=?im hrr/ffffW'Ri& F$TFA7D ^ n^?v*;'•.•;*'' * U.S. NATIONAL ru LD o □ OF A SURGEON GENERAL'S OFFICE LIBRARY Section Form 113c No W.D..S.G.O. _J.f. taking a pain," as it is called. This " taking a pain " is nothing more than making an examina- tion by inserting the two fingers of the right hand gently into the vagina and feeling the mouth of the womb to ascertain if it be dilating and if the child is presenting properly. In the first part of labor by making this examination occasionally, he learns whether the mouth of the womb is dilating, and from this knowledge may be able to make a rough guess as to the duration of labor. Later he can tell by this examination what part of the child is presenting, and thus learn whether it is a natural labor or not. If either the apex of the head, the face, the feet, or the buttocks present, no inter- ference is necessary. These examinations should be made as seldom as possible, as no good and possible harm can come from frequent examinations. The fingers should be greased with a little lard before passing them into the vagina. I92 ATTENTION TO THE CHILD. The doctor need not be in the room with the patient in the early part of labor, except occasion- ally to note the progress of the labor. At the very last he should be at the bedside, for it is his duty to attend to the child. I give these duties of the physician not as advice to any member of the profession at all, but that the woman may have a correct idea, and not be led to think that the physician is doing more or less than his duty. Also that in case the physician be absent, any attendant of ordinary intelligence may perform his duties. ATTENTION TO THE CHILD. As soon as the child's head is born the physician should ascertain whether the cord is around its neck as sometimes is the case. If so, it should be removed, or else the child is in danger of being strangled. The finger ought to be put into the mouth of the child to clean away any mucus, or membrane which might interfere with respiration. Until the body is born the head should be supported by the hand. As soon as the body is born the child should be brought out from under the clothes far enough for it to get plenty of air, and placed on its right side with the head removed from the dis- charges. The cord should not be tied until the infant is heard to cry. The cord is tied in the following manner: A piece of strong linen thread is made doubled or trebled and tied around the cord with a double knot and tightly, at a distance of about two and a ATTENTION TO THE CHILD. I93 half inches from the navel. Another piece of thread is tied about an inch beyond the first, that is, to- ward the mother. The cord is then to be cut with a pair of blunt pointed scissors half way between the two ligatures. Care should be taken not to clip off a finger of the child, as has been done by careless operators. The child, being thus separated from the mother, should be wrapped in a warm blanket, old woolen shawl, or piece of flannel, taking care not to cover its face so that it can not breathe perfectly. It should then be put in a safe place while preparations are being made to wash and dress it. Do not place it in a chair where some one may without thinking sit down on it. Should the infant fail to cry a smart tap on the buttocks will generally cause it to do so. You may then be sure it is all right. But should it be ap- parently dead, means should at once be taken to cause it to breathe. Sometimes a little cold water sprinkled in its face is all that is necessary. If this fail, a sudden plunge into water, blood warm, may start respiration. So long as there is pulsa- tion in the cord, it ought not to be tied. The fol- lowing method of restoration may be tried : 'k Place the infant on his face ; turn the body gently, but completely on the side and a little beyond, and then on the face, alternately ; repeating these meas- ures deliberately, efficiently and perseveringly, fif- teen times in the minute only." 13 I94 ATTENTION TO THE MOTHER. ATTENTION TO THE MOTHER. The placenta, or afterbirth, is a circular mass composed mainly of blood-vessels, to which the umbilical cord, or naval string of the child is at- tached. Before birth it lies closely attached to the inner wall of the womb, from which it derives blood, which is sent through a vein in the cord to the child, supplying it with nourishment. After the blood has circulated through the child it re- turns through two arteries in the cord back to the placenta, from which it passes back to the mother. Now, when the child is born, or shortly after, the placenta becomes detached from the womb, and the blood ceases to flow through the cord. The placenta then is no longer of any use, and the womb expels it as it did the child. This generally takes place in from fifteen minutes to a half hour after the birth of the child. Sometimes it comes away * immediately, sometimes it may be retained for many hours or even weeks. It is generally thought to be exceedingly danger- ous to leave the afterbirth for any length of time in the womb, but there is no immediate danger, and it is better to leave it for awhile than attempt to re- move it by force. There is a notion among people that it is not safe even to let go of the cord after it is severed from the child. I was once called to see a casein which the child was born before I arrived. I found one of the attendants sitting by the bedside holding the end of the cord which they had severed. She explained that she had always been told it ATTENTION TO THE MOTHER. 195 would not do to let go of the cord until the after- birth was removed. If the afterbirth does not come away of itself no severe pulling on the cord should be allowed, as it may break or tear loose. It often happens that the patient being exhausted by the labor, the womb does not seem inclined to contract sufficiently to expel the afterbirth. In such cases, time is the best remedy. Just wait awhile and it will come all right. Some- times the hand of an attendant placed upon the belly, so as to grasp the womb, may cause contrac- tions of the latter, which will expel the placenta. Placing the patient over a vessel of hot water for a few minutes has been known to be effectual. Only the most gentle pulling on the cord should be allowed. If, while pulling very gently on the cord, the woman be asked to cough several times, it may come away. If these simple means fail, and no physician be present, one should be sent for. If it be not removed for three or four hours there is possible danger of blood-poisoning. There may be internal hemorrhage, the afterbirth plugging up the womb and keeping the blood in. This will be indicated by paleness and exhaustion of the patient. Send for a physician at once and in the meantime make attempts to remove the afterbirth. As soon as the afterbirth has been removed the mother should be moved a little to one side of the bed, while the soiled clothes are removed and clean ones substituted. