes in the breast occur. sensation in the breasts akin to those which usually accompany menstruation are manifested at this time in connection with the unusual sensations of stinging, prickling, etc. fully one-half of our patients do not suffer with "morning sickness;" however, it is the general consensus of opinion that "morning sickness" is one of the early signs of pregnancy, and these attacks consist of all gradations--from slight dizziness to the most severe vomiting. it is an unpleasant experience, but in passing through it we may be glad in the thought that "it too, will pass." because of the pressure exerted by the growing uterus upon the bladder, disturbances in urination often appear, but as the uterus continues to grow and lifts itself up and away from the bladder these symptoms disappear. chief of the later signs of pregnancy are "quickening" or fetal movements. the movements are very much like the "fluttering of a young birdling." they usually are felt by the expectant mother between the seventeenth and eighteenth weeks. this sign, together with the noting of the fetal heartbeat at the seventh month, constitute the positive signs of pregnancy. probable date of delivery and now our expectant mother desires to know when to expect the little stranger. from countless observations of childbirth under all conditions and in many countries, the pregnant period is found to cover about thirty-nine weeks, or two hundred and seventy-three days. there are a number of ways or methods of computing this time. many physicians count back three months and add seven days to the first day of the last menstruation. for instance, if the last menstruation were december 2 to 6, then, to find the probable day of delivery, we count back three months to september 2, and then add seven days. this gives us september 9, as the probable date of delivery. the real date of delivery may come any time within the week of which this calculated date is the center. as a rule, ten days to two weeks preceding the day of delivery, the uterus "settles" down into the pelvis, the waist line becomes more comfortable, and the breathing is much easier. on the accompanying page, may be found a table for computing the probable day of labor, prepared in accordance with the plan just described. table for calculating the date of confinement =========+=================================================+======= jan. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 | oct. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 | ---------+-------------------------------------------------+------jan. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 | oct. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 | nov. =========+=================================================+======= feb. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 | nov. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 | ---------+-------------------------------------------------+------feb. | 17 18 19 20 21 22 23 24 25 26 27 28 | nov. | 24 25 26 27 28 29 30 1 2 3 4 5 | dec. =========+=================================================+======= mar. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 | dec. | 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 | ---------+-------------------------------------------------+------mar. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 | dec. | 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 | jan. =========+=================================================+======= april. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 | jan. | 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 | ---------+-------------------------------------------------+------april. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 | jan. | 22 23 24 25 26 27 28 29 30 31 1 2 3 4 | feb. =========+=================================================+======= may. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 | feb. | 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 | ---------+-------------------------------------------------+------may. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 | feb. | 21 22 23 24 25 26 27 28 1 2 3 4 5 6 7 | mar. =========+=================================================+======= june. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 | mar. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 | ---------+-------------------------------------------------+------june. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 | mar. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 | apr. =========+=================================================+======= july. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 | apr. | 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 | ---------+-------------------------------------------------+------july. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 | apr. | 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 | may. =========+=================================================+======= aug. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 | may. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 | ---------+-------------------------------------------------+------aug. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 | may. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 | june. =========+=================================================+======= sept. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 | june. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 | ---------+-------------------------------------------------+------sept. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 | june. | 24 25 26 27 28 29 30 1 2 3 4 5 6 7 | july. =========+=================================================+======= oct. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 | july. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 | ---------+-------------------------------------------------+------oct. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 | july. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 | aug. =========+=================================================+======= nov. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 | aug. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 | ---------+-------------------------------------------------+------nov. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 | aug. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 | sept. =========+=================================================+======= dec. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 | sept. | 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 | ---------+-------------------------------------------------+------dec. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 | sept. | 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 | oct. =========+=================================================+======= supposing the upper figure in each pair of horizontal lines to represent the first day of the last menstrual period, the figure beneath it, with the month designated in the margin, will show the probable date of confinement. chapter ii story of the unborn child to every physician in every community, sooner or later in his experience there come thoughtless women making requests that we even hesitate to write about. their excuses for the crime which they seek to have the physician join them in committing, range all the way from "i don't want to go to the trouble," to "doctor, i've got seven children now, and i can't even educate and dress them properly;" or, maybe, "i nearly lost my life with the last one." embryological ignorance one little woman came to us the other day from the suburbs, and honestly, frankly, related this story: "we've been married just six months, i have continued my stenographic work to add the sixty-five dollars to our monthly income. doctor, we must meet our monthly payments on the home, i must continue to work, or we shall utterly fail. i am perfectly willing a baby shall come to us two years from now, but, doctor, i just can't allow this one to go on, you must help me just this once. why doctor, there can't be much form or life there, it's only three months now, or will be next week, and you know it's nothing but a mass of jelly." she had talked with a "confidential friend" in her neighborhood, had been told that she "could do it herself," but fearing trouble or infection, had come to the conclusion she had better go to a "clean, reputable physician," to have the abortion performed. this is not the place to narrate the experiences of the unfortunate victims of habitual criminal abortion, but we would like to impress upon the reader some realization of the untimely deaths, the awful suffering, and the life-long remorse and sorrow of the poor, misguided women who listen to the criminal advice of neighborhood "busybodies." the infections, the invalidism, the sterility that so often follow in the wake of these practices, are well known to all medical people. the stream of life and so after the patient's last statement, "it's nothing but a mass of jelly," we began the simple but wonderfully beautiful story of the development of the "child enmothered." just as all vegetables, fruits, nuts, flowers, and grains come from seeds sown into fertile soil, and just as these seeds receive nourishment from the soil, rain, and sunshine, so all our world of brothers and sisters, of fathers and mothers, came from tiny human seeds, and in their turn received nourishment from the peculiarly adapted stream of life, which flows in the maternal veins for the nourishment and upbuilding of the unborn embryo. every little girl and boy baby that comes into the world, has stored within its body, in a wonderfully organized capsule, a part of the ancestral stream of life that unceasingly has flowed down through the centuries from father to son and from mother to daughter. this "germ plasm" is a divine gift to be held in trust and carefully guarded from the odium of taint, to be handed down to the sons and daughters of the next generation. any young man who grasps the thought that he possesses a portion of the stream of life, that he holds it in sacred trust for posterity, cannot fail to be impressed with a sense of solemn responsibility so to order his life as to be able to transmit this biologic trust to succeeding generations free from taint and disease. the process of fertilization just as within the body of "mother morning glory" (see fig. 15) may be found the ovary or seed bed, so there are two wonderfully organized bodies about the size of large almonds found in the lower part of the female abdomen on either side of the uterus, and connected to it by two sensitive tubes. there ripens in one of these bodies each month a human baby-seed, which finds its way to the uterus through the little fallopian tube and is apparently lost in the debris of cells and mucus which, with the accompanying hemorrhage go to make up the menstrual flow. this continues from puberty to menopause, each gland alternatingly ripening its ovum, only to lose it in the periodical phenomenon of menstruation, which is seldom interrupted save by that still more wonderful phenomenon of conception. at the time of conception, countless numbers of male germ-cells (sperms) are lost--only one out of the multitude of these perfectly formed sperms made up of the mosaics of hereditary depressors, determiners, and suppressors that so subtly dictate and determine the characteristics and qualifications of the on-coming individual--i repeat, only one of these wonderful sperms finds the waiting ovum (fig. 1). in this search for the ovum, the sperm propels itself forward by means of its tail--for the male sperm in general appearance very much resembles the little pollywog of the rain barrel (fig. 1). the fateful meeting of the sperm and the ovum takes place usually in the upper end of one of the fallopian tubes. it is a wonderful occasion. the wide-awake, vibrating lifelike sperm plunges head first and bodily into the ovum. the tail, which has propelled this bundle of life through the many wanderings of its long and perilous journey, now no longer needed, drops off and is lost and forgotten. this union of the male and female sex cells is called "fertilization." there immediately follows the most complete blending of the two germ cells--one from the father and one from the mother--each with its peculiar individual, family, racial, and national characteristics. here the combined determiners determine the color of the eyes, the characteristics of the hair, the texture of the skin, its color, the size of the body, the stability of the nervous system, the size of the brain, etc., while the suppressors do a similar work in the modification of this or that family or racial characteristic. the first weeks of life the fertilized ovum remains in the tube for about one week, when it slowly makes its way down into the uterus, all the while rapidly undergoing segmentation or division. it does not grow much in size during this first week, but divides and subdivides first, into two parts, then four, then eight, then sixteen and so on, until we have a peculiar little body made up of many equally divided parts, and known as the "mulberry mass" (fig. 1). the blending of the sperm and ovum has been perfect, the division of the original body multitudinous. [illustration: sperm and ovum cell division fetus at six weeks fetus at three months fig. 1. steps in early development] while this division of the united sex cells is progressing, a wonderful change is also taking place in the inside lining of the uterus. instead of the usual thin lining, it has greatly thickened and has become highly sensitized, and as the ovum enters the uterus from the fallopian tube, this sensitized lining catches it and holds it in its folds--actually covers it with itself--holding the precious mass much as the cocoon, you have so often seen fastened to the side of a plant or leaf, holds its treasure of life. just as soon as the new uterine home is found the baby heart begins to make its appearance, as also do many other rudimentary parts. by the end of the third week, our round mass has flattened and curved and elongated, and the nervous system and brain begin to develop, while the primitive ears begin to appear. at this time, the alimentary canal presents itself as one straight tube which is a trifle larger at the head end. and it is interesting to note that at this early date, even the arms and legs are beginning to bud and push out from the body. later embryonic development in the fourth and fifth weeks, the lungs and the pancreas may be found, the heart develops, the nervous system has taken on more definite form, and several of the larger blood-vessels are appearing. by the eighth week, by the most wonderful and complicated processes of overlapping, pushing out, indentation, enfolding, budding, pressing, and curving, the majority of the important structures are formed--the eyes, ears, nose, hands, feet, abdominal organs, and numerous glands. thus, at the end of two months, almost every structure and organ necessary to life is present in a rudimentary state. at the end of three months by the close of the third month, witness the work of creation! from the blending of the two germ cells there has come forth a beautifully formed body (fig. 1). true, it is but three and one half inches in length, but it is nevertheless a perfect body. about this time, the sex may be determined. the eyes, nose, ears, chin, arms and legs and even the fingers and toes may all be clearly distinguished. a "jelly mass" at three months? no, by no means! no! life and form and features are all there. it really has a face, whose features may easily be delineated. in all my experience, i have yet to find the woman who wished to continue in her wicked and criminal intent after she had listened to this story of the creative development of the first three months of her "child enmothered." during the next four months, which take us to the close of the seventh, rapid growth and farther development take place to the extent, that, should birth occur at that time, life may continue under proper conditions. last weeks of pregnancy everything is now nearing completion--only awaiting further growth, development, and strength--except some of the bone development, which takes place during the remaining two months. growth is rapid, strength is doubled, and as the two hundred and seventy-three days draw to a close, everything has been completed. it has all taken place according to the laws of creation in an infinite way and with clock-like precision. with the developmental growth of the product of conception, the uterus or room that had been particularly prepared for the "big reception" of the second week, has also grown to great dimensions. it fills almost the entire abdomen and as a result of the pressure against the diaphragm the breathing is somewhat embarrassed. the door of this "room" has been closed by a special mechanism, while, in the fullness of time, mother nature begins the delicate work of opening the door, through whose portals passes out into the world the completed babe. the authors feel that this discussion of, and protest against, abortions, _should be_ accompanied by an appropriate consideration of the control of pregnancy. we are never going to eliminate the abortion curse of present-day civilization by merely preaching against it--warnings and denouncements alone will not suffice to remove the stain. notwithstanding our feelings and convictions in this respect, we are also well aware of the fact that public sentiment is not now sufficiently ripe to welcome such a full and frank discussion of the subject of the prevention of conception as the authors would feel called upon to present; we are equally cognizant of the fact that existing postal regulations and other federal laws are of such a character (at least capable of such interpretation) as possibly to render even the scientific and dignified consideration of such subjects entirely out of question. chapter iii birthmarks and prenatal influence in the preceding chapter we learned that when the two germ cells came together, there occurred a complete blending of two separate and distinct hereditary lines, reaching from the present away back into the dim and distant past. by the union of these two ancestral strains a new personality is formed, a new individual is created, with its own peculiar characteristics. hereditary traits probably none of the laboriously acquired accomplishments of the present generation can be directly--and as such--handed down to our children. what we are to be and what we will do in this world was largely determined by the laws of heredity by the time we were well started on our development experience _en-utero_ during the third or fourth week of our prenatal existence, as outlined in a former chapter. it is now generally accepted in scientific circles that acquired characteristics are not transmissible. someone has aptly stated this truth by saying that "wooden heads are inherited, but wooden legs are not." this does not by any means imply that we do not have power and ability to fashion our careers and carve out our own destiny, within the possible bounds of our hereditary endowment and environmental surroundings. heredity does determine our "capital stock," but our own efforts and acts determine the interest and increase which we may derive from our natural endowment. from the moment conception takes place--the very instant when the two sex cells meet and blend--then and there "the gates of heredity are forever closed." from that time on we are dealing with the problems of nutrition, development, education, and environment; therefore, so-called prenatal influence can have nothing whatever to do with heredity. a father may have acquired great talent as a physician or a surgeon, in fact he may hold the chair of surgery in a medical college, but each of his children come into the world without the slightest knowledge of the subject, and, as far as direct and immediate heredity is concerned, will have to work just about as hard to master the subject as will the same average class of children whose parents were not surgeons. this must not be taken to mean that certain abilities and tendencies are not inheritable--for they are; but they are inherited _through_ the parents--and not _from_ them--directly. these transmitted characteristics are largely "stock" traits, and usually have long been present in the "ancestral strain." maternal impressions a mother may sing and pray all through the nine months of expectancy, or she may weep and scold, or even curse. in neither case can she influence the spiritual or moral tendencies of her child and cause it, through supposed prenatal influence, to be born with criminal tendencies or to grow up a pious lad or become a devout minister. these tendencies and characteristics are all largely determined by the "depressors," "suppressors," and "determiners" which were present in the two microscopic and mosaic germ cells which united to start the embryo at the time of conception. the child is destined to be born, endowed, and equipped with the mental, nervous, and physical powers which his line has fallen heir to all through the past ages. down through the ages education, religion, environment, and other special influences have no doubt played a small part in influencing and determining hereditary characteristics; just as environment in the ages past changed the foot of the evolving horse from a flat, "cushiony" foot with many toes (much needed in the soft bog of his earlier existence) into the "hoof foot" of later days, when harder soil and necessity for greater fleetness, assisted by some sort of "selection" and "survival," conspired to give us the foot of our modern horse, and this story is all plainly and serially told in the fossil and other remains found in our own hemisphere. it would appear that many, many generations of education and environment are required to influence markedly the established and settled train of heredity regarding any particular element or characteristic in any particular line or lines of hereditary tendencies. eugenic superstition there is probably more misinformation in the minds of the people on the subject of "maternal impressions" and "birthmarks" than any other scientific or medical subject. the popular belief that, if a pregnant woman should see an ugly sight or pass through some terrifying experience, in some mysterious way her unborn child would be "marked," deformed, or in some way show some blemish at birth, is a time-honored and ancient belief. such unscientific and unwarranted teaching has been handed down from mother to daughter through the ages, while the poor, misguided souls of expectant women have suffered untold remorse, heaped blame upon themselves, lived lives literally cursed with fear and dread--veritable slaves to superstition and bondage--all because of the simple fact that a certain percentage of all children born in this world have sustained some sort of an injury or "embryological accident" during the first days of fetal existence. for instance, take the common birthmark of a patch of reddened skin on the face, brow, or neck. as soon as the baby is born, the worried mother asks in anxious tones: "doctor, is it all right, is it perfect, has it got any birthmarks?" on being told that the baby has a round, red patch on its left brow, the ever-ready statement of the mother comes forth: "yes, i knew i'd mark it, i was picking berries one day about three months ago, and i ate and ate, until i suddenly remembered i might mark my baby, and before i knew what i was doing, i touched my brow and i just knew i had marked my baby." do you know, reader, that that birthmark was present fully four months before she passed through that experience in the berry patch? and yet so worried and apprehensive has been the pregnant mother, that, although she can never successfully predict the "birthmarks" and blemishes of her child, nevertheless when these defects are disclosed at birth she is unfailingly able immediately to recall some extraordinary experience which she has carefully stored away in her memory and which, to her mind, most fully explains and accounts for the defect. is it much wonder that in the very early days of embryonic existence, during the hours of delicate cell division, indentation, outpushing, elongation, and sliding of young cells--is it much wonder, i repeat--that there occur a few malformations, blemishes, or other accidents which persist as "birthmarks?" causes of birthmarks there are many factors which may enter into the production of birth-blemishes, deformities, monstrosities, etc. these influences are all governed by certain definite laws of cause and effect. a pre-existent systemic disease in the father, or a coexistent disorder in the mother, may be a leading factor. a mechanical injury, such as a sudden fall, a blow, or a kick, or certain kinds of prolonged pressure, not to mention restrictions and contractions of the maternal bony structures, may all possibly contribute something to these prenatal miscarriages of growth and development. maternal or prenatal embryonic infections could bring about many sorts of birthmarks and malformations. these defects might also be caused by certain types of severe inflammatory disorders in the uterus during the early days of pregnancy. the same factors that produce the accidents of embryology resulting in malformations or monstrosities in the human family, are also operative in the case of our lesser brethren of the animal kingdom, for monstrosities and birth-defects are very common among the lower animals, notwithstanding the fact that the animal mother probably does not "believe in birthmarks." "it is a striking fact that during the nineteenth century, the teratologists, those who have scientifically investigated the causes of monstrosities and fetal morbid states, have almost without exception, rejected the theory of maternal impressions." scientists and physicians are coming to recognize the fact that fears and frights do not in any way act as causes in the production of monstrosities and deformities. let us seek forever to liberate all womankind from the common and harassing fear and the definite dread and worry that, because they failed to control themselves at the instant of some terrifying sight or experience, they were directly responsible for the misfortune of their abnormal offspring. it should be remembered that there exists no direct connection whatsoever between the nervous system of the unborn child and the nervous system of the mother. the only physiological or embryological relationship is of a nutritional order, and even that is indirect and remote. role of the placenta by the end of the third month, the "cocoon" attachment described in chapter two has disappeared; the fetus is slowly pushed away from the uterus which has so snugly held it for more than eleven weeks; while upon the exact site of its previous attachment the thickened uterine membrane undergoes a very interesting and important change--definite blood vessels begin to form--which begin indirectly to form contact with the maternal vessels, and thus it is that the placenta, or "after birth" is formed; and then, by means of the umbilical cord, nourishment from the mother's blood-stream is carried to the growing and rapidly developing child. in exchange for the nourishing stream of life-giving fluid by which growth and development take place, the embryo gives off its poisonous excretions which are carried back to the placenta, from which they are absorbed into the veinous circulation of the mother; so, while the mother does, through the process of nutrition, influence growth and development in the embryo, she is wholly unable to produce specific changes and such definite developmental errors as birthmarks and other deformities. just as truly as it would be impossible so to frighten a setting hen as to "mark" or otherwise influence the form or character of the chicks which would ultimately come forth from the eggs in her nest, it is just as truly impossible to frighten the pregnant mother and thereby influence the final developmental product of the human egg which is so securely tucked away in its uterine nest; for, when conception has occurred, the human embryo is just as truly an egg--fashioned and formed--as is the larger and shell-contained embryo of the chick which lies in the nest of the setting hen. and so we are compelled to recognize the fact that there is little more danger to the unborn child when the mother is frightened than when the father is scared. the one contributes as much as the other to the general character of the child, while neither is to blame for development errors and defects. suggestion and heredity certain fears are suggested to children. for twenty years i lived under the delusion that i was terribly afraid of snakes--more so than any other human being; for i was told when a mere child that i had been "marked with the fear of snakes," that just two months before i saw the peep of day, my esteemed mother had been terrified by a snake. everywhere i went, i announced to sympathizing and ofttimes mischievous friends, that "i was marked with the fear of snakes and must never be frightened with them." it is needless to add in passing, that i was teased and frightened all through my girlhood days. i was a veritable slave to the bondage of snake-fear. everywhere i went i looked for my dreaded foe, expecting to sit on one, step on one, or to have one drop into my lap from the roof. the day of deliverance came after marriage, when in a supreme effort to deliver me from the shackles of fear, the goodman of the house tenderly, but firmly, maneuvered a morning walk so that it halted in front of a large plate-glass window of the snake drug store in san francisco. just back of this plate glass, and within eighteen inches of my very nose, were fifty-seven varieties of the reptiles, big and small, streaked and checkered, quiet and active. after much remonstrance and waiting, i came-to--gazed at the markings, beautiful in their exactness--while slowly the change of mind took place. faith took the place of fear, calmness subdued panic, and i was wondrously delivered from the veritable bondage of a score of years. and so it is that the mother suffers and then the child suffers, ofttimes a living death, because of the superstition "i'm marked," while there is ever present the fear or dread that "something is going to happen, because i'm different from all other individuals--because 'i'm marked!'" chapter iv the hygiene of pregnancy as soon as a woman discovers that she is pregnant, she should sit down and quietly think out the plan for the nine months of expectancy. the cessation of the menses may come as a surprise to her, and for a while she is more or less confused; she must go over the whole situation and adjust future plans to fit in with this new and all important fact. from a large experience with maternity cases, i have reached the conclusion that the larger percentage of pregnancies do come as a surprise, and in many instances a complete change of program must be painstakingly thought out. this is especially true of the business woman, the professional woman, the busy club woman, or the active society woman. early planning let me say to the woman who is pregnant for the first time, the experiences of the pregnant state should cause you no fear, worry, or anxiety. giving birth to a baby is a perfectly natural, normal procedure, and if you are in reasonable health--if your physician tells you you are a fairly normal woman--then you can dismiss further thought of danger and go on your way rejoicing. for thousands of years maternity has been women's exclusive profession and no doubt will continue to be many ages hence. by far the most important and the first thing to do is carefully to select the best physician your means will allow, and place yourself under his or her care. your doctor will help you to plan wisely and intelligently during the waiting time, for physicians have learned from experience that the better care the pregnant woman receives, the easier will be her labor, and the more speedy and uneventful the recovery. and now, we proceed to take up one by one the particular phases of the hygiene of pregnancy which touch the comfort, convenience, and health of both the mother and her unborn child. the clothing at all times and under all circumstances the pregnant woman's clothing should be comfortable, suitable for the occasion, artistic, and practical. and to be thus beautifully clothed is to be as inconspicuous as is possible. of all times, occasions, and conditions, that of pregnancy demands modesty in color, simplicity in style, together with long straight lines (fig. 2). for the "going out" dress, select soft shades of brown, blue, wine, or dark green. let the house dresses be simple, easy to launder, without constricting waist bands, of the one-piece type, in every way suitable for the work at hand. under this outer dress, a princess petticoat should cover a specially designed maternity corset (if any corset at all be worn), to which is attached side hose-supporters. a support for the breasts may be worn if desired, it should be loose enough to allow perfect freedom in breathing. the union suit may be of linen, silk, or cotton, with the weight suitable for the season. stockings and shoes should be of a comfortable type, straight last, low or medium heel and at least as wide as the foot. there are two or three shoes on the market that are particularly good, whose arches are flexible, heels comfortable, straight last, and whose soles look very much like the lines of the foot unclothed. this style is particularly good during the maternity days. painful feet are a great strain upon the general nervous system. who of us has not seen women with strained, tense faces hobbling about in high-heeled, narrow-toed shoes? and if we followed them we would not only see tenseness and strain in the features of the face, but could hear outbursts of temper on the least provocation. aching feet produce general irritability. if ease of body and calmness of spirit is desired, wear shoes that are comfortable, and the surprising part of it is that many of them are very good looking. [illustration: fig. 2. the "expectant" costume the long lines, so admirable for maternity wear are portrayed in this handsome afternoon costume. tunic waist is made with shoulder yoke from which fullness hangs in fine plaiting with panel at back, front and under arms. the set in vest is of black-striped gold cloth trimmed with gold thread crochet buttons and with tiny waistcoat of black moire. sleeves are of georgette crepe. loose adjustable girdle of black moire ribbon. full skirt is attached on elastic to china silk underbodice. material crepe de chine or any other soft, clinging fabric.] toward the end of pregnancy ofttimes the feet swell, in which instance larger shoes should be worn in connection with the bandaging of the ankles and legs. during the latter days of expectancy an abdominal supporter may be worn advantageously. much of the backache and heaviness in the pelvis is entirely relieved by the supporting of the pendulous abdomen with a well-fitted binder. an ordinary piece of linen crash may be fitted properly by the taking in of darts at the lower front edge; or elastic linen, or silk binder may be secured; in fact, any binder that properly supports the abdomen will answer the purpose. it should be within the means of every pregnant woman to have a neat, artistic out-door costume, for social, club and church occasions (fig. 2). for no reason but illness should an expectant mother shut herself up in doors. true men and true women hold the very highest esteem for the maternal state, and the opinion of all others matters not; so joyfully go forth to the club, social event, concert, or church; and to do this, you must have a well-designed, artistic dress. the material does not matter much, but the shade and style are important. diet there are certain laws which govern the diet at all times; for instance, the man who digs ditches requires more of a certain element of food and more food in general, than does the man who digs thoughts out of his brain. the growing child requires somewhat different elements of food than does an adult. in other words, "the diet should suit the times, occasions, occupations, etc." in the case of the expectant mother it should be remembered that the child gains nine-tenths of its weight after the fifth month of pregnancy, and it is, therefore, not necessary that a woman shall begin "eating for two" until after the fifth month. and since it is also true that the baby doubles its weight during the last eight weeks of pregnancy, it follows that then is the time when special attention must be given to the quantity as well as the quality of "mothers' food." during the first five months, if the urine and blood-pressure are normal, the "lady in waiting" should follow her usual dietetic tastes and fancies so long as they do not distress or cause indigestion. because of the additional work of the elimination of the fetal wastes, much water, seven or eight glasses a day, should be taken; while one of the meals--should there be three--may well consist largely of fruit. all of the vegetables may be enjoyed; salads with simple dressings and fruits may be eaten liberally. of the breads, bran, whole wheat, or graham are far better for the bowels than the finer grain breads, or the hot breads. something fresh--raw--should be taken every day, such as lettuce, radishes, cabbage salad, and fresh fruits. if the prospective mother is accustomed to the liberal use of meat, providing the blood-pressure and urine are normal, she may be able to indulge in meat once a day. many physicians believe that the maternal woman should eat meat rather sparingly--from once a day to once or twice or three times a week. of the desserts, gelatine, junket, ice cream, sponge cake, and fruit are far better than the rich pastries, which never fail even in health to encourage indigestion and heart burn. the fruitades are all good. candies and other sweets may be eaten in moderation. alcohol should be avoided. tea and coffee should be restricted, and in many cases abandoned. for many, two meals and a lunch of fruit or broth are better than three full meals. there is a continual and increased accumulation of waste matter which must be thrown off by the lungs, kidneys bowels, and skin; so that clogging of one channel of elimination makes more work for one or more of the other eliminative organs. sometimes the craving for food is excessive, and the desire to nibble between meals is quite troublesome. these unusual feelings should be controlled or ignored. a glass of orangeade will sometimes satisfy this unnatural craving. save your appetite for meal time--for a good appetite means good digestion--all things equal. the woman who habitually eats between meals is the sluggish, constipated individual who needs to acquire self-control and learn self-mastery. water drinking water is the circulating medium of the body, from which the digestive secretions are formed, and by which the food is assimilated and distributed to individual cells. and, finally, water is the agent for dissolving and removing waste products from the body through the various eliminating organs. we literally live, think, and have our being, as it were, under water. the tiny cell creatures of our bodies, from the humble bile workers of the liver to the exalted thinking cells of the brain, all carry on their work submerged. accordingly, the amount of water we drink each day, determines whether the liquids circulating through our tissues shall be pure, fresh, and life-giving, or stagnant, stale, and death-dealing. thirst is the expression of the nervous system, constituting a call for water, the same as hunger represents a call for food. pure water, free from all foreign substances, is the best liquid with which to quench this thirst. it is just as important to supply abundance of water for the proper bathing and cleansing of the internal parts of the body, as it is to wash and bathe the external skin frequently. the living tissues are just as literally soiled and dirtied by their life action and their poisonous excretions, as is the skin soiled by its excretions of sweat and poisonous solids. thus the regular drinking of water is absolutely necessary to enable the body to enjoy its internal bath, and this internal cleansing is just as grateful and refreshing to the cells and tissues, as is the external bath to the nerves which exist in the skin. the total amount of water necessary varies according to the nature of one's work, the amount of sweating from the skin, the moisture of the atmosphere, the amount of water in the food, etc. we believe the average person requires about eight glasses of liquid a day; that is, about two quarts. by the word "glass" we refer to the ordinary glass or goblet, two of which equal one pint. this amount of water should be increased, if anything, throughout pregnancy; while, during the later months, the amount of water taken each day should be at least doubled. in the condemnation of so-called artificial beverages, an exception should be made of the fruit juices. the fresh, unfermented juices of various fruits come very near being pure, distilled water, as they consist of only a little fruit sugar and acid, together with small amounts of flavoring and coloring substances, dissolved in pure water. none of these substances contained in pure fruit juice needs to be digested. lemonade not too sweet, and taken in moderate quantities, is certainly a beverage free from objection when used by the average pregnant woman. unripe or overripe fruits frequently cause bowel disturbances; as also do the millions of germs which lurk upon the outside of fruits, and which find their way into the stomach and bowels when these fruits are eaten raw without washing or paring. otherwise, the juices of fruits and melons are wholesome food beverages when consumed in moderation. exercise it should be the regular practice of every expectant mother to spend a portion of each day in agreeable, suitable exercise or physical work of some description. this exercise will be far more beneficial if it can be taken in the open air. the weather and the strength of the patient must be taken into consideration and the necessary modifications of the daily exercise should be made. an expectant mother living in the city and enjoying the average health and strength, should engage in such agreeable exercise as the raising of flowers, the training of vines, with brisk walks in the fresh air. as much time as possible should be spent in the parks. the rural "mother in waiting," may do light gardening, raising of chickens, or pigeons, training of vines, or other outdoor work she may enjoy. no matter what kind of weather prevails, a daily brisk walk should be taken, out of doors, on the porch or in a room with open windows. a daily sweat, as well as the daily prayer, is good for the well-being of the expectant mother. all forms of light housework are commendable. keep out of crowds. spend more time in the parks than in the department stores. an occasional evening at the concert or theater is diversion and harmless provided the ventilation is good. such exercises as horseback riding, bicycling, dancing, driving over rough roads, lifting and straining of any kind, and all other forms of fatiguing exercise should be avoided. rest rest and relaxation are quite necessary for men and women even in the best of health. a kind providence has arranged that we spend a large portion of our time resting, and sleeping. in addition to unbroken rest at night it is well for the prospective mother quietly to withdraw from the family circle, when the first signs of fatigue begin to appear, and indulge in a little rest, before she gets into a state of nervousness--where nerves twitch and she becomes irritable. a mother who has borne six children, who has had little domestic help, and who yet retains her youthful appearance and energy, thinks her present condition due to the fact that while carrying and nursing her babies she never permitted herself to reach that stage of exhaustion where her nerves twitched, her voice shrilled, and she became irritable. she made it a practice to drop her work when these symptoms began to appear, and to seek the sanctuary of a quiet room apart from her family, if only for ten or fifteen minutes. and, most important, from the very start she trained her household to respect her right thus to draw apart. i have told many women whose household duties press hard: "your husband would rather see a cold lunch on the table, or 'go out' for dinner, while his wife rested, smiling and happy, than to have a most sumptuous meal spread before him and the wife tired, and fretful." every woman should make it the rule of her life to stop just this side of the outburst of words, and lie down long enough, breathing deeply, to calm the spirit. fresh air "with all persons plenty of fresh air, night and day, is indispensable to health, and to none more than the pregnant woman. she should sleep with the windows open, or out of doors, at all seasons of the year; of course, making due allowance for the severity of the winters in the north. it is not only necessary to provide for the adequate ventilation of sleeping-rooms, but also for that of the living-rooms of the house. many persons, who are quite particular to open wide the windows of the bedrooms, forget that the other rooms need it quite as much. all the rooms of the house which are occupied should be thoroughly ventilated by throwing doors and windows open every morning; at night when the family is assembled the air must be changed now and then or it will become unfit for human lungs." men and women are outdoor animals. they were made to live in a garden, not a house. remember that each person requires one cubic foot of fresh air every second. don't allow the temperature of living-rooms, during the winter season, to go above sixty-eight degrees. if your home has no system of ventilation, open wide the windows and doors several times a day and enjoy the blessings of a thorough-going flushing with fresh air. oxygen is the vital fire of life. our food, however well digested and assimilated, is just as useless to the body without oxygen, as coal is to the furnace without air. it is equally important to keep up the proper degree of moisture in the air of the living-rooms. bathing bathing is made necessary by the clothes we wear and by our indoor life. if the skin were daily exposed to sunshine and fresh air, it would seldom be necessary to bathe. the neglect of regular bathing results in overworking the liver and kidneys, and debilitates the skin. regular bathing--ofttimes sweating baths--is very essential to the hygiene of pregnancy. the neutral bath (97 f.) is excellent to quiet the nerves and induce sleep. morning bathing is an exceedingly valuable practice. if properly taken before breakfast or midway between breakfast and lunch, it is found to be refreshing and tonic in nature. the feet should be in warm water, the application of cold should be short and vigorous. a rough mit dipped in cold water, rubbed over the body until the skin is pink, is a splendid tonic. warm cleansing baths should be taken twice a week at night. there is no good reason for the use of the vaginal douche during pregnancy. the teeth because the mother's system is drained of the lime salts which aid in building up the bones of the child, along with other metabolic changes which cause the retention of certain acids which ofttimes affect the teeth, they should be frequently examined and carefully guarded. severe dental work should be avoided, but all cavities should receive temporary fillings while the teeth are kept free from deposits. as a preventive to this tendency of the teeth to decay, a simple mouth wash of one of the following may be used after meals: 1. one teaspoon of milk magnesia. 2. one tablespoon of lime water. 3. one-half teaspoon common baking soda. any one to be dissolved in a glass of water. directions for saving urine specimens beginning with the second voiding of urine after rising on the morning of the day you are to save the specimen, save all that is passed during the following twenty-four hours, including the first voiding on the second morning. measure carefully the total quantity passed in the twenty-four hours. shake thoroughly so that all the sediment will be mixed, and immediately after shaking take out eight ounces or thereabouts for delivery to the physician the same forenoon. the following items should be noted, and this memoranda should accompany the specimen: 1. patient's name. 2. address. 3. this specimen was taken from a twenty-four hour voiding of urine, which began at .... a.m. ...., and ended at .... a.m. .... 4. the total quantity voided during this twenty-four hours was .... pints. this specimen should reach the laboratory by ten o'clock the same morning. it is of utmost importance the specimen should be taken to your physician every two weeks, and oftener if conditions indicate it. take it yourself at the appointed time. the bowels owing to the increasing pressure exerted upon the intestines, most expectant mothers experience a tendency to sluggish bowels and constipation. this unpleasant symptom is usually increased during the later months. in the first place, a definite time must be selected for bowel action. it may ofttimes be necessary, and it is far less harmful, to insert a glycerine suppository into the rectum, than to get into the enema habit. the injection of a large quantity of water into the lower bowel will mechanically empty it; but the effects are atonic and depressing as regards future action. before we take up the advisability of taking laxatives let us consider what foods will aid in combating constipation. the following list of foods are laxative in their action and will be found helpful in overcoming the constipation so often associated with pregnancy: 1. all forms of sugar, especially fruit sugar, honey, syrup, and malt. all the concentrated fruit juices. sweet fruits, such as figs, raisins, prunes, fruit jellies, etc. 2. all sour fruits, and fruit acids: apples, grapes, gooseberries, grape fruit, currants, plums, and tomatoes. 3. fruit juices, especially from sour fruits: grape juice, lemonade, fruit soup, etc. 4. all foods high in fat: butter, cream, eggs, eggnog, ripe olives, olive oil, nuts--especially pecans, brazil nuts, and pine nuts. 5. buttermilk and koumiss. 6. all foods rich in cellulose: wheat flakes, asparagus, cauliflower, spinach, sweet potatoes, green corn and popcorn, graham flour, oatmeal foods, whole-wheat preparations, bran bread, apples, blackberries, cherries, cranberries, melons, oranges, peaches, pineapples, plums, whortleberries, raw cabbage, celery, greens, lettuce, onions, parsnips, turnips, lima beans, and peanuts. white bread should be tabooed, and in its place a well-made bran bread should be used. two recipes for bran bread follow, one sweetened and containing fruit, the other unsweetened: bran bread recipes 1. two eggs, beaten separately; three-fourths cup of molasses, plus one round teaspoon of soda; one cup of sour cream; one cup of sultana seedless raisins; one cup of wheat flour, plus one heaping teaspoon baking powder; two cups of bran; stir well and bake one hour. 2. one cup of cooking molasses; one teaspoon of soda; one small teaspoon of salt, one pint of sour milk or buttermilk, one quart of bran, one pint of flour. stir well, and bake for one hour in a very slow oven. it may be baked in loaf, or in gem pans, as preferred. the bread should be moist and tender, and may be eaten freely, day after day, and is quite sure to have a salutary effect if used persistently. the drinking of one-half glass of cold water on rising in the morning often aids in keeping the bowels active. of the laxative drugs which may be used at such a time, cascara sagrada and senna are among the least harmful. two recipes of senna preparation follow, and may be tried in obstinate cases: 1. _senna prunes._ place an ounce of senna leaves in a jar and pour over them a quart of boiling water. after allowing them to stand for two hours strain, and to the clear liquid add a pound of well-washed prunes. let them soak over night. in the morning cook until tender in the same water, sweetening with two tablespoons of brown sugar. both the fruit and the sirup are laxative. begin by eating a half-dozen of the prunes with sirup at night, and increase or decrease the amount as may be needed. 2. _senna with prunes and figs._ this recipe does not call for cooking. take a pound of dried figs and a pound of dried prunes, wash well. remove the stones from the prunes and if very dry soak for an hour. then put both fruits through the meat chopper, adding two ounces of finely powdered senna leaves. stir into this mixture two tablespoons of molasses to bind it together, the result being a thick paste. begin by eating at bedtime an amount equal to the size of an egg, and increase or decrease as may be necessary. keep the paste tightly covered in a glass jar in a cool place. if the senna is distasteful a smaller quantity may be used at first. care of the breasts the breasts are usually neglected during the months of pregnancy, and as a result complications occur after the baby comes which cause no end of discomfort to the mother. if, during the pregnancy, the breasts are washed daily with liquid soap and cold water, and rubbed increasingly until all sensitiveness has disappeared, they may be toughened to the extent that no pain whatsoever is experienced by the mother when the babe begins to nurse. during the last month of pregnancy a solution of tannin upon a piece of cotton may be applied after the usual vigorous bathing. if the nipples are retracted they should be massaged until visible results are attained. the mental state keep the mind occupied with normal, useful, and healthy thoughts. listen to no tales of woe. stay away from the neighborhood auntie dolefuls. keep yourself happy and free from all worry, care, and anxiety. "put no faith in fables of cravings, markings, signs, or superstitions. they are all unfounded vagaries of ignorant old women and will not bear investigation." don't take drugs for worry and sleeplessness. take a bath. the secret of deliverance from worrying is self-control. minimize your difficulties. cultivate faith and trust. the conditions which favor sound sleep are: quiet, mental peace, pure blood, good digestion, fresh air (the colder the better), physical weariness (but not fatigue), mental weariness (but not worry). when tempted to borrow trouble, when harassed by fictitious worries, remember the old man who had passed through many troubles, most of which never happened. train the mind to think positive thoughts. replace worry-thought with an opposite thought which will occupy the mind and enthuse the soul. drive out fear-thought by exercising faith-thought. cultivate the art of living with yourself as you are, and with the world as it is. learn the art of living easily. associate with children and learn how to forget the vexing trifles of everyday life. there is something decidedly wrong with one's nerves when everybody is constantly "getting on them." they are either highly diseased or abnormally sensitive. every woman is a slave to every other that annoys her. fear is capable of so disarranging the circulation as to contribute to the elevation of blood-pressure--which will be more fully considered in a later chapter. chapter v complications of pregnancy it is the purpose of this chapter to take up the various complications which may appear in the course of an otherwise normal pregnancy, and offer advice appropriate for their management. morning sickness about one-half of the expectant mothers that come under our care and observation, experience varying degrees of nausea or "morning sickness." this troublesome symptom makes its appearance usually about the fourth week of pregnancy and lasts from six to eight weeks. on attempting to rise from the bed, there is an uncomfortably warm feeling in the stomach followed by a welling up into the throat of a warmish, brackish tasting liquid which causes the patient to hasten to rid herself of it; or, as she rides on the train, on the street cars, in a carriage or automobile, she frequently senses the same unpleasant and nauseating symptoms during the second and third months of pregnancy. normally, this uncomfortable symptom quite disappears by the end of the third month. a number of remedies have been suggested for it, but that which seems to help one, gives little or no relief to another; we therefore mention a variety of remedies which may be tried. first and most important of all remedies--is to keep the bowels open. sluggishness of the intestinal tract greatly increases the tendency to dizziness and nausea. during the attack, it is advisable not to attempt to brush the teeth, gargle, or even drink cold water. while you are yet lying down, the maid or the goodman of the house should bring to you a piece of dry, buttered toast, a lettuce sandwich with a bit of lemon juice, or perhaps a cup of hot milk or hot malted milk. coffee helps to raise the blood-pressure, and all articles of diet that tend to raise the blood-pressure are best avoided during pregnancy. a cup of cocoa may be tried, but, as a rule, women at this time do not relish anything sweet. oftentimes a salted pretzel is just the thing, or a salted wafer will greatly help. remain in bed from one-half to one hour and then rise very slowly. there should be plenty of fresh air in the room, as remaining in overheated places is quite likely to produce a feeling of sickness at the stomach. when the attack comes on during a train ride, open the window and breathe deeply, this, with the aid of a clove or the tasting of a bit of lemon, will usually give relief. in extreme instances the patient should lie down flatly on the back, with the eyelids closed. go to the rear of the street car, so that you can get off quickly if necessity demands; breathe deeply of the air; resort to the use of cloves or lemons; and thus by many and varied methods will the expectant mother be enabled to continue her journey or finish her shopping errand. we would suggest that, as far as possible, walking should be substituted for riding. i have never heard of a woman being troubled with nausea while walking in the parks, on shady streets, along the country road, or on the beach. of the medicines prescribed for "morning sickness" and the nausea of pregnancy, cerium oxalate taken three times a day in doses of five grains each, is probably one of the best. the persistent or pernicious vomiting which continues on through pregnancy will be spoken of later. heartburn acid eructations are spoken of as "heartburn," and are occasioned by the increased activity of the acid making glands of the stomach. under certain conditions this acid content of the stomach is regurgitated back into the throat and even belched up into the mouth. in this condition it is well to avoid most acid fruits. ice cream and other frozen desserts are beneficial. the lowered temperature of cold foods depresses the activity of the acid glands, as also does the fats of the cream, while protein food substances such as white of egg, cheese, and lean meat, help by combining with the excess of acid present in the stomach. buttermilk or the prepared lactic acid milk, if taken very cold, is often helpful, notwithstanding it is an acid substance, in connection with the dietetic management of heartburn. if the acid eructations be troublesome between the meals, the taking of calcined magnesia (one round teaspoon in a glass of cold water), or, one-half teaspoon of common baking soda in a glass of water, will afford immediate and temporary relief. simply nibbling a little from a block of magnesia will often give instant relief. these alkalines effectively neutralize the mischievous acids which cause the so-called "heartburn." irritability of the bladder the flexing or bending forward of the gravid uterus, by making pressure on the bladder, sets up more or less irritation and consequent disturbance of the urinary function. the capacity of the bladder is actually diminished, and this produces frequent urination. there is usually no pain connected with this annoying symptom--the chief discomfort is the frequent getting up at night. this inconvenience may be lessened by drinking less water after six p.m. these bladder disturbances are most marked in the earlier months, and gradually disappear as the uterus raises higher up into the abdomen; although this symptom may reappear in the last two weeks, as the head descends downward on its outward journey. should the urine at any time become highly colored, take a specimen to your physician at once. twenty-four hour specimens of urine should be taken by the patient to her physician every two weeks. do not send it--take it. leucorrhea while leucorrhea is an unusual complication of pregnancy, it is often very troublesome and sometimes irritating. do not take a vaginal douche unless it has been ordered by your physician, and even then make sure that the force of the flow of water is very gentle. the bag of the fountain syringe should be hung only about one foot above the hips. soap and water used externally, followed by vaseline or zinc ointment, will usually relieve the accompanying irritation. threatened abortion in the third chapter attention was called to the formation of the placenta or "after birth," on the site of the attachment of the cocoon embryo. at this particular time of the pushing away of the embryo from the uterine wall, one of the accidents of pregnancy occurs, in which the embryo becomes completely detached and starts to escape from the uterus, accompanied by varying degrees of pain and hemorrhage. the symptoms of this threatened abortion are: 1. heavy menstrual pains. 2. backache. 3. hemorrhage. the approach of the calendar date of the third month of pregnancy should be watched for, and all work of a strenuous nature studiously avoided; while at the first signs of the backache or any unusual symptom, the expectant mother should immediately go to bed and send for the physician. one patient who had aborted on four different occasions was able to pass this danger period by adhering to a rigid program of prevention during her fifth pregnancy. two weeks before the third month arrived she discontinued her teaching and went to bed. she remained there four weeks, thus running over into the middle of the following month. gradually, she resumed her duties of teaching, carried her precious bundle of life to full term, and is now the proud and happy mother of a splendid baby girl. should abortion seem imminent, from one-eighth to one-fourth of a grain of morphine sulphate will greatly reduce all uterine contractions, and this, with the general quieting effect on the whole system, will usually suffice to prevent an abortion. the patient should quietly remain in bed from three days to one week. if the abortion takes place--if a clot accompanied by hemorrhage is passed--save everything, lie in bed very quietly and send for your physician at once; and when he does arrive, be content if he does not make an internal examination at once, for if he should there is more or less danger of infection. and i repeat--throw nothing away--burn nothing up, save everything that passes until your physician has carefully examined it. sudden abdominal pain sudden or severe pains in the abdomen should be reported at once to your physician, while you should immediately go to bed and quietly remain there until you receive further instruction from your doctor when he calls. in the later stages of pregnancy any appearance of blood should likewise be noted and reported without delay. these symptoms may not always be serious, but they are also associated with grave complications, and should, therefore, be given prompt attention. miscarriage abortion is a term used to designate the loss of the embryo prior to or at the third month. miscarriage applies to the expulsion of the fetus or emptying of the uterus after the third month. it is possible for a miscarriage to occur anytime during the interim between the fourth and ninth months. after the uneventful passing of the third month, if an accident threatens, we instruct the mother to remain quietly in bed three to five days at the calendar date comparable with each menstrual period; and as she approaches the seventh month, we adjure her to be unusually careful and prudent. the causes of miscarriages are many: disease of the embryo, imperfect fetal development, some constitutional disease of the mother, a faulty position of the uterus, or it may result from something unusual about the lining of the uterus such as an endometritis--an inflammation of the mucus membrane. expectant mothers who manifest symptoms of a threatened miscarriage should studiously avoid such exercises as climbing, riding, skating, tennis, golf, dancing, rough carriage or automobile riding, and such taxing labor as sweeping, lifting, washing, running the sewing machine, window cleaning, the hanging of pictures, draperies, etc. cravings within reason, a pregnant mother should follow her natural appetite and satisfy her dietetic longings. should she desire unusual articles of food, as far as possible she should have them. the idea has long prevailed that if the mother does not get what her longing soul supremely desires, that the on-coming baby is going to cry and cry until it is given what the mother wanted with all her heart and did not get. such an idea is the very quintessence of folly and the personification of foolishness and superstition. many a precious babe has suffered as a victim of this notion of "craving" and "marking." one mother gave her baby a huge mouthful of under-ripe banana because "she knew that was just what he wanted, because, when pregnant, she had craved and craved bananas and for some reason or another she did not get them." the soft, smooth piece of banana slipped down the baby's throat--on into the stomach and intestines--caused intestinal obstruction and finally the end came; and we registered one more victim to the fallacies of fear and the superstitious belief in "cravings" and "markings." occasionally some cravings are unusual and freakish, for instance, egg shells, leather, candles, chalk, and other abnormal tastes are developed. of these we have only to say, "rise above them, become mistress of the situation and change your longings." if such abnormal cravings come to you in the kitchen, don your bonnet and go at once out of doors and take a walk. don't be foolish just because somebody told you foolish stories about these things. constipation bowel hygiene is an important part of the management of pregnancy. constipation often proves to be very troublesome. in another chapter this subject is treated at some length. here, we pause only long enough to say that habit has much to do with this difficulty. a regular time should be set apart each day for attending to this important matter. hemorrhoids of all the maladies that the human family falls heir to, hemorrhoids are among the commonest and, we may add, the most neglected. any woman who enters pregnancy, suffering from hemorrhoids, is going to have her full share of suffering and pain before she has finished with her labors. taken early, they may be greatly helped, if not entirely relieved, by the daily use of the medicated suppository (see appendix). the bowel movements should never be allowed to become hard, the dietetic advice of another chapter should be carefully followed and the oil enema, as described in the appendix, should be used if necessary. for immediate relief, hot witch-hazel compresses may be applied; or, in the case of badly protruding piles, the patient should immerse the body in a warm bath and by the liberal use of vaseline they can usually be replaced. the physician should be called and he will advise any further treatment the case may require. varicose veins varicose veins or the distension of the surface veins of the legs are very common among women in general and pregnant women in particular. the legs should be elevated whenever the patient sits, while in bad cases they should be bandaged while standing. there are many elastic surgical stockings on the market today that, if put on before rising in the morning, will give much relief and comfort all during the day. any large medical house or physician's supply house can furnish them according to your measurements--which should be taken before getting out of bed in the morning. these measurements are taken according to instructions and usually are of the instep, ankle, calf of leg, length of ankle to knee, etc. cramps cramps are sharp, exceedingly painful muscular spasms occurring in the muscles of the calf of the leg, the toes, etc. the expectant mother in the later months of pregnancy awkwardly turns in bed, is suddenly awakened and without a moment's warning, is seized with a most excruciating pain in her leg or toe. the most effectual treatment for these cramps is quickly to apply a very cold object to the cramping muscle. extremes of either heat or cold usually relieve as well as the vigorous grasping or kneading of the muscle. a hot foot bath on going to bed will often prevent an attack. a long walk in the latter months of pregnancy should invariably be followed by a short hot bath or a foot bath. many attacks may be avoided by this procedure. swellings all swellings should be taken seriously by the pregnant mother to this extent, that she save a twenty-four hour specimen of urine and that she personally take it to her physician, with a report of her "swellings." this symptom may or may not indicate kidney complications. the blood-pressure together with chemical and microscopical analysis of the urine will determine the cause. slight swelling of the feet is often physiological and is due to pressure of the heavily weighted uterus upon the returning veins of the legs. the progress of the veinous blood is somewhat impeded, hence the accumulation of lymph in the tissues of the legs, ankles, and feet. never allow yourself to guess as to the cause of swellings, always take urine to the physician and allow him definitely to ascertain the true cause. all tight bands of the waist and knee garters must be discarded at this time. the same general treatment suggested for varicose veins holds here. goitre the enlargement of the thyroid gland--goitre--is physiological during pregnancy, and is believed to be caused by the throwing into the maternal blood stream of special protein substances derived from the fetus. as just stated, this is more or less physiological, will usually pass away after the babe is born, and, therefore, need give the mother no particular concern. tight neck bands should be replaced by low, comfortable ones. the bowels should move freely every day, and water drinking be increased as well as sweating of the skin encouraged by a short, hot bath, followed by the dry blanket pack, while the head is kept cool by compresses wrung from cold water. in this manner the elimination of these poisons is increased through both the skin and the kidneys. backache the backache of the later months of expectancy is very annoying and often spoils an otherwise restful night's sleep. this is probably also a pressure symptom, if the physician's analysis of the urine proves that the kidneys are not at fault. if you have electric lights in the home, a very useful contrivance can be made which will give you great relief. the light end of an extension cord, five to seven feet in length, is soldered into the center of the bottom of a bright, pressed tin pail about twelve inches in diameter at the top and nine or ten inches deep. with the bail removed, screw in a sixteen or thirty-two candle power bulb and attach the extension cord to a nearby wall or ceiling socket. this arrangement supplies radiant heat and is called a photophore (see fig. 3). apply this twofold remedial agent--light and heat combined--to the painful back (underneath the bed clothing) and our restless mother will go to sleep very quickly. this may safely be used as often and as long as desired. [illustration: fig. 3. the photophore.] pernicious vomiting persistent, prolonged, and very much aggravated cases of morning sickness are termed pernicious vomiting. the patient emaciates because of the lack of ability to keep food long enough to receive any benefits therefrom. in treating these cases the sufferer should be put to bed in a room with many open windows, or, if the weather permit, should be out of doors on a comfortable cot. she should remain in bed one hour before the meal is served and from one to three hours afterward. the mind should be diverted from her condition by good reading, friends, or other amusements. the utmost care and tact should be used in the preparation of her food, and art should be manifested in the daintiness of the tray, etc. we found one mother was nauseated even at the sight of her tray and so we planned a call that should bring us to her home at the meal hour. the tray came in with the attendant in unkempt attire, who said, as she placed it carelessly down on a much-loved book our patient had been reading: "i heard you say you liked vegetable soup so i brought you a big bowl full." as i gazed at the tray, i saw a large, thick, gravy bowl running over with the soup. i usually like vegetable soup, but at the sight of that sloppy looking bowl--well, i thought i should never care for it again. after installing a new maid who had a sense of service and daintiness, and who took real pleasure in the selection of the dishes for the tray, as well as the quality and quantity of food served in them, our patient made speedy recovery, went on to full term and became a happy mother. there is no doubt that the mind has very much to do with this vexing complication of pregnancy. one mother immediately stopped vomiting everything she ate when told by her husband that "the doctor said he was coming in the morning to take you away from me to the hospital if you didn't stop vomiting." everything known should be tried for the relief of these patients and in extreme cases, when the mother's life is endangered, pregnancy should be terminated. insomnia the neutral full bath, temperature 97 f., maintained for twenty minutes to one-half hour, should be taken just on going to bed. the patient must not talk--must rest in the bath--absolutely quiet. the causes of insomnia should be determined if possible, and proper measures employed to remove them. they may consist of backache, cramps, frequent urination, pressure of the uterus on the diaphragm or pressure against the sides of the abdomen. the bed should be large, thus giving the patient ample room to roll about. the following procedures may be tried in an effort to relieve the sleeplessness: rubbing of the spine, alcohol or witch-hazel rubbing of the entire body, the neutral bath, or the application of the electric photophore--described a few pages back--may be made to the painful part. _do not resort to drugs_, unless you are directed to do so by your physician. headache headaches should not be allowed to continue unobserved by the attending physician. measure the daily output of urine, which should be at least three pints or two quarts. in case of daily or frequent headaches, notify your physician at once and take a twenty-four hour specimen of urine to him. headache is an early symptom of retained poisons and if early reported to the physician quick relief can be given the patient and often severe kidney complications be avoided by the proper administration of early sweating procedures. water drinking should be increased to two quarts (about ten glasses) a day. less food and more water are the usual indications in the headaches of pregnancy. high blood-pressure blood-pressure is called _high_ when the systolic pressure registers above 150 to 160 millimeters of mercury. pressure above 165 should be taken seriously and the patient should keep in close touch with her physician. tri-weekly examinations of the urine should be made, while eliminating baths should be promptly instituted. the subject of blood-pressure in relation to pregnancy will be fully dealt with in the next chapter--in connection with toxemia, eclampsia, etc. chapter vi toxemia and its symptoms at the close of the preceding chapter on the complications of pregnancy, brief mention was made of blood-pressure as a possible source of anxiety. this chapter will be devoted to a further discussion of the subjects of toxemia, eclampsia, convulsions, and especially blood-pressure--in connection with other leading symptoms of these serious complications of pregnancy. toxic symptoms in a former chapter we learned that the developing child nearly doubled its weight in the last two months of pregnancy. as the child grows, its metabolic waste matter is greatly increased, while all these poisonous substances must finally be eliminated by the mother. now, the mother's waste matter is of itself considerably increased; and so, if the kidneys, the liver, and the skin are already over-taxed in their work of normal elimination--if they are already doing their full quota of work--we can readily see that the additional waste matter of the unborn child will throw much extra work on the already overworked eliminative organs, and this results in a condition of toxemia. certain symptoms accompany this state of constitutional poisoning or auto-intoxication--the chief of which are: 1. headache. 2. dizziness. 3. blurring of the vision. 4. swelling of the feet and hands, or puffiness of the face. 5. diminished urine. 6. vomiting. 7. high blood-pressure. 8. albumin and casts in the urine. any one of these symptoms may or may not indicate toxemia; but it should be reported at once to the attending physician. in the presence of one or more of these symptoms an expectant mother is always safe, while awaiting the physician's advice, in carrying out the following program: 1. drink more water or lemonade. 2. take a mild cathartic. 3. avoid eating much meat and other highly protein foods. convulsions of pregnancy this serious complication of the last weeks of pregnancy demands immediate attention. they may almost invariably be avoided if the blood-pressure and the urine are studiously watched during the latter part of the expectant period. if you are unable to get your physician at once, the following treatment should be administered immediately. 1. a hot colonic flushing (see appendix). 2. a hot bath followed by the hot blanket pack (see appendix). 3. one drop of croton oil on a bit of sugar may be placed on the back of the tongue. 4. chloroform may be administered, provided a competent nurse or other medical person is present. the appearance of convulsions which have been preceded by one or more of the symptoms noted under the head of "toxemia," indicates that the patient has become so profoundly intoxicated and poisoned by the accumulating toxins, that the lives of both mother and child are jeopardized by threatened eclampsia. at such a time, the attending physician will immediately set about to bring on labor, and thus seek to empty the uterus at the earliest possible moment. cardinal symptoms of toxicity since toxemia (eclampsia) is one of the complications of pregnancy most to be dreaded, it is fortunate that it almost invariably exhibits early danger signals which, if recognized and heeded, would enable the patient and physician to initiate proper measures to avert danger and escape the threatened disaster. the presence of this toxic danger is indicated by the persistent presence of the following three symptoms: 1. persistent, dull headache. 2. presence of casts in the urine. 3. persistent high blood-pressure, with tendency to increase. of course, albumin will probably appear in the urine along with the casts, but it is the continued appearance of the casts that is of more importance as a danger signal. albumin is quite common in the urine of the expectant mother, but casts--long continued--suggest trouble. headache as an indicator of toxemia is of special significance when coupled with the other two cardinal symptoms of eclampsia--urinary casts and increasing high blood-pressure. therefore, the necessity for frequent urinary tests and blood-pressure examinations during the last weeks of pregnancy--especially, if the patient has suffered from headaches and has been running albumin in the urine. [illustration: fig. 4. taking the blood pressure] high blood-pressure blood-pressure is a term used to indicate the actual pressure of the blood stream against the walls of the blood vessels. the blood-pressure machine tells us the same story about our circulatory mechanism, that a steam gauge does about a high-pressure boiler (see fig. 4). the normal blood-pressure varies according to the age of the patient. for instance, the normal pressure of a young person, say up to twenty years of age, runs from 100 to 120 millimeters of mercury; and then, as the age advances, the blood-pressure increases in direct ratio; for every two years additional age the blood-pressure increases about one point--one millimeter. the average pregnant woman starts in her pregnancy with a blood-pressure of say, 125 millimeters, but as pressure symptoms increase, and as constipation manifests itself, and as the circulating fluids are further burdened with the toxins which are eliminated from the child, the blood-pressure normally increases to about 140 mm., and later, possibly to 150 mm. if the pressure goes no higher, we are not alarmed, for we have come to recognize a blood-pressure of 140 as about the normal pressure of the pregnant woman. there are a number of factors which enter into the raising of the blood-pressure. for instance, at any time during the pregnancy, if the eliminative organs of the mother are doing inefficient work, if she falls a victim to a torpid liver, diseased kidneys, decreased skin elimination, or sluggish bowels, then, with the added and extra excretions from the child, there is superimposed upon the mother far more than the normal amount of eliminative work--and then, because of improper and incomplete elimination, the blood-pressure is increasingly raised. eclampsia prevented this whole subject can best be illustrated by relating a story, the actual experience of mrs. a. this patient came to the office with a history of bright's disease (albumin and casts in the urine), and chronic appendicitis. while treating her for the kidney condition, preparatory to an operation for the removal of the troublesome appendix--in the very midst of this treatment--she became pregnant, and great indeed was our dismay. we entertained little hope of getting both the mother and child safely through. frequent examination of urine was instituted, the albumin did not increase and the blood-pressure remained at normal--about 124 mm. she paid weekly or bi-weekly visits to the office and carefully followed the regime outlined. she drank abundantly of water and strictly followed the dietary prescribed. weeks and months passed uneventful, until we approached the last six weeks of pregnancy, and then we found to our surprise one day that the blood-pressure had made a sudden jump up to 175 mm., while the urine revealed the presence of numerous casts and albumin--in the meantime the albumin had entirely disappeared. there were also other urinary findings which showed that the liver was not doing its share in the work of burning up certain poisons. in her home we began the following program: every day we had her placed in a bathtub of hot water, keeping cold cloths upon her brow, face and neck, and then, by increasing the temperature of the bath, we produced a very profuse perspiration. she was taken out of this bath and wrapped in blankets, thus continuing the sweat. all meat, baked beans, and such foods as macaroni and other articles containing a high per cent of protein were largely eliminated from her diet. at times she did not even eat bread. her chief diet was fruit, vegetables, and simple salads, and yet the albumin and casts continued to increase in the urine and the blood-pressure climbed up to 190 mm. as we approached the last two weeks of pregnancy, this little woman was taken to the hospital and systematic daily treatment with sweating procedures was begun. among other things, she had a daily electric light bath. after each of these baths she was wrapped in blankets and the sweating continued for some time. careful estimations of albumin were made daily and the blood-pressure findings noted three times a day. during the last week of pregnancy she lived on oranges and grapes. day by day she was watched until the eventful hour arrived. she went into the delivery room and gave birth to a perfectly normal child. the albumin and casts quickly cleared up, the blood-pressure lowered, and today the little woman is a fond mother of a beautiful baby boy. it is hard to estimate what might have taken place had not her elimination been stimulated. the blood-pressure was our guide. had the albumin (without casts) appeared in the latter weeks of pregnancy with a blood-pressure of 140 or 150 mm., we would not have become excited, for the reason that in every normal pregnancy there is often present a trace of albumin in the latter weeks; but when the blood-pressure jumped to 170 or 190, then we knew that toxemia--eclampsia--convulsions--were imminent. so we have in recent years, come to look upon the blood-pressure as an exceedingly important factor--as an infallible indicator of approaching trouble--as a red signal light at the precipice or the point of danger; and it not only warns us of the danger, but it tells us about how near the boilers are to the bursting point. the glassy eye, the headache, the full bounding pulse and the blurring of vision, are all symptoms accompanying this high blood-pressure, so that in these enlightened days no practitioner can count himself worthy the name, or in any way fit to carry a pregnant woman through the months of waiting, unless he sees, appreciates, and understands the value of blood-pressure findings in pregnancy. chapter vii preparations for the natal day two months before baby is to arrive, the expectant mother should pay particular attention to the conservation of her strength. the woman who is compelled to leave her home for the factory, the laundry, the office, or other place of employment, should stop work during these last two or three months. the active club woman should pass the burdens on to others, and the woman of leisure should withdraw from active social life with its varied obligations. during the final weeks of pregnancy, the prospective mother needs the same hygienic care regarding fresh air, exercise, diet, and water drinking, as outlined in a former chapter. the final weeks as the gravid uterus rises higher in the abdomen, increased pressure is exerted on the stomach, the lungs, and upon the nerve centers of the back; and it is because of this situation, that the duties and obligations of the prospective mother should be reduced to a minimum, that she may feel at liberty to lie down several times during the day on the porch or in a well-ventilated room, in the midst of the best possible surroundings. sexual intercourse should be largely discontinued during the last months of pregnancy. i sometimes wish the prospective mothers in our dispensary districts might have some of the care and the kind treatment which is bestowed upon an ordinary prospective mother horse, which at least enjoys a vacation from heavy labor, and whose food is eaten with calm nerves and in the quietness of a clean stall. while the state of the mother's mind does not materially influence the child; nevertheless, the state of the mother's body, the weary over-worked muscles and nerves of hot, tired women, bending over cook stoves, laundry tubs, or scrubbing floors, does materially derange the mother's health and digestion, which in turn, reflexly interferes with the growth and physical development of her child. extra strength is required for the day of labor, and since the baby doubles its weight during the last two months, the mother is living for two, and should, therefore, avoid extreme fatigue, over tiring, and irksome labor during these final weeks of watchful waiting. selection of the home it may or may not be within the province of prospective parents to rearrange, rebuild, or otherwise change the home. usually the size of the pocketbook, the bank account, or the weekly pay envelope decide such things for us. the home may be in the country or suburbs, with its wide expanse of lawns, its hedges of shrubbery, and with its spacious rooms and porches; or it may be a beautifully equipped, modern apartment on the boulevard of a city, with its sun parlors, large back porches, conveniently located near some well-kept city park, or it may be one of those smaller but "snug as a bug in a rug" apartments, in another part of the city, where usually there is a sunny back porch; or again some of my readers may themselves be, or their friends may be, in a darkened basement with broken windows, illy ventilated rooms, with no porches, no yards, no bright rays to be seen coming in through windows--and yet into all of these varied homes there come little babies--sweet, charming little babies, to be cared for, dressed, fed, and reared. and we must now proceed to the subject of making the most of what we have--to create out of what we have, as best we can, that which ought to be. sanitary premises in both the country and city place, yards and alleys should be cleaned up. garbage--the great breeding place of flies--should be removed or burned. the manure pile of the stable or alley should also be properly covered and cared for. in this way breeding places for flies are minimized and millions and billions of unhatched eggs are destroyed. in the large cities, provision is made for the prompt disposal of garbage, and laws are beginning to be enforced regarding the covering and the weekly removal of manure, and thus in many of our large cities flies are diminishing in numbers each year. fly campaigns and garbage campaigns are teaching us all to realize the dangers of infection, contagion, and disease as a result of filth; while through the schools, the children of even our foreign tongued neighbors take home the spirit of "cleaning up week." even in the rural districts we hope for the dawning of the day when filth, stagnant pools, open manure piles, and open privies, will be as much feared as scorpions or smallpox. engaging the doctor as suggested elsewhere, as soon as the expectant mother is aware that she is pregnant, she should engage her physician. and since these are days of specialists, he may or may not be the regular family doctor. the husband and friends may be consulted, but the final choice should be made by the prospective mother herself. "the faith which casts out fear, the indefinable sense of security which she feels in her chosen physician, supports her through the hours of confinement." twenty-four hour specimens of urine should be saved and taken to the physician twice each month and oftener during later months of pregnancy. the chosen physician's instructions and suggestions should be carried out and counsel should be sought of him as to the place of confinement. the place of confinement there are a number of factors that enter into the selection of the place of confinement. in the first place, if the home be roomy, bathroom convenient, if the required preparation of all necessities for the day of labor can be effected, and it is further possible to prepare a suitable delivery-room at home with ample facilities for emergencies and complications, and you can persuade your physician to do it--then the best place in the world for the mother to be confined is within the walls of her own home. but such is the case in but one home out of hundreds, and i regret that time and space will not allow me to describe and portray the many untimely deaths that might have been avoided if this or that supply had only been ready at the moment of the unexpected complication of delivery. why should we needlessly risk the lives of prospective mothers, when, in every up-to-date hospital delivery-room, all these life-saving facilities are freely provided? here in the modern hospital, the mothers from small homes and apartments, the mothers who live in stuffy basements, as well as those from the average home in the average neighborhood, can come with the assurance of receiving the best possible care and attention. every woman who can arrange or afford it, should plan to avail herself of the benefits, comforts, quietness, and calm of a well-equipped hospital and the surgical cleanliness and safety of its aseptic delivery-room. fortunately, the mother of the basement home may have the same clean, sterile dressings used upon her as does the mother of the boulevard mansion. the maternity ward bed at $8.00 to $10.00 a week can be just as clean as the bed of the $40.00 a week room. the methods and procedures of the delivery-room can be just as good in the case of the very poor woman as in the case of the magnate's wife. in no way and for no reason fear the hospital. it is the cleanest, safest, and by far the cheapest way. the weekly amount paid includes the board of the patient, the routine care, and all appliances and supplies of every sort that will be used. under no circumstances should a midwife be engaged. any reputable physician or any intellectual minister will advise that. let your choice be either the hospital or the home; but always engage a physician, _never_ a midwife. the nurse after selecting the place of confinement, the question of the nurse may next be considered. if it is to be the hospital, you need give little further thought to the nurse, for your physician will arrange for the nurse at the time you enter the hospital. she will be a part of the complete service you may enjoy. you will find her on duty as you, quietly resting in your room, awaken in the sweet satisfaction that at last it is all over--at last your baby is here. a competent nurse is a necessity, if the confinement takes place in the home. she may be a visiting nurse, who, for a small fee, will not only come on the day of labor, but will make what is known as "post-partum calls" each day for ten or twelve days. these are short calls, but are long enough to clean up the mother and wash and dress the babe. she is not supposed to prepare any meals or care for the home. then there is the practical nurse--women who have prepared themselves along these lines of nursing, whose fees range from $12.00 to $18.00 a week. if your physician recommends one to you, you may know she is clean and dependable. the trained nurse, who has graduated from a three years' course of training, is prepared for every emergency, and will intelligently work with the physician for the patient's welfare and comfort. her fees range from $25.00 to $35.00 a week. both the practical and the trained nurses are human beings, and require rest and sleep the same as all other women do. one nurse, after having faithfully remained at her post of duty some sixty hours reminded the husband and sister of the patient that she must now have five hours of unbroken rest and they replied in a most surprised manner, "why we are paying you $30.00 a week, and besides, we understood you were a _trained_ nurse." the physician usually makes arrangement with the family for competent relief for the nurse. she should have at least one to two hours of each day for an airing, and six hours out of the twenty-four for sleep. preparations for a home delivery the supplies should all be in the home and ready, as the seventh month of pregnancy draws near. in the first place, select the drawer or closet shelf where the supplies are to remain, untouched, until your physician orders them brought out. the supplies requiring special preparation and sterilization are: three pounds of absorbent cotton. one large package of sterile gauze (25 yards). four rolls of cotton batting. two yards of stout muslin for abdominal binders. two old sheets. twelve old towels or diapers. one yard of strong narrow tape for tying the cord. three short obstetrical gowns for the patient. two pairs of extra long white stockings. four t-binders. other articles needed by physician, nurse, and patient are: fifty bichloride of mercury tablets (plainly marked "_poison_"). four ounces of lysol. two ounces of powdered boric acid. one half ounce of 20% argyrol. one quart of grain alcohol. one pound jar of surgeon's green soap. one half pound of castile soap. one bottle white vaseline. one drinking tube. one medicine glass. one two-quart fountain syringe. one covered enamel bucket or slop jar. one good sized douche pan. three agateware bowls, holding two quarts each. two agateware pitchers, holding two quarts each. two stiff hand-brushes. one nail file. one pair surgeon's rubber gloves. one and one-half yards rubber sheeting 36 inches wide. two no. 2 rubber catheters. two dozen large safety pins. small package of tooth picks, to be used as applicators. six breast binders (fig. 5). six sheets. just before confinement send for one ounce of fluid extract of ergot and an original pint bottle of squibb's chloroform. the preparation of the supplies 1. _the sanitary pad_ is used to absorb the lochia after confinement, and needs to be changed many times during the day and night; fully five or six dozen will be required. they are usually made from cotton batting and a generous layer of absorbent cotton. if made entirely from absorbent cotton they mat down into a rope-like condition. they are four and one-half to five inches wide and ten inches long. the sterile cheesecloth is cut large enough to wrap around the cotton filling and extends at both ends three inches, by which it is fastened to the abdominal binder. with a dozen or fifteen in each package these vulva pads are wrapped loosely in pieces of old sheets and pinned securely and marked plainly on the outside. 2. _delivery pads._ these pads should be thirty-six inches square and about five inches thick, three or four inches of which may be the cotton batting and the remainder absorbent cotton. three of these are needed. each should be folded, wrapped in a piece of cloth and likewise marked. 3. _gauze squares._ five dozen gauze squares about four inches in size may be cut, wrapped and marked. these are needed for the nipples, baby's eyes, etc. [illustration: fig. 5. breast binder] 4. _cotton pledgets._ these are cotton balls, made as you would a light biscuit with the twist of the cotton to hold it in shape. they should be about the size of the bottom of a teacup. these are thrown in a couple of pillow slips and wrapped and marked. 5. _the bobbin._ cut the bobbin or tape into four nine-inch lengths and wrap and mark. 6. the _tooth picks_ are left in the original package and do not require sterilization. 7. _sterilization._ before steaming and baking, wrap each bundle in another wrapping of cloth and pin again securely. mark each package plainly in large letters or initials. these packages may be sent to the hospital for sterilization in the autoclave or they may be steamed for one hour in the large wash boiler, by placing them loosely into a hammock-like arrangement made by suspending a firm piece of muslin from one handle of the boiler to the other. the center of the hammock should come to within five inches of the bottom of the boiler which contains three inches of boiling water. the cover of the boiler is now securely weighed down and the water boils hard for one hour, at the end of which time they are removed and placed in a warm oven to dry out. the outer wrapping may be slightly tinged with brown by this baking. after a thorough drying they are allowed to remain in the same wrappings into which they were first placed and put away in a clean drawer awaiting the "natal day." requisites for the hospital each hospital has its own methods and regulations for caring for obstetrical patients and it is well for the expectant mother to visit the obstetrical section, the delivery-room and the baby's room, that she may personally know more about the place where she is to spend from ten days to two weeks. here she may ascertain from the superintendent just what she will need to bring for the baby. many of the hospitals furnish all the clothes needed for the baby while in the hospital; in such instances, the hospital also launders them. other hospitals require the baby's clothes to be brought in, in which case the mother looks after the laundry. the mother always takes her toilet articles, a warm bed jacket with long sleeves, several night dresses and a large loose kimono or wrapper to wear to the roof garden or porch in the wheel chair. warm bedroom slippers and a scarf for the head completes the outfit. baby's necessities baby's basket on the day of confinement should contain: one pound of absorbent cotton. one pint of liquid albolene. one half ounce of argyrol (mentioned in the mother's list). safety pins of assorted sizes. a powder box containing powder and puff. an old soft blanket in which to receive the child after birth. a soft hair brush. three old towels. small package of sterile gauze squares. scales. diapers. a silk and wool shirt (size no. 2). an abdominal band to be sewed on with needle and thread. a pair of silk and wool stockings. a flannel skirt. an outing flannel night dress. a woolen wrapper. the confinement room by special preparation, the ordinary bedroom may be fashioned into a delivery-room. carpets, hangings and upholstered furniture must be removed. clean walls, clean floors, and a scrupulously clean bed must be maintained throughout the puerperium. bathroom, and if possible, a porch should be near by. in the wealthy home, a bedroom, bathroom and the nursery adjoining is ideal; but i find that real life is always filled with anything but the ideal. the dispensary doctor is compelled to depend upon clean newspapers to cover everything in the room he finds his patient in. the only sterile things he uses he brings with him, and should he have to spend the night, the floor is his only bed. a student who was in my service told me that there was not one article in the entire home, which consisted of but one room, that could be used for the baby. he wrapped his own coat about it and laid it carefully in a market basket and placed it on the floor at the side of the pallet on which the mother lay and by the aid of a nearby telephone secured clothes from the dispensary for the babe. always select the best room in the house for a home confinement. if the parlor is the one sunny room, take it; remove all draperies, carpet, etc., and make it as near surgically clean as possible. while sunshine is desirable, ample shades must be supplied, as the eyes of both mother and babe must be protected. the bed a three-quarter bed is more desirable than a double bed. if it is low, four-inch blocks should be placed under each leg, the casters having been removed to prevent slipping. the bed should be so placed that it can be reached from either side by the nurse and physician. the mattress may be reenforced by the placing of a board under it if there is a tendency to sag in the middle. over this mattress is securely pinned the strip of rubber sheeting or table oilcloth. a clean sheet covers mattress and rubber cloth and at the spot where the hips are to lie may be placed the large sterile pad to absorb the escaping fluids. the floor about the bed is protected by newspapers or oilcloth. good lighting should always be provided. much trouble and possible infection may be avoided by clean bedding, plenty of clean dressings, boiled water, rubber gloves, and clean hands. chapter viii the day of labor as the two hundred and seventy-three days come to a close, our expectant mother approaches the day of labor with joy and gladness. the long, long waiting days so full of varied experiences, so full of the consciousness that she, the waiting mother, is to bring into the world a being which may have so many possibilities--well, even the anticipated pangs of approaching labor are welcomed as marking the close of the long vigil. these days have brought many unpleasant symptoms, they have been days of tears and smiles, of clouds and sunshine. the time of waiting the prospective mother has thought many times, "will my baby ever come?" but nature is very faithful, prompt, and resourceful. she ushers in this harvest time under great stress and strain, for actual labor is before us--downright, hard labor--just about the hardest work that womankind ever experiences--and, as a rule, she needs but little help--good direction as to the proper method of work and the economical expenditure of energy. in the case of the average mother this is about all that is needed, and if these suggestions come from a wise and sympathetic physician--one who understands and appreciates asepsis--she may count herself as fortunately situated for the oncoming ordeal. in the days of our grandmothers it was almost the exception rather than the rule to escape "child-bed fever," "milk leg," etc.; but in these enlightened days of asepsis, rubber gloves, and the various antiseptics, puerperal infection is the exception, while a normal puerperium is the rule; and this work of prevention lies in the scrupulous care taken by anyone and everyone concerned in any way with the events of the day of labor. on this day of labor, the mother, who has gone through the long tedious days of waiting, should see to it that nothing unclean--hands, sponges, forcep, water, cloth--is allowed to touch her. above all things do not employ a physician who has earned the reputation of being a "dirty doctor." puerperal infection is almost wholly a preventable disease and every patient has a right to insist upon protection against it. in a former chapter will be found a detailed description of the "delivery bed." beside this bed, or near by, are to be found the rack on which are airing the necessary garments for the baby's reception--the receiving blanket and other requisites for the first bath--together with numerous other articles essential to safety and comfort. there should be an easy chair in the room for the mother to rest in between her walking excursions during the first stages of labor. the sterilized pads and necessary articles mentioned in an earlier chapter are, of course, close at hand. first symptoms of labor regular, cramp-like pains in the lower portion of the abdomen which are frequently mistaken for intestinal colic, often beginning in the lower part of the back, and extending to the front and down the thigh, are often the first symptoms of the approaching event. with each cramp or pain the abdomen gets very hard and as the pain passes away the abdomen again assumes its normal condition. these regular cramp-like pains are the result of the early dilation of the cervix--the first opening of the door to the uterine room which has housed our little citizen through the developmental stages of embryonic life--and as a result of this stretching and dilating there soon appears that special blood-tinged mucus flow commonly known as "the show." the preliminary bath at this time a very thorough-going colonic flushing should be administered. the patient takes the "knee-chest" position, or the "lying-down" position, and there should flow into the lower bowel three pints of soapy water; this should be retained for a few moments; and after its expulsion, a short, plain water injection should be given. now follows the preliminary general bath. just prior to the bath, the pubic hair should be clipped closely, or better shaved. then should follow a thorough soap wash, with patient standing up in the tub, using plenty of soap, applied with a shampoo brush or rough turkish mit. the rinsing now takes place by either a shower or pail pour. _do not sit down in the tub._ this is a rule that must not be broken, because of the danger of infection in those cases where the bag of waters may have broken early in the labor. a weak antiseptic solution, prepared by putting two small antiseptic tablets into one pint and a half of warm water, is now applied to the body from the breasts to the knee. put on a freshly laundered gown, clean stockings and wrapper. the head should be cleansed and hair braided in two braids. the progress of labor if all the mothers who read this volume could bear children with the comfort mrs. c. does, i should be happy, indeed. at four o'clock one morning a very much excited father telephoned me, "hurry, quick, doctor, it's almost here." it was well that we did hurry, for the first sign the little mother had was the deluge of the waters--at this point the husband ran to telephone for the doctor--no more pains for thirty-eight minutes (just as we entered the door) and the baby was there. but such is not usually the case, nor will it be, as labor usually progresses along the lines of conscious dilating pains, occurring at intervals twenty minutes apart at first, later drawing nearer together until they are three to five minutes apart. this "first stage of labor" lasts from one to fifteen hours--during which time the tiny door to the uterine room which was originally about one-eighth of an inch open--dilates sufficiently to allow the passage of the head, shoulders and body of the fully developed child. about this time the bag of waters usually bursts, and, as a rule, this marks the beginning of the "second stage of labor." the amount of water passed varies in amount. should the rupture take place before the door is fully open, then labor proceeds with difficulty and the condition is known as "dry labor." the head after proper rotation now begins the descent; and here the pains begin to change from the sharp, lancinating, cramp-like pains which begin in the back and move around to the front, to those of the "bearing down" variety, while at the same time there begins to appear the bulging at the perineum, which means that the head is about to be born. at this time great stress is brought to bear upon the perineum and often, in spite of anything that can be done to prevent it, the perineum is more or less lacerated. as soon as the baby is born the "second stage of labor" has passed and within thirty to fifty minutes the close of the third stage of labor is marked by the passage of the placenta or "afterbirth." false labor pains sometimes, as long as two weeks before the birth of the child, certain irregular, heavy, cramp-like pains occur in the abdomen and back. for a half-dozen pains they may show some signs of regularity; but they usually die down only to start up again at irregular intervals. these are known as "false pains." when the pains begin to take on regularity and gradually grow heavier and it is near the appointed time for the labor, the patient should prepare to start for the hospital; or, if it is to be a home delivery, the physician should be called. as noted above, the first subjective symptom may be the rupture of the bag of waters, and it is imperative to prepare at once for the labor. it is far better to spend the day at the hospital, or even two days waiting, rather than to run the risk of giving birth to the child in a taxicab or street car; or, in the event of a home labor, to have the child born before the doctor arrives. what to do in the absence of a doctor it is often the case that when we need our physician the most, he is busy with another patient and cannot come, or perhaps an automobile accident detains the man of the hour. the hospital delivery always possesses this advantage over the home--physicians are always on hand. we deem it wise to relate in detail the method of procedure during the rapid birth of a child; that the husband or nurse may give intelligent and clean service. after the patient has been given the enema and has been shaved and the bath has been administered as previously directed, the helper most vigorously "scrubs up." there are three distinct phases to the "scrubbing up": first, the three-minute scrubbing of the hands and forearms with a clean brush and green soap; to be followed by, second, the trimming and cleaning of the finger nails, for it is here, under the nails, that the micro-organism lives and thrives that causes child-bed fever or septicemia; and, third, the final five-minute scrubbing of the fingers, hands, and forearms. an ordinary towel is not used to dry the well-cleansed hands, but they are now dipped in alcohol and allowed to dry in the air. and now if the pains are returning every three to five minutes or if the bag of waters has broken, the patient should go to bed. she will lie down on her back with the knees drawn up and spread apart. the patient, having had the cleansing bath, is now washed with the disinfectant bath (2 antiseptic tablets to 1½ pints of water), from the breasts to the knees. another member of the family takes the outer wrappings off the sterilized delivery pad and the "clean" helper places the sterile delivery pad under the expectant mother, who is directed to "bear down" when her pains come. she may be supported during these pains by pulling on a sheet that has been fastened to the foot of the bed. the _clean_, helper then sits by her constantly until the baby is born but under no circumstances should touch her until after the head appears. immediately after the birth of the head, the shoulders usually follow with the next pain, which ought to occur within two or three minutes. occasionally the face turns blue, in such an instance, the mother is directed to strain vigorously and presses down heavily on the abdomen with both her hands, this usually hurries matters materially, and the body of the child follows quickly. the baby should cry at once. if the child does not show signs of life, quick, brisk slapping on the back usually brings relief. during the birth of the head it is imperative that, in the event of liquid passing at the same time, no water or blood be sucked into the mouth by the baby. great care must be exercised in this matter. should the baby remain blue, lay it quickly upon its right side near the mother, and after the pulse of the cord has stopped beating the clean helper ties the cord twice, two inches from the child and again two inches from this tying toward the mother, and then the cord is cut between the two tyings with scissors that have been boiled twenty minutes. should there be more difficulty with the breathing of the new born child, if slapping it on the back brings no relief, its back (with face well protected) may be dipped first in good warm water, then cold, again in the warm, again in the cold--this seldom fails. the child should then be kept very warm, lying on its right side. care of the mother all this time, a member of the family has been firmly grasping the mother's abdomen, and within an hour the afterbirth passes out through the birth canal. if the physician has not yet arrived, all dressings, the pad, the afterbirth, must all be saved for his inspection. the inside of the thighs and the region about the vagina is now washed with bichloride solution, the soiled delivery pad removed, a clean delivery pad is placed under her; an abdominal binder is applied and two sterile vulva pads are placed between the legs, and hot water bottles are put to her feet, as usually at this stage there is a slight tendency toward chilliness. she should now settle down for rest. fresh air should be admitted into the room. there may be some hemorrhage, and if it is excessive, grasp the lower abdomen and begin to knead it until you distinctly feel a change in the uterus from the soft mass to a hard ball about the size of a large grape fruit; thus contraction has been brought about which causes the hemorrhage to decrease. if the doctor has not yet arrived put the baby to the breast, and place an ice bag for ten or fifteen minutes on the abdomen just over the uterus. should there be lacerations, the doctor will attend to their repair when he comes. one teaspoonful of the fluid extract of ergot is usually given at this time, if possible get in touch with the physician before it is administered. care of the baby after the mother is comfortable, your attention is directed to the baby; the condition of the cord is noted; should it be bleeding, do not disturb the tying, but tie again, more tightly just below the former tying, and with the long ends of the tape, tie on a sterile gauze sponge or a piece of clean untouched medicated cotton, thus efficiently protecting the severed end of the cord. no further dressing is needed until the doctor arrives. grave disorders have arisen from infection through the freshly cut umbilical cord. should the doctor be longer delayed, one drop of twenty per cent argyrol should be dropped in each of the infant's eyes and separate pieces of cotton should be used for each eye to wipe the surplus medicine away. this application must not be long neglected, for a very large per cent of all the blindness in this world might have been avoided had this medicine been placed in each eye soon after birth. the warmed albolene is now swabbed over the entire body of the infant (this is done with a piece of cotton), the arm pits, the groins, behind the ears, between the thighs, the bend of the elbow, etc, must all receive the albolene swabbing. in a few minutes, this is gently rubbed off with a piece of gauze or an old soft towel, and the baby comes forth as clean and as smooth as a lily and as sweet as a rose. the garments are now placed on the child--first the band, then shirt, diaper, stockings, flannel skirt, and outing flannel gown--and it is put to rest after the administration of one teaspoonful of cooled, boiled water. in six to eight hours it will be put to the breast. chapter ix twilight sleep and painless labor in recent years much has appeared in both the popular magazines and the medical press concerning the so-called "twilight sleep" and other methods of producing "painless childbirth." many of these popular articles in the lay press cannot be regarded in any other light than as being in bad taste and wholly unfortunate in their method and manner of presenting the subject; nevertheless, these writings have served to arouse such a general public interest in the subject of obstetric anesthetics, that we deem it advisable to devote two chapters to the brief and concise consideration of the subjects of pain and anesthetics in relation to the day of labor. the pain of labor first, let us briefly consider the question of pain in connection with childbirth. many women--normal, natural, and healthy women--suffer but comparatively little in giving birth to an average-sized baby during an average and uncomplicated labor. like the indian squaw, they suffer a minimum of pain at childbirth--at least this is largely true after the birth of the first baby; and so there is little need of discussing any sort of anesthesia for this group of fortunate women; for at most, all that would ever be employed in the nature of an anesthetic in such cases, would be a trifle of chloroform to take the edge off the suffering at the height or conclusion of labor. but the vast majority of american mothers do not belong to this fortunate and normal class of women who suffer so little during childbirth; they rather belong to that large and growing class of women who have dressed wrong; who have lived unhealthful and sometimes indolent lives; who are more or less physically and temperamentally unfitted to pass through the experiences of pregnancy and the trials of labor. the average american woman shrinks from the thought and prospect of suffering pain; she is quite intolerant with the idea of undergoing even the few brief moments of physical suffering attendant upon childbirth. she refuses to contemplate the day of labor in any other light than that which insures her against all possible pain and other physical suffering. and it is just this unnatural and abnormal fear of labor-pains--this unwomanly dread of the slightest degree of physical suffering--that has indirectly led up to so much discussion regarding the employment of "twilight sleep" and other forms of obstetric anesthesia. while the authors recognize the great blessing of anesthesia to the woman in labor--and almost unfailingly make use of it in some form--nevertheless, we also recognize that it would be a fine form of mental discipline and mighty good moral gymnastics, if a great many self-centered and pampered women would "spunk right up" and face the ordeal of labor with natural courage and normal fortitude. it would be "the making of them," it would make new women out of them, it would start them out on the road to real living. at the same time we do not mean to advocate that women should suffer unnecessary pain in childbirth any more than we allow them to suffer in connection with surgery. preparation for labor while so much is being written about "twilight sleep" and "painless labor," it might be well to remind the american mother that much can be done to lessen the sufferings of the day of labor by one's method of living prior to the confinement. we believe that child-bearing is a perfectly normal physical function for a healthy and normal woman--that it is even essential to her complete physical health, mental happiness, and moral well-being. theoretically, child-bearing ought to be but little more painful than the functionating of numerous other vital organs--stomach, heart, bladder, bowels, etc.--and, indeed, it is not in the case of certain savage tribes and other aboriginal people, such as our own north american indian. but we must face the facts. the average american woman does suffer at childbirth; and she suffers more than we are disposed to allow her, or more than she, as a general rule, is willing to suffer. so, while we discuss appropriate methods of lessening the pain of labor and the pangs of childbirth by the scientific use of anesthetics, let us also call attention to certain things which may aid in decreasing the amount of pain which may reasonably be expected to attend child bearing. to assist in bringing about this preparation for decreased pain at childbirth, mothers should teach their daughters how to develop, strengthen, and preserve their physical, mental, and moral resistance. the young mother should be taught by both her mother and her physician how to dress, how to work, and how to eat. every care should be given to the hygiene of pregnancy and labor. the expectant mother should have plenty of fruits and fruit juices, and if not physically well endowed to give birth to a large babe, she should have her diet restricted in meat, bread and milk, as well as the cereals. overeating during pregnancy should be carefully guarded against, as emphasized in an earlier chapter. deformities of the pelvis, etc., should rule out a consideration of pregnancy. while artificial painless childbirth by means of "twilight sleep" and other similar methods all have their place; nevertheless, these procedures should not lead to the neglect of those natural methods and preventive practices which aid in preparing the normal expectant mother for nature's relatively painless labor. when so much anesthesia has to be used in a normal labor, it cannot but strongly suggest that both patient and physician have neglected those common but efficient methods which contribute indirectly to lessening the pangs of child bearing. what is twilight sleep? "twilight sleep" is a recent term which has become associated in the public mind with "painless labor." the reader should understand that "twilight sleep" is not a new method of obstetric anesthesia. while this method of inducing "painless labor" has been brought prominently before the public mind in recent years by much discussion and by numerous magazine articles--being often presented in such a way as sometimes to lead the uninstructed layman to infer that a new method of obstetric anesthesia had just been discovered--it has, nevertheless, been known and more or less used since 1903. later known as the "freiburg method," and as the "dammerschlaf" of gauss, and still later popularized as "twilight sleep," this "scopolamin-morphin" method of obstetric anesthesia, has gained wide attention and acquired many zealous advocates. "twilight sleep" is, therefore, nothing new--it is simply a revival of the old combination of _scopolamin_ and _morphin_ anesthesia. while many different methods of administering "twilight sleep" have been devised, the following general plan will serve to inform the reader sufficiently regarding the technic of this much-talked-of procedure. the scopolamin must always be fresh, although different forms of the drug are used. it tends quickly to decompose--forming a toxic by-product--and, according to some authorities, this decomposed scopolamin is responsible for many undesirable results which have attended some cases of "twilight sleep." various forms of morphin are also used, as also is narcophin. technic of "twilight sleep" the "twilight-sleep" injections are not started until the patient is in the stage of active labor. the initial injection consists of the proper dose of scopolamin and morphin (or some of their derivatives), while the patient's pupils, pulse, and respiration are carefully noted, as also are the character of the uterine contractions and the character of the fetal heart action. usually within an hour, a second dose of scopolamin is given, while the application of so-called "memory tests" serves to indicate whether it is advisable to administer additional injections. some leading advocates of this method claim that the majority of the unfavorable results attendant upon "twilight sleep" are the direct result of failure to control the dosage of the drug by these "memory tests;" and they call attention to the large percentage of "painlessness" as proof of probable overdosing. if the patient's memory is clear and she is not yet under the influence of the drug, a third dose is soon given. if, however, the patient is in a state of amnesia (lack of memory), this third injection is not commonly given until about one hour after the second injection. the amount of amnesia present is used as a guide for repeated injections at intervals of one to one and a half hours. as a rule, the morphin is not repeated. it must be evident that the success of such a method of anesthesia must depend entirely upon thoroughgoing personal supervision of the individual patient by a properly trained and experienced physician; and it is for just these reasons that "twilight sleep" is destined to remain largely a hospital procedure for a long time to come. experience has shown that those cases of "twilight sleep" that are not under the influence of scopolamin over five or six hours do vastly better than those under a longer time. when employed too long before labor this method seems to favor inertia and thus tends to increase the number of forceps deliveries. the number of injections may run from one to a dozen or more, and patients have come through without accident with fifteen or more doses, running over a period of twenty-four hours. the claims of "twilight sleep" while "twilight sleep" as a method of anesthesia is not altogether new, many of the claims made for it by recent advocates are more or less new; and, to enable the reader clearly to comprehend both the advantages and disadvantages of this method, both the favorable and unfavorable facts and contentions will be summarized in this connection. the favorable claims made for "twilight sleep" are: 1. that eighty to ninety per cent of all women who use this method can be carried through a practically painless labor. 2. that there is practically no danger to the mother (some degree of danger to the child is admitted by most of its champions) other than those commonly attendant on the older and better known methods in general use. 3. that "twilight sleep," being almost exclusively a hospital procedure, would result in more women going to the hospital for their confinement--if it were used more; and would, therefore, tend to bring about more careful supervision and individual care on the part of the attending obstetrician. 4. that by lessening the dread of labor and the fear of painful childbirth, there will probably occur an increase in the birth rate of the so-called "higher classes of society"--the social circles which now show the lowest birth rates. 5. that it is of special value in the cases of certain neurotic women and those of low vital resistance; especially those patients suffering from certain forms of heart, respiratory, kidney, and other organic diseases. 6. some authorities maintain that "twilight sleep" is of value even in threatened eclampsia, although they admit it tends to produce a rise in blood-pressure. 7. it is supposed to shorten the first stage of labor--by facilitating the dilation of the cervix--owing to the painless stretching; although the majority of its special advocates admit that it lengthens the second stage of labor, during which the patient must be very closely watched. 8. that even in those cases where the sense of pain is not entirely destroyed, the patient seems to possess little or no subsequent memory of any physical suffering or other disagreeable sensations. 9. that the method is of special value in sensitive, high-strung, nervous women of the "higher classes," who so habitually shun the rigors of child bearing--especially in the instance of their first child. 10. that the action of scopolamin is chiefly upon the central nervous system--the cerebrum--that it diminishes the perception of pain without apparently decreasing the contractile power of the uterus; labor may, therefore, proceed with little or no interruption, while the patient is quite oblivious to the accompanying pains. 11. that the physical and nervous exhaustion is quite entirely eliminated--especially in the case of the first labor--that patients who have had this method of anesthesia appear refreshed and quite themselves even the first day after labor. 12. that there is decidedly less "trauma" (appreciable injury) to the nervous system and therefore less "shock;" and that all this saving of nervous strain tends greatly to hasten convalescence. 13. and, finally, that "twilight sleep" does not interfere with the carrying out of any other therapeutic measures which may be deemed necessary for a successful termination of the labor. dangers of twilight sleep while we are recounting the real and supposed advantages of "twilight sleep"--especially in certain selected cases--it will be wise to pause long enough to give the same careful consideration to the known and reputed dangers and drawbacks which are thought to attend this method of anesthesia in connection with labor cases. we desire to state that these expressions, both for and against "twilight sleep," are not merely representative of our own experience and attitude; but that they also represent, as far as we are able to judge at the time of this writing, the consensus of opinion on the part of the most reliable and experienced observers and practitioners who have used and studied this method in both this country and europe. the dangers and difficulties of "twilight sleep" may be summarized as follows: 1. that this method tends to weaken the mental resistance of many women; to lessen their natural courage and to decrease that commendable fortitude which is such a valuable feature of the character endowment of the normal woman. 2. that "twilight sleep" is essentially a hospital method and is, therefore, inaccessible to the vast majority of women belonging to the middle and lower classes of society, as well as to those women who live in rural communities. 3. that in fifteen or twenty per cent, the method fails to produce the desired results--at least, when administered in amounts which are deemed safe. 4. that this method does decrease the baby's chances of living; that the second stage of labor is definitely prolonged; that from ten to fifteen per cent of the babies are sufficiently under the influence of the anesthesia when born as to be unable to breathe or cry without artificial stimulus. 5. that it is a method requiring special training and experience; that it will be many years before the average practitioner will become proficient in its use; and that the older methods are probably far safer for the average physician. 6. that the method requires more care in its administration than can be expected outside of the hospital in order to avoid the dangers of fetal asphyxiation--which danger has led not a few obstetricians to abandon it. 7. that a satisfactory technic is almost impossible of development; that every patient must be individualized; that the chief dangers are connected with the over dosage of morphin; that the method is not adaptable to the general practice of the average doctor. 8. that by prolonging the second stage of labor and by sometimes giving too much morphin, the number of forceps deliveries is greatly increased, with their attendant and increased dangers to both mother and child. 9. that the prospects of passing through labor which may be rendered painless by artificial methods, tends to produce an attitude of carelessness and indifference towards those natural methods of living and other hygienic practices which so greatly contribute to naturally painless confinements. 10. that this method as sometimes practiced greatly increases the dangers of a general anesthetic, if such should be found necessary later on during the labor. 11. that "twilight sleep" is contra-indicated (should not be used) in the following conditions: primary inertia (abnormally delayed and slow labor); expected short labor--especially in women who have already borne children; when the fetal head is known to be large and the mother's pelvis small; placenta praevia (abnormal placental attachment); accidental hemorrhage; absent or doubtful fetal heart beat; when labor is already far advanced; and in threatened convulsions and eclampsia. conclusions regarding twilight sleep having presented the evidence both for and against "twilight sleep," it may be of assistance to the lay reader to have placed before her the personal conclusions and working opinions of the authors. we, therefore, undertake to summarize our present attitude and outline our practice as follows: 1. "twilight sleep" as a method of obstetric anesthesia in certain selected cases and in well-equipped hospitals, and in the hands of careful and experienced practitioners, has demonstrated that it is a scientific reality--and has probably come to stay--at least until better and safer methods of affecting a relatively painless confinement are discovered; although we are compelled to state that it is not the panacea the lay press has led many of our patients to believe. (that we believe a much better and safer method has been devised, the next chapter will fully disclose.) 2. we do not expect this method ever to become general in its use; we do not look for a chain of special "twilight hospitals" to stretch across the continent and then to overrun the country. we expect much of the recent forced enthusiasm to die down, while scopolamin-morphin anesthesia takes it proper place among other scientific methods of alleviating the pangs of labor. 3. we know that standard and fresh solutions--as already noted--are absolutely essential for the success of this method. 4. we are certain that no routine method or technic can be developed. each patient must be individualized. the method does not consist in injecting scopolamin every so often. the patient's mental and physical condition--as also that of the unborn child--must control the administration of "twilight sleep." 5. the patient must be in a quiet and partially darkened room. she must not be disturbed; while the physician, or a competent trained nurse, must be in constant attendance. 6. while this method of treatment is best carried out in the well-appointed hospital, there is no real reason why it cannot be fairly well carried out in a well-regulated private home, provided the necessary preparations have been made, a trained nurse is present, and provided, further, that the physician is willing to remain in the home with the patient the length of time required properly to supervise the treatment. 7. even when the treatment is not instituted early in labor, it can, in certain selected and appropriate cases, be utilized even in the second stage of labor--thus saving these special cases much unnecessary pain; in fact, some authorities regard it as a valuable adjunct in the management of "borderland contractions" as it allows the patient a full test of labor. 8. in our opinion, this method has little effect on the first stage of labor if properly administered; but it does undoubtedly prolong and tend to complicate the second stage; in fact, we are coming to look upon "twilight sleep" as being more distinctly a first stage procedure; that it bears the same relation to the first stage of labor that chloroform bears to the second stage--relieving the pain but not stopping the progress of labor. 9. that when safe amounts of the drug are used the pain is greatly lessened in all cases--the subsequent memory of pain is absent in the majority of the patients--but the labor is not always entirely painless as is popularly supposed. 10. we do not believe that this method when properly administered increases the number of forceps deliveries--at least not in the case of high forceps operations. it undoubtedly does cover up the symptoms of a threatened rupture of the uterus, and thus increases danger from that source; nevertheless it may be safely stated that this method does not in any way greatly interfere with any other measures which might be found necessary to institute in order to bring about a successful termination of the labor. 11. the baby's heart beat must be carefully and constantly watched; sudden slowing means that the treatment must be discontinued and the child delivered as soon as possible; even then, difficulty may be experienced in getting the baby's breathing started after it is born. in the vast majority of cases where the baby does not cry or breathe at birth, the usual methods employed in such cases serve quickly to establish normal respiration, and the baby seems to be but little the worse for the experience. 12. while altogether too much has been claimed for "twilight sleep" at the same time many false fears have also been suggested, among which may be mentioned the fear of the mother losing her mind after the treatment; the undue fear of asphyxiation on the part of the baby; the fear of post-partum hemorrhage; and the fear that it will lessen the milk supply. we cannot deny that the child's dangers are often increased; but in other respects, this method (in properly selected cases) presents little more to worry us than the older methods of anesthesia. 13. we are inclined to the belief that this method has but little influence on the course of convalescence following labor. certain nervous and highly excitable women certainly seem to do better, as a result of experiencing less pain and nervous shock; while other cases do not turn out so well. it certainly does not retard repair and recovery during the puerperium. 14. this method seems to have its greatest field of usefulness in those cases of highly intelligent but excessively neurotic women who have an abnormal dread of pain and child bearing; or women who have suffered unusually at the time of a previous confinement--perhaps in the case of the first baby--or from other complications; women such as these, and other special cases, are the ones to benefit most from the employment of "twilight sleep." 15. this method as has already been intimated, is most useful in the case of the first baby, or in the case of women who have established a record of tedious and painful labors. it has no place in normal and short labors; although it may be used to great advantage in certain cases during the first stage of labor--being carefully and lightly administered--while chloroform or gas is utilized at the end of the second stage just as has been our custom for a generation. 16. as noted under the special claims made for this method, it is (as also is nitrous oxid) the ideal procedure in cases of heart, respiratory, kidney, and other organic difficulties, the details of which have already been noted, and their repetition here is not necessary. 17. it must be remembered that scopolamin and morphin are more or less uncertain in their action; scopolamin is variable in its results, often producing such marked nervous excitement in the patient as greatly to interfere with the carrying out of an aseptic technic; while morphin has been shunned by obstetricians for a whole generation, because of its well-known bad effects on the unborn child as well as its interference with muscular activity on the part of the mother. in germany, it is said, that a great many damage suits against prominent physicians have resulted because of the alleged ill effects which have followed the use of "twilight sleep." 18. in presenting these facts and opinions regarding "twilight sleep," the reader should bear in mind that we are not only endeavoring to state our own views and experience, but also to give the reader just as clear and fair an idea of what other and experienced physicians think of the method, both favorably and unfavorably; and we will draw these conclusions to a close by citing the opinion of one or two who have had considerable experience with the method and who, in summing up their observations, say: the disadvantages of the method are entirely with the accoucheur and not to the mother or child. _it requires his presence at the bedside from the time the treatment is undertaken until the completion of labor_, not so much because of any danger, but to keep the patient evenly under anesthesia on a line midway between consciousness and unconsciousness, for if she is allowed to go above that line in several instances she will have several so-called "isles of memory," and will be able to draw a picture of her labor in her mind and thus lose the benefit of the treatment. these methods of anesthesia are very important and have merit. they should be used when properly indicated. no one should limit himself to a routine method. each case should be individualized and the form of anesthesia best suited to the case in hand should be employed. for instance, in dealing with a primipara--one who is full of fear, who cannot stand pain, who is of an hysterical nature--morphin-scopolamin anesthesia is best suited in that particular case, because these drugs have a selective action when it comes to allay fear and produce amnesia. on the other hand, in a multipara who has had three or four children, whose soft parts are relaxed and who has short labors, the anesthetic of choice would be a few whiffs of chloroform as the head passes over the perineum. it is ridiculous to try to give such women the "twilight sleep." furthermore, take the cases you see for the first time at the end of the first stage of labor, or during the second stage; these cases are best treated with the nitrous oxid and oxygen method. you have to individualize your cases. the prospective mother now consults the obstetrician early to find out if her particular case is suitable for the "twilight sleep." she has been informed that certain examinations--urine, blood pressure, etc.--are necessary. she knows that these examinations have to be made at regular intervals. in other words, we get the patients early and we can give them good prenatal care. this chapter has been devoted to "twilight sleep;" the following chapter will consider "nitrous oxid" and other methods of anesthesia in connection with labor, and should be read along with the foregoing discussion in order to obtain an intelligent view of the whole subject of "painless labor." chapter x sunrise slumber and nitrous oxid since the public has already been told so much about obstetric anesthesia, we deem it best to go into the whole subject thoroughly, so that the expectant mothers who read this book will be able to form an intelligent opinion regarding the question, and thus be in a position to give hearty cooperation to the decision of their physician to employ, or not to employ, any special form of anesthesia or analgesia in their particular case. in order to give the reader a complete understanding of "painless labor," it will be necessary to give attention to that newer and more safe method of obstetric anesthesia called "sunrise slumber." this method of anesthesia consists in the employment of nitrous oxid or "laughing gas," and will be fully considered in this chapter. obstetric fear in this connection we desire to reiterate and further emphasize some statements made in the preceding chapter concerning the unnatural fear and abnormal dread of childbirth. we feel that it is very important in connection with this new movement in obstetrics to reduce the woman's pain and suffering to the lowest possible minimum, that the trials of labor should not be overdrawn and the pangs of confinement overestimated. we must not educate the normal woman to look upon labor as a terrible ordeal--something like a major surgical operation--which, since it cannot be escaped, must be endured with the aid of a deep anesthesia. the facts are that a very small per cent of healthy women suffer any considerable degree of severe pain--at least not after the first child. we often observe that judicious mental suggestion on the part of the physician or nurse in the form of encouraging words and supporting assurances tends to exert a marked influence in controlling nervousness and subduing the sufferings of the earlier labor pains. we must not allow the efforts of medical science to lessen the sufferings of child-bearing, to rob womankind of their natural and commendable courage, endurance, and self-reliance. we do not mean to perpetuate the old superstition that pain and suffering are the necessary and inevitable accompaniments of child-bearing--that the pangs of labor are a divine sentence pronounced upon womankind--and that, therefore, nothing should be done to lessen the sufferings of confinement. severe and unnatural pain is not at all necessary to childbirth, and there exists no reason under the sun why women should suffer and endure it, any more than they should suffer the horrors of a very painful surgical operation without an anesthetic. in this connection, it should be recalled that analgesic drugs have been introduced into obstetric practice only during the last fifty years, while such methods of relieving pain have been used in general surgery for a much longer period. it is now only sixty-nine years since simpson first employed anesthetic in obstetrics, while six years afterwards queen victoria gave her seal of approval to the use of chloroform in labor cases. thirty years ago, in speaking of the expectant mothers, lusk warned us: as the nervous organization loses in the power of resistance as the result of higher civilization and of artificial refinement, it becomes imperatively necessary for the physician to guard her from the dangers of excessive and too prolonged suffering. nitrous oxid--"laughing gas" nitrous oxid, or "laughing gas," was first used in labor cases in 1880 by a russian physician. during the last twenty-five years it has been used off and on by numerous practitioners in connection with confinement, but not until the last few years has this method of relieving labor pain come into prominent notice. while the "laughing gas" method of obstetric anesthesia did not gain notoriety and publicity from being exploited in magazines and other lay publications, it did get its initial boost in a very unique and unusual manner. a gentleman who manufactured and sold a "laughing gas" and oxygen mixing machine for the use of dentists, insisted that this method of anesthesia should be used in the case of his daughter, who was about to be confined. this patient was kept under this nitrous oxid anesthetic for six hours--came out fine--no accidents or other undesirable complications affecting either mother or child, and thus another and safe method of reducing the sufferings of childbirth has been fully demonstrated and confirmed, although it had previously been known and used in labor cases to some extent. starting from this particular case in 1913, many obstetricians began experimental work with "gas" in labor cases; and, at the time of this writing, it has come to occupy a permanent place in the management of labor, alongside of chloroform, ether, and "twilight sleep." analgesia vs. anesthesia the reader should understand the difference between analgesia and anesthesia. anesthesia refers to the condition in which the patient is more or less unconscious--wholly or partially oblivious to what is going on, and, of course, entirely insensible to all pain. analgesia is a term applied to the loss of pain sensation. the patient may not be wholly or even partially unconscious--merely under the influence of some agent which dulls, deadens, or otherwise destroys the realization of pain. this is the condition aimed at by the proper administration of any form of "twilight sleep," whether by the scopolamin-morphin method, or by the nitrous oxid ("sunrise slumber") method. any method of treatment which can more or less destroy the pain of labor without in any way interfering with its progress, and which in no way complicates its course or leaves behind any bad effects on either mother or child, must certainly be hailed with joy by both the patient and the physician. while chloroform has served these purposes fairly well, there have been numerous drawbacks and certain dangers; and it was the knowledge of these limitations in the use of both chloroform and ether, that has led to further experimentation and the development of these newer methods of producing satisfactory analgesia--freedom from pain--without bringing about such a state of profound anesthesia as accompanies the administration of the older methods. it should be borne in mind that in using "sunrise slumber" (nitrous oxid) for labor pains, the gas is so administered that the patient is just kept on the "borderline"--in a typical "twilight" state--and not in the condition of deep anesthesia which is developed when nitrous oxid is employed by physicians and dentists as an anesthetic for major and minor surgical operations. analgesia is the first stage of anesthesia--the "twilight zone" of approaching unconsciousness--in which the sense of pain is greatly dulled or entirely lost, while even that which is experienced is not remembered. it seems to the authors that "gas" is the ideal drug for producing this condition whenever it is necessary, as nitrous oxid is the most volatile of anaesthetics, acts most quickly, and its effects pass away most rapidly, while its administration is under the most perfect control--it may be administered with any desired proportion of oxygen--and may be discontinued on a moment's notice. it is practically free from danger even when continued as an analgesic for several hours. nitrous oxid never causes any serious disturbance in the unborn child, as chloroform sometimes does when used too liberally. effects of nitrous oxid it will not be necessary to compare the favorable and unfavorable claims for nitrous oxid as we did the contentions for and against "twilight sleep." whatever service "laughing gas" or "sunrise slumber" can render the cause of obstetrics we can accept, knowing full well that, in competent hands, it can do little or no harm; and this we know from the facts herewith recited and from the further fact that we have gained a wide experience with this agent in the practice of both dentistry and surgery. in a general way, the influence of "sunrise slumber" on mother and child may be summarized as follows: 1. it can accomplish its purpose--can quite satisfactorily relieve the mother of severe pain--when employed as an analgesic. it is not necessary to administer the gas to the point of anesthesia except at the height of suffering at the end of the second stage of labor, when the head of the child is passing through the birth canal. 2. this method can be stopped at any moment--the patient ran be brought out from under its influence entirely and almost instantaneously. it is not like a hypodermic injection of a drug which may exert a varying and unknown influence upon the patient, and which, when once given, cannot be recalled. 3. it is a method which may be used in the patient's home just as safely as in a hospital; the only drawback being the inconvenience of transporting the gas-containing cylinders back and forth. this is even now partially overcome by the improved combination gas and oxygen form of apparatus which has been devised. 4. the administration of nitrous oxid analgesia or anesthesia does not interfere with or lessen the uterine contractions or expulsive efforts on the part of the mother--at least not to any appreciable extent. 5. just as soon as a severe uterine contraction--attended by its severe pain--begins to subside, the gas inhaler is immediately removed, and in a few seconds the patient is again conscious. it is not necessary to keep the patient continuously under the influence of the drug, as in the case of the scopolamin-morphin method of "twilight sleep." 6. this method ("sunrise slumber") is certainly far more safe in ordinary and unskilled hands than the "twilight sleep" procedure. the patient is more safe with this method in the hands of the average doctor or trained nurse. 7. it has been our experience that nitrous oxid in the smaller, interrupted and analgesic doses, actually tends to stimulate the uterine pains and contractions, while at the same time rendering the patient quite oblivious to their presence. when properly administered, the freedom from pain is perfect. 8. under the influence of "gas," patients often appear to "bear down" with increased energy. it certainly does not lessen their cooperation in this respect. 9. we have not observed, nor have we learned of, any cases of inertia (weak and delayed contractions), post partum hemorrhage, or shock, as a result of "laughing gas" or "sunrise slumber" analgesia. 10. this method lends itself to perfect control--it may be decreased, increased, or discontinued, at will; it may be given light now and heavy at another time; while, at the height of labor, it may be pushed to the point of complete anesthesia, if desired. 11. we have found "sunrise slumber" (nitrous oxid) analgesia to be the ideal obstetric anaesthetic, and have adopted it quite to the exclusion of both chloroform and "twilight sleep." we find that this form of analgesia has all the advantages of "twilight sleep" without any of its dangers or disadvantages. 12. a possible objection to the nitrous-oxid method is the cost, especially in the private home. the average cost in the hospitals where we are using this method runs about $2.00 for the first hour and $1.50 for each hour thereafter. this is the cost when using large tanks of gas, and is, of course, somewhat increased when the smaller tanks are used in the patient's home. method of administration since it was thought best to give the reader some idea of the technic for the administration of "twilight sleep," it may not be amiss to explain how "sunrise slumber" is usually employed in labor cases. the technic is very simple. the administration of the gas is generally begun about the time the patient begins seriously to complain of the severity of the second stage pains; although, of course, the gas can be given during the first stage pains if desired. in the vast majority of cases, however, we think it is best to encourage the patient to endure these earlier and lighter pains without resorting to analgesic procedures. the form of apparatus used is the same as that employed by dentists and contains both nitrous oxid and oxygen cylinders. a small nasal inhaler is best, although the ordinary mouthpiece will do very well. the gasbag attached to the tank should be kept under low pressure and, as a pain begins, the patient is told to breathe quietly, keeping the mouth closed. as a rule this sort of light inhalation serves to produce the desired analgesic effect. it is not necessary to put the patient deeply under in order to relieve the pain. it is our custom to begin "sunrise slumber" as soon as the uterine contractions become painful. the earlier the gas is started, the more oxygen should be used. two or three inhalations will suffice to take the "edge" off the earlier and lighter pains. when the pains grow heavier we use less oxygen and permit three or four deep inhalations just before a bearing-down pain. at the first suggestion of a contraction, the patient must begin to inhale the gas; while after the patient has pulled hard on the traction strops--just as the contraction pain is passing--she is given an inhalation containing a larger percentage of oxygen. at the beginning of a pain, pure nitrous oxid is administered, and the patient is instructed to breathe deeply and rapidly through the nose. the gasbags should be about half filled. the mixture of gas and oxygen must be determined by the severity of the pains and individual behavior of the patient. four to six inhalations of the gas are sufficient to produce the required analgesia in the average case. following the first few deep inspirations through the nose, the patient can be instructed to breathe through the mouth, while the gas is well diluted with oxygen and continued until the end of the pain. in this way a satisfactory analgesia is maintained throughout the "pain" with a minimum of "gas." the proportion of oxygen used will run from nothing up to ten per cent. this procedure is repeated with the occurrence of each pain. the use of the "mask" is just as effective as a nasal inhaler, but wastes more gas and so is more costly. when the head is passing the perineum the gas should be pushed to the point of anesthesia, while the patient's color will suggest the amount of oxygen to be used as well as serve to control the administration of the nitrous oxid. chloroform and ether for many years chloroform and ether have been used to alleviate the pains of women in labor. valuable as these agents are when deep anesthesia is required for the carrying out of operative procedures, they have not proved satisfactory as analgesic agents. if administered in small quantities at the commencement of a strong uterine contraction, the patient does not usually inhale sufficient to abolish pain. she is then apt to be irritated and is certain to insist on being given a larger quantity. if a sufficient amount be administered to satisfy the woman, the continued repetition gradually inhibits the power both of the uterus and of the accessory muscles, so that labor is unnecessarily prolonged, and, possibly, the life of the fetus endangered. physicians have, therefore, been accustomed to employ these drugs very sparingly, restricting their use to the very end of the second stage, during the painful passage of the head through the vulva. the results of the administration at this time are also uncertain. if delivery be rapid the woman may not be able to inhale sufficient to abolish her consciousness of pain. if it be slow she may take too much and weaken the muscular powers, thereby prolonging labor and, often, necessitating forceps delivery. it is not surprising, therefore, that the medical profession has long been hoping that a more satisfactory method of relieving the pain of labor would be found. conclusions in summing up our conclusions regarding analgesia and anesthesia in labor cases, the authors would state their present position as follows: 1. that anesthetics or analgesics are a necessary accompaniment of confinement in this day and age; that the average labor case demands some sort of pain-relieving agent at some time during its progress; but that intelligent efforts should be put forth to limit and otherwise control their use. while we recognize the necessity for avoiding needless suffering, at the same time we must also avoid turning our women into spineless weaklings and timid babies. 2. that we should seek to develop, strengthen, and train our girls for a normal and natural maternity; that we should study to attain something of the naturalness and the painlessness of the labors of indian tribes; and, even if we partially fail in this effort, we shall at least leave our women with ennobled characters and strengthened wills. 3. that the scopolamin-morphin method of inducing "twilight sleep" has its place--in the hands of experts--and in the hospital; and that in many cases it probably represents the best method of obstetric anesthesia which can be employed. 4. that as a general rule and in general practice, the safest and best method of inducing the "twilight" state of freedom from severe pain, is by the use of nitrous oxid or "laughing gas"--the "sunrise slumber" method. it has been our practice to start all general ether anesthetics with "gas" for a number of years, while we have been doing an increasing number of both minor and major operations with "gas" alone. 5. that we still employ general ether or chloroform anesthesia in cesarean sections and other major obstetric operations, although several operators are beginning to use "gas" in even these heavy cases. 6. that the intelligent and careful use of pituitary extract in certain cases of labor serves greatly to shorten the second stage; that it is of great value in certain "slow cases," and serves greatly to reduce the use of low forceps. we have treated the subject of obstetric anesthesia in this full manner, because of the fact that so much has appeared in the public press on these subjects, and, further, because we desired that our readers should have placed before them the facts on all sides of the question just as fully as a work of this scope would permit. chapter xi the convalescing mother popularly spoken of as the "lying-in period," and medically known as the puerperium, this time of convalescence immediately following childbirth is usually occupied by two important things: the restoration of the pelvic organs to their normal condition before pregnancy, and the starting of that wonderfully adaptative mechanism concerned with the production of the varying and daily changing food supply of the offspring. the uterus, now more than fifteen times its normal size and weight, begins gradually to contract and assume its normal weight of about two ounces; and it requires anywhere from four to eight weeks to accomplish this involution. in view of all this it is obvious that there can be no fixed time to "get up." it may be at the end of two weeks, or it may not be until the close of four or five weeks, in the case of the mother who cannot nurse her child; for the nursing of the breast greatly facilitates the shrinking of the uterus. extensive lacerations may hinder the involution as well as other accidents of childbirth, so it must be left with the physician to decide in each individual case when the mother may enter into the activities of life and assume the responsibilities of the care of the baby and the management of her home. the nurse during this period of the puerperium a member of the family, a neighbor, a visiting nurse, a practical nurse, or a trained nurse, looks after the mother and gives to the babe its first care; whoever it may be, certain laws of cleanliness must be carried out if infection is to be guarded against. if there are daily or semi-daily calls made by the physician, a member of the family may be trained to care for the mother with proper cleanliness and asepsis; but it is far better for the mother, if possible, to secure the services of a trained nurse, or the visiting nurse, in which instance she will call each day, wash and dress the baby, clean up the mother and care for the breasts. she is not supposed to clean the room, make the bed or prepare the food. if a trained nurse can be in charge, the convalescing time is usually shortened as the responsibilities are taken from the mother, her mind freed from care and it is her's to improve, rest, and wait for the restoration of the pelvic organs, when she may again go forth among her family. the nurse may have to sleep in the same room; but, if it be possible, she should occupy an adjoining room, she should have a regular time each day for an hour's walk in the fresh air, she should be served regular meals, and be allowed some time out of the twenty-four hours for unbroken slumber. in return she will intelligently cooperate with the physician in bringing about the restoration of body and upbuilding of the mother's nerves. rest and exercise from a monetary standpoint there can be nothing so wasteful or extravagantly expensive in the home as to allow the mother to drag about from day to day and week to week with chronic weakness or invalidism because she did not have proper care during her already too short puerperium, or because she got up too soon. having a baby is a perfectly normal, physiological procedure. it is also, usually, downright hard work; and, beside the hard laborious work, there is not only a wearied and severely shocked nervous system to be restored, but there is also a certain amount of uterine shrinkage which must take place--and this requires from four to eight weeks; and so our mother must be allowed weeks or even a month or two to rest, to enjoy a certain amount of well-directed exercise, to have an abundance of fresh air, to be wheeled or lifted out of doors if possible into the sunshine, that she may be the better prepared for the additional duties and responsibilities the little new comer entails. sunshine and fresh air are wonderful health restorers as is also a well-directed cold water friction bath administered near the close of the second week of a normal puerperium. during the second week a few carefully selected exercises such as the following are not only beneficial, but tend to increase circulation and thus to promote the secretion of milk and the shrinking of the uterus. 1. head raising, body straight and stiffened. 2. arm raising, well extended. 3. leg stretching, with knees stretched and toe extended. 4. massage, administered by the nurse. a splendid tonic circulatory bath may be administered at the close of the second week (in normal puerperium), known as the "cold mitten friction," which is administered as follows: the patient is wrapped in a warm blanket, hot water bottle at feet, and each part of the body--first one arm then the other; the chest, the legs, one at a time--is briskly rubbed with a coarse mit dipped in ice water. as one part is dried it is warmly covered, while the next part is taken, and so on until the entire body has been treated. the body is now all aglow, the blood tingling through the veins, and the patient refreshed by this wide-a-wake bath. properly given, the cold-mitten friction bath is one of the most enjoyable treatments known and under ordinary conditions, if intelligently administered, may be given as early as the eighth day. after pains after the birth of the first baby the uterus usually is in a state of constant contraction, hence there are no "after pains;" but after the birth of the second or third child, the uterine muscle has lost some of the tone of earlier days--there is a tendency toward relaxation--so that when the uterine muscle does make renewed efforts at contraction, these "after pains" are produced. they usually disappear by the third day. nothing should be done for them, indeed they should be welcomed, for their presence means good involution (contraction) of the uterus. the temperature careful notations of the temperature should be made during the first week. a temperature chart should be accurately kept and if the temperature should rise above 100° the physician should be notified at once. the third day temperature is watched with expectancy, for if an accidental infection occurred at the time of labor, it is usually announced by a chill and sudden rise of temperature on the third day. this may be as good a place as any to mention the commonly met night sweating. this is due to a marked accentuation of the function of the skin. it is not at all unusual for a sleeping mother in the early puerperium to wake up in a sweat with night gown very nearly drenched. the gown should be changed underneath the bedding, while alcohol is rubbed over the moistened skin surface. these sweats will disappear as soon as the mother begins to regain her strength. a vinegar rub administered on going to bed may often prevent these sweats. the toilet of the vulva immediately after the birth of the baby and the expulsion of the afterbirth, the thighs and vulva are cleansed as follows: into a basin of warm, boiled water are dropped four small antiseptic tablets of bichlorid of mercury; this gives a proper antiseptic wash. into this solution are placed four pieces of sterile cotton two of these are used, one at a time, without being returned to the solution to wash each inside of the thigh, the remaining two to cleanse the vulva. without drying the vulva, two sterile pads are applied and pinned to the binder. these pads are changed every hour during the first day or two because of the profuse lochial flow. after each urination and bowel movement, a lysol solution (prepared by putting one teaspoonful of lysol in a quart of sterile water) is poured from a clean pitcher over the vulva into the bed pan, and fresh pads applied. this toilet continues until the close of the second week or longer, if there is a lochial flow. these sterile pads not only absorb the lochia but also, among ignorant or thoughtless mothers, prevent contamination by the patient's hands. urination the patient should be encouraged to urinate during the first few hours after labor; catheterization should not take place until every effort has been made to bring about normal urination; or, until there is a well marked tumor above the bony arch of the pelvis in the lower part of the abdomen. it is far less harmful to the patient for her to sit up on the jar placed on the edge of the bed, than to undergo the risk of inflammation of the bladder which so often follows catheterization. the lochia the first few days the lochia is very red because of the large amount of blood which it contains. after the third or fourth day it is paler and after the tenth it assumes a whitish or yellowish color. during the three changes it should always smell like fresh blood. any foul, putrifying odor should be promptly reported to the physician. if on getting up at the close of the second week the lochia should resume its red color, the patient should return to bed and notify her physician. the abdominal binder after the tenth day, the abdominal binder may be pinned as tightly as the patient desires, but prior to the tenth day many physicians believe the exceedingly tight binder causes misplacements of the enlarged, softened, and boggy uterus. it should be pinned snugly; but not drawn as tight as possible with the idea of keeping the uterus from relaxing, for at best, it does not do it; while tight constriction may produce a serious turning or flexion of the uterus. the breast binder is applied during the first twenty-four hours to support the filling breasts, loosely at first, and as they increase in size, as the glands become engorged, the binder is drawn more tightly. a sterile piece of gauze is placed over the nipples. the bowels on the morning of the second day a cathartic is usually given--say one ounce of castor oil or one-half bottle of citrate of magnesia. the bowels should move at least once during each twenty-four hours; if they are obstinate, a simple laxative may be nightly administered. certain constipation biscuits, sterilized dry bran, or agar-agar may be eaten with the breakfast cereal. prunes and figs should be used abundantly. bran bread should be substituted for white bread. the enema habit is a bad one and should not be encouraged; however, the enema is probably less harmful than the laxative-drug habit. mineral oil is useful as a mild laxative, and does not produce any bad after results. care of the nipples fissures of the nipples should be reported to the physician at once. there are many good remedies which the physician may suggest; in his absence, balsam peru may be advantageously applied. boracic acid solution should be applied before and after each nursing from the very first day; in this way much nipple trouble may be prevented through cleanliness and care. the nipples should be kept thoroughly dry between nursings nipple shields should be used where fissures persist. the diet for the first three days a liquid and soft diet is followed such as hot or cold milk, gruels, soups, thin cereals, eggnog (without whiskey), eggs, cocoa, dry toast, dipped toast, or cream toast. there should be three meals with a glass of hot milk at five in the morning (if awake) and late at night; nothing between meals except plenty of good cold water. after the third day, if temperature is normal, a semi-solid diet may be taken, such as baked, mashed, or creamed potatoes, soups thickened with rice, barley or flour, vegetables (peas, corn, asparagus, celery, spinach, etc.); eggs, light meats, stale breads, toast, bland or subacid fruits (sweet apples, prunes, figs, dates, pears, etc.); macaroni, browned rice (parched before steaming), etc.; ice cream, custards, and rice puddings for desserts after the seventh day. three good meals a day, at eight and one and six, with a couple of glasses of hot milk or cocoa or an eggnog at five a.m., to be repeated at 9 or 10 p.m., with plenty of cold water between the meals, will abundantly supply the necessary milk for the growing babe. tea and coffee are not of any special value in encouraging a flow of milk. the constant coaxing of the mother with "do drink this," and "you must drink this, or you won't have any milk," not only saddens her but seriously upsets digestion and thus indirectly interferes with normal lactation. getting up everybody should stay at home and away from the mother and her new born child until after the seventh day, and then, if our patient is normal, visitors may call, but should not stay longer than five minutes. the convalescing mother will improve faster without the neighborhood gossip, or the tales of woe so often carried by well-meaning, but woefully ignorant acquaintances. when the hard ball-like mass can no longer be felt in the lower abdomen, when the lochia has passed through the three changes already mentioned, and the flow is whitish or yellowish, scanty and odorless, the patient may sit up in a chair increasingly each day. such conditions are usually found anywhere from the tenth to the fifteenth day. the patient first sits up a little in a chair--she has already been exercising some in bed--and this enables her to sit up with ease for a half-hour the first day, increasing one-half hour each day during the week following. at the end of three weeks, she may be taken down stairs providing there is ample help to carry her back up stairs. after another week (at the close of the fourth), if the lochia is entirely white or yellow, with no blood, she may begin carefully to go about the house. there should be no lifting, shoving, pulling, wringing, sweeping, washing, ironing, or other heavy exercise for at least another two weeks, better four weeks. any variance from this program usually means backache, lassitude, diminished milk supply, and frequently a general invalidism for weeks or months--sometimes years. complications _cystitis_, or painful urination, is avoided by tardy "getting up;" quietly, slowly moving about; abundant water drinking; and the avoidance of catheterization. _hemorrhage._ notify the physician if it occurs at any time. the treatment is heavy kneading of the abdomen until the uterus again becomes like a hard ball. cold compresses over the lower abdomen may sometimes help. _infection_ is manifested by chilly sensations or a distinct chill followed by fever, usually on the third day. take a cathartic; notify the physician at once and follow his directions. _mastitis_, inflammation or caking of the breasts. very hot fomentations wrung out of boiling water, alternating with ice-cold compress, should be applied to the breast for an hour or more, three or four times a day. cathartics should be administered, and eliminative measures instituted such as the hot-blanket pack. _pneumonia._ keeping the arms and chest well protected by a long-sleeved coat of warm texture, should help in preventing this serious complication. pneumonia complicating labor is usually the result of carelessness and exposure. part ii the baby part ii the baby chapter xii baby's early days happy is the mother and fortunate is the home that possesses the intelligent services of a trained attendant during the early days of the baby's career. a century or more ago skilled nurses were unheard of, and both mothers and babies seemed to thrive on the unskilled but faithful and sympathetic care given by the willing neighbor who "thought i'd just run over and help out." who of us cannot remember the days when mother was "gone to a neighbor's" to give this same willing but unskilled care at the time of "confinement." modern methods and why are we so concerned today about asepsis, sterilization, etc., when a generation ago they were not? we used to live more slowly than we do now. then it took the entire day to do the marketing for the week, now we take a receiver from the hook and a telephone wire transmits the verbal message. our days are literally congested with events that were almost impossibilities a century ago. the ease and leisure of former days are unknown and unheard of today. the artificial way in which we live exerts more or less of a strain upon the present generation; the average woman's nervous system is keyed up to a high pitch; her general vital resistance is running at a low ebb; while child-bearing brings a certain added stress and strain that requires much planning to avoid and overcome. for many days and ofttimes weeks the mother is unfit--physically unable--properly to care for her child, and so whether it be the trained assistant in constant attendance or the visiting nurse in her daily calls, or the kind, willing, but unskilled neighbor--each helper must acquaint herself, in varying degrees, with the physical, nervous, and mental needs of the child, as well as take into account and anticipate the numerous habits and wants of the new born babe, such as urination, bowel movement, pulse, respiration, temperature, etc. the head at birth, the head is remarkably large as compared to the rest of the body, for, surprising as it may seem, the distance from the crown to the chin is equal to the length of the baby's trunk; and, too, if birth has been prolonged this large head has also been pressed or squeezed somewhat out of shape. this state of affairs, however, need give no cause for either alarm or anxiety, for the head will shape itself to the beautiful rotundity of the normal baby's head within a few days. the general shape of the baby's head, as seen from above is oval. just back of the forehead is formed a diamond-shaped soft spot known as the anterior fontanelle which should measure a little more than one inch from side to side. on a line just posterior to this soft spot and to the back of the head, is found another soft spot somewhat smaller than the one in front. gradual closure of these openings in the bones occurs, until at the end of six or eight months, the posterior fontanelle is entirely closed; while eighteen months are required for the closure of the anterior fontanelle. these "soft spots" should not be depressed neither should they bulge. the head is usually covered with a growth of soft, silky hair which will soon drop out, to be replaced, however, by a crop of coarser hair in due season. the scalp should always be perfectly smooth. any rash or crusts or accumulation of any kind on the scalp is due to uncleanliness and neglect, and should be carefully removed by the thorough application of vaseline followed by a soap wash. the vaseline should be applied daily until all signs of the accumulation are entirely removed. the eyes of all babies are generally varying tints of blue, but usually change to a lighter or darker hue by the seventh or eighth week. the whitish fur which often is seen on the baby's tongue is the result of a dry condition of the mouth which disappears as soon as the saliva becomes more abundant. chest, abdomen, and legs the baby's chest, as compared to the size of the head and abdomen, appears at a disadvantage, while the arms are comparatively short and the legs particularly so, since they measure about the same as the length of the trunk. they naturally "bow in" at birth so that the soles of the feet turn decidedly toward each other. all these apparent deformities, as a rule, right themselves without any help or attention whatsoever. pulse and respiration the pulse may be watched at the anterior fontanelle or soft spot on top of the head while the child quietly sleeps and should record, at varying ages, as follows: at birth 130 to 150 first month 120 to 140 one to six months about 130 six months to one year about 120 one to two years 110 to 120 two to four years 90 to 110 the above table is correct for the inactive normal child. muscular activity, such as crying and sucking, increases the pulse rate from 10 to 20 beats per minute. the respiration of the baby often gives us no small amount of real concern at the first. the baby may be limp and breathless for some few moments at birth, and this condition calls for quick action on the part of the nurse and doctor. the utmost care to avoid the "sucking in" of any liquid or blood during its birth must be exercised, for this often seriously interferes with the breathing. sometimes this condition is not relieved until a soft rubber catheter is placed in the throat and the mucus is removed by quick suction. when you are reasonably sure that there is no more mucus in the throat, then sudden blowing into the baby's lungs (its lips closely in touch with the lips of the nurse or physician) often starts respiration. slapping it on the back also helps, while the quick dip into first hot then cold water seldom fails to give relief. a quiet-sleeping infant breathes as shown below at varying ages. an increase of six to ten breaths per minute may be allowed for the time it is awake or otherwise active. at birth and for the first two or three weeks 30 to 50 during the rest of the first year 25 to 35 one to two years about 28 two to four years about 25 the weight the normal weight of the average baby is seven to seven and one-half pounds. its length may range anywhere from sixteen to twenty-two inches. there is an initial loss of weight during the first few days; however, after the milk has been established the child should make a weekly gain of four to eight ounces until it is six months old, after which time the usual gain is from two to four ounces per week. if the weight has been doubled at six months and the weight at one year is three times the birth weight, the child is said to have gained evenly and normally. the skin at birth the skin of the baby is red and very soft owing to the presence of a coating of fine down. a blue-tinged skin may be occasioned by unnecessary exposure or it may be due to an opening in the middle partition of the heart which should close at birth. as soon as the baby is born, it should be placed on its right side while the cord is being tied, as this position facilitates closure of this embryonic heart opening. with the provision for a little additional heat the blue color should disappear, if it is not due to this heart condition. at the close of the first week the red color of the skin changes to a yellow tint due to the presence of a small amount of bile in the blood. this sort of jaundice is very common and is in no wise evidence of disease. the "down" falls off with the peeling of the skin which takes place during the second week; by the end of which time, the skin is smooth and assumes that delightful "baby" character so much admired. the cord dressing the cut end of the tied umbilical cord is swabbed and squeezed with a sterile sponge saturated with pure alcohol. it is then wrapped in a sterile dressing made as follows: four or five thicknesses of sterile cheese cloth are cut into a four-inch square with a small hole cut in the center and one side cut to this center. this is slipped about the stump of the cord and wrapped around and about in such a manner as entirely to cover the stump of the cord. the wool binder is then applied and sewed on, thus avoiding both pressure and the prick of pins. if it remains dry this dressing is not disturbed until the seventh or eighth day, when the cord ordinarily drops off. should it become moistened the dressing is removed and the second dressing is applied exactly like the first. the eyes the closed eyes of the newly born child are generally covered with mucus which should be carefully wiped off with a piece of sterile cotton dipped in boracic acid solution, in a manner not to disturb the closed lid. a separate piece of cotton is used for each eye and the swabbing is done from the nose outward. the physician or nurse drops into each opened eye two drops of twenty per cent argyrol, the surplus medicine being carefully wiped off with a separate piece of cotton for each eye. the baby should now be placed in a darkened corner of the room, protected from the cold. the eyes are washed daily by dropping saturated solution of boracic acid into each eye with a medicine dropper. separate pieces of gauze or cotton are used for each eye. the first oil bath as soon as the cord and the eyes have received the proper attention and the mother has been made comfortable, the baby is given its initial bath of oil. this oil may be lard, olive oil, sweet oil, or liquid vaseline. the oil should be warmed and the baby should be well covered with a warm blanket and placed on a table which is covered with a thick pad or pillow. the temperature of the room should be at least eighty degrees fahrenheit. quickly, thoroughly, and carefully the entire body is swabbed with the warmed oil--the head, neck, behind the ears, under the arms, the groin, the folds of the elbow and knee--no part of the body is left untouched, save the cord with its dressing. this oil is then all gently rubbed off with an old soft linen towel. the first clothing after the oil bath, the silk and wool shirt (size no. 2), the diaper and stockings are quickly put on to avoid the least danger of chilling. the band having been applied at the time of the dressing of the cord, our baby is now ready for the flannel skirt. this should hang from the shoulders by a yoke of material adapted to the season, cotton yoke without sleeves if a summer baby, and a woolen yoke with woolen sleeves if a winter baby. the outing-flannel night dress completes the outfit and should be the only style of dress worn for the first two weeks. loosely wrapped in a warm shawl, the baby is about ready for its first nap, save for a drink of cooled, boiled water. this cooled, boiled, unsweetened water should be given in increasing amounts every two hours until the child is two or three years of age. it is usually given the child in a nursing bottle. in this way it is taken comfortably, slowly, can be kept clean and warm, and should the babe be robbed of its natural food and transferred to the bottle as a substitute for mother's milk, it will already be acquainted with the bottle and thus one-half of a hard battle has already been fought and won. baby's first nap the baby's bed should be separate and apart from the mother's. it may be a well-padded box, a dresser drawer, a clothes basket, or a large market basket. a folded comfortable slipped in a pillow slip makes a good mattress. a most ideal bed may be made out of a clothes basket; the mattress or pad should come up to within two or three inches of the top, so the baby may breathe good fresh air and not the stale air that is always found in a deeply made bed. into this individual bed the baby is placed as soon as it is dressed; and a good sleep of four to six hours usually follows. frequent observations of the cord dressing should be made as occasionally hemorrhage does take place, much to the detriment of the babe. if bleeding is at any time discovered the cord is retied just below the original tying. by the time baby has finished a sixor eight-hour nap the mother is wondrously refreshed and is ready to receive it to her breast. putting to the breast during the first two days the baby draws from the breasts little more than a sweetened watery fluid known as the colostrum; but its intake is essential to the child in that it acts as a good laxative which causes the emptying of the alimentary tract of the dark, tarry appearing stools known as the meconium. on the third day this form of stool disappears and there follows a soft, yellow stool two or three times a day. the child should be put to the breast regularly every four hours; two things being thus encouraged: an abundant supply of milk on the third day and the early shrinking of the uterus. more than once a mother has missed the blessed privilege of suckling her child because some thoughtless person told her "why trouble yourself with nursing the baby every four hours, there's nothing there, wait until the third day;" and so when the third day came, there was little more than a mere suggestion of a scanty flow of milk, which steadily grew less and less. the urine the urine of the very young child should be clear, free from odor and should not stain the diaper, nor should it irritate the skin of the babe. often urination does not take place for several hours, sometimes not at all during the first twenty-four hours. if the infant does not show signs of distress, there is no cause for alarm; the urine should pass, however, within thirty hours. as a rule there are usually between ten and twenty wet diapers during each twenty-four hours. the following table shows about the amounts of urine at different ages: birth to two years 8 to 12 ounces two to five years 15 to 25 ounces five to ten years 25 to 35 ounces genitals of the male child the foreskin of the male child is often long, tight, and adherent, and is often the direct cause of irritability, nervousness, crying, and too frequent urination. it should be closely examined by both physician and nurse and when the foreskin does not readily slip back over the acorn-like head of the organ, circumcision is advised early in the second week. this simple operation will start the child out on his career with at least one moral handicap removed and one desirable possibility established--that of being able to keep himself clean. post-operative care of circumcision the dressings that are loosely applied at the time of the operation should remain untouched (especially those next to the skin), unless otherwise directed by the physician, until the seventh or eighth day when the babe is placed in a warm soap bath, at which time the dressings all come off together. clean sterile gauze is so placed as entirely to protect the inflamed skin from the diaper at all times before this bath, and these same dressings should be continued for at least another week. sterile vaseline (from a tube) should be applied twice a day after the original dressings are removed in the bath at the end of the first week. there should be little or no bleeding following the operation, neither should the penis swell markedly; if either complication should occur, the physician should be promptly notified. care of the female genitals the girl baby is often neglected in respect to the proper care of the genitals. the lips of the vulva should be separated and thorough but careful cleaning should be the daily routine. the foreskin or covering of the clitoris should not be adherent; while the presence of mucus, pus, or blood in the vulva should be at once reported to the physician; in his absence, the application of twenty per cent argyrol should be made daily. [illustration: fig. 6. how to hold the baby] handling the baby let us thoroughly come to understand the very first day the little one's life, that it was not sent to us because the family needed something to play with; it is not a ball to toss up, neither is it a variety show. it is a tiny individual, and your responsibilities as parents and caretakers are very great. the child was sent to be fed, clothed, kept warm, dry, and otherwise cared for by you, until such a time as it will become able to care for itself. remember, what we sow, that shall we also reap. if we sow indulgence we shall reap anger, selfishness, irritability, "unbecomingness"--the spoiled child. at two or three days the baby learns that when it opens its mouth and emits a holler, someone immediately comes. if we do it on the second and third day, why should we object to run, bow, and indulge on the one hundredth and second day? handle the baby as little as possible. turn occasionally from side to side, feed it, change it, keep it warm, and let it alone; crying is absolutely essential to the development of good strong lungs. a baby should cry vigorously several times each day. if the baby is to be handled, support the back carefully (fig. 6). the early baths during the first week the baby is oiled daily over his entire body, with the exception that the cord dressing remains untouched. the face, hands, and buttocks are washed in warm water. after the third week the bathroom is thoroughly warmed and the small tub is filled with water at temperature of 100 f. the baby having been stripped and wrapped in a warm turkish towel, is placed on a table protected by a pillow, while the caretaker stands by and vaselines the creases of the neck, armpits, folds of the elbows, knees, thighs, wrists, and genitals; and then, with her own hands, she applies soap suds all over the body--every portion of which is more quickly and readily reached--than by the use of a wash cloth. and now, with the bath at 100 f., with a folded towel on the bottom of the small tub, the soapy child is placed into the water and after a thorough rinsing is lifted out again to a warm fresh towel on the table and the careful drying is quickly begun. after the bath all the folds and creases are given a light dusting with a good talcum. during hot weather the bath should be given daily, soap being used twice a week. on the other days there should be the simple dipping of the child into the tub. during the cold weather the full bath is given but twice a week, while on the other days a sponge bath or an oil rub may be administered. a weak, delicate child should not be exposed to the daily full bath, but rather the semi-weekly sponge bath and the daily oil rub should be administered. we have found the late afternoon hour to be better than the early morning hour for baby's bath. it requires too much vital resistance to react to an early morning bath, especially when the house is cool. regarding soap the use of soap is very much abused with young babies. i recall one mother who came into the office with her poor little baby which was constantly crying and fretting because of a greatly inflamed body--all a result of the too frequent use of soap. i said, "i am afraid you do not keep your baby clean." "o doctor!" she replied, "i wash him with soap every time i change him; i am sure he is clean." and come to find out, the poor little fellow's tender skin had been subjected to soap several times a day. we ordered the use of all soap discontinued, vaseline and talcum powder to be used instead, and the child's skin got well in a very short time. care of the umbilicus tight bands should not be placed about the babe. if the umbilicus protrudes, do not endeavor to hold it in by a tight band, but consult your physician about the use of a bit of folded cotton and adhesive plaster, and then allow the child the freedom of the knitted bands, with skirts suspended from yokes. the day of tight bands and pinning blankets with their additional and traditional windings is over. after the complete healing of the cord, the need for a snug binder to hold the dressings in place is over. should the baby cry violently, the umbilicus should be protected in the manner described above--the fold of cotton and the adhesive plaster. the diaper, stockings, shirt, skirt, and dress with an additional wrapper for cold days completes the outfit at this age. birth registration "one of the most important services to render the newborn baby is to have his birth promptly and properly registered." in most states the attending physician or midwife is required by law to report the birth to the proper authority, who will see that the child's name, the date of his birth, and other particulars are made a matter of public record. birth registration may be of the greatest importance when the child is older, and parents should make sure this duty is not neglected. a public health official some time ago epitomized some of the uses of birth registration as follows: there is hardly a relation in life from the cradle to the grave in which such a record may not prove to be of the greatest value. for example, in the matter of descent; in the relations of wards and guardians; in the disabilities of minors; in the administration of estates; the settlement of insurance and pensions; the requirements of foreign countries in matters of residence, marriage, and legacies; in marriage in our own country; in voting and in jury and militia service; in the right to admission and practice in the professions and many public offices; in the enforcement of laws relating to education and to child labor, as well as to various matters in the criminal code; the irresponsibility of children under ten for crime or misdemeanor; the determination of the age of consent, etc., etc. chapter xiii the nursery we wish it were possible for every mother who reads this book to have a special baby's room or nursery. some of our readers have a separate nursery-room for the little folks, and so we will devote a portion of this chapter to the description of what seems to us a model arrangement for such a room; but, realizing that ninety-five per cent of our readers can only devote a corner of their own bedroom to the oncoming citizen, we have also carefully sought to meet their needs and help them to take what they have and make it just as near like the ideal nursery as possible. the separate nursery the nursery should be a quiet room with a south or southwesterly exposure. the bathroom should adjoin or at least be near. a screened-in porch is very desirable. draperies that cannot be washed, and upholstered furniture, do not belong in the baby's room. a hardwood floor is better than a carpet or matting; while a few light-weight rugs, easily cleaned, are advisable. enameled walls are easily washed and are, therefore, preferable to wall paper or other dressings. the windows should be well screened, for by far the greatest dangers to which the baby is exposed, are flies and mosquitoes--carriers of filth and disease. flies, mosquitoes, cockroaches, bed bugs, cats, dogs, lice, and mice are all disease carriers and must therefore be kept out of baby's room. nursery equipment at each window should be found dark shades, and if curtains are desired they should be of an easily washable material, such as mull, swiss, lawn, voile, or scrim. the hardwood floor may be covered where necessary with easily handled rugs which should be aired daily. the other necessary articles of furniture are a crib of enameled iron whose bedding will be described elsewhere in this chapter, a chest for baby's clothes and other necessary supplies, a screen or two, a low table and a low rocker, a small clothes rack on which to air the clothes at night, a pair of scales, and a medicine chest placed high on the wall. if the room will conveniently admit it, a couch will add greatly to the mother's comfort; and, if possible, it should be of leather upholstery; otherwise, it should possess a washable cover, for all articles that promote the accumulation of dust are not to be allowed in the nursery. in these early weeks and months baby will not benefit from pictures or other wall decorations, and so let him have clean walls that are easily washed and quickly dusted. the necessities for baby's personal care are: talcum powder. castile soap. soft wash cloths. soft linen towels. bottle of plain vaseline. boracic acid, oz. iv (saturated solution). olive oil. sterile cotton balls in covered glass jar. safety pins of different sizes. hot water bag with flannel cover. baby scales. drying frames for shirt and stockings. baby's bed since the days of solomon, accidents have occurred where mother and babe have occupied the same bed. not only is there the ever-present danger of smothering the babe, but there are also many other reasons why a baby should have its own bed. the constant tendency to nurse it too often and the possibility of the bed clothing shutting off the fresh air supply, are in and of themselves sufficient reasons for having a separate bed for baby. the first bed is usually a basinet--a wicker basket with high sides--with or without a hood. a suitable washable lining and outside drape present a neat as well as sanitary appearance. the mattress of the basinet is usually a folded clean comfort slipped into a pillow slip; this is to be preferred to a feather pillow, as it is cooler and in every way better for the babe. drapes about the head of the basinet are not only often in the way, shutting out air, etc., but they also gather dust and are unsanitary. screens are movable--they may be used or put away at will--and are, therefore, very convenient about the nursery. the basinet may be dispensed with entirely if the sides of the enameled crib are lined to cut off draughts and the babe is properly supported by pillows. after the baby is four to six months of age it is transferred to the crib. the basinet has an advantage over the crib during those early weeks in that its high sides protect the babe from draughts, and the comforts and blankets can be more easily tucked about the little fellow to keep him warm. the sides should not extend more than four inches above the lying position of the child. the crib the enameled iron crib should be provided with a woven-wire mattress, over which is placed a mattress; hair is best as a filling for the mattress, wool next, and cotton last. over the mattress should be placed a rubber sheet, and over all a folded sheet. a pillow of hair or down is not to be discarded; for recent investigation has shown that the pillow favors nasal drainage, while lying flat encourages the retaining of mucus in the nose and nasal chambers--the sinuses. the pillow slip should be of linen texture. during the winter a folded soft blanket over the rubber sheet increases both softness and warmth. no top sheet is used during the first months, particularly if the first months are the winter months. the baby is wrapped loosely in a light weight clean blanket or shawl, and other blankets--as many as the season demands are tucked about the child. these blankets should be aired daily, and the one next to the baby changed, aired, or washed very often. [illustration: fig. 7. making the sleeping blanket] the sleeping blanket to prevent baby from becoming uncovered the sleeping blanket has been devised. the blanket is folded and stitched in such a way as completely to envelop the sleeping babe, and at the same time afford the utmost freedom (fig. 7). the babe may turn as often as he desires, but cannot possibly uncover himself. bed clothes fasteners are also used--an elastic tape being securely fastened to the head posts and then by means of clamps or safety pins attachment is made to the blankets on either side. the elasticity allows considerable freedom to the child in turning (see fig. 8). nursery heating and ventilation the subject of ventilation has been so fully discussed by the authors in another work that we refer the reader to _the science of living, or the art of keeping well_. for the first two or three weeks the nursery temperature should be maintained at seventy degrees fahrenheit by day and from sixty degrees to sixty-five degrees by night. in the third week the day temperature should be sixty-eight degrees fahrenheit measured by a thermometer hanging three feet from the floor. after three months the night temperature may go as low as fifty-five degrees fahrenheit, and after the first year it may go as low as forty-five degrees. the heating of the nursery is usually controlled by the general heating plant, and no matter what system of heating is maintained, humidifiers must be used, the necessity for which is doubled when the system is that of the hot-air furnace. these shallow pans of water with large wick evaporating surfaces will evaporate from three to four quarts during the twenty-four hours. the humidity should be fifty throughout the seasons of artificial heating. many colds may be entirely avoided by the use of humidifiers or evaporators. the open grate is one of the very best means of nursery heating. gas and oil heaters should not be depended upon for nursery heat. only in an emergency should they be used at all, and the electric heater is by far the best device for such occasions. [illustration: fig. 8. in the sleeping blanket] baby's corner in mother's room it is probably a conservative estimate to say that ninety-five per cent of all the babies occupy a corner of mother's and father's bedroom for the first two or three years. and believing this estimate to be correct, it is advisable to give the matter some consideration. to begin with, a lot of the non-essentials, ruffles and fluffles of the average bedroom, must go. the good father's chiffonier may have to be put in the bath room; heavy floor coverings must be discarded, to be replaced by one or two small, light-weight rugs; wall decorations and the usual bric-a-brac of dressers, tables, etc., should be carefully packed away. in fact, there should be nothing in the room save the parents' bed, dresser (several drawers of which must be devoted to baby's necessities), table, low rocker, a stool, baby's bed and a good big generous screen, made out of a large clothes horse enameled white and filled with washable swiss. window draperies must be taken down and packed away, while they are replaced with simple muslin which can go to the laundry twice a month. if it be within the means of the family purse, it is well to renovate the walls just prior to the advent of the little stranger. and now the baby's bed is placed in the corner most protected from draughts and the glare of the sunlight. if it can be so arranged that baby looks away from the light, and not at it, we are guarding it from defective vision in the future. crib substitutes many a beautiful artistic creation so much admired in this world is found to be, on closer inspection, a very ordinary thing which has received an artistic touch; and so, many convenient, sanitary, and beautiful cribs are fashioned from market baskets fastened to tops of small tables whose legs are sawed off a bit; from soap boxes fastened to a frame, and from clothes baskets. a can of white enamel, a paint brush and the deft hand of a merry, cheery-hearted expectant mother can work almost miracles. remember, please, that all draperies must be washable and attached with thumb tacks so as to admit of easy and frequent visits to the laundry. a medium-sized clothes basket will take care of our baby for four or five months. the same general plan for the mattress and bedding is followed as before described. extra heat to the crib if necessary--and it usually is, especially during the winter months--a hot-water bottle may be placed underneath the bedding on top of the mattress. this insures a steady, mild, uniform warmth and it not only saves the baby from the danger of being burned, but it also obviates the temporary overheating of the child which usually occurs when the bottle is placed inside the bed, next to the baby. if the bed is properly made--the blankets coming from under the babe up and over--there is little or no need for extra heat for well babies after the first month. lighting baby's room if electric lighting is not an equipment of the home neither gas or oil lamps should be allowed to burn in the room for long periods. for emergency night lighting a well-protected wax candle should be used. however, don't go to sleep and allow a candle to burn unprotected as did one tired, exhausted mother. the father, suddenly aroused from his sleep, saw a large flame caused by the overturning of a wax candle into a box of candles, while the lace drapery of the basinet was within a few inches of the flame and the baby just beyond. grabbing a pillow he smothered the flames and saved baby and all. fresh air plenty of fresh air and lots of sunshine should enter baby's room. the large screen amply shields from draughts, and when thus protected there need be no unnecessary concern about cool fresh air, especially after two or three months, as it is invigorating and prevents "catching cold." warm, stuffy air is devitalizing and even during the early weeks when the fresh air must be warm, an electric fan should be advantageously placed so that many times each day the warm fresh air may be put in motion without creating a harmful draught. warm stuffy air makes babies liable to catch cold when taken out into the open. throw open the windows several times each day and completely change the air of baby's room. in the absence of the large screen, a wooden board five or six inches high is fitted into the opening made by raising the lower window sash. then as the upper sash is lowered the impure air readily escapes while fresh air is admitted. the bath equipment make early preparations for bathing the baby in the easiest possible manner; in fact, the young mother should seek to attend to all her duties--the family, the home, and the baby--in the easiest way. for the administration of a bath during the early months, a table is needed, protected by oilcloth on which is placed a roomy bathtub with a folded turkish towel on the bottom for baby to sit on. in addition to the tub, have: an enameled pitcher for extra supply of warm water. a small cup for boracic acid solution. castile soap. a soft wash cloth. several warmed soft towels. a bath thermometer. a medicine dropper for washing baby's eyes. talcum powder. oil or vaseline. sterile cotton. tooth picks. a needle and thread for sewing on the band. all of the clean clothing needed. see that the bathtub is clean and enamel unbroken, and if it has been used by another babe, freshen it with a coat of special enamel sold for that purpose. bath temperatures during the first eight weeks temperature 100 f. from two to six months temperature 98 f. from six to twenty-four months temperature 90--97 f. a bath at ninety-eight degrees is a neutral bath, and after the baby is six months and over, the bath may be given at this temperature, and at the close quickly cooled to ninety degrees. nursery cleanliness the nursery should furnish the baby's first protection from contagious diseases. it must be a veritable haven of safety. therefore, no house work of any kind should be done in the room, such as washing or drying the baby's clothes. the floors and the furniture should be wiped daily with damp cloths. a dry cloth or feather duster should never be used to scatter dust around the room. all bedding and rugs should receive their daily shaking and airing out of doors, remembering that particles of dust are veritable airships for the transportation of germs. in every way possible avoid raising a dust. so much of the lint which commonly comes from blankets may be avoided with the daily shaking out of doors. soiled diapers should not accumulate in a corner or on the radiator; their removal should be immediate, and if they must await a more opportune time, soak them in a receptacle filled with cold water. even those diapers slightly wetted should never be merely dried and used again, but should be properly washed and dried. no washing soda should be used in the cleansing of diapers--just an ordinary white soap, a good boil, and plenty of rinse water, with drying in the sun if possible. they require no ironing. hands that come in contact with soiled or wet diapers must be thoroughly cleansed before caring for the baby or preparing his food. as before mentioned, and it will bear repetition often, all windows and doors must be well screened, for flies and mosquitoes are dreaded foes in any community and in babyland in particular. all used bottles and nipples as well as used cups, pitchers, bits of used cotton, should be removed at once. the washcloth is a splendid harbinger of germs. there should be one for the face, and one for the body and bath, and both should receive tri-weekly boiling. bath towels should not be used more than twice, better only once. the technic of bathing, together with the location, furnishings, and cleanliness of the baby's sick room, will be taken up in later chapters. chapter xiv why babies cry it is surprising how soon even a young and inexperienced mother will learn to distinguish between the _pain_ cry and the _plain_ cry of her baby; for most crying can easily be traced to some physical discomfort which can be relieved, or to some phase of spoiling and indulgence which can be stopped. normal healthy crying the young baby can neither walk, talk nor engage in gymnastics, except to indulge in those splendid physical exercises connected with a good hearty cry. to be good and healthy, an aggregate of an hour a day should be spent in loud and lusty crying. he should be allowed to kick, throw his arms in the air and get red in the face; for such gymnastics expand the lungs, increase general circulation and promote the general well-being of the normal child. as the child grows older and is able to engage in muscular efforts of various sorts, these "crying exercises" should naturally decrease in frequency and severity. when baby cries, see that the abdominal band is properly applied, that rupture need not be feared. the birth cry the sound most welcomed by both doctor and nurse is the cry of the newly born child, for it shows that the inactive lungs have opened up and the baby has begun to use them, for all the time baby was living in the uterine room he did not breathe once, the lungs having been in a constant state of collapse; and not until now, the very moment the air comes in contact with his skin, do the lungs begin to functionate as he emits his first lusty holler. abnormal crying the cry is said to be abnormal when it continues too long or occurs too often. it may be strong and continuous, quieting down when he is approached or taken up; or it may be a worrying, fretful cry, a low moan or a feeble whine. and now as we take up the several cries, their description, cause, and treatment, we desire to say to the young mother: do not yourself begin to fret and worry about deciding just which class your baby's cry belongs to; for help, knowledge, and wisdom come to every anxious mother who desires to learn and who is willing to be taught by observation and experience. the hunger cry the continuous, fretful cry, accompanied by vigorous sucking of the fists, both of which stop when hunger has been satisfied, is without question the hunger cry. if this cry is constant with regular feedings, then the quantity of the food must be increased, or the quality improved. the tired, fretful hunger cry must not be neglected; the cause must be removed, for it points to malnutrition. the cry of thirst one day when lecturing at an iowa chautauqua, i remained in the beautiful park for the noonday meal. it was a warm day and the tables in the well-screened dining tent were filled with mothers who, like myself, preferred the cool shade of the park to the hot ride through the city to the home or hotel dinner. at my table a baby was pitifully crying. the mother had offered the little child seated in a small uncomfortable go-cart, milk, bread, and a piece of cake--all of which were ruthlessly pushed aside. my little son, then only four and a half, said "mamma, maybe the baby's thirsty," and up he jumped, hurried to the mother's side with his glass of water, saying, "i haven't touched it, maybe the baby's thirsty." the mother brushed the boy aside, saying, "no, i never give the baby water." in spite of the mother's remonstrance, the baby cried on and on, and finally on "trying" the water, the child drank fully one-half the glass and the crying was hushed. babies should be given water regularly--many times every day--from birth, in varying amounts from two teaspoons to one-half cup, according to the age of the child. the water should be boiled for the first few months, and longer if there is any suspicion of impurities. milk to the nursing infant is like beefsteak and potatoes to the adult; and many times the milk bottle or the breast is just as nauseating to the thirsty babe, as meat would be to the very thirsty adult whose hunger has previously been fully satisfied. the fretful cry the babe who is wet, soiled, too hot, or is wrapped too tightly, or who has on a tight, uncomfortable belly band, or whose clothing is full of wrinkles, has only one way to tell us of his discomfort, and that is to cry. it is a fretful cry and should command an immediate investigation as to the possible cause. it takes but a moment to discover a wet diaper; to run the hand up the back under the clothes; to sprinkle with talcum if perspiring; to straighten out the wrinkled clothing; to find the unfastened pin that pricks; or to loosen the tight band. acquire the art of learning to perform these simple tasks easily, and any or all of these services should be rendered without taking the child from its bed. let the child early learn to rest happily and quietly in his own bed. the pillow or mattress may be turned or perhaps the mattress be raised nearer the edge of the basinet. one poor youngster instantly stopped his fretful cry when his mattress was raised four or five inches so he could get the air, at the same time taking him out of his hot room to a cooler room with raised windows. babies like cold air. they cry when the air is hot, or even warm and close. every day--rain or shine, wind or sleet--babies should nap out of doors on the porch, in a well-sheltered corner. a screen or a blanket protects from the wind, sleet, or rain; and if the baby's finger tips are warm, you can rest assured the feet and body are warm. scores of babies will sleep out on the porch, on the protected fire escape, or in a room with opened windows, from one bottle or feeding to another; being aroused at the end of the three or four hour interval just enough to nurse, when back they go to their delightful, warm nest in the cool, fresh air to sleep for another period. babies should never sleep in a room with closed windows. one of the incidents that surprised me most in my early work with dispensary babies was the utter misconception of the purpose of the belly band. invariably it was put on so tightly that i could not slip a finger between it and the babe. it is not a surgical instrument, neither is it a truss. these tight belly bands are a source of much fretting and crying. the pain cry the little pinched look about the face, the drawing up of the legs, the jerking of the head, arms, or legs, associated with a strong, sharp, unceasing or intermittent cry, demands immediate attention our first work should be to go about quietly, painstakingly, and systematically to locate the cause of this "cry of pain." there are often some accompanying symptoms to the cry of pain which demand skilled medical advice and attention, such as the arching of the body backward, the drawing of the head strongly to one side, the inability to use one side of the body, or the presence of fever. there may be an earache, an abdominal complication, or a sore throat, any one of which will be detected by the skilled doctor. earache frequently occurs in young babies who have been taken out of doors without proper protection to the ears; or, it may be associated with a cold in the head, which is not detected until the mischief has already been done, while the resulting running ear tells the tale of woeful suffering. earache must always be thought of as a possible cause when the cry of pain accompanies a cold in the head, and if medical aid is secured early, the abscess may be aborted and the deafness of later years entirely avoided. there is only one home remedy for earache, and that is the application of external heat, either by a hot-water bottle or hot-salt bag. medical advice should be sought before anything whatsoever is dropped into the baby's ear. in this connection should be mentioned the wild cry at night which so often accompanies tuberculosis of the bone. a careful x-ray examination will reveal the disease, and proper medical measures should be instituted at once. other fretful night crying will be mentioned further on. habit crying by the frequent repetition of actions, habits are formed. when the baby is two or three days old, he is so new to us and we have waited for him so long, and it is such a great big world that he has come into, that we jump, dance, and scramble to attend to his every need and adequately to provide for his every want. at this very early, tender age whenever he opens his mouth to cry or even murmur--some fond auntie or some overly indulgent caretaker flies to his side as if she had been shot out of a gun, grabs him up and ootsey tootsey's him about as she endeavors to entertain and quiet him. the next time and the next time and the succeeding time he whimpers--like a flash someone dashes to the side of the basket, and baby soon learns that when he opens his mouth and yells, somebody comes. in less than a week the mischief has been done and baby is badly spoiled. no other factor enters so largely into the sure "spoiled" harvest as picking a new baby up every time he cries. often in the early days some indulgent parent will say, "oh, don't turn out the light, something might happen to the dear little thing"--and old mother nature sees to it that a constant repetition of "leaving the light on" brings its sure harvest of "he just won't go to sleep without the light." and then, "just once" he had the pacifier--perhaps to prevent his crying disturbing some sick member of the family--and so we go on and on. if a thing is bad, it is bad, and a supposedly good excuse will not lessen the evil when the habit has been thus started and acquired. the rocking of babies to sleep may be a beautiful portrayal of mother love, but we all pity the child who has to be rocked to sleep as much as we do the mother who sits and rocks, wanting, oh, so much! to do some work or go for a walk--but she must wait till baby goes to sleep. the temper cry and so now we come to the temper cry--that lusty, strong outburst of the cry of disappointment when he finds that all of a sudden people have stopped jumping and dancing for his every whim. the baby is not to blame. we began something we could not keep up, and he--the innocent recipient of all our indulgences--is in no sense at fault. it is most cruel to encourage these habits of petty indulgence, which must cause so much future disappointment and suffering on the part of the little fellow as he begins to grow up. nobody is particularly attracted to the spoiled baby. after the over-indulgent parent and caretaker have completed their thoughtless work, they themselves are ashamed of it and not infrequently begin to criticise the product of their own making--the formation of these unpleasant bad habits. more than anything else, the spoiled child needs a new environment, new parents, and a new life. the spoiled baby seek to find out if possible--and it usually is possible--just what he is crying for. it may be for the pacifier, for the light, or to be rocked, jolted, carried, taken up and rocked at night, or a host of other trifles; and if he is immediately hushed on getting his soul's desire--then we know he is "spoiled." the unfortunate thing about it all is that the one who has indulged and spoiled the baby usually does not possess the requisite nerve, grit, and will power to carry out the necessary program for baby's cure. and the pity of it all is that overindulgence in babyhood so often means wrecked nerves and shattered happiness in later life. so, fond, indulgent parents, do your offspring the very great kindness to fight it out with them while they are young, even if it takes all summer, and thus spare them neurasthenia, hysteria, and a host of other evils in later life. this sort of "spoiled baby crying" can be stopped only through stern discipline--simply let the baby "cry it out." the first lesson may require anywhere from thirty minutes to an hour and thirty minutes. the second lesson requires a much shorter time, and, in normal babies with a balanced nervous system, a third or fourth lesson is not usually required. the cry of serious illness the cry of the severely sick child is the saddest cry of all. the low wail or moan strikes terror to the saddened mother-heart. it is often moaned out when the child is ill with "summer complaint" or other intestinal disturbances. instant help must be secured, and, if medical help is not obtainable, remember, with but one or two exceptions, you are safe in carefully washing out the bowels, in applying external heat and giving warmed, boiled water to drink. another cry which demands immediate attention, and the faithful carrying out of the doctor's orders, is the hoarse, "throaty" cry indicative of croup or bronchitis. the colicky cry perhaps the greatest cause of the most crying during infancy, next to that of over-indulgence, is ordinary colic which- ... manifests itself in every degree of disturbance from mere peevishness and fretfulness to severe and intensely painful attacks in which restlessness passes into grunting, writhing, and kicking; the forehead becomes puckered and the face has an agonized expression; the baby tends to scream violently and draws his thighs up against his belly, which will usually be found to be hard and more or less distended. a colicky baby completely upsets the household and greatly disturbs the mother, who requires both quiet and rest that she may the better produce the life-sustaining stream so much needed for the upbuilding and development of the growing child. colic in the breast-fed while colic is so often seen in the bottle-fed babe, it often occurs in the breast-fed child, and is usually traceable to some error in the mother's diet or to some other maternal nutritional disturbance. one mother who was sure she had eaten nothing outside the diet suggestions she had received, was requested to bring to the office a fresh voiding of her own urine which was found to be highly acid. the administration of an alkaline such as simple baking soda or calcined magnesia to the mother, corrected this acidity, and the colic in the baby entirely disappeared. i recall the case of one mother who ate her dinner in the middle of the day, with a light meal in the evening and thereby stopped the colic in her babe. another source of colic in the breast-fed baby is the unclean nipple. the nipples should be washed with soap and water and rinsed in boracic acid solution before each nursing. if the mother worries greatly, or thoughtlessly "gets very angry" just before the nursing hour, there is a substance known as "epinephrin" secreted by the glands located just above the kidneys which is thrown into the blood stream and which raises the blood pressure of the mother and often produces not only colic in the babe, but many times throws him into severe convulsions. colic in bottle-fed babies there are many opportunities for colic in the bottle-fed baby; for instance, dirty bottles, dirty nipples, careless cleansing of utensils used in the preparation of baby's food, improper mixtures, too much flour, the wrong kind of sugar, too much cream or too little water--all these things help to produce wind under pressure in the intestine, which is commonly known as colic. underfeeding or overfeeding, too rapid feeding or too frequent feeding also contribute their mite in producing colic. as a rule, the bottle-fed child is fed too often. in the new born, the interval between feeds should be three hours from the start; after six months the interval may be lengthened to four hours. colic and chilliness hiccough--a spasm of the diaphragm--often accompanies colic, and, in the case of infants, is usually due to the swallowing of air or over-filling the stomach; gentle massage, external heat, and a few sips of very warm water usually corrects the condition. the chilling of the skin very often produces a temporary intestinal congestion with colic as the result. cold feet, wet diapers, and loitering at bath are all very likely to produce colic; and when it is thus caused by chilling, quickly prepare a bath at 100 f., and after immersing the child for five minutes, wrap up well in warm blankets. the treatment of colic those of my mother readers who have electric lights in their home, will find the photophore to be a source of great comfort and convenience; for this simple contrivance is usually able to banish colic in a few moments. the photophore is simply radiant heat--heat plus light (see fig. 3)--and as this heat is applied to legs and buttocks of the crying child the diaper is warmed, the abdomen relaxes, gas is expelled, intestinal contractions relieved, and the baby is soon fast asleep. occasionally with the aid of the photophore, and even without it, the warm two-ounce enema containing a level teaspoon of baking soda and a level teaspoon of salt to a pint of water when allowed to flow into the bowel, will soon bring down both gas and feces to the great relief of the baby. warm water to drink is also very helpful. putting the feet in very warm water is also quieting to the crying colicky babe. it is often necessary in cases of repeated and persistent colic, to give a full dose of castor oil to clear out the bowel tract. do not jolt or bounce the baby, do not carry him about, and don't walk the floor with him. heat him up inside and outside, warm his clothing and his bedding, and thus bring about relief without sowing seeds for future trouble--the sorrow of a spoiled child. one very quiet little baby was one day brought to the dispensary whose mother said: "doctor, i didn't bring him 'cause he's sick, but 'cause he looks so pale; he's as quiet as a mouse; he never cries any more since i got to giving him medicine." on examination of the baby and on inquiring about the medicine, we found that the baby was dead drunk all the time. some "neighbor friend" had told the tired out mother, "give him a teaspoon of whiskey at each feeding and that'll fix him all right." if a few more states go dry maybe it will not be so easy for the ignorant mother to dope and drug her helpless baby. and neither is paregoric to be administered wholesale for colic. it contains an opiate, and should not be given without definite orders from a physician. and so as a parting word on "why babies cry," we ask each mother to run over the following summary of the chapter, and thus seek to find out why her baby cries. baby cries because: he is hungry. he is thirsty. he has been given a dirty bottle. his mother has failed properly to cleanse the nipples. his food is not prepared right. his food is too cold. his bowels are constipated. his band is too tight. his clothes are wrinkled. his diaper is wet. he is too hot. he wants fresh air. he is too cold. he is in pain. he is very sick. his throat is sore. his ear aches. he has been rocked, carried, or bounced. he has been given a pacifier. he has had too much excitement. his mother has eaten the wrong food. chapter xv the nursing mother and her babe happy is the mother, and thrice blessed is the babe when he is able to enjoy the supreme benefits of maternal nursing. the benefits to the child are far reaching; he stands a better chance of escaping many infantile diseases; the whole outlook for health--and even life itself--is greatly improved in the case of the nursing babe, as compared with the prospect of the bottle-fed child. maternal nursing lays the foundation for sturdy manhood and womanhood. out of every one hundred bottle-fed babies, an average of thirty die during the first year, while of the breast-fed babies, only about seven out of every one hundred die the first year. at the same time, nursing the babe delivers the mother from all the work and anxiety connected with the preparation of the artificial food, the dangers and risks of unclean milk, and the ever-present fear of disease attendant upon this unnatural feeding. the mother who nurses her child can look forward to a year of joy and happiness; whereas, if the babe is weaned, she is compelled to view this first year with many fears and forebodings. mother's milk contains every element necessary for the growth and development of the child, and contains them in just the proportions required to adapt it as the ideal food for that particular child. a dirty baby, properly fed, will thrive. a baby deprived of fresh air, but wisely fed, will survive and even develop into a strong healthy man or woman. but the baby raised according to the latest and most approved rules of sanitation and hygiene, if improperly fed, will languish and die. hygiene of nursing mothers _outings and exercise._ it is most highly important that the nursing mother should be able thoroughly to digest her food; otherwise the flow of milk is likely to contain irritants that will disturb the baby's digestion, even to the point of making him really sick. in order to avoid these complications, exercise and outings are absolutely essential for the mother. a vigorous walk, gardening, light housework or other light athletics, greatly facilitate digestion and increase the bodily circulation, as well as promote deep breathing, all of which are of paramount importance to a good appetite and good digestion. _the bowels._ the bowels should move regularly and normally once or twice during the twenty-four hours. unfortunately, this is not usually the case: and in this connection we would refer our reader to the chapter on "the hygiene of pregnancy," particularly those sections relative to the care of the bowels, recipes for bran bread, lists of laxative foods and other suggestions pertaining to the hygiene of the nursing mother. _sleep._ nothing less than eight hours sleep will suffice for the nursing mother, and during the day she should take at least one nap with the baby. _care of the skin._ salt-rub baths are very beneficial taken once a week. the daily cold-friction rub described elsewhere, will tone up the system and increase digestion and improve the general well being. the soap wash may be taken once a week. the thorough cleansing of the breasts, and the frequent changing of the undergarments, will help to keep the baby happy; for oftentimes it is the odor of perspiration as well as the smell of soiled clothing that spoils the appetite of the baby, causing it to refuse food. _recreation._ pleasant diversion is very essential for the mother, and should be indulged in at least once a week. the bedtime hours, however, should not be interfered with and the recreation should be selected with a view to amuse, refresh and create a harmless diversion for the mother's mind. under no circumstances should the mother settle down to the thought: "no, i can't go out any more. i can't leave my baby." you should get away from the baby a short time each day, and go out among your former friends and acquaintances. many a wrecked home--a shattered domestic heaven--dates its beginnings back to the days when the over-anxious young mother turned her back on her husband and looked only into the face of her (their) child. nothing should come in between the filial friendship of husband and wife, not even their child. so, dear mother, if you can, go out occasionally, away from the baby, and enjoy the association of your husband and keep in touch not only with his interests, but with the outside world. you will come back refreshed and wonderfully repaid, and the face of the adored infant will appear more beautiful than ever. diet of the nursing mother the general suggestions on diet which we made to the expectant mother are also valuable for the nursing mother. the food should be appetizing, nutritious, and of a laxative nature. three meals should be eaten: one at seven a. m., one at one p. m. and one about six-thirty at night, with the heaviest meal usually at one p. m. as the mother usually wakens at five o'clock, or possibly earlier, she should be given a glass of milk, cocoa, or eggnog. if she awakens at six, nothing should be taken until the breakfast, which should consist of a good nourishing meal, such as baked potatoes with white sauce, poached eggs, cereal, milk or cocoa, prunes, figs, or a baked sweet apple, with bread and butter, etc. from that hour until one p. m. only water is taken, and several glasses are urged during this interval. with nothing between meals but water and a little outdoor exercise, a good appetite is created for the one p. m. meal which should abundantly supply and satisfy the hungry mother; and then again, nothing is to be taken between dinner and supper but water. and after the supper hour, a walk out into the cool night air should be enjoyed with the husband and on going to bed about ten p. m., an eggnog or glass of milk may be taken. at the close of the other meals a cup of oatmeal gruel or milk or any other nourishing liquid may be enjoyed. the eating of food or the drinking of nourishing drinks between the meals not only interferes with digestion and disturbs the mother, but it also upsets the baby; and it is often the reason why the appetite of the mother is so deranged at the meal time, her spirits depressed, and her milk diminished. plenty of good nourishing food, taken three times a day with an abundance of water drinking between the meals, together with a free happy frame of mind occasioned by the recreation before mentioned, usually produces good milk and plenty of it. a nap between meals will probably produce more milk than eating between meals. objectionable foods all foods that cause indigestion in the mother or babe should be avoided. some mothers continue to eat tomatoes, peaches, sour salads, acid fruits, and it appears in no way to interfere with baby's comfort; but they are the exception rather than the rule. usually tomatoes, acid salad dressings, and mixed desserts must be avoided. each mother is a law unto herself. certainly none of our readers will selfishly continue any food she feels will make her baby cry. all acid fruits, rich desserts, certain coarse vegetables, concoctions of all descriptions such as rarebit, condiments, highly seasoned sauce, etc., should be avoided. acid fruitades, such as lemonade, limeade and orangeade, can be taken by a small per cent of nursing mothers; and, since fruit acids are neutralized and alkalized in the process of digestion and assimilation, and since they are the very fruit-drinks we prescribe for patients suffering with an increased acidity, it would appear that they were in every way wholesome for the mother--if they in no way interfere with the baby. practically, they do as a rule disturb the baby's digestion and should be avoided by those mothers who have found this to be the case. caked breasts during the first week of lactation the milk tubes of the breasts very often become blocked and the breasts become engored with milk, this condition being known as "caked breasts." at this particular time of the baby's life, he takes little more than an ounce of milk at a feed; so, beside the incoming engorgement of milk, an additional burden is thrown upon the milk tubes of the breasts in that they are not entirely emptied each nursing time by the young infant. when the breasts threaten to "cake," immediate steps must be taken to relieve the condition--to empty the breasts--and this is usually accomplished in the following manner: with hands well lubricated with sweet oil or olive oil the nurse begins gentle manipulation of the breasts toward the nipple in circular strokes, with the result that the milk soon begins to ooze out. this massage should be continued until relief is obtained; or the breast pump may be applied. hard nodules should not be allowed to form or to remain in the breasts. hot compresses (wrung from boiling water by means of a "potato ricer") may be applied to the caked breast which is protected from the immediate heat by one thickness of a dry blanket flannel. these hot compresses should be removed every three minutes until three have been applied, then an ice water compress is quickly applied, to be followed by more hot ones and then a cold; and so on, until as many as four sets each have been administered. gentle massage may again be administered and it will be found that they empty now with greater ease because of the preceding heat. after the breasts have been emptied, and thoroughly washed with soap suds and carefully dried, they should be thickly covered with cotton batting and firmly compressed against the chest wall by a snug-fitted breast binder, which serves the double purpose of relieving pain by not allowing the breasts to sag downward, at the same time preventing an over-abundant secretion of milk by diminishing the blood supply to the glands of the breast. in case the persistent manipulation of the breast and the use of the breast pump do not relieve the condition, and if the repeated effort day after day seems to avail nothing; then, as a rule, we must look for a breast abscess to follow if the breasts are not immediately "dried up." in all such cases of engorgement, the attending physician should be notified at once. sore nipples the nipple must be kept _dry_ between nursings, which should be limited to twenty minutes. regularity should be maintained. the nipples should never be touched or handled by hands that have not been scrubbed with soap and a nail brush. during the early nursing days they are wet much of the time and are subject to much stress and strain in the "pulling effort" of the baby, as a result of which they become very tender, chapped, cracked, and often bleed. allowing the baby to go to sleep with the nipple in his mouth also exposes the nipple to unnecessary moisture which increases the possibility of painful cracking. the pain occasioned by nursing at this time is truly indescribable, and is most often the cause of absolute refusal on the part of the mother to nurse her babe--with the result that it is put on the bottle. again, the fear and dread of being hurt so often tends to diminish the flow of milk. it is entirely possible so to prepare the nipple for this exposure, during the last months of pregnancy, that all this discomfort and pain may be entirely avoided (see chapter, "the hygiene of pregnancy"). before the mother is put to rest after the birth of the baby the breasts are prepared as follows: a thorough cleansing with soap and water is followed by a careful disinfection with alcohol which leaves the nipple perfectly dry. a soft sterile pad is then applied and held in place by a breast binder. before and after each nursing the nipple and surrounding area is swabbed with boracic acid (saturated solution) and carefully dried by applying a clean, dry, sterile pad. painful cracks and fissures are nearly always due to lack of the care described above, and are almost wholly preventable. when the first crack appears and nursing becomes painful, the baby's mouth should not touch the nipple again until healing has taken place. a thorough cleansing with boiled water should be made and then the sterile nipple shield should be applied through which baby will get abundant satisfaction, while the mother is spared the pain, and the nipple has an opportunity to get well. in the case of sore and cracked nipples, thorough cleansing with boiled water and boracic acid solution follows each nursing seance; and, after careful drying, balsam peru--equal parts with glycerine--may be applied with a tiny piece of sterile gauze or cotton; a sterile cotton pad is then applied to each breast which is held in place by a breast binder. the nipple shield, when employed, is boiled after each nursing and washed in boracic acid solution just before each nursing. the strictest cleanliness must be observed, and then we hope to bring relief and comfort to the mother, and effect the saving of nature's best food for the baby. constituents of mother's milk mother's milk--that wonderfully adaptable, ever-changing food, so accurately and scientifically suited to the hourly and daily needs of the growing child--is composed of five different parts, totally unlike in every particular, and each part exactly suited to the needs which it supplies. the cream of the milk, as well as the lactose or sugar, builds up the fatty tissues of the body as well as helps provide the energy for crying, nursing, kicking, etc. the proteins (the curd of the milk) are exceedingly important; they are especially devoted to building up the cells and tissues of the body of the growing child. the salts form a very small part of the baby's food, but an important one, for they are needed chiefly for the bones and the blood. the fats, sugars, proteins, and salts, taken together, form the solids of mother's milk, and are held in solution in the proportion of thirteen parts of solids to eighty-seven parts of water; which so holds these solids in solution that the baby can digest and assimilate these necessary food elements. the mother's milk increases in strength day by day and month by month as the baby grows, and is the only perfect infant food on earth. the time of the first feeding soon after the birth of the baby the wearied mother seeks rest--she usually falls into a quiet, restful slumber; the baby likewise goes to sleep and usually does not awaken for several hours. after six or eight hours the child is put to the breast and he begins to nurse at once, without any special help. this first nursing should be discontinued after four or five minutes, while he is put to the other breast for the same length of time. if there is difficulty in sucking, a bit of milk may be made to ooze out on the clean nipple, while the baby's lips are pressed to it, after which the nurse gently presses and rubs the breasts toward the nipple. after the nursing, the nipples should be elongated, if necessary, by rubbing, shaping, or breast pump. the baby gets but little nourishment during the first two days, but that which he does get is essential; for the colostrum--the first milk--is highly laxative in nature and serves the important purpose of cleaning out the intestinal tract of that first tarry, fecal residue, the meconium. this early sucking of the child accomplishes another purpose besides the obtaining of this important laxative--it also reflexly increases the contractibility of the muscles of the womb, which is an exceedingly important service just at this time. should the mother or caretaker feel that baby will starve before the milk comes, or that it is necessary to provide "sweetened water;" let us assure them that nothing is needed except what nature provides. nature makes the babe intensely hungry during these first two days, so that he will suck well, and if he is fed sweetened water, gruel, or anything else, he will not suck forcefully; and so nature's plan for securing extra or increased uterine contractions and the stimulation of the breast glands will be seriously interfered with. water drinking as soon as the new born babe is washed and dressed he is given two teaspoons of warmed, boiled water; and this practice is continued every two hours during the day, until as much as two to four ounces of unsweetened water is taken by the tiny babe during the twenty-four hours. inanition fever--the fever that sometimes follows a failure to give water to the new born infant--is thus avoided. the bottle from which the water is given should be scalded out each time, the nipple boiled, and just before the "water nursing" the nipple should be swabbed with boracic acid solution. regularity in feeding from earliest infancy the baby should be nursed by the "clock," and not by the "squawk." until he reaches his sixth-month birthday, he is fed with unerring regularity every three hours during the day. asleep or awake he is put to the breast, while during the night he is allowed to sleep as long over the three-hour period as he will. babies are usually nursed at night: during the early weeks, at nine o'clock in the evening, at midnight, and at six o'clock in the morning. after four months all nursing after ten p. m. may be omitted. the baby is ordinarily allowed to remain at the breast for about twenty minutes. he may often be satisfied with one breast if the milk is plentiful; if not, he is given both breasts; and may we add the following injunction? insist that nothing shall go into your baby's mouth but your own breast milk and warm or cool-boiled water; no sugar, whiskey, paregoric, or soothing syrup should be given, no matter how he cries. never give a baby food merely to pacify him or to stop his crying; it will damage him in the end. more than likely he is thirsty, and milk to him is what bread and meat are to you, neither of which you want when you are thirsty. position of mother during the nursing a perfectly comfortable position during nursing for both mother and babe is necessary for satisfactory results. during the lying-in period the mother should rest well over on her side with her arm up and her hand under her head, the other hand supports the breast and assists in keeping the nipple in the baby's mouth, as well as preventing the breast from in any way interfering with baby's breathing. a rolled pillow is placed at the mother's back for support. after the mother leaves the bed, she will find a low chair most convenient when nursing the baby, and if an ordinary chair be used, she will find that a footstool adds greatly to her comfort. once during the forenoon and once during the afternoon the nursing mother will find it a wonderful source of rest and relaxation if she removes all tight clothing, dons a comfortable wrapper, and lies down on the bed to nurse her babe; and as the babe naps after the feed, she likewise should doze and allow mother nature to restore, refresh, and fit her for restful and happy motherhood. worry, grief, fatigue, household cares, loss of sleep, social debauches, emotional sprawls--all debilitate the mother, and usually decrease the flow of milk. nursing when angry and overheated overheating, irritability, and sudden anger, almost invariably tend to raise the blood-pressure, which means the entry into the blood stream of an increased amount of epinephrin, which disturbs the baby greatly, often throwing him into convulsions or other sudden, acute illness. menstruation often interferes with the nursing mother, the milk becoming weaker at this time; however, if the infant continues to gain and the mother feels comparatively well, no attention need be paid to this fact. another pregnancy demands a drying up of the breast at once, as the tax is too great on the mother. the stools the stools of the breast-fed baby do not require as much attention as those of the bottle-fed child. in cases of constipation, after four months, from one teaspoon up to one-half cup of unsweetened prune juice may be given one hour before the afternoon feed. in instances of colic with signs of fermentation in the stool, the mother may take several doses (under her physician's orders) of common baking soda; or, if she is constipated, calcined magnesia will usually right the condition. nature's mother milk is so beautifully adapted to the baby's needs that it is the rule for baby to have perfectly normal stools. symptoms of successful nursing a happy baby is a satisfied baby. he lies quietly in a sleepy, relaxed condition if he has enough to eat, provided he is otherwise comfortable and dry. he awakens at the end of two hours and perhaps cries; but plain, unsweetened, warm, boiled water quenches his thirst, and he lies content for another hour, when he is regularly nursed. he gains on an average of about one ounce a day. earmarks of unsuccessful nursing constant discomfort, vomiting, fretful crying, passing and belching of gas, colicky pain, disturbed sleep, greenish stools with mucus, are among the more prominent earmarks of unsuccessful nursing. these symptoms appearing in a pale, flabby, listless, indifferent or cross baby, with steady loss of weight continued over a period of three or four weeks, point to "nursing trouble;" which, if not corrected, will lead to that much dreaded infantile condition--malnutrition. bolting of food or overeating results in vomiting and gas, and thus interferes with normal nursing, as also may tongue-tie. a condition in the mouth, medically known as "stomatitis," and commonly known as "thrush," often gives rise to a fretful cry when nursing is attempted. in the first place, the baby cannot "hold on" to the nipple; while, in the second place, it hurts his inflamed mouth when he makes an effort to nurse. long continued nursing covering three-fourths of an hour or more, seizing of the nipple for a moment and then discarding it, apparently in utter disgust, are the earmarks of very scanty milk supply and should receive immediate attention. aids to the milk supply believing that many more mothers than do so should nurse their babies, we have carefully tabulated a number of aids to the milk supply, which we hope will be most earnestly tried before the baby is taken from the breast--for so many, many more bottle-fed babies die during the first year than the breast fed. the dangers of infection, the worry of the food preparation, the uncertainty of results, all call for a most untiring effort on the part of every doctor, nurse, and mother, in their endeavors to secure maternal nursing. the following is a summary of "aids to the milk supply:" 1. regular periodical sucking of the breasts from the day of baby's birth. 2. systematic applications of alternate hot and cold compresses, followed by massage to the breasts. 3. three good nourishing meals each day, eaten with merriment and gladness of heart. 4. a glass of "cream gruel," milk, cocoa, or eggnog at the close of each meal, with a glass just before retiring. 5. three outings each day in the open air. 6. nurse the baby regularly and then turn its care over to another, you seek the out of doors and engage in walking, rowing, riding and other pleasurable exercise. 7. take a daily nap. 8. you can bank on fretting and stewing over the hot cook stove to decrease your milk. it seldom fails to spoil it. 9. regular body bathing, with cold friction rubs to the skin. 10. a happy, carefree mental state. nothing dries up milk so rapidly as worry, grief, or nagging. 11. the administration, preferably in the early days, of desiccated bovine placenta; although it may be given at any time during the period of nursing. when the baby should not be nursed as much as we desire maternal nursing for the babe, there do occur instances and conditions which demand a change to artificial feeding, such as the following: 1. a new pregnancy. 2. mothers with uncontrollable tempers. 3. cases of breast abscess. 4. prolonged illness of the mother with high fever. 5. wasting diseases such as tuberculosis, bright's disease, heart disease, etc. 6. maternal syphilis. 7. when maternal milk utterly fails, or is wholly inadequate. when a maternal anesthetic is to be administered, or in case of inflammation of the breast or during a very short illness not covering more than two or three days, then the breast pump may be used regularly every three hours to both breasts; the baby may be artificially fed and then returned to the breast after the effects of the anesthetic has worn off or the temperature has been normal for twenty-four hours. there may also appear definite indications in certain children which make it imperative that the nursing child should early be weaned. these manifestations of disordered nutrition and failing health admonish us to put the baby on properly modified milk, or to transfer it to a wet nurse. these conditions are: 1. progressive loss in weight. 2. a bad diarrhea of long standing; one which does not yield to the usual remedies, at least not as long as the baby continues to feed from the breast. these diarrheas are especially serious when accompanied by a steady loss in weight. 3. excessive vomiting accompanied by progressive loss in weight. the wet nurse because of the rarity of good, healthy wet nurses, it is always better to attempt to feed the baby with scientifically modified milk (not proprietary foods), good, clean, cow's milk properly modified to suit the weight and age of the child. we put weight first, for we prepare food for so many pounds of baby rather than for the number of months old he is. if modified food has failed and the best specialist within your reach orders a wet nurse; she must have the following qualifications: 1. she must be free from tuberculosis and syphilis. 2. she should be between twenty and thirty years of age. 3. she should abstain from all stimulants. 4. she should be amiable, temperate, and should sense her responsibility. if an unmarried mother of her first child is engaged as a wet nurse, she should not be "stuffed" or allowed to overeat, which is commonly the result of moving her from her lower life into more comfortable surroundings, or given ale or beer to increase her milk. she should continue her normal eating, take light exercise, which does not mean the scrubbing of floors or doing the family washing, and live under the same hygienic regime outlined for the nursing mother. should she be the mother of the second or third illegitimate child, then she is quite likely to be mentally deficient and she should not be engaged. her own babe will have to be fed artificially as very few mothers can endure the strain of two suckling children. the baby's own mother should keep general supervision and not turn her babe entirely over to the care of the wet nurse. remember always that no one in the wide world will ever take the same mother interest in your offspring that can spring from your own mother heart. chapter xvi the bottle-fed baby in taking up the subject of the bottle-fed baby, we must repeat that the only perfect baby food on earth is the milk that comes from the breast of a healthy mother. but sudden illness, accident, chronic maladies, or possibly the death of the mother, often throw the helpless babes out into a world of many sorts and kinds of artificial foods--foods that are prepared by modifying cow's, ass', or goat's milk; foods arranged by the addition to the milk of various specially prepared cereals, albumens or malted preparations, otherwise known as "proprietary foods." we shall endeavor, then, in this chapter and in that on "the feeding problem," to lay down certain general suggestions to both the nurse and the mother, which may assist them in their effort to select the food which will more nearly simulate nature's wondrous mother-food, and which will, at the same time, be best suited to some one particular baby. the hourly schedule the normal baby, from birth to six months, should receive properly prepared nourishment every three hours, beginning the day usually at six a. m., the last feeding being at nine p. m. during the early weeks an additional bottle is given at midnight, but this is usually discarded at four months, at which time the last feeding should be given at about ten instead of at nine at night. should the baby continue to awaken during the night before six in the morning, unless he is under weight, a bottle of warm, boiled, unsweetened water should be given. quantity of food the quantity of food to be given is always determined by the size of the baby's stomach, which, of course, depends somewhat upon the age of the child; for instance, the stomach of the average baby one week old holds about one ounce, while at the age of three months the stomach holds five ounces; so it would not only be folly to give two ounces at one week and seven ounces at three months, but it would also be very detrimental to the babe, causing severe symptoms due to the overloading of the stomach. careful study of the size of the stomach at different ages in infancy, together with the quantity of milk drawn from the breast by a nursing baby, has led to the following conclusions regarding the capacity of the baby's stomach: age quantity 1--4 weeks 1--2 ounces 4 weeks--3 months 2½--4 ounces 3 months--6 months 4--6 ounces 6 months--1 year 6--8 ounces refrigerator necessity it is highly important that the day's feedings be kept in a cold place, free from the odors of other foods as well as free from dust, flies, and filth. in order that this may be accomplished, the well-protected bottles, each containing its baby-meal, are placed in a covered pail containing ice and water. this covered receptacle is now put in an ice box; and, in order that our most economical reader--one who may feel that she cannot afford to keep up the daily expense of the family refrigerator--may herself prepare a simple home refrigerator, the following directions are given (fig. 9). homemade ice box procure a wooden box about eighteen inches square and sixteen or eighteen inches deep and put four inches of sawdust into the bottom; now fill in the space between a ten-quart pail, which is set in the middle of the box with more sawdust. a cover for the box is now lined with two or three inches of newspaper, well tacked on, and is fastened to the box by hinges. we are now ready for the inside pail of ice, into which is carefully placed the well-protected bottles of milk, all of which is then set into the ten-quart pail in the box. five cents worth of ice each day will keep baby's food cool, clean, and provide protection against the undue growth of germs. [illustration: fig. 9. homemade ice box] preparing the bottle at each feeding hour, one of baby's bottled meals is taken from the ice box and carefully dipped in and out of a deep cup of hot water. a very convenient receptacle is a deep, quart aluminum cup, which may be readily carried about. the hot water in the cup should amply cover the milk in the bottle (fig. 10). to test the warmth allow a few drops to fall on the inner side of the arm, where it should feel quite warm, never hot. a baby's clean woolen stocking is now drawn over the bottle, which keeps it warm during the feeding. no matter how great the danger of offending a fond grandparent or a much adored friend never allow anyone to put the nipple in her mouth to make the test for warmth of baby's food. there are many contrivances, both electrical and alcoholic, for heating baby's bottle, many of which are both convenient and inexpensive. position during feeding and now we realize that we are about to advise against the time-honored injunction which has been handed down from "grandma this" and "mother that" to all young mothers who have lived in their neighborhoods: "my dear young mother, if you can't nurse your precious infant, you can at least 'mother it' at the nursing time by holding it in your arms and gently rocking it to and fro as you hold the bottle to its lips." this so-called "mothering" has resulted in regurgitation, belching, and numerous other troubles, as well as the formation of the "rocking habit." a young mother came running into my office one day saying: "doctor, it won't work, the food's all wrong; my baby is not going to live, for he throws up his food nearly all the time." we arranged to be present when the next feeding time came and watched the proceedings. a dear old friend had told her "she must 'mother' her baby at the nursing time," and so she had held the child in a semi-upright position as she endeavored to hold the bottle as near her own breast as was possible. the hole in the nipple was a bit large, which occasioned the subsequent bolting of the food, and then to continue the "mothering" she swayed him to and fro, all of which was interrupted suddenly by the vomiting of a deluge of milk. [illustration: fig. 10. heating the bottle] i drew the shade in an adjoining room, opened the windows, and into a comfortable carriage-bed i placed the baby on his side. seating myself beside him i held the warm, bottled meal as he nursed. several times i took it from his mouth, or so tipped it that "bolting" was impossible. gradually, carefully, and slowly, i took the empty bottle away from the sleepy babe, and as i closed the door the mother said in anxious amazement: "he won't forget i'm his mother if i don't hold him while he nurses?" you smile as i smiled at this girl-mother's thought; but, nevertheless there are many like her--anxious, well-meaning, but ignorant. the infant stomach is little more than a tube, easily emptied if the baby's position is not carefully guarded after nursing. no bouncing, jolting, patting, rocking, or throwing should take place either just before, during, or immediately after meals. time allowance for one feeding from twelve to twenty minutes is long enough time to spend at a bottle meal. the nipple hole may have to be made larger, or a new nipple with a smaller hole may have to be purchased. when new, you should be able to just see a glimmer of light through the hole, and if the infant is too weak to nurse hard, or the hole too small, it may be made larger by a heated hatpin run from the inside of the nipple out; great care must be taken, else you will do it too well. if the nipple hole is too large, bolting is the sure result; while too small a hole results in crying and anger on the part of the hungry child, because he has to work too hard to get his meal. after the feed we have seen some mothers, in their anxiety to prevent the sucking in of air from the emptied bottle, rush in and jerk the nipple from the going-to-sleep babe so forcibly that all thoughts of sleep vanished and a crying spell was initiated. the tactful mother is the quiet one who slowly, quietly, draws the empty bottle with its "much loved nipple" from the lips. if you observe that the babe is going to sleep, with an occasional superficial draw at the nipple, wait a moment; he will drop it himself, and you can pick it up as you quietly leave the room. in all instances, whether it be indoors or out of doors, arrange the babe in a comfortable sleeping position, remembering that nursing is warm exercise and the babe gets uncomfortably sweaty if overbundled, especially about the head and neck. no one should unnecessarily touch the babe immediately after feeding; even his diaper may be changed without awakening him while he is thus lying quietly in his bed. intervals between meals the three-hour interval is reckoned from the beginning of the meal, and not from its close. more than two hours is spent in the stomach digestion, and any food or sweetened water which may enter between meals only tends to cause indigestion and other disturbances. and that this important organ may have a bit of rest, we fix the interval at three hours, which in our experience and that of many other physicians, has yielded good results. as a rule we have no regurgitation and no sour babies on the three-hour schedule. sick babies, very weak babies, and their feeding time, will be discussed in a later chapter. additional foods at six months, and often as early as four, in cases of constipation, unsweetened, well-strained prune juice may be given, beginning with one-half teaspoon one hour before the afternoon feed and increasing it daily until two tablespoons are taken. at six months, both orange juice and vegetable broths are given, whose vegetable salts add a very important food element to the baby's diet--an element which our grandmothers thought could only be obtained through the time-honored "bacon rind" of by-gone days. orange juice is also unsweetened and well strained, and is administered in increasing amounts, beginning with one-half teaspoon one hour before the afternoon feeding, until the juice of a whole orange is greedily enjoyed by the time of the first birthday. the vegetable juices are obtained from cut-up spinach, carrots, tomatoes, and potatoes, strained, with a flavor of salt and onion--really a bouillon--and is given just before the bottle at the six p. m. feeding. they are also begun in teaspoon amounts. food for the traveling babe baby travel should be reduced to a sheer necessity; never should the babe be subjected to the exposure of disease germs, the change of food, the possibilities of draughts and chilling, for merely a pleasure trip--the risks are too great and the possibilities of future trouble too far reaching. if you are in touch with the milk laboratory of a large city, you will find that they make a specialty of preparing feedings which are good for a number of days for the traveling baby, and we strongly advise that their preparations be accepted; but in the event of not being in touch with such a laboratory we suggest the making of a carrying ice-box covered with wicker, which must be kept replenished with ice. food kept in such a device may be kept fresh for twenty-four to forty-eight hours. plans other than the laboratory preparations or the ice-box are risky, and should not be depended upon. many of our railway dining cars now pick up fresh, certified milk at stations along the line for use on their tables, and where such is the case fresh preparations of milk may be made on a trans-continental trip by the aid of an alcohol stove. malted milk may also be used, provided you have accustomed the baby to its use a week before leaving home, by the gradual substitution of a fourth to a half ounce each day in the daily food; all of which, of course, should be done under your physician's direction. if possible, leave baby at home in his familiar, comfortable environment in the care of a trained nurse and a trusted relative, and under the supervision of the baby's own physician. he is much better off, much more contented, and we are all aware of the fact that contentment and familiarity of sights and people promote good appetite, good digestion, and happiness--the very essentials of success in baby feeding. we speak touchingly and sympathetically to the mother who must leave her babe; and likewise we wish to cheer her as we remind her that by wireless messages and night letters it is possible to keep in touch with loved ones though a thousand miles away. the sanitation and modification of cow's milk, as well as stools, etc., are taken up in later chapters. rules for the bottle-fed 1. never play with a baby during or right after a meal. 2. lay the baby on his side when nursing the bottle. 3. three full hours should intervene between feedings. 4. don't give the food too hot--it should just be warm. 5. make the test for warmth on the inner side of your arm. 6. give a drink of water between each meal if awake. 7. never save the left-overs for baby. 8. if possible, give three feedings each day in the cool air, with baby comfortably warm. 9. do not jump, bounce, pat, or rock baby during or after meals. 10. never coax baby to take more than he wants, or needs. 11. no solid foods are given the first year. 12. orange juice may be given at six months; while, after four months, unsweetened prune juice is better than medicine for the bowels. chapter xvii milk sanitation cow's milk, like mother's milk, is made up of solids and water. in a previous chapter we learned that in one-hundred parts of mother's milk, eighty-seven parts were water and thirteen parts were solid. these thirteen parts of solids consist of sugar, proteins, and salts; this is likewise the case with cow's milk, except that in the case of the cow's milk, the sugar is decreased while the proteins are increased as will be noted by the accompanying comparative analysis: mother's milk fat % 4.00 sugar 7.00 proteins 1.50 salts 0.20 water 87.30 ----- % 100.00 cow's milk fat % 4.00 sugar 4.50 proteins 3.50 salts 0.75 water 87.25 ---- % 100.00 mother's milk is absolutely sterile, that is, free from the presence of germs; on the other hand, cow's milk is anything but sterile--the moment it leaves the udder it begins to accumulate numerous bacteria, all of which multiply very rapidly. cow's milk is generally twenty-four to forty-eight hours old before it can possibly reach the baby. it is just as important to keep in mind these facts of milk contamination--dirt, filth, flies, and bacteria--as it is to plan for the modification of cow's milk for the purpose of making it more nearly resemble mother's milk. while mother's milk has about the same percentage of fat as cow's milk, it is almost twice as rich in sugar, and has only one-fourth to one-third as much protein. this protein is vastly different from that found in cow's milk, which you recall has a tough curd, as seen in cottage cheese. while mother's milk contains a small amount of casein similar to that found in the cheese of the cow's milk, the principal protein constituent is of another kind (lactalbumin), and is much more easy of digestion than the casein of cow's milk. this is a most important point to remember, because the baby's stomach is not at first adapted to the digestion of the heavier and tougher protein curds of cow's milk. it requires time to accustom the infant stomach to perform this heavier work of digestion. there are a number of factors which must be borne in mind in the modification of milk, whether it be cow's milk, or goat's milk (for many european physicians use goat's milk entirely in the artificial feeding of infants): namely, the cleanliness of the milk, the acidity of milk, the difference in the curd, the percentage of sugar, and the presence of bacteria. sugar in the modification of cow's milk, sugar must be added to make up for the sugar which is decreased when the water was added to reduce the protein. there are several sorts of sugar used in the modification of milk. these sugars are not added to sweeten the milk alone, but to furnish a very important element needed for the growth of the baby. sugar is the one element which the infant requires in the largest amount. milk sugar is probably most universally used in the modification of milk, but a good grade of milk sugar is somewhat expensive, costing from thirty to sixty cents a pound, and this places it beyond the reach of many mothers. it is added to the food mixtures in the proportion of one ounce to every twenty ounces of food. cane sugar (table sugar) may also be used, but it must be clean and of good quality. it is used in rather less quantity than that of milk sugar, usually from one-half to one-third of an ounce by measure to each twenty ounces of food. dextri-maltose (malt sugar) is very easy of digestion and may be used in the modification of milk. maltose seems to help the children to gain more rapidly in weight than when only milk or cane sugar is used. it is also exceedingly useful in constipation, as its action is more laxative than any of the other sugars; but it should not be given to children who vomit habitually or have loose stools. acidity like mother's milk, the cow's milk is neutral as it comes from the udder; but, on standing, it quickly changes, soon becoming slightly acid, as shown by testing with blue litmus paper. in fact, what is known as ordinarily fresh milk, if subjected to the litmus paper test, always gives an acid reaction. this acidity is neutralized by adding lime water to the formula in the proportion of one ounce to each twenty-ounce mixture. ordinary baking soda is sometimes prescribed by physicians in place of the lime water. in the event of obstinate constipation, milk of magnesia is sometimes added to the day's feedings. cream there may be procured in any large city an instrument called the cream gauge, which registers approximately (not accurately) the richness of milk. some milk, even though rich, parts with its cream very slowly; while some poor milk allows nearly all the cream quickly to rise to the surface. we know of no way for the mother to determine the amount of cream (without the cream gauge) except by the color and richness of the milk. in cities it is very convenient to send a specimen of the milk to the laboratories to be examined by experts, who will gladly render a report to both physician and mother. the lactometer is a little instrument used to estimate the specific gravity of milk. an ordinary urinometer such as used by physicians in estimating the specific gravity of urine may also be used. the specific gravity of cow's milk should not register below 1028 or above 1033. [illustration: fig. 11. a sanitary dairy _courtesy of lakewood farm_ _courtesy of lakewood farm_] herd milk milk from a single cow is not to be desired for baby's food because of its liability to vary from day to day, not to mention the danger of the cow's becoming sick. authorities have agreed that herd milk of holstein or ordinary grade cows is best for infant feeding. this mixed-herd milk contains just about the proper percentage of fat; whereas, if jersey milk must be used, some of the cream should be taken away. our milk should come from healthy cows which have been tested for tuberculosis at least every three months. annatto is sometimes added to milk to increase its richness of color. to test for annatto proceed as follows: to a couple of tablespoons of milk add a pinch of ordinary baking soda. insert one-half of a strip of filter paper in the milk and allow it to remain over night. annatto will give a distinct orange tint to the paper. the commonly used milk preservatives are boracic acid, salicylic acid, and formaldehyde, any of which may be readily detected by your health officials. sanitary dairies in close proximity to most large cities there is usually to be found one or more sanitary dairies. it is a joy indeed to visit a farm of this kind with its airy stables and concrete floors, which are washed with water coming from a hose. the drainage is perfect--all filth is immediately carried off (fig. 11). the cows are known to be free from tuberculosis, actinomycosis (lumpy jaw), and foot and mouth disease. the milkmen on this farm wear washable clothes at the milking time, and their hands are painstakingly cleansed just before the milking hour. previous to the milking the cattle have been curried outside the milking room and their udders have received a careful washing. the milkman grasps the teat with clean hands, while the milk is allowed to flow through several thicknesses of sterilized gauze into the sanitary milking pail. this milk is at once poured into sterile bottles, is quickly cooled and shipped in ice to the substations where the delivery wagon is waiting. in the ideal delivery wagon there are shallow vats of ice in which the bottles are placed, thus permitting the milk to reach the baby's home having all the while been kept at a temperature just above the freezing point. and why all this trouble? why all this worry over temperature and cleanliness? babies were not so cared for in the days of our grandmothers. the old-fashioned way of milking the cows with dirty clothes and soiled hands, while cattle were more or less covered with manure, with their tails switching millions of manure germs into the milking pail, produced a milk laden not only with manure germs--the one great cause of infantile diarrhea--but also swarming with numerous other mischief making microbes. even tuberculosis, that much dreaded disease germ of early infancy, may come from the dairy hands as well as from infected cows. there used to be many dairymen like the old farmer who, when interrogated by the health commissioner concerning the cleanliness of his milk, laughed as he reached down into the bottom of a pail of yellow milk and grabbing up a handful of manure and straw, said: "that's what makes the youngsters grow." but it does not make them grow; it often causes them to die, and even if they do live, they live in spite of such contaminated food, for the germ which is always found in the colon of the cow (_coli communis_), probably kills more babies every year than any other single thing. it is possible to reduce the growth of these germs by keeping the milk at a very low temperature from the time it leaves the cow until the moment it gets to the home refrigerator. those which survive this process of refrigeration may be quickly rendered harmless by pasteurizing or sterilizing at the time of preparing baby's food. in the absence of the modern sanitary dairy, we would suggest that the milk supply be improved by giving attention to the following: the cattle should be tested for tuberculosis every three months. the walls of the cowhouse should be whitewashed three times a year. the manure should be stored outside the barn. the floor of the cowhouse should be sprinkled and swept each day. the cattle should be kept clean--curried each day, and rubbed off with a damp cloth before milking. the udders should be washed before each milking. the milker can wear a clean white gown or linen duster which should be washed every two days, while his hands should be washed just before the milking. the milking pail should be of the covered sanitary order. the barn should be screened. certified milk immediately after leaving the cow, the milk should be cooled to at least 45 f. it should at once be put into bottles that have been previously sterilized and then be tightly covered, and should be kept in ice water until ready for consumption. no matter how carefully the milk is handled, it is infected with many bacteria, but if it is quickly cooled, the increase of the bacteria is greatly retarded. under no circumstances buy milk from a grocery store out of a large can. go to your health officer and encourage him in his campaign for sanitary dairies and certified milk. such milk as we have described under the head of sanitary dairies, when it has been tested by the board of health and has received the approval of the medical profession, is known as "certified milk;" and, although the price is usually fifteen to twenty cents a quart, when compared with the cost of baby's illness it will prove to be cheaper than the dirty milk which sickens and kills the little folks. there is no doubt that the increased use of "certified milk" has been a great factor in the reduction of deaths from infant diarrhea in recent years. boiling the milk when certified milk cannot be had, it is absolutely dangerous to give raw, unboiled, or unpasteurized milk to the baby, particularly in warm weather; for the countless millions of manure germs found in each teaspoon of ordinary milk not only disturbs the baby's digestion, but actually makes him sick, causing colic, diarrhea, and cholera infantum. the only way this milk can be rendered safe is by cooking it--actually killing the bacteria. this process of boiling, however, does not make good milk out of bad milk nor clean milk out of that which is dirty, it simply renders the milk less dangerous. there are two methods of killing bacteria--sterilization and pasteurization. by sterilization is meant the process of rendering the milk germ free by heating, by boiling. many of the germs found in milk are comparatively harmless, merely causing the souring of milk; but other microbes are occasionally present which cause serious diseases, such as measles, typhoid and scarlet fever, diphtheria, tuberculosis, and diarrhea. it is always necessary to heat the milk before using in warm weather, and during the winter it is also important when infectious or contagious diseases are prevalent. milk should be sterilized when intended for use on a long journey, and may be eaten as late as two or three days afterward. to sterilize milk, place it in a well-protected kettle and allow to boil for one hour and then rapidly cool. this process renders it more constipating, and for some children many of its nutritive properties seem to be destroyed, as scurvy is often the result of its prolonged use. when a child must subsist upon boiled milk for a long period, he should be given the juice of an orange each day. children are not usually strong and normal when fed upon milk of this character for indefinite periods. all living bacteria (except the spores or eggs) may be destroyed by boiling milk for one or two minutes. pasteurization when baby is to use the milk within twenty-four hours, "pasteurization" is better than boiling as a method of destroying microbes. there are many pasteurizers on the market which may be depended upon, among which are the walker-gordon pasteurizer, and freeman's pasteurizer; but in the absence of either of these pasteurization may be successfully accomplished by the following method: on the bottom of a large kettle filled with cold water, place an ordinary flatiron stand upon which is put a folded towel. on this place the bottle of milk as it comes from the dairyman, with the cap of the bottle loosened. the cold water in the kettle should come up to within an inch of the top of the bottle of milk. heat this water quickly up to just the boiling point--until you see the bubbles beginning to rise to the top. the gas is then turned down or the kettle is placed on the back of the range and held at this near-boiling point for thirty minutes, after which it is taken to the sink and cold water is turned into the water in the kettle, until the bottle of milk is thoroughly cooled. it is now ready to be made up into the modified food for baby. never let pasteurized milk stand in the room, nor put it near the ice when warm. it must be cooled rapidly, as described above; that is, within fifteen or twenty minutes. the "spores" of the milk are not killed by pasteurization and they hatch out rapidly unless the milk is kept very cold, and, as already stated, it should be used within twenty-four hours after pasteurization. the care of bottled milk the certified milk or the ordinary milk that has been delivered to your home and is to be used without pasteurization or sterilization, should receive the following care: 1. it should be placed at once in a portion of the ice box that is not used to store such foods as radishes, cabbage, meats or any other open dishes of food whose odors would quickly be absorbed by the milk. the milk should never be left standing on the doorsteps in the sun, for many reasons: the sun heats the milk, encourages the growth of bacteria, and a passing cat or dog, whose mouth often contains the germs of scarlet fever, tonsilitis, and diphtheria, should it be hungry, laps the tops of the bottles, particularly in the winter when the cream has frozen and is bulging over the edge. 2. it should never be kept in the warm kitchen, as when visiting her sick baby we discovered one young mother doing. in answer to my question, she explained; "doctor, we do not take ice in the winter time, everything is ice outdoors, so i just set the bottle outside the window bringing it in whenever i need to give the baby some food. i forget to put it out sometimes, but really now, does it matter?" it really matters much, for you see, reader, the milk is first freezing then thawing and it is rendered entirely unfit for the baby. 3. milk should be kept covered and protected from dust and flies; it should be kept in glass jars which have been sterilized by boiling before being filled, and then placed in the refrigerator. if the milk is sour, or if there is any sediment in the bottle, it is unfit for baby's use. chapter xviii home modification of milk in a previous chapter it was found from comparing the analysis of mother's milk with that of cow's milk, that they widely differed in the proteins and sugar. the art of so changing cow's milk that it conforms as nearly as is possible to mother's milk is known as "modification." where protein, sugar, and fat are given in proper amounts, healthy infants get along well; but when either the fats or proteins are given in excess, or when the digestion of the child is deranged, there is often no end of mischief. there are two groups of milk formulas that are useful. first, those in which the fats and proteins are about the same, known as "whole milk," or "straight" milk mixtures; second, those in which the fats are used in larger proportions than proteins, and known as "top milk"--milk taken from the upper part of the bottle after the cream has risen. and since the larger proportion of babies take the lower fats or "whole milk" formulas, and seem to get along better than the babies who have the "top milk" formulas, we will first take up the consideration of the modification of whole milk. preparation for modification to begin with, everything that comes in contact with the preparation of baby's food must be absolutely clean. the table on which the articles are placed, and any towel that comes in contact with the articles or the mother's hands, or those of the nurse, must be thoroughly scrubbed. there is only one way to prepare the utensils that are to be used in making the baby's food, and that is to put them in a large kettle and allow them to boil hard for fifteen minutes just before they are to be used. the articles needed are (fig. 12): 1. as many bottles as there are feedings in one day. 2. a nipple for each bottle. 3. waxed paper for each bottle top. 4. rubber bands for each bottle. 5. a two-quart pitcher. 6. a long-handled spoon for stirring the food. 7. a tablespoon. 8. a fork. 9. an eight-ounce, graduated measuring glass. 10. a bottle of lime water. 11. a fine-mesh, aluminum strainer. 12. a square of sterile gauze for straining the food (should be boiled for fifteen minutes with the utensils). 13. one plate, and later a double boiler (14). 15. the sugar. 16. the milk. 17. ready for the ice box. 18. refrigeration. bottles and nipples there is but one bottle which can be thoroughly washed and cleaned, and that is the wide-mouthed bottle. it should hold eight ounces and should have the scale in ounces blown in the side (fig. 10). the nipple for this bottle is a large, round breast from which projects a short, conical nipple, which more nearly resembles the normal breast than do the old-fashioned nipples so frequently seen on the small-necked nursing bottles. there is a great advantage in this, in that the baby cannot grasp the nipple full length and thus cause gagging. these bottles and nipples are known as the "hygeia," and have proven to be a great source of comfort to the baby as well as to the mother or nurse whose duty it is to keep them clean. there are a number of other nursing bottles on the market, which, if they are used, must be thoroughly cleansed with a special bottle brush each day. the neck is small and the nipple is small and great care must be taken in the cleansing of both of them. care of bottles and nipples when there is a bottle for each individual feeding in the day, immediately after each nursing both bottle and nipple should be rinsed in cold water and left standing, filled with water, until the bottles for one day's feeding have all been used. the nipples should be scrubbed, rinsed, and wiped dry and kept by themselves until their boiling preparation for the following day's feeding. [illustration: fig. 12. articles needed for baby's feeding] if the same bottle is to be used for the successive feedings during the day, it should be rinsed, washed with soap and water, and both bottle and nipple placed in cold water and brought quickly to the boiling point and allowed to boil for fifteen minutes. no bottles or nipples must ever be used after a mere rinsing; boiling, preceded by a thorough washing in soap and water, must take place before they are used a second time. new nipples are often hard and need to be softened, which is readily done by either prolonged boiling or rubbing them in the hands. all new bottles should be annealed by placing them on the stove in a dishpan of cold water and allowing them to boil for twenty minutes, and then allowing them to remain in the water until they are cold. when bottles are treated in this manner they do not break so readily when being filled with boiling water or hot food. preparing the food in a large preserving kettle place all the utensils needed in the preparation of the food--pitcher, spoon, fork, measuring glass, bottles, nipples, cheesecloth for straining, agate cup, wire strainer, in fact everything that is to be used in the preparation of the food. now fill the kettle with cold water and place over the gas and allow to boil for fifteen minutes. on a well-scrubbed worktable place a clean dish towel, and on this put the utensils and the bottles right side up. the nipples on being taken out of the boiling water will dry of themselves; they should be placed in a glass-covered jar until they are needed for each individual feeding, the nipples not being placed on the bottles as they go to the ice box. having been given your formula by your physician, proceed in the following way. suppose we were preparing the food for a normal two-months old baby that weighed ten pounds, with the prescription as follows: baby smith. r_{x} whole milk ounces 11 cane sugar level tablespoons 2 boiled water ounces 12½ lime water ounces 1 amount at each feeding ounces 3½ number of bottles 7 interval between feedings hours 3 details of preparation two level tablespoons of cane sugar are placed in the agate cup and dissolved in a small amount of boiling water. the solution should be perfectly clear, and if it does not clear up put it over the heat for a few moments. this is now turned into the eight-ounce measuring glass which is then filled with boiling water and emptied into the two-quart pitcher. we need four and one-half more ounces of boiling water to complete the prescription requirement of twelve and one-half ounces. the bottle of milk, if properly certified, need not be pasteurized; but if it is not, it should have been previously pasteurized while the utensils were boiling according to the suggestions found in the chapter on "milk sanitation." the top of the milk bottle should be thoroughly rinsed and wiped dry, and after a thorough shaking of the milk, the cover is removed with the sterile fork and eleven ounces are measured out by measuring glass and poured into the pitcher. all is now stirred together with an ounce of lime water, which should never look murky, but should be as clear as the clearest water and should always be kept in the ice box when not in use. the sterile cheesecloth which has been boiled for fifteen minutes is now put over the nose of the pitcher, the contents of which is accurately measured into the seven clean, empty bottles, each containing three and one-half ounces. over the top of each of the nursing bottles is placed a generous piece of waxed paper which is held down by a rubber band. each meal for the day is now contained in a separate bottle, and all are placed in a covered pail of water containing ice, and put in the ice box. if the prescription for the baby's food contains gruel, it is prepared in the following manner: suppose the baby is eight months old and the prescription called for two level tablespoons of flour and eight ounces of boiled water. the two level tablespoons of flour, whether it be wheat (ordinary bread flour), or barley flour, are put into a cup and stirred up with cold water, just as you would stir up a thickening for gravy; now measure out eight ounces of water and allow it to come to a boil in the inner pan of the double boiler, into which the thin paste is stirred until it comes to a boil. after boiling for twenty minutes, remeasure in the measuring glass and what water has been lost by evaporation must be added to complete accurately the prescription requirement of eight ounces; this is now added to the other ingredients of the prescription. table for infant feeding we now offer a monthly schedule--a table which is the result of our experience in feeding hundreds of babies in various sections of chicago. it is not a schedule for the sick baby, but it is a carefully tabulated outline for the normal, healthy, average child ranging from one week to one year in age. in offering this table we remind the mother, if the baby is six months old and not doing well on the food it is getting and a change is desired by both mother and physician, that it is far better to begin with the second or third month's prescription and quickly work up to the sixth month's. this change may often be accomplished in two or three days. in all large cities there are to be found milk laboratories which make it their business to fill prescriptions for the modification of milk under the direction of baby specialists. this milk can be absolutely relied upon. in specialized diet kitchens in many large hospitals, these feeding prescriptions also may be filled. artificial feeding schedule ==========+========+=======+=======+=======+========+=======+========+ age | | | | | | | amount | | baby's | whole | cane | wheat | boiled | lime | at | | weight | milk | sugar | flour | water | water | feeding| ----------|--------|-------|-------|-------|--------|-------|--------| | | | level | level | | | | | pounds |ounces | table-| table-| ounces | ounces| ounces | | | | spoon | spoon | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 1 week | 7½ | 2½ | 1 | | 5 | ½ | 1 | ----------|--------|-------|-------|-------|--------|-------|--------| 2 weeks | 7½ | 4½ | 1½ | | 9 | ½ | 2 | ----------|--------|-------|-------|-------|--------|-------|--------| 3 weeks | 7¾ | 7 | 2 | | 10 | ½ | 2½ | ----------|--------|-------|-------|-------|--------|-------|--------| 4 weeks | 8 | 9 | 2 | | 11 | 1 | 3 | ----------|--------|-------|-------|-------|--------|-------|--------| 2 months | 10 | 11 | 2 | | 12½ | 1 | 3½ | ----------|--------|-------|-------|-------|--------|-------|--------| 3 months | 12 | 15 | 2 | ½ | 15 | 1 | 4½ | ----------|--------|-------|-------|-------|--------|-------|--------| 4 months | 13 | 18 | 2½ | 1 | 13½ | 1½ | 5½ | ----------|--------|-------|-------|-------|--------|-------|--------| 5 months | 14 | 21 | 2½ | 1½ | 13½ | 1½ | 6 | ----------|--------|-------|-------|-------|--------|-------|--------| 6 months | 15 | 23 | 2½ | 1½ | 10½ | 1½ | 7 | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 7 months | 16 | 25 | 2 | 1½ | 8½ | 1½ | 7 | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 8 months | 17 | 27 | 1½ | 2 | 8 | 1½ | 7¼ | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 9 months | 18 | 29 | 1 | 2 | 8 | 2 | 7¾ | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 10 months | 19 | 30 | ¾ | 2 | 8 | 2 | 8 | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 11 months | 20 | 31 | ½ | 2 | 8 | 2 | 9 | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 12 months | 21 | 32 | | | 7 | 2 | 9 | | | | | | | | | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 18 months | 24 | 36 | | | | | 12 | | | | | | | | | ----------+--------+-------+-------+-------+--------+-------+--------+ ==========+=========+==========+=========+==========+======== age | number | interval | | soups | total | of | between | fruit | and | daily |feedings | feedings | juices | broths |calories ----------|---------|----------|---------|----------|------- | | | | | | in 24 | hours | | | | hours | | | | ----------|---------|----------|---------|----------|------- 1 week | 8 | 3 | | | 112 ----------|---------|----------|---------|----------|------- 2 weeks | 7 | 3 | | | 184 ----------|---------|----------|---------|----------|------- 3 weeks | 7 | 3 | | | 267 ----------|---------|----------|---------|----------|------- 4 weeks | 7 | 3 | | | 309 ----------|---------|----------|---------|----------|------- 2 months | 7 | 3 | | | 351 ----------|---------|----------|---------|----------|------- 3 months | 7 | 3 | | | 447 ----------|---------|----------|---------|----------|------- 4 months | 6 | 3 | | | 553 ----------|---------|----------|---------|----------|------- 5 months | 6 | 3½ | | | 628 ----------|---------|----------|---------|----------|------- 6 months | 5 | 4 | one | one | 680 | | |teaspoon |tablespoon| ----------|---------|----------|---------|----------|------- 7 months | 5 | 4 | two | ¼ | 732 | | |teaspoons| cup | ----------|---------|----------|---------|----------|------- 8 months | 5 | 4 |one-half | ¼ | 767 | | | orange | cup | ----------|---------|----------|---------|----------|------- 9 months | 5 | 4 | one | ½ | 854 | | | orange | cup | ----------|---------|----------|---------|----------|------- 10 months | 5 | 4½ | one | ¾ | 875 | | | orange | cup | ----------|---------|----------|---------|----------|------- 11 months | 5 | 5 | one | 1 | 906 | | | orange | cup | ----------|---------|----------|---------|----------|------- 12 months | 5 | 5 | one | 1 cup | | | | orange | arrowroot| 950 | | | | cracker | ----------|---------|----------|---------|----------|------- 18 months | 3 | 6 | toast, gravies, baked | | | potato and apple, etc. ----------+---------+----------+---------+----------+------- note 1 ounce of whole milk equals 21 calories 1 level tablespoon of cane sugar equals 60 calories 1 level tablespoon of milk sugar equals 45 calories 1 level tablespoon of flour equals 25 calories the juice of 1 average orange equals 75 calories 1 cup of average bouillon equals about 100 calories (this table is calculated on the basis of about 45 calories for each pound of baby weight) top-milk formula top milk is the upper layer of milk which has been removed after standing a certain number of hours in a milk bottle or any other tall vessel with straight sides. it contains most of the cream and varying amounts of milk. it may be removed by a small cream dipper which holds one ounce, or it may be taken off with a siphon, but it should never be poured off. to obtain seven per cent top milk which is the one most ordinarily used in the preparation of top milk formulas, we take off varying amounts--according to the quality of the milk--which doctor holt describes as follows: from a rather poor milk, by removing the upper eleven ounces from a quart, or about one-third the bottle. from a good average milk, by removing the upper sixteen ounces, or one-half the bottle. from a rich jersey milk, by removing the upper twenty-two ounces, or about two-thirds the bottle. cream is often spoken of as if it were the fat in milk. it is really the part of the milk which contains most of the fat and is obtained by skimming, after the milk has stood usually for twenty-four hours; this is known as "gravity cream." it is also obtained by an apparatus called a separator; this is known as "centrifugal cream," most of the cream now sold in cities being of this kind. the richness of any cream is indicated by the amount of fat it contains. the usual gravity cream sold has from sixteen to twenty per cent fat. the cream removed from the upper part (one-fifth) of a bottle of milk has about sixteen per cent fat. the usual centrifugal cream has eighteen to twenty per cent fat. the heavy centrifugal cream has thirty-five to forty per cent fat. the digestibility of cream depends much upon circumstances. many serious disturbances of digestion are caused by cream. it is convenient in calculation to make up twenty ounces of food at a time. the first step is to obtain the seven per cent milk, then to take the number of ounces that are called for in the formula desired. one should not make the mistake of taking from the top of the bottle only the number of ounces needed in the formula, as this may be quite a different per cent of cream and give quite a different result. there will be required in addition, one ounce of milk sugar and one ounce of lime water in each twenty ounces. the rest of the food will be made up of boiled water. these formulas written out would be as follows: formula from seven per cent milk i ii iii iv v vi vii viii ix oz. oz. oz. oz. oz. oz. oz. oz. oz. 7 per cent milk 2 3 4 5 6 7 8 9 10 milk sugar 1 1 1 1 1 ¾ ¾ ¾ ¾ lime water 1 1 1 1 1 1 1 1 1 boiled water 17 16 15 14 13 12 11 10 9 -- -- -- -- -- -- -- -- -- 20 20 20 20 20 20 20 20 20 the approximate composition of these formulas expressed in percentages are as follows: formula fat sugar proteins i 0.70 5.00 0.35 ii 1.00 6.00 0.50 iii 1.40 6.00 0.70 iv 1.75 6.00 0.87 v 2.00 6.00 1.00 vi 2.40 6.00 1.20 vii 2.80 6.00 1.40 viii 3.10 6.00 1.55 ix 3.50 6.00 1.75 it is necessary to make the food weak at first because the infant's stomach is intended to digest breast milk, not cow's milk; but if we begin with a very weak cow's milk the stomach can be gradually trained to digest it. if we began with a strong milk the digestion might be seriously upset. usually we begin with number one on the second day; number two on the fourth day; number three at seven to ten days; but after that make the increase more slowly. a large infant with a strong digestion will bear a rather rapid increase and may be able to take number five by the time it is three or four weeks old. a child with a feeble digestion must go much slower and may not reach number five before it is three or four months old. it is important with all children that the increase in the food be made very gradually. it may be best with many infants to increase the milk by only half an ounce in twenty ounces of food, instead of one ounce at a time, as indicated in the tables. thus, from three ounces the increase would be to three and one-half ounces; from four ounces to four and one-half ounces, etc. at least two or three days should be allowed between each increase in the strength of the food. peptonized milk another modification which at times may be ordered by your physician is peptonized milk. since it is infrequent for the proteins of milk to be the cause of indigestion, peptonized milk has only a limited use, chiefly in cases of acute illness. the milk is peptonized in the following manner: place the peptonizing powder (it is procurable in tubes or tablets from the drug store) in a small amount of milk, and after being well dissolved, put into the bottle or pitcher with the plain or modified milk, after which the whole is shaken up together. the bottle is then put into a large pitcher containing water heated to about 110° f. or as warm as would bear the hand comfortably, and left for ten or twenty minutes (if the milk is to be partially peptonized). to completely peptonize the milk, two hours are required. either of these formulas is only used on the advice of a physician. buttermilk in many cases of chronic intestinal indigestion, buttermilk is used in place of the milk. it is prepared as follows: after the cream has been taken from the milk and it has been allowed to come to a boil, it is cooled to just blood heat. a buttermilk tablet, having first been dissolved in a teaspoonful of sterile water, is now stirred into the quart of warmed, skimmed milk and allowed to stand at room temperature for twenty-four hours at which time it should look like a smooth custard. with a sterile whip this is now beaten and is ready for the sugar and the boiled water which is added according to the written prescription from the doctor. condensed milk under no circumstances should condensed milk be used as the sole food of the baby for more than one month. children often gain upon it, but as a rule they have little resistance, and they are very prone to develop rickets and oftentimes scurvy; and, as noted elsewhere, orange juice should always be administered at least once during the twenty-four hours as long as condensed milk is used. of all the brands of condensed milk, those only should be selected which contain little or no cane sugar. perhaps the "peerless brand" of evaporated milk is the most reliable and in the preparation of food from this evaporated milk the same amount of sugar, etc., should be added as we do in the preparation of "whole milk" or "top milk." we do not in any way advise the use of condensed milk. fresh milk should always be used where it is obtainable, but in traveling it sometimes has to be used. holt says, "it should be diluted twelve times for an infant under one month and six to ten times for those who are older." malted milk is a preparation suitable in some cases where fresh cow's milk is not obtainable. even better than condensed milk, this food will be found serviceable in traveling, or in instances where only very bad cow's milk is within reach. special foods most patent foods are made up of starches and various kinds of sugars, and some of them have dried milk or dried egg albumin added. many flours under fanciful names are sold on the market today. for instance, one flour with a very fanciful name is simply the old fashioned "flour ball" that our great, great grandmothers made; and, by the way, perhaps there is no flour for which we are more grateful in the preparation of infant food than the flour ball which is prepared as follows: a pound of flour is tied tightly in a cheesecloth and is put into a kettle of boiling water which continues to boil for five or six hours, at the end of which time the cheesecloth is removed and the hard ball, possibly the size of an orange, is placed on a pie pan and allowed slowly to dry out in a low temperatured oven. at the end of two or three hours, the ball, having sufficiently dried, has formed itself into a thick outer peel which is removed, while the heart which is very hard and thoroughly dry, is now grated on a clean grater, and this flour has perhaps helped more specialists to serve more sick babies than any other form of starch known. it is used just as any other flour is used--wet up into a paste, made into a gruel, which is boiled for twenty minutes before it is added to the milk. whey is sometimes used in the preparation of sick babies' food and is prepared as follows: to a pint of fresh lukewarm cow's milk are added two teaspoons of essence of pepsin, liquid rennet or a junket tablet. it is stirred for a moment, then allowed to stand until firmly coagulated, which is then broken up and the whey strained off through a muslin. the heavy proteins remain in the curd, and the protein that goes through with the whey is chiefly the lactalbumin. chapter xix the feeding problem a friend of ours who presides over a court of domestic relations in a large city, recently told us that he believed much trouble was caused in families--many divorces, occasioned, and many desertions provoked--because improperly fed babies were cross and irritable and so completely occupied the time of the mother, who, herself, knew nothing about mothercraft or the art of infant feeding. consequently, the home was neglected and unhappy, quarreling abounded and failure, utter failure, resulted. the children were constantly cross, and so much of the mother's time was consumed in caring for these irritable, half-fed babies, that the home was disheveled, the meals never ready, the husband's home-coming was a dreaded occurrence, and he, endeavoring to seek rest and relaxation, usually sought for it in the poolroom or the saloon, with the usual climax which never fails to bring the time-honored results of debauch--despair and desertion. in the beginning of this book we paid our respects to the present-day educational system which does not provide an adequate compulsory course in which all women could be given at least a working knowledge of home making and the care and feeding of the babies; so that statement need not be repeated in this chapter. but we wish to add, in passing, that ignorance is the basis and the foundation of more unhappy homes, broken promises, panicky divorces, and shattered hopes, as well as of more deaths during the first year of infancy, than any other cause. and in speaking of its relationship to babycraft, we believe that ignorance concerning normal stools, how many times a day the bowels should move; how much a baby's stomach holds; how often he should be fed, etc.--i say it is ignorance of these essential details that lies at the bottom of many problems which come up during the first year, particularly the "feeding problem." infant welfare in the city of chicago at the time of this writing, the infant welfare association maintains over twenty separate stations where meetings are held for mothers, where lectures are delivered on the care and feeding of babies. babies are brought to these stations week in and week out; they are weighed and measured and, if bottle-fed, nurses are sent to the homes to teach the mother how properly to modify the milk in accordance with the physician's orders. the health authorities of our city also maintain several such stations where mothers and babies may have this efficient help. a corps of nurses are employed to carry out the instructions and to follow up the mothers and the babies in their homes, and thus the death rate has been greatly reduced, not only in our city but in all such cities where baby stations have been instituted. in a certain ward in philadelphia the death rate was reduced forty-four per cent in one year after the baby stations were established. choosing a formula there are three classes of infants who require weak-milk mixtures to begin with: namely, the baby who has been previously nursed and whose mother's milk has utterly failed; the baby just weaned; and the infant whose power to digest is low. if these children were six months old, and the formula best suited to them is unknown, we must begin with a formula suited to a twoor three-month-old child and quickly work up to the six-month formula, which may often be accomplished within two or three days. the bottle-fed baby when a baby is getting on well with his food, he should show the following characteristics: he should have a good appetite; should have no vomiting or gas; he should cry but little; and he should sleep quietly and restfully. his bowels should move once or twice in twenty-four hours. his stool should be a pasty homogeneous mass. he should possess a clear skin and good color. he should show some gain each week--from four to eight ounces--and he should also show mental development. as long as a baby appears happy and gains from four to eight ounces a week and seems comfortable and well satisfied, the feeding mixture should not be changed or increased. make changes gradually in our experience with the artificial feeding of infants, we have come to look upon the practice of gradually changing the food formula as the most important element in successful baby feeding. we recall one mother in the suburbs who came to us with her baby who had been feeding on a certain proprietary food. she declared that it "just couldn't take cow's milk." she admitted "it was not doing well," and so she would like to have help. the baby was old enough, had it been normal, to have been taking whole milk for some time. we recall our having the mother prepare the proprietary food just as she had been used to preparing it, and each day we had her throw away one-half ounce and put in one-half ounce of whole milk, this mixture she fed the baby for two days. the next time, we had her take out one ounce of the mixture and put in one ounce of whole milk, which we fed the baby for three successive days; and then one and one-half ounces were substituted which was fed to the baby for four days; and thus we carefully, slowly, and gradually withdrew the proprietary food and substituted fresh, certified cow's milk. it took us a month to complete the change, but we are glad to add that it was done without in the least disturbing the child. now, had the change been made abruptly--in a day or two, or three days--the baby would probably have been completely upset, while both the mother and the doctor would have been greatly discouraged. many mothers and even some physicians have jumped from one baby food to another baby food; they have tried this and they have tried that, until the poor child, having been the victim of a number of such dietetic experiments, finally succumbed. we cannot urge too strongly the fact that, as a rule, whenever a change is made from one food to another, it should be done gradually, unless it be the change of a single element such as that of a very high per cent of cream found in top milk mixtures, when it seems to be a troublesome element in the milk. no bad effects will follow the quick change to skimmed milk with added sugar, starches, etc; but in changing from a proprietary food to a milk mixture, the change should always be made gradually, the quantity of the new food being increased gradually. milk should be increased by quarter (1/4) ounce additions, and it should not be increased more than one ounce in one week; while the mixture should not be increased as long as the baby is gaining satisfactorily. a wise mother and an experienced physician can usually see at a glance when a child is doing well--by the color and consistency of the stools, the child's appetite, his sleep, and his general disposition. common mistakes in formulas first and foremost, we believe a great mistake is often made in using too heavy cream mixtures; babies as a rule do not stand the use of too high a percentage of cream. formulas that call for whole milk should contain four per cent fat or cream; and while babies often gain rapidly on the higher percentage of cream found in a rich jersey milk, nevertheless, sooner or later serious disturbances of digestion usually occur. herd milk is, therefore, better for the babies because in the "whole milk" of the herd of holsteins we have only about four per cent fat. another common mistake is too heavy feeding at the time of an attack of indigestion; even the usual feeding may be too heavy during this time of indisposition. it is not at all uncommon for us to dilute baby's food to one-third its strength at the time of an acute illness. still another trouble maker is dirt--dirt on the dish-towel, dirt on the nipple, dirt in the milk, dirt on the mother's hands. dirt is an ever present evil and an endless trouble maker, as evidenced by stool disturbances, indigestion, fretful days, and sleepless nights. a dirty refrigerator is another factor which has been responsible for much illness and distress. indigestion is often brought on because a nurse, caretaker, or possibly the mother, not wishing to go down to the refrigerator in the middle of the night, brings up the food early in the evening and allows it to become warm--to remain in a thermos bottle--and we are sure that had they been able to see the enormous multiplication of germs because of this warm temperature, they would never have given occasion for such an increase in bacteria just to save themselves a trifle of inconvenience. still another common mistake is to use one formula too long; a feeding mixture which was good for four or possibly six weeks, must be changed as the child grows older and his requirements become greater. let the weight, stools, general disposition and sleep of the child be your guides, and with these in mind errors in feeding can be quickly detected and minor mistakes speedily rectified. symptoms of dissatisfaction some of the pointed questions which are put to a young mother who brings her child into the office of the baby specialist, are the following: does the baby seem satisfied after his feeding? does he suck his fist? how much does he gain each week in weight? does he sleep well? does the baby vomit? what do his bowel movements look like? will you please send a stool to the office? with the intelligent answers to these questions--after knowing the birth weight and the age of the child and its general nervous disposition--the physician can formulate some conclusion as to the babe's general condition and can usually find a feeding formula that will make him grow. vomiting, restlessness, sleeplessness and the condition of the bowels, are the telltales which indicate whether or not the food is being assimilated; and the stools may vary all the way from hard bullet-like lumps to a green diarrhea. babies do not thrive well in large institutions where the food is so often made up in a wholesale manner, for the simple reason that the food elements are not suited to the need of each individual baby. some infants are unable to digest raw milk, and for them sterilized or boiled milk should be tried; others require a fat-free mixture such as skimmed milk, while still others may need buttermilk for a short time. babies require individual care, particularly in their food, and the good or bad results are plainly shown in the stools, weight, sleep, etc. flatulence flatulence is an excessive formation of gas in the stomach and bowels leading to distension of the abdomen and the belching of gas, and often the bringing up of a sour, pungent, watery fluid. flatulence is seen in infants suffering from intestinal indigestion and the food is nearly always at fault. this condition is the result of the faulty digestion of the sugar and starches--particularly the starch--which should be immediately reduced. in such conditions the addition of a slight amount of some alkaline (such as soda, magnesia or lime water) to the food often produces good results. great patience must be exercised with a child that suffers from flatulence, for immediate improvement can hardly be expected; time is required for the restoration of good digestion. vomiting vomiting is perhaps more often the result of over feeding or too frequent feeding than anything else. a healthy, breast-fed baby may now and then regurgitate a bit, but it simply spills over because it is too full. we do not refer to this as vomiting, we refer to the belching up or vomiting of very sour or acrid milk which leaves a sour odor on the clothing. this can all usually be rectified by lengthening the intervals from two to three hours and preventing bolting of food by getting a nipple whose hole is not so large. too much cream in the food will also sometimes cause vomiting. too frequent feeding at night is another cause of vomiting. when the stomach is full, the failure to lay the baby down quietly, as is so often seen in those homes where bouncing and jolting are practiced, may also result in vomiting. vomiting may be the first sign of many acute illnesses such as scarlet fever, measles, pneumonia, whooping cough, etc. the treatment for acute vomiting is simple. all foods should be withheld--nothing but plain, sweetened water should be administered, while it is often advisable to give a dose of castor oil. a physician should be called at once if the vomiting continues, and not until the vomiting has entirely ceased for a number of hours and water is easily retained, should food be given, and even then it should be begun on very weak mixtures. over-feeding the size of the child's stomach should be the guide to the quantity of food given, and attention is called to the table given in a previous chapter. all food taken in excess of his needs lies in his stomach and intestines only to ferment and cause wind and colic. the symptoms of over-feeding are restlessness, sleeplessness, stationary weight (or loss in weight), and oftentimes these very symptoms are interpreted by the mother as sufficient evidence that the baby needs more food; and so the reader can see the terrible havoc which is soon wrought where such ignorance reigns. weight the weighing time should immediately follow a bowel movement and just before a feeding time; then, and only then, we have the real weight of baby, as a retained bowel movement may often add from four to five ounces to the child's weight. there should be a careful record of each weighing, for there may develop a great difference if different members of the family endeavor to keep the weight in their minds. the normal baby should gain four to eight ounces a week up to six months, and from then on the weekly gain is from two to four ounces; in other words, by six months the baby should double his birth weight and at the end of a year his weight should be three times the birth weight. a stationary or diminishing weight demands careful attention; a good doctor should be called at once. likewise, a very rapid increase in weight is not to be desired, as we do not want a fat baby, but we do desire a well-proportioned and alert baby, and, as someone has said, it is better to have little or no gain during the excessive heat than to upset the digestion by over-feeding, designed to keep the baby gaining. in weighing, usually the outside garments are removed, leaving on a shirt, band, diaper, and stockings with the necessary pins; the little fellow thus protected is placed into the weighing basket and at each successive weighing, these same clothes or others just like them are always included in the weight, and it should be so reported to the physician. the stools in the chapter "baby's early care," the first stools were described in detail, and there we learned that the dark, tarry, meconium stools are quickly changed within a week to the normal canary-yellow stool, having the odor of sour milk. the bottle-fed babies' stools differ somewhat in appearance; they are thicker and a lighter color, but should always be homogeneous if the food is well digested. they do not have nearly the number of bowel movements each day that the breast-fed baby does. if a bottle-fed baby's bowels move once a day and he seems perfectly well otherwise, we are satisfied. and curds (white lumps), or mucus (sedimentary, slimy phlegm), indicate that the food is not well digested. bottle feeding and constipation a bottle baby may be constipated because the proteins are too high, the fat too high, the food of an insufficient quantity or quality, or the milk have been boiled, while weak babies really may lack the muscular power to produce a bowel movement. with the help of your physician endeavor to arrive at the cause of the constipation, and, if the baby is two or three months old, from one to two teaspoons of unsweetened prune juice may be administered. milk of magnesia may be added to the food (leaving out the lime water), or a gluten suppository may be used. the change from milk sugar to malt sugar has helped many infants; while the giving of orange juice (after six months) is very beneficial in many cases. a small amount of sweet oil may be injected into the rectum which will lubricate the hard lumps and thus favor comfortable evacuation. the periodicity of the bowel movement (at definite times each day) is a matter of great importance. immediately after a meal, if the child is old enough, he should be placed on the toilet chair. a bit of cotton, well anointed with vaseline and inserted into the rectum just before meals, will often aid in producing a bowel movement shortly after the meal has been taken. abdominal massage should be administered in all instances of constipation, beginning with light movements and gradually increasing, with well-oiled hands. diarrhoea diarrhoea usually accompanies acute intestinal indigestion and is so often associated with the common disorders of infancy that we refer the reader to the chapter "common disorders of infancy." dark stools should always be saved for the physician to observe, as they frequently contain blood. stools full of air bubbles with pungent sour odor show fermentation; in which cases the starches should be reduced, if not entirely taken away from the food mixtures. green stools mean putrefaction from filth-germs; a thorough cleansing of the bowel should be immediately followed by a reduction in the strength of the food and the boiling of the milk. regulation of the stools at a certain time each day the napkin should be removed and the child should be held out over a small jar. it is surprising to note how quickly and readily the little fellow cooperates. diaper experiences may be limited to much less than a year if the mother has patience enough and the baby has the normal intelligence to enter into this regulation regime. we recall one caretaker who complained bitterly because the child under her care constantly wet his diaper; so the caretaker was instructed to keep a daily schedule of the baby's actions for five days; and, to her surprise, she discovered that the baby urinated about the same time each day. a regularity was also noted concerning the bowel movements. the variations in the time of the urinations were only fifteen or twenty minutes, so nearly did the kidneys act at the same time each day. the caretaker was instructed to remove the diaper and hold the baby out at the earliest occurrence on the daily schedule, and, to the astonishment of the entire family, no further accidents occurred, and the child soon acquired the habit of letting them understand when he was about to wet his diaper. bowel movements may be regulated more easily than the urination. after the child is about a year old, very few accidents should occur. mixed feeding in many instances, and particularly if the infant is under six months of age, and where he has had to have additional feeding from the bottle--under such circumstances the breast milk may be continued as "partial feeding," at least until the baby has reached his ninth or tenth month, at which time it may be wholly discontinued. at each nursing time the baby empties both breasts, and the amount he draws may readily be estimated by carefully weighing him before and after each nursing. by referring to the directions in a previous chapter, the quantity of food needed for his size and age may be determined; while the deficit is made up from a bottle of milk containing properly modified cow's milk. if the mother's health admits, or if the breasts continue to secrete a partial meal for the babe, mixed feeding should be continued until after the ninth or tenth month, when it can gradually be reduced from four or five times each day to once or twice a day, until it is finally omitted altogether. in the meantime, the baby is gradually getting stronger food and at eleven or twelve months the little fellow is able to subsist and thrive upon whole milk. infant feeding puzzles it is very difficult to explain how some babies thrive on some certain food while others grow thin and speedily go into a decline on the same régime. the hereditary tendencies and predispositions undoubtedly have a great deal to do with such puzzling cases. again, sometimes a slight variation in technic or some other trifling error in connection with the preparation of the baby's food, may be more or less responsible for the variation in the results obtained. no two mothers will prepare food exactly alike even when both are following the same printed directions and these slight discrepancies are enough to upset some delicately balanced baby. on the other hand, some babies are born with such strong digestive powers and such a powerful constitution that they are easily able to survive almost any and all blunders as regards artificial feeding, while at the same time they also manifest the ability to surmount a score of other obstacles which the combined ignorance and carelessness of their parents or caretakers unknowingly place in the pathway of early life which these little folks must tread. the fact that so many babies do so well on such unscientific feeding only serves to demonstrate the old law of "the survival of the fittest"--they are born in the world with an enormous endowment of "survival qualities"--and in many cases the little fellows thrive and grow no matter how atrociously they are fed. there may be other factors in the explanation of why some babies do so well on such poor care, but heredity is the chief explanation, while adaptation is the other. if the little fellows can survive for a few weeks or a few months, the human machine possesses marvelous powers of adaptation, and we find here the explanation why many a neglected baby pulls through. infant foods rickets and scurvy have so often followed the prolonged use of the so-called "infant foods" which have flooded the market for the past decade, that intelligent physicians unanimously agree that they are injurious and quite unfit for continued use in the feeding of infants. if they are prescribed to replace milk during an acute illness, or at other times when the fats and proteins should be withheld for a short period, both the physician and the mother should be in the possession of definite and exact knowledge as to just what they do and do not contain. to provide such knowledge, we present the analysis (holt) of some of the more commonly used infant foods. 1. _the milk foods._ nestle's food is perhaps the most widely known. the others closely resembling it in composition are the anglo-swiss, the franco-swiss, the american-swiss, and gerber's food. these foods are essentially sweetened, condensed milk evaporated to dryness, with the addition of some form of flour which has been dextrinized; they all contain a large proportion of unchanged starch. 2. _the liebig or malted foods._ mellin's food may be taken as a type of the class. others which resemble it more or less closely are liebig's, horlick's food, hawley's food, malted milk, and cereal milk. mellin's food is composed principally (eighty per cent) of soluble carbohydrates. they are derived from malted wheat and barley flour, and are composed chiefly of a mixture of dextrins, dextrose, and maltose. 3. _the farinaceous foods._ these are imperial granum, ridge's food, hubbell's prepared wheat, and robinson's patent barley. the first consists of wheat flour previously prepared by baking, by which a small proportion of the starch--from one to six per cent--has been converted into sugar. in chemical composition these four foods are very similar to each other, consisting mainly of unchanged starch which forms from seventy-five to eighty per cent of their solid constituents. 4. _miscellaneous foods._ under this head may be mentioned carnrick's soluble food and eskay's food. the composition of the foods mentioned is given in the accompanying table. composition of infant foods malted nestle's mellin's eskay's milk ingredients food food food (horlick's) per cent per cent per cent per cent fat 5.50 0.24 1.16 8.78 proteins 14.34 11.50 5.82 16.35 cane sugar 25.00 ... ... ... dextrose ... ... } 53.46[1] ... lactose (milk sugar) 6.57 ... } } 49.15[2] maltose } 27.36 60.80 ... } dextrins } 19.20 14.35 18.80 carbohydrates (soluble) 58.93 80.00 67.81 67.95 starch 15.39 ... 21.21 ... inorganic salts 2.03 3.59 1.30 3.86 water 3.81 4.73 2.70 3.06 ridge's imperial carnrick's ingredients food granum food per cent per cent per cent fat 1.11 1.04 7.45 proteins 11.81 14.00 10.25 cane sugar ... ... ... dextrose 0.52 0.42 ... lactose (milk sugar) ... ... maltose ... ... dextrins 1.28 1.38 ... carbohydrates (soluble) 1.80 1.80 27.08 starch 76.21 73.54 37.37 inorganic salts 0.49 0.39 4.42 water 8.58 9.23 3.42 [1] chiefly lactose. [2] largely maltose. chapter xx baby's bath and toilet from earliest girlhood, women have loved their dolls, and one of the greatest joys connected with the adored experience was the make-believe bath and the dressing of the make-believe baby; so now, when we are the happy possessors of real live dolls, we should go about the task with the same lightheartedness of a score of years ago when we hugged, kissed, bathed, and dressed our dolls. there is one big advantage now, the doll won't break; but, we sigh as we stop to think, we can't stick pins into it as we all did into the sawdust bodies of our dolls those years and years ago. the first week in the chapter on "baby's early care," this subject was fully discussed and we only wish to repeat, in passing, that before baby's bath or toilet is undertaken the hands of the mother, nurse, or caretaker must be scrupulously clean. and while the first day's bath usually consists of sweet oil, albolene, or benzoated lard, if the new baby happens to come during the very warm days of july or august and the oil seems to irritate the soft downy skin, as it often does during those hot days, a simple sponge bath may be substituted. the cord dressing remains as the doctor left it, and if there be any interference, let it be subject to his orders. the cord usually drops off, and the abdomen is entirely healed by the seventh to the tenth day, after which time baby is daily sponged for another week. and now we will describe in detail the simplest, easiest manner of administering an oil bath or a sponge bath. giving the bath a large pillow or a folded soft comfort is placed on a table in a warm room--temperature not below 75 f. on baby's tray near by, and within reaching distance, are the boracic acid solution in a small cup, a medicine dropper, the warm saucer of oil, the toothpick applicators (made by twisting cotton about one end, making sure the sharp end of the pick is well protected), a glass jar of small cotton balls made from sterile absorbent cotton, the castile soap, talcum powder, needle and thread. a vessel of warm water, several old, soft, warmed towels and the clean garments required, complete the layout. into the warm, soft blanket on the pillow or comfort we place the partially undressed baby, for the binder, diaper, and socks are not removed until the head-and-face toilet is completed. the top of the head, behind the ears, the folds of the neck, and the armpits are now gently but thoroughly rubbed with oil, which is then all rubbed off with a soft linen towel. the eyes next receive two or three drops of the boracic acid solution, put in by the aid of the medicine dropper, while, with a separate piece of cotton, the surplus solution is wiped off each eye, rubbing from the nose outward. then with the applicator made by wrapping cotton about the end of a toothpick, oil is put into each nostril, all the time exercising the utmost care not to harm the tender mucous membrane. the ears are also carefully cleansed with a squeezed-out dip of boracic acid on the applicator. unless there is an inflammation present in the mouth, and the physician in attendance has ordered mouth swabbing, do not touch it; for much harm is done the mucous membrane of the baby's mouth by the forceful manner in which much of the swabbing is done. the face and head are then washed with warm water; very little soap is needed and, when used, must be most thoroughly rinsed off. the second week and now during the second week, we proceed to sponge the baby's body; the hands are washed with soap and rinsed, and, only those who have performed this feat know just how tightly they hold shut their little fists. these hands must be relaxed, and all the lint, dirt, and perspiration be thoroughly washed away. the arms, shoulders, chest, and back are then sponged. all the time the nurse or caretaker is standing while carrying out this most pleasant task. at any time she may quickly cover the babe and stop for this or that with no inconvenience to herself or the child. after the thorough drying of baby's upper body, a bit of talcum is put under the arms, in the folds of neck, etc., and the shirt is slipped on. next the band, diaper, and stockings are removed and after first oiling the groin and the folds of the thighs and the buttocks, the same sponging, drying, and powdering is done here as on the upper body. the band is now applied, and _sewed on_. the diaper, stockings, booties, and--if a winter baby--the skirt and outing flannel gown (for babies should wear only night dresses for the first two or three weeks) are now slipped over the feet and drawn upward, and baby is ready for nursing or for his nap. temperature of baths first few weeks, 100 f.; early infancy, 98 f.; after six months, 97 f., cooling down to 90 f. a wooden bath thermometer may be purchased for twenty-five cents and it should be in every home where babies are bathed. in the absence of a thermometer do not depend upon the hand to determine temperature. thrust the bared elbow into the water and if it is just comfortable--neither hot or cool--it is probably about the correct temperature for baby. do not shock the baby by dashes of cold water, for, while it may amuse an onlooker, it unnecessarily frightens your child, and, subconsciously, he learns to dread his bath. the bathing place if the bathroom is warm--temperature 75 f.--that is the most logical place for the bath, provided baby has his own tub. place a couple of strong slats several inches wide across the big tub, six inches apart, and on this place the baby's tub. of course, care must be exercised to prevent slipping by means of properly fitted cleats on the under surface of the slats. the mother should always stand to bathe her baby and the small tub should be placed at such a height that she neither has to stoop nor bend. thus the bathing of the baby becomes a pleasure instead of a "job" or an "irksome task." if the bathroom is not warm then the kitchen table or a small table pulled up near the stove is a place par excellence for the dip. many boils seen on young baby's tender skin have been traced to the careless use of the family tub to bathe the baby in. not until the child is two or three years of age, when his skin has become more toughened, should he be allowed to use the family tub. frequency of baths to begin with, we never bathe either a baby or an adult immediately after a full meal. from one hour to one and one half hours should intervene. the frequency of baths depends somewhat upon the season of the year, the vitality of the child, and the warmth of the home. we have seen many infants who were bathed too often. the vitality expended upon the necessary reaction following a tub bath was too much for the little fellow; the daily bath was stopped and a semi-weekly bath substituted, much to the gain of the child. of course in this instance the hands, face, and buttocks received a daily sponging. the oil bath may be administered daily. in robust children the tub bath may be a daily affair; while in pale, anemic little folks, the tub bath is perhaps better given twice a week. in hot summer days a sponge bath may be given many times a day. best hour for bathing again this depends upon several factors; the warmth of the house or apartment, the vitality of the child, and the kind of bath to be administered. an oil bath may be given any time--often it may be administered entirely under the bed clothes, only care must be taken to keep oil from the blankets. many of our mothers prefer to give the tub bath at five o'clock in the afternoon, when the house is thoroughly warm, and the child is thereby prepared for the long night's sleep. before dressing in the morning an oil bath or rub may be given in such cases. if the forenoon is selected as the time for bathing the child, then an hour just before the mid forenoon meal is the best. in either event, be regular about it--do it at the same time every day. let the caretaker attend to her many duties, and, as far as possible, mothers, bathe your baby yourself. the folds of the skin, the creases in the neck, the clenched fists, must all receive particular care, and no one in all the world will ever care as you--the mother--cares. soap and water select a soap free from irritants and excess of alkalis. there are few kinds that equal the old-fashioned, white castile soap our grandmothers used. very hard water which makes the skin rough and sore may be improved by boiling, but if possible substitute rain water for it. a flannel bag tied over the faucet and changed each day will help to clarify muddy water, provided the stream flows gently through it. routine of the tub bath just as we directed the nurse or caretaker to stand while the oil rub or sponge bath was given, so we admonish the mother to stand while the tub bath is given. first, get everything in readiness for the bath as directed for the oil bath, and then the baby's tub setting on the securely cleated slats placed across the top of the family tub may be filled with water by means of a hose attached to the faucet. the temperature should be 100 f. when baby is dipped in to be rinsed. the head and face toilet are identical with that described before, and with the baby undressed and wrapped in a warm towel placed inside the warm blanket on the pillow or comfort as before mentioned, we proceed with a good lather of castile soap and water to lather the baby's body all over--under the arms, the neck, chest, groins, thighs, buttocks, legs, feet, and between the toes, while the genitals also receive their share of attention. the foreskin of the boy baby is gently pushed back and cleansed thoroughly; while the vulva of the little girl baby, having first been swabbed with boracic acid, is now gently lathered and cleansed. now grasp the ankles and legs with the right hand and support the upper back and neck and shoulders with the left and gently lower the baby into the water in a semi-reclining position (see fig. 13). the water should cover the shoulders. keep a good firm supporting left hand under the head, neck, and shoulders, and with the right, rinse all soap from the body. [illustration: fig. 13. supporting the baby for the bath] after this is thoroughly done, lift the baby out onto a fresh warm towel inside the warm blanket on the pillow, and remain standing, while you gently pat (never rub) the baby dry. all the little folds, creases, and places between fingers and toes, are carefully patted _dry_, and where any two skin surfaces rub together put on a bit of talcum. the dressing takes place in the manner already described--first the shirt, then the band (sewed on), the diaper, stockings, skirt, and gown. please note that the soap bath is contra-indicated (should not be given) in case of eczema. baby's daily rub this soap bath should be administered for cleanliness only, and should be given twice a week. if a tub bath is to be given on other days, after the routine head and face toilet, the baby is simply dipped into the water and the soft skin gently rubbed. if the sponge or tub bath is given in the afternoon just before the long sleep at night, then the oil rub should take place before the mid-forenoon meal; and likewise, if the sponge or tub bath is given during the mid forenoon, then the oil rub or dry hand rub is given before the going-to-bed time. the rub should be a daily procedure for the first two years. nothing rougher than the soft palm of the hand should be rubbed on baby's soft skin. use and abuse of talcum babies have come to my clinic with _cakes_ of talcum under their arms, and particularly between their thighs and in the crease of the buttocks. here the well-meaning but thoughtless mother had reasoned, "a little is good; more is better" which is not always the case. talcum is not used to replace careful drying, and it should never be found in quantities on the baby's skin any more than you would expect to find quantities of face powder caked in the creases of the neck or behind the ears of an adult. the skin is first cleaned, then patted entirely dry, and, as a finishing touch, a bit of talcum is put on by means of a puff. tonic and medicated baths tonic baths are usually given to older children when they are able to enter into the sport and frolic of a cool bath. baths are called tonic because they call forth from the body a reaction--a sort of circulatory rebound. this rebound or reaction brings the blood to the skin, increases the circulation, and tones up the nerves. the room should be properly warmed and, if necessary, some form of exercise be continued after the bath to prevent the chill that sometimes follows a poorly administered bath. in the case of the anemic child, after six months of age, the mother's hand dipped in cold water may briskly rub the chest and back until it glows or becomes red. the child should enjoy this bath. never frighten a child by throwing cold water on it or by giving it a too sudden cold plunge; great harm may be permanently done by these efforts to "toughen the baby." the simple medicated baths may be administered according to the following directions: _salt._ use half a teacup of common salt or sea salt to each gallon of water. the salt should first be dissolved in a cup of warm water to prevent the sharp particles from pricking the skin. the doctor sometimes orders a salt bath. _starch._ add a cup of ordinary, cooked laundry starch for every gallon of water in the bath. _soda._ a soda bath requires two tablespoons of ordinary baking soda to a gallon of water, dissolving it in a little water before adding it to the bath. _bran._ make a cotton bag of cheesecloth or other thin material, six inches square. fill loosely with bran. soak the bag in the bath water, squeezing it frequently until the water becomes milky. starch, soda, and bran baths are often used in place of the ordinary soap and water bath when the skin is inflamed, as in cases of chafing or prickly heat. fear of baths force and harshness are not likely to cause baby to overcome very much of the fear of a tub bath. patience, perseverance, and purposeful diversion of mind will bring sure results. in the case of a very young baby, have a helper stretch a towel across the filled baby tub, lay the baby in it, with its head well supported, and then gently lower the towel into the water, keeping the head out. (most anyone would fear an all-over ducking, if he had ever been completely ducked into water by a careless or mischievous friend). in the case of older children, celluloid ducks, fish, or boats may float about on the water, and the entire bath be forgotten by the little fellow's enjoyment of "his boats." out of door bathing although a baby under two years should never be given a sea bath, a word of caution about sea bathing for young children may not be amiss. the cruelty with which well-meaning parents treat young, tender children by forcibly dragging them into the surf, a practice which may be seen at any seaside resort in the summer, can have no justification. the fright and shock that a sensitive child is thus subjected to is more than sufficient to undo any conceivable good resulting from the plunge. on the other hand, a child who is allowed to play on the warm sand and becomes accustomed to the water slowly and naturally will soon learn to take delight in the buffeting of the smaller waves, but he should not be permitted to remain more than a minute or two in the water, and should be thoroughly dried, dressed immediately, and not left to run about the beach in wet clothing. milk crust any roughness on the scalp must receive immediate attention. this roughness, or milk crust, is entirely avoidable; it is the result of accumulated oil and dirt. when it has formed a complete crust or cake, it may quickly become eczematous and require a physician's advice; however, in the beginning, at the first sight of brown patches or roughness, oil the scalp thoroughly at night with vaseline or cold cream, which should be gently rubbed off in the morning. this vaseline or cold cream should be applied repeatedly, several nights in succession, followed by the morning's gentle rubbing and daily washing of the head. often the washing with water must be entirely avoided; only sweet oil or vaseline being used in those cases where the crusting seems to be persistent. the eyes, ears, and nose at birth the eyes are particularly cared for. first, the mucus is gently swabbed off the closed lids from the nose side outward, and then follows the application of one drop of twenty per cent argyrol or two per cent silver nitrate, either of which thoroughly disinfects the eye and prevents the growth or development of any bacteria that may have gotten into the child's eye during the descent of the head through the birth canal. the neglect of this procedure may sometimes result in lifelong blindness. under no circumstances should "a mere cold in the eyes" be neglected; it may result in blindness. call your physician at once, and if he is not at hand, wash out the eye thoroughly every hour with warmed ten per cent boracic acid solution, by means of a medicine dropper, using a separate piece of cotton for each eye, for if the slightest bit of discharge be carried from one eye to the other an inflammation will quickly appear. from birth, especially during the first week, baby's eyes are very sensitive to light; hence they must be carefully protected. babies should be so placed during their outings, sleep, or naps, that they do not directly gaze at either the sunlight or sky. the lining of the hood of the carriage should be green, instead of white, as much eye strain is thus prevented. the daily care of the normal, well eye has been already described, and while it need not be reiterated, we may say, in passing, that if the eyelid be at all inclined to be sticky or adherent, never use force, but instead, gently swab with boracic acid. as a preventive of this condition, a little vaseline from the tube may be rubbed on the edges of the lids at night. in the toilet of the ears, never attempt to introduce anything beyond the external ear, which may be carefully cleansed with a soft cloth. it is often found necessary to apply oil to the creases behind the ears before the daily bath. there should be no irritation, redness, or roughness present, all such conditions being readily prevented by the use of oil or vaseline before the bath. with the sharp point removed, make a cotton applicator out of a toothpick, and gently (with no force, whatever) introduce vaseline or oil into the nose. this should be a part of baby's daily toilet. any stoppage of mucus or snuffiness in the nose should be reported at once to baby's physician. young babies often have adenoids. care of the mouth leave the well mouth alone until the teeth appear, and then keep the teeth very clean (allowing no particles of milk to accumulate at their bases) with a soft bit of cotton and gentle rubbing. when a child attains the age of two, he should have his own toothbrush; previous to this time all food particles should be removed from between the teeth with waxed silk floss. all decay should be promptly attended to by a competent dentist. thrush and ulcers are often caused, not prevented, by the frequent wiping out of baby's tender mouth. the treatment of thrush and other mouth infections will be considered in a later chapter, "the common disorders of infancy." the care of the genital organs before the bath, the baby girl's genitals are carefully swabbed between all the folds with boracic acid solution. the foreskin of the boy baby should be pushed well back and washed gently with water. if the foreskin of the male child be long, tight, or adherent, circumcision is advised. see our chapter, "teaching truth." the genitals of both the boy and girl should be kept scrupulously clean every day, with as little handling as possible, and, upon the appearance of the least swelling, discharge, or even redness, the physician's attention should be at once called to it. in a later chapter, the subject of irregularities of sex habits will be taken up. care of the buttocks often, because of irritating bowel movements, the buttocks become reddened, chafed, and sometimes raw in places. some poor little babies are sometimes roughly rubbed--scoured on the buttocks--much like the kitchen sink, many times a day, and it is not surprising that they become reddened, chafed, and very much inflamed. the buttocks require a gentle swabbing and thoroughgoing "patting dry" after each soiling or wetting of the diaper, but no soap is required in this region but once a day, and even then it should be used sparingly. when the buttocks are inflamed, after a good cleansing with water and a thorough drying, vaseline or zinc ointment should be applied on a piece of sterile cotton, and this application should be repeated after each changing of the diaper. wet diapers should be removed at once, for the acidity of the urine causes more chafing. a dusting powder composed of starch two parts, and boracic acid one part, may be dusted on after a cleansing with oil. great care should be exercised in the thorough daily rinsing of the diapers as well as in the tri-weekly boil in the laundry. white soap only should be used in their cleansings; no washing sodas or other powders should be used. other special care under the arms and in the creases of the neck the skin sometimes becomes irritated because of neglect. to prevent such chafing the following program should be carefully carried out: 1. not too much soap--and no strong soap. 2. careful rinsing of the skin area. 3. avoid harsh rubbing, but thoroughly dry. 4. the use of talcum powder in all folds of the skin. with a fine camel's hair brush the hair should receive its brushing after the cleansing of the scalp. combs are for just one purpose and that is to part the hair. the brush should be used to do all the smoothing. while the frequent trimming of the hair has no marked effect upon its growth, yet the comfort the little girls enjoy, especially during the warm-weather months, should not be denied them. and certainly the boy should become a boy when he puts on trousers and not be made the laughing stock of his mirthful companions just because his "beautiful long curls are much admired by the mother and his aunts." the finger nails should be trimmed round with the scissors, while all hangnails are properly cared for every day. toe nails should be cut straight across and the corners never rounded off. many ingrowing nails may be thus avoided. chapter xxi baby's clothing the eden story suggests that in the beginning of our racial experience artificial clothing was unnecessary; but after a time, in that selfsame garden, proper clothing became an important problem and has remained so ever since. everybody seems to agree, however, that baby's clothing in particular should at least be comfortable. it may give the child great discomfort because it may be too warm, or it may not be warm enough, or it may be too tight, and so, in the discussion of baby's clothing in this chapter, we are going to keep in mind these two things--comfort and heat. general suggestions the choice of material demands some thought and attention. as a rule, baby's clothing materials should be light in weight, good moisture absorbers, and at the same time able to retain the body heat. most layettes have the common fault of being prematurely outgrown; and so it is well to allow for ample growth in making baby's first clothes. since the principal object of clothing is to insure a uniform body temperature, it is important that the mother be constantly on her guard to keep the baby cool enough in the summer and warm enough in the winter. the mothers of various races and nations have their own ideas concerning the clothing of their babies. one mother will wrap her baby in cotton, which is held in place by means of a roller bandage, and as you visit this home during the first week of baby's life, you will be handed a little mummy-shaped creature--straight as a little poker--all wrapped up in cotton and a roller bandage. the surprising feature is that the baby does not seem to complain. in another district of the city we find the baby dressed in starched clothes, ribbon sashes, bright ribbon bows on its arms and around its neck. at first glance you wonder if the little child is not many years older and is about to make a visit to a county fair, but on inquiry we find that he has only been prepared for the event of circumcision on the eighth day. and if you go into the forest of primeval days you will find another mother bandaging her baby to a board, head and all, and he seems to live and thrive in his little woven nest strapped on the back of his indian mother. other babies in the warmer portions of the earth have almost less than nothing on, and are left to be swung by the breezes in little baskets tied to the boughs of trees; being taken up only when it is time to feed. baby's layette in preparing an outfit for the newcomer it is wise to provide for the necessities only, because of the fact that since the baby grows very fast the layette will soon have to be discarded; it is always possible to get more clothing after the baby is here and started on his little career. we offer the following list of essentials for the new born baby: slips 8 to 10 skirts (flannel) 3 shirts 3 light-weight wool wrappers 2 abdominal bands 3 to 5 diapers (first size) 2 doz. diapers (third size) 2 doz. stockings, pairs 3 booties, pairs 3 nightgowns 7 handling blankets 2 silkaline puffs 2 baby blankets, pair 1 hair or cotton mattress 1 basinet 1 bands and shirts the binder should be made of an unhemmed strip of flannel six inches wide and twenty inches long, so that it goes around the abdomen once with a small overlap. this binder should be sewed on instead of being pinned, and serves the purpose of holding the dressings of the cord in place. it is usually worn from four to six weeks, when it is replaced by a silk and wool barrel-shaped band with shoulder straps and tabs at the bottom, both front and back, to which may be pinned the diaper. this band is worn through the first three or four years to protect the abdomen from drafts and chilling, thus guarding against those intestinal disturbances which are caused by sudden weather changes. there is great danger of having the bellyband too tight, and, in the early weeks, it is often the cause of great discomfort--often interfering with the normal expansion of the stomach at meal time. no matter what the season, the new-born baby should be clothed in a light-weight silk and wool shirt, preferably the second size. after the first month, if the weather is exceedingly warm, this woolen shirt may be displaced by a thin silk or lisle shirt. in buying the second-size shirts always secure the stretchers at the same time, for in the laundering they soon shrink so that they are very uncomfortable for the young babe. diapers there are a number of materials on the market from which comfortable diapers may be made for the baby. the cotton stockinet (ready-made shaped diaper) is excellent, fitting smoothly at the waist, while it is large and baggy at the seat, thus permitting not only a comfortable feeling but the free use of the hips, without the bulkiness of the ordinary diaper. the large square of cheesecloth is easily laundered, and if an inside pad is used makes a very acceptable diaper. the stork diapers are made of materials resembling turkish toweling and are used to some extent. this diaper should not be confused with the stork rubber diaper which will be spoken of later. birdseye cotton is popular and extensively used. it absorbs quickly, and is much lighter in weight than linen. the firstand third-size widths should be purchased as a part of the layette, and the number of diapers needed depends upon the opportunities to wash them out, for diapers are never used but once without washing; they should always be quickly rinsed and dried in the sunshine if possible. so if there are good laundry privileges, and daily washing is possible, the mother can get along with fewer diapers, but no less than four dozen should be provided. the diaper pad will be found convenient and serviceable in the early days when the skin of the child is so very tender. this pad should be pieces of clean old linen or small pads of absorbent cotton. changing the diaper during the mother's waking hours, the diaper should be changed as soon as it is soiled or wet. if the child cries during the night it should be changed immediately, but the mother should not feel called upon to lay awake nights merely to change the baby's napkin when it is soiled. if she places a pad underneath the baby, which will absorb the urine quickly, he often does not awaken or become chilled. the pad should be sufficiently thick to ensure that the nightgown does not get wet. rubber diapers rubber sheeting diapers of any description should never be used. avoid all patent diapers with a covering or an inner lining of rubber, for, like the rubber diaper, they not only irritate the child but also retain moisture and heat, which produce such irritation and itching that the subsequent "habit-scratching" often lays the foundation for future bad practices. it is far better for the mother to carry about with her, whenever it is necessary to take the baby away from home, a rubber pad which she puts on her lap underneath the little fellow, thus affording ample protection to herself without in the least harming the baby. stockings and booties during the winter months merino stockings are required, while during the summer months a thin wool or silk stocking is sufficient; on the extremely hot days thin cotton hose may be worn. during infancy, the stockings should be fastened to the diaper with safety pins, while on the second-year child, hose supporters attached to the waist are found very convenient. a friend told me the other day of a mother who told her the following story: "do you know, i don't have any trouble any more about my baby keeping up his socks for i have fixed it so they won't come off any more. every time i looked at his feet he had kicked off his socks and they were no good to him at all, so i took little chunks of brown laundry soap, moistened them and rubbed his legs, as well as the inside of his socks and i never, never have any more trouble with them coming off." it does not seem possible in this enlightened age that a mother could be so ignorant as to keep the socks up with brown soap, but the friend assured me it was a true story, and while it may shock some of my readers as it did me, i must add, in passing to another subject, that the use of round garters on little babies and young children is just about as shocking. during the fall, winter, and spring, booties are worn on top of the stockings. these booties should be crocheted or knitted out of the heavy germantown yarn, and there should be enough of them so that the child may have a clean pair on every day. skirts and petticoats the flannel petticoat is made with yokes instead of bands, and during the fall, winter, and spring these yokes are made of flannel like the skirt and should have long sleeves of the same material. the yokes should be made large enough so that they may be used during the entire first year (the plait in the front can easily be taken out when the baby is six months old so that it may be used much longer than if the yoke is made without a plait). for the hot summer months, the yokes should be a thin cotton material without sleeves; and, if the baby is housed in an over-heated apartment, this fact should be borne in mind and the winter skirt should be made accordingly. we have found, however, that the baby who is amply protected and uniformly dressed, does not require the outer bundlings that the poorly dressed child requires. part wool and cotton materials are very comfortable in the overheated city apartments. white skirts are not necessary for small babies. they only add extra weight and it is always foolish to put anything on a small baby simply for looks. nightgowns, wrappers, and slips the nightgowns should be made of soft cotton flannel or stockinet. the latter is really the better, and can be purchased in sizes up to two years; it is absorbent, easily laundered, and may be conveniently drawn up at the bottom by means of a drawstring. at least seven nightgowns are needed. a fresh nightgown should be used each day and each night during the first four or five weeks of baby's life; while as he gets older (two or three years), the night drawers with feet in them are used to advantage. the wrappers are usually made of challis, nun's veiling, cashmere, or other light woolen materials which can be readily washed. they are very serviceable to wear over the baby's thin slips and on cool nights they may be used over the nightdress. they should be simply made, containing no heavy seams, and at the neck there should be the simplest kind of a soft band that will in no way produce friction or in any other way irritate the baby's skin. slips are usually made of some very soft material such as nainsook, batiste, pearline, or sheer lawn cloth. twenty-seven inches is the length that will be found both comfortable and convenient. all laces, ruffles, and heavy bands which will scratch or irritate should be avoided as eczema is often caused by such mistakes. sleeping bag the sleeping bag is of inestimable value, affording extra and secure covering for the child, and peace of mind for the mother. in the early weeks it should be made of light flannel, but as the child gets older the sleeping blanket is made according to illustration (see fig. 5) by merely folding a blanket in such a manner that the child cannot possibly uncover himself. the mother can sleep undisturbed, knowing that the baby is always safely protected by at least one warm blanket cover. common faults with most layettes as a usual thing the first clothes are made too small. the sleeves are too short as well as too small around. there is nothing more uncomfortable than a tight sleeve. everyone of our readers knows that, and we recall one poor little fellow who kept up a fretful cry until we took the scissors and cut the tightly stretched sleeve up to and including the arm hole. he then relaxed and went to sleep. sleeves should be made two inches longer than they are needed at first, and it is a very simple matter to pin them up or turn them back at the wrist. they should be loose and roomy. the yokes of the dresses usually are too tight before the slips are discarded. heavy seams and raw seams irritate and often make ugly impressions on the baby's skin. usually the first layette is profusely embroidered, and, while it is beautiful to look at, the mother feels when she sees it outgrown so quickly that a lot of vital energy was wasted on garments that mattered so little as long as baby was comfortable. baby is dear and sweet enough without the fuss and furbelows of such elaborate garments. heavy materials are sometimes used where lighter ones would serve better. errors in clothing a soiled garment should never be put back on the baby. dirt draws flies, and flies are breeders of disease. sour-smelling garments should be changed at once. they are likely to make the baby sick and interfere with his appetite if left on indefinitely. the care of the diaper has already been mentioned. the main symptom of too much clothing is sweating, and when the baby sweats something must come off. if he has perspired so much that his clothes are moist, the clothing should be changed and the skin well dried with talcum powder. the feet and hands should be kept warm, but the little head should always be kept cool. when the baby is crying and getting his daily exercise, remove some of the covering, loosen his diaper, and let him kick and wave his arms in perfect freedom. when the baby's feet and hands are cool he is not warm enough. cotton underskirts cannot be used in the dead of winter on little babies. they do not hold the body heat as woolen garments do. the baby's feet should always be warm and this is particularly necessary in poorly nourished children. the outer wrapper of woolen material should be added to such baby's clothing. it is a safe rule to follow that if baby's hands are warm and he is not sweating, he is "just about right." short clothes at the age from four to six months, baby's clothes are shortened. this should not take place at the beginning of winter if it can be avoided. if the first layette has consisted of only the necessary garments, they are nearly worn out by the time the short clothes are due; of those that do remain, the sleeves should be lengthened, the arm holes enlarged, and all the little waists let out. creeping garments and bibs are now added to baby's outfit, as well as leggings and other necessities for outdoor wear. remember that all garments must be loose--then baby is happy. about the same number of garments are found necessary for the short clothes as were required at first; except that a large number of creeping rompers should be added. these creeping rompers should not be made of dark materials that do not show the soil. we desire the dirt to be seen that we may keep the baby clean, and if the creeping romper is made of a firm, white material it may be boiled in the laundry, thus affording ample and thorough cleansing. we attributed a sick spell of one baby to the dark-blue calico creeping romper which he wore day in and day out because it "did not show" the soil. white ones are much to be preferred, not only for looks but chiefly for sanitary reasons. caps and wraps the cap should be made of a material that will protect from drafts and cold air, but not of such heavy materials as will cause too much sweating. there are a number of outside wraps that can be purchased ready-made and which are comfortable, convenient, and warm. they should be long enough not only to cover the baby's feet well, but to pin up over the feet, thus giving good protection from winds and drafts. during the summer months nainsook caps or other thin materials are to be preferred to the heavy crocheted caps that are sometimes worn by babies. no starch should be used in the caps or strings, and there should be no ruffles to scratch the delicate skin of the baby. in all these outer garments, as well as the under garments, the irritation of the skin must be constantly borne in mind, as eczema is often produced in this manner. the first shoes the first shoe that is usually worn during the creeping days is a soft kid shoe without hard soles. it is important that this soft shoe be worn to protect the child's foot from chilling drafts while creeping about. as the baby nears one year of age the hard-sole shoe is secured which must be wide, plenty long and comfortable in every respect, and without heels. rubbers and overshoes may be worn on damp and cold days. moccasins and slippers do not give sufficient support to the ankles, so, when the baby begins to walk, the shoes should be high and of sufficient support to the tender ankles. play suits as the baby grows up into the child, the tiny clothes are laid aside and the boy is given substantial garments that in no way remind him of girls' clothing. a child's feelings should be respected in this manner, and while it often adds joy to the mother's heart to see her boy "a baby still," remember that he is not only chagrined but is nervously upset by these "sissy clothes." a child three or four years of age should still wear the woolen binder supported from the shoulders, over which is the union suit, stockings, and the buttoned waist from which hang the hose supporters. the most comfortable and easily laundered garment we know of for the small lad is the "romper," which should be made of washable materials that may be readily boiled. for cool days a buster brown coat of the same material, with patent-leather belt, may be slipped on over this washable romper--which completes the boyish outfit. we recall the pleasant days with our own little fellow when he was between the ages of two and one-half and five years. we were often compelled to be away from home--on the train, in the hotel--and when traveling we used a black, smooth silk material which was made up into rompers with low neck and short sleeves. there were three such rompers, and two buster brown coats with wide, black, patent-leather belts which completed the traveling outfit. during the warm days on the train the coat was folded carefully and laid aside. in the early morning and in the cool of the evening the coat was put on, and he always looked neat and clean. at night, before undressing him, the entire front of the romper was cleansed with a soapy washcloth, rinsed, and rubbed dry with a towel, and, after carefully spreading to avoid wrinkles, it was hung over the foot of the bed. the coats were sponged or pressed once or twice a week, and this simple outfit served its purpose so well that it was repeated three different summers. the little girl as she leaves her babyhood days should be put into garments that do not necessitate the constant admonition, "keep your dress down, dear." we like to see knickerbockers, the exact color of the dress, made for every outfit, in which the little girl may kick, lie down, jump, dance, climb--do anything she pleases--unmindful of the fact that her "dress is not down." the same undergarments are used for the little girl as were mentioned for the little boy. winter garments always bear in mind the over-heating of the child with heavy garments indoors, and the danger of skin chilling and drafts on going out to play in this over-heated condition. let the children dress comfortably cool in the house, and as they go out to play add rubber boots or leggings and rubbers, sweaters, caps with ear laps or the stockinet cap. allow them the utmost freedom in clothes, and always encourage romping in the cool frosty air. clothing rules do not overload the baby with clothing. dress according to the temperature of the day and not the season of the year. avoid starched garments. avoid tight bellybands or old-fashioned pinning blankets. change all clothes night and morning. use woolen shirts and bands. see that hands and feet are always warm. protect the abdomen night and day with the band. use the sleeping bag on cold nights. baby should sleep in loose stockings at night. avoid chilling the child. use hot water bags if necessary. chapter xxii fresh air, outings, and sleep fresh air is just as important and necessary for the baby as for the adult. neither baby, youth, nor adult can receive the full benefit of his food--in fact it can not be burned up without the oxygen--without an abundance of fresh air. during the early weeks of life, the air baby breathes must be warm; nevertheless, it must be warmed _fresh_ air, for baby requires fresh air just as much as he needs pure food. indoor airing the delicate child often requires more fresh air than does the normal baby. both appetite and sleep are improved by fresh air. the digestion is better, the cheeks become pink, and all the signs of health are seen in the child who is privileged to breathe fresh air. during the early days, say after the third week, baby should be well wrapped up with blanket and hood, tucked snugly in his basinet or carriage, while the windows are opened wide and the little fellow is permitted to enjoy a good airing. even in the winter months the windows may be raised in this way for a few minutes each day. these "airings" may be for ten minutes at first, and, as the child grows older, they may be gradually increased to four or five hours daily. the carriage or basket should stand near the window, but not in a direct draft. outdoor life in summer, a baby one week old may be taken out of doors for a few minutes each day; in the spring and fall, when baby is one month old, it may go out for an airing; while, during the winter months, the airing had better be taken indoors until he is about two months old, and even at that age he should go out only on pleasant days and should always be well protected from the wind. a young baby may enjoy the fresh air in his carriage or crib on the porch, on the roof under suitable awnings, in the yard, under the trees, and even on the fire escape. in fact, at proper age and in season, he may spend most of his time out of doors in the fresh air, if he has proper protection from the sun, wind, and insects. best hours for airing during the balmy days of summer and early autumn, baby may spend most of the time outdoors between seven in the morning and sunset. during the cooler days of winter and the cool and windy days of spring, the best hours for the airing are to be found between eleven in the morning and three in the afternoon. at six weeks, perhaps an hour a day in the fresh air is sufficient; while at six months, four to six hours a day are a necessity, and from then on--the more the better. now we realize that the mother of the farm household does not always have as much time to take the baby out for his airings as many of our city mothers; but we suggest to this busy mother that the baby be rolled out on the porch or in the yard, within her sight and hearing, and allowed to enjoy the fresh air while the mother continues her work. it is virtually a crime to try to keep baby in the kitchen, hour after hour, while the busy mother is engaged at her tasks. a hammock, a crib on casters, or a carriage, is just the coziest place in the world for baby--out on the porch. the country baby the average city baby really gets more fresh air than ninety per cent of the country babies. our city apartments are usually steam heated, and our windows are open in the winter nearly as much as in the summer. the country home is often only partially heated by two or three stoves. the windows are closed in summer to keep out the dust, heat, and flies, in the winter to shut out the cold, and so the baby who lives in such a home has little chance to get fresh air. the city mother is constantly talked to about the benefits of fresh air. the daily paper brings its health column to her, her pastor talks of it on sunday, and--best of all--the older children come home from school and reiterate the doctrine of fresh air that is constantly being preached to them at school. screen the windows, rural mother, and oil the roads in front of your residence, and then keep your windows open. remember that baby's health is of more value than the meadow lot or even a fortune later on in life. plan for a new heating plant, if necessary, so that the home can be both warmed and ventilated during the winter. when not to take baby out if a sheltered corner of the porch is within the reach of the mother, we can hardly think of a time when the baby cannot be taken out. it may rain, the wind may blow, it may snow or even hail, but baby lies in his snug little bed with a hot water bottle or a warmed soapstone at his feet. as long as the finger tips are warm, we may know he is warm all over, and a long nap is thus enjoyed in the cool fresh air. when the sheltered corner of the porch is lacking, we wish to caution the mother concerning the following weather conditions: 1. when the weather is excessively hot, take him out only in the early morning and late in the afternoon. 2. in extremely cold, below zero, weather, let his airing be indoors. 3. sharp and cold winds may do much mischief to baby's ears, as well as blow much mischief-making dust into his nose and eyes. in the case of dust or sand storms, baby remains in the house. 4. all little people enjoy the rain, and only when the raincoat, rubbers, and umbrella are missing should they be robbed of the "rainy-day fun". in the case of baby's outing on rainy days, ample roof protection is the only factor to be considered; if it is adequate, then take him out; if it is lacking, let the airing be done indoors. winter outings the very young baby is taken out for a fifteen-minute airing during the noon hour when he is two months old; before this time he receives his airing indoors. the interval is gradually lengthened until most of the time between eleven and three is spent out of doors. the reddened cheeks, the increased appetite, all tell the story of the invigorating benefits of cool, fresh air. most babies dislike heavy veils, and they may be avoided by a fold of the blanket arranged as a protection shield from the wind. the wind shield, procurable wherever baby carriages are sold, should be a part of the outdoor equipment, as it greatly helps in the protection of the baby. the wind should never blow in his face; neither should he lie, unprotected, asleep or awake to gaze up into the sunshine or the sky--or even at a white lining of the hood of his carriage. the lining should be a shade of green, preferably dark green. and while it may be necessary during the summer to suspend a netting over the carriage to protect from flies, mosquitoes, etc., it should never lie on his face. open windows many of our readers recall with sadness of heart a little hunchback child or a life-long invalid confined to a bed or wheel chair because some careless but well-meaning caretaker or mother left an open window unguarded; and--in an unlooked for moment--baby crawled too near, leaned out too far, and fell to the ground. the little fellow was picked up crippled for life; and so while it is very essential to baby's health to have open windows, admitting fresh air, they should be amply guarded. screens afford protection if well fastened, and in their absence a slat three inches wide and one inch thick may be securely fastened across the opening, thus preventing all such tragedies with their life-long regrets. sleep if any of our readers have seen a new-born baby immediately after he has been washed, dressed, and comfortably warmed, they have observed that he usually goes to sleep at once, and that he generally sleeps from four to six hours. babies, especially new-born babies, need just four things: warmth, food, water, and sleep. and while the babies sleep they are not to be disturbed by the fond mother's caresses and cuddling--feeling of the tiny hands, smoothing out the soft cheek, or stroking his silky hair--for all such mothers are truly sowing for future trouble. let baby absolutely alone while sleeping, and let this rule be maintained even if some important guest must be disappointed. if such cannot wait till baby wakens, then he must be content with the mental picture drawn from the mother's vivid description of baby--his first smile, his first tooth, his first recognition of the light, etc. the wise mother cat never disturbs her sleeping kittens. sleep requirements sleeping, eating, and growing occupy the whole time of young babies. until they are two months old they need from eighteen to twenty hours sleep out of each twenty-four; and not less than sixteen hours up to the end of the first year. at six months, baby should sleep right through the night from six in the evening until six in the morning, with a ten o'clock feed, which should be given quietly, in a darkened room, the babe being immediately returned to his bed. at two or three years of age, twelve to fourteen hours of sleep is required; while at four to five years, eleven to twelve hours are needed; when they attain the age of thirteen years they should still have ten hours of unbroken sleep each night. as a general rule, children should sleep alone; even in the case of two brothers or two sisters, separate beds are far better than a double bed for both hygienic and moral reasons. baby should have a separate bed. the temptation to nurse him on the least provocation, as well as the danger of overlying, are reasons enough for such an arrangement. putting baby to sleep at five-thirty in the afternoon, baby should be undressed, rubbed or bathed, made perfectly comfortable, and fed; then, my mother reader, he should be laid down in his little bed and allowed to go to sleep, without any coaxing, singing, rocking, or even holding his hand. babies will do this very thing and continue to do it if you never begin to rock, jolt, bounce, or sing to them; and, mind you, if you do sing to them or rock them, or even sit near without doing anything but "just hold their tiny hands," there will come a time when you greatly desire to do something else--you have many urgent duties awaiting you--and baby not being old enough to understand the circumstances, begins to wail out his feeling of neglect and abuse. it is nothing short of wicked thus to spoil a child. we have seen so many beautiful babies go to sleep by themselves without any patting, dangling, or rocking, that we encourage and urge every mother to begin right, for if the little one never knows anything about rocking and pattings he will never miss them; and even if the baby is spoiled through extra attention which sickness often makes necessary, then at the first observance of the tendency on the part of the child to insist on the rocking, or the presence of a light in the sleeping-room, or the craving for a pacifier, we most strongly urge the mothers to stick to the heroic work of "letting him cry it out." the notion that the household must move about on tiptoes is not only unnecessary but perfectly ridiculous. from the very hour of his birth, let the child become accustomed to the ordinary noises of the home, and if this plan is early started he will prove a blessing and a ray of sunshine to the family and not an autocrat to whom all must bow and bend the knee. bedtime and sleeping position bedtime is regulated somewhat by the hour of rising in the morning. usually, up to two years, baby is put to bed from five to six p. m. regularity is urged in maintaining the bedtime hour. the seven o'clock bedtime hour is later established and continued until the young child attains school age, when retiring at the curfew hour of eight o'clock gives our boy or girl from ten to eleven hours of sleep, which is essential to proper growth, calm nerves, and an unruffled temper. the first few days finds our little fellow sleeping nine-tenths of his time. let him lie on his right side, for this favors the complete closure of the fetal heart valve, the foramen ovale. whether baby lies on his stomach, his side, or with the hands over his head is of little or no consequence. his position should be changed first from one side to the other until he is old enough to turn himself. waking up at night before baby is three months old, he should receive nourishment during the night at nine and twelve, and again at six in the morning. after four or five months a healthy child should not be fed between the hours of ten p. m. and six a. m. at this age, many children sleep right through from six p. m. to six a. m. without food. after five months, if a healthy baby awakens between ten p. m. and six a. m. warm water may be given from a bottle; he soon forgets about this and the night's sleep becomes unbroken. there are many other reasons than the need of food that cause the wakefulness of the child; and since the baby should, after a few months, sleep undisturbed and peacefully, if he is wakeful and restless--crying out in a peevish whine--and then quiets down for a few moments only to cry out again, you may suspect one of a half-dozen different things. let us, therefore, summarize the things which may disturb baby's sleep: 1. _lack of fresh air._ babies cannot sleep peacefully in a hot, stuffy room, or in a room filled with the fumes of an oil lamp turned low. a crying fretful baby often quiets down as if by magic, providing he is not hungry and the diaper is dry, when taken into a cool room with fresh air. after the first two months the temperature of the sleeping room should be fairly cool and fresh. 2. _clothes and bedding._ the night clothes may be irritating and causing perspiration, while the bedding may be wrapped too snugly about the child. if baby's neck is warm and moist, you may know that he is too warm. if the diaper is wet it should be changed at once. one of the worst habits a baby can possibly get into is to become so accustomed to a wet diaper that it does not annoy him. in cold weather he is changed under the bed clothing without exposure or chilling. it may be the bedding is cold and, if so, it should be warmed up by the use of the photophore previously described, or by means of the flannel-covered hot water bottle. 3. _the food._ too little, too much, or the wrong kind of food, will disturb baby's sleep. indigestion is very easily produced in babies who are improperly fed. for instance, the mother's milk may be lacking in nourishment and baby may really be hungry; or, as in the case of a bottle-fed baby, it is usually due to over feeding. many mothers we have known who sleep with their babies or who sleep very near them, nurse them every time they wake up or murmur, and this soon becomes one of the biggest causes of disturbed sleep. 4. _spoiling._ a lighted nursery or bedroom, rocking to sleep, jolting the carriage over a door sill or up and down, the habit of picking baby up the moment he cries, late rompings--any and all of these may disturb sleep, as well as unsettle the tender nervous system of the child, thus laying the foundation for future nervousness, neurasthenia, and possibly hysteria. this is particularly true in the case of the children who have nervous parents. 5. _reflex causes._ wakefulness is sometimes due to reflex nervous causes such as the need for circumcision, or the presence of adenoids, enlarged tonsils or worms. does baby have to breathe through his mouth? then you may suspect adenoids or other conditions which should be removed. 6. _chronic disorders._ the presence of scurvy or syphilis causes the child to cry out sharply as if in acute pain, while in older children tuberculosis of the spine or hip is attended by a sharp, painful crying out during sleep. malnutrition or anemia are also conditions which greatly disturb sleep. 7. _soothing syrups._ untold trouble, both physical and nervous, is bound to follow the giving of soothing syrups. these medicines soothe by knocking the nerves senseless and never by removing the cause. they contain morphin, opium, cocain, heroin, and other drugs which deaden pain, and are most dangerous to give baby. daily naps the morning nap from the sixth month on should be from two to three hours long, out on the porch, well protected; while the afternoon nap may be from one to one and a half hours long with an interval of two or three hours before bedtime. the child should be wakened at regular intervals for feedings during the day--every three hours until he is six months old, and then every four hours. these naps should be taken in a cool place--on the porch, on the roof, in the yard, under a tree, or on the protected fire escape. if the nap is to be taken indoors, then lower the windows from the top and darken the room. all children should take daily naps until they are five or six years old. chapter xxiii baby hygiene possibly if all our babies could grow up in a mild, warm climate, out of doors, where they were cared for by mothers who had nothing else to do but enjoy nature in a garden, their babies unhampered by clothes and other conventionalities inflicted upon us by our present standards of living--well, if that were our environment, probably this chapter on baby hygiene would not need to be written. but realizing that variable climatic conditions, the indoor life, and the necessary bundling up with clothes, all tend to increase the ever-present danger of infection from thickly settled peoples and their domestic pets--these facts, together with the further fact that modern social conditions make it necessary for some mothers to toil long hours--all these influences, i say, considered separately or combined, make it imperative for us to give thoroughgoing consideration to the essentials of baby hygiene. the subjects of fresh air, sleep, bathing, etc., have been duly discussed in previous chapters. water drinking as soon as the newborn baby has been washed and dressed, before he is put to sleep, he is given two teaspoons of warm, boiled water in a sterile bottle with a clean nipple. this is repeated every two hours when he is awake, until he is old enough to ask for water himself. this water should contain no sugar, or anything else--just clean, boiled water. it is better to give this water from a bottle; for in case of enforced weaning, this practice of taking his water from a bottle, will have made him acquainted with that method of feeding. urination the baby may pass very little urine during the first day or two of his life, but if the warm, boiled water is administered regularly, the urine will soon become more abundant. as the child nears two years of age, if put to bed at six p. m. he should be taken up at ten or eleven to urinate. in older children, bed wetting is often corrected by serving the last meal not later than four p. m. and not allowing any liquids after that hour. the physician should be consulted in all instances where the habit of bed wetting extends beyond three years. the subject will be treated more fully in a later chapter. exercise a baby pen, lifted up from the floor, well protected at the sides, and covered with mosquito bar--if exposed to flies or mosquitoes--affords splendid opportunity for exercise. here the little fellow may lay on a well-padded mattress and kick, move his arms, and otherwise roll about to his own satisfaction. it should not be in the direct sunshine, but rather in a protected, somewhat shady place, yet where the air is pure and fresh. much exercise is obtained from the daily cry. here, the arms, legs, hands and feet, as well as the body, are all exercised until the baby is pink. a good rebound of blood is flowing through the well-warmed skin, while the baby is greatly benefited by such daily exercise. later on, "creeping" is urged, but not forced. with regard to standing--he will pull himself up on his feet just as soon as nature qualifies him, and so he needs no urging or coaxing in this matter. older children should be encouraged in active romping, games, etc., rather than to spend the entire day in the more sedentary amusements, puzzle pictures, etc. it is a most abnormal situation when a three-, or four-year-old child is content to sit quietly all day. there is usually something seriously wrong with a child who never soils his rompers, who never makes a noise, and who does not seem to enjoy normal play and fun. let the little folks early learn that the home is theirs to enjoy and that their little friends are welcome; and thus you may be spared such a reproof as one little lad of four unknowingly gave his mamma. his little friend was approaching the stairs of the play room, when the thoughtless mother carelessly and impatiently remarked: "oh, are you going to bring ned upstairs? you'll make so much noise." the little host met his friend at the top with the words: "they don't want boys in the house, we'd better go outdoors." the mother "woke up" and arranged a little "party" upstairs for the two husky, healthy--and noisy--boys. during the creeping days remember that the floor is the coolest part of the room, and in the absence of the creeping pen, which is "built up" two feet above the floor, extra clothing should be put upon the child while on the floor. during the damp days of early spring and the cool days of late fall, as well as on the bleak days of winter, baby is better off if he is kept off the floor. it is a fine plan to put a number of table boards on top of the springs of the baby's bed; in this way a sort of pen is produced which is high above the cold floor and the baby is content to spend much of his time in this little pen, happy with his playthings. kissing the baby we most strongly protest against the haphazard, promiscuous kissing of babies. many forms of disease, such as tuberculosis, syphilis, diphtheria, influenza, common colds, etc., may be carried to the child in this way. the baby, notwithstanding his attractiveness, his beauty, and his grace, should not be overfondled. kissing the hand is not much better than the mouth, for the hand quickly finds its way to the mouth. if it be necessary to kiss a baby, then let the kissing be done on the back of the neck or on top of his head, but never on the face or hand. suckling habits there came into the office one day a woman forty or more years of age, whose mouth was markedly disfigured, and on my inquiring as to the probable cause she said: "doctor, it is the result of sucking my thumb when i was a mere child, too young to know better, and every time i look into the glass, which i assure you is only when i am compelled to, i curse my parents for not breaking me of that habit." the indulgent parents were hated and despised for neglecting their duty, because of the disfigurement which resulted from this unrestrained habit of early childhood. thumb sucking, finger sucking, or pacifier sucking, are all filthy habits, and should be early discouraged. to aid in overcoming the habit of sucking the thumb or biting the fingernails, the ends of the fingers and edges of the nails may be painted with a solution of aloes or quinine. in extreme cases, a splint may be placed on the anterior bend of the elbow, thus preventing the possibility of raising the hand to the mouth. the "sugar teat" of our mother's generation has passed, as has also the "mumbling" of food for the young child; we no longer give the babies concentrated sugar, nor do we "chew" our children's food at the table. extreme cases of chalk or dirt eating have been noted; such tendencies are decidedly abnormal, and require medical attention. keep baby warm much colic and fretfulness may be avoided if baby is kept warm. the finger tips are a good thermometer, for if they are warm the feet usually are. "bundling" is unnecessary, but careful attention should be paid to keeping the feet and hands warm without making the child sweat; that is an art, and all mothers should attain it. an extra flannel wrapper and a pair of heavy wool booties in the winter are good warmth producers. cotton flannel petticoats should be replaced by warm woolen ones, and when the baby begins to get about on his hands and knees a pair of loosely fitting wool tights, made from discarded woolen underwear are of inestimable comfort and value. in the effort to avoid draughts and body chilling, ever bear in mind baby's need of fresh air and the dangers of sweating, for the sudden cooling of a sweating child is a forerunner of pneumonia, cold catching, diarrhoea, and other troubles. baby's temperature during early infancy, baby's temperature sometimes varies greatly; for instance, a rectal temperature may register 97.5 or 100.5 f. while the child may be in perfectly good health. the baby's temperature should be taken at the rectum--which should normally register 99.5 f. this temperature, as stated above, may register 100.5 f., with no other symptoms of illness. in taking rectal temperature the thermometer should remain in place two minutes. the groin is the next best place to take the temperature; here the thermometer should remain five minutes, and the registry is usually a degree lower than that of the rectum. the baby's temperature usually is a good guide to the severity of any illness. in case the temperature runs above 101 f. the physician should always be notified and his orders carefully followed. slight causes often produce a high temperature of 103 to 105 f. for a short time; but such a temperature of long duration means serious trouble and demands expert advice and attention. abnormal temperature will be more fully considered in that section of this work entitled "common disorders of infancy." baby bouncing the common custom of bouncing or trotting baby on the knee is a harmful one. the young and growing nervous system of the child is decidedly injured by this constant jolting and jiggling, to say nothing of the "spoiling" effects of this practice. there is a vast difference between the sensitive nervous system of the infant, with its liability to shock and disturbances, and that of the settled and developed nervous system of an adult. the strength of the mother or nurse is so great that the jarring not only often causes indigestion and vomiting in the infant, but sometimes also lays the foundation for "wrecked nerves" in later life. the tossing of baby in the air comes in for the same condemnation. baby is not "our plaything," and must not be bounced and tossed about like a rubber ball. carriages and go-carts the first carriage should be roomy and comfortable. the bed should be thirty-three inches long and fourteen inches wide, and should be twenty-eight or thirty inches from the floor. the wheels should be rubber tired. the cover should be a good sized hood containing a dark lining, and provided with a wind shield. this dark lining creates a neutral shade for the eyes and protects them from the glare of the sun and the bright skies. the bed of the carriage should be soft and warm; and, with the size before mentioned, there is ample room for the "tucking in" with warm blankets, which are first spread out on the bed and then the baby placed into the blanket, after which it is brought up and over him. the folding go-cart and the small carrying-basket are to be used only in an emergency. they are convenient in traveling or shopping for the mother who has no maid or caretaker with whom to leave the baby; but they are not satisfactory pleasure vehicles, neither should the baby be left to sit fastened in one of these carts for any great length of time. the mattress of the carriage should be of hair, while needed warmth may be secured by the use of a thick, light-weight woolen blanket, placed under the child and brought up and around him. a top covering for the carriage must have washing or dry cleaning qualities. a crocheted afghan, a washable embroidered cover, or a firm silk puff, are good covers. the one thing to be remembered is that everything about the carriage soils readily, and if this thought enters into the selection of fabrics, you will not be disappointed when cleaning time comes. the carriage pillow should be of down, except in the very hot months, when hair is preferable. simple, easily laundered slips may be made from two men's-size handkerchiefs. bow legs particularly in boys and men, bow legs are not only awkward but are a noticeable deformity; even the little folks notice them and often remark about it, as did one child who sat profoundly eyeing a very important visitor who stood before the cheerfully lighted grate warming himself. the little fellow suddenly exclaimed, "oh, mister, look out! you're warping." such a painful experience might have been saved this distinguished gentleman had his mother or caretaker not urged his standing too soon; and at the same time had fed him on the proper food, so as to avoid "rickets." the ossification or hardening of the bones of the legs continues all through childhood and is often interfered with by improper feeding during the first two years of life. urging the little people to stand too early is to be discouraged. nature prepares them for it when the right time comes; which time varies--thin children standing and walking usually much earlier than heavy children. lifting the baby a very young baby should be lifted from his bed by grasping the clothing below the feet with the right hand, while the left hand slips underneath the back and with spreading fingers supports the neck and head. it is then raised upon the left arm. during the early months the entire spine must be supported in this manner (see fig. 6). in grasping a baby under the arms or about the waist, undue pressure is made upon the abdomen and chest. serious injury often follows the careless lifting of the older child by his wrists or hands. the throwing or whirling of the older children by the arms is strongly condemned. dislocations have followed such careless so-called fun. prevention of falls in the selection of the high chair, care should be given to the possibility of overturning. fortunately, baby's bones are only partially ossified, else he would sustain many fractures in the frequent falls and bumps. when we pause to consider the thoughtless manner in which many babies are left on beds and in unguarded chairs, it is not strange that they fall so often. open windows must be carefully protected by well-fastened screens or by slats of wood. beds afford a good place for a romp or play, but high-backed chairs should be placed at the side to prevent a fall. a strap across the waist should be fastened to the sides of the carriage to prevent falling out. everything possible should be done to prevent falls. outdoor hammocks are exceedingly dangerous for the baby. never leave a child in one unguarded. a little caution, a large amount of common sense--the "good use of brains"--will prevent scars and other lifelong deformities. the baby's breasts never allow anyone to manipulate or "break down" a swollen breast in a girl or boy baby during the first week or two. this swelling occurs often and should not be interfered with. a hot compress of boracic acid solution may be applied, after which a piece of sterile gauze should be placed over the swollen part and held on by a muslin bandage. secure medical attention if the swelling does not go down in a day or two. visiting unless absolutely necessary, babies should not be taken on trains and street cars; nor should they take long journeys into the country to attend "reunions." infections accompany crowds, and baby is far better off at home, in the quiet of his natural surroundings, than he is in the dust, closeness, and bustle of illy ventilated cars, streets, shops, movies, or even at church. many an infant has been sacrificed by a train journey to "show him off" to the fond grandparents; scores of babies acquire whooping cough at the movies; and many a baby has nearly lost his life by catching measles, scarlet fever, or diphtheria at church; while the only thing accomplished by the church experiment was the spoiling of the entire service by its fretful, tired cry--the infant's only means of protest. the runabout baby "runabouts" are the little folks between the age of one and three years, and they require good care, good feeding, and warm and comfortable dressing. in general, they need the same fresh air, daily outings, and daily naps of the younger child. their hands need washing oftener, and their clothing, which is usually a play romper, should be either of white or fast colors that it may be most thoroughly boiled, thus getting a good disinfection. their eyes, nose, and ears, as well as the genital organs, all require the most rigid daily cleanliness. the "bugbear" second summer need not be feared by the mother who takes particular care to see that: 1. the drinking water is boiled or distilled. 2. the orange is not overripe. 3. the banana is not underripe or overripe and is not eaten in chunks. 4. the milk is fresh and pasteurized. 5. the baby does not eat candy, ice cream, or other forbidden foods. 6. the baby's bowels move daily. 7. he does not remain dirty. 8. he naps daily. 9. he is protected from dust, flies, flees, and mosquitoes. 10. he does not go visiting, to church, shops, or "movies." the second summer is no harder than the first, as good clean water, easily digested foods, and good general hygiene are all a baby needs at this time. a large army of little folks grow up in spite of the little care they get and the place in which they live. did they not possess good vital resistance, sound nerves, and good digestion, the children of the "slums" and of the "ghetto" would quickly succumb to their unhygienic surroundings. toys in selecting toys for the infant, it must be borne in mind that they will be put to the mouth, and hence they should not be: 1. toys with sharp points. 2. small enough to swallow, or to push into the nose. 3. covered with hair or wool. 4. glass that is easily broken. 5 painted toys. 6. toys that may be taken apart and the small parts swallowed. 7. paper books that may be chewed or torn. bear in mind that babies are easily amused with such simple toys as: 1. a half-dozen clothes pins. 2. an aluminum pan and a spoon. 3. rubber toys (easily washed). 4. celluloid dolls, ducks, and other floating toys. 5. blocks. 6. a large rubber ball. the older children have wonderfully good times out of doors with a spade, a cart, and the sandpile. boys most thoroughly enjoy a track with its engine and cars, switches, etc. they build sham fortifications, truly works of art, with their blocks, while the girls are happiest with dolls and household sets. however, occasionally we meet a mother who has a girl who is really a boy in her tastes for toys, and so we say to that mother: give the little girl the desire of her heart; if it's a train instead of a doll, or a toy gun instead of a doll's trunk, well and good, let her have them. what we want are free and easy, natural, children. they are much more likely to have good nerves, clean thoughts, sound digestion, and equalized circulation. chapter xxiv growth and development the newborn baby comes into the world in an absolutely helpless condition and completely unconscious of his surroundings. he unconsciously performs certain acts, such as opening his eyes, crying, urination, movement of the bowels, and even nursing of the breast; but there is probably no distinct voluntary action connected with any of these acts. all of his senses at birth are practically dormant, but as the days and weeks go by, they begin to awaken. special senses the baby cries, but the tears do not actually flow over the lids until he is three or four months old, and while the baby may fix his eyes upon objects and distinguish light from darkness, he will not wink nor blink when the finger is brought close to the eye. vision is probably not complete until the beginning of the third month. infants are said to be deaf for the first twenty-four to forty-eight hours after birth, and some authorities hold that they are deaf for several days. taste is early developed, as a newborn baby will often repeatedly show a desire to taste sweet things, while if sour or bitter things are put to the tongue, it shows its displeasure. hair and scalp the newborn baby usually comes into the world with a good head of hair, but the end of the first or second week witnesses the falling out of much of this hair, and falling may continue for even another week or two. the hair is often worn off on the back of the head because of constant friction upon the pillow. children differ greatly in the growth of hair. some of them come into the world with heavy hair, and others lose it quickly and remain nearly bald-headed until after the first year. as the second hair grows in, it is usually lighter than it was at birth and lighter than it will be later in life, as the hair has a tendency to grow darker as the years go by. the scalp should receive the care already mentioned. as the hair comes in it should be shampooed once in two weeks and brushed often, making it healthy and vigorous. misshapen heads it is wise to turn the baby first on one side and then on the other and not allow him to sleep night after night on one side of his head. the newborn head may be misshapen by laying the child constantly on one side, and the ear may be misshapen if it is allowed to curl under or become pressed forward. markedly protruding ears may be partially corrected by having the child wear a well-ventilated cap made for the purpose. the saliva many mothers think that the presence of drooling or the excessive flow of saliva is associated with teeth cutting. while it may be associated with the teeth, this is not usually the case; it is more probably due to the beginning of a new function of secretion. the newborn baby has only enough saliva to furnish moisture for the mouth, and not until the age of four or five months does saliva really flow, and since the teeth appear a bit later we often confuse the institution of a new secretion with the oncoming teeth. sensations and recognition the young baby manifests a number of sensations early in its career. hunger and satisfaction as well as comfort and discomfort seem to be recognized by the little fellow. he early learns that the approach of someone when he cries usually means that he is to be taken up, and he usually ceases crying as soon as he is taken up. he early manifests a sense of comfort when he is cuddled; there also is early present a manifestation of the desire to sleep, and the satisfying pleasure of a drink of water. at the age of three months he has recognized many things such as the light or a bright object. he distinctly recognizes his mother and often smiles at her approach. he recognizes his hands at four months, and now begins to recognize other members of the household aside from his mother. even as early as one month, he may smile at his mother. at two months of age he will often smile at other members of the family. he laughs out loud or chuckles during the fourth or fifth month. but, on the whole, he must be considered as just a little animal whose greatest needs are to have his appetite and thirst satisfied, his little body clothed, and his little nerves put to rest--to sleep. sitting alone at four months the normal baby will hold up his head; and if he is supported at the back with a pillow, he will sit erectly--holding his head up--at six months; while at eight months or not later than nine, the normal child should sit alone on the floor with no support. later in the ninth month he often manifests a desire to bear his weight upon his feet. care is here urged that the mother protect the little fellow at this time and not allow him to rest his weight upon his feet but a moment or two at a time. he will reach for a ball suspended from the top of his carriage or bed as early as the fifth month. about this time he discovers his toes while in his bath. he will handle a rattle at six or seven months, and shows delight in such toys. dentition in both the upper and lower jawbones of the newborn infant there are hidden away in snug little cavities two sets of tiny teeth; the first set, or milk teeth, and the second set, or permanent teeth. these rudimentary teeth grow as the baby grows and push their way up or down from the jawbones until they finally make their appearance through the gums. the milk teeth appear in a definite way and in five definite groups. there should be no physical disturbance at the appearance of the teeth, which is a physiological process, and it is to be deplored that all of the ills of babyhood are laid upon the teeth with the careless remark: "oh, its his teeth!" many, many illnesses are neglected because our inexperienced mother has been told that she can expect "anything to happen when the baby is cutting its teeth." now, it is true that the babies of many families do have trouble in cutting their teeth, but the majority of babies cut their teeth comfortably and the first knowledge anyone has of it is the appearance of the tooth itself. as the teeth push their way nearer the surface of the gums, there is a broadening and a hardening of the gums themselves, and it is the exception rather than the rule that the baby needs any help in cutting his teeth. usually by the time the baby is seven months old it has two central teeth on the lower jaw (the central incisors), which constitute the first group. the second group of teeth to appear is the four upper central teeth which are all through by the time the baby is twelve months old, and are often through at ten months. then there is a pause of from one to three months before the next teeth appear--the four anterior molars. as these four anterior molars come in, the two lateral incisors appear on the lower jaw, which now gives us, by the time the baby is fourteen or fifteen months old, four central teeth upper, four central teeth lower, and the four anterior molars, which make twelve teeth. another pause of two or three months and then we get the four canine, which fill in the space between the first molars and the front teeth. the canine on the upper jaw are commonly known as the eye teeth, while the canine teeth on the lower jaw are spoken of as the stomach teeth. this brings us to the age of eighteen to twenty-four months, when there is still another pause of two or three months, after which time the big teeth or the four posterior molars appear, which completes the first set of twenty teeth--the milk teeth. when baby is twenty months old the milk teeth are often all in. the complete set should appear not later than the thirtieth month. during the life of the milk teeth the child should be taken to the dentist at least once a year, better once in six months, for all defective teeth must be properly and promptly cared for. inexpensive but sanitary fillings should be placed in all decayed teeth, for the roots of the first teeth are very soft and infection readily spreads to the jaws and the permanent teeth and serious trouble often begins thus early. if dentition is seriously delayed, investigation should be started concerning the general condition of the child, for this delay often accompanies ill health. when the child is six years old, the mother should be watchful, for it is at this time that the first permanent teeth appear just behind the last molar of the milk teeth. they do not replace any of the teeth present, and many times they come through and decay without receiving any attention. it is seldom necessary to assist these milk teeth as they come through the gum, and should the gums become highly colored and swollen it is not wise to lance them, for if the teeth are not ready to come through immediately, the gum only toughens the more and makes the real cutting still more painful. this is the time to cut down the baby's food as well as to look for other digestive disturbances, for the number of stools may increase and vomiting may occur, and by reducing the quantity and quality of the food and encouraging abundant water drinking, much trouble may be avoided. under no circumstances urge the baby to eat when he refuses his food, when the gums seem swollen and red during the teething time. you will find that he will enjoy orange juice, pineapple juice, or prune juice. all of these digestive symptoms are simply the result of "feeling bad," and if heavy food of his regular feeding is greatly diminished he will get along much better than if fed his regular allowance of food. appearance of the teeth the normal child has: six teeth at one year. twelve teeth at one and one-half years. sixteen teeth at two years. twenty teeth at two and one-half years. when the child is six years old the first permanent tooth appears just back of the last of the milk teeth. by the time he is seven, the four central teeth, two above and two below, are out and the new ones begin to appear. the order of their appearances is as follows: four first molars 6 years four central incisors 7 years four lateral incisors 8 years four first bicuspids 9 to 10 years four second bicuspids 10 to 11 years four canines 11 to 13 years four second molars 12 to 15 years four third molars 17 to 25 years dental suggestions a better plan than to lance swollen gums is to rub them gently with ice wrapped in a soft cloth, or to dip the finger in ice water and rub the gums--this often gives the baby much relief. often the baby finds comfort in biting on an ivory ring, but the utmost care must be used in keeping it clean and avoiding contamination by allowing it to drop on the floor. convulsions are never the symptoms of teething. consult a physician at once, as such seizures probably spring from causes other than teething. cleansing of the teeth should be carried out systematically every morning by means of a piece of cotton which has been dipped in a boric-acid solution or a solution of bicarbonate of soda (common baking soda). a soft brush may be used for cleansing, and when there are particles of food between the teeth they should be removed by strands of waxed floss. throughout life, frequent visits should be made to the dentist; during early childhood days he should be on the lookout for symptoms which indicate deformity--narrow jaws and other conditions which affect the permanent teeth. during adolescence and adult life the teeth should be examined every six months and cleansings of the mouth should become a part of the daily toilet. the weight during the first year, nothing gives us so much information concerning the child's general well-being as the weight. such a record will not only enlighten the mother concerning the development of the child, but the grown-up child appreciates the record and preserves it along with the other archives of babyhood days. every sunday morning, when the father is at home, the baby should be weighed and an accurate record kept. it is important that the baby be weighed each time in the same garments--shirt, band, diaper, and stockings--for every ounce must be accounted for. until the baby is five or six months old he should gain from four to eight ounces a week. anything short of this is not enough and should be reported to the physician. after six months the gain is about a pound each month. this varies somewhat; possibly during the tenth and eleventh month the gain is lessened, but by the close of the first year the baby should have trebled its birth weight. dr. griffith gives us the following very interesting bit of information concerning the weight of boys and girls after the first year, and to him also belongs the credit for the accompanying table showing the growth, height, and weight of the child up to sixteen years of age. after the first year we notice that, taking it all together, there is a gradual increase in the number of pounds and a decrease in the number of inches added yearly, four inches being gained in both the second and third years, three inches in the fourth and fifth years, and after this two inches a year. the gain in weight is four pounds yearly from the age of three to that of seven years, then five, then six, and then about nine pounds. it sometimes happens that at about the age of nine in girls and eleven in boys there is almost a cessation of growth for a short time. later, at about twelve years, girls take on a particularly rapid growth, and decidedly exceed boys of the same age in weight, and sometimes in height also. at fifteen or sixteen years the rapidity of growth in girls, both in weight and height, will be greatly diminished, while boys of this age will often begin to develop very rapidly, and will soon materially exceed the other sex in both respects. table showing growth in height and weight age. height. weight. birth 19 inches. 7 lbs. 8 oz. 1 week 7 " 7½ " 2 weeks 7 " 10½ " } gained 1 oz. 3 weeks 8 " 2 " } a day; 1 month 20½ inches 8¾ " } 7 oz. a week 2 months 21 " 10¾ " } 3 months 22 " 12¼ " } {gained 3/4 oz. a day; 4 months 23 " 13¾ " } {5-1/2 oz. a week. 5 months 23½ " 15 " } {double original weight. 6 months 24 " 16¼ " } {gained 2/3 oz. a day; {4-2/3 oz. a week. { 7 months 24½ " 17¼ " } { 8 months 25 " 18¼ " } {gained 1/2 in. a month. 9 months 25½ " 18¾ " } { 10 months 26 " 19¾ " } {gained about 1 lb. a month. 11 months 26½ " 20½ " } { 1 year 27 " 21½ " } {treble original weight. 2 years 31 " 27 " } { 3 years 35 " 32 " } {gain 4 in. a year. 4 years 37½ " 36 " } double original length. 5 years 40 " 40 " } {gained 3 in. and 4 lbs. } {a year. 6 years 43 " 44 " } {gained 2 in and 4 lbs. 7 years 45 " 48 " } {a year. 8 years 47 " 53 " } {gained 2 in. and 5 lbs. 9 years 49 " 58 " } {a year. 10 years 51 " 64 " } {gained 2 in. and 6 lbs. 11 years 53 " 70 " } {a year. 12 years 55 " 79 " } 13 years 57 " 88 " } 14 years 59 " 100 " } {gained 2 inches and 15 years 61 " 109 " } {about 9 lbs. a year. 16 years 63 " 117 " } general development the accompanying illustration (fig. 14), taken from dr. yale, represents the developmental changes at one, five, nine, thirteen, seventeen, and twenty-one years. each figure is divided into four equal parts, and as we watch the development from the baby who at one year, as dr. yale says, is four heads high, at the age of twenty-one the legs and the trunk have much outgrown the growth of the head, so that at this age the head is only two-thirteenths or less of the whole length of the body. the legs have grown more rapidly and equal one-half the entire body length. the trunk has not kept pace with the legs, for as you will see from the diagram the line reaches the navel of the child in one year, while in the adult it is much lower. the rapid growth of the legs is accomplished after nine years of age. [illustration: fig. 14. developmental changes] the proportions of the head, chest, and abdomen are exceedingly important in the growing child. at the end of the first year the head, chest, and abdomen are about uniform in circumference. the head may measure one-fourth of an inch more, but the chest and abdomen should both measure eighteen inches in circumference at this time. should the head or the abdomen be two inches larger than the chest; the attention of the physician should be called to it, for either are indicative of conditions that should be carefully investigated. normal breast weaning as a general rule the normal, healthy, breast-fed baby is given a feeding of a bottle each day after he is ten months old. these bottles are increased in number until, by the time the baby is a year old, he is gradually weaned from the breast. should the ninth month of baby's life arrive in the hot summer months we urge the mothers to continue breast feeding, with possibly the addition of some fruit juices, as noted elsewhere, until early autumn. under no circumstances should the baby be weaned and compelled to use cow's milk during the season of the year when the risks of contamination are greatest. if the baby is nursed up to the close of his first year he hardly need be trained to use the bottle, but may take his food from a cup. from one to two months should always be consumed in weaning the baby, unless sudden weaning is necessitated by ill health, as noted elsewhere. the baby should have, if possible, from thirty to forty days to accustom himself to cow's milk exclusively. if the child is weaned slowly there should be no trouble with the breasts, but in the instance of sudden weaning the mother should restrict her liquids, put on a tight breast binder, and for a day or two should take a dose of a saline cathartic, which will assist in taking care of the liquids and thus decrease the secretion of milk. normal bottle weaning if the bottle food is agreeing with the baby he should be allowed to use it up to the end of the first year when he will be given whole milk with possibly the addition of a little lime water. we see no reason why the child should give up his bottle during the second year unless other food is refused--unless he will not accept other food than from his bottle--and if you are convinced that he has formed the "bottle habit," then the milk should be put into a tiny cup or glass, and he should learn to sip it along with his solid foods; but if he takes his other foods without any hesitancy, then we know no reason why he should not take his milk in this comfortable manner from his bottle at least two or three feedings each day. if you desire to wean him from his bottle, serve the first part of it with a spoon from a cup or glass and then give him the remainder in the bottle. the beautiful picture of a big, robust baby lying on his back, knees flexed, both hands holding his beloved bottle still lingers in my mind as one of the pleasant memories of my lad's babyhood days, and at the close of the second year, when the beloved bottle was left behind, i believe i missed something as well as did the lad. i recall no difficulty with his taking the food from a cup. the success of all normal weanings is due entirely to the fact that it is done gradually and slowly, and under no circumstances should it be roughly and abruptly attempted--particularly in case of the bottle feeding. training the bowels and bladder reference is made to this subject in another part of this book--where we went into the detail of keeping the daily record of these physiological occurrences--and it was found that the bowels moved and the bladder was emptied at about the same time each day. any mother, caretaker, or nurse, who will take the time to keep a daily record of the hours of defecation and urination, will observe the time carefully and will catch the child on nearly every occasion before an accident occurs. often as early as four months the bowels will move in an infant's chamber at regular times each day. the nurse or mother places this receptacle in her lap and holds the child gently and carefully upon it. a little later it can be made to sit on a special chair prepared for the purpose, and at eight or nine months by careful training the urination can be controlled, and by the end of the first year the diapers ought to be discontinued. if the child has not learned to control the bladder by the age of two years, medical attention should be called to the fact and remedial measures instituted. baby's speech the baby should begin to talk at one year. he early learns to say "mamma" and "papa," and gradually adds nouns to his vocabulary, so that at eighteen months the normal child should have a vocabulary of one hundred to one hundred and fifty words. as he nears the two-year mark, he has acquired a few simple verbs and he can possibly put three words together, such as, "willie wants drink." pronouns come in late, as we all recall that the young child usually speaks of himself by his own name. children are born mimics. if you talk baby talk to them, they will talk baby talk back. for instance, a well known author told us just the other day that for many years no other name was given to the sewing machine in his house but the word "mafinge," and not until he went to school did he correct the word "bewhind," for in the nursery he learned the line "wagging their tails bewhind them." baby talk is very cunning, and often the adult members of the family pick it up and keep it up for years, and only when they are exposed in public, as one mother was on a suburban platform by her four-year-old lad shouting, "mamma, too-too tain tumin, too-too tain tumin," do they sense their responsibility and realize how difficult it is to form new habits. this poor mother tried in vain to have her little fellow say, as did another little lad two and one-half years old, "mother, the train's coming; let's get on." many words of our beloved language at best are hard to understand; so let us speak correct english to the little folks and they will reward us by speaking good english in return. if at two years the child makes no attempt at speech, suspicions should be aroused concerning mutism or other serious nervous defects. medical advice should be sought. defective speech all guttural tones which may be occasioned by adenoids or enlarged tonsils, all lisping, stuttering, or defective speech of all words should be taken in hand at the very start, as they are usually overcome by constant repetition of the correct manner of speaking the particular word in question. children of defective speech need special training, and should in no way be allowed rapidly to repeat little nursery rhymes, as oftentimes this rapid repetition of rhymes by a child with hereditary nervous defects may occasion stuttering or stammering later on. calisthenics special exercise should not be forced upon young children. physical culture, along with many other things intended for sedentary adults, should never be forced upon little folks who get all of the exercise they need in the many journeys they take building their blocks, sailing their boats, tearing down imaginary houses, making imaginary journeys--from morning until night the little feet are kept busy--never stopping until the sandman comes at sleepy time. do not yourself attempt to stimulate a child who seems backward. consult your physician. you had much better put a child out to grow up in the yard by himself with his sandpile than to force calisthenics or advance physical training upon him. bow legs and walking do not attempt to hasten nature in aiding the child to walk. let him creep, roll, slide, or even hunch along the floor--wait until he pulls himself to his feet and gradually acquires the art of standing alone. if he is overpersuaded to take "those cute little steps" it may result in bow legs, and then--pity on him when he grows up. sometimes flat foot is the result of early urging the child to rest the weight of the body upon the undeveloped arch. a defect in the gait or a pigeon toe is hard to bear later on in life. a certain amount of pigeon-toeing is natural and normal. if the baby is heavy he will not attempt to walk at twelve months. he will very likely wait until fourteen or fifteen months. the lighter-weight children sometimes walk as early as eleven months, but they should all be walking at eighteen months, and if not, it is usually indicative of backward mentality. if the training of the bowels and bladder will replace the diapers with drawers, the baby will attempt to walk sooner than when encumbered with a bunglesome bunch of diaper between the thighs. the little fellow runs alone at sixteen months and thoroughly enjoys it, and the wise mother will pay no attention to the small bumps which are going to come plentifully at this particular time. summary of baby's development he discovers his hands at three or four months. at six months he sits alone, plays with simple objects, grasps for objects, and laughs aloud from the third to the fifth month. he says "goo goo" at four or five months. at one year he should stand with support, listen to a watch tick, follow moving objects, know his mother, play little games, such as rolling a ball, should have trebled his birth weight, and have at least six teeth, and should use three words in short sentences. at eighteen months he should say "mamma" spontaneously, walk and run without support, should have quite a vocabulary, should be able to perform small errands like "pick up the book," and should have twelve to sixteen teeth. at two years he should be interested in pictures, able to talk intelligently, and know where his eyes, nose, mouth, hands, and feet are. at three years, he should enumerate the objects in a picture, tell his surname, and repeat a sentence with six words. in the case of a premature baby or a very delicate child, or as a result of a prolonged illness or a very severe sickness, such as spinal meningitis, the time of these mental and physical developments may all be postponed, while rickets, which will be spoken of later, is often the cause of late sitting, late standing, and late walking. diet after the first year milk is the principal article of diet during the second year. it should be given with regularity at distinct intervals of four meals a day. it may be given from the nursing bottle, unless the child has acquired the bottle habit and refuses to eat anything else but the food from his bottle, in which case it should be given from a cup. beginning with the sixth month, aside from his milk, be it breast milk or bottle milk, he is to be given orange juice once each day as well as the broth from spinach and other vegetables. this is necessary to give the child certain salts which are exceedingly essential to the bottle baby. at the close of the year when he is taking whole milk he should be given arrowroot cracker, strained apple sauce, prune pulp, fig pulp, mashed ripe banana (mashed with a knife), a baked potato with sauce or gravy (avoiding condiments), and a coddled egg. fruit juices may be added to the diet, such as grape, pineapple, peach, and pear juice. later in the second year he may be given stale bread and butter, and for desserts he may have cup custard, slightly sweetened junket, and such fruit desserts as baked apple and baked pear. we do not think it is necessary to give children much meat or meat juices. we appreciate that there is a diversity of opinion upon this subject, but we do not hesitate to say that in the families where meat is little used, the children seem to grow up in the normal manner with sound healthy bodies, sometimes having never tasted it. when meat is used, it should be well cooked to avoid contamination with such parasites as tapeworm and trichina; it should also be well chewed before swallowing, as many of the intestinal disturbances of the older children are due to the swallowing of unmasticated food such as half-chewed banana, chunks of meat, rinds of fruit, and the skins of baked potatoes. let the children's diet be simply planned, well cooked, thoroughly masticated, and above all things have regular meal hours, and no "piecing" between meals; and if the mother begins thus early with her little fellow, she will be rewarded some later day by hearing him say to some well-meaning neighbor, who has just given him a delicious cookie or a bit of candy: "thank you, i will keep it until meal time." children learn one of the greatest lessons of self control in following the teaching that nothing should pass the lips between meals but water or a fruit-ade. children in the second year require four meals a day, one of which is usually only the bottle or a cup of milk. these meals are usually taken at six, ten, two, and six in the evening. oftentimes this early six o'clock meal is just a bottle or cup of milk, as may also be the evening meal. candy now, a word about candy. pure candy is wholesome and nourishing. it is high in calorific value, and children should be allowed to have it if it does not enter the stomach in solutions stronger than ten or fifteen per cent. we can see at a glance that chocolate creams, bonbons, and other soft candies should never be given to children. candies that they can suck, such as fruit tablets, stick candy, sunshine candy, and other hard confections that are pure, and free from mineral colorings and other concoctions such as are commonly used in the cheaper candies, may safely be given at the close of the meals--but never between meals. all such articles as tea, coffee, beer, soft candies, condiments, pastries, and fried foods, should be positively avoided in the case of all children under five and six years of age. the diet from now on will be considered in the chapter "diet and nutrition." part iii the child part iii the child chapter xxv the sick child to the mother who has passed through the experience of bringing the child into the world is usually given that intuitiveness which helps her in caring for that child when it is well and in recognizing certain symptoms when it is sick. the newborn baby brings with him a large responsibility, but as the weeks pass by his care becomes less and less of a nervous strain, as the routine duties, so nearly alike each day of his little life, have made the task comparatively easy; but when the baby gets sick, particularly if he is under one year of age, and it is impossible for him clearly to make known his wants, and being unable to tell where it hurts or how badly it hurts, the average mother is likely to become somewhat panicky; and this confusion of mind often renders her quite unfit successfully to nurse the sick baby. the nurse it is often wise to secure the services of a trained nurse, and if the family purse will allow such services, a good, sincere, capable, practical nurse should be engaged, for her firm kindness will often accomplish much more than the unintentional irritability and anxious solicitude of an overworked and nervous mother. usually the mother not only attempts the care of the sick baby with the long night vigil--often not having the opportunity to take a bath or change her raiment day in and day out--but she often attempts to manage the entire household as well, including the getting of the meals and keeping the house cleaned, and it is not to be wondered at that her nerves become overtaxed and in an unlooked for moment she becomes irritable and cross with the sick child. no matter how low the financial conditions of the family may be, outside help is always essential in cases of severe or long-continued illness of the children. should the mother insist upon caring for the baby herself, then all household duties should be given over to outside help, and as she takes the rôle of the nurse, the same daily outing and sleep that an outside nurse would receive should be hers to enjoy. dr. griffith has so ably detailed the "features of disease" that we can do no better than to quote the following:[a] [a] from griffith's _care of the baby_, copyrighted by w. b. saunders company. position the position assumed in sickness is a matter of importance. a child feverish or in pain is usually very restless even when asleep. when awake it desires constantly to be taken up, put down again, or carried about. sometimes, however, at the beginning of an acute disease it lies heavy and stupid for a long time. in prolonged illnesses and in severe acute disorders the great exhaustion is shown by the child lying upon its back, with its face turned toward the ceiling, in a condition of complete apathy. it may remain like a log, scarcely breathing for days before death takes place. perfect immobility may also be seen in children who are entirely unconscious although not exhausted. a constant tossing off of the covers at night occurs early in rickets, but, of course, is seen in many healthy infants, especially if they are too warmly covered. a baby shows a desire to be propped up with pillows or to sit erect or to be carried in the mother's arms with its head over her shoulder whenever breathing is much interfered with, as in diphtheria of the larynx and in affections of the heart and lungs. the constant assumption of one position or the keeping of one part of the body still, may indicate paralysis. when, however, a cry attends a forcible change of position, it shows that the child was still because movement caused pain. sleeping with the mouth open and the head thrown back often attends chronic enlargement of the tonsils and the presence of adenoid growths in young children, although it may be seen in other affections which make breathing difficult. in inflammation of the brain the head is often drawn far back and held stiffly so. sometimes, too, in this disease the child lies upon one side with the back arched, the knees drawn up, and the arms crossed over the chest. a constant burying of the face in the pillow or in the mother's lap occurs in severe inflammation of the eyes. gestures the gestures are often indicative of disease. babies frequently place the hands near the seat of pain; thus in slight inflammation of the mouth they tend to put the hand in the mouth; in earache to move it to the ear; and in headache to raise it to the head. in headache or in affections of the brain they sometimes pluck at the hair or the ears, although they may often do this when there is no such trouble. picking at the nose or at the opening of the bowel is seen in irritation of the intestine from worms or oftener from other cause. a child with a painful disease of its chest may sometimes place its hand on its abdomen, or a hungry child try to put its fists into its mouth. in approaching convulsions the thumbs are often drawn tightly into the palms of the hands and the toes are stiffly bent or straightened. very young babies, however, tend to do this, although healthy. the alternate doubling up and straightening of the body, with squirming movements, making of fists, kicking, and crying, are indications of colic. this is especially true if the symptoms come on suddenly and disappear as suddenly, perhaps attended by the expulsion of gas from the bowel. skin color the color of the skin is often altered in disease. it is yellow in jaundice, and is bluish, especially over the face, in congenital heart disease. there is a purplish tint around the eyes and mouth, with a prominence of the veins of the face, in weakly children or in those with disordered digestion. a pale circle around the mouth accompanies nausea. the skin frequently acquires an earthy hue in chronic diarrhea, and is pale in any condition in which the blood is impoverished, as in bright's disease, rickets, consumption, or any exhausted state. flushing of the face accompanies fever, but besides this there is often seen a flushing without fever in older children the subjects of chronic disorders of digestion. sudden flushing or paling is sometimes seen in disease of the brain. facial expression the expression of the face varies with the disease. in whooping cough and measles the face is swollen and somewhat flushed, giving the child a heavy, stupid expression. there is also swelling of the face, especially about the eyes, in bright's disease. repeated momentary crossing of the eyes often indicates approaching convulsions. in very severe acute diarrhea it is astonishing with what rapidity the face will become sunken and shriveled, and so covered with deep lines that the baby is almost unrecognizable. the same thing occurs more slowly in the condition commonly known as marasmus. often the face has an expression of distress in the beginning of any serious disease. if the edges of the nostrils move in and out with breathing, we may suspect some difficulty of respiration, such as attends pneumonia. the baby sleeps with its eyes half open in exhausted conditions or when suffering pain. the head the head exhibits certain noteworthy features. excessive perspiration when sleeping is an early symptom of rickets. it must be remembered, however, that any debilitated child may perspire more or less when asleep. both in rickets and in hydrocephalus (water on the brain) the face seems small and the head large, but in the former the head is square and flat on top, while in the latter it is of a somewhat globular shape. the fontanelle is prominent and throbs forcibly in inflammation of the brain, is too large in rickets and hydrocephalus, bulges in the latter affection, and sometimes sinks in conditions with only slight debility. the chest the chest exhibits a heaving movement with a drawing in of the spaces between the ribs in any disease in which breathing is difficult. a chicken-breasted chest is seen in pott's disease of the spine, and to some extent in bad cases of enlargement of the tonsillar tissue; a "violin-shaped" chest in rickets; a bulging of one side in pleurisy with fluid; and a long, narrow chest, with a general flattening of the upper part, in older children predisposed to consumption. the abdomen the abdomen is swollen and hard in colic. it is also much distended with gas in rickets, and is constantly so in chronic indigestion in later childhood. it is usually much sunken in inflammation of the brain or in severe exhausting diarrhea or marasmus. it may be distended with liquid in some cases of dropsy. the cry the study of the cry furnishes one of the most valuable means of learning what ails a baby. a persistent cry may be produced by the intense, constant itching of eczema. the paroxysmal cry, very severe for a time and then ceasing absolutely, is probably due to colic, particularly if accompanied by the distention of the abdomen and the movements of the body already referred to. a frequent, peevish, whining cry is heard in children with general poor health or discomfort. a single shrill scream uttered now and then is often heard in inflammation of the brain. in any disease in which there is difficulty in getting enough air into the lungs, as in pneumonia, the cry is usually very short and the child cries but little, because it cannot hold its breath long enough for it. a nasal cry occurs with cold in the head. a short cry immediately after coughing indicates that the cough hurts the chest. crying when the bowels are moved shows that there is pain at that time. a child of from two to six years, waking at night with violent screaming, is probably suffering from night terrors. in conditions of very great weakness and exhaustion the baby moans feebly, or it may twist its face into the position for crying, but emit no sound at all. this latter is also true in some cases of inflammation of the larynx, while in other cases the cry is hoarse or croupy. crying when anything goes into the mouth makes one suspect some trouble there. if it occurs with swallowing, it is probable that the throat is inflamed. with the act of crying there ought always to be tears in children over three or four months of age. if there are none, serious disease is indicated, and their reappearance is then a good sign. coughing the character of the cough is also instructive. a frequent, loud, nearly painless cough, at first tight and later loose, is heard in bronchitis. a short, tight, suppressed cough, which is followed by a grimace, and, perhaps, by a cry, indicates some inflammation about the chest, often pneumonia. there is a brazen, barking, "croupy" cough in spasmodic croup. in inflammation of the larynx, including true croup, the cough may be hoarse, croupy, or sometimes almost noiseless. the cough of whooping cough is so peculiar that it must be described separately when considering this disease. then there are certain coughs which are purely nervous or dependent upon remote affections. thus the so-called "stomach cough" is caused by some irritation of the stomach or bowels. it is not nearly so frequent as mothers suppose. irritation about the nose or the canal of the ears sometimes induces a cough in a similar way. enlarged tonsils or elongated palate or throat irritation may also produce a cough. the breathing the breathing of a young child, particularly if under one year of age and awake, is always slightly irregular. if it becomes very decidedly so, we suspect disease, particularly of the brain. a combination of long pauses, lasting half a minute or a minute, with breathing which is at first very faint, gradually becomes more and more deep, and then slowly dies away entirely, goes by the name of "cheyne-stokes respiration," and is found in affections of the brain. it is one of the worst of symptoms except in infancy, and even then it is very serious. the rate of respiration is increased in fever in proportion to the height of the temperature. it is increased also by pain in rickets, and especially in some affections of the lungs. sixty respirations a minute are not at all excessive for a child of two years with pneumonia, and the speed is frequently decidedly greater than this. breathing is often very slow in disease of the brain, particularly tubercular meningitis. poisoning by opiates produces the same effect. frequent deep sighing or yawning occurs in affections of the brain, in faintness, or in great exhaustion, and may be a very unfavorable symptom. breathing entirely through the mouth shows that the nose is completely blocked, while snuffling breathing is the result of a partial catarrhal obstruction. a gurgling in the throat not accompanied by cough may indicate that there is mucus in the back part of it, the result of an inflammation, sometimes slight, sometimes serious. "labored" breathing, in which the chest is pulled up with each breath while the muscles of the neck become tense, the pit of the stomach and the spaces between the ribs sink in, and the edges of the nostrils move in and out, is seen in conditions where the natural ease of respiration is greatly interfered with, as in pneumonia, diphtheria of the larynx, asthma, and the like. long-drawn, noisy inspirations and expirations are heard in obstruction of the larynx, as from laryngeal diphtheria or spasmodic croup. the pulse the rate of the pulse is subject to such variations in infants that its examination is of less value than it would otherwise be. in early childhood its observation is of more service, although even then deceptive. slight irregularity is not uncommon. unusual irregularity is an important symptom in affections of the brain or heart. fever produces an increase in the pulse rate, the degree of which depends, as a rule, upon the height of the temperature. slowing of the pulse is a very significant symptom, seen particularly in affections of the brain, and sometimes in bright's disease and jaundice. the temperature the temperature is of all things important to remember in infancy and childhood because fever is easily produced and runs high from slight causes. even slight cold or the presence of constipation or slight disturbances of digestion may in babies sometimes produce a temperature of 103 f. or more. we do not speak of fever unless the elevation reaches 100 f. a temperature of 102 or 103 f. constitutes moderate fever, while that of 104 or 105 f. is high fever, and above 105 f. very high. a temperature of 107 f. is very dangerous, and is usually not recovered from. the danger from fever depends not only upon its height, but upon its duration also. an elevation of 105 f. may be easily borne for a short time, but it becomes alarming if much prolonged. the mouth the tongue of newborn infants is generally whitish and continues to be so until the saliva becomes plentiful. after this we usually find it coated in disturbances of the stomach and bowels and in nearly any disorder accompanied by fever. in scarlet fever the tongue becomes bright red after a few days, and in measles and whooping cough it is often faintly bluish. in the latter affection an ulcer may sometimes be found directly under the tongue, where the thin membrane binds it to the floor of the mouth. in thrush the tongue is covered with white patches like curdled milk. a pale, flabby tongue, marked by the teeth at its edges, indicates debility or impaired digestion. in prolonged or very high fever the tongue grows dry, and in some diseases of the stomach or bowels it may look like raw beef. grinding of the teeth is a frequent symptom in infants in whom dentition has commenced. it generally indicates an irritated nervous system. most often this depends upon some disturbance of digestion; less often upon the presence of worms. the symptom is present during or preceding a convulsion, and may occur, too, in disease of the brain. in some babies it appears to be only a nervous habit. nursing the manner of nursing or swallowing frequently affords important information. a baby whose nose is much obstructed or who has pneumonia can nurse but for a moment, and then has to let the nipple go in order to breathe more satisfactorily. if it gives a few sucks and then drops the nipple with a cry, we must suspect that the mouth is sore and that nursing is painful. if it swallows with a gurgling noise, often stops to cough, and does as little nursing as possible, we suspect that the throat may be sore. the ceasing to nurse at all, in the case of a very sick baby, is an evidence of great weakness or increasing stupor, and is a most unfavorable symptom. the urine urine that is high-colored and stains the diaper, or that shows a thick, reddish cloud after standing, may accompany fever or indigestion. sometimes the urine under these conditions is milky when first passed. in some babies a diet containing beef juice or other highly nitrogenous food will produce the reddish cloud, or even actual, red, sandlike particles. a decidedly yellow stain on the diaper occurs when there is jaundice. a faint reddish stain seldom indicates blood. the amount of urine passed is scanty in fever, in diarrhea, and especially in acute bright's disease. in the latter disease the urine is often of a smoky or even a muddy appearance. the possibility of the occurrence of this symptom after scarlet fever must always be kept in mind, in order that a physician may be summoned very quickly, since it is a serious matter. the stools we find that the passages are often putty-colored in disorders of the liver, frequently bloody or tarry in appearance in bleeding within the bowel, and liable to be black after taking bismuth, charcoal, or iron, and red after krameria, kino, or haematoxylon. infants who are receiving more milk than they can digest constantly have whitish lumps in their stools, or even entirely formed but almost white passages. the presence of a certain amount of greenish coloration of the passages is not infrequent. this is usually an evidence of indigestion, but passages which are yellow when passed and turn to a faint pea green some time later are not an indication of disease. when baby gets sick when baby shows that he is sick, take his temperature as directed elsewhere, cut down the feeding to at least one half, or, if his temperature is around 102 f. give him nothing but rice water or barley water. if he is constipated give him a cleansing enema, and if hot and feverish a sponge bath may be administered. he should then be put into a bed with light covers and wait further orders which the doctor will give on his arrival. give the baby no medicine unless ordered to do so by the physician. known to every physician who undertakes the care of children, is the failure of many well-meaning mothers to call him early. the mother attempts the care of the baby herself, and not until the condition gets beyond her knowledge and wisdom does she seek medical advice. in the early hours of an approaching cold, the beginning of intestinal indigestion, or at the beginning of bronchitis, if the physician can see the child early, prolonged illness may be avoided as well as unnecessary expense and many heart-breaking experiences. feeding the sick baby feeding the sick baby differs somewhat with the character of the individual disease, but in the outset of any and all diseases the intestinal tract should not be overburdened with food. at the approach of any illness, the food should at least be cut down one half; for instance, in the case of a serious acute illness accompanied by fever, not only should the strength of the food be reduced one half, but water should be given plentifully between feedings. it is better never to urge the baby to eat at such times--for the ability to digest food is very much reduced. in cases of acute attacks with much vomiting and fever, all milk should be immediately stopped and rice water or barley water substituted. when vomiting ceases and the fever approaches normal and food is desired, begin with boiled skim milk in small amounts, well diluted with cereal water, and do not approach the normal amount of milk for twenty-four to forty-eight hours. in this way the weak digestive organs are not overtaxed and they gradually resume their usual work of good digestion. when a baby seems to have no appetite for food, lengthen the intervals from three to four or five hours, for feeding when food is not desired usually aggravates disease disturbances. examining sick children and now, above all times, the early seed sowing of teaching the child self-control, teaching him to gargle if he is sufficiently old enough, to open his mouth and allow observation without resistance, brings sure results. the great harm of making the doctor and his medicine a threat to obtain obedience also brings its harvest at this time; for the doctor, of all people, ought to be regarded as the child's best friend. when baby is sick, the doctor is needed, his daily visits must not be resisted, his medicines must not be feared--these and such other matters should be made a part of every child's early education. under no circumstances or conditions should we directly falsify to a child. nothing is accomplished by telling a child it will not hurt when you know that it will hurt, or that the medicine tastes good when you know it is bad-tasting. every physician can recall unnecessary disturbances in the office because a mother has allowed a child to acquire a wrong mental attitude toward the family physician. one mother told her little girl in my office when i wished to make an examination for adenoids which necessitated my putting my finger back of the child's uvula, "now mary, the doctor won't hurt you at all, it will feel nice." i turned to the little girl and said: "mary, it will not feel nice, it really won't hurt you, but it will feel uncomfortable." it was a grave mistake to tell her that it would feel nice. the child resisted, and, while the examination was successfully made, the greatest of tact had to be used in securing the friendship of the child after the examination. it is far better when the throat is to be examined to wrap the child in a shawl or a sheet with his arms placed at his side, and for a member of the family to take him in her lap and hold him securely while the physician quickly makes the observation. and while we appreciate that sickness is not the time to introduce new methods of training, in instances where children have been spoiled, it is far better quietly and firmly to go about the task in a manner that you know can be carried through to a successful finish. treatment of sick children a sick child should be encouraged to lie in his bed much of the time, and the bed should be kept clean and cool. he should never be set up suddenly or laid back quickly. in the case of a broken leg, all rapid movements should be avoided. a simple story or a soothing lullaby, or the giving of a toy, will often divert attention when some painful movement must be made or some disagreeable task performed. both cleanliness of the body and cleanliness of the mouth are exceedingly necessary in sickness. in all instances of disease or indisposition, the mouth must receive daily care, for stomatitis or gangrene of the mouth often follows neglect. a listerine wash in proportion of one to four, or a magnesia wash, or the addition of a few drops of essence of cinnamon to the mouth wash will do much to prevent such conditions, as well as to relieve them. applications of medicine to the throat may be made without resistance if the tactful nurse watches her time. she should slowly introduce the tongue depressor which may be a flat stick or a spoon, when the application of medicine with a camel's-hair brush is quickly made to the rolled-out throat as the child gags, and if the nurse then quickly diverts his attention to some beautiful story or a picture or a new toy, the treatment is soon forgotten. under no circumstances argue with or scold a sick child. get everything ready, if possible behind his back or in another room, and then with plenty of help make the application or the observation without words, always with gentleness and firmness. nursing records whether the nurse be the mother, caretaker, practical or professional nurse, a record should always be kept of the condition of the patient. the temperature should be reported at different periods designated by the physician. the pulse should be recorded, the amount of urine passed and the time it was passed, the number of bowel movements, all feedings and the general well being of the child--whether it is restless or comfortable, sleeping or awake, together with the water that he drinks. the record may be kept, if necessary, on a piece of common letter paper, and should read something like this: march 26, 1916 7 a. m. temperature 102; pulse 132; respiration 40; morning toilet; took 4 ounces of milk; 2 ounces of barley water; 1 ounce of lime water. 9 a. m. enema given; good bowel movement; mustard paste applied to chest, front and back, and oil-silk jacket applied; drank boiled water, 4 ounces. 11 a. m. took the juice of one orange; temperature 103; pulse 135. 12 noon. very listless and nervous; temperature 104. has coughed a great deal. gave mustard paste to chest, front and back, and wet-sheet pack. 1:30 p. m. temperature 101.8; 4 ounces of water to drink; looks better. 3 p. m. has slept 1½ hours; temperature 102.5; pulse 134; respiration 40; 6 ounces of food given (3 ounces of milk, 2 ounces of barley water and 1 ounce of lime water). a record like this is a great help to the physician, and such a record may be kept by anyone who can read and write. there are printed record blanks which may be procured from any medical supply house and most drug stores. bad-tasting medicines castor oil has neither a pleasant smell nor taste, and nothing is accomplished by telling the child that it does smell good or taste good. if the patient is old enough to drink from a cup, put in a layer of orange juice and then the castor oil and then another layer of orange juice, and in this way it often can be easily taken. someone has suggested that a piece of ice held in the mouth just before the medicine is taken will often make a bad dose go down without so much forcing. a taste of currant jelly, or a bit of sweet chocolate, or the chewing of a stick of cinnamon is a great adjunct to the administration of bad-tasting medicines. all oily medicines must be kept in a cool place and should always be given in spoons or from medicine glasses that have first been dipped in very cold water. very often the addition of sugar to bad-tasting medicines will in no wise interfere with their action, while it often facilitates the administration of the disagreeable dose. the majority of bad-tasting medicines are now put up in the form of chocolate-flavored candy tablets. temperatures and pulse the normal temperature of a baby is 98.5 to 99 f. in the rectum. after shaking the mercury of the thermometer down below the 97 mark it is well lubricated with vaseline and then carefully, gently, pushed into the rectum for about an inch and a half or two inches, and left there for three minutes before removing. mothers should exercise self-control in taking the temperature, for nothing is gained by allowing a panicky fear to seize you should the mercury register higher than you anticipated. notify your physician when the temperature registers above 100 f. the respirations of a child are fairly regular and rhythmic and occur about forty times per minute during the first month of life and about thirty times per minute during the remainder of the year. from one to two years, twenty-six to twenty-eight is the average. breathing is somewhat irregular when the child is awake and may be a bit slower when asleep. before the baby is born the fetal pulse is about 150. at birth it ranges from 130 to 140. during the first month the pulse is found to be from 120 to 140. by the sixth month it gets down to 120 or 130, and from that on to a year the normal pulse beat of the baby is about 120. the pulse is influenced very much by exercise and is often increased by crying or nursing or any other excitement. fever children get fever very easily--the digestive disturbance of overeating, constipation, a slight bilious attack--all produce fever which disappears quite as suddenly as it came. the first thing to do under such circumstances is to withhold food, give plenty of water to drink, produce a brisk movement of the bowel by giving a dose of castor oil, give a cleansing enema, and treat the fever as follows: after removing all of the clothes from the child, place him in a warm blanket and then prepare a sponge bath which may be equal parts of alcohol and water; expose one portion of the body at a time and apply the water and alcohol first to one arm and then to the other arm, the chest, one leg, the other leg, the back and then the buttocks. do not dry the part but allow evaporation to take place, and this, accompanied by the cooling of the blood which is brought to the skin by the friction, readily reduces the fever. another procedure which may be employed if the fever registers high is the wet-sheet pack which is administered as follows: three thicknesses of wool blankets are placed on the bed and a sheet as long as the baby and just enough to wrap around him once, is wrung out of cool water and spread over these blankets. with a hot-water bottle to the feet, the child is then laid down in the wet sheet which is now brought in contact with every portion of his body, then the blankets are quickly brought around, and he is allowed to warm up the sheet--which lowers his temperature. another valuable procedure is the cooling enema. water the same temperature as that of the body, is allowed to enter the bowel and is then quickly cooled down to 90 or 85 f.; in this manner much heat is taken out of the body and the fever quickly reduced. (for further treatment of fevers see appendix.) chapter xxvi baby's sick room visitors should never be allowed in the sick room during the height of a disease, and during convalescence not more than one visitor should be allowed at one time, and the visit then should be only two or three minutes in length. the order and the quietness and the system of the sick room should be perfect. visitors and loitering members of the family do no good and they may do much harm to the recuperating nervous system of the child. location of the sick room in these days of high rents, we realize that the greater per cent of our readers are living in apartments and homes just big enough conveniently to care for the family during health, and while it would be pleasant and convenient to have a spare room or an attic chamber that could be used in case of illness, it is the exception rather than the rule that the families to whom sickness comes have these extra apartments. when a contagious or an infectious disease comes to the family, it is of great importance that the sick child be isolated, preferably on another floor, from that used by the immediate family. those living in homes, more than likely can fix up a room on the attic floor for the isolation, and those living in apartments may put the sick child in one end of the apartment, while they inhabit the other end. one family under my observation not long ago had a child stricken with the measles. in the same apartment there lived a puny baby not quite two years old. coming as it did in february, the mother of the child was apprehensive, fearing that measles would leave a severe bronchitis which might mean the death of the already too-delicate baby. she was instructed to move the baby's bed to the sun parlor in the front of the flat, while the boy with the measles was put in the parents' room in the rear end of the flat. a sheet was suspended in the middle of the hall leading from the living-room to the bedrooms. door knobs were disinfected daily, a caretaker was put in charge of the measles patient, the mother very frequently was compelled to go back and administer a treatment, but each time she donned a large apron and completely covered her hair with a towel, she administered the treatment, took off her wrappings, thoroughly washed her face and hands--disinfected them--and returned to her baby in the front part of the house. at night this mother slept on the floor on springs and mattress in the living-room, and to that home the measles came and departed, and the baby did not get them at all, so perfect was the isolation, so vigilant the disinfection, and so scrupulous the care to prevent contamination. so you see from this one instance that it is altogether possible to make isolation complete even on the same floor. but, mind you, the dishes that the lad ate from were all kept in his room. food was brought to the sheet and there the caretaker held her dishes while the cook poured or lifted the food from her clean dishes to the dishes the caretaker brought from the sick room. whether the sick room is in the attic or whether it be the rear end of an apartment, if the principles of contagion and disinfection are understood i believe it is perfectly possible to isolate even scarlet fever without danger to the other members of the family. necessary furnishings for slight indispositions and trifling disorders, it is not necessary to strip the room of its adornment, but it is well to clear off the dresser tops, protect them well with many thicknesses of newspapers covered over by a folded sheet so that alcohol, witch-hazel and other necessaries will not injure the mahogany or oak-top dresser. whenever the children are sick, rob the room of anything that is going to be in your way. in instances of infectious or contagious diseases, take down all silk or wool hangings, replace them by washable curtains or inexpensive ones that can be burned if necessary, and remove valuable paintings and other bric-a-brac that later fumigation will harm or that may gather the dust during the days of illness. just as it is necessary for the man who mines the coal to wear suitable garments, and for the woman who does the scrubbing to dress accordingly, and for the nurse who cares for the case to wear washable clothes--so it is necessary to dress the sick room in garments that are suitable, convenient, and capable of being thoroughly disinfected, fumigated, or even burned if the occasion demands. hence, expensive rugs should be replaced by rag carpets or no rug at all, while unnecessary articles and garments should be removed from closets, etc. remembering that the little fellow is to remain in this room for possibly two weeks or maybe six weeks, let us put up some bright-colored pictures that he will enjoy, bring in some books and magazines by which he may be entertained, secure a few simple toys that will not tax the brain, but serve as a help to pass away the long hours. there are many paper games that may be had, such as transfer pictures, picture puzzles, kindergarten papers, drawing pictures, as well as toys that may be put together to fashion new articles. a whole lot of fun can be gotten out of a bunch of burrs that can be stuck together to make men, animals, houses, etc. scissors and pictures are entertaining as well as paper dolls with their wardrobes. rubber balloons, or a target gun for the boy of six will be a great source of delight to him; as will a doll with a trunk full of clothes for the little girl during her convalescent days. a tactful nurse and a resourceful mother will think of all the rest that we have not mentioned--which will amuse, entertain and keep happy our convalescent children, help them to forget that they are "shut ins." the nursery refrigerator it is wise in instances of the more severe childhood troubles, such as infectious and contagious diseases, to keep as many things in the sick room as possible, and so we remind our reader of the home-made ice box, described elsewhere in this book, in which may be kept the fruit juices and the fruits, as well as the milk and the buttermilk. many medicines, particularly the oily medicines, should be kept in this home-made ice box and five cents worth of ice a day will not only make things taste better, especially during the warm months, but will protect the other members of the family, for the family ice box is a big central station which must be protected against infections and carriers of disease. in connection with the ice box, we are reminded that it would be a great convenience to have a simple contrivance for heating bouillon, milk, or making a piece of toast, which can be readily done with an electric heater, an alcohol stove, or a small apparatus fitting over the gas jet. sick room disinfectants the most important thing which we are going to mention in this division of the chapter is the disinfection of the door knobs. according to the directions on the poison bottle, place an antiseptic tablet into a small amount of water which will make a solution of 1 to 1000 of bichlorid of mercury, and several times a day disinfect the door knobs, particularly in the sick end of the house--thoroughly washing and adequately rubbing with a towel moistened in this solution. all stools and urine from the sick one will receive attention as directed by the physician. the stools from a typhoid patient should stand for one-half hour in a chamber covered with a layer of lime. it is not at all necessary to have vessels containing disinfectant substances standing about the room and in the closet. in a room adjoining should be kept all of the dishes used by the sick patient, his tray, half a dozen napkins, knife, fork, spoon, serving dishes, drinking glass, pitcher, etc. all bedding and all linen used by the sick member should be allowed to stand in a solution of disinfectant for several hours when they may be wrung out of the solution, dropped into a bucket and carried to the laundry without any danger to other members of the family. the nurse is not allowed to leave this room in the garments that are worn while caring for the sick. she should have her meals in an adjoining room which is also under strict isolation. the medicine chest the sick room medicine chest should be so placed on the wall that it is outside the reach of the smaller members of the family, for in it should be placed poisons for external use that are capable of producing death if taken internally. bottles that hold these poisons--such as bichlorid of mercury, lysol, carbolic acid, laudanum, paregoric, belladonna, etc.--should be so different from the other bottles in the medicine chest that if one should reach for them with his eyes shut or in the dark he would at once recognize that he had hold of a poison bottle. this is absolutely necessary. it usually means a bit of extra expense, but when we realize what tragedies may be avoided by such slight expense, it must not be considered. bottles may be procured that have been molded with points of glass projecting from the outside which make them rough to the touch, or they may be covered with a wire mesh or with a wicker covering which may easily be told from the other bottles in the case. one woman lost her life because the nurse placed two ounces of carbolic acid in the enema instead of two ounces of saline solution. saline solution is nothing but salt and water, while carbolic acid cost the woman her life, simply because the carbolic acid was not placed in a specialized poison bottle and the attendant could not read the label in the dark. under no circumstances keep from one year to another the remnants of unused medicine of a former sickness, for medicines do not keep well and often lose their strength if kept longer than the physician intended. in this medicine chest should be found the following articles: a glass graduate marked with fluid drachms (1 teaspoon), and fluid ounces (8 teaspoons). a medicine dropper. absorbent cotton. boric acid. camphorated oil. castor oil. aromatic spirits of ammonia. alcohol. olive oil. epsom salts. soda-mint tablets. vaseline. zinc ointment, together with other medicines the physician orders. ice bag, hot-water bottle and oiled silk. besides these articles, in the nursery--in readiness for emergencies and accidents--should be found the following: gauze bandages of various sizes. sterile gauze. boric acid crystals and powder. mustard. a pocket case of instruments containing scissors, knife, dressing forceps, etc. syrup of ipecac. glycerin. tincture of iodine. package of ordinary baking soda. peroxid of hydrogen. absorbent cotton. needle and thread. lime water. patent medicines aside from the giving of castor oil and the application of vaseline to the nose, or of applying boracic acid to the eyes, no medicine should be administered to the baby without competent medical advice. there are numerous widely advertised nostrums frequently sold as soothing syrups to be used during the teething or during attacks of diarrhea, or cough spasms, croup, or worms, that contain dangerous drugs and should not be given to children. many well-meaning but ignorant mothers are slowly but surely laying the foundations for serious nervous disorders and are often making veritable dope fiends out of their children. patent medicines are dangerous things in the hands of the people; if we are going to give medicines to our little babies let us at least know what we are giving. let some conscientious, scientific physician examine the baby and prescribe for its needs. if urged to use a patent medicine, examine the label carefully, for the federal food and drug act requires the manufacturer of patent medicines to print plainly on the label of the bottle the name and amount of certain dangerous drugs which it may contain. the drugs mentioned in this drug act and which are often used in patent medicine nostrums are, chloral hydrate, cocaine, heroin, chloroform, alpha or beta eucaine, opium, morphin, alcohol, cannabis indica, or any derivative or preparation of any such substance contained therein. there are many other drugs sold on the market containing syrups or flavoring materials which may do harm--which may upset the baby's digestion. mothers avoid patent medicines. consult your physician. never give a baby any sort of medicine to induce sleep. unless babies are sick or spoiled or hungry, they will go to sleep of themselves, and even in the days of a high fever a wet-sheet pack seldom ever fails to put the baby to sleep and can do no harm if properly given. this may be as good a place as any to mention the dosage of castor oil which is as follows: up to three months, 1/2 teaspoon. from three to six months, 1 teaspoon. from six to nine months, 1½ teaspoons. from nine to twelve months, 1 dessert spoon (2 teaspoons). from twelve months on, 1 to 2 tablespoons. after the sickness is over the physician will direct when the disinfectant bath is to be given to the patient previous to his liberation from isolation. the different diseases demand different treatment, but, on the whole, it is about as follows: the day before the boy is to be allowed to go out among the family once more he receives a soap wash, clean sheet and bedding on the bed, and puts on clean garments. the following morning, his head thoroughly shampooed, his nails manicured, a second soap wash is given followed by a weak bichlorid bath (1 to 10,000 solution) which is followed by an alcohol rub. he is then allowed to go out of the sick room which is now to be thoroughly disinfected and fumigated. after the illness is over, the sick room and the adjoining closets and ante rooms must be thoroughly disinfected or fumigated. if you are located in a city, the health authorities will do this after an infectious or contagious disease. away from such conveniences, use the following method: place two ounces of crystals of permanganate of potash in a pan and have a pint bottle of formalin near by. everything in the room is now exposed, dresser drawers are opened, all bedding, all garments--in fact everything that is in the room--is put in such a position as to be readily exposed to the fumes which are to follow. a line should be stretched across the room over which are thrown the bedding, garments, etc. the cracks of the windows and doors, except the one door of exit, are now sealed up with paper which has been dipped in green soap, and having the paper strips and pan of green soap ready just outside the exit door, the formalin is now poured over the permanganate crystals. fumes will immediately arise and permeate every corner, crack and crevice of the sick room. now quickly make your exit, close the door and seal up key hole and cracks and space under the door with paper dipped in green soap. leave the room for six hours. after this with a well-moistened cloth to the nose, rush in and throw the windows open, hurry out and allow the room to air from twelve to twenty-four hours, after which wash woodwork and painted walls or take paper off and repaper walls; recalcimine ceilings and closets; scrub closet shelves and dresser drawers, bedsteads, and other furniture thoroughly. if the mattress is old throw it away, but if not, sun it for several days following the fumigation. chapter xxvii digestive disorders in this chapter we will consider the diseases which commonly occur during infancy and early childhood relative to digestion and the alimentary tract. irregularity of feeding, feeding between meals, feeding too much at any given time, as well as feeding the wrong kind of food may cause stomach disturbances and intestinal troubles. vomiting in a previous chapter, "the feeding problem," a common stomach disturbance, vomiting, was gone into quite thoroughly, and in passing to other disorders, we wish to remind the mother that vomiting should always be taken seriously. the interval between meals should usually be lengthened, the time spent in feeding shortened, and it is often necessary to withhold all milk and food of any kind for twelve or eighteen hours, giving only boiled, unsweetened water. vomiting frequently ushers in some acute disease, and in remote cases, when it is very persistent, it may indicate inflammation of the brain. complete rest is essential, trotting on the knee, suddenly changing the baby's position, or other quick movements must all be avoided. a physician should see the sick one and determine the cause of the trouble. colic cases of ordinary colic are usually relieved by heat to the abdomen and feet, drinking hot water in which there has been dissolved a pinch of ordinary baking soda, or a portion of a soda mint tablet, or by the use of the photophore, as previously described. the treatment of such ordinary colic need not be given further consideration here because it has been described at length in a former chapter; but we do call the attention of the mother to a more serious form of recurring colic which so often accompanies chronic intestinal indigestion, marasmus, and malnutrition. in most instances the food is radically at fault and should be reduced to a mixture which can more readily be digested and assimilated by the child. often whey mixtures, peptonized foods, or buttermilk may be indicated. the weight of the baby, the age of the baby, and the color of the stools, must all be taken into account in the preparation of this easily digested food. weak mixtures should be given at first and then gradually and carefully the quality may be strengthened until the normal formula is again used for the baby. injections into the bowel of water, to which has been added one level teaspoon of soda to the pint, will often give relief in this form of colic. chronic indigestion while this condition may occur at any time during babyhood days, it often makes its appearance during the last half of the first year and up to the fifth year. it is accompanied by mucus in the stools, chronic flatulence, constipation or diarrhea, or the alternating of the two, restlessness at night, distention of the abdomen ("pot bellied") accompanied by pain, a coated tongue with a fetid breath, and loss of appetite. it is a pitiable picture--the weight is usually reduced and the child gives the appearance of being decidedly undernourished. this condition is usually occasioned by errors in diet, whether it be over-feeding or feeding of the wrong element of food, and, since the diet is usually responsible for the condition, in the line of treatment diet is a prime factor. all fats must be taken from the food, sugars should be avoided, and the amount of starchy foods, such as flour, potatoes and bread, should be greatly reduced. buttermilk, skimmed milk, eggs, green vegetables, and fruit juices should be given. in the older child, if grains are used, they should be well toasted or baked. jaundice it is altogether common and physiological for the newborn baby to pass through a few days of yellow skin which usually clears up in the second or third week, but it should not recur. occasionally this yellow tint deepens, the whites of the eyes are yellow, the urine passed leaves a yellow stain on the diaper, while passages from the bowels are white or clay colored. if the child shows symptoms of ill health other than the yellow tint, it should receive medical attention. older children troubled with jaundice should receive the following treatment: the photophore as described elsewhere should be applied to the liver and abdomen (the liver is on the right side), and this should be followed by the application of what is known as a heating compress, consisting of three layers--a cloth wrung from cold water, a mackintosh, and then two thicknesses of blanket flannel--which are all applied when the skin has been made red by the application of heat. (if the photophore is unavailable, a hot-water bottle may be applied.) the flannel is pinned snugly on the outside as the wet cloth goes next to the skin with the mackintosh between. this should remain on the abdomen for three or four hours, after which the hot application is again made to the liver and abdomen. the administration of broken doses of calomel is sometimes indicated in obstinate cases in connection with these applications of heat to the liver. hot milk or mineral water may be taken with dry toast. in a day or two the color should clear up, the stools should be normal again, and the treatment may be discontinued. worms irritation about the rectum which cannot be otherwise explained is usually suggestive of pinworms. these seatworms or pinworms are very much like little pieces of cotton thread--one-fourth of an inch in length. they grow and thrive in the lower part of the large bowel. simple and effective treatment is as follows: it is well to bathe the parts about the rectum after each bowel movement and often two or three times a day with a weak antiseptic solution. itching may be controlled by the application of a disinfectant ointment, or the local applications of ice may serve the same purpose. after a thorough cleansing of the colon by an injection of lukewarm water containing a teaspoon of borax to the pint in order to remove the mucus, doctor holt suggests that after the discharge of this borated enema, infusions of quassia are very helpful (see appendix). children suffering from roundworms experience a loss of appetite, varying temperature from above normal to subnormal, with colicky pains in the abdomen on coming to the table and beginning to eat. they are pale and listless, or nervous and irritable. roundworms very much resemble earthworms in shape and color. while their home is in the small intestines they often travel to other parts of the body. they have sometimes crawled into the stomach and have been vomited. the only definite symptom of worms is to find the eggs or the worms themselves in the stool. no worm medicine should ever be given by the mouth without being prescribed by a physician. cases are on record where well-meaning mothers have killed their children by giving an over dose of worm medicine. tapeworms sometimes trouble children; their segments are found in the stool, and look like small pieces of tape line. the segments are flat and thin, one-fourth inch to one-half inch in width and three-fourths to one inch in length. they are joined together and often their number is so great the worm is many feet in length. the segments grow smaller and smaller as they approach the neck, the head of the worm being a mere point. as the worm is passing from the child it should never be pulled, as the head is easily broken off, and, on remaining in the bowel, it will grow to a full-sized worm. worms come from the eating of half-cooked meats; they enter the stomach as eggs or tiny worms, and pass out into the small intestines, where they begin to grow. they are a common parasite in the human family and should be suspected in all instances where digestive symptoms are masked or do not yield to treatment. hookworm disease this disease, once seen only in the southern part of the united states, is leaving its former domains as the migrating population is distributing it more or less widely everywhere. sandy soil and country districts are infected by a tiny worm which thrives in polluted soil and enters the body through the skin of the feet. it also gets into the body through the drinking water or from the eating of uncooked vegetables, such as are used in salads. the disease is manifested by "sallow skin, paleness, headache, swollen abdomen and sores on the legs." little swollen places where the worm enters the skin may be seen on the flesh. the condition yields readily to treatment. if a child is discovered scratching his feet (especially in the southern part of this country), he should be taken at once to a physician. disordered stomach at the first symptom of a disordered stomach take all food from the baby and give him rice water prepared by throwing a cupful of well-washed rice into a kettle of boiling water and allowing it to continue to boil for a couple of hours. the water which is strained off is rice water, ready for use after it is cooled. this may be given to the child at the meal hour in the place of his regular food. it should be kept in a glass-covered jar in the ice box. a dose of castor oil, according to the age, should be administered before the feed. the bowels should be washed out and boiled water given freely between the meals of rice water. for a day or two (twenty-four to forty-eight hours), the child should be fed only this rice water, or until the temperature returns to normal and he appears very hungry, at which time milk, which has been boiled for five minutes, may be added to the rice water, first in one-half ounce quantities and gradually increased. each day a little more milk is added until baby is taking his regular food again. many a death and many acute attacks of summer complaint are avoided by the quick use of castor oil, and by withholding food and stopping the use of milk as soon as the child becomes ill. stomatitis or thrush thrush is evidenced by fretfulness or crying on attempting to nurse. on examination of the mouth it is found to be hot and very tender and covered with little white specks which, if looked at under the microscope, appear to be a fungus growth. if scratched off, the mucous membrane bleeds easily. thrush often occurs during a fever or in connection with other diseases, and is often due to neglect and lack of cleanliness about the bottles, nipples, etc. taken in time it is quickly cured. an immediate dose of castor oil or milk of magnesia is indicated, and the use of a mouth wash which will be prescribed by the physician. if neglected, it may become ulcerous or gangrenous, which is a very serious condition. everything pertaining to the feeding, as well as the child's toys, hands, etc., must be kept scrupulously clean. constipation in the chapter, "the feeding problem," constipation in bottle-fed babies was discussed. the bowels should move at least once in twenty-four hours. the passages are frequently very hard and leave the body only after a very great effort of straining. this constipation, often continuing until late childhood, should be corrected in the following manner: in early infancy--as early as the fourth month--prune juice may be given as directed elsewhere, while in later months prune pulp or fig pulp, which has been carefully rubbed through a fine-mesh colander, may be given at meal time. by the time the baby is eleven or twelve months old, strained apple sauce may be given. we deplore the use of the water enema as a regular daily procedure; in its place we suggest the use of the enema of oil or the introduction into the rectum of a gluten suppository or in obstinate cases a glycerine suppository. abdominal massage should be daily administered. with a well-oiled hand, begin on the right abdomen and proceed upward to the lower border of the right ribs and across to the left side and down. this should be repeated many times at a regular hour each day. the mother should select an hour for the bowels to move, preferably after the forenoon feeding, and if the child is too small to sit upon the toilet chair, a gluten suppository may be placed into the rectum before the forenoon feed and some time during the middle of the day the bowel movement will be found in the napkin. for the older child, before a certain meal each day, a well-vaselined piece of cotton may be inserted in the rectum; this often produces a bowel movement immediately after the meal. laxative foods, such as bran, stewed figs, stewed prunes, or a raw apple, should be used faithfully--as repeated medication never corrects the difficulty, but usually prolongs it. to immediately flush out the bowel, a soapsuds enema or a plain water enema may be allowed to flow into the lower colon, or a glycerine suppository inserted into the rectum will quickly bring a bowel movement. these methods are only of temporary value; a regular habit should be formed, if possible, to bring about a natural, normal bowel movement. when necessary to resort to drugs--such remedies as cascara sagrada, milk of magnesia, or syrup of rhubarb, are satisfactory, as well as our old stand-by--castor oil. regular habits must be insisted upon, and if the mother pays attention to regularity at stool in early childhood very little trouble will be met later on in adolescence and adult life. chronic constipation often produces abnormal conditions about the rectum such as fissures, hemorrhoids, or prolapse, which may be of serious import. diarrhea diarrhea is a symptom of an acute illness, or it may be associated with a chronic condition such as chronic intestinal indigestion, tuberculosis of the bowel, or may occur alternately with constipation in colitis. it is the most dangerous of all symptoms that babies develop, and in spite of all the instruction given to mothers at the present time, in spite of all the welfare stations in large cities, and in spite of all the efforts put forth by the commissioner of health, with his corps of visiting nurses--even yet, more babies die of diarrhea each summer than from any other single cause. there are usually just two reasons for diarrhea--uncleanliness and bad milk. during the hot summer days flies multiply greatly and all manner of bacteria and germs grow in warm, moist, shadowy places, so that usually before the milk leaves the dairy farm it is seriously contaminated with disease-producing germs. if the milk is not kept at a temperature of 35 or 40 f. (which is just above the freezing point), these bacteria, particularly the manure germ, grow at such a rate that by the time the milk gets to the infant it is teeming with bacteria, and diarrhea is the sure result. another form of diarrhea is cholera infantum, where the stools soon become watery and colorless. the vomiting is almost incessant and there is high fever. fortunately it is a rare disease, but when once seen it is never forgotten. one beautiful baby weighing nearly thirty pounds was reduced to sixteen within forty-eight hours, and when death came he could hardly be recognized because of the wasting from this most dreaded of infant diseases. another form of diarrhea is seen in an acute inflammatory condition of the intestine itself. the stools contain more or less mucus and blood. the bowel movements, which are very frequent, are accompanied by a great deal of pain and straining. this form is often seen in the more severe types of summer dysentery. we wish to impress upon the reader's mind that these diarrheas may all be avoided if the baby's food is clean and free from germs, if the apple or pear is not only washed, but thoroughly scrubbed before paring during the summer months. if all the bottles, nipples, water, toys, etc., are adequately clean, no summer diarrhea, no dysentery, no other infection due to dirt, will attack the baby. of paramount importance is the pasteurization of milk during the summer months, as mentioned elsewhere. treatment of diarrhea simple diarrhea in the older child of two or three years is treated as follows: take away all solid foods. give a big dose of castor oil, thoroughly wash out the bowel by warm water containing a level teaspoon of salt and a level teaspoon of baking soda to the pint, and put the child to bed in a quiet room. boil all milk for ten minutes and thicken it with flour that has been browned in the oven; feed this to the child at five-hour intervals. after each bowel movement, no matter how often they come, the colon should be washed out with the salt and soda enema as before mentioned. bear in mind that the child is losing liquids, and so, after the bowels have moved, boiled water should be given by mouth, or a cupful of water can often be retained if it is introduced into the rectum slowly under very low pressure. twenty-four or forty hours should clear up a case of simple diarrhea, and on returning to food it should be dry toast and boiled milk. for the younger baby, withhold all milk and give barley water or rice water for the first twenty-four hours, returning to milk very gradually and slowly. for the more severe types, such as the dysentery containing mucus and blood, everything that has been done for the simple diarrhea should be done; the baby should be kept very quiet, while castor oil should be promptly administered. food is withheld and the bowels are carefully irrigated after each movement with the salt and soda solutions. after the bowels have moved from the castor oil, then bismuth subnitrate, which has been dissolved in two ounces of water, should be given--one or two teaspoons every three hours. this will naturally turn the bowel movements dark. under no circumstances should any other medicines be given without the physician's knowledge, as it is at such times as this that many "would-be friends" advise laudanum, paregoric, and other opiates. the skin must be kept warm, and fluids must replace those that have been carried off in the many stools. water may be given by an enema, by water drinking, and in such rare cases as cholera infantum, when water cannot be retained on the stomach, it often becomes necessary to inject it under the skin (hypodermoclysis) so that it may go at once to the wasted tissues and perhaps save the baby's life. give the baby ten days or two weeks to return to normal condition, and under no circumstances hurry the feeding of milk, as a second attack may occur much more readily than the first; may more profoundly overcome the baby and result in death. rupture a protrusion of a loop or portion of intestine through a weakened abdominal muscle--which grows larger when baby cries and smaller when he is lying down in a relaxed condition--is known as rupture or hernia, and is of common occurrence in infancy. it is often seen at the navel and sometimes in the groin as early as the second week. hernia is always dangerous and should never be neglected. the physician will protect the navel by a special support with adhesive plaster which is carefully renewed twice a week, and if worn for several months usually entirely corrects the condition. a comfortable truss made from skeins of white yarn will amply protect a groin hernia. the condition should always be taken seriously and receive immediate treatment. prolapse of the bowel occasionally, as the result of severe straining in constipation, the rectum protrudes sometimes one-half inch, and in rare instances two or three inches. the placing of a young child upon a toilet chair and insisting upon severe straining sometimes results in such a protrusion of the rectum. this may be avoided by the application of vaseline to the rectum or by the use of the gluten or glycerine suppositories which cause the hardened masses to make their way out easily. someone has suggested that if the buttocks are supported by a board placed over the toilet seat with a two-inch opening so that severe straining of the rectal muscles is impossible, the prolapse of the rectum will not recur. the moment the mother observes the slightest protrusion of the rectum she should quickly put it back and have the child lie down and move the bowel in the diaper. very severe cases require a physician's attention, but if prompt and quick measures are taken on the first appearance it may be quickly corrected and serious consequences be avoided. in this connection we might mention a condition which sometimes babies are born with--the absence of the rectal opening. if the baby's bowels do not move for the first two days, surgical interference is more than likely necessary. often the external opening alone is missing. sometimes there is a complete closure or atresia of the lower part of the colon. bleeding from the navel there should be no hemorrhage from the umbilical stump after it has been properly tied, but occasionally a bit of blood is found upon the dressing and a second tying of the cord stump is necessary. the cord drops off in eight or ten days, and the umbilicus that is left may be moist or it may bleed slightly; if such is the case, great care should be exercised in bathing this ulcer that has been left behind. it simply should be touched with alcohol, a bit of boric acid powder applied, and a small piece of sterile gauze be placed over it. in the course of two or three days it will entirely heal. care should always be exercised in washing the umbilicus. extensive hemorrhage from this portion of the body is rare, but it does happen occasionally and is a severe condition which demands surgical attention. if the umbilicus remains moist and foul smelling, general blood poisoning of the infant may easily follow. thorough dusting with boric acid powder, with possibly a little oxide of zinc, will usually effect a cure promptly, but should the condition continue, which it does only in rare instances, the doctor may have to cauterize it. chapter xxviii contagious diseases never under any circumstances knowingly expose a child to any of the so-called "childhood diseases." the old method of "have the child get them as quickly as possible and get over them," has laid the foundation for many chronic disorders later in life. for instance, eye troubles and running ears are often the sequelae of measles; chronic coughs, tuberculosis and bronchitis frequently follow in the wake of whooping cough; heart disorders follow diphtheria, while kidney disease often follows in the course of scarlet fever. catching disease under all circumstances keep the children away from these dangerous childhood diseases. when a contagious disease breaks out in a school and the little fellow has, along with the other pupils, been exposed to it, begin at once systematically to keep the nose and throat very clean with such well-known sprays as the champhor-menthol-albolene spray, which should be used in the nose morning, noon, and night. throat gargles, such as listerine, or equal parts of alcohol and water, help to keep the throat in condition to resist the microbic invasion. during this anxious time of patient waiting the bowels should move every day and the food should be cut down at least a third. in other words, moderate eating and a clean bowel tract go a long way toward keeping a child well and preparing him for an attack of disease. the skin at this time should be kept well bathed and free from the accumulated skin secretions which clog up the sweat glands and otherwise lower the vitality. stuffy, close rooms, where the ventilation is poor, not only harbor disease germs, but also lower the vitality of the child. never take your child into a household where there is any form of sickness, for it may turn out to be a contagious disease--no matter how it began, it must be remembered that many contagious diseases, in their earlier stages, much resemble a simple cold. measles come on rather gradually, and one might suspect that the child was simply suffering from a severe cold in the head. scarlet fever usually begins with a sore throat, while chickenpox has very few initial symptoms; usually the first thing noted is the rash itself. diphtheria begins with a sore throat, while whooping cough begins very insidiously. the most important thing is to keep children away from people who are sick, and if a contagious or infectious disease is prevalent in the neighborhood discourage the mingling of the children in hot, illy ventilated rooms. put a stop to "parties" and all similar gatherings. let the little folks have good books, plenty of toys, in a well-ventilated room, and the more they keep to themselves at this particular time the better they are off. the spread of contagion it is possible to "stamp out" any known disease if only proper cooperation takes place and certain sanitary regulations are maintained. it is within the memory of most of our readers when yellow fever was put to flight and the cause of malaria discovered. we learned to screen our camps and no longer did our soldiers contract the fever; while the simple covering of stagnant pools with oil, together with proper screenage, stopped the ravages of malaria. likewise, many of the woeful tragedies of infant summer diarrhea and dysenteries have been tracked to the so-called "innocent house fly." we have all learned--only recently--that if we move the manure pile once in seven days the hatching of the maggots may be prevented, and so millions, yes trillions, of these carriers of disease may never be born. if there is one sweet morsel above another for this fly pest it is tubercular sputum or feces, and from these feasts they go directly to walk over baby's hands, crawl over his cheek, and wash their feet in his milk. proper screenage will prevent such contamination of food, such opportunities for carrying disease. sunshine, hot water, soap, and fresh air, are the best ordinary every-day disinfectants. it is possible so to conduct the treatment of a contagious or infectious disease that no other member of the family may contract it. a few simple but very important hints are: 1. door knobs are one of the very greatest avenues of contagion--disinfect them. 2. cleanse the hands both before and after attending to the sick; first, scrub with stiff brush, soap and water, then dip in alcohol. 3. an epidemic of sore eyes may be stopped by absolute "hand disinfection" and using separate towels. 4. do not go visiting when you have a "common cold." 5. kissing is one of the best ways of spreading many diseases. 6. in cases of contagious and infectious diseases completely cover all excretions from the body with lime. 7. country homes would be as healthy as city homes if the privies and stables were screened. 8. in the country, the well water should be boiled; one infected well may be the cause of the death of a score of beautiful children. incubation periods the incubation period of scarlet fever is from one to seven days. measles, ten to twenty days. whooping cough, from one to two weeks. chicken-pox, fourteen to sixteen days. german measles, seven to twenty-one days. diphtheria, any time from one to twelve days. mumps, from one week to three weeks. of all the diseases, measles and chicken-pox are probably the most contagious. in scarlet fever and diphtheria, close contact is necessary for exposure, while whooping cough can actually be contracted in the open air, young babies being particularly susceptible. typhoid fever typhoid fever is a disease of the small intestine. typhoid germs accumulate in the little lymph nodes of the small intestines and that is the reason why we often have so many hemorrhages from the bowel--actual ulcerations take place--and if an ulcer is situated in the neighborhood of a blood vessel hemorrhage may result. typhoid fever begins rather insidiously with a slight debility and loss of appetite, but if a temperature record is kept the fever will be found to rise from one-half to a degree higher each day. a steady climb in the temperature curve is noted until the end of the first week, when it remains for a week, possibly 103 or 104 f. after one week it begins slowly to decrease and, if all goes well, the early part of the fourth week usually finds the temperature about normal. it is exceedingly important that the child be kept in bed during the entire course of the disease. the bed pan must be used at each bowel movement or urination. _first week treatment._ during this week the child may feel quite well, but he should be kept in bed and sustaining treatments begun--such as wet-sheet packs and cold frictions to the skin (during which time there should always be external heat to the feet). the diet must be full and nourishing, but all pastries and "knicknacks" should be avoided. abundance of fresh fruit that has been well washed before paring, eggs, pasteurized milk, baked potatoes, and toasted bread may be taken at regular periods--with an interval of not less than five hours between meals. the bowels should be opened in the beginning of the disease with a liberal dose of castor oil, after which daily colonic irrigations should be employed. these enemas should be given at least once a day, the temperature being about that of the body, with a smaller terminal enema about five degrees cooler at the close of each bowel cleansing. _second week treatment._ the normal temperature at this time is no longer 98.6, it is 101.5 f. this fever is essential to the curative and defensive processes of the body; and while we do not care to have the fever fall below 101.5, at the same time nothing is to be gained by allowing the fever to go up much above 102.5 or 103 degrees f. and so, during the second week, while the disease is at its height, we make frequent use of the wet-sheet pack, always remembering that the extremities must be kept warm and never permitting the skin to become blue or mottled while the cold treatment is being administered. since the real disease is localized in the small intestine, we will now describe a very important treatment for the diseased bowel--and one which is also very useful in combating high temperature. _the cooling enema._ the temperature of this enema begins one degree higher than that of the body (supposing the body temperature to be 103, the temperature of the enema would start at 104 f.). this is allowed to flow into the colon and out again, under low pressure, without disturbing the patient, by means of a glass tube connection (see fig. 15). the temperature is quickly brought down to 100, then to 98, then to 90, usually finishing up at 80 or 85 f. the water is allowed to enter the rectum slowly through a soft rubber catheter (not a hard rectal point), and as it comes out it will be noted that the water is very warm, sometimes registering 105, and it is needless to add that if the water goes in at 80 and comes out at 105 f., much heat has been taken from the body; and so, of all the treatments we have to suggest for typhoid fever, the one just mentioned is possibly the most important. when it is necessary to keep up this enema for an hour or two, the cool water may cramp the bowels, but this may be entirely obviated by applying hot compresses to the abdomen. another treatment of great importance in this second week is the cold abdominal compress. much fever is occasioned in the abdomen because it is the seat of disease, and the much dreaded hemorrhages which often cause the death of the patient are usually avoided by the use of abdominal compresses--wrung out of water at 55 f.--the temperature of ordinary well water--and changed every twenty minutes. [illustration: fig. 15. the cooling enema] i recall one mother in my dispensary practice who was so poor she could not afford a nurse, her only helper being a son twelve years old. a nurse went to the house twice each day and taught this lad of twelve years to give his mother the cooling colonic irrigation; he was also taught to warm up the abdomen by a hot application and afterwards to apply the cold compresses. the mother made a good recovery. during this second week the diet should be sustaining. it should consist of boiled milk, eggs, fresh fruit and fresh fruit juices, dextrinized grains (hard toast, toasted corn flakes, shredded wheat biscuits, etc.). the mouth should be kept scrupulously clean, for in all the infectious and contagious diseases there is always the possibility of gangrene in the mouth if it is neglected. _third week treatment._ this is the week we look for hemorrhage from the bowel unless the abdomen has been well treated during the second week; and even so, the cool compresses to the abdomen will be continued well into the third week--also the daily or semi-daily enema. the skin is kept in good condition with soap washing and friction baths, and a fairly liberal diet is maintained. during the whole course of the disease the skin is never allowed to get blue or mottled, being quickly restored to the normal red color by the mustard sheet bath, the short hot-blanket pack, or the dry-blanket pack with hot-water bottles. under no circumstances let the child leave the room or his bed for at least another week. mumps infants are rarely affected with mumps. it is a disease of the salivary glands and (as a rule) is usually preceded by pain between the ear and the angle of the jaw, accompanied in a short time by swelling and temperature. it is distinctly contagious even during the incubation period. there is much tenderness on pressure, and chewing is difficult and may be impossible. it usually occurs on the face and only one side may be affected. the bowels should be kept open, the mouth should be kept clean, and the side of the face should be protected by a layer of cotton held in place by bandages. hot fomentations may be applied if the pain is severe. the electric light bulb on an extension cord, that was mentioned in connection with earache, is very comforting in this condition. isolation should be maintained for ten days or two weeks after all symptoms have disappeared. scarlet fever scarlet fever is one of childhood's most dreaded diseases because of, first, its long quarantine; second, its terrible possibilities of contagion; and, third, its sequelae. absolute quarantine is necessary until ten days after the last signs of desquamation have disappeared. this disease is always alarming because of the possibilities of its sequelae--the danger of pneumonia, inflammation of the ears, abscesses of the glands of the neck, and nephritis (inflammation of the kidneys). scarlet fever is highly contagious at any time during its onset and course. among the first symptoms of the disease are sore throat, swollen glands, fever, etc. vomiting on a street car or at the movie may spread the disease to more than one child who might otherwise have escaped. one child who may have only a very light form of the disease may give it to another child in the most severe form. any such group of classic symptoms--vomiting, fever, rapid pulse, and sore throat--should cause any parent immediately to isolate the little sufferer for several days--awaiting the "rash"--which usually puts in its appearance after three or four days of increasing temperature. this rash has an appearance "all of its own," unlike any other. because the fine "meal-like" red points are in such close proximity, the skin assumes a smooth "lobster red" color that is never to be forgotten. after three days of increasing redness, the color begins slowly to fade, and after four or five days of this fading a peculiar peeling takes place, whose scales vary in size from a small fleck to casts of the whole of the soles of the feet and the palms of the hands. during the height of the disease, the throat is very red, the tonsils are not only inflamed, but covered over with white patches, the head aches and the tongue possesses a peculiar coating through which peep the red points of the swollen papillae, presenting the classic "strawberry tongue" of scarlet fever. after ten days the fever disappears and the "real sick" stage of the disease is in the past. each morning of the ten previous days a small dose of epsom salts is usually administered and the itching, which so often accompanies the rash, is relieved by carbolized-water sponge baths. the nose, throat, and ears receive daily care--sprays to the nose and gargles to the throat, as well as special swabbing to the tonsils. the physician in charge of the case will note the urinary findings, guard the heart and kidneys, prevent the spreading of the scales of desquamation by frequent rubbing of the skin with oil, and otherwise work for the future well-being of the patient. measles measles, one of the most common diseases of childhood, is not to be regarded lightly, for very often its sequelae--running ears, weak eyes, and bronchial coughs--may prove very serious and troublesome. tuberculosis of the lungs not infrequently follows in the wake of measles. the early symptoms of measles are so mild that often the child is out of doors, at school, or about his usual play, until the second or third day of the fever. he was supposed merely to be suffering from a simple "cold in the head." on the third or fourth day the patient begins heavy sneezing and wears a stupid expression; and it is then that the mother ascertains that his temperature is perhaps 101 to 102 f. he is put to bed and the next day the rash usually appears. the rash is peculiar to itself, not usually mistaken for anything else, being a purplish red, slightly elevated, flattened papule, about the size of a split pea. the coughing, which is very annoying, usually remains until about the seventh or eighth day--at which time the fever also disappears. the bowels must be kept open; a daily bath be given--in which has been dissolved a small amount of bicarbonate of soda (simple baking soda)--after which an oil rub should be administered. the nose should be frequently sprayed with three per cent camphor-menthol-alboline spray, while the throat is gargled with equal parts of alcohol and water. the feet should be kept warm by external heat, while the physician in charge may order additional attention to the chest, such as a pneumonia jacket, etc. care should be taken to guard against "catching cold," for bronchitis or pneumonia is quite likely to develop in many cases of measles. the eyes should be protected by goggles and the room should be darkened; under no circumstances should the little patient be allowed to read. carelessness in this respect may mean weakened eyesight all the rest of his life. until two weeks after the rash has disappeared, the little fellow should be kept by himself, for the desquamation keeps up almost continuously during this time. the food during the course of the disease is a liquid and soft diet. children should never be allowed to go to a party or gathering with a cold in the head; the mothers of a group of small children will never forget the time that one certain mother allowed her little fellow to attend a party with "simply a cold in the head." he laughed, talked, and sneezed during the afternoon and when he went home the rash appeared that night, while eight of the ten exposed children came down with measles during the next two weeks. chickenpox the incubation period of chickenpox is from ten to seventeen days. it is a mild disease, with a troublesome rash consisting of widely scattered pimples appearing over the scalp, face, and body. these pimples soon became vesicles (small blisters), which in turn quickly become pustular, afterwards drying up with heavy crust formation. severe itching which attends these pustules may be greatly allayed by either the daily carbolic-acid-water bath or a baking-soda bath. the itching must be relieved by proper measures, for if the crust is removed from the top of the blebs by scratching, a scar usually results. the bowels should be kept open, the diet should be soft. rigidly isolate, for chickenpox is highly contagious. smallpox this disease occurs oftenest during the cold season. it spares no one unless vaccinated, attacking children and adults alike. the early symptoms are: headache, pain in the back, high fever, vomiting, and general lassitude. in many respects these resemble the symptoms of the grippe, while on the third day the eruption appears. the pimples are hard and feel like shot under the skin. within a day or two these shotlike pimples have grown and pushed themselves beyond the skin into little conical vesicles which soon turn to pus. by the eighth or ninth day crusts are formed over the vesicle, beginning to fall off about the fifteenth day. patients are quarantined usually eight weeks and when a case of smallpox in the home breaks out everyone in the family should be revaccinated. the strictest isolation is important from the first of the disease. we will not enter into the treatment of smallpox, for medical aid is sought at once and usually the patient is removed to a special isolation hospital. vaccination the history of the change brought about in the philippines since vaccination has been introduced is an argument of itself which ought to convince the most skeptical of the value of vaccination. by all means, every child in a fair degree of health should be vaccinated. it is wise to vaccinate babies before the teething period--from the third to the sixth month. babies with any skin trouble or suffering from malnutrition, but not living in a smallpox district, should be vaccinated during the second year. in young babies, under six months, the leg is the proper place to receive the vaccination. if proper surgical cleanliness is practiced and ample protection is afforded in after dressing, vaccination need not be a taxing process. the child suffers from general lassitude--a little drowsiness with loss of appetite and a small amount of fever--but this passes off in a reasonable length of time, especially if he is not overfed and his bowels are looked after. on the second or third day after vaccination a red papule appears which soon grows larger, and, after five or six days, it becomes filled with a watery fluid. by the tenth day it has the appearance of a pustule about the size of a ten-cent piece, surrounded by a red areola about three inches in diameter. at the end of two weeks the pustule has dried down to a good crust or scab, in another week it falls off, leaving a pitted white scar. if the vaccination does not take, it should be repeated after an interval of two months. diphtheria diphtheria is a disease much dreaded during childhood and adolescence. it may attack any age--even little babies are susceptible. it begins with a general feeling of heavy, drowsy lassitude with a sore throat. white spots appear on the tonsils which may resemble a simple follicular tonsillitis, while in a short time white patches spread over the throat and tonsils. it is not at all uncommon for this membrane to attack the nose, producing a bloody, pustular discharge; and when it does attack the nose, it is none the less contagious and must be regarded just as seriously. a physician is called at once, and, not only to the child, but to the other members of the family, antitoxin is immediately administered. the disease runs a regular course and its most dangerous complication is the membrane which forms in the larynx and threatens to suffocate the child unless prompt intubation is performed--the slipping of a silver tube in the larynx to prevent suffocation and death. the early use of antitoxin greatly lessens all these serious complications. care must be exercised to prevent sudden heart failure; and this is done by raising the child to an upright position with the utmost care; while you insist upon him lying quietly upon his back or his side, long after the disease has left his throat. while the throat or nose is the seat of disease, the toxins from these most dreaded diphtheritic microbes spread through the lymph channels and the blood vessels to the heart itself--so weakening that organ that it sometimes suddenly fails, or becomes more or less crippled for life. these serious results are to be prevented by the science of good nursing and the prompt use of antitoxin. in these days the "schick test" may be administered for the purpose of ascertaining whether one is susceptible to contracting diphtheria. a physician is always in charge of diphtheria, and he will supply directions for the bowels, the diet, and the sprays for the nose and throat, and the general well-being of the suffering child. isolation and quarantine should continue for two weeks, and in bad cases three weeks, after the membrane has disappeared from the throat. whooping cough a child suffering from a continuous cough, particularly if it is accompanied by a whoop or a condition which is so often seen in children who cough--not able to stop--should not be taken to church, nor to the movies, nor allowed to go to school; neither should he be allowed to leave his own yard. the average duration of the disease is usually six weeks. the child should have an abundance of fresh air, should spend much of his time out of doors, and while in the house should avoid dust of every kind; at night he should not be exposed to drafts. call the physician early in the case and he may attempt to thwart the progress of the disease by certain administrations of vaccine medication. in very bad cases, where a young child cannot catch his breath and gets blue in the face--which, fortunately, is uncommon--he should be slapped in the face with a towel wet in cold water; or, he may be lifted into a tub of warm water, then quickly in cold water, then back into the warm, etc. hygienic measures should prevail, such as keeping the bowels open, the skin clean, and the use of the usual throat gargles and nasal sprays. do not be misguided by the old-time thought that whooping cough must run its course; for, if medical aid is promptly secured, the disease may often be cut short and the severe paroxysms greatly lessened. eye infections not long ago while in north dakota near canada, we took a trip one day just over the border to visit several villages of russian peasants. we found the boys and girls of nearly the entire village suffering from trachoma--a dangerous, infectious disease of the eyes which spreads alarmingly from one child to another. we saw the disease in all of its varying degrees among the children. some of them had swollen, reddened lids. a discharge of pus was coming from the eyes of others, and they could not look toward a light or the sun. this disease is spread in a hundred different ways--through the common use of wash basins, towels, handkerchiefs, tools, toys, door knobs, gates, etc., and that is the reason why these isolated villages of foreign people who could neither read nor write the english language were nearly all so sorely afflicted. the ordinary condition of "catching cold in the eye" ("pink eye") is just as infectious as the trachoma which we have mentioned, although it is more of an acute disorder and nothing like so serious. in all such cases a physician is to be called immediately, isolate the patient, and give strict attention to carrying out the doctor's orders. another form of inflammation of the eye which was mentioned in a previous chapter, is the inflammation of the eye of the newborn. in most civilized districts at the present, especially where the cases are attended by a physician, the eyes of all newborn babies are treated with either argyrol or silver nitrate. just as soon as defective sight is discovered in the child the eyes should be examined at once and proper glasses fitted. while the glimmer and shimmer of moving pictures may seriously interfere with the child's vision, on the other hand, this very thing often discovers the defect in the eyesight earlier than it would otherwise be found out. running ears inflammation of the ears was fully covered in our discussion of adenoids and tonsils, but we would like to add at this time that under no circumstances should a running ear be regarded lightly. a chronic mastoiditis (inflammation of the middle ear) often follows measles, scarlet fever, adenoid infection, and inflammation of the tonsils. the attention of a specialist should be called to it and his instructions most carefully carried out; for, when we have a sudden stopping of the discharge from the ear with high fever and pain behind the ear, sometimes an operation is imperative or the child may be lost. chapter xxix respiratory diseases next to digestive disturbances, babies suffer more frequently from respiratory disorders--colds, bronchitis, and pneumonia. in fact, during very early infancy, pneumonia heads the list of infant deaths, only to be displaced a few months later by that most dreaded summer disease--diarrhea. little tiny babies are so helpless--they are so dependent upon their seniors for life itself--that our responsibility is indeed great. we should put forth our best endeavor to avoid and prevent common colds. among all the common maladies that afflict the human race "colds" probably head the list; and, in the case of babies and the younger children, the common colds often go on into coughs, croup, bronchitis, and even pneumonia. why babies catch cold 1. someone has brought the infection to him. 2. somebody coughed in his face. 3. germ-laden hands have handled the baby. 4. he has drunk from an "infected" glass. 5. there was not enough moisture in the air. 6. somebody wiped his face with an infected towel. 7. baby was allowed to play on the cold floor. 8. baby's lowered vitality could not stand the combined strain of overeating and clogged up bowels. 9. baby was kissed in the mouth by a "cold-germ" carrier. 10. baby was dressed too warmly--and then taken out. 11. somebody carelessly breathed in baby's face. 12. he slept in a stuffy room. 13. his extremities got chilled. 14. baby has adenoids or diseased tonsils. babies should not be allowed to sit or play on cold, drafty floors. they may play on mother's bed whose open side is protected with high-back chairs, or they may play in their own bed whose raised sides are sheltered by blankets. it is possible for a mother so to disinfect her hands, and so garb herself with clean, washable garments, that, although she may be suffering from an acute cold, she may continue to care for her baby and the baby need not contract the cold. coryza--cold in the head this most annoying ailment, a cold in the head, is particularly hard on babies because the obstruction of the nasal passages not only makes breathing difficult, but renders nursing well-nigh impossible. the throat end of the eustachium tube (the ear tube) is found in the upper and back part of the throat, just behind the nose. the infection of the cold extends from both the nose and throat and there results a spreading inflammatory process on through these ear tubes into the middle ear itself. now if this tube swells so much that it entirely closes, as so often happens in cases of "cold in the head" as well as in constant irritation from adenoids, then may follow a vast train of difficulties--earache, mastoiditis, etc.--with the result that the tiny bones in the middle ear which vibrate so exquisitely may become ankylosed (stiffened) and deafness often follow. everything known must be done to prevent baby's catching "cold in the head." if the sinuses become infected it may also lead to serious consequences. when the nose becomes clogged it may be opened up by repeatedly disinfecting the inside of the nose with oily sprays such as simple albolene or camphorated-albolene spray. the bowels should be quickly opened by castor oil, and the feedings should be cut down at least two-thirds or one-half. public drinking cups should always be avoided and kissing the baby be tabooed. grippe the treatment of influenza in infancy and childhood is to avoid contact with an older person suffering with the grippe. ordinarily, the so-called "grippe" is a common, mixed infection--not true influenza. coryza and cough are the chief respiratory symptoms which attend these widespread epidemics. often vomiting and diarrhea are seen in the young sufferers. in cases of grippe put the child to bed and call the doctor. in the case of the older children, the treatment and care to be recommended has been fully outlined by the author in the little work entitled _the cause and cure of colds_. complications from the grippe are very frequent in children--such as severe diarrhea, enlarged glands of the neck, running ears, bronchitis, pneumonia, and sometimes tuberculosis. every effort should be put forth to isolate and quarantine the first member of the family to be stricken with grippe so that the remaining members may, if possible, escape an uncomfortable and unhappy siege. sore throat the danger of permanent deafness which so often follows a sore throat as well as a cold in the head, should cause every mother or caretaker earnestly to begin treatment at the very first sign of a sore throat. when a little baby gulps or cries on swallowing, a sore throat should always be suspected and remedial measures promptly instituted. a most convenient article with which to examine an infant's throat is a small pocket flashlight. the pillars of the throat or the tonsils or both may be much inflamed, and since tonsillitis, diphtheria, and scarlet fever all begin with a sore throat, it is wise early to seek medical counsel in order that the differential diagnosis may be promptly made. we urge the mother, as a rule, not to attempt to diagnose severe cases of sore throat. send for the physician. tonsillitis is a severe form of sore throat which, fortunately, rarely troubles tiny infants; but for every sore throat, while waiting for medical help to arrive, lay your plans to empty the bowels, diminish the quantity of the food, swab or spray the throat, and later closely follow the physician's advice concerning the general treatment of the child. adenoids adenoid growths appear as grape-like lymphoid formations located in the upper and posterior-nasal pharynx. these adenoids secrete a very toxic, thickened fluid, which slowly makes its way down along the back wall of the throat, and reddens and inflames first the anterior and posterior pillars of the throat and then often inflames and enlarges the tonsils. adenoids not only obstruct the respiratory passage way to the throat and lungs, but they also exert a harmful influence on the general physical and mental development of the child. it is nothing less than criminal for heedless parents to allow adenoid growths to remain in the child's post-nasal pharynx. the little fellow's face is disfigured, more or less for life, his mentality dulled, while he is compelled to breathe through his mouth. an almost miraculous change often follows the complete removal of these obstructive adenoids--the child takes a renewed interest in everything about him. more oxygen finds its way to the tissues, his face takes on better color, he gains in weight, in fact, there appears to be a complete rejuvenation mentally and physically. the signs or symptoms of adenoids are mouth breathing, restlessness at night, snoring, recurring colds, nasal discharge, swelling of the glands of the neck, poor nutrition, loss of appetite, bed wetting, impaired hearing, lack of attention, and mental dullness. the removal of adenoids is neither a serious or difficult procedure, and they may safely be removed at any age. diseased tonsils tonsils which remain permanently enlarged and show signs of disease and debilitation--filled crypts--may be removed as early as the fourth or fifth year, if necessary. if proper treatment does not improve the tonsils as the child grows older, their removal should seriously be considered. the tonsils may serve some special secretory or defensive function during the first few years of life and we think best, therefore, not to advise their removal--except in extreme cases--until the child is at least four or five years old. when it is necessary to attack the tonsils, they should be thoroughly dissected out--not merely burned or clipped off. if they are properly removed, the danger of heart trouble, rheumatism, and many other infections may be considered as greatly lessened. after five years of age the normal tonsils should begin to shrink, and at about the beginning of adolescence they should be no larger than a small lima bean, hidden almost completely out of sight behind the pillars of the throat. while healthy tonsils may serve some useful purpose even in the adult, it is almost universally conceded that the thoroughly bad and diseased tonsil is utterly useless to the body--only an open gateway for the entrance of infection. bronchitis a very common disorder of early infancy and childhood is bronchitis--an inflammation of the bronchial tubes--accompanied by severe coughing. its tendency to pass into pneumonia renders it a disease for skilled hands to treat--a disorder hardly safe for even the well-meaning mother to undertake to manage without medical advice and help. and since bronchitis is usually accompanied by alarming symptoms of high fever, weakened heart, embarrassed breathing, mottled or blue skin, green stools, troublesome cough, disturbed sleep, "stopped up nose," and "choked up throat," it is of utmost importance not only to seek medical aid early, but also that the mother, herself, should have definite ideas concerning the proper manner of doing the following things in the line of treatment: 1. making and applying a mustard paste. 2. the fashioning of an oil-silk jacket. 3. improvising a steam tent. 4. flushing out the colon, and a score of other things which the watchful doctor may want given any moment. _mustard pastes_ are prepared by mixing one part of mustard and six parts of flour in warm water and applying to the chest between two pieces of thin muslin. it is left on just seven minutes and then talcum powder is thickly sprinkled on the moist, reddened skin; this powder quickly absorbs all the moisture and leaves the skin in a good condition--ready for another paste in three hours if it is so ordered. _the oil-silk jacket_, or pneumonia jacket, consists of three layers--the inside of cheesecloth, an inner thin sheet of cotton wadding, and an outside layer of oil silk (procurable at any drug store). it should open on the shoulder and under the arm on the same side. it is worn constantly (change for fresh cheesecloth and cotton every day) during the inflammatory stage; it is removed only during the mustard pastes. _a steam tent_ may be prepared by placing a sheet over the infant's crib and allowing steam to enter from a large paper funnel placed in the nose of a tea kettle of boiling water kept hot on a small stove of some sort. the mattress and bedding are covered with rubber sheeting and the infant's clothes protected from moisture. the baby should remain in this steamy atmosphere ten minutes at a time. another method is to hold baby in arms near the large end of a big funnel placed in a tea kettle on the gas stove or range, and then have an assistant help hold a sheet tent over both the mother and babe. or the baby carriage may be placed over a small tub of water into which are dropped several hot bricks. a sheet canopy spread over the carriage holds the steam in and baby reaps the benefits of the warm moisture. _colonic flushing_ is necessary when green stools accompany bronchitis. a well-lubricated end of a large davidson's syringe is inserted into the rectum, and with the hips of the baby brought to the edge of a basin (the heels held in the hands of the assistant), water is forced into the rectum. not more than one ordinary cup of water should be introduced at any one time. after expulsion, another may be gently injected. _the diet_ in bronchitis is always reduced so that no extra work will be thrown on the already overtaxed constitution of the child. _absolute rest_ is necessary and perfect quiet should prevail. the humidity of the room should not be lower than 50 at any time, while the air should be moderately cool and fresh. numerous other details which may be necessary in the management of bronchitis will be directed by the physicians and nurses in charge of the case. spasmodic croup it is believed that children with enlarged tonsils and adenoids are much more subject to croup than others. although very sudden in its onset and very alarming, spasmodic croup, fortunately, is seldom dangerous. a little child goes to bed in apparently normal condition and wakes up suddenly with a coarse metallic cough, difficult breathing, and with a distressed expression on the face. alternate hot and cold compresses should be applied to the throat--first the hot cloths (wrung from very hot water) being applied over the throat, which should be covered with a single thickness of dry flannel. then after three minutes of the hot cloths a very cold cloth is applied to the skin itself for one half minute; then more of the hot compress, followed again by the short cold, until five such changes have been made. a bronchitis tent should be quickly improvised so that the child can be "steamed." vomiting must be produced by kerosene (three or four drops on sugar), alum and molasses, or ipecac (ten drops every fifteen minutes). some remedy must be administered continuously until free vomiting occurs. a good dose of castor oil should be given after the spasm. suitable treatment should be administered through the day to prevent a recurrence of the attack the next night. the general vital resistance should be raised by outdoor life, improved circulation, good food; adenoids if present, should be removed. medical advice should be sought in every case of severe croup, for membraneous croup usually is indicative of diphtheria, and the diagnosis is important, as on it hangs the determination of the administration of antitoxin. pneumonia pneumonia is always a serious disease. it is accompanied by high fever, painful, very short cough, and rapid breathing with a moving in and out of the edges of the nose as well as the spaces between the ribs. the possibilities of complications are always great--the dangers are many--so that the combined watchfulness of both the mother and a proficient trained nurse are required; not to mention the skill of the physician. the steam tent, the mustard paste, the oil-silk jacket and the colonic flushing (described earlier in this chapter) may all be asked for by the physician in his untiring efforts to prevent dangerous complications during the course of the disease. plenty of moderately cool, fresh air (without drafts) is of great benefit. never allow blue finger tips, or cold ear tips to exist; send at once for the doctor and administer a hot bath, or wrap in a sheet dipped in hot mustard water while awaiting his arrival. no mother should think of attempting to carry her baby through an attack of bronchitis or pneumonia without the best medical help available. chapter xxx the nervous child while each child possesses an individuality all its own, nevertheless, there are certain general principles of psychologic conduct and family discipline which are more or less applicable to all children. the so-called nervous child, in addition to the usual methods of child culture, stands in need of special attention as concerns its early discipline and training. this chapter will, therefore, be devoted to special suggestions with regard to the management and training of those children who are by heredity predisposed to nervousness, over-excitability, and who possess but a minimum of self-control. hereditary nervousness the so-called nervous child--all things equal--is the child who is born into the world with an unbalanced or inefficiently controlled nervous system; and while it is all too true that the common nursery methods of "spoiling the child" are often equally to blame with heredity for the production of an erratic disposition and an uncontrolled temper, nevertheless, it is now generally recognized that the foundation of the difficulties of the nervous child reaches back into its immediate and remote ancestral heredity. i no longer doubt but that many of these babies with a bad nervous heredity, who are born predisposed to saint vitus' dance, bad temper, chronic worry, neurasthenia, and hysteria could be spared much of their early troubles and later miseries by prompt and proper methods of early nursery discipline. these nervous babies are born into the world with an abnormal lack of self-control. their "inhibition control" over the natural and spontaneous tendency of the nervous system to manifest its inherent impulses and passing whims is decidedly deficient. the child is unduly sensitive, whines, hollers, or flies into a violent rage when its will is crossed in the least degree. such a child sometimes keeps its mother living in constant terror because, when its will is crossed in any particular, it will scream and hold its breath until it turns black in the face and sometimes actually goes into a convulsion. in dealing with these unfortunate little ones, fathers and mothers, while they should be firm and persistent in their methods of correction, should also be kind and patient; fully recognizing that whatever undesirable traits the little ones manifest they have come by honestly--these naughty tendencies being the result either of heredity or spoiling, for both of which the parents stand responsible. early training one of the very first things that a child, especially the nervous child, should learn is that crying and other angerful manifestations accomplish absolutely nothing. the greatest part of the successful training of the nervous child should take place before it is three and one-half years of age. it should early learn to lie quietly in its little bed and be entirely happy without receiving any attention or having any fuss made over it. it should not become the center of a circle of admiring and indulgent family friends and caretakers who will succeed in effectually destroying what little degree of self-control it may be fortunate enough to possess. when the little one is discovered to be nervous, fretful, impatient, and easily irritated early in the morning, it should be left alone in its bed or in the nursery until it quiets down. if it has a good, healthy crying spell, leave it alone. let it early get used to living with itself--teach the little fellow to get along with the world as it is--and you will do a great deal toward preventing a host of neurasthenic miseries and a flood of hysterical sorrows later on in life. you must not expect to train the nervous child by the simple and easy methods which are successful in the case of a normal child; that is, you cannot repeat a simple discipline two or three times and have the child learn the lesson. in the case of the high-strung nervous child it requires "line upon line and precept upon precept;" for, whereas a normal child will respond to a certain discipline after it is repeated a half dozen times, the nervous child will require the persistent repetition of such a discipline from twenty-five to one hundred times before the lesson sinks into his consciousness sufficiently to enable him to gain control of his erratic and unbalanced nervous mechanism. spoiling the child as bad as all spoiling methods are in child culture, they are decidedly disastrous--almost fatal--in the case of the nervous child; and yet it is these delicate, sensitive, cute little things that are the very ones who are most frequently the worst spoiled. nervous children simply must not be played with all the time. they must be by themselves a great deal, at least this is true in their earlier years. the nervous baby must early learn absolute respect for authority, so that what it lacks in its own nervous control may be partially made up for by parental suggestion and discipline. of course, as suggested in a later chapter, the more ideal methods of suggestion, education, and persuasion should be employed in your efforts to secure obedience and promote self-control; but, when through either the deep-rooted incorrigibility of a child, or the inefficiency of the parent's efforts in the employment of suggestion--no matter what the cause of the failure of your ideal methods to control temper, stop crying, or otherwise put down the juvenile rebellion, whether the child has been spoiled on account of company, sickness or through your carelessness--when you cannot effectively and immediately enforce your will any other way, do not hesitate to punish; spank promptly and vigorously and spank repeatedly if necessary to accomplish your purpose. you must not fail in the case of the nervous child to accomplish exactly what you start out to do. when the little fellow wakes up in the night and cries, see if he needs anything and administer to him. if you have previously tried the method of letting him "cry it out," which is usually entirely sufficient in the case of a normal child, and if such treatment does not seem to cure him, then speak to him firmly, give him to understand that he must stop crying, and if he does not, turn him over and administer a good spanking--and repeat if necessary to get results. in dealing with a nervous child we must follow the directions on the bottle of the old-fashioned liniment "rub in until relief is obtained." no "spoiling practices" should be countenanced in the case of nervous children. they should be taught to sleep undisturbed in a room in the presence of usual noises. they should not be allowed to grow up with a sleeping-room always darkened by day and a light to sleep by at night. they should be taught to sleep on without being disturbed even if someone does enter the room; they should be taught to sleep normally without having to quiet and hush the whole neighborhood. playmates the early play of nervous children should be carefully supervised and organized. under no circumstance should they be allowed exclusively to play with children younger than themselves. they must not be allowed to dictate and control their playmates; it is far better that they should play at least a part of the time with older children who will force them to occupy subordinate rôles in their affairs of play; in this way much may be accomplished toward preventing the development of a selfish, headstrong, and intolerant attitude. when the nervous child is miffed or peeved at play and wants to quit because he cannot have his way, see to it that he quickly takes his place back in the ranks of his playfellows, and thus early teach him how to react to defeat and disappointment. the nervous child must not be allowed to grow up with a disposition that will in some later crisis cause him to "get mad and quit." if the nervous baby has older brothers and sisters, see to it that he does not, through pet and peeve and other manifestations of temper, control the family and thus dictate the trend of all the children's play. early train him to be manly, to play fair, and when his feelings are hurt or things do not go just to his liking, teach him, in the language of the street, to be "game." it is equally important that the little girls be taught in the same way how to take disappointment and defeat without murmur or complaint. teaching self-control when nervous children grow up, especially if their parents are well to do, and they are not forced to work for a living, they are prone to develop into erratic, neurasthenic, and hysterical women, and worrying, inefficient, and nervous men; and in later years they throng the doctor's offices with both their real and imaginary complaints. these patients always feel that they are different from other people, that something terrible is the matter with them or that something awful is about to happen to them. their brains constantly swarm with fears and premonitions of disease, disaster, and despair, while their otherwise brilliant intellects are confused and handicapped because of these "spoiled" and "hereditary" nervous disturbances--with the result that both their happiness and usefulness in life is largely destroyed. the fundamental abnormal characteristic of that great group of nerve-patients who throng the doctor's office is sensitiveness, suggestibility, and lack of self-control. sensitiveness is nothing more or less than a refined form of selfishness, while lack of self-control is merely the combined end-product of heredity and childhood spoiling. i am a great believer in, and practitioner of, modern methods of psychological child culture, but let me say to the fond parent who has a nervous child, when you have failed to teach the child self-control by suggestive methods, do not hesitate to punish, for of all cases it is doubly true of the nervous child that if you "spare the rod" you are sure to "spoil the child." let me urge parents to secure this self-control and enforce this discipline before the child is three or four years of age; correct the child at a time when your purpose can be accomplished without leaving in his subconscious mind so many vivid memories of these personal and, sometimes, more or less brutal physical encounters. every year you put off winning the disciplinary fight with your offspring, you enormously increase the danger and likelihood of alienating his affections and otherwise destroying that beautiful and sympathetic relationship which should always exist between a child and his parents. in other words, the older the child, the less the good you accomplish by discipline and the more the personal resentment toward the parent is aroused on the part of the child. crime and intemperance while it is generally admitted that feeble-mindedness lies at the foundation of most crime, we must also recognize that failure on the part of parents to teach their children self-control is also responsible for many otherwise fairly normal youths falling into crime and intemperance. the parents of a nervous child must recognize that they will in all probability be subject to special danger along these lines as they grow up. the nervous child, as it grows up, is quite likely to be erratic, emotional, indecisive, and otherwise easily influenced by his associates and environment. nervous children are more highly suggestible than others, and if they have not been taught to control their appetites and desires, their wants and passions, they are going to form an especially susceptible class of society from which may be recruited high-class criminals, dipsomaniacs, and other unfortunates. it is true that any spoiled child, however normal its heredity, may turn out bad in these respects if it is not properly trained; but what we are trying to accomplish here is to emphasize to parents that the nervous child is doubly prone to go wrong and suffer much sorrow in after life if he is not early and effectively taught self-control. unspoiling the child if the child of nervous tendencies forms the habit of crying, sulking, or otherwise misbehaving when it is denied its desires, or when something it wants done is not immediately attended to, it will be found an excellent plan simply to stand still and let the little fellow have it out with himself, in the meanwhile kindly reminding him to say, "please mamma," "please papa," etc. i well remember one nervous little girl who would yell at the top of her voice and become black in the face the moment she wanted a door opened or anything else. a few weeks of patience and firmness on the part of the mother entirely cured her of this unbecoming trait. as a rule, it will be found best not to argue with the nervous child. the moment your commands are not heeded, when you have admonished the child once or twice without effect, take him quickly to the crib or the nursery and there leave him alone, isolated, until he is in a state of mind to manifest a kindly spirit and an obedient disposition. it is an excellent plan quietly and quickly to deprive such children of their pleasures temporarily, in order to produce thoughtfulness; and these methods are often more efficacious than the infliction of varying degrees of pain under the guise of punishment. nervous children must be taught to go to sleep by themselves. they are not to be rocked or allowed to hold the hand of the mother or the caretaker. the nervous baby should not be encouraged to exhibit its cuteness for the delectation of the family or the amusement of strangers and visitors. he should be especially trained in early and regular habits, taking particular pains to see that bed wetting and similar bad habits are early overcome; otherwise, he may drag along through early life and become the cause of great embarrassment both to himself and his parents. the control of these nervous habits is somewhat like the management of the slipping of the wheels of a locomotive when the track is wet and slippery. the little folks ofttimes endeavor to apply the brakes, but they are minus the sand which keeps the wheels from slipping. the parent, with his well-planned discipline, is able to supply this essential element, and thus the child is enabled to gain a sufficient amount of self-control to prevent him making a continuous spectacle of himself. when nervous children do not walk or talk early, let them alone. of course, if later on it is discovered that they are manifestly backward children, something must be done about it; but if the nervous child is encouraged to talk too soon there is great danger of his developing into a stutterer or a stammerer. preventing hysteria every year we have pass through our hands men and women, especially women, who possess beautiful characters, who have noble intellects, and who have high aims and holy ambitions in life, but whose careers have been well-nigh ruined, almost shattered, because of the hysterical tendency which ever accompanies them, and which, just as soon as the stress and strain of life reaches a certain degree of intensity, unfailingly produces its characteristic breakdown; the patient is seized with confusion, is overcome by feeling, indulges in an emotional sprawl, is flooded with terrible apprehensions and distracting sensations, may even go into a convulsive fit, and, in extreme cases, even become unconscious and rigidly stiff. now, in the vast majority of cases, if this nervous patient, when a baby, had been thoroughly disciplined and taught proper self-control before it was four years of age, it would have developed into quite a model little citizen; and while throughout life it would have borne more or less of a hysteria stigma, nevertheless it would have possessed a sufficient amount of self-control to have gotten along with dignity and success; in fact, the possibilities are so tremendous, the situation is so terrible in the case of these nervous babies, that we might almost say that, in the majority of such, success and failure in life will be largely determined by the early and effective application of these methods of preventive discipline. i was recently consulted by a patient whose nervous system was in a deplorable state, who had lost almost complete mental control of herself, and who really presented a pathetic spectacle as she told of the fears and worries that enthralled her. in an effort to get to the bottom of this patient's heredity i had a conference with her father, and i learned that this woman, in her childhood days, had been constantly humored--allowed to have everything she wanted. she was a delicate and sensitive little thing and the parents could not bear to hear her cry, it made her sick, it gave her convulsions, it produced sleepless nights, it destroyed her appetite, and so she grew up in this pampered way. the father recognized the greatness of his mistake and he told me with tears in his eyes how, when the ringing of the school bell disturbed his little girl baby, he saw the school directors and had them stop ringing the bell, and he even stopped the ringing of the church bells. he was an influential citizen and could even stop the blowing of the whistles if it disturbed his precious little daughter. and so this woman has grown up with this nervous system naturally weakened by heredity and further weakened by "spoiling"; and fortunate indeed she will be if off and on the most of her life she is not seeking the advice of a physician in her efforts to gain that self-control which her parents could have so easily put in her possession at the time she was three or four years of age, if they had only spent a few hours then, instead of the many months and years that subsequently have been devoted to medical attention. methods of discipline we run into many snags when we undertake to discipline the nervous baby. the first is that it will sometimes cry so hard that it will get black in the face and may even have a convulsion; occasionally a small blood vessel may be ruptured on some part of the body, usually the face. when you see the little one approaching this point, turn it over and administer a sound spanking and it will instantly catch its breath. this will not have to be repeated many times until that particular difficulty will be largely under control. it will be discovered when you undertake to break a bad habit in the case of a spoiled child who is of a nervous temperament, that your discipline interferes with the child's appetite and nutrition. the delicate little creature who has perhaps already given you no end of trouble regarding its feeding, will begin to lose in weight, and even the doctor often becomes so alarmed that he advises against all further methods of discipline. we think this is usually a mistake. both the nutrition and discipline should be kept in mind and carried harmoniously through to a successful finish. it will be necessary during such troublous times to conserve both the physical and nervous strength of the child; it should not be allowed to run about and over-play, as such high strung children often do. it should be given a reasonable amount of physical exercise, and two or three times a day should have short periods of complete isolation in the nursery, where it may quietly play with its blocks and toys, sing and croon or talk as the case may be, but should be left entirely alone. wise efforts should be put forth to keep the feeding up to the proper number of calories, and to see, if the child does not gain during this disciplinary struggle, that at least it does not lose; and i give it as my experience that i have yet to see a case in which both the child's nutrition and discipline cannot be efficiently maintained at one and the same time, though it does sometimes require adroit scientific and artistic management. but the game we are playing is worth the effort--the battle must be fought--and it can be fought with the least suffering and sorrowing the earlier the conflict is waged to a successful issue. i am decidedly opposed to allowing these young nervous children to over-play and thus wear themselves out unduly. this over exhaustion sometimes renders the training of the child much more difficult, as it is a well-known fact that we are all much more irritable and lacking in self-control when we are tired, more especially when we are over-tired and fatigued. let me emphasize the importance and value of proper periods of isolation--complete rest and partial physical relaxation. you can take a child who has gotten up wrong in the morning, whose nerves are running away with him, who is irritable, crying at everything that happens, who even rejects the food prepared for him, and who, when spoken to and commanded to stop crying, yells all the louder--i say you can take such a little one back to its crib, place it in the bed and smilingly walk out of the room. after a transient outburst of crying, within a very few minutes you can return to find a perfect little angel, winsome and smiling, happy and satisfied, presenting an entirely different picture from the little culprit so recently incarcerated as a punishment for his unseemly conduct. but let me repeat that while such methods of discipline often work like magic on normal children, they must be repeated again and again in the case of one who is nervous in order to establish new association groups in the brain and to form new habit grooves in his developing nervous system. respect for authority there are just two things the nervous child must grow up to respect; one is authority and the other is the rights and privileges of his associates. the nervous child needs early to learn to reach a conclusion and to render a decision--to render a decision without equivocation--to move forward in obedience to that decision without quibbling and without question; that is the thing the nervous man and woman must learn in connection with the later conquest of their own nerves; and a foundation for such a mastery of one's unruly nerves is best laid early in life--by teaching the child prompt and unquestioning obedience to parental commands. at the same time, endeavor so to raise the child that it acquires the faculty of quickly and agreeably adapting itself to its environment, at the same time cheerfully recognizing the rights of its fellows. it is a crime against the nervous child to allow it to hesitate, to debate, or to falter about any matter that pertains to the execution of parental commands. let your rule be--speak once, then spank. never for a moment countenance anything resembling dilatoriness or procrastination, let the child grow up to recognize these as its greatest dangers, never to be tolerated for one moment. false sympathy we are aware that many good people in perusing this chapter will think that some of the advice here given is both cruel and hard hearted; but we can safely venture the opinion that those who have reared many children, at least if they have had some nervous little ones, will be able to discern the meaning and significance of most of our suggestions. sympathy is a beautiful and human trait and we want nothing in this chapter in any way to interfere with that characteristic sympathy of a parent for its offspring--the proverbial "as a father pitieth his children"--nevertheless, there is a great deal of sympathy that is utterly false, that is of the nature of a disastrous compromise, for the time being making it easy for both parent and child, but making things unutterably more difficult later on in life when both (or perhaps the child alone) must face the calamitous consequences of this failure early to inculcate the principles of self-control and self-mastery on the mind and character of the nervous child. we so often hear "mother love" eulogized. it is a wonderful and self-denying human trait; but, as a physician, i have been led to believe that "mother loyalty" is of almost equal or even greater value. all mothers love their children more or less, but only a few mothers possess that superb loyalty which is able to rise above human sympathy and maternal love, which qualifies the mother to stand smilingly by the side of the crib and watch her little one in a fit of anger--yelling at the top of its voice--and yet never touch the child, allow the little fellow to come to himself, to wake up to the fact that all his yelling, his emotion, his anger, and his resentment are absolutely powerless to move his mother. thus has the mother--by her loyalty to the little fellow--taught him a new lesson in self-control, and thus has she added one more strong link in the chain of character which parent and child are forging day by day, and which finally must determine both the child's temporal and eternal destiny. system and order system and order are desirable acquisitions for all children, but they are absolutely indispensable to the successful rearing of the nervous child, who should be taught to have a place for everything and everything in its place. when he enters the house his clothes must not be thoughtlessly thrown about. every garment must be put in its proper place. these little folks must be taught a systematic and regular way of doing things. nervous children must not be allowed to procrastinate. they must not be allowed to put off until tomorrow anything which can be done today. they must be taught how to keep the working decks of life clear--caught right up to the minute. they should be taught proper methods of analysis--how to go to the bottom of things--how to render a decision, execute it, and then move forward quickly to the next task of life. when they come home from school with home work to do it would be best, as a rule, first to do the school work before engaging in play. in fact, all the methods which are needful for the proper discipline of the ordinary child are more than doubly needful for the training of the nervous child; while more than fourfold persistence is needed on the part of parents to make them really effective. emotional runaways whether the child be two years of age or ten years of age, when the parent discovers that the nervous system is "losing its head," that the child is embarking on a nervous runaway, or that it is about to indulge in an emotional sprawl, it is best to interfere suddenly and spectacularly. lay a firm hand on him and bring things to a sudden stop. speak to him calmly and deliberately, but firmly. set him on a chair, put him in the bed, or take him to a room and isolate him. in the case of the older children, tell them a story of the horse which becomes frightened, loses self-control, and tears off down the highway, wrecking the vehicle and throwing out its occupants. explain to them that many of the mistakes of life are made during the times of these emotional runaways, these passing spells of lost self-control. tell the little folks that you have perfect confidence in them if they will only take time to stop and think before they talk or act. explain to them that since you saw that they were rapidly approaching a foolish climax you thought it was your duty to call a halt, to stop them long enough to enable them to collect their wits and indulge in some sober thinking. personally, we have found it to be a good plan not to be too arbitrary with the little folks, like putting them on a chair and saying, "you must sit there one hour by the clock." they usually begin to indulge in resentful thoughts and a situation is often produced akin to that of the stern father who felt compelled to go back and thrash his boy three different times during his hour on the chair, because of what he was satisfied was going through the boy's mind. no, that is not usually the best way. put them on the chair with an indeterminate sentence. i prefer to carry it out something like this: "now, son, this will never do; you are running away with yourself. stop for a moment and think. now i am going to ask you to sit down in that chair there and think this over quietly. i will be in the next room. whenever you think you have got control of yourself and have thought this thing out so you can talk with me, you may get up from the chair and come into the room to me." sometimes five minutes, sometimes fifteen minutes, and the little fellow will walk in and talk to you in a very satisfactory manner. he will give you his viewpoint and you will be able to adjust the matter in a spirit of conference which will be satisfactory to both parent and child, without doing the least violence to the responsibility of the one or the individuality of the other. very little is to be accomplished, when the child starts to indulge in an emotional runaway, if the parent contracts the same spirit, begins to talk fast and loud, to gesticulate wildly, grabs the child, begins to slap and shake it--that is merely an exhibition on the part of the parent of the very same weakness he is trying to correct in his offspring. i am afraid it is entirely too true that for every time you shake one demon out of a child in anger, you shake in seven worse devils. when all other methods fail and you must resort to punishment, do it with kindness, deliberation, and dignity. never punish a child in haste and anger. the final reward the advice offered in this chapter is not mere theory. it has been successfully used by many parents in the management of their nervous children, and while all principles of child culture must be carefully wrought out and made applicable to the particular child in question, nevertheless, the methods of repeated and firm discipline herein set forth will enable you to take many a child who has been born into this world almost neurologically bankrupt, and, by this training and discipline, enable him in adult life to draw such dividends of self-control and self-mastery as will far exceed the outward results obtained in the case of many children who are born with sound nervous systems, but who were early spoiled and allowed to grow up without that discipline which is so essential to later self-control and dignity of character. chapter xxxi nervous diseases in this chapter we shall consider a number of the more common diseases which are associated with the nervous system of the child. some of these so-called nervous diseases are hereditary or congenital, while others are the result of infection and environment. sleeplessness--insomnia there are many conditions which cause sleeplessness or insomnia in a child aside from disturbance of the mental state or nervous system. for instance, late romping, too hearty and too late a dinner, lack of outdoor life during the day, illy ventilated sleeping rooms, too much bedding, too little bedding which causes cold extremities, too much sleep during the day, too much excitement (movies or receptions), intestinal indigestion which is associated with accumulation of gas, and constipation--any or all of these are causes of sleeplessness. some peculiarly nervous children--those with an hereditary strain of nervousness--are easily upset or disturbed by any of the conditions above mentioned. the treatment of insomnia consists, first, in finding the cause and removing it. children with a nervous tendency should be let alone as nearly as possible, and just allowed to grow up as the little lambs and calves grow up. they should be fed, watered, kept clean and dry, and allowed to live their lives undisturbed and without excitement. the medicinal remedies on the market for insomnia are all harmful if used too long or in excess, and we most earnestly urge the mother not to seek drug-store information concerning remedies for sleeplessness. the neutral bath is beneficial in ninety per cent of these cases. it is administered as follows: enough water is allowed to run into the bath tub to cover the child. the temperature should be 99 to 100 f. it should be taken accurately--and should be maintained. bath tub thermometers may be purchased at any drug store. the restless child, after the bowels have been freely moved, is placed in the water, and, without whispering, talking, or laughing, he remains there for at least twenty minutes, after which he is carefully lifted out, wrapped in a sheet and very gently dried off with soothing strokes and placed at once into his night clothes. as before said, ninety per cent of restless children will go at once to sleep after such a treatment. another method of treating sleeplessness is by the wet-sheet pack. three single woolen blankets are placed on the bed and a sheet large enough to wrap the child in is wrung from warm water, about 100 f. the child is stripped and this sheet is brought in contact with every portion of his body, quickly followed by bringing the flannel blankets about him and he is allowed to remain there for twenty minutes--if he does not fall asleep before the lapse of that time. with witch-hazel or alcohol, the body is sponged off, night clothes are put on and a restful night usually follows. if fresh air is lacking, open the windows. if there is too much bedding, remove some of it. talcum powder the sweaty back and neck and make the child perfectly comfortable. give a small drink of water and turn out the light. night terrors night terrors are probably due to some digestive disturbance, with a coexisting highly nervous temperament. they oftentimes, in older children, follow the reading of thrilling stories or a visit to an exciting moving-picture show. the child goes to sleep and gets along nicely for two or three hours and then suddenly jumps up out of bed and rushes to its mother with little or no explanation for the act. in his dreams the thoughts and the imaginations of his waking moments are all confounded and alarming. we recall one little fellow who constantly feared big, black birds coming in the window and attacking him--he had been reading about sinbad the sailor and his experiences with the big bird. he so feared this big, black bird that he could not go to sleep. for a number of nights he did not have the courage to tell his parents that it was the fear of the big bird that kept him from going to sleep, but finally he confided in his mother and told her of his fear. the mother and father both entered into a conversation with him through an open door which connected the two rooms, after the lights were out; they laughed and talked about the big bird, they openly talked of it and allowed their imagination to work with the child's imagination in planning how he could combat with the bird, should it really come, asking him how big it really was and what color he thought its eyes were and how big an object he thought its feet could carry. they all three planned a fairy story they might write which would rival the fairy stories of the arabian nights. in a very short time--possibly a week or ten days--the little fellow felt quite equal to these imaginary assaults, his fears were quieted and his slumbers were no more disturbed by visions of the big, black bird. everything should be done to relieve the stomach and intestines of laborious work during the sleeping hours, hence let the evening meal be light and eaten early enough to be out of the way, as far as digestion is concerned, by bed time. nervousness during the formative period of the nervous system--the first few years--under no circumstances should the children be played with late at night, when they are tired and sleepy, or hungry, for it is at such times that the nervous system is so easily excited and irritated. when the baby is to be played with, if at all, it should be in the morning or after the mid-day nap. rest and peaceful surroundings are of paramount importance to the nervous child, and he should be left alone to amuse himself several hours each day. it is a deplorable fact that the nervous child--the very one that should be left alone--is the very child that usually receives the most attention, the very one who is most petted, indulged, and pacified; all of which only tends to increase his lack of self-control and to multiply the future sorrows of his well-meaning but indulgent parents. headache headache attacks old and young alike, and the young infant that is unable to tell us he has a headache manifests it by rolling the head from side to side, putting his hand to his head, or by wrinkling up his brow. headaches may be occasioned by disorders of the brain and spinal column, such as meningitis. it nearly always accompanies fever, and is often a result of constipation, intestinal indigestion, overeating, as well as eating the wrong kind of food. the treatment of headache in children (aside from removing any known cause) consists of a hot foot bath, a brief mustard paste to the back of the neck, a light diet--sometimes nothing but water--and the administration of a laxative. convulsions--spasms in the very young, convulsions are easily produced. that which will produce but a headache in an adult will often produce a convulsion in the child. aside from diseases of the nervous system such as epilepsy, etc., convulsions frequently accompany gas on the bowels, intestinal indigestion, disordered dentition, an acute illness, intestinal parasites (worms), irritation about the genitals such as the need of circumcision, an adherent clitoris, adenoids and enlarged tonsils, inflammation of the ears, and poor nutrition of any sort such as rickets. the convulsion picture is a stiffening of the body--sometimes arching backwards--rolling or staring of the eye-balls, blueness of the skin, a drooling mouth (often foamy mucus at the mouth), clinched hands, biting the teeth--if there are teeth--and even biting the tongue. there is at first a succession of quick, jerking, convulsive movements of the body which in a few moments grow less and less violent and finally cease. the child begins to cry and then soon goes off into a deep sleep, while the body seems more heavy and logy than usual. in extreme cases, the child relaxes but for a moment of time, when he goes off into another convulsion, sometimes going from one fit into another until death relieves him. treatment for convulsions must be instituted at once. do not wait entirely to undress the child--pull off his shoes, place him at once into a good warm bath, temperature about 100 to 102 f. an ice cap should be placed to his head (cracked ice done up in a towel), and while in the bath or immediately upon taking him out, give a warm soapsuds enema. the bath that the child is placed in should be always tested with the bared elbow. a half cupful of mustard may be added to the bath. just as soon as the child is able to swallow, give a teaspoon of syrup of ipecac. enema after enema should be given until the water comes back clear. undue excitement after the bath only predisposes to repeated attacks, and while the mother may be very happy that the child is himself again, under no circumstances should she caress and fondle him. put the little one to bed and allow his nervous system to calm down; let him rest quietly and undisturbed. nervous twitchings habit spasms or "tics" are common in childhood, and are caused by an over irritability of the nerves supplying certain groups of muscles. it is not at all uncommon to see a child nervously blink the eyes, twitch the nasal muscles, shrug the shoulders, constantly open and close the hand, and execute a score of other minor habit-spasms; which, day by day, wear deeper and deeper paths into his nervous system as a result of their constant repetition. these minor habit-spasms of childhood are but telltales of an unstable nervous system, of a nervous heredity lacking poise and balance; and, mind you, if this nervous system is studied, treated, and properly harnessed with self-understanding and self-control, much may be accomplished; the habit may be more or less completely eradicated. if left to itself, unchecked, the habit deepens the "spasm-groove," and the "energy-leaks" grow bigger and bigger until finally, in later, adult life, all that is necessary to convert such persons into first-class neurasthenics or hysterics is some bad news, a few worries, or a sudden shock. by all means study to nip all childhood twitchings in the bud; remembering all the while that childhood--the formative period for the nervous system of the child--presents the golden opportunity to prevent and abort the more grave neuroses of later life. there may be a special contraction of one or more muscles of the eyeball which produces either a "cross-eye," when the contraction is convergent, or a turning of one eye outward when the contraction is divergent. it is not possible for the mother to correct this condition. the one important thing for her to do is to take the child to a skilled ophthalmologist early in his life, that treatment may be instituted for the correction of the difficulty. retention of urine not an unusual condition during childhood is a temporary retention of urine. it may follow an attack of colic or accompany any acute illness. increase the water drinking, and, after seven or eight hours, hot cloths should be applied over the bladder; a large enema (enema bag should be hung low) should also be given, retaining as much as is possible. these simple measures usually relieve the condition. if retention follows circumcision, due to swelling of the parts, the surgeon should be notified. bed wetting nocturnal enuresis (bed wetting) usually is found to "run in families." it is seldom the case to find that both the father and the mother escaped bed wetting during childhood when the child is sorely afflicted. early bad habits may be the prime factor in this distressing and humiliating difficulty. a little child that has been compelled to lie in wet diapers for hours at a time gradually becomes accustomed to "being wet," and the desire to urinate is not under the keen control of a will that has been trained by untiring patience to "sit on a chair" at regular intervals throughout the day. this lack of training in a child who possesses an unstable nervous system, creates the proper environment for the habit of bed wetting--which often marches steadily on until puberty. in the treatment of bed wetting give attention to the following: 1. the urine should be thoroughly examined. 2. the size of the bladder should be determined. 3. the last meal of the day should not be after four o'clock in the afternoon. 4. all during the day, in young children, systematic training should be begun--put the child on the chair every hour, then every hour and a half, then every two hours. let the work be done most painstakingly and much will be accomplished toward training the bladder to "hold its contents" during the night. for a time it will be necessary to set an alarm clock to ring every three hours during the night, that the bladder may be relieved at regular intervals. 5. no liquids whatever are allowed after four p. m.; even the four o'clock meal should be very light. 6. in older children the habit is often broken by appealing to the pride--by requesting or demanding the child to rinse out the bed linen and hang it up to dry himself. usually at puberty the trouble ends, and while no amount of whipping will correct the difficulty, the promise of rewards, an appeal to the pride, correction of dietetic errors, the establishment of regular times to empty the bladder, the removal of all reflex causes such as adenoids, need of circumcision, worms, etc.--these combined influences--will bring results in the end, if they are faithfully and intelligently applied. meningitis cerebro-spinal meningitis is not highly contagious. children old enough to complain of symptoms usually first complain of an intense headache with frequent vomiting and very high fever. great prostration is seen, the pulse is weak, the respirations are irregular, the child may have convulsions, or it may have chills and fever, and rigidity of the body may be present. the position of the child is very characteristic. it does not want to lie on its back but usually rests on one side, with the spine more or less arched. it is a very serious disease and demands the early attention of a physician. some cases are very mild and others are exceedingly grave. if the physician is secured early, and special remedies administered that are known today, many of the children may be saved. infantile paralysis infantile paralysis is a serious disease of the spinal cord which comes on very suddenly and is associated with vomiting, pain in the legs, and a high temperature. after these symptoms have lasted a day or two the paralysis is discovered. there may be convulsions. the paralysis is progressive, and the wasting of the muscles increases until by the end of a couple of months one limb is considerably shorter than the other. sometimes the baby goes to bed at night in apparent good health and wakes up in the morning paralyzed. in this disease the attention of the best physician in your community should be called to the case at once, for there are being developed in our large research laboratories special vaccines for this condition as well as for spinal meningitis. but what is done must be done very, very early, so let there be no delay in calling in medical counsel. there are other forms of spinal paralysis which, associated with tuberculosis of the spine and other spinal diseases, result in loss of power to one or more groups of muscles. the only treatment that can be given in the home is to keep all of the paralytic portions of the body very warm by external heat, care being taken to avoid burning, and secure medical advice. often, later in the course of the disease, by the aid of crutches and braces, the child can be taught to go to school and to get around the house about his little duties. the slight facial paralysis which is so often seen in babies that have been delivered with forceps, usually clears up in a few days or at the latest in a few weeks or months. saint vitus' dance saint virus' dance (chorea) is a peculiar disorder seen in nervous children, and which usually clears up in a few weeks or months under proper treatment. it is characterized by irregular jerkings pretty much all over the body, so that the child staggers as he walks, drops his food at the table, and executes many other noticeably abnormal movements. the child should be taken out of school at once and removed from association with children who might make sport of him or otherwise annoy him and thus increase these irregular jerkings. he should at once be put under the direction of competent medical authority. simple food, colon hygiene, more or less complete rest, and freedom from annoying circumstances, will usually bring about a speedy recovery. congenital disorders _water on the brain_ is characterized by an enlarged head due to an increased accumulation of fluid within the cranium. while the face remains small the head greatly increases in size so that oftentimes it must be braced while the child is compelled to remain in a wheel chair. the mentality is usually fairly normal, but the enormous weight of the head compels the life-long occupancy of a wheel chair. _deaf-mutism._ the child born deaf pays no attention whatever to sounds. an intellectual expression is seen on his face and by six months he is able to do all that a normal baby can do with the exception of hearing. the child should early be taken to an ear specialist in the endeavor, if possible, to correct the defect of hearing. such little ones who are destined to a life without sound, should be given every opportunity to learn to read the lips and to secure a good education--to be taught a vocation where eyesight is of more value than hearing. special institutions are in existence today which can take these deaf mutes when small and so teach them to make audible sounds that they can make themselves understood--at least partially. lip reading is a wonderful improvement over the deaf and dumb alphabet, and should be taught early. _congenital blindness._ perhaps not until the child is six months old can the observer distinguish between blindness and idiocy. the blind child of course will not fix his eyes upon any object; but the general lassitude and the inability to hold up its head, while seen in idiocy, is not present in blindness. _feeble mindedness._ a baby that is born with a weak mind is found to be very backward in all the normal developmental attainments of the growing child. a normal baby holds up its head at four months and should be able to sit erect at six months. the weak-minded baby will not do this, and often as late as two years it will not make any attempt to walk or to talk. there is an unnatural expression--a vacant look--to the face, while there is often much dribbling at the mouth. _early training should be instituted._ it is necessary to call the attention of a physician to these facts, that the parents may be instructed in regard to the early training which is so essential in all these weak-minded little folk. in our opinion it is best to remove these children early to special institutions, where their education can be superintended by those thoroughly accomplished and accustomed to dealing with this class. there are varying grades of feeble mindedness--the backward child who requires a longer time to learn things, and the child who is slow at school and possibly cannot get through more than the fourth or fifth grade--but as soon as weak mindedness is discovered, it is best to transfer the child to some special institution. chapter xxxii skin troubles one of the earliest skin troubles that the average normal child suffers from is prickly heat--a tiny, red-pointed rash always accompanied by sweating and usually resulting from over-dressing, stuffy rooms, and other conditions that make the child too warm. prickly heat produces more or less discomfort but usually little or no itching. ordinarily, a sponge bath followed by the application of talcum powder is sufficient to give relief in mild cases; but severe or neglected cases should be treated by means of bran baths, a cupful of bran being tied up in a gauze bag and suspended in water until the water assumes a milky color. soda baths, two tablespoons to a gallon of water, are also very soothing. a baby should never receive any friction with a towel after such baths, but should be rolled up in a clean linen towel and simply patted dry. chafing great care should be exercised in the choice of baby's soaps. among a number of soaps that might be mentioned castile soap is, perhaps, as good as any. frequent sponging is required to wash off the irritating perspiration; cool clothing, plenty of talcum powder, a dose of calcined magnesia, and a regulated diet are necessary to clear up the trouble. chafed skin, particularly between the buttocks or in other folds and creases, should be kept free from soap. either the starch or bran bath may be tried, while olive oil should be frequently and lightly rubbed over the chafed part. a bit of sterile cotton placed between the folds to prevent friction is often all that is necessary to correct the difficulty. dandruff or milk crust which is often seen on young babies' scalps has been described in detail elsewhere. it should early receive the vaseline rub at night which will often loosen up the hardened crusts. it may be gently removed in the morning with soap and water unless the case has gone on to great severity. in such neglected cases the mother should not undertake to correct the difficulty alone. taken early, when the scalp is covered with tiny flakes known as milk crust, it can be quickly relieved. vulvovaginitis vulvovaginitis is a very contagious disease, and before the days of hospital asepsis, which is so perfectly maintained today in our large institutions, this disease used to go right through a children's ward because of carelessness in the handling of soiled diapers, etc. the sign of this disease is a yellow-white vaginal discharge, while the surrounding skin covering the inside of the thighs and buttocks may be very much reddened. the baby should be taken at once to the physician at the first appearance of these symptoms. only rigid isolation can possibly prevent other children from getting it--essentials are separate towels, wash towels, soap (in the case of the older children), and, in the case of the baby, separate diapers and rigid scrubbing of the attendant's hands--in this way only can this infection be held in check. the infected child should sleep by herself, and utmost care must be exercised in preventing her fingers from first touching the itching vulva and then placing them to the eyes or to the mother's eyes. a vulva pad must be worn as long as the disease lasts. the physician will give you the proper medicines to be used in these cases, and if no physician is within reach, you are perfectly safe in dropping into the spread apart vulva a few drops of twenty-per-cent argyrol and then applying the vulva pad. after each treatment the hands of the mother or nurse must be most rigidly cleansed. eczema eczema is a very troublesome disease, particularly in infants; there are so many forms of it that there is neither time nor space in this volume to describe them individually. this disease may be produced in children by either internal or external causes--from friction on the skin, from coarse, rough woolen clothes, or from starched garments, or from lace or starched bonnet strings which rub into the folds of the skin. irritating soap, the contact of soiled diapers, cheap toilet powders, and discharges from the nose and ears may also be responsible for the disease. the particular internal causes are over-feeding, digestive disturbances, the too early use of starches which create fermentation in the intestinal tract. in the most frequent form of eczema the skin becomes red and then there appear tiny vesicles (water blisters) which soon rupture and "weep." this fluid which oozes from these tiny, ruptured vesicles, in connection with the perspiration and exfoliation of old skin, forms heavy crusts upon the face which are both unsightly and annoying. another form of eczema is simply a very badly chafed condition accompanied by intense itching, and commonly known as "dry eczema." a very disagreeable form is the pustular variety. one poor little sufferer that was once brought to us had so many pustules on his head that one could not put a ten cent piece on his scalp without touching a pustule. the treatment of these cases, in order to be effective and leave the child's head in normal condition, must be administered with the utmost patience every day for weeks. a doctor's help is always required in combating this sort of skin trouble. if the cause is external, then the clothes should be changed. all irritation should be removed--the clothing must not be allowed to scratch the skin. the child must not scratch himself. if necessary, little splints may be placed on the inside of his arms to prevent his bending the elbows if the eczema is on the face, while the little sleeves may be pinned to the side of the dress to resist the movement of the arms. eczema treatment the diet should be most carefully looked into. the nursing mother will earnestly look into every article of food she herself is eating, and carefully avoid all foods that produce fermentation or decomposition. the mother's urine should be examined and its acidity noted; if it is above normal she should take some alkalines such as ordinary baking soda or calcined magnesia. if it is a bottle-fed baby, any form of flour should be removed from the food and the quantity of the milk reduced. all this, of course, is done under the direction of the physician. repeated doses of castor oil may be given. the name of the medicinal agents that have been used in the treatment of eczema, is legion. perhaps one of the most widely used is the early varnishing of the affected skin with ichthyol (one part ichthyol, one part distilled water), which is swabbed on after the skin has been cleansed with olive oil. allow this to almost dry, and then sprinkle on talcum powder which smooths over the dry varnish of ichthyol. this is worn every night and during the day, in bad cases, even when the eczema is on the face. it is renewed each day, and is preceded by the olive-oil bath. no water or soap is ever used in eczema. fortunately, the eskimo has taught us that the skin really can be cleansed with oil as well as with water. in the appendix will be found two prescriptions, number one and number two, that have proved very beneficial in some of the most severe forms of eczema. hives and freckles hives, a crop of little raised red papules closely resembling lesions caused by the sting of a mosquito, may make their appearance upon the skin of the child, remain a few hours, and then disappear. hives are usually due to digestive disturbances and may be caused by such foods as strawberries, nuts, pastries, pineapple, certain sea foods, mushrooms, etc. a good cathartic, the taking of alkalines, such as baking soda or calcined magnesia, with a bran or starch bath, or possibly a soda bath, will usually correct the difficulty. the same treatment may be used in nettle rash or prickly heat. freckles seem to run in families. broad-brimmed hats or sunbonnets may be worn, but under no circumstance should a little girl be bidden to remain in the house and shun the beautiful, sunshiny outdoors just because she freckles easily. do not apply any lotions to the freckled face without medical advice, for great harm may be done the tender skin of the child. ringworm often upon the scalps of young children may be seen circles--rather, patches--which are slightly rough to the touch, and which cause the hair to fall out and the spots to remain bald. they are known as ringworms of the scalp. the affection may likewise appear on the body or the face, presenting a ring of reddened skin with a scaly border. ringworm on the scalp is hard to treat and medical help should be secured, for, in spite of all that can be done, the disease often runs its course, leaving round bald spots over the head. ringworm of the face, taken early, is helped by carefully painting with tincture of iodine. the mother should constantly bear in mind that ringworm is a "catching" disease, so that all handkerchiefs, towels, and clothes are to be kept separate. the disease known as mange which so often attacks dogs, is nothing more than ringworm, and children often contract the disease from dogs. ringworm, whether it be on children or dogs, may be greatly helped by the use of tincture of iodine and other appropriate remedies. boils the much poulticing of boils has done an untold amount of mischief. many children and adults are in their graves today because of improper treatment of boils. blood poisoning which so often follows the careless poulticing, as well as the uncleanly opening of boils, can all be avoided. before touching a boil, the surrounding skin should be thoroughly washed with sterile cotton and laundry soap and then disinfected with alcohol. then, with a scalpel or a surgeon's knife which has been either boiled for twenty minutes or allowed to remain in pure carbolic acid two minutes and then in alcohol two minutes, it should be thoroughly opened down to the core so that the pus may come out. it is very much better for the trained hands of a physician to do this than for any member of the family to undertake such an operation--where the danger of blood poisoning is always present. the only treatment of skin eruptions containing pus which is justifiable for the home folks to undertake is to simply paint them with iodine. under no circumstance should poultices be used. fever blisters it is not at all uncommon for small children to develop a group of fever blisters on the lips when suffering with any disease, or experiencing a high fever. even a simple cold or a spell of indigestion may be accompanied by fever blisters. they appear not only on the lips but also on the edges of the nose and may even be seen on the chin. early in their first appearance they may be treated with spirits of camphor or plain alcohol, which sometimes tends to abort them; but they usually run their course, and when they are fully developed they may be treated with zinc oxide, simple borated vaseline, or ichthyol. warts very often children's hands are disfigured by warts. they appear suddenly, develop rapidly, and many times disappear just about as suddenly as they appeared. every child suffering from warts usually passes through the stage of charms and lingoes which are popularly used to remove these disagreeable growths. we hardly see any efficacy in "bean-ie, bean-ie take this wart away," or any particular virtue in stealing mother's dishcloth, cutting it up into as many pieces as there are warts on the hand and rubbing each wart with a separate piece of the cloth; but you will find people in every town or village who will assure you that their warts were driven away by one of these charms or lingoes. warts are either better left alone or removed by a physician with the high-frequency spark or some other reliable method. birthmarks a red or purplish patch on the skin is the result, as mentioned in an earlier chapter, of an embryological accident in which one or more embryonic cells slipped out of place in the early days of skin formation. these accidental markings may occur on the face, the scalp, or on any other portion of the body, and they should be let alone, unless they show a tendency to grow, when it may prove best to give them proper surgical attention. a mole is also a birthmark, and if found upon the neck or shoulders where it is likely to disfigure, it may be removed by the high-frequency spark, or by surgery, in the same way as warts. never tamper with moles. leave them alone or turn them over to the surgeon. erysipelas erysipelas is a much-dreaded disease which is the result of infection with the blood-poisoning germ--streptococcus. it usually occurs about a wound, and is due to infection by this microbe. if it follows circumcision, it is due, of course, to infection, and may be very serious, even causing death. it attacks persons of any age and is oftenest seen on the face. in appearance, the skin is a bright and shiny red, with a definite line of demarcation slightly raised at the edges because of the swollen tissues underneath. on pressure, the redness disappears but reappears immediately upon relieving the pressure. the inflammation, pain, and fever often continues a number of days, during which the child should be isolated from all other members of the family. the bowels should be freely opened, and the diet should be liquid and soft; while local treatment is cared for by the physician who should always be called. should erysipelas develop on a very young baby it is very important that he should be removed at once from the mother. as stated before, the disease is produced by the blood-poisoning germ which is very much to be avoided in any and all stages of obstetrics. one attack in no way renders the patients immune. they may have repeated attacks of erysipelas. the treatments should be started early and kept up most rigidly. scabies and lice in thickly settled districts among the poor and uneducated, where filth and untidiness reign, the "itch" is a very prominent disease. it is caused by the itch mite, a parasite which burrows underneath the skin leaving behind its eggs in little irregularly shaped, bluish tinted ridges. such a profound itching is set up by this burrowing and depositing of eggs that the child cannot resist scratching, and all taken together produces the typical itch-rash. the common site for this rash is on the sides and between the fingers and toes; on arm pits and buttocks of the child, as well as at the waistline. the treatment is usually beyond home remedies. a physician should have charge of the case who will conduct a line of treatment which, if diligently followed, will rid the body of this scourge within a week or ten days. along with the itch are often found parasites of the head, or lice (pediculi). it is not at all infrequent to find them in the heads of uncared for children; but if a much-cared-for child is brought in contact with an infected head he will probably "catch" the infection. a most intense and disagreeable itching is set up at once. the treatment consists in getting the head clean by the use of a very fine comb, thus endeavoring to remove the adult parasites as well as the eggs or "nits." however, great care should be taken to avoid injuring the scalp. perhaps the simplest and most effective treatment known is the kerosene bath which should be applied at night, the hair being done up in a bandage until morning, when the kerosene is washed off with soap and water and then the hair given a vigorous vinegar shampoo in order to destroy the "nits." tincture of larkspur, or an ointment made from the seeds, may also be used. it is applied several days in succession and then washed out. chapter xxxiii deformities and chronic disorders reference has already been made to certain accidents of embryology during the very early days or weeks of the formative period of the embryo. common illustrations of such deforming developmental accidents are harelip, cleft palate, and club foot. harelip and cleft palate in the case of a partial or complete failure of the two sides of the face to come together in the median line, a deformity results which is known as harelip--a partial or complete cleft of the upper lip. it may be a single or a double cleft, exposing the teeth, or the cleft may even extend up into the nose. this deformity may seriously interfere with nursing, making it necessary to resort to feeding with a medicine dropper and later a spoon. the success of the operation for the relief of harelip, which should usually be performed during the early months of life, is often very remarkable. should this failure to unite be in the deeper structures of the head, then cleft palate is the result. this, too, may be partial or complete: partial as seen in a cleft of the soft palate only; and complete, when the hard palate also is involved. in such an instance it is the floor of the nose that is defective; hence the nose and mouth are one cavity. a specially devised apparatus which assists the child in nursing may be found on the market, for nursing is well-nigh impossible without the closure of the roof of the mouth. the operation for cleft palate is usually successful when performed at the proper time and by competent hands. in tongue-tie the weblike membrane underneath is attached too far forward, so that the child is quite unable to protrude his tongue, and this condition greatly interferes with sucking. the operation for the relief of this condition is slight, and should be performed as soon as the defect is discovered. deformed hands and feet occasionally there is a webbing of one or more fingers of the hand, and there are sometimes seen too many fingers or a double thumb. it is needless to allow such a deformity to continue; the operation for relief is often remarkably successful and should be performed very early. clubfoot results when short tendons or contracted tendons pull the toes inward or outward with raising of the heel. treatment must be instituted early; braces or splints are applied; and untiring efforts are put forth in massage and other lines to prevent a lifelong handicap of clubfoot. an inward rotating of the legs presents the deformity of pigeon-toe. the normal foot naturally inclines toward "pointing in," and such a condition should not be discouraged. many flat feet (broken arch) are due to shoe lasts which compel the toes to slant "out," and the bunions which so often follow such mistreatment may be exceedingly painful. by all means place shoes on the pigeon-toed child that possess straight lasts with flexible arches, and which admit of the exercise of many muscles of the foot which otherwise remain inactive. as the child grows older the toenails thicken, and often in their trimming they are cut so closely at the corners that sometimes a condition results known as ingrowing nails. such are very painful and must receive special attention. first of all, the nail is cut squarely, and after scraping it thin the corner is lifted and cotton so placed under it that the nail's downward and inward growth is stopped. spinal curvature curvature of the spine is more common than is usually thought. the most frequent variety of it is the lateral curvature. one shoulder is lower than the other, and the hips are therefore uneven. rickets, during infancy, is the most common cause of spinal curvature. improper sitting at school--sitting on the edge of the seat--or carrying heavy loads are often contributing factors to the production of lateral curvatures. only the muscles and ligaments enter into this deformity, hence the treatment should be started early and should consist of: 1. stretching exercises. 2. hanging from the rounds of a ladder securely fastened to the wall. 3. certain applications of hot fomentations to the spinal muscles for their relaxation. 4. firm cushion placed under one or other of the hips to encourage the re-establishment of muscular poise. 5. special supervision of the case. pott's disease pott's disease, or tuberculosis of the bone, often results in an angular spinal deformity. this curvature, unlike the lateral curvature, is a sequela of an actual disease of the bones. it is always very serious and demands early treatment from skilled hands. early in the disease there is a peculiar stiff, tottering gait. the little child holds the spine rigidly, and in picking up objects from the floor bends the knees instead of the spine. if the trouble is in the upper spine, the shoulders are held high and the head is stiffly poised, it is never rotated; in looking about the entire body turns. medical aid should be secured early. the x ray not only locates the difficulty but also determines the extent of the process. if the spine be put to perfect rest, outdoor life begun, a diet rich in fats established, the results are often wonderfully successful. another tubercular condition is seen in the much dreaded hip-joint disease which parents should always be on the lookout for. the earliest symptoms are crying out in the night suddenly, unnatural standing on one leg (to relieve the strain on the diseased hip) and so-called "growing pains." call in a physician very early and institute proper treatment. a posterior curvature of the spine is often associated with a bad case of rickets. it is of temporary duration, and usually clears up when the symptoms of rickets have been eradicated. it involves only the back muscles--not the vertebral bones. the young mother is often very much concerned over the misshapen head of the child as a result of a prolonged labor; and it does seem quite miraculous to see a head, more nearly resembling an egg than anything else, become beautifully round and shapely by the end of two or three days. protruding ears may be encouraged to lie more flatly by the wearing of a specialized bonnet at night. when the babies are too young to turn themselves they should be turned first to one side and then the other, while care should always be exercised in properly straightening out a curled under ear or an overlapping ear. rheumatism while we so often regard rheumatism an adult disease, nevertheless, children do suffer its aches and pains as well as the fever which so often attends the inflammatory type. the so-called "growing pains" are often of rheumatic origin. diseased tonsils not only are often--very often--the avenue of entry of infectious microorganisms that cause one type of rheumatism, but many forms of valvular heart disease are also directly traceable to these same diseased tonsils. the treatment consists in giving proper attention to the tonsils, even removal if necessary--and if the child is old enough. all other possible causes should be located and removed; the child should have absolute rest in bed with brisk cathartics and a liquid diet (no meat broths). the diet should consist more of alkalinizing foods as shown in the special table in the appendix. medicinal alkalines are often given when the urine shows a very high acid reaction. scurvy scurvy, seen in children who subsist on "prepared foods," is manifested by tender legs and swollen gums which have a tendency to bleed easily. pallor, loss of appetite, and insomnia accompany the condition. the treatment of scurvy is change of diet from "patent foods" to fresh cow's milk, with the addition of orange juice, daily. in older children the food must be very nutritious; out of door life, salt glows, friction baths (see appendix), and the taking of large amounts of fats are all essential to the cure. adenitis--enlarged glands enlarged glands, or what our grandmothers used to call "kernels" in the throat are often the result of inflammation in the mouth or throat, and occur in connection with many of the childhood diseases, notably diphtheria, scarlet fever, and scarlatina. glands appearing in the back of the neck may be occasioned by pediculli (lice), ring worm, or eczema, while those seen in the neck just back and below the ears may come from mastoiditis (inflammation of the middle ear) or adenoids. glands felt under the arm enlarge because of trouble or infection in the breast, hand, or arm; while glands in the groin are usually due to some infection of the feet, legs, or abdomen. these glands usually disappear when the general health and well-being of the child is improved by: 1. outdoor life. 2. morning dry-friction rub to the skin. 3. good liberal diet, including plenty of fats. 4. no feeding between meals. 5. the salt glow and general tonic treatment (see appendix). 6. the oil rub at night. rickets rickets (a disease of the bones) often follows in the wake of faulty feeding and unhygienic surroundings. the bones lack a proper amount of lime salts and other elements. development in general, especially that of the bones, is greatly interfered with. bowlegs, prominent square brow, enlarged perspiring head, weakness, and often tenderness of the flesh, are notable signs of the disease. the treatment varies little from that of scurvy, and will be provided in detail by the attending physician. malaria children often suffer from malarial parasites. sudden rise of fever on regular days (sometimes daily, every two days or every three days) should demand a careful medical examination including the examination of the blood where the offending organism is seen in the red blood cells. we recently saw a little girl who happened to have an earache and was about to be operated on for ear trouble, when examination of the blood revealed the fact that she was suffering from malaria. tuberculosis in the routine examination of adult patients, the x ray observations of the lungs often reveal deposits of lime salts which tell the story of a successful fight against tuberculosis (fig. 16). and while it may seem surprising, we believe beyond a doubt that most of us have had some varying degree of tuberculosis while young--the unrecognized battle has been fought--and these small monuments of lime salts alone remain to tell the interesting story. the pity of it is that whole armies of little folks fall in this struggle against disease, for it is one of the common and fatal diseases of childhood. fresh-air schools, playgrounds, and free school lunches are saving hundreds of children from the ravages of this disease each year. tuberculosis is strictly a house disease, hence the little tubercular patient must seek outdoor life. all avoidable exposure to the disease must be denounced, and public sentiment must continue to be aroused to the hygienic betterment of the tenement districts and basement homes. the sanitary drinking cup and the bubble fountain must be encouraged, as must also the proper ventilation of all places where crowds assemble, be it the schoolroom, the theater, or the church. syphilis while tuberculosis is known as the "great white plague," syphilis and gonorrhea constitute the "great black plague," which seen in the little folks is pitiable indeed, leading us to realize that surely "the children's teeth have been set on edge" because of the careless eating of sour grapes by the parents. syphilitic parents who have not been properly treated, should think many times before they take upon themselves the awful responsibility of bringing into the world a tainted child. proper mercurial treatment should be instituted at once not only for the child but also in the case of both parents. [illustration: fig. 16. x ray showing tuberculosis of the lung] chapter xxxiv accidents and emergencies in this chapter we wish to instruct the mother or the caretaker in doing the one thing needful for every one of the more common household accidents and emergencies while waiting for the doctor. in every household there should be found an accident and emergency "kit" of necessary paraphernalia for the quick application of the one necessary medicine, dressing, etc. this "kit" should contain baking soda for burns, bandages and sterile gauze for cuts or tears, together with adhesive plaster, needle and thread, etc. insect bites and stings far greater harm is often done the skin by the subsequent scratching of the insect bite with dirty finger nails than by the bite itself; and so it is very important that we remember to allay quickly the intense itching by the application of ammonia water or camphor. almost instantly the itching is stopped, and the added "scratching" irritation to the already injured skin is thus avoided. by the aid of a magnifying glass, and often by the naked eye, we may detect the stinger which has been left behind by the greedy guest, and which should be removed by a pair of tweezers. ice-water compresses will stop the swelling and even an old-fashioned mud dressing, which was used and appreciated by our great grandmothers, is a thing not to be despised. if the much admired shrubbery be removed one hundred feet away from the porch, mosquitoes would trouble the household less. it has been demonstrated in many localities that clearing away the near-by clumps of shrubbery permits the family to sit on unscreened porches unharmed. mosquitoes multiply rapidly in stagnant pools of water, but if oil is poured over these stagnant waters the increase of mosquitoes is abated, and their total extinction is not unheard of in swampy districts receiving such care. whenever baby is out of doors where mosquitoes, flies, or other insects are to be found, he should be properly protected from such pests by mosquito netting stretched over a frame eighteen inches above his face, for we can think of nothing more uncomfortable than a mosquito netting dragging over a sweaty baby's face. the fact that mosquitoes, flies, roaches, and other insects are carriers of tuberculosis, infantile paralysis, typhoid fever, cholera, yellow fever and malaria, as well as a host of minor ailments, should make us the more anxious for either their extermination or the protection of our children from their greedy bites and stings. dog bites and snake bites dogs, cats, rats, or mice bite at any time of the year, and provision should always be made for ample protection against such accidents. such a wound should always be squeezed or sucked until it has bled freely, and then be cauterized by a red-hot iron or touched with an applicator that has been dipped in sulphuric acid or nitric acid. a subsequent dressing of balsam peru is healing. the dog should be watched, and if it shows signs of hydrophobia the bitten child should be promptly taken to the nearest pasteur institute for treatment. in the case of snake bites the same sucking and cauterizing treatment is indicated, with the additional tying of a handkerchief or cord a few inches above the wound to stay the progress of the blood and to keep the poison out of the general circulation. a solution of twenty-per-cent permanganate of potash should be used to wash the wound. the popular administration of large draughts of whiskey is of no benefit, for the secondary depressant effect of alcohol increases the body's poison burden, and those who survive do so in spite of the whiskey, and not because of it. swallowing foreign bodies small articles such as buttons, safety pins, thimbles, coins, etc., are often swallowed by little folks, and if they lodge in the throat and the child struggles for his breath the treatment is as follows: grasp him by the heels and turn him upside down while a helper briskly slaps him on the back. the foreign body generally flies across the room. if it is lodged high up in the throat it may often be dislodged by the thumb and finger. if it cannot be reached and it will not go down, lose no time in seeking an x-ray laboratory where its exact location may quickly be discovered and proper measures instituted for its removal. a troublesome fish bone is easily dislodged by swallowing a half-chewed piece of bread which carries it down to the stomach. cathartics and purgatives are not to be given; in due time the object will appear in the stool. in all instances it is well to locate its exact position by the x ray--that there may be assurance that it will do no harm. it is surprising what large objects can be swallowed. one old gentleman swallowed his false teeth, and a six months old baby swallowed, or at least had lodged in its throat, a silver dollar. all detachable parts should be removed from toys that are given to babies, such as the whistle from rubber animals, the button eyes of wool kittens and dogs, and other such removable parts. foreign bodies in the eye to begin with, do not get "panicky," but carefully, painstakingly, and patiently do the following: 1. rub the well eye until the tears flow plentifully in both eyes. 2. blow the nose on the injured eye side, closing the other side. this often encourages the tears to wash the foreign speck down through the tear duct, into the nose and out into the handkerchief (in case the child is old enough to follow such instruction). if the foreign body be sharp, as a piece of steel or flint is likely to be, it may be driven right into the eyeball. seek a physician who will drop medicine into the eye to deaden the pain and then if it cannot be gently rubbed off the eyeball, a magnet will promptly remove it. an eye bath of warm boracic acid is always comforting and never does harm, so that may be given while waiting for the doctor to come, if the object seems to be beyond the reach of family help. if an alkaline, such as lime, be blown into the eye it is very painful, but much relief may be obtained by gently pouring into the eye, by means of a medicine dropper or eye cup, warm water to which has been added a little vinegar or lemon juice. likewise, acid in the eye produces much pain. in this instance, an eye bath of a weak soda solution is indicated. foreign bodies in ear and nose insects that have crawled into the ear may be suffocated by dropping sweet oil or castor oil into the ear, which, after twenty minutes, should be washed out by gentle syringing with warm water from a fountain syringe, hung one foot above the child's head. peas, beans, shoe buttons, or beads are sometimes put into the ear and nose by adventurous or experimenting children. the shoe button or bead will not swell as does the pea or the bean, and may often be safely washed out. if it is causing no pain and will not drop out in case of the ear, or will not be easily blown out in case of the nose, see your physician at once. he has in his possession just the necessary instruments for its immediate removal. peas and beans swell, and consequently cause greater discomfort the longer they are in; do not poke at any foreign body lodged either in the nose or the ear, for the ear drum may thus be injured, while in the former case it may be pushed into one of the accessory sinuses. earache one of the most comforting and highly effectual forms of heat for an aching ear is a four-candle-power carbon electric light on an extension cord that permits the light to come in close contact with the ear. a shade is made from a piece of stiff letter paper that fits the socket snugly and flares out to a three inch opening, which should extend below the point of the bulb one inch. this shade holds all the heat and light and directs it into the aching ear. in every well-ordered household there will be found a three-per-cent solution of carbolic acid and glycerine of which one drop should be put into the aching ear, and then the external heat, mentioned above, should be applied. a bag of warm salt, a hot water bag, or a warm plate will provide external heat if an electric light is not available. do not put laudanum or other remedies into the ear, other than are herein suggested, without your physician's knowledge. earache is always serious, and since it is usually indicative of trouble which, if left untreated, may cause deafness, it demands thorough treatment from skilled hands. running ears invariably need medical attention and should never be neglected. nosebleed if the nose bleeds whenever it is cleansed, more than likely there is an ulcer on the septum which will continue to bleed if left untreated. the physician should heal the ulcer, and the child should be taught always to vaseline the nostril before cleansing it. in case of persistent nosebleed, put the child to bed with the head elevated. pressure should be put on the blood vessels going to the nose by placing two fingers firmly on the outer angles of the nose on the upper lip, while a helper may put firm pressure at the root of the nose at the inner angle of each eye. an ice bag may be placed at the back of the neck, and another piece of ice held on the forehead at the root of the nose. if these measures do not stop the flow of blood a few drops of adrenalin may be put into the nose and repeated in five minutes if necessary. as the bleeding begins to stop, as well as during the bleeding, all blowing of the nose is forbidden as it will only cause the bleeding to start afresh. it sometimes helps to hold a piece of ice in the hands. cuts and tears a cut with smooth edges, if deep, should be allowed to bleed freely, should be washed in boracic acid solution, and its edges held together by a stitch which is usually put in by a physician; but if treatment is to be given at home, the hands of the nurse must be thoroughly washed and the thread and needle boiled for twenty minutes. if the physician has been sent for, make firm pressure over the wound by bandaging tightly with a dressing of sterile gauze dipped in boracic acid solution. in case of a slight cut, make it bleed freely, then wash in boracic-acid solution and apply sterile gauze held in place by a binder. if no odor or pain follows, let alone for two or three days, when a new dressing is applied. a physician should be called in case of ragged wounds or tears, as such usually leave bad scars. cleanse carefully, leaving no dirt in the wound, cause it to bleed, if possible, and apply a sterile gauze compress wet in boracic-acid solution, bandaged on as directed above. zinc ointment may be applied to surfaces that have been skinned. all dressings on dirty wounds should be changed daily. blood poisoning may readily follow a wound, hence the utmost cleanliness should prevail. the hands of the attendant, the dressings, the surrounding skin, must all be clean. the bowels should be kept open, and under-feeding rather than over-feeding is indicated. if a needle be needed to open a sore or boil, always disinfect the part and surrounding area by painting with tincture of iodine, and heat the needle to red heat through a flame before it touches the sore. in case of cuts or wounds of the eyeball apply a compress of sterile gauze wet in boracic acid, held on by a bandage, and go immediately to a good eye specialist. punctured wounds and slivers wounds made by pins, needles, fishhooks, tacks, and splinters are always very painful and great care must be exercised to force bleeding freely, which helps to wash out infection, as more than likely microbes entered with the instrument or sliver when the wound was made. fishhooks are exceedingly troublesome, as they often occasion the enlarging of the wound to get them out, especially if they have gone in beyond the barb. slivers are easily broken off, so great care is needed in their removal. a pair of tweezers is convenient for seizing the protruding portion, while all side movements are avoided lest it break off in the flesh, in which case it may be gotten out with a needle that has been sterilized in a flame. all puncture wounds should be dressed with the wet, sterile compress, covered over with wax paper and bandaged loosely; this encourages cleanliness and favors healing. bruises if left untreated, bruises swell, become highly discolored, and in the process of healing pass through the dark blue, green, and yellow stages. the treatment is as follows: apply hot and cold alternately--the heat should be as hot as can be borne and left on very hot for three minutes, then ice water compresses should be applied for one minute, then hot again--these changes should continue for an hour, and if carried out immediately after the injury all discolorations and most of the swelling may be avoided. witch-hazel compresses are comforting. if discoloration has taken place, the application of hot compresses will often hasten its disappearance. fractures and dislocations while there is very little a member of the family or a non-medical friend can do in case of a fracture, and while it is unwise to offer suggestions relative to the setting of bones, yet it is highly important that both the family and friends know how properly to support a broken leg while carrying a disabled person into the house or to near-by medical aid. for instance, in the case of a fractured leg below the knee, if a couple of flat boards three inches wide be tied about the leg with two pocket handkerchiefs, the ends of the fractured bone will not rub against each other and the pain will be much less in carrying. in this way all danger of causing the broken bones to protrude and thus "compounding" the fracture is also avoided. and also, if there is no near-by ambulance, a good emergency stretcher may be improvised out of two or three buttoned vests with two poles, rakes, or brooms run through the armholes--one vest under the shoulders and one under the hips and still another under the fracture. an injured person may in this way be carried for miles quite comfortably. two people may fashion a seat out of their four hands on which the disabled child may sit with his arms about the necks of his two friends. if the fractured end of the bone penetrates the flesh it is then known as a compound fracture and the utmost cleanliness must prevail--as in dressing other wounds. an x ray laboratory should always be sought, where convenient, to ascertain if the ends of the bones are in good position. in dislocations, the bone has slipped out of place at the joint. medical aid should be called to replace the bone, while hot applications may be used in the meantime. sprains all sprains (a twist or straining of a joint) should promptly be put into a very hot bath and held there for thirty minutes. if this is impossible, then a rubber tube or a handkerchief is tied snugly between the sprain and the trunk of the body. almost instantly the pain, which is often intense and severe, is very much lessened. the hot-water bath is very hot, and the joint should be very red on taking it out. immediately following the bath the injured joint is wrapped in a very cold wet compress, which is next completely covered by silk, gutta-percha, mackintosh, or many thicknesses of newspaper--anything that will hold all the heat in--as the cold compress is quickly heated up. lastly, a bandage of heavy flannel completely covers the whole--compress, impervious covering, etc. the joint is now elevated for three hours, when it is again immersed in a very hot bath and then again the cold compress is applied. this is continued every three hours, except during sleep, for two days, after which it may be done morning and evening. massage is now administered every three hours, first four inches below the injury then four inches above it, while in a day or so the joint itself may be gently rubbed with well-oiled hands. by the end of one week the patient begins to use the injured member. in the case of a sprained ankle a properly applied adhesive strap bandage will give no end of relief and support. various liniments may be applied, but usually the good obtained is from the thorough rubbing which always accompanies their use according to directions. sprains treated as above directed will often liberate the child in one-third the usual time generally allotted for its healing. frost bites and chilblains keep the child who has frozen some part of his body in a cool room, and rub the frost-bitten part with snow or ice water, or wrap it up in cold water compresses. the return to heat must be slow indeed, else much pain may be experienced; blisters followed by discoloration, and even mortification, may set in. you may be surprised some morning on awakening to find your child's hand twice its normal size and very red, because it was out from under the cover a good share of the night exposed to jack frost. do not bring it to heat quickly but immerse it in cold water, gradually and slowly raising the temperature of the bath until it is warm and comfortable. the intense itching and burning of a chilblain may often be relieved by painting with iodine or triple chloride of iron (monsel's solution). soap liniment has also been suggested, as well as alternate applications of hot and cold water. chilblains are troublesome, painful, and their yearly recurrence is often very annoying. swallowing poisons poisons of an acid nature, such as hydrochloric, sulphuric, nitric, or oxalic acids, are neutralized by alkalines, such as magnesia, chalk, soda, and soap, followed by soothing drinks or sweet oil. remember that carbolic acid is not an acid, and is not antidoted with alkalines. the swallowing of carbolic acid should be quickly followed by diluted alcohol, and if this drug is not ready at hand many of the numerous alcoholic patent medicines will do just as well. epsom salts should be given in abundance. poisons of an alkaline nature, such as lye, washing soda, ammonia, etc., are antidoted with vinegar or lemon juice, followed by soothing drinks or sweet oil. a complete table of poisons and their antidotes will be found in the appendix. poison ivy, as soon as detected, should be treated as follows: thoroughly scrub the affected part with tincture of green soap and hot water, which often prevents the trouble developing. clean pieces of gauze may be wrung out of lime water and placed over the inflamed and much swollen surface, keeping them very wet. at night an ointment of zinc oxide may be applied over a painting of "black wash" (to be obtained at drug stores). poison (trifoliolate, or _three-leaved_) ivy resembles virginia creeper, and all nurses and caretakers should be able to recognize it. another treatment for poison ivy which is said to be very efficient is as follows: moisten a bit of cotton with a ten-percent solution of carbolic acid and apply to the affected area--then immediately (about one-half minute) wipe off this carbolic acid with another piece of cotton saturated with alcohol. matches, roach powders, fly poisons, washing fluids, lye, paris green, antiseptic tablets, and pieces of green paper, should all be kept out of the child's reach; and, in case of accidental swallowing of any of them, the physician should be sent for at once, and with the message "come!" should be given the name of the poison swallowed--if it is known. after the antidote is given, soothing drinks are usually administered, such as raw white of egg, milk, flaxseed tea, slippery elm, etc. complete rest in bed is always essential, and external heat is necessary for the body chills easily as the child grows weak. toothache may be temporarily relieved by applying an ice bag below the jaw, thus diminishing the flow of blood to the tooth, and a hot-water bottle to the cheek, which causes the skin vessels to fill with blood, thus relieving the tension in the vessels of the tooth. if there is a cavity, a small piece of cotton moistened with oil of cloves and packed well into it may give much relief. children and adults should make a bi-annual pilgrimage to the dentist, who seeks out beginning cavities, early treatment of which will prevent these dreadful aches and later ill health. burns burns and scalds are not at all uncommon with children, whose eagerness to explore and desire to investigate often leads them into trouble. 1. the simple reddening of the skin--slight burns and sunburn--simply needs protecting oil, or equal parts of oil and lime water, and is to be covered with sterile gauze. 2. the burns which destroy the outer layer of the skin, producing a blister, are treated much as a wound would be treated. the blister, if larger than a half dollar, should be opened near the edge with a needle which has been passed through a flame. the serum should be pressed out and the parts protected by a piece of gutta-percha that has been disinfected with some antiseptic solution; this covering keeps the dressings from sticking, thus avoiding the destruction of the new-forming tissues. 3. when the tissues are injured in the more severe burns, the surrounding flesh is carefully disinfected with boracic-acid solution, and the same dressing applied as described for the "blister burns." balsam peru is a healing balm for burns of this classification. if a child's clothes catch on fire he is instantly to be thrown on the floor and any heavy woolen fabric, such as a curtain, table spread, blanket, or rug, is to be thrown over him (beginning at the neck) and the flames thus smothered. the clothing is now cut off, and if more than one-third of the body is burned the child should be taken to the hospital for constant care; and if more than one-half of the body is injured recovery is doubtful. great care should be taken in keeping the unburned portion of the body warm, as there is a great tendency for the child to become very cold as he weakens from both the nervous shock and from the absorption of toxins. acid chemical burns are treated with baking soda, except in the case of carbolic acid (misnamed), which is treated with alcohol; alkaline chemical burns are dressed in vinegar or lemon juice compresses. methods for restoring the drowned should be understood by every man, woman, and youth. these methods are more fully taken up in works devoted to emergencies and will not be discussed in detail at this time. fainting consciousness is quickly restored to the fainting child by lowering the head--laying him flat on the floor--while an assistant raises the legs perpendicularly. cold dashes of water may be slapped on the chest with a towel, while the face is bathed or sprinkled with cold water. consciousness is usually quickly restored by the above suggestions, in connection with plenty of fresh air. a sudden blow on the head occasionally results in a severe condition known as concussion of the brain. there is a partial or complete loss of consciousness lasting from a few moments to an hour or two. pallor of the skin and a sense of bewilderment accompany concussion of the brain. rest, quiet, and darkness should prevail until the physician arrives and makes an examination. external heat to the extremities may be applied, but no stimulants are to be administered until so ordered by the physician. it is wise to seek medical advice in the case of odd or unusual behavior after a fall on the head. chapter xxxv diet and nutrition most interesting is the study of the food as it passes through the processes of digestion, absorption, assimilation, and oxidation--all definite and important parts of the great cycle through which everything we eat passes on its way from the table to the tissues. elimination is the last step in nutrition, and is the process by which the body rids itself of the broken down cells and other poisonous and useless wastes. these various phases of bodily nutrition may be expressed in a single term--metabolism. what we eat and how much we eat must be carefully planned, for our body temple is really made of what we eat. if you were erecting a beautiful mansion you would not think of allowing cheap, trashy, and inferior building materials to enter into the construction of your home. neither should you permit unfit and inferior materials to become a part of the daily dietary of your little boy or girl, thus to become a part of their bodily structure. assimilation of food following the process of digestion in the stomach and intestine, the nutritive food elements are absorbed through the wall of the bowel by the wonderfully adapted little villus, and distributed by various routes to the uttermost parts of the body. the sugars (all starches are changed into sugar) are carried in the portal blood stream to the liver, where they are actually stored away in the form of glycogen which, in a most intelligent manner, is dealt out to the body from hour to hour as it is needed for fuel. if all the sugar, after a hearty meal, were poured into the circulation at once, the blood stream would be overwhelmed and the kidneys would be forced to excrete it in the urine. this unnecessary waste is avoided by the liver's storing sugar after each meal and dealing it out to the body as required. likewise, the proteins also pass through the liver on their way to the body. just what action the liver exerts upon proteins is not wholly known at the present writing. the digested fats are absorbed at once by the lacteals, the beginning of the intestinal lymphatic system, by which they are carried to the large veins at the root of the neck and there emptied into the blood stream. we have now traced our various food elements through the processes of digestion and absorption in the alimentary tract, some going through the liver, and others through the lymphatic system, until they circulate in the blood stream itself. it is from these food substances, circulating in the blood stream, that the various cells of the body must assimilate into themselves such portions as they require for purposes of heat and energy and for the repair of their cell substance. this specialized work of cell assimilation converts the dissolved watery food in the blood into solid tissues, exactly reversing the process of digestion. with a most profound intelligence, each of these body cells and tissues, bone and nerve fiber, muscle and organ, selects from the blood stream just its supply or portion of the food elements requisite to its upbuilding and maintenance. the mysteries of assimilation are effected by means of chemical substances called "enzymes," similar to those found in the digestive organs, but acting in an entirely different manner, in that they build up solids out of liquids instead of converting solids into liquids. elimination of body wastes metabolism consists of a twofold rôle--an upbuilding and a tearing down process. after the food is all digested, absorbed, and assimilated, having become a part of the bodily organ, bone, muscle, and nerve fiber, then begins the work of tearing it down--of liberating its heat and energy--to be followed by its elimination from the body through the sweat glands, uriniferous tubules of the kidneys, etc. the carbohydrates (starches and sugars), together with the fats, are completely burned up in the body and are then eliminated in the form of water (thrown off through the sweat) and carbonic acid gas given up by the lungs. the proteins, or nitrogenous foods, are not so completely burned up in the body. the ashes which result from their combustion are not simple substances like the water and co_{2} of the carbohydrates. this protein ash is represented by a number of complicated substances, some of which are solid (protein clinkers), which accumulate in the body and help to bring about many diseases, such as gout, headache, fatigue, biliousness, etc. these protein ashes and clinkers are further acted upon--split up and sifted--by the liver, and are finally eliminated by the kidneys in the form of urea, uric acid, etc. the body being unable to store up protein, is often greatly embarrassed when one eats more of this substance than is daily required to replenish the waste of the body, for it must all be immediately split up in the system, and the over-abundant and irritating ashes must be carried off by the eliminating organs. now, the overeating of sugars, starches, or fats, is not such a serious matter, as they may be stored in the liver and subsequently used; and even if they are eaten in excess of what the liver can care for they accumulate as fat or add extra fuel to the fires of the body, their ashes being carried off in the form of such harmless substances as water and carbon dioxide (co_{2}); but the overeating of protein substances is always a strain on the body and should be avoided. elements of nutrition there are seven distinct elements entering into the composition of human foods--protein, starch, sugar, fat, salts, cellulose, and water, not to mention enzymes, vitamines, and other little-known chemical principles. these elements are all variously concerned in the nourishment, energizing, and warming of the body. proteins the proteins are the structure builders of the body. while starches, fats, and sugars may be compared to the coal that feeds the locomotive, the proteins represent the iron and steel that are used from time to time to repair the engine and replace its worn parts. the essential chemical difference between starch and protein is that the latter contains nitrogen and a small amount of sulphur and phosphorus. the most common forms in which protein is used for food are the glutens of the grains, the legumes, nuts, cheese, the white of egg, and lean meat. starches the starches are by far the most abundant of all elements in human food. they enter largely into the composition of nearly all plants and seeds. under the influence of the sunlight, the green-colored plants gather up the co_{2} of the air and, with the water absorbed from the ground, build up starch. the plant takes all the carbon from which starch is made from the air, but while the atmosphere contains almost eighty per cent of nitrogen, the plant is unable to use it; it must secure its nitrogen from the decaying refuse of the soil. thus the plant utilizes the waste products found in air and earth in the building of its food substances. starch exists in the form of small granules. since each little starch granule is surrounded by a woody envelope of cellulose, it becomes necessary to cook all starches thoroughly in order to burst this cellulose envelope and thus enable the saliva to begin, and other secretions to continue, the work of digestion. fruit sugars the sugar of fruits represents a form of food requiring practically no digestion; while the sugar found in beets, the cane plant, and the maple tree, must be acted upon by the digestive juices of the intestine before their absorption can take place. during the winter, the maple tree stores its carbohydrates in its roots in the form of starch. with the advent of spring mother nature begins the digestion of this starch--actually turns it into sugar--and in the form of the sweet sap it finds its way up into the tree trunk to be deposited in the leaves and bark in the form of cellulose, a process very similar to that performed by digestion in the human body, where starch by digestion is first turned into sugar, and afterwards deposited in another form in the liver and muscles. dextrine is a form of sugar resulting from thoroughly cooking or partially digesting starch. there are about twenty-five stages or forms of dextrine between raw starch and digested starch or fruit sugar. dextrine is found in the brown-colored portions of well-toasted bread. fats fat is a combination of glycerine and certain fatty acids. as a food, it is derived from both the animal and the vegetable kingdom. animal fat consists of lard, suet, fat meat, etc., while fat of animal origin is represented by cream, butter, and the yolks of eggs. the vegetable fats are found in nuts, especially the pecan, cocoanut, brazil, and pine nuts; also in the grains, particularly oats and corn. the peanut also contains a considerable amount of fat. of the fruits, the banana and strawberry contain a trace of fat, while the olive is the only fruit rich in fat. as a food, fat is used in three forms. the emulsified form is represented by cream, olive oil, and nuts. when the tiny globules of fat, which are each surrounded by a little film of casein, are crushed--united into a solid mass--we have a free fat. this form is represented by butter and other animal fats. another form is fried fat--fat which has been chemically changed by heat with the development of certain irritating acids. mineral salts the mineral elements comprise but a small part of human food as regards weight, but they are extremely important to the health of the child as well as the adult. as found in the food, they are not in the form of mineral salts, like common table salt. the salts of food are living salts, organic or organized salts, such as are found in the growing plant. these salts are of great value to the various fluids of the body, and also as stimulants to nerve action, but more particularly in the work of building up the bones. salts are found largely in the cereals. a small amount is also found in vegetables, particularly the potato, as well as in most fruits. cellulose cellulose represents the great bulk of all vegetables and fruits. it is digested by most animals, but in man it is digested only to the extent of about thirty per cent. the presence of a large amount of cellulose in the food enables us often to satisfy the appetite without injury from overeating. it serves to give bulk to the food, and thereby possibly acts as a preventive to constipation. water water fills an important place in the nutrition of the body. the food changes in connection with digestion, assimilation, and elimination, can take place only in the presence of water. water constitutes from fifteen to ninety-five per cent of the various foods. the watery juices of vegetables and fruits consist largely of pure, distilled water, in which fruit sugar is dissolved, with added flavoring substances. water is absolutely essential to the performance of every vital function connected with human metabolism. animal heat the source of heat in the animal body was the subject of much superstitious speculation on the part of ancient scientists. it is now known that animal heat is derived from the food we eat by means of a peculiar process of vital oxidation--effected in the presence of oxygen--by the action of water and enzymes upon the food elements absorbed by the living cell. this process of oxidation liberates the heat and energy stored by the sun in the food, and thus the body is kept warm by this constant combustion of the digested foodstuffs. the starches and sugars, together with the fats, represent food elements which serve as the body's fuel. by this means we are able to maintain a constant body temperature of almost one hundred degrees. the average human body produces enough heat every hour to raise two and one-half pounds of water from the freezing point to the boiling point. this is equivalent to boiling about seven gallons of ice-water every twenty-four hours. differently expressed, the body gives off each hour the same amount of heat as a foot and a half of two-inch steam coil. this is the same amount of heat which would be produced by burning about two-thirds of a pound of coal. fuel value of foods expressed in terms of english weight, the fuel value of the three different food elements would be: 1 ounce of carbohydrates 127.5 calories 1 ounce of proteins 127.5 " 1 ounce of fat 289.2 " it will be observed that fat contains more than twice as much heat as the carbohydrates. this is due to the fact that fat contains more carbon than either starch or sugar. next to fats, starches and sugars are the most important fuel elements. protein is a very extravagant form of food for fuel purposes. proteins are the most expensive elements of human food; they are incompletely burned in the body, and inasmuch as they leave behind distressing and disease-producing ashes, it is clearly evident that only sufficient amount of proteins should be eaten each day to supply the demand of the body for repairs. we should depend more largely upon the carbohydrates and fats for heat and energy. a large part of our food is required to furnish heat to take the place of that lost by radiation from the skin, and this is why children require more food than adults--they have a larger skin surface in proportion to their weight, and therefore lose more heat by radiation, and it is for this reason that the food for the growing child must be wisely and carefully selected. diet for child two to three years old _breakfast_, 7-8 a. m.: fruit; cooked or toasted cereal served with thin cream; a soft boiled or coddled egg; bread (two or more days old) and butter; plenty of milk. _dinner_, 12-1: soups; creamed vegetables--tomato, corn, peas, and celery; any two of potatoes--creamed, mashed, or baked--carrots, beets, spinach, peas, cornlet, squash, cauliflower, asparagus tips, string beans; protein dish--the puree of dried beans, peas, or lentils; macaroni or carefully selected meats; dessert--apples, baked or sauce--or other fruits, junket, custard, milk. _supper_, 5-6 p. m.: fruit, bread (bran bread if constipated); milk; porridge, with rich milk or milk toast; sweetened graham crackers. foods allowed children of four years and older _protein dishes_: purees of dried peas; lentils; beans; macaroni; eggs--soft boiled, poached, scrambled, or omelette; meats--steak, chops, chicken, turkey, broiled fish. _cereals_: all the toasted-flake foods; toasted and not too fresh bread, including both graham and bran; hominy; corn meal; oatmeal; farina; rice; barley; tapioca; sago, etc. _soups_: creamed vegetable soups of all kinds and broths. _vegetables_: potatoes; all the small green vegetables; lettuce; stewed celery; beets; squash; cauliflower, etc. _fruits_: all, if stewed or baked. raw fruits--pears, peaches, ripe apples, berries, oranges, persimmons, grape-pulp without seeds, etc. _desserts_: custard; jellos; junkets; home-made ice cream; sponge cake; baked fruits with whipped cream, etc. foods to be avoided by young children 1. _doughy breads_, griddle cakes, insides of muffins, hot biscuits, etc. 2. _fried meats_, such as sausage, oysters, pork, ham, veal, salt fish, corned beef, dried beef, etc. 3. _foods that are hot when they are cold_--such as catsup, horse radish, mustard, highly spiced pickles, sauces, etc. 4. _rich pastries_, puddings, unripe fruit, salted peanuts, and highly concocted dishes. 5. _certain salads_, containing coarse but easily swallowed foods, with highly seasoned sauces. 6. _tea, coffee, and all alcoholic beverages._ 7. _soft candies_, chocolate creams, bon-bons, patties, etc. average normal children crave sweets, and since their normal food is about seven per cent sugar it is not to be wondered at. there are many forms of pure, hard candies which may be taken by the three-year-old child. they are stick candy, fruit tablets, sunshine candies, and other varieties which may be sucked. all soft candies, such as chocolate creams, bon-bons, patties, etc., are to be avoided. hard candies, taken along with the desserts at meal time, in no wise injure the normal stomach of the healthy child. the other members of the family should set a correct example by sucking the hard candies rather than chewing them; for if the hard candies are allowed to dissolve slowly in the mouth they produce a weak solution of sugar, which does not interfere with digestion as do the strong and concentrated sugar solutions which result from chewing chocolate creams, bon-bons, etc. candy, cookies, sandwiches, or bits of cake should never be allowed between the meals. eating between meals children who do not eat well at the breakfast table, if given a "piece" at 10 a. m., will not be ready for the 12 o'clock meal; and then another "piece" at 2 p. m. interferes with the normal appetite at 6 p. m. digestion is disturbed, the nervous system irritated, and a "puny child" is often the result. bring the three-or-four-year-old to a well-selected breakfast some time between 7 and 8 a. m. then nothing--absolutely nothing--but water must pass the lips between that breakfast hour and the 12 o'clock meal, which should be a good one. then the interval until 5 or 6 p. m. is passed in the same manner. at the evening meal the appetite is again whetted: and a good appetite always means good gastric juice to digest the meal. and so, good mother, guard carefully the interval between meals if you would have good digestion and good health for the little folks. daily food requirement the following table, taken from _the science of living_,[b] shows the minimum of calories or food units required by boys from five to fourteen years of age and girls from five to twelve: boys skin daily age height in weight in surface in calories or years inches pounds sq. ft. food units 5 41.57 41.09 7.9 816.2 6 43.75 45.17 8.3 855.9 7 45.74 49.07 8.8 912.4 8 47.76 53.92 9.4 981.1 9 49.69 59.23 9.9 1043.7 10 51.58 65.30 10.5 1117.5 11 53.33 70.18 11.0 1178.2 12 55.11 76.92 11.6 1254.8 13 57.21 84.85 12.4 1352.6 14 59.88 94.91 13.4 1471.3 girls skin daily age height in weight in surface in calories or years inches pounds sq. ft. food units 5 41.29 39.66 7.7 784.5 6 43.35 43.28 8.1 831.9 7 45.52 47.46 8.5 881.7 8 47.58 52.04 9.2 957.1 9 49.37 57.07 9.7 1018.5 10 51.34 62.35 10.2 1081.0 11 53.42 68.84 10.7 1148.5 12 55.88 78.31 11.8 1276.8 [b] sadler, william s., _the science of living; or, the art of keeping well_. a. c. mcclurg & co. chapter xxxvi caretakers and governesses because of her versatile adaptability to the management of details, woman, all through the ages, has willingly and happily sacrificed herself upon the altar of service. it is not in the province of this chapter to go into the details of the tribal life of the early hordes and clans that came from the north and from the east to establish civilization in the cities of rome and britain--space forbids. in this chapter we wish to hold up a picture to the mother, a picture which may speak volumes to her soul; one which perhaps she may ruthlessly throw away--nevertheless, we propose to exhibit it. homemaking vs. housekeeping a newspaper woman in my office recently told me a story of a mother who finished her high-school education, took some work in a university, and who yielded to the earnest pleas of her lover-classmate through grammar school, high school and college--and married him. to this happy family there came a number of beautiful children. the mother willingly, lovingly, cared for them during their helpless infancy--made their clothes, managed their meals, opened the door for them as they came home from school, met them with a cheery story, listened to their problems, helped them with their lessons--but all through it, first, last and all the time, she also managed the entire home. she dusted the furniture, changed the curtains, looked after the linen, mended the clothes, and even pressed the trousers of her "rapidly rising" husband that he might go out into his "club life" and enjoy the evenings with his associates. the duties of the day so wearied her, and the night vigils with the sick child,--looking after the little coughs, the uncovered shoulders, getting the drinks of water and performing a dozen other details--that she was too weary to accompany her husband to the dance, to the theater, to the social gathering or to ladies' night at the club; and so, in the course of a dozen years, the mother had grown old, and quite naturally she had grown "home centered." her world's horizon was the walls of her home. she was happy and quite contented in her children's smiles, in the cheery "how do you do" of her husband, in the fact that that gravy was good or that steak was fried to the king's taste. she was happy and contented until one day when the awakening blow came. in the attic she and her thirteen-year-old son, who was just entering high school, were looking through an old chest when she drew forth some examination reports and some old school cards--holding them up side by side. one set of the cards bore the father's name and the other set the mother's maiden name. in great surprise the boy exclaimed, "why, mother, i never knew you studied algebra and latin; why, mother, i never knew you were educated." her eyes were immediately opened, the scales fell off, she was awakened to the fact that her own son was coming to regard his mother as somewhat inferior, in intellectual attainments, to the father--that she was considered in that home as a mere domestic. true, the steak had been broiled well, the pudding was exquisite, the children's clothes were always in order, the husband's trousers were always beautifully pressed, his ties were cleaned as well as a cleaner could clean them; but where did she stand in her boy's mind and where was she in her husband's mind? "do you notice how trim and nice mrs. smith always looks? her clothes are always in the latest style, and she combs her hair so becomingly." such remarks as this from the well-meaning husband cut keenly, and it is well that they do, for often it is only such remarks that wake up our "home mother." dear reader, i want you to ponder this story. i wish to say to the mother who has started out upon a career in life, who has prepared herself for teaching school, for a business career, for story writing, for millinery, for lecturing, or has perhaps graduated in a domestic science course, that she makes the mistake of her life in settling down, just because she has taken another's name, to be perfectly satisfied with becoming the household domestic, the household mender, the household cook. mothers in the professions i have in my acquaintance scores of mothers in the professions, newspaper women, women who have carved out brilliant careers for themselves, women who have taught school for twenty years while their children have been growing up, women physicians who have risen in the esteem of all their professional brothers and sisters, women who have conducted cooking schools, who have occupied positions of trust in hospitals and in every walk of life, and who have successfully reared children at the same time. you will pardon me for being personal when i say that since our own little fellow was six weeks old his clothes have been washed and mended and his food has been prepared by earnest and honest women who had not fitted themselves for the career which this boy's mother had chosen. his mother went to her office, cared for her patients, kept up by the side of her husband in the battle of life. all the time there was a woman at home just devoted to that little fellow. a newspaper woman recently told me her story--a story which should impress everyone of my readers as it did myself, and she, like many other mothers in the professions, leaves her home as the little fellow goes to school. his hands have been washed, his bowels have moved, his hair has been combed, his breakfast has been eaten by the side of his mother--she has directed it all. he goes forth to the schoolroom and she goes forth to her profession. all through the day she lovingly keeps in mind these children that are growing up. she works the harder, real love entering into everything she does, because she is not merely earning the bread that goes into their mouths, but is forming a character not only for herself but, because of her broadened horizon, is instilling into their little minds the possibilities of their own career, their own opportunity to enter into the world's work as real world workers. i contend that the mother in a profession has many blessings that the mother who remains at home never has. the mother who remains at home has a viewpoint that is often quite likely, wholly unconsciously, of course, to become small, to become narrow, to become focused upon small details; on the other hand, the mother whose mind and whose heart are so full of the affairs of the office, of the newspaper article she has just written, or the lecture she has just given or is about to give, or the meeting that she is to preside over, is quite likely to become somewhat irritated sometimes if the little fellow doesn't stand quietly to have his hair combed, she is quite likely to "feel rushed;" but under all circumstances, dear reader, whether this mother be a home mother or in a profession, never, never must she allow mental panic to seize her. ever must we keep in mind that these little ones are just children--children that are still in the developmental stage. work outside the home and now for the home mother. i believe it is necessary and of paramount importance that she get away from her children (if possible) several hours each day; that she provide for them a caretaker who can relieve the children of her or relieve her of the children, whichever way you may look at it, for we are inclined to think that the children often tire of the mother just about as often as the mother tires of the children. i would have the woman who remains at home, whose husband is able to provide outside help for the heavy work of the house, enter into some uplifting neighborhood work, social settlement work, church work, wholesome club work--anything but bridge and whist and gambling games. i would have them bring into the nursery a woman who is cheery, who is capable of teaching games, of entertaining and amusing these little folks under their own roof. the woman who has graduated from high school, who has a diploma to teach, i would have take a school or, at least, do substitute work. she will be happier--far happier--continuing along the lines for which she has prepared herself, even if all the money she earns be used to pay the help. some women are especially fitted for the important work of mother and homemaker, and such wives will find for themselves a worthy career in the home and its neighborhood activities. each woman must find a field of action suited to her own temperament, education, experience, talents, and opportunities. selecting a caretaker for a caretaker, the professional or business woman should not select an ignorant servant girl; that would be a great mistake--a crime--a violation of the law that should govern the training of these little people who have come to us to be reared and cared for and fitted to occupy their place among the world's workers. as a rule, one soul does not possess the qualifications for scrubbing and laundry work and also the firm but gentle ministering qualifications necessary for a successful caretaker. they do not combine as a rule. it has been my experience, as a mother with a profession, and that of many others of my acquaintances, that an art student or a music student makes a splendid caretaker. there are hundreds and hundreds of genteel women, with winning manners and beautiful dispositions, who may be obtained to sew on the buttons, wash the faces, and change the clothes of our darlings while we are carrying forward in the world the great work for which we have fitted ourselves during the long struggles of our teens and early twenties. the young woman who is brought in to care for the child should be above the usual "servant" class. she must eat in our dining-room, she should be welcome in the living-room or sun parlor, and be treated as a respected member of the family. her salary is usually not large for she realizes that she is given something in that home--something that money cannot buy. the up-to-date mother now this young woman (the caretaker) wants to hold her position, and so she is very anxious to carry out in detail the laws and rules that are laid down by the mother. mother can keep abreast with the world, mother has time to read periodicals that keep her in touch with the great, wide, pulsating affairs of life. she is able to meet more women worth while, and with her husband attend lectures, musicals, theaters, and other places for intellectual culture. anyone of my readers need not look four blocks from her home to find a mother who is run down at the heel, whose dresses are calico, whose hat is five or six years old, whose black silk dress (the only one she ever had) is worn shiny or threadbare, who works and saves every penny that she can that her children may look well; and, even when the husband does invite her to go out with him, he will often be confronted with this remark: "john, i would like to go, but really my clothes are a little bit shabby." the world is just full of such women, with their very hearts being eaten out of them for the want of a beautiful gown, a beautiful hat or a pretty pair of evening shoes, and they might have them every one if they would be willing to allow the duties of the household to be presided over by a woman that cannot do the things the mother can do, while she goes out and accrues a number of dollars each week which will more than provide for the things that her soul desires so that she may go well dressed by the side of her husband in quest of that very necessary intellectual culture and social diversion. the wife of a prominent judge, in my office just this week, said to me that she believed that most of our social and domestic uneasiness was due to the fact that fathers and mothers and children went out together so seldom. the father goes to his club, the children go to their little gatherings, and mother usually stays at home; although of late, she is beginning to realize the value of the women's clubs. qualifications of the governess the caretaker should not be too old. it is a very great blessing if there is an older sister in the family who can come in and assist with this work, or if there is an aunt. if one is to be selected from the open market, then we suggest a woman in her late teens or early twenties whose heart is full of play, whose face is sunny, and who is young enough to appreciate and like the becomingness of youthful dress. it is needless to say she should be free from tuberculosis and other diseases. she should be trustworthy enough not to administer soothing syrups because the children won't sleep, or to give candy when mother has forbidden her, or to teach the children bad habits of any sort. it is impossible to exercise too much care in the selection of this substitute mother, and when you do find one it is often wise not to keep her too long. a year or so is plenty long enough for any person to be with our children. it is only necessary for anyone to walk out into the public parks and casually listen to the conversations of many of the "chewing-gum caretakers" to discover with what carelessness some people select caretakers for their children. the language they use is not only ungrammatical but oftentimes both slangy and profane. the flirtations carried on with many of the park policemen and bystanders lead us to feel that many people arrive at the idea that their little folks "will grow up some way." if the caretaker is a student, a young woman of culture, and is kept with the family, she will be found to be more circumspect and dependable. her gentleman friend, if she has one, should be allowed to come to the home. she does not have to meet him out in the park any more than a sister would have to go away from home to meet a friend; and, to my mind, everything centers around the viewpoint of the mother as she selects this caretaker, for if she is her social equal it puts her in a different place entirely to the well-meaning but ignorant servant girl to whose care is often intrusted the lives of the little people. hints for the caretaker there are a number of hints we wish to bring together in this chapter for the mother to suggest to the caretaker. for instance, here is a group that one author gives us: baby is happy because he is dry. he is healthy. his food is right. he has sleep enough. his meals are on time. he is dressed properly. he is bathed regularly. his habits are regular. his bowels move regularly. he has fresh air day and night. he is not dosed with patent medicines. he is not excited by frequent handling. he is not annoyed by flies or other insects. things bad for babies candy. pacifiers. thumb-sucking. soothing syrups. patent medicines. waterproof diapers. moving picture shows. sucking on empty bottles. being kissed on the mouth. play of any sort after feeding. sleeping in bed with the mother. whiskey or gin for supposed colic. sneezing or coughing in the face. irregular or too frequent feedings. sleeping on the mother's breast while nursing. spitting on handkerchief to remove dirt from baby's face. allowing a person with a cough or a cold to hold the baby. violent rocking, bouncing, and rollicking play at any time. dirty playthings, dirty nipples, dirty bottles, dirty floors. allowing any person with tuberculosis to take care of the baby. testing the temperature of the baby's milk by taking the nipple in the mouth. things to remember keep baby out of dust. don't cover his face. don't rock him to sleep. keep baby away from crowds and sick people. don't neglect a sore throat or a running ear. his health, growth, and happiness depend largely upon _you_. cats and dogs have no place about a baby. they carry disease. the baby is not a toy or a plaything, but a great responsibility. don't wipe out baby's mouth. it tends to cause ulcers and thrush. overcoming bad habits there are a few bad habits which older children fall into such as lip-sucking or thumb-sucking or finger-sucking which not only narrow and deform the upper jaw, but likewise deform the hand itself. they should be stopped at the earliest opportunity by pinning the sleeve to the bedding or putting mittens on the hand or putting a slight splint on the anterior bend of the elbow. some children suck their handkerchiefs, or bite holes in their aprons and neckties. children often bite their finger nails, and a habit of this kind fully developed during early childhood often remains with them throughout life; whenever a nervous spell seizes them they instantly begin to bite their finger nails. other people pick their nose when nervous, so during very early childhood these habits should be discouraged. one mother helped her little son by beautifully manicuring his nails for him each week. another child was cured by old-fashioned spanking. the finger tips may be painted with tincture of aloes, or dipping the tips of the fingers in strong quinine water will sometimes help. i know of nothing better for the adolescent child than to teach him how properly to manicure his own nails. another bad habit that children often get into is stooping or allowing the shoulders to become rounded. shoulder braces are not indicated in these cases. the children should be allowed to enter the gymnasium or the father should take off his coat and vest and go through gymnasium stunts with the boy. the mother can do the same for the girl. it is often the case that round-shouldered children are near sighted. the child really has to stoop to see things. when a child holds his head to one side constantly on looking at objects, astigmatism, an error of eyesight, is usually indicated. an eye specialist should be consulted, the eyes examined, and properly fitted eye glasses should be worn. just as early as possible in the life of the little child he should be taught to blow his nose, to spit out the coughed up mucus from his lungs, to hold out his tongue for inspection and to allow his throat to be examined. he should be taught to gargle, and to regard the physician as one of his best friends. attention to these minor accomplishments will make it very easy indeed for the physician in case of illness. chapter xxxvii the power of positive suggestions a child is the most imitative creature in the world. before he is out of pinafores he tries to talk and act just like his elders. it is because of this inherent tendency to say and do those very things which he hears others say and do, that, if faith-thoughts are early and constantly suggested to the unfolding mind of the child they will assist greatly in evolving a character of joy, confidence, and courage. on the other hand, if fear-thoughts are continuously sown in the young mind they will eventually distort the emotions, deform the conceptions, and wholly demoralize the health and life activities of the growing child. within the limitations of the possibilities of hereditary endowment, and in view of this wonderful imitative nature, we are able to make of a child almost anything we desire; not "an angel," in the ordinary acceptation of the term, but a child who knows his place and possesses the power of normal self-control. early fears from two to six years of age, when the imagination is most plastic and vivid, when the child's imitative instinct is so unconsciously automatic, is the most effective and opportune time to initiate good habits and lay the foundations for the later development of a strong and noble character. "baby's skies are mamma's eyes" is just as true as it is poetical. while a tired and worn-out mother, exhausted by a multitude of harrassing household cares, may be pardoned for her occasional irritability, nevertheless the little one unconsciously partakes of her spirit. when the mother is happy the child is happy. when mother is sick and nervous the child is impatient and irritable. it is unfortunate that this very time of a child's life, when we can do practically anything we choose with him, is the very time when so many parents fill the child's mind with the unhealthful fear-thoughts. "the bogie man'll get you if you don't mind mamma," or, "i'll get the black man to cut your ears off," or, "the chimney sweep is around the corner to take bad little boys," are familiar threats which are so frequently made to the little folks. these efforts to terrorize the young child into obedience never fail to distort the mind, warp the affections, and, more or less permanently, derange the entire nervous system. the arousal of fear-thoughts and fearful emotions in the mind of the growing child is very often such a psychologic and a physiologic shock to the child that the results are sometimes not wholly eradicated in an entire lifetime. just see how far we carry this unwholesome introduction of fear-thoughts--even to the almighty. thousands of us remember being told as a child that "god don't like naughty boys," or, "god will send the bad man to get you if you don't be good." thus, early in life, an unwholesome fear of the supreme being is sown in the mind of the child, and, as time passes, these false fears grow and come so to possess the mind and control the emotions that in adult life this early teaching comes to mold the character and shape the religious beliefs of the individual. to the child who has been reared to dread god, who has come to look upon the creator as an ever present "threat," how is it possible to convey the beautiful teaching of his fatherhood? fear of noises how frequently some unusual noise leads a parent to say: "keep still! what was that? did you hear that noise?" the little folks of the family are startled, their eyes grow large and their faces pale, while they cling to the frightened mother. of course, investigation usually shows that the strange and alarming noise was merely the slamming of a cellar door, the rattling of a curtain in the wind, some one walking about downstairs, or the action of the new furnace regulator in the basement. but meantime the harm is done to the children--fear, the worst enemy of childhood, has been unconsciously planted in the mind by the thoughtless and nervous parent. fear of darkness consider for a moment the thousands of children who are early taught an abnormal fear of the dark. even when the child is absolutely free from such a fear, when sent into a dark room some member of the family will thoughtlessly remark, "do you think it is quite right to send that child into that dark room? suppose something should happen." the child quickly catches the suggestion that something is supposed to be or happen in the dark, and in his mind is sown the seed of fear. when our boy was about two years old he was carried one night to the window by a caretaker, and as they looked out into the darkness the young woman said, "boo! dark!" the little fellow shuddered, drew back and repeated, "boo! dark! boo! dark!" that night, as was our custom after the evening story, we tucked him in his little bed, turned out the light, and saying, "sweet dreams, darling," closed the door. imagine our surprise to hear, "mamma, mamma, willie 'fraid of dark, willie 'fraid of dark," and it was with difficulty that he was induced to go to sleep in the dark. immediate inquiry revealed the occasion of his fears, and the next night we set about to eradicate the fear of darkness from the little fellow's mind. for ten successive nights we took his hand, and, leading him into a dark room, said, "nice dark, restful dark; we go to sleep in the dark; we're not afraid of the dark, no." each night, save one, we were met with, "no, no, naughty dark. willie 'fraid of dark." on the tenth night as we entered the room as usual, repeating, "nice dark, restful dark; we go to sleep in the dark; we're not afraid of the dark, no," his little mind responded. suggestion had at last routed fear and given birth to faith. we had won! but it had taken ten nights of constant work to undo one moment's work of a thoughtless girl. every night since he has gone to sleep in the dark without a murmur. the folly of making threats threats only show weakness on the part of the disciplinarian. most school teachers early learn the folly of making threats. when i was teaching school i recall that a number of slate pencils had been dropped on the floor one afternoon. thoughtlessly i threatened, "now the next child that drops a pencil will remain after school and receive punishment!" my fate! the weakest, most delicate girl in the room was the next to drop her pencil, and she was a pupil with a perfect record in deportment. the reader can imagine my embarrassment. i had threatened punishment, and so had to get out of the predicament as best i could. this experience effectually cured me of making such foolish threats. most of us live to regret the threats we make. "your father will thrash you when he comes home tonight," or, "you'd better not let your father see you doing that," or, "you wouldn't behave that way if your father was here," etc., are common threats which we hear directed at headstrong and willful boys. what is the result? do such threats cause the love of the child for his father to increase? they make the child actually afraid of his father. "i'll 'bust' your brains out," said a four-year-old to his pet lion, because it wouldn't stand up. now it should be remembered that these things do not originate in the minds of the boy and girl. they only repeat the things they hear others say. it betrays both cowardice and ignorance to undertake to secure obedience by such threats as "i will box your ears if you don't mind," etc. obedience that is worth anything at all is only secured by suggestion and love, never by promises of reward or threats of punishment. children who are called "cowards" recently we overheard a little fellow say, "father says i'm the only coward in the whole family." looking him straight in the face we said to him: "you're not a coward. such a fine boy as you couldn't possibly be a coward." the boy was greatly amazed, and, as we left him, he was saying over to himself, "i'm not a coward. she said i'm not a coward," finally adding, "she said i couldn't be a coward." this one thought, repeated to him several times and turned over and over in his mind, eventually overthrew the false fears instilled by his father. a short time ago the daily papers contained the story of the ten-year-old son of a new york business man who drew his few dollars from the savings bank, boarded a train for chicago, and, after three days of amusement and loneliness, his money all gone, was found in a hotel bitterly weeping. his identity was revealed, the parents were notified at once, and the boy was sent on the first train back to his home. on the way to the station he sobbed out through his tears, "well, my brother can't call me a coward any more, anyway." who knows but that this everlasting taunting of the child with the accusation of being a baby or being a coward has much to do with many such escapades and other daring exploits on the part of the juveniles who are chafed by such unjust insinuations? those of us who are acquainted with the vice and crime of a great city can imagine just what might have happened if this boy had been a little older, if his heredity had not been so good, if his money hadn't run out, if he had been able to remain in the big city long enough to make undesirable acquaintances. many criminals have confessed behind prison bars that when they were children they were called cowards. after a while they actually came to believe that they were cowards, and in their efforts to acquire courage and demonstrate their bravery they were led to desperate and even criminal acts. they prowled around the dark alleys just to convince themselves that they were not afraid, that they were not cowards, and there they made the acquaintance of the criminals who led them into new and dangerous paths. even if a child enters this world handicapped by heredity, let us not lessen his chances of success by adverse suggestion. faith-thoughts, thoughts of bravery and of courage, may just as easily be instilled into the mind of the normal child as thoughts of fear and cowardice. a child should never have suggested to him that he is afraid. he should be constantly assured that he is brave, loyal, and fearless. the daily repetition of these suggestions will contribute much to the actual acquirement of the very traits of character that are thus suggested. this does not mean that a child should not be taught caution and forethought. the girl who would "turn out bad" parents do not begin to realize how fearfully dangerous is this habit of constantly reiterated negative suggestion. let me illustrate by an actual incident: a beautiful girl in a near-by state grew up quietly in the little village until she was eighteen years of age, when suddenly she decided to run away from home, declaring she was old enough to do as she pleased. she confided in one of her girl friends that she was going to chicago, and had made all arrangements to lose herself in the "redlight" district. all that this girl friend said had not the slightest influence. as the train bore her away to the city and to ruin, a social worker in chicago was wired to meet her at a suburban station. the girl was met, taken from the train and whisked in a cab to the home of a christian woman. so possessed was this girl with the idea of throwing herself away that the captain of police was asked to talk to her; but the combined efforts of the police captain, a magistrate, and several christian people could not persuade her to recall her threat. she declared she would kill herself if her parents were notified. this siege lasted for ten days. then she finally broke down, saying: "i simply can't help it. all my life my mother has told me that i was going to turn out bad. no matter what would happen at home, if i broke a dish or went out with the young people and remained away ten minutes later than i was told to, it would always be thrown up to me. 'oh, some day you'll turn out bad.' i have heard it until i am sick of it, and something within seems to push me on and on, telling me i must turn out bad." of course the girl was persuaded to believe that these were only fear-thoughts; that she was a beautiful, virtuous girl, that she simply had received the wrong training, that she couldn't possibly turn out bad. she was thus saved by the sympathy and advice of understanding friends, was subsequently married and is today the mother of a splendid boy. what healthy faith-thought will do here is another story which illustrates what healthy faith-thought will do. a young man was not long ago selected for the highest position within the gift of a large religious organization. when he was a lad his parents held this thought constantly before his mind: "david, if you will be a good boy, if you will do what is right, you may some day be president of the general assembly." he became a minister of the gospel, a very successful one, and subsequently married a young woman who was also much interested in religious work. she continued to encourage him in this ambition, saying: "david, preach the best sermons you can; make an effort to bring many souls to christ, and some day i believe you will be president of the general assembly." the man presided over the general assembly of his denomination, not one term, but term after term. he kept his eye long fixed on that particular aim, and by faith he won it. the power of suggestion to see how powerful suggestion may be in a child's life take this incident that every parent knows: the little one trips and tumbles. mamma says, "oh, did you fall? well, never mind; come here, i'll kiss it. there, now it's well." immediately the child goes back to his play perfectly happy. one little fellow was taught that when he fell he should get up at once, rub the bump, and say, "that didn't hurt." all through his career the bumps and the hardships of life were met with the same pluck. on the other hand, a thoughtless caretaker will excitedly jump and catch up the slightly injured child, coddle it, rock it, pet it--and the crying continues indefinitely. this early training in meeting minor hurts and obstacles lasts throughout the lifetime. pluck and grit are lacking. the behavior of the man in the face of difficulties is foreshadowed by the attitude of the child toward his petty trials and bumps. successful child training follows in the path of positive suggestion. impatient words and careless threats of punishment can only contribute to the wrong training of the young mind. when is the best time to suggest to the child? catch the little fellow when he is happiest, when he is overjoyed and filled with glee; for it is at such times that the suggestions offered will meet with the least resistance. teach the children through the spirit of play and through the medium of the story. the boy or girl in the story always can have a clean face, always close the doors quietly, and otherwise so conduct himself or herself as to constitute a powerful positive suggestion for good. the story-child always says, "all right, papa," "all right, mamma," when corrected. bedtime a good time to suggest the "going-to-bed time" is the time _par excellence_ for suggestion in early childhood. after the play time, the study time, and the evening story, when all is quiet, in the peacefulness of the darkness, while you are seated in a low chair close beside the little bed, with your hand in his, repeat over and over again the positive suggestions which you desire to take root in the mind and bear fruit in the character. again and again tell the little fellow that he is the noblest and bravest of boys, that he loves truth and hates deceit. no matter what disturbs him, if it is the lessons at school or a wrong habit, first think out exactly what you desire him to be or to do, and firmly, but quietly, tell it over and over to him. as a concrete example: suppose henry, at three-and-a-half years of age has to be coaxed or almost forced to eat. say to him: "now, henry, you are a good little boy. papa and mamma love you dearly. if you are going to grow up to be a big man you must not forget to eat; so tomorrow when you go down to the table you will eat everything mamma or nurse puts before you. it won't be necessary for papa to feed you at all; you will eat the potatoes, the gravy, the toast, and the cereal, and drink your milk. you will make mamma very happy, and papa will be proud of you; and then after dinner we will have a good romp, and you will soon grow up to be big enough to have a velocipede and a watch." after two or three evenings of this suggestion you will be surprised to see there is a great difference in his eating. take the timid little girl who is unable to recite well at school, who is shy, and has great difficulty with her lessons. at the going-to-sleep time sit by the side of her bed and tell her that tomorrow she will have her lessons better, that she will not any more be afraid, that she will get up and recite without the least fear in her heart. by constantly repeating these suggestions she will be given confidence, and in most cases it will result in effecting the deliverance of the child from her bondage to fear. never tell her that she is shy or that she cannot do things. constantly tell her that she is a successful girl with a strong character, and that she is going to make a very useful and courageous woman. hold high aims and ideals before her. suggestion cannot atone for all the defects of character which may be inherited, but it can do much to help such unfortunate little ones gracefully bear their burdens. never accuse children of dishonesty never tell children that you suspect they are dishonest or untruthful. be very slow to accuse and suspect them of falsehood or theft. tell them over and over again they are the best boys and girls in the world; that they are going to make the noblest of men and women; that they love honesty and truth. even when you discover them in minor faults do not make the mistake of unduly magnifying and emphasizing the error. as soon as possible direct the thoughts and attention of the wrongdoer away from his error, and focus his thoughts and attention on the high goal you expect him to reach. this will not be construed as doing away with proper punishment for persistent faults after the more ideal methods seem to have failed. a patient recently called us to see her little girl, and as we made ready to make the examination the mother said: "now, mary, stop your playing and come and be undressed and let the doctor look at you." "i don't want to stop playing," murmured mary. "but you must come. you know you don't feel well at all, your cheeks are so red. now swallow and see if it don't hurt. now try again. i know you don't feel well." by the time we had begun our examination mary began to succumb to her mother's suggestions, and began to feel a trifle indisposed. she was being made temporarily ill by the unwise and unfortunate suggestions of the overanxious mother. the examination revealed that there was nothing whatever the matter with her. it is easy to form good habits let us get the truth firmly into our minds as parents that it is just about as easy to form a good habit as a bad habit, just about as easy to acquire helpful, happy thoughts as those that are injurious; and we can do it, if we will but see to it that our children early form correct and proper habits of thinking and acting. while the children are taught proper respect for authority, let fear be an unknown word to them. don't let a thought of the fear of insanity, of haunted houses, of drafts, of this and of that enter into your home. instead, live in the glorious sunshine of strong, healthy, faith-thought, and a supreme happiness will come into your life, and you will give a legacy to your children for which they will "rise up and call you blessed." chivalrous spirit the love of mother and sister can naturally and happily be turned early to a chivalrous attitude toward all women when it is developed by suggestion and other training. in giving up a chair or bringing one for a guest, in lifting the hat, in noticing ways to be polite and attentive to mother, a lifelong conduct may be ensured. each day gives us trying and sometimes shocking revelations of the prevalent lack of courtesy, or even humanity, on the street cars during the "rush" hours. the indifference to the comfort of women, even the aged, on the part of many men and boys in the matter of giving them seats or other care, indicates a dangerous social condition. the mother, instead of exercising selfish concern for her boy, should make it her duty very early to suggest that he give his seat to a woman or girl, as he would be glad to have someone do for his mother or sister. such unselfish service will become a habit of pleasure, and help the boy become a pure-minded, manly gentleman with that respect for womanhood without which a nation is doomed. chapter xxxviii play and recreation there are a number of theories advocated by late authors on the "psychology of play," in which they connect the free and easy play of the modern child with the more serious and sober pursuits of our ancestors--our racial parents of prehistoric and primitive times. we quote from _worry and nervousness_: and so we are told that the spectacle of the young infant suspending its weight while holding on to some object, and the early instincts so commonly shown to climb ladders, trees, or anything else available, are but racial mementos of our ancestral forest life. the hide and seek games, the desires to convert a blanket into a tent, the instinct for "shanties"--which all boys universally manifest--we are told that these forms of play are but the echo of remote ages when our ancestors sojourned in caves, lived in tents, or dwelt in the mountain fastness. in this same way the advocates of this theory seek to explain the strange and early drawings which the young lad has for wading, swimming, fishing, boating, and other forms of aquatic recreation.[c] in this chapter we purpose to discuss the play of the child, whose career we will divide, for convenience, into three stages: 1. the age from three to six--juvenile days. 2. the age from six to twelve--the "going to school" child. 3. the age from twelve to twenty--the adolescent youth. [c] william s. sadler, _worry and nervousness_, p. 377. juvenile play days as nearly as is possible the little child should be out of doors the greater part of his waking hours: to our mind it is nothing short of criminal to keep the little folks in the house when the weather permits outdoor life. of the outdoor games which we have to suggest, perhaps the sand pile stands at the head of the list. clean white sand should be placed in an inclosure just low enough for the child to climb over. many, many happy hours may be spent in this sand pile, at the same time the little fellow is in his own yard and the watchful mother knows the drift of the conversations which take place. in a previous chapter we called attention to the fact that the little girls' frocks should be provided with knickerbockers, so that she may run and jump, or sit as comfortable as the little boy, without a conscious reproof ever ringing in her ears, "mary, do keep your dress down." outdoor play tree climbing is another source of enjoyment to these little people and they should early be taught how to climb. instead of suggesting fear to the child let the mother go into the yard and talk with her something like this: "now, mary, put your foot in that fork, now catch hold of that upper limb, hold on tight, you will get there yet;" instead of the following conversation, which all of our readers have heard: "john, do take care or you will fall and break your neck; be careful, you will fall. there, i knew you'd fall!" etc. both mothers are trying to accomplish the same thing--one mother suggests "fore-thought," while the second mother thoughtlessly suggests "fear-thought." these little people should be provided with rakes, spades, and hoes, and a portion of the yard should be given them in which they are at liberty to dig and rake and have a royal good time. we have yet to see the child who is not interested in flower-bed making, and the mother should think of the virgin opportunity to instill the story of life into the child's mind as he plants the seed, and day by day watches its development and growth. a pen of rabbits may be a good thing, if proper measures are taken to prevent their burrowing out of the pen, destroying the lawn, causing much sadness of heart to their little keeper, and no end of annoyance to the neighbors. roller skating and hoop rolling, as well as sledding, are all valuable recreations. the snowman, snowballing, and the sled riding all bring the ruddy glow of health to the cheek, and are wonderful producers of good appetites and restorers of "tired out nerves." indoor games there is no end to the number of things that can be done when the weather shuts us in, but before we take up these games let us never forget that every child thoroughly enjoys going out in the rain well protected with rubber boots, raincoat, and umbrella. it is not extravagant to burn plenty of electricity or gas on cloudy days, for the artificial sunlight helps to cheer the heart. such indoor games as those which may be had from blocks, puzzles, cutting out of pictures, darning of cardboard, soldier games, dolls, housekeeping, etc., are all splendid means of recreation for the little ones. let the mother or caretaker join with the little folks in these pleasant games. for the older children, checkers and dominoes are most excellent indoor games. the "going to school" child first of all we must decide upon the bedtime hour, as well as the hour for rising. between the ages of six to twelve, the bedtime hour should be eight o'clock, or not later than eight-thirty, and the rising hour at seven, or seven-thirty in the morning, for children of this age require eleven to twelve hours sleep. again, there must be taken into consideration the home work that the children at school are asked to do by their teachers. while this home work is not usually taxing, yet the time spent in doing the work must be taken account of. in our opinion the best time for home work is an hour and a half to two hours after the little fellow gets home from school. he should be allowed to relax for one and a half or two hours, to play out of doors whenever the weather permits, and then with either his mother or his caretaker from one-half to three-quarters of an hour should be spent on the lesson for the following day. following this, the dinner hour is enjoyed with the parents, and after that there should always be provision in the daily duties of the father and mother for at least a half hour for the evening romp; so that play and recreation during the school age occupies possibly not more than two or two and one-half hours a day outside of school hours. the playgrounds of schools are of inestimable value, and we quite agree with one who said: "if we can only afford one of the two--the playground or the school--have the playground first and afterward the school." the small parks and playgrounds of the cities are a great blessing to the little folks. companions the companions of the school child are usually his playfellows at school, and we urge the throwing open of the home during inclement weather to allow these school friends to come in and make trains out of our chairs and tents out of our couch covers, steamer rugs, afghans, etc. we do suggest that caution be used in allowing children to play indoors who are suffering from colds in the head, running noses, running ears, tuberculosis, or other chronic disorders, which are often highly contagious. running noses and running ears, as well as tuberculosis, may be contracted by susceptible children when the play at recreation time takes place indoors; while such disorders are much less dangerous in connection with outdoor play. we are well aware of the fact that some playmates may choose the bathroom, requesting that doors be locked, or wish to play in a bedroom securely away from mother and the caretaker. under no circumstances should this be allowed. let the child early learn that good wholesome play in the open is better than secretive misdemeanor behind closed doors. the "in the house" hour it is a pitiful fact that many mothers apparently are wholly unconcerned as to the whereabouts of their little folks, even after dusk; this is unwise to say the least, for a boy or girl under twelve years of age should be found under the parental roof at dusk. the city mother should impress upon her child that when the street lamps are lighted his first duty is at once to come into the house. during the winter months this lighting of the street lamps occurs anywhere from four to six. during the summer months another rule should be laid down, depending upon the neighborhood, the character of the friends on the street, the surroundings, etc. by all means let us see that our young people are in the house by dusk. parties every mother who reads these lines has had to meet this question: "shall i let my little one begin to go to parties?" and every mother will have to answer that question for herself. we personally feel that the social life extended by the school, together with the meeting of the companions at sunday school, in the park, or on the playground, is quite enough; and we deplore the fact that many children grow into the idea that much time must be spent at "parties" in the drawing-room under unnatural surroundings, in dressed-up clothes, eating ice cream and cake, etc. outdoor gatherings of children are wholesome and hygienic, but most of these indoor gatherings of groups of children we consider decidedly unhygienic. one child coming down with scarlet fever, measles, or whooping cough can infect twenty others at an afternoon party. the eating of so much ice cream, candy, and cake is deplorable in that it upsets the digestion, and all this is irritating to the developing nervous system of the child; and not infrequently brings on a lot of other symptoms, resulting in discomfort and disease. we believe in outdoor picnics but not in too frequent indoor parties. picnics groups of children gathering in the park, on the beach, in the woods, when well chaperoned, are among the pleasant and profitable pleasures of childhood. it is just such gatherings that mothers and children should indulge in--and once a week is not too often during the long vacation. the mothers, too, should enter enthusiastically into the joys of a day's outing, where the enormous intake of oxygen, the hearty laughter, the races, the games, etc., all create a wonderful appetite, which can be so delightfully satiated from the well-filled lunch baskets; and while the children are thus playing together what a wonderful opportunity for the mothers to engage in an exchange of helpful ideas. each mother has her own way, which is "the best way" to make this cake or that salad; or has met this particular difficulty in child training in a carefully thought out way; a neighborhood women's club can thus be held out in the open, while the children are having the time of their lives in the frolic of the picnic. "movies" the movie is an institution that has come to stay, and today mothers everywhere are perhaps discussing this particular institution more than any other. the movie affords a wonderful opportunity to see the sights and scenes of other lands, of feeding the imagination of the child on travel pictures and nature pictures. it is a most deplorable fact, however, that this wonderful institution which is fraught with so many opportunities to educate and enlighten the mind of the growing child has carefully to be censored. women's clubs have done much to purify the movies for the school-age child; many theaters are now showing on certain days a special afternoon movie for the children; and while many of these movies have great possibilities for good, we most earnestly urge that the school child see the movie that he is to see before dinner, and not have his mind excited and his nervous system "thrilled" just before going to bed. someone asked me several years ago, "are you going to let your little fellow go to movies?" i instantly answered, "no, but i shall take him." if the mother or the father sits by the side of a growing child and carefully, thoughtfully, and, yes, prayerfully, points out the good and explains the evil, then even the questionable movies will prove the means of bringing father and son and mother and daughter, into closer companionship. under no circumstances should children under twelve years of age be taken to long lectures, entertainments, or concerts, which will keep them out until eleven. vacations let the vacation be well planned. this is the opportunity "de luxe" for the child to earn a few pennies to enlarge his bank account. allow him a truck garden, guinea pigs, chickens, anything remunerative, which will enable him to become one of the world's workers and one of the world's savers. let him start a bank account when he is six, and watch him as he puts the dime in the bank, instead of taking it to the ice-cream-soda cashier. some time during the vacation, if possible, mother and father should accompany the little folks to the camp, to the beach--somewhere, anywhere--to get back to nature and live like indians for a short time. each member of the family will come back rested, happier, and more ready for the next year's work. in the summer time learn to eat on the porch--it is great sport for the children. many meals can be served on porches that are so often served in hot, stuffy rooms. the "home" does not consist in the furniture, the rooms, the bric-a-brac, or the curtains. the home is the mother and the father and the children and the spirit of good fellowship which should possess them. make the companions of the little folks very welcome, letting them learn the early use and abuse of the different articles of furniture in the house. it is all right to play tent with the beautiful couch cover; it is all right at certain times to dress up in father's best clothes and mother's beautiful gown, but while they are thus having a good time let them learn that all these things are to be used and not abused. adolescent days the homely boy or the homely girl usually grows up free from the flattery and undue attention which are sure to be heaped upon the good-looking boy and the popular girl. way back in the early days of five or six, and all the way up to the ages of twelve to twenty, children should be taught that it is altogether natural and correct to do things well and to look well; parents should stop, and cause their acquaintances to stop, "making over" the boy or the girl just because they have done something well, or have beautiful curls, or because their eyes are a magnificent brown, etc. if a girl should be especially endowed with a charming complexion, a wonderful chin, and if she does possess a beautiful nose or neck, let her early realize that she has been made the custodian of goodly features and that she must give an account for this particular blessing, and under no circumstances must she become self-conscious about it. ofttimes a good frown to an unwise friend is all that is necessary to stop this "lip service" flattery. the "chewing-gum girl" is just a thoughtless girl, that is all; sit her in front of a mirror and compel her to chew gum for one-half hour and watch herself do it, and it will often suffice to cure her. young ladies should be taught that chewing gum should be done in the bedroom, but never in the living-room or on the streets. it is not only a disgusting habit, but it often creates an occasion for criticism as to the quality of one's home training. ice-cream parlors the mother who cares will not allow her lovely daughters nightly, or even semi-weekly, to frequent the ice-cream parlors and secluded soda fountains. she had far better arrange group dinners and group receptions in her own parlor; with ice cream served in her own dishes and eaten with spoons that she has supervised the washing of. young women and young men in their late teens crave companionship, and they should have it; but let it be under wise chaperonage at home or in public rooms, and not in the solitude of a lonely bench in the public park, or the seclusion of an out-of-the-way, ice-cream parlor. this "running the streets" which is so freely indulged in by the adolescent youth in the early teens need not occur, if wise provision is made for the assembly of small groups in the home. some elders think it pleasing and cute for young men and young women--fourteen to sixteen, or even seventeen--to wrestle and roll around on the floor like two huge kittens; but it is unwise and indiscreet and should be discouraged. dancing we hesitate to speak of dancing for we realize it is a very popular indoor recreation of today, but we most earnestly urge that if dancing must be done, it be done under proper chaperonage, and if young people must meet in public dance halls let them be municipal dance halls, where motherly matrons are in charge. many of the social dances which bring the participants into such close physical contact are to be discouraged and stricken off the list; and while dancing is a splendid form of exercise--let us add that it is also sometimes a dangerous one. questionable play after the boys and girls graduate from grammar school they may come into contact with such agencies as secret societies--which nine times out of ten are questionable--and while we realize that there is a contention both for and against these organizations, we may dismiss the subject here by simply adding that we have known little special good to come out of these societies. while it may not be any more wrong to hit a ball from the end of a stick--as in billiards--than it is to hit it from a mallet in croquet; or from a stretched tendon, as in tennis; or from a bat, as in baseball--we do not feel that we have to argue the point, when we remind the reader that billiards and pool, especially in the public parlors, do assemble questionable companions, who use questionable language; while these games are often accompanied by betting, which is always to be deplored. and so with card playing, we see no greater harm in playing a game of euchre, than a game of authors, as far as the cards are concerned, but your boy and girl, as well as mine, as a rule, have cleaner and purer minds at the home game of authors than is probable in a game of cards in a public place. in closing this chapter we have to announce a group of wholesome recreations which may be entered into by our lovely young people--the man and the woman of tomorrow--whom we one and all wish to keep clean and good and pure; all the while helping them to develop the sense of humor and the element of play. such recreations are tennis, golf, croquet, roque, boating, sledding, skiing, bicycling, motoring, horseback riding, and a host of others too numerous to mention. let us not forget that ofttimes pursuits such as garden-making and helping the parent in the office or in the home, may be made a great source of enjoyment to the adolescent youth, if they are allowed to earn a small amount of money each week, which they may deposit in the bank. we close this chapter "play and recreation" with the wish that all, old and young, would develop a greater sense of humor, a greater love for play and recreation, which will increase the health of both mind and body and prevent many nervous disorders such as neurasthenia. chapter xxxix the puny child in every neighborhood there is to be found the delicate child, and everywhere anxious mothers are putting forth every effort to improve the condition of their puny boys and girls. in carefully looking over the puny child, we see an underweight little creature with pale skin, and as he comes to the table everybody notes that he refuses more or less food. diet and hygiene as we give the child a closer examination we find that certain lymph glands are enlarged, possibly adenoids are present in the post-nasal pharnyx, and, in many instances, there are badly diseased tonsils. usually the puny child is constipated, hands and feet are cold, and he jumps and starts at any unusual noise, thus showing a tendency to nervousness. one of the first things necessary is to take this little one to a good specialist and if necessary have the adenoids and tonsils removed. this having been done, the diet should be carefully looked into. there should be served him for breakfast a generous bowl of dextrinized grains with a good portion of diluted cream, a glass of rich milk, a baked potato, and fruit. for lunch at twelve o'clock he should be given a glass of malted milk with egg, or eggnog, six or eight dates or three or four figs, a handful of pecan kernels, and perhaps a lettuce sandwich. for dinner at half past five, another nourishing meal of baked potatoes, a protein dish of either cheese and macaroni or eggs or meat, a generous fruit salad, a glass of rich milk, and bread and butter, should be enjoyed. there is no class of little folks who eat between meals more often than do these delicate children, for mothers painstakingly endeavor to feed these children all they can possibly take; so one mother thoughtlessly went about it something like this: the half past seven breakfast having been only touched--nibbled at--with the ten o'clock hour came this request: "mother, i am so hungry, i want something to eat." eagerly the mother prepared either a meat sandwich or a jelly sandwich and possibly a glass of milk. when it was time for the twelve o'clock dinner hour, or lunch hour, again the well-filled plate was refused, the appetite having been satisfied at ten o'clock. having taken very little nourishment at noon, by half past two the plaintive plea again came to the mother ears: "may i have a piece?" and again the well-meaning mother gave him the desire of his heart. so the day passed, the dinner making the fifth time food was taken into the stomach, and in all probability there was eaten a cookie in between. the reader can readily see that the digestion was consequently very much disturbed, fermentation occurred, decomposition of food took place in the digestive tract, with its result--constipation. improving the appetite not a morsel should pass the lips of any child, and particularly our delicate child, between meals. let him come to the table at half past seven or eight o'clock, and if he does not want to eat tell him frankly that that is all he is to receive until twelve--and stick to it. nothing more than water or fruit juices should be taken between meals. it may be necessary to create an appetite for the three meals we have just described, and as we now take up the outdoor hygiene we would not forget that some simple treatment should be instituted each day in a well-heated bathroom or bedroom. roller skating or ice skating, hoop-rolling, rope-skipping, and irish mail, or a coaster, all furnish splendid exercise for the delicate child. under no circumstances should he be allowed to remain all the time in the house; and so pleasing recreations must be provided for him out of doors. the sand pile should not be forgotten, flower-bed making, raking the lawn, a polished coasting board fastened in a slanting position to an upright which can be mounted by means of a ladder, create splendid outdoor sports for these children. the daily program take the child into a warm bathroom each morning and let him stand in six inches of well-warmed water. with a rough mitten made out of either mohair, crash, or turkish towel, the entire body should now be rubbed until it is pink. this procedure is known as a dry-friction rub. do not stop until the skin is pink, particularly the arms and legs, for the back and chest usually get pink quickly. then with simply a cold dash of water to the feet, dry them well and allow him to dress. twenty minutes before the meal hour, let him get out of the house and roller skate around the square as many times as he can in twenty minutes, or let him race and have a royal good time in the fresh morning air and then after this forced oxygen intake let him come in to breakfast. and now for school, and as we say "school," we regret that there are not more "open-air schools." some day the american people, more particularly the american mothers, will awaken to the fact that we need more schools with simply window space rather than so many closed glass windows. some day we will send our children with sweaters, leggings, stockinet caps, mittens, even in the cool days of spring and fall, to "open-air schools," and in the cool fresh air they will think better and work faster and make wonderful progress in both studies and appetites. the particularly delicate child, under treatment, will not spend the whole day in school. in all probability the forenoon session only will be attended, after which the half-past-twelve or one-o'clock meal that has been previously described will be given him. now if the appetite is variable, arrange a little surprise for him by serving this meal on the porch or in the living-room by the open grate, or out under the trees. in all probability such a meal will be taken eagerly, particularly if the mother will read a pretty story. now the afternoon is to be spent in doing a number of different things. we would like a pleasant walk, a visit to the park, hoop-rolling, roller-skating, rope-skipping, ice-skating, outdoor sliding, anything that will take our little fellow out of doors to increase his oxygen intake until possibly the half-past-three hour is reached, when he should come into the house and lie down and prepare for the treatment for that particular day. treatment suggestions twice a week he should be given a salt glow (described in the appendix). twice a week he should be given a thorough soap shampoo (also described in the appendix). after each of these baths a special rub should be administered to the spine, and as there is so often spinal curvature in these children, certain stretching movements of the spine are valuable, together with hot fomentations (see appendix) over the spinal centers. these are wonderful stimulants to the delicate child and should precede the salt glow twice a week. every afternoon a hot-and-cold foot bath may be given to create a better circulation. the feet are put in hot water from three to five minutes (as hot as can be borne), and then they are quickly plunged into the coldest water obtainable for three seconds, then back into the hot water, and vice versa, until three changes have been made, always finishing the treatment with the cold dip. on the three remaining days of the week at half past three, the child will simply relax in the hammock or on the porch couch while the mother aids in the relaxation by a pleasant story. we would suggest that on monday the salt glow be administered; tuesday a rest is taken; wednesday the soap shampoo is to be administered; thursday another rest; friday a salt glow; saturday another rest, and sunday the shampoo, etc. before going to bed at night, with the mother's hands well oiled with either olive or sweet oil, the circulation is again stimulated by the heavy friction rub. constipation is taken care of along the same lines as mentioned elsewhere in this book. it is surprising to see how often these delicate children are infested by worms, and while a great deal of dependence cannot be put in that single symptom "grinding the teeth at night," or "pallor around the mouth," yet we do believe that many a delicate child continues to suffer from worms many years. it is a very simple procedure to obtain a specimen of the stools. a cathartic should be given and after usual free-bowel movement, the second time the child desires to go to stool this should be saved and taken to the laboratory for a careful search for worm eggs which are usually in evidence if worms infest the child. the treatment for worms is described elsewhere in this work. we have seen scores of young people between the ages of eight and eleven who, before treatment, were pale, listless, under weight, irritable and cross, after three months of such treatment as has been outlined gain six to ten pounds and look as ruddy as their healthiest neighborhood friends. it is perfectly marvelous to notice how a child will put on from six to eight pounds in a short period, at the same time overcoming his irritableness and fretfulness. i am more and more inclined to believe that most bad children are sick children--are undernourished children--and it behooves us american mothers and fathers to give proper attention to this undernourished child, call a halt, and devote three months to giving him the help that he needs. he did not ask to come into this world; and it is "up to us" to give this child what he deserves--for every child in this world has a right to be well born, to be well fed, and to be well reared. chapter xl teaching truth we confidently believe that most of the sex immorality seen in young people is more or less the result of ignorance and curiosity; therefore we most earnestly desire in this chapter to portray so interestingly the beautiful story of life as seen in the vegetable and animal world, that our mother-readers will be seized with the great desire wisely to convey to the young child's mind this sublime and beautiful story. the questions most naturally arising in the mind of the reader at this time are: when shall we begin to tell this story? how shall we tell it? where shall we begin? where shall we stop? realizing full well that the subject is usually handled prematurely and with unpreparedness, we will attempt in this chapter to discuss it with courage and candor, believing that there is a right way, a right time, and a right place to impart this information. a lesson from nature when the little folks are about three or four years of age, when confidence and trust are at their height, they often come to us begging for a "story;" and this is the golden opportunity for the parent or caretaker to tell them the story of mr. and mrs. corn, and all their little babies; or mr. and mrs. morning glory and their little folks. there are a score of other equally interesting and instructive botanical stories which are just as beautiful in their sublimity, and fairy-like in their personality. the little children's eyes grow big with wonder as you tell the story of a whole township of families by the name of corn (see fig. 17), who have their residences out in the wide country fields. [illustration: fig. 17] [illustration: fig. 18] we will first introduce the child to mr. corn, the tassel, waving proudly and majestically in the breezes, and seeming to say: "i am master of all i survey." the little fellow is filled with wonderment as he learns how the clouds give up their drops of water to quench his thirst and how the sun smiles upon him to yellow his beard; and how the wonderful all-important _pollen_ is developed and ripened. often the child eagerly asks, "and where, mamma, is mrs. corn?" and to that interested upturned face we relate the pleasing story of the beautiful silken tresses of mother corn. early in her life she is a beautiful shade of green, and as she thus gracefully hangs out from the ear of corn, day by day the smiles of sunshine turn this mother corn to brown, and then to a still darker shade. "and where, mamma, are the babies?" the child next inquires; and, as we take the ear of corn, removing the outer clothing--the husks--we find the underclothing, a much lighter shade of green, and here now we are in close contact with the babies themselves--the kernels--and to each little kernel or baby corn we find mamma closely clinging. here is a beautiful opportunity to teach mother-love and mother watchfulness, as also the opportunity to draw lessons from the baby kernels sitting there in even rows, with their faces clean, silently contented--just doing their duty. the stories that may be told are limitless, and possibly as interesting as are the myths and fairy-tales, yet all the while as true as truth itself, with no fakery, no legends--just simple truth. the all important pollen now on a second trip into the cornfield, another story may be told of the important work of the pollen. this "father part" of the plant falls upon the silken tresses of the "mother part," by which the pollen is carried down to the sleeping corn-baby seeds--the kernels. and when the "corn dust" does reach the sleeping seeds a great change begins to take place. this change is known to the adult as "impregnation;" to the little child it may be presented as "an awakening" of the sleeping seeds, so that they begin to grow, to develop, to expand and push out, until we have the full-grown seeds seen in the delicious and juicy roasting ear. sometimes, in the case of the larger plants and trees, father tree may be miles and miles away from mother tree and so this all important pollen must be carried by the wind or by the bees, and as it blows against the mother part of the plant-flower she catches it and pushes it downward to the seed babies. the wind scatters the pollen of the oak tree, the hazlenut, the walnut, the birch, the willow and many others; for, without the good kind wind or the bees, the pollen would never find its way to many a mother flower, and the "fertilization" of the seed could not take place. the morning glory family perhaps the story of life can be told as beautifully from the morning-glory as from any other flower. here the beautiful flower cup is the home of father and mother morning-glory and all their little babies. (see fig. 18). as we carefully take away their little home, the flower cup, we have left a little green cup, and coming up from the center you will see five little stems, every one of them wearing a hat of powder or pollen and this--if you please--is papa morning-glory. look closely and you will see coming up from the center of these five stems (stamens) one central stalk without a hat, mother morning-glory, known in botany as the "pistil"; and as you follow down this pistil you will find an enlarged part at the base, which is known as the cradle-nest--the home of the seed babies. little was known about this wonderful fertilization of the seeds by the pollen two hundred years ago, and a whole century passed before the secret of the blossom and the bees was discovered; and even then it was not fully realized how great was the work of the bees in cross-fertilization. nor was it understood that the beautiful blossom of the flower, with its sweet nectar, was an exceedingly important factor in attracting the bees. another century passed before darwin gave to the world the story of the great work performed by the bees in cross-fertilization--in carrying the pollen from flower to flower, for it is now a well-known fact that all of the blossoms visited by the bees produce better fruit and better flowers. in the flower where the father and mother part matures at the same time, self-fertilization is the rule. cross-fertilization occurs in instances where either the father part or mother part ripen at different times, in these cases the pollen is carried from plant to plant by the wind or by the nectar-seeking bees. these busy bees, with their fluffy little feet and fuzzy coats, become completely covered with this all-important flower dust, and in seeking nectar from other flowers they leave the "awakening dust" behind, and thus cross-fertilization takes place; new types of babies are produced, new generations of fruits and flowers. how mother nature works dr. chadwick, in her _blossom babies_, gives us a beautiful recital concerning the fertilization of plants, which provides an endless number of interesting stories. the water plants are very interesting in that the pollen is just light enough to float on the exact level of the mother part of the flower, otherwise fertilization could never take place, and there would be no more lovely lilies. long throated blossoms are fertilized by their attraction for certain moths or humming birds who have long tongues. mother nature is exceedingly careful to reproduce her children, and in every conceivable way she sees to it that her plant-seeds are fertilized and distributed. we are all familiar with the dandelion and the thistle and a host of others which fly through the air with actual plumes, some seeds fly with wings, such as the maple; other seeds travel by clinging or sticking, such as the cockle burr; still others float and shoot; while we all know about a lot of seeds that are good to eat, such as the nuts and fruits, as well as many of the grains, such as corn, etc. an incubator about hatching time is a wonderful object lesson in teaching the story of life. take the children to visit one and let them actually see the live baby chicks coming forth from the seed-shells. other wonderful lessons may be drawn from the mother horse or the mother cow; and it is impossible to portray the close companionship, the sublime trust and confidence, which exists between the mother and the child who have been bound together by these ties and sentiments of truthfulness, trustfulness, and frankness. the salmon family the little fellow is daily learning that everything that grows comes from a seed, even the salmon which was eaten at lunch yesterday was the text for an impressive story about papa and mamma salmon. in the beautiful columbia river mother salmon is swimming about quietly seeking a shallow place in the stream where she may deposit her cluster of baby seeds, which looks very much like a mass of tapioca pudding as they gently sink to the bed of a shallow spot in the river. there they lay "sound asleep" until father salmon, swimming by, is attracted to the spot and, hesitating, talks something like this to himself: "why the idea, here are some helpless fish-baby seeds, they can't grow and develop without me, here they are sound asleep;" and, nestling over them, he contributes the self-same and all important "something"--comparable to the pollen of the plants--which wakes them up. in the case of the fish the "awakening" substance is not in the form of a powder as in the plant world; but is in the form of a semi-liquid mass, much resembling the white of an egg. the little seeds soon begin to tremble--begin to wake up--and then begin to swell and grow and develop. in a few days what do you suppose happens to these little bulging baby seeds? the very same thing that happened to the chick seed--they burst and out come hundreds of cute little fish minnows. in just a few hours they are all swimming about in a most wonderful fish-like manner. early questions some day you will be surprised by your little child suddenly asking you some such question as this: "mother, where did i come from?" while in the same frank manner you reply: "why from your mamma, of course; where do you think you could have come from? everything that grows comes from its mamma--oranges, apples, radishes, cabbages, cats, dogs, and chickies--everything that grows has to have a mamma and papa," and they are often satisfied with this answer for a long time. no child should go to kindergarten without knowing that he came from his mother, and this knowledge should come to him from his own mother's lips. these are different days than those in which our grandmothers lived. the spirit of investigation and of inquiry is in the air. the moving-picture show makes it necessary for children of nine or ten to understand these things--to have a knowledge of certain of the conventionalities of life. twenty years ago this may not have been so necessary--the youth of that day might have waited several years longer for certain phases of his sex instruction. it is highly important that this knowledge be obtained from a wise and pure and sympathetic mind--from the child's own parents. one mother put her little girl's questions off week after week, saying: "i will tell you when you get older, dear--no, not now, dear; run away, you are not old enough to know such things, you must forget about them." thus the unprepared mother sought to gain time in which to consult the doctor or the library. finally the day came when the mother felt that she was sufficiently wise to answer the query, "where did i come from," and so with her heart in her throat she approached her daughter, saying: "come, mary, mother is going to tell you all about it. i am now ready to answer your question." imagine her surprise and astonishment when mary said: "oh, you needn't mind, mother, kate told me all about it last week." now the question in my mind is: how did kate tell her? how much unnecessary information did this older and experienced kate put into the pure mind of this innocent little girl? one mother's awakening one mother in a western state--a county superintendent of schools--told us the following interesting story of her own experience, which we think may be of help to some of our mother readers. one morning her seven-year old son rushed into the house exclaiming: "oh, mother, there is a new calf out in the barn, and i know where it came from; i saw a wagon load of calves come by here yesterday, and one of them must have dropped off, for it is right out there in the barn with old bess this minute." the mother was very busy with her papers and her reports, and she let the incident pass with a smile, thinking it was a very pretty little story. a week later the six-year old brother came in saying: "mother, i think there must have been another wagon load of calves passed by, and one must have been lost off, for old nell is cleaning up a little calf out in the barn for all she is worth," while the older brother piped up: "sure, it was another load of calves; that is just exactly the way the other calf got here;" and the two little fellows went off to school. about a month later that county superintendent suddenly became a much wiser mother than she was before, although her heart was made to ache. both boys came home from school one day and the older one met her with something like this: "i am mad! i've been lied to; all the fellows at school say i have, and they are making sport of me, too," and with a glare in his reddened eye he continued, "you know that new calf did not come off that wagon; you know that calf came from old bess herself; all the fellows say so at school, and they are making all kinds of fun of me, and i don't want to go back. i'd like to run away from home." the mother quietly drew the boy to her side and reminded him that she had simply listened; that she had not opened her mouth; that he came into the room and told about the incident himself, but this did not satisfy him. he turned to her wounded and crushed, saying: "well, you let a fellow believe it, and that's just as bad;" and this educated mother--this trusted custodian of a county full of school children--beseeched me to warn mothers everywhere to teach their children the truth, and to never let a child go to school with a sex misunderstanding. she told me that it took her six months to get that boy's confidence back again. don't get shocked i believe that many mothers make the sad mistake of showing the child that they are shocked by trivial sayings and trifling experiences of their little people. if we could only get it into our heads for once and for all that our children are born into this world veritable little thieves and falsifiers, as well as adventurers and explorers, we would then cease being so shocked and outraged by their frank statements of what they have heard or have done. let the mother listen to all these things with calmness, while she seeks to direct the child's mind in pure and elevated channels--to help him upward by imparting "precept upon precept; here a little and there a little." children will come in with stories that at first thought do greatly shock the parent; but under no circumstances should the boy or girl discover that the parent is shocked, for if he does he will not likely come again with another such "shocking" difficulty. one mother told me that her seven-year-old boy, beginning third grade, came into her bedroom one morning saying: "mother, i am just busting to say something," and this mother very wisely said, "well, say it; certainly i don't want you to burst," and she told me that this boy whispered to her three of the filthiest words that he could possibly have heard on the streets. in relating this experience to me she said: "do you know, doctor, that i really did not know what to think at first, but i remembered that you had taught me never to be shocked, and so i looked up and asked: "do you feel better?" whereupon he breathed a big sigh and exclaimed: "what a relief! i have just been busting to say that to somebody." mother, to whom would you rather he would say these things? to you, or to some little girl out on the street, or to some older boy? think what trouble and possible mischief were avoided by whispering into the sympathetic ear of mother. this wise mother turned to that little boy and said: "son, that ear is always waiting for just such things and whenever you feel like saying something--like getting it off your mind--you just come to me;" and he came repeatedly. one time he came in saying: "i don't know whether you want me to play with harold or not; he does some of those things you told me about the other day." and the mother thoughtfully and wisely looked up and said: "did he do it in front of his mother? why of course he didn't. did he ask you to go into the bedroom or bathroom and lock the door?" and the little fellow quickly answered: "why sure he did; how did you guess it?" and added "now i suppose you are not going to let me play with him any more," and this wise mother, knowing that if she denied him this privilege that it would quite likely be frequently sought, said: "why, certainly play with harold in the open, but whenever he suggests secrecy--" she did not have time to finish the sentence, the boy said: "i am wise; whenever he gets to doing that 'funny business' i'll skiddoo." the confidence between that mother and son, to my mind, was wonderfully sublime--all the while practical and helpful in his daily training. don't repulse the child a little older child sees the fowls, the dogs, or the cats, "mating," and then, rushing into the house, inquires what it is all about; and unless the mother is on her guard some older member of the family may show surprise and thus thoughtlessly convey to the child's mind that his question is improper and entirely out of place. to the question, "what are they doing, mamma?" quietly answer, "just mating, dear, just as the flowers mate; everything that lives or grows comes as the result of mating." suppose that you were repulsed every time you approached a dear friend, your husband, or some other member of the family? take, for instance, the matter of a caress or an embrace--how would you react to repeated rebuff? and so with the little child; he comes into this world full of confidence and trust, full of wonder and curiosity; possessed with the spirit of exploration and investigation--everywhere and all the time he asks questions. usually, his questions are answered thoughtfully and without hesitancy, except along the line of one thought--that of sex. do not think for one moment that he is satisfied by your evasive answers. you have but to recall your own childhood experiences, and remember that today the moving picture show and general public sentiment has placed the age for such knowledge from one to five years earlier in this generation than in the past. i do not care what the child comes into your presence with, be it the most shocking thing in this world, do not under any circumstances let it disturb your mental poise, or raise your ire or shock you; for if you do, then and there--at that moment--occurs a break in the sublime confidence which the child reposes in you. necessary moral training while we are using the plant and animal world as object lessons in teaching our children the facts of sex and the secrets of life; while we face the commonplace sex matings of the animals about us without cringing, without appearing to be shocked when our children call attention to these things; nevertheless, when the child is old enough to take cognizance of these phenomena, he is old enough to begin to receive some definite instruction from his parents regarding the moral phase of these great biologic problems. we cannot safely and indefinitely utilize the animal world as an object lesson in sex education, without at the same time emphasizing the moral difference between man and the beast. many parents treat these sex problems so lightly and endeavor to act so naturally and unconcerned about these questions, that the child comes to look upon the promiscuous sexual relations of the animal world as something altogether natural; and, unless proper moral and religious training is carried on at this time, he stands in danger of coming to regard lightly the moral standards of modern society. at the same time of life that mother nature fully develops the sex instincts--at adolescence--she also awakens the religious emotions; the one being so necessary for the proper and adequate control of the other. let parents take a cue from old mother nature, and at the same time the sex relations of animals are freely discussed with the growing child, let the mother or father wisely call attention to the fact that but very few of the animals live family lives as do human beings. in this connection valuable use--by way of illustration--can be made of the ostrich and some of the ape family who are loyal and true to their chosen companions. moral and religious instruction must accompany sex-hygiene teaching just as soon as you leave the realms of botany and enter the sphere of zoology. we could here relate many a tragic experience which our patients have passed through as a result of volunteering too much sex knowledge and at the same time neglecting this very necessary moral instruction. santa claus and the stork we must bear in mind that the child believes what we tell him; he trusts us implicitly and we owe it to him to teach him the truth in answer to his numerous questions. we must keep his confidence. take the matter of christmas, for instance. how many confidences have been broken over the falsehood of santa claus and the chimney. two little fellows hesitated in their play in the back yard, and the following conversation was heard: "you know that story about santa claus is all a fake." "sure it is, i know it isn't so, i saw my father and mother filling the stockings. you know that stork story is all a lie too, there's nothing to it, babies don't come that way, and now i'm investigating this jesus christ story, i suppose that's all a fake too." the fact of the matter is, that while these children have discovered the truth of the first two stories, for a long time they will query the third story, for to them, that too is mysterious and fairy-like. they hadn't seen santa or the stork and had only heard about jesus. story of the human baby the story of the human baby may be told to any child of seven to ten years. each mother will have to decide in her own mind the right time to go into the details of the human baby seed. the child should have had an opportunity to have planted some seeds in the ground, to have visited an incubator, or to have visited the farm and observed the family groups of babies--the chicks, pigs, calves, etc.--with their mothers. let me see now how many different baby seeds do we know? yes, we do know the radish seeds, many flower seeds, chicken seeds, bird seeds, corn, potatoes, and many others, and we can tell them all apart. the boy and girl baby seeds are too tiny to be seen with the eye. they are so small that it takes about two hundred of them in a row to make one inch. we can only see these human baby seeds with the aid of a microscope. it is such a precious seed that it cannot be intrusted to the ground or to a tree nest for development. the great wise father decided that a mamma would love and care for it better than anything or anybody in all the world. so, just as there is a cradle bed in the mamma flower, so there is in the human mother's own warm body, tucked far away from the cold rains and the hot sun, a little bed, for the boy and girl baby seeds. right near to this little seed bed mother nature has prepared a little room, which holds the tiny "waked up" seed for nearly a year as it slowly grows into a little baby girl or baby boy. the mating story you remember the story of how bob robin found jenny robin, don't you? you remember mamma told you how bob came up from the southland early in the spring and asked jenny in lovely bird song to come and be his very own wife? how he promised her he would feed her on cherries, and currants and the fattest of worms? and that she told bob she loved him and went to live with him, and how they built that cute little nest to hold the eggs; and how jenny robin sat on the nest until the little baby robins were all hatched out. well, one day papa found mamma. he met her and loved her dearly and told her he wanted her to come and live with him, and they built their home nest and were very happy together, because they decided they would always love each other more than any one else in the world. after mamma and papa built their home and lived together, one day a wonderful change came to one of the baby seeds and it awakened and began to grow. mother nature whispered to it, and told it how to find its way into this little room and there it clung to the wall and grew for nearly a year. papa brought mamma nice things to eat, just as bob robin did jenny. papa did everything he could to make mamma happy and comfortable. for nearly five months this little seed just grew and did not let anybody know it was there, until one day it began to tap against the sides of the walls of this little room, and every time it did mamma's heart just bounded with joy as she thought of the precious seed growing to be a darling baby--and all inside of her very own body. and one day, after nearly a whole year had passed, the door to the room began to open, and, very soon, a lovely baby found its way out of this special room into the big, big world. mother nature then told this little baby that it might still remain close to the mamma it had been with so long, and so she taught it how to get its food every day from mamma's breast. at this point the child usually breaks out by saying, "now, mamma, i know just why i love you so much." unfolding the truth i shall always remember with pleasure my own son, not quite two-and-a-half years old, who sat at the table one day asking numerous questions such as, "mamma, what is that? mamma, where did that come from?" etc. he picked up a navel orange, and pointing to the navel said, "what is that?" i frankly said to him, "why, my dear, that is the baby orange." "why, mamma," he exclaimed, "do oranges come from oranges?" "certainly, dear child; where else could they come from?" "but," he says, "mamma, do potatoes come from potatoes?" "why, honey," i said, "orange babies come from orange mammas, potato babies from potato mammas, grapes come from grape mammas, little kitties from kitty mammas, and little boys from their mammas." we simply mixed all the babies up, just as you would mix up a delicious fruit salad. we took from the mind all question of mystery and surprise by quickly and honestly answering his question. thus, his first knowledge of his origin, if he is able to recall it, will ever be associated with oranges, grapes, potatoes, kittens, etc. we did not tell the whole story for some two or three years later, but day by day we simply answered the questions as he asked them. one day, when he was about three, he burst into my bedroom, saying, "mamma, dear, i did come from you, didn't i?" "why, yes, darling, from nobody else; just from your own mamma and papa." "say, mamma, was my hand in your hand, my foot in your foot, my head in your head?" "no, dear," i replied, "you were all curled up as snug as a little kitty is when it's asleep, and you slept for nearly a year in a little room underneath mamma's heart." it was a wonderful story. he threw his chubby arms about my neck, his legs around my waist, and said: "you dear, dear, mamma. i do love you and papa more, just awful much." the doctor's part in my private sitting-room, where william and i have had many conferences, there hangs my medical-class picture with classmates and faculty. a member of my family was one day answering the boy's queries as to who this one or that one was, etc. finally, on pointing to one particular face, the answer came to his inquiry, "that's dr. p. you wouldn't be here if it wasn't for him." that evening the little fellow, just past three years, came to me and asked, "mamma, didn't you say i came from you?" "yes, dear," i replied. "well, auntie says i wouldn't be here if it wasn't for dr. p. what did the doctor have to do with it?" "why, simply this, dear. the door to the little room in which you grew in mamma's body wouldn't open, and so kind dr. p. came and helped open the door." "and let me out?" exclaimed the eager child. "oh, i want to go and see dr. p. and thank him for helping me out!" and this little fellow was neither shocked or surprised, any more than he was over finding out that orange babies came from orange mammas. in the same frank manner in which the simpler questions are answered, strive to answer these important ones. if we seek to evade, to postpone, to wrap in mystery these sex questions, the little ones will not forget but will ponder and worry over them, and seek to obtain certain knowledge from others who oftentimes tell too much or too little, and such information is usually mixed with much unnecessary matter which may or may not be foreign to this particular subject. on the other hand, if we frankly and honestly answer the question at hand, curiosity is avoided and the child feels he understands it all. the subject drops into the background of his mind--into the marginal consciousness--with the countless other facts he has accumulated. a sense of "knowledge possession" is as comfortable to the child as it is to the adult. trusting your child often the question arises: "will they tell to other children this newly found knowledge?" if the wise mother makes them feel they are a part of a "family," and reminds them that such matters as the secrets about santa claus, the stork, and the baby nest are only discussed in "family groups," they are often seized with the normal pride which accompanies confidence, and often keep secrets as well or even better than do most adults. one day a little man, three-and-a-half years old, was posing for a photograph. the photographer said: "my little fellow, you pose well. we've had such a good time together. where did they get such a lad as you?" the mother's heart stood still. from her hiding place behind a large curtain at the back of the studio, she listened, wondering what would be his answer. at first he hesitated, but after a moment's pause, said: "really, mr. w. if you don't know i feel sorry for you, and i'd really like to tell you, but i can't, it's a secret between me and my mamma." children enjoy secrets. if possible, isolate a group of subjects that are not to be discussed with playmates, such as santa claus facts, the stork story, and the baby story; often the very isolation of one single fact stands out so big in the child's mind that he is many times tempted to mention it, when, if it were associated with a whole group of "family secrets" he would seldom be led to talk about it. as we have said, children can keep secrets much better than most adults; and just suppose they _should_ tell something--what harm? with twenty-five false stories in the neighborhood, suppose one story of truth should escape! no particular harm would result; but i find they keep these secrets well. numerous questions will arise which should be met with open frankness. no blush, no shame, should even suggest itself, for we are dealing with a wonderful truth, so let us give out our answers with clean hearts and pure minds. the great father will bless us and surround our loved "flock" with a garment of confidence in mother and father that will protect from much of the evil which is in the world, and, eventually, our little ones will grow into men and women whose very life of purity will cast its influence into the social circle. only the company of the good and the true and the pure will be sought when associating with the opposite sex; while, in the end, better mothers and better fathers will be developed for the work of the next generation. ten possible causes of secret vice 1. the attention of the little folks is often drawn to the sexual organs by a sensation of itching which accompanies a state of uncleanliness and filth. the genitals must be kept scrupulously clean. elsewhere in this book we paid our respects to the rubber diaper, and we wish to reiterate at this time that it is in all probability responsible for a great deal of masturbation. the constant moisture and heat keeps the genital organs in a state of congestion which is more or less accompanied by itching sensations. 2. a long or tight foreskin in the male child favors the accumulation of secretions which not only occasion itching sensations but oftentimes are the cause of convulsions in early infancy. in the case of the female, a tight foreskin over the clitoris will retain secretions which also cause an itching sensation. 3. unscrupulous nurses sometimes actually teach these little fellows to masturbate. 4. lying in bed on the back with a full bladder, in the case of the boy, often produces an erection of the penis, and this is usually accompanied by a feeling of fullness which serves to direct the mind to the genital organs. 5. lying in bed alone with nothing to do but to investigate often results in secret vice. 6. the unwise practice of allowing children to visit each other over night and sleep together, is often productive of mischief. 7. constantly telling a little girl to keep her feet down, to keep her dress down, makes her over conscious of sex and otherwise causes the attention to be directed in unhealthy channels. 8. teasing a child unnecessarily about a little sweetheart often produces an emotional reaction which is not altogether desirable. these suggestions are especially bad in the older children. 9. unwise sex knowledge is usually productive of curious investigations, which if not properly followed up, particularly in those children who are temperamentally secretive, and who do not fully confide in mother and father, often results in moral misdemeanors. 10. do not allow two young children habitually to isolate themselves in their play. direct their play away from the attic, the basement, and other places remote from direct observation. there is no use telling a child not to touch that part of his body, particularly if it is a boy, for it is going to be absolutely impossible for him to carry out such instructions. one mother overheard her caretaker say, "don't put your hand there, it isn't nice." immediately the wise mother called the caretaker to her and reminded her that most children usually continue to investigate even though they are told not to, and so the caretaker received this instruction: "when you see harry putting his hand to that particular part of his body, just gently draw it away and divert his attention to something else, and when he goes to sleep in his little bed teach him to lie on his side and bring his little hands up under his chin or the side of his face and remain near him telling him a beautiful story until the eyes begin to get sleepy and pick him up immediately on awaking in the morning." this mother was quite unlike the mother who once came to my office, saying: "doctor lena, i have done everything to prevent my boy's handling himself, why every time he wakes up at night i am always awake and i instantly say to him, charlie where are your hands? you see doctor, i am doing the best i know how." very likely it is unnecessary to call the attention of the reader to the fact that this mother was doing more harm than good in constantly calling his attention to the fact that he did have a sexual side to his nature. truth vs. exaggeration and just here let us add that while masturbation is an unclean habit, an impure habit, and a thing altogether to be shunned, we would not be honest to ourselves and to our readers if we did not explain that under no circumstances does it make foolish minds out of sound minds or insane minds out of sane minds. if your boy or your girl is going to grow up to be foolish or insane he had a through ticket for the feebleminded institution or the insane asylum when he was born into the world. the time when masturbation does affect the mind of the child is when the mind awakens to the fact that it is allowing an abnormal, unclean, or filthy habit to dominate mind, soul, and body, and then, and usually not until then, does this bad habit begin to cause mental depression and a host of other symptoms that so often accompany masturbation. in our worthy efforts to combat the evils of secret vice let us not go to the other extreme and create such a condition of mind in the youth of our generation as to lay the foundation for sexual neurasthenia later on in life, as a result of the protracted worry, constant brooding, and conscientious condemnation, which they so often experience following some brief or trivial indulgence in early secret vice. let us fight this vice with the truth, and not resort to over-exaggerated pictures which can only serve to blight the hopes and destroy the courage of over-sensitive boys and girls after they have grown up--as they look back on their lives and recall perhaps a single misstep in their childhood. in this way we can hope to do good today without mortgaging the child's happiness and mental peace in years to come. appendix appendix baths used to reduce fever 1. _the sponge bath._ the child, completely undressed but loosely wrapped in a wool blanket, is placed on a table so that the mother or a nurse may conveniently stand while administering the bath. close at hand have a number of soft linen towels and a large bowl of tepid water which may or may not contain a small amount of alcohol, witch-hazel, salt, or vinegar, according to the doctor's directions. the upper portion of the body is partially uncovered and the tepid water is applied with the hands to the skin surface of one arm. the hands may be dipped in water from one to four times, thus making repeated applications of the water to the arm. these are followed by careful drying--patting rather than rubbing. the other arm is now taken, then the chest, then the back and last the legs. 2. _the wet-sheet pack._ two light-weight wool blankets are folded to fit the child; they should extend eighteen inches below the feet and should be wide enough to lap well in front. a sheet just large enough to envelop the body is then wrung out of cold water and spread out over the woolen blankets. the feverish child is entirely disrobed and is placed on the wet sheet, which is quickly wrapped about the body, over the chest, under the arms, and between the legs--coming in contact with the entire skin surface. the dry blankets are quickly brought around and tucked snugly about the patient. this is a cooling wet-sheet pack and will often so relieve the nervousness and irritability of a feverish child that he will go to sleep in the pack. in the very young child, under two years, it is important to put some accessory warmth to the feet such as a warm-water bottle--not hot. the effect of this pack is very quieting, and is indicated when the temperature of the child reaches 103 f. or more. 3. _the graduated bath._ this is usually administered in a large bathtub and is beneficial in the fevers of the older children. the temperature of the water should be one or two degrees higher than the body temperature, for example--if the child's temperature is 103 f. then the bath starts out with a temperature of 104 or 105 f. the temperature is then gradually lowered, about a degree every two minutes, until it reaches 92 or 90 f. a helper should support the head while the mother or nurse briskly rubs the entire skin surface of the body. this friction greatly facilitates the fever-reducing work of the bath because it brings the blood to the surface where it is more readily cooled by the bath. this bath should last ten or fifteen minutes. 4. _the hot sponge bath._ often, in combating the high fever of typhoid, the hot sponge bath is valuable. the hands are dipped in water just as hot as can be borne and are applied to the chilly, mottled skin which is so often seen in high fever. this bath is administered just as is the tepid sponge bath. evaporation is allowed to take place to some extent by delaying the drying. in this instance the child should be wrapped in a warm wool blanket with only a portion of the body exposed at one time. 5. _the hot-blanket pack._ the hot-blanket pack is indicated at the onset of many fevers such as in typhoid, grippe, pneumonia, etc. like the wet-sheet pack, the blankets are spread upon the bed, abundant accessory heat is applied--such as a half-dozen hot-water bottles. in the absence of these, glass jars or hot ears of corn may be utilized. hot bricks or hot stove lids wrapped in paper are also serviceable. a blanket, in size to suit the individual (an adult would use a full single blanket, a child one-half of a single blanket), is wrung very dry from boiling water. this may be done by the means of a wash wringer, or two persons grasping the blanket by its gathered ends may so twist it that it looks very much like an old-fashioned twisted doughnut. the twist is now lowered into boiling water, and as each pulls the twist wrings itself. this is at once quickly spread out so as to let the child lay on the center, and then the hot sides are brought in contact with the skin, just as in the wet-sheet pack. the dry blankets are now brought quickly and snugly about the child. just outside the second dry blanket the accessory heat is placed to the sides of the trunk, the sides of the thighs, and one at the feet. a wrapped stove lid or a hot-water bottle is placed over the pelvis and one under the back. cold cloths are put on the face and around the neck, and these should be changed every three minutes. this pack continues for fifteen or twenty minutes, at the end of which time the accessory heat and the wet blanket are removed and the patient is cooled off by a cold mitten friction, a saline rub, a witch-hazel rub, or an alcohol rub; or the patient may be placed in a tub of water, temperature 98 f., after which he should be carefully dried off. 6. _sweating baths._ another bath which is effectual at the onset of grippe or pneumonia is the sweating bath. the bowels should have moved some time before the treatment. have ready a large bowl of ice water, two turkish towels, one sheet, and four wool blankets. the bathtub is now filled with water at the temperature of 100 f.; which is quickly raised up to 103 or 104 f. ice-water towels are applied to the head, neck and heart. the patient remains in this bath for about ten minutes, after which he steps out and at once gets into the four hot, dry blankets previously spread out on the bed. no time is lost, the patient is quickly wrapped in the hot blankets and sweating continues for twenty minutes. the covering is now loosened and gradual cooling takes place. it is well to go to bed at once. tonic baths 1. _the cold mitten friction._ the cold mitten friction is a bath that is applicable to any condition where the child or adult needs "toning up." it should always be preceded by heat to the feet. the following articles are necessary. four or five turkish towels, a warm wool blanket, a hot-water bottle for the feet, a bowl containing water, a generous piece of ice, and a rough mitten without a thumb. the patient's clothes are removed and he is wrapped in the warm blanket with heat to the feet. one part of the body is taken at a time, first the arm, then the other arm, then the chest, the abdomen, one leg, the second leg, and last the back and the buttocks. a dry turkish towel is placed under the part to be treated, and after the mittened hand is dipped in ice-water, brisk short friction strokes are given to the arm until it is pink. several dippings of the mitten in ice-water are necessary. one cannot be too active in administering this bath. slow, delsarte movements are entirely out of place at this time. action--and quick action--is a necessity. no part of the child's body is left until it is pink. it is an invigorating tonic bath and is indicated in all conditions of low vitality, functional inactivity, puniness, rickets, etc. 2. _the salt glow._ fill the bathtub half full of warm water, temperature 100 f. slightly moisten one quart of coarse salt. stand the patient in the water, placing one foot on the side of the tub while you rub the entire leg with the salt until it is very pink. the other leg is treated in the same manner, as also are the arms, abdomen, chest, and last, the back. by this time he will be all aglow from head to foot. rinse off the salt, and give him a cold dash with the hands or a spray. the neutral bath fill the tub with water at just 97 f., and remain in the bath for twenty minutes or more, with the eyes covered, all the while maintaining the temperature at 97 f. dry gently with a sheet to avoid exertion and exposure. go at once to bed. fomentations hot fomentations often relieve suffering and are indicated in such conditions as menstrual pain, abdominal cramps, colic, backaches, etc. a good substitute for fomentations may be given as follows: fill a hot bag half-full of boiling water. over this place a wet flannel and two layers of dry flannel. apply for fifteen or twenty minutes over the skin area to be treated, finishing up with a cold water or alcohol rub. a very effectual way of applying moist heat to any portion of the body is by the means of hot fomentations which are given as follows: one-fourth of a single woolen blanket (part cotton) is folded and grasped at the ends and twisted like an old-fashioned doughnut. the twist is then immersed in boiling water, the hands still grasping the dry ends, and then by simply pulling out the twist (widely separating the hands) the fomentation wrings itself. this is placed steaming hot over the affected area which has been first covered by a dry flannel. it is allowed to remain on for three or four minutes, and then another hot one wrung from the boiling water replaces the cool one. about four or five such applications are made. the skin should be very red at the close of this treatment. it is finished up with a quick, cold application to the reddened skin area. the soap shampoo the undressed child is placed upon a low stool in the half-filled bathtub at 100 f. with the feet in the warm water. a good lather is applied all over the body with good friction by the means of a shampoo brush and soap. he is then allowed to sit down in the tub and splash about all he pleases, rinse the soap off and allow him to have a good time generally. at the close of the treatment the water is cooled down and the treatment is finished with a brisk rub with the hands dipped in cold water. the skin of the child should be pink at the close of the treatment. moist abdominal bandage the moist abdominal bandage is indicated in such conditions as kidney inflammation which is so often seen in the second week of scarlet fever; or in congestion of any of the internal organs such as the liver, the stomach, intestines, etc., and is applied as follows: spread out the flannel bandage and over it place the mackintosh. wring dry the cotton strip from cold water, and spread it over the mackintosh. wrap all three layers, the wet cloth next the skin, closely about the body, so as to prevent the air from getting under it. be sure that the feet are warm while adjusting the bandage. in the morning remove the bandage, and rub the skin briskly with a turkish towel dipped in cold water, until the skin is pink and dry. the cotton strip should be boiled every other day to avoid skin eruptions. heating compress the heating compress is indicated in the following cases: sprained ankles, rheumatic joints, arthritis, sore throat, etc. directions: wring two thicknesses of cheesecloth from cold water, place over the painful part, and quickly cover with a mackintosh and two thicknesses of woolen blanket bandage. on removing in the morning, sponge with cold water or alcohol. mustard paste in the bronchitis of small children, particularly babies, mustard pastes are to be preferred to the hot fomentations which are used to such great advantage in children above ten. the mustard paste is administered as follows: one part of mustard and six parts of flour of the same measurements are quickly stirred up with warm water to a paste thin enough to spread well upon a piece of thin muslin, which is large enough to cover twice the part to be treated. one-half of this muslin is thus covered with the mustard and the dry piece of cloth brought over. the edges are then folded in such a way that the mustard will not run out. this is applied to the affected part and allowed to remain for seven minutes on an infant, nine minutes on a child, and ten or twelve minutes on an adult. it is then removed and the moisture which is always seen on the reddened skin surface is _not_ wiped off but talcum powder is sprinkled on thickly to absorb it. if this is done, a mustard paste may be repeated every two hours if necessary and no blistering or other harm will come to the skin. the oil-silk jacket the oil-silk jacket is used in bronchitis of babies and children. it consists of three layers, the innermost layer of cheesecloth, the middle layer of thin sheet wadding, and the outer layer of oil-silk. this jacket should comfortably cover the chest, front, and back; it has no sleeves, and is opened on the shoulder and under the arm. it should always follow the mustard paste in bronchitis. there should always be two such cheesecloth and cotton jackets with the oil-silk covering so they may be changed every twelve hours, thus allowing for airing. steam inhalations 1. steam inhalations are indicated in hoarseness and bronchitis. they may be given in a number of ways. perhaps that most convenient for the young infant is the "bronchitis tent." a sheet completely covers the crib, and, with the bed amply protected with rubber sheeting or an extra blanket, steam is allowed to enter under the sheet at the foot of the bed from a funnel put into the nose of the teakettle. the steam should continue for seven or eight minutes. 2. a large, heavy-paper funnel is put in the nose of the teakettle which is boiling on the gas range. the mother holds the child in her arms while she is enveloped with a sheet which also includes the funnel. a helper carefully guards the flame. the mother and baby may thus conveniently get the steam with very little difficulty. 3. for the older child or adult, steam inhalations are to be had from the ordinary croup kettle or from a twelveor fourteen-inch tin can which is filled two-thirds full of boiling water. over the top is loosely spread a cheesecloth upon which a few drops of compound tincture of benzoin or eucalyptus are sprinkled. the opened mouth is brought near the top of this can and a towel is thrown over the head, can and all; the patient thus being able satisfactorily to inhale the medicated steam. lotions for sore mouth boric-acid-and-myrrh lotion. boric acid 20 grains tincture of myrrh 1/2 fluidrachm glycerine 1 fluidrachm water, enough to make 1 fluid ounce apply frequently to the inside of the mouth for inflammation or thrush. for nosebleed tannic acid 2 drachms glycerine 1 fluidrachm water 2 fluid ounces to be injected or snuffed into the nose in obstinate cases of nosebleed. throat gargles dobell's solution is an excellent throat gargle. a solution of half alcohol and half water is also a splendid gargle. mouth wash listerine 2 teaspoons soda bicarbonate 10 grains water 4 ounces essence of cinnamon, six drops in one-half glass cold water, may also be used in brushing the teeth and in cleansing the tongue and mouth. disinfectants 1. carbolic acid. carbolic acid (95%) 6 ounces glycerine 4 ounces water 1 gallon clothes should be soaked in this for several hours, then removed in a covered receptacle and boiled thoroughly. sheets may be wet with this and hung at the doors in case of infectious diseases. 2. chloride of lime. chloride of lime 4 ounces water (rain) 1 gallon in typhoid fever, all the movements from the bowels should be thoroughly mixed with this, covered and allowed to stand several hours before pouring down the water closet. all vomited matter should be treated the same way. poultices there are a number of mush poultices recommended for different conditions--boils, felons, etc., but we find the aseptic heating compress to be as effectual as any of these dirty, mush poultices and we suggest that our readers try the boracic-acid poultice which is put on as follows: over any infected area or abrasion of the skin a thick padding of cotton moistened by a saturated boracic-acid solution is placed. this is entirely covered with wax paper or oiled-silk, and held in place by a binder. it is sanitary and much to be preferred to any of the mush poultices of bygone days. cough syrup a very useful cough syrup may be made as follows: two tablespoons of flaxseed are steeped on the stove until clear, the jelly strained and flavored quite sour with lemon juice to which is added rock candy for sweetening. this will often effectively relieve the irritating coughs of childhood. lotions for chapped hands no. 1. glycerine 3 ounces tr. benzoin 1/2 ounce water 1 ounce no. 2. glycerine 2 ounces lemon juice 1/2 ounce tr. myrrh 1/2 ounce no. 3. glycerine 2 ounces rose water 2 ounces acetic acid 2 ounces eczema we wish to submit two very useful prescriptions for that troublesome skin disease which is so annoying in childhood as well as in adult life. prescription no. 1 is a clear fluid, and after the affected area is thoroughly cleansed with resinol soap and rinsed in soft water, the lotion is applied and allowed to dry. no. 2 is then patted on with sterile cotton and often repeated to keep the eczematous skin area moist. this has proved curative in many persistent cases. lotion no. 1. acid carbolic 1 drachm listerine 1 drachm rose water 3 ounces alcohol q. s. 6 ounces apply no. 1 and allow to dry of itself. lotion no. 2. ichthyol 4 drachms lime water 1 ounce oil sweet almonds 1 ounce glycerine 1½ ounces rose water 1½ ounces apply no. 2 and repeat to keep moist. constipation we submit the following home regime, which has proved successful to many sufferers for the treatment of constipation. 1. on rising in the morning, remove the moist abdominal bandage (mentioned above); drink two-thirds of a glass of cold water; and spend fifteen to twenty minutes in the following exercises, before dressing: abdominal lifting with deep breathing, auto-massage, leg raising, trunk twisting, trunk bending--forward and to sides; lying down for the trunk raising, and sitting for the trunk circumduction. immediately following these exercises, go to stool. have feet raised from the floor eight or ten inches, in order to simulate the squatting position. 2. breakfast should include bran or bran bread, and two or three of the following foods: apples with skins, grapefruit, cranberries with skins (but little sugar), and figs. immediately after breakfast walk fifteen minutes in the open air, practicing deep abdominal breathing. if the results at stool before breakfast were not satisfactory, vaseline rectum and go to stool again. 3. lunch should consist of fruit only, while dinner should include bran bread and two of the following foods: spinach, celery, carrots, parsnips, squash, or cabbage. 4. before retiring, walk in the open air for fifteen minutes; after undressing, exercise same as morning; and on retiring, apply the moist abdominal bandage. table of poisons and antidotes _poison._ _antidotes._ unknown { emetic, followed by jeaunel's antidote { and soothing drinks. acid--acetic, hydrochloric, { an alkali, such as magnesia, chalk, sulphuric, nitric { whiting, soda, soap; followed by { soothing drinks or sweet oil. acid--carbolic, creosote { epsom salts in abundance; soap; no { oil. dilute alcohol. acid--oxalic, including { emetic, followed by lime (as chalk, "salts of lemon" { plaster, whiting) or magnesia, but { not by potash or soda; then soothing { drinks. acid--prussic { fresh air; ammonia to nostrils; cold { douche; artificial respiration. aconite { emetic, followed by digitalis; no pillow { under head; free stimulation. alcohol (brandy, etc.) { emetic; cold douche on head; warmth { and artificial respiration. alkalies--ammonia, spirits { vinegar or lemon juice, followed by of hartshorn, lye, caustic { soothing drinks or sweet oil. potash { antimony (tartar emetic). { emetic if vomiting is not already { profuse; then tannic acid freely, or { strong tea; later, milk or other { soothing drinks; finally, castor oil { to empty the bowels. { emetic, quickly followed by plenty of { a fresh mixture of the tincture of { chloride of iron with calcined magnesia, arsenic (fowler's { washing or baking soda, or solution, paris { water of ammonia, or by jeaunel's green, "rough { antidote. then white of egg, soothing on rats") { drinks, or sweet oil; castor oil { to empty bowels. atropine (see belladonna). { emetic; tannic acid freely; cold to belladonna (atropine) { head; coffee. stimulants and { warmth if needed. blue stone; blue vitriol (see copper). { emetic (but often useless); external chloral { heat; stimulants; strong coffee; { strychnine; atropine; artificial respiration. chloroform, inhaled { cold douche; friction of skin; inverting { child; artificial respiration. copper (blue stone; blue { emetic, followed by white of egg or vitriol; verdigris) { milk, yellow prussiate of potash; { then soothing drinks. { emetic, followed by white of egg or corrosive sublimate { milk; soothing drinks; tannic acid (bichlorid of mercury) { freely; castor oil to open bowels. cyanide of potash (see acid, prussic). fowler's solution (see arsenic). { inhalation of oxygen; artificial gas (illuminating gas, coal { respiration; ammonia to nostrils; gas) { cold douche. iodine {starch or flour mixed with water given { freely; emetic; soothing drinks. laudanum (see opium). lead (sugar of lead) {emetic, followed by epsom salts; { white of egg or milk; alum. matches (see phosphorus). morphine (see opium). nux vomica (see strychnine). {emetic (but generally useless); opium (including laudanum, { permanganate of potash in doses of 4 morphine, paregoric, { or 5 grains if case is seen early; soothing syrups, { strong coffee; atropine; keep child etc.) { awake and breathing by cold douche to { head and spine, walking, etc., but { not to extent of exhaustion; { artificial respiration. paregoric (see opium). paris green (see arsenic). phosphorus (match-heads, {emetic; then permanganate of potash some roach and rat poisons) { in doses of 4 or 5 grains well { diluted, and frequently repeated; { then epsom salts or magnesia to { open bowels, but no milk or oil of { any kind. poisonous plants (jimson {emetic, followed by tannic acid; weed, poisonous mushrooms, { strong coffee or brandy; ammonia deadly nightshade, { to nostrils; external warmth; tobacco, etc.) { artificial respiration. prussic acid (see acid, prussic). silver nitrate (lunar caustic) {table-salt, followed by emetic; milk { or white of eggs. spoiled food {emetic, followed by castor oil as { purgative. strychnine (nux vomica, {emetic, followed by tannic acid, some rat poisons) { bromide of potash freely, or chloral. tartar emetic (see antimony) table showing the average weight, height, and circumference of head and chest of boys[d] at birth. weight 7½ pounds height 20½ inches chest 13½ inches head 14 inches one year. weight 21 pounds height 29 inches chest 18 inches head 18 inches two years. weight 27 pounds height 32 inches chest 19 inches head 19 inches three years. weight 32 pounds height 35 inches chest 20 inches head 19¼ inches four years. weight 36 pounds height 38 inches chest 20¾ inches head 19¾ inches five years. weight 41 pounds height 41½ inches chest 21½ inches head 20½ inches six years. weight 45 pounds height 44 inches chest 23 inches seven years. weight 49½ pounds height 46 inches chest 23½ inches eight years. weight 54½ pounds height 48 inches chest 24½ inches nine years. weight 60 pounds height 50 inches chest 25 inches ten years. weight 66½ pounds height 52 inches chest 26 inches [d] weights for the first four years are without clothes, after that with ordinary house clothes. the weight of girls is on the average about one pound less than boys. they are about the same in height. ichthyol suppositories ichthyol 5 per cent cocoa butter q. s. ad. to make 24 suppositories. sig. use one suppository in the rectum each evening for hemorrhoids. oil enema the best way to administer an oil enema is by means of a special enema can which holds one pint, to which is attached a rubber tube. it is wise not to use an ordinary fountain syringe as the oil spoils the rubber very quickly. this oil is allowed to flow in slowly, under low pressure, and should be retained over night. any oil is acceptable, the cheaper sweet oils will serve just as well as olive oil. table of infectious diseases disease. |incubation lasts- | |date of characteristic symptom from beginning of invasion. | | |characteristic symptom. | | | |other principal symptoms. | | | | |whole duration of disease from onset. | | | | | |quarantine lasts from onset. | | | | | | typhoid fever. |7 to 10 days. | |7th or 8th day. | | |rose-red, slightly elevated spots. | | | |apathy; diarrhoea; nosebleed; headache. | | | | |2 to 4 weeks. | | | | | |while disease lasts. scarlet fever. |1 to 7 days. | |1st or 2d day. | | |intense, bright-red blush over body. | | | |sore throat; often vomiting with onset. | | | | |7 to 9 days or more (not including | | | | | desquamation). | | | | | |6 weeks. measles. |10 to 11 days. | |4th day. | | |dusky or purplish-red, slightly elevated spots, | | | scattered and in characteristic groupings. | | | |cold in head; running eyes; cough; hoarseness. | | | | |7 to 8 days. | | | | | |3 weeks. german measles. |7 to 21 days. | |1st day. | | |pale, rose-red spots or uniform blush; no | | | characteristic groupings. | | | |slight sore throat; sometimes slight running | | | | of eyes and nose. | | | | |3 to 4 days. | | | | | |3 weeks. chicken-pox. |13 to 17 days. | |1st day. | | |pea-sized, scattered vesicles. | | | |none; or slight fever. | | | | |a week or less. | | | | | |3 to 4 weeks. varioloid (variola). |7 to 12 days. | |3d day (may be 1st or 2d). | | |red, elevated papules; then vesicles; then often | | | pustules. | | | |headache; backache; vomiting. | | | | |about 14 days. | | | | | |4 to 8 weeks. vaccinia (vaccination). |1 to 3 days. | |1st day (3d after vaccination). | | |a red papule, becoming a vesicle and then a pustule; | | | surrounded by a broad red area. | | | |often feverishness and malaise. | | | | |about 3 weeks. | | | | | |none. erysipelas. |3 to 7 days. | |1st or 2d day. | | |bright-red blush; puffy skin; often vesicles. | | | |fever; pain. | | | | |4 to 6 days, or several weeks if it | | | | | spreads. | | | | | |averages 2 weeks. diphtheria. |2 to 12 days. | |1st or 2d day. | | |white membrane on tonsils and other parts of throat. | | | |debility; fever. | | | | |10 to 14 days. | | | | | |3 to 4 weeks. whooping-cough. |2 to 7 days. | |7th to 14th day. | | |a prolonged paroxysm of coughing followed by a | | | crowing inspiration (whoop). | | | |vomiting; spitting of blood. | | | | |6 to 8 weeks. | | | | | |6 to 8 weeks (while whoop lasts). mumps. |7 to 21 days. | |1st day. | | |swelling in front, below, and behind the ear and | | | below the jaw. | | | |pain when chewing. | | | | |a week or less. | | | | | |3 to 4 weeks. influenza. |uncertain. probably 1 to 7 days. | |1st day. | | |fever, prostration. | | | |various respiratory, digestive, or nervous | | | | symptoms, commonest being general aching and | | | | cough. | | | | |3 or 4 days to two weeks or more. | | | | | |while disease lasts. hot colonic flushing the hot colonic flushing is particularly serviceable in combating the sick headaches of migraine. they should be taken at night just before retiring with the temperature of water as hot as can be borne, from 108 to 110 f. half of the water is allowed to flow into the colon and is retained as long as possible. this brings the heat in close contact with the sympathetic nervous system whose headquarters is in the abdomen. enemas _position for an enema._ lie on left side, knees brought up against abdomen, with the left arm well underneath. this will relax the abdominal muscles and allow the water to pass upward more freely. the water should be allowed to flow until it is felt low on the right side. _the one, two, three enema_ is an injection that is used for the relief of gas in the bowel. it consists of the following: one part epsom salts, two parts glycerine, and three parts soap suds. it is introduced by the aid of the colon tube and retained as long as is possible. glycerine and soapy water, equal parts, may be introduced into the bowel for temporary relief of a persistent constipation. in instances when feeding by the mouth is impossible, _nutrient enemas_ should be given every three or four hours during the day. the absorption does not take place in the large bowel as readily as in the small intestines, so only a small amount of a more highly concentrated solution is given at one time. a child one year of age will be given one teaspoon, from one to four years of age a teaspoon to a tablespoon is allowed, and up to twelve years from one to eight tablespoons are given in the nutrient enema. peptonized meat preparations may be employed in greater concentration than directed by the use of the mouth. peptonized milk containing an egg is often used. the pepsin is added to the mixture only when warm, and is injected at once. emetics 1. a glass of warm water containing as much common table salt as can be dissolved. 2. a teaspoon of mustard in a large glass of warm water. 3. a teaspoon of syrup of ipecac, repeated in fifteen minutes if necessary. any one of these emetics is useful in instances where it is desirable to empty the stomach at once. a calorie a calorie is the heat unit used in the estimation of the fuel value of various foods. for instance, an ordinary slice of homemade bread contains 100 calories. an ordinary fig contains almost 100 calories. a large orange or an apple or a glass of grape juice contains about 100 calories. there are 100 calories in three teaspoons of sugar or honey. a complete food list with the estimation of calorie value of foods is found in _the science of living_, page 370, while on page 99 of the same book is a very helpful table showing the amounts of various foods required to equal 100 calories. the reader will find this exceedingly practical in estimating food values for the household. acidifying and alkalinizing foods since we find that in all acute diseases the acidity of the urine is greatly increased and in time of health it is less acid, we submit two lists of foods which tend to acidify the urine or to alkalinize the urine. foods which tend to acidify. 1. _animal foods_: all forms of flesh foods, fish, fowl, etc., including all kinds of meat broths, soups, beef tea, bouillon, etc. 2. _eggs._ 3. _breadstuffs_: all kinds of breads, whether made of wheat, rye or corn, crackers, toasts, griddle cakes, etc. 4. _pastries._ all sorts of pies and cakes--except fruit pies, and other desserts containing milk or sour fruits. 5. _cereals_: rice, oatmeal, and breakfast foods of all kinds, including the flaked and toasted breakfast foods. 6. _peanuts_, plums, prunes, and cranberries. plums and cranberries fall in this column because of their benzoic acid, which the body cannot fully oxidize. foods which tend to alkalinize. 1. _dairy products_: milk, ice cream, cottage cheese, cheese, buttermilk, etc. 2. _potatoes_ and _bananas_. 3. _soups_: all forms of vegetable and fruit soups and broths. 4. _fruit juices_: all the fresh fruit juices except plums. 5. _fresh fruits_: all fresh fruits, sweet and sour, except plums and cranberries. 6. _vegetables_: all kinds, especially beets, carrots, celery, lettuce, and muskmelon. 7. _dried fruits_: figs, raisins, dates, currants--all except prunes. 8. _the legumes_: beans, peas, and lentils. 9. _the nuts_: all the nuts belong in this column, including almonds and chestnuts. cereal waters, etc. it is often necessary to give the infant or the young child cereal water to replace food in occasions of summer diarrhoea, etc. 1. _barley water._ one tablespoon of barley flour in one pint of water. boil for one-half hour, strain, and add sufficient boiled water to make one pint. 2. _flaxseed tea._ one tablespoon of flaxseed, one pint of boiling water; let stand and keep warm for one hour; strain. add juice of lemon. 3. _oatmeal jelly._ four tablespoons of oatmeal, one pint of water; boil for three hours in double boiler, adding water from time to time; strain. 4. _toast water._ one, two, or three slices of bread toasted dark brown, but not burned. put in one quart of boiling water, cover, and strain when cold. 5. _arrowroot water._ wet two teaspoons of arrowroot with a little cold water, and rub until smooth; then stir into one pint of boiling water and boil for five minutes, stirring all the while. 6. _oatmeal water._ one tablespoon of oatmeal to one pint of boiling water, cover and let simmer for one hour. add water from time to time as it evaporates; strain. 7. _rice water._ one tablespoon of (washed) rice to one pint of water. boil three hours adding water from time to time. fruit juices fruit juices are exceedingly beneficial all through life; particularly is this true during early childhood when the little ones are so likely to be constipated. any of the fruit juices are good, particularly the juices from oranges, raisins, prunes, apples, pears, and cranberries. all these juices are better cooked than raw with the exception of orange juice. all children should have some fruit juice every day. for the very young baby the juices are strained through a wire strainer and a clean cheesecloth so as to remove every particle of solid matter, and there should be added an equal amount of cold, boiled water for the infant under ten months. lemonade and eggnogs lemonade, along with orangeade, grapefruitade and limeade should be used for children above a year. they should be well diluted and not too sweet. eggnogs are splendid for children who need to be helped along with their diet. they may be given at the close of the meal, never between meals--unless so prescribed by a physician. the stomach should have ample time to complete the work of digesting one meal before another partial meal is allowed to enter it. eggnogs consist of a well-beaten egg into which there is placed a small amount of sugar, flavoring with either nutmeg, vanilla, or cinnamon, and the glass filled up with rich milk. milkshake milkshake is a delightful drink. the white of an egg with one or two teaspoons of sugar, two tablespoons of chopped ice, flavoring, and one ounce of cream are briskly shaken in a milk-shaker for two minutes. cold milk is added to fill the glass. meat and meat juices beef extracts are regarded by the medical profession as purely stimulants. beef juice is practically without food value. in the preparation of beef juice the extractives and juices leave the fibre. the food is in the fibre of the meat. the extractives are purely of a stimulating order. we do not advocate the giving of beef tea and beef juices to children; as a rule, we think that cereal, gruels, strained soups, and milk are preferable. the only reason for cooking meats is to destroy the parasites such as tapeworm, trichina, etc., which are so often found in the meat. the cooking of meat decreases its digestibility, as raw meat is more easily digested than cooked meat, but we feel it is necessary to advocate the cooking of meat in order to kill the parasites. coddled egg a fresh egg, shell on, is placed in boiling water which is immediately after removed from the fire. the egg then cooks slowly in the water, which gradually cools, for seven or eight minutes, when the white should be about the consistency of jelly. for a delicate digestion the white only should be given, with salt; it can be easily separated from the yolk. the above is the best form of egg for the young child. later on the eggs may be soft boiled or poached, or even soft scrambled. soups two varieties of soups are given children. in the early months of childhood, from six years to eighteen months, the soups are usually strained, but after eighteen months, soups may be thickened with flour and rich milk making a cream soup of it. most vegetables make good soups. the pulp from such vegetables as asparagus, carrots, beans, peas, tomatoes, and potatoes are made into cream soups by the addition of a little flour, rich milk, butter, and a dash of salt. breads new breads should never be given to a child. only bread twenty-four hours old should ever be given to a child under six years; it should be cut into slices and allowed to dry out; and even then is better if slightly toasted. we publish a recipe for bran bread and bran biscuits which are exceedingly good for children and adults. _recipe for bran bread._ two eggs, beaten separately; three-fourths of a cup of molasses, with one round teaspoon soda; one cup of sour cream; one cup of sultana seedless raisins; one cup of wheat flour, with one heaping teaspoon baking powder; two cups of bran; stir well and bake one hour. _bran biscuits._ mix one pint of bran, one-half pint of flour, and one level teaspoon of baking soda. mix one-half pint of milk and four tablespoons of molasses. add this to the bran mixture and bake in gem pans. index index abortion, advice on occurrence of, 39; care needed at third month of pregnancy, 38; consequences of, 7, 8; defined, 39; remedy for threatened, 38; warning signs of, 38. _see also_ miscarriage; pregnancy adenitis, 345 adenoids, 303 air, supply of fresh, for baby, 213-17, 219 baby, care of the: abdomen, shape of, at birth, 105; advice in care of baby, 377-78; bathing, 107-8, 111-12, 190-201; bed for, arrangement of, 108, 115; bouncing harmful, 226; bowels and bladder, training of, 242; breast of baby, care of, 229; buttocks, care of, 200; chafing, how prevented, 201, 333; chest, shape of, 105; circumcision, when desirable, 110; clothing of the, 108; constipation, 279; cord, dressing of, 107; diet after first year, 245-47; ears, treatment of, 198-99; exercise of baby, 223; eyes, treatment of, 107, 198-99; falls, to be prevented, 228; feeding the, 109; genitals of the, how cared for, 110, 200; habits to be guarded against, 378; hair, treatment of, 201, 233; handling, 111; head, treatment of, 104, 233, 344; legs of, at birth, 105; lifting the baby, how accomplished, 228; mouth, treatment of, 199; necessities for newborn baby, 60-61, 64; nose, treatment of, 198-99; pulse and respiration, 105; putting to sleep, 127, 217; registration of birth of, 113; respiration, how started at birth, 105-6; second summer, care during, 230; skin of baby, 106; stools, regulation of, 142; temperature of baby, 226; the "spoiled" baby, 128; things bad for babies, list of, 377; treatment of baby during and after birth, 67, 69; umbilicus, how cared for, 112; urine of baby, 109, 223; warmth necessary, 225; water, how and when administered, 140, 222; weight of baby at birth, 106; when to give first feeding, 70. _see also_ colic; crying; nursery; nursing the baby; sleep; urine; _see also_ under several diseases babyhood, 1 backache, cause of, 43; method of relief for, 43-44 bathing the baby, toilet, etc., 190-201. _see also_ baby, care of the bed for baby. _see_ baby, care of the; sleep bed-wetting, 328. _see also_ urine birthmarks, discussion of, 16, 17, 18, 40, 338 bites, of dogs, snakes, cats, etc., 349 blindness, precautions to avoid, in new-born infant, 69, 331. _see also_ baby, care of the blisters (fever), 338 blood-pressure, 46; observation of, 3 boils, 337 bottle feeding, additional foods, 153; bottle, preparation of, 149; ice-box, home-made, 148; intervals between meals, 153; nipple, how withdrawn, 152; position of baby during feeding, 150-51; quantity of food, 148; refrigeration a necessity, 148; rules for, 154; schedule for, 147; stomach, capacity of, 148; time allowance for, 152; traveling, food for baby while, 153; treatment of baby after, 152; water, when and how administered, 147 bowel, prolapse of the, 283 bow legs, how avoided, 228 bran bread, recipes for, 448 bravery, how to instil in a child, 382-84 breasts, caked (mastitis), care of, 100, 136 ff.; changes in, a sign of pregnancy, 4; care of, during pregnancy, 33. _see also_ pregnancy bronchitis, 304 bruises, 354 burns, 358 calisthenics, how applied, 244 caretaker (for children), 376-77 carriages and go-carts, 227 chafing, 333. _see also_ baby, care of the chicken-pox, 294-95 chilblains, 356 child culture, 1 cleft palate, 341 clothing the baby, bands, 204; booties, 206; caps, 210; diapers, 204; errors in clothing, 208; layette, the, 203-208; nightgowns, wrappers, and slips, 207; rules for, 212; shirts, 204; shoes, 210; short clothes, 209; skirts and petticoats, 206; sleeping-bag, 207; stockings, 206; suggestions for, 202; suits for play, 210; winter garments, 211; wraps, 210 clubfoot, 342 colds, 300, 301 colic, causes and treatment of, 129-32, 142, 274 confinement, bed and accessories, 61-62, 64; calculation of date of, 5, 6; preparations for, 53 ff., 57; supplies needed for, 58 ff.; room for, 61. _see also_ labor constipation, treatment of, 31, 40; in baby, 184, 185, 279 contagious diseases, how contracted, 285; incubation period of various, 287; spread of, 286. _see also_ under various diseases convulsions, 326 coughing, 255 cramps, 41 croup, 306 crying, abnormal, 124; birth cry, 123; cause of, 132; colicky cry, 129; fretful cry, 125; habit cry, 127; healthy crying, 123; hunger cry, 124; illness cause of, when, 129; pain cry, 126; "spoiled-baby" crying, 128; temper cry, 128; thirst cry, 124 cuts, wounds, etc., 353 deaf-mutism, 331 deafness, 302 deformities, causes of, 17 delivery, calculation of date of, 5, 6 depressors, function of, 9, 15 determiners, function of, 9, 15 development of child, 240-41 diarrhoea, 185, 280 diet: appetite, improvement of the, 401; assimilation, 360; baby, diet of, 245-47; cellulose, 365; eating between meals, 368; elimination, 360-62; fats, 364; food requirement (daily), 369; foods, full value of, 366; for children, 367; fruit sugars, 363; hygiene, 400; mineral salts, 364; nutrition, 362; proteins, 363; starches, 363; treatment of child, daily program for, 402-4; water, 365. _see also_ feeding the baby; nursing the baby digestion: disorder of, chronic indigestion, 275; stomach, disordered, 278; stomatitis or thrush, 279; vomiting, 274. _see also_ under various diseases diphtheria, 296 discipline, methods of, 316-22 dislocations and fractures, 254 doctor, choice of, 55 earache, 351 ears, running, 299 eclampsia, 47, 48; prevention of, 50. _see also_ urine eczema, 334-35 embryonic development, 11, 12 enema, how administered, 280 exercise, necessity of, during pregnancy, 27 exercise of baby, 223 eye infections, 298 eyes, ears, and nose, care of, 198; foreign bodies in, 351 fainting, 359 fear, overcoming of, in children, 380-82 feeble-mindedness, 331 feeding the baby: bottle-fed baby, healthy characteristics of, 178; changes in food to be gradual, 179; constipation, how treated, 185, 279; diarrhoea, cause of, 185, 280; dissatisfaction, signs of, 181; flatulence, 182; formula, choice of, for, 178; infant foods, 187-89; mistakes in formulas, 180; mixed feeding, 186; overfeeding, 183; vomiting, 182; weight of baby, 183. _see also_ diet; milk; nursing the baby fertilization, process of, 8, 9 fever, 264. _see also_ sickness of child flatulence. _see_ feeding the baby "flour ball," how prepared, 175 foods, for baby, 153, 165-76; full value of, 366. _see also_ bottle feeding; infant foods; milk freckles, 336 frostbites, 356 games for children, 392 germ plasm, 8 glands, enlarged, 345 goitre, 42 governesses, 370-75 grippe, 302 habits, inculcation of good, 380-89 harelip, 341 headache, in children, 326; relief for, during pregnancy, 45; sign of auto-intoxication during pregnancy, 47 heartburn, care for, 36 hemorrhoids, treatment of, 41 heredity, effect of, on individual, 9, 14; extent of influence of, 14, 15, 19, 20 hip-joint disease, 343 hives, 336 homemaking, 370-75 hookworm, 278 hospital, recommended for confinement, 55-56; requisites for, 60 housekeeping, 370-75 hygiene, of baby, 222-31; of child, 400-4. _see also_ diet hysteria, prevention of, 315 indigestion, 275 infant foods, 187-89. _see also_ feeding the baby; nursing the baby infant welfare, 178 insects, bites of, 348 insomnia, relief for, 45; in children, 323 itch, the, 339-40 jaundice, 276 kissing the baby, precautions against, 224 labor, analgesia in, 86; anesthesia in, 84-92; bath, preliminary, 64; care of mother during and after, 67-68; chloroform and ether, administration of, 91; duration of, 65; duties of nurse before and during, 67; "false pains" in, 66; fear in, importance of allaying, 84; laughing gas (nitrous oxid), administration of, 85; effect of, 87; pain of, 71, 84-85; preparations for, 64-65, 67, 72-73; progress of, 65; second stage of, 66; "sunrise slumber" in, 84-90; symptoms of approaching, 64; third stage of, 66; "twilight sleep" in, 71-72, 73-83; what to do in, before arrival of doctor, 67 layette. _see_ clothing of baby leucorrhea, relief for, 37-38 lice, 339 lime water, use of, in baby's food, 173 lochia, the, 97 lying-in period, the, 93; abdominal binder, 97; "after-pains," 95; bowels, care of, 98; breast binder, 97; "cold-mitten friction" during, 95; cystitis, how avoided, 100; diet, rules for the, 98; getting up from bed, when to be permitted, 99; hemorrhage, treatment of, 100; infection, advice for treatment of, 100; lochia, the, 97; nipples, care of, 98; nurse, duties of, during, 93; pneumonia, how avoided, 100; rest and exercise during, 94; temperature of mother, 96; toilet of the vulva, 96 malaria, 346 maternal instinct, the, 1 maternal impressions, explained and discussed, 16 measles, 293-94 medical supervision in early days of pregnancy, 2 medicine chest, the, 270 meningitis, 329 menstruation, cessation of, a sign of pregnancy, 4; cessation of, due to other causes than pregnancy, 4; passage of ovum at time of, 9. _see also_ pregnancy milk, acidity, how counteracted, 158; analysis of cow's, 156; analysis of mother's, 156; annatto, test for, 159; boiling, when necessary, 161; bottled milk, care of, 163; bottles, care of, 166; buttermilk, when used, 174; certified milk, 161; condensed milk, how used, 175; cow's milk, modification of, 157; cream gauge, 158; cream, gravity of, 172; dairy, essentials of a good, 159; "flour ball," the, 175; food, special, 175; formulas for feeding, 171, 173; goat's milk, use of, 157; herd milk desirable, 159; lactometer, 158; lime water, use of, 173; "modification" of cow's milk, 165; nipples, care of, 166; pasteurization of, 162; peptonized, 174; preparation of, 168-70; schedule for feeding, 171; seven per cent milk, 173; spores, how guarded against, 163; sterilization of, 162; sugar, use of, with, 157; "top-milk" formula, 172; whey, how used, 176. _see also_ feeding the baby milk crust, 198 miscarriage, care needed at seventh month of pregnancy, 39; causes of, 39; defined, 390. _see also_ abortion; pregnancy monstrosities, causes of, 17 moral training of child, 415-24 morning sickness, a sign of pregnancy, 4; remedies for, 35 ff.; vomiting (pernicious), 44. _see also_ pregnancy mothercraft, 1; science of, 2, 370-75 motherhood, characterized, 1; preparation for, 2 mouth of baby, care of, 199 mouth wash for use during pregnancy, 30 "mulberry mass," the, 11 mumps, 291 nails, ingrowing, 342 nature, lessons from, in teaching children, 405-12 navel, bleeding from the, 284 nervousness, hereditary (in child), 308-10; how overcome, 310-14, 323-32 nervous system, absence of connection between, of mother and child, 18 nitrous oxid, effects of, 87-90 nosebleed, 352 nurse, choice of, 56-57 nursery, bath equipment, 121; bed, arrangement of, 108, 115, 119; cleanliness, necessity for, 122; equipment of, 114; heating and ventilation, 118; lighting, 120; refrigerator, 268; sleeping blanket, 118; ventilation of, 120 nursing the baby, caked breasts, 136-37; diet of mother, 135; foods to be avoided by mother, 136; hygiene of nursing mother, 134; importance of, 133; irritability of mother, effect of, 142; mastitis (caked breast), treatment for, 100; milk supply, how increased, 143; mixed feeding, 186; mother's milk, constituents of, 139; overheating of mother to be guarded against, 142; position of mother when, 141; regularity in feeding, 141; sore nipples, how treated, 138; stools, regulation of, 142; successful or unsuccessful, how determined, 142-43; time of first feeding, 139; to be avoided, when, 144; water, administering, 140; wet nurse, the, 145. _see also_ bottle feeding; diet ovary, the, 8 ovum, development of, into foetus, 11, 12 paralysis, infantile, 330 parents, relation of to children, 413-24 pernicious vomiting. _see_ morning sickness physician, selection of, for treatment during pregnancy, 21-22 pigeon toe, 342 placenta, role of, 18 play and recreation, 390-91 playmates of children, 311 pneumonia, 307 poisons and antidotes, 356-58 pott's disease, 343 pregnancy: bathing, necessity of, during, 29; blood-pressure in, 49, 50, 52; breasts, care of the, 33; cheerful anticipation, advantages of, 4; clothing appropriate during, 22; constipation, how avoided during, 31-33, 40; convulsions, treatment for, 48; craving for special food, in, 40; diet during, 24 ff.; dizziness during, 47; duration of, 5, 12; exercise, necessity of, 27; fresh air, necessity of, 29; goitre in, 42; hemorrhoids, treatment of, 41; hygiene of, 21 ff.; irritation of the bladder, 37; kidney complications, 3; medical supervision in early days of, 2; mental state during, how regulated, 33; miscarriage, danger of, at seventh month, 39; morning sickness, remedies for, 35; progress of, 11, 12; quickening, 5; resentfulness of mother, consequences of, 3; rest, necessity of, 28; signs of, 4; swellings in, 42, 47; teeth, care of, during, 30; urine, diminution of, 47; urine, testing of, 30; vision, blurring of, the, 47; water, necessity of, in, 26. _see also_ abortion; miscarriage puerperium. _see_ lying-in period "quickening," 5. _see also_ pregnancy rheumatism, 344 rickets, 345 ringworm, 337 rupture, 283 saint vitus' dance, 330 saliva, flow of, not indicative of teeth-cutting, when, 233 scalds, 358 scarlet fever, 292-93 scurvy, 344 senses of new born baby, 232, 233 shortening clothes of baby. _see_ clothing the baby sickness of the child: abdomen in sickness, 254; breathing, 256; chest in sickness, 254; convalescence, 272-73; cough, the, 255; cry of infant in sickness, 255; disinfectants for sick room, 269; examination of sick child, 260; facial expression, 254; feeding directions, 259; fever, 264; gestures indicating sickness, 253; head indicates sickness, 254; medicine chest, the, 270; medicines, 263; mouth, the, 257; nurse, the, 251; nursing records, 262; patent medicines, 271; position of, in sickness, 252; pulse, the, 257; sick room, location of, etc., 266; skin color, 253; stools, the, 258; swallowing, 258; temperature and pulse, 263; temperature, the, 257; treatment of sick child, 261; urine, the, 258. _see also_ under several diseases skin troubles, 333 sleep: air, supply of fresh, 213-17, 219; bed-clothes, 219; bedtime for baby, 218; daily naps, 221; food, effect of, on, 220; position of baby in, 218; putting baby to, 127, 217; requirements of, by baby, 217; soothing syrups, 220; waking up in night, 219 smallpox, 295 soothing syrups, 220 sore throat, 302 spasms, 326 speech of baby, 243 sperm, blending of, with ovum, 11 spinal curvature, 342-44 spoiling the child, 310 sprains, 355 stools of baby, 184, 185 stream of life, the, 8 sucking habits in baby, to be guarded against, 224, 378 suggestion, effect of, 19, 380-89 summer complaint, 278. _see also_ diarrhoea; dysentery sunrise slumber. _see_ labor suppressors, function of, 9, 15 swallowing of bones, buttons, etc., 350 syphilis, 346, 347 teeth, care of, during pregnancy, 30 teething, 234-37; suggestions for treatment during, 237 thrush, 279 tonsils, diseased, 303; tonsilitis, 302 toys, selection of, 230 tuberculosis, 346 twilight sleep. _see_ labor twitchings, 327. _see also_ nervousness, hereditary typhoid fever, 288-91 umbilical cord, function of, 18 uremic poisoning. _see_ urine urine: albumin and casts in, 47, 50; bed-wetting, 328; diminution of, during pregnancy, 47; disturbance in, a sign of pregnancy, 4, 5; eclampsia, 3; examination of, 3; irritation of the bladder, 37; retention of, by child, 328; testing of, during pregnancy, 30, 42, 45, 49, 55; toxemia, indications of, 48; uremic poisoning, 3; urinating after labor, 97; urination of baby, 223; urine an index of disease or sickness, 258. _see also_ pregnancy; sickness of child uterus, entrance of fertilized ovum into, 9, 10 vaccination, 295 varicose veins, 41 vice, secret, causes of, 421 vomiting, 274. _see also_ digestion, disorders of; feeding the baby vulva, toilet of the, 96 vulvovaginitis, 334 walking of baby, 244 warts, 338 water: administered to baby, when, 222; necessity of, during pregnancy, 26, 45, 48, 50; part played by in nutrition of body, 365 water on brain, 331 weaning: breast-fed babies, 241; bottle-fed babies, 241 weight of baby, 183, 238-39 whooping cough, 297 worms, 276 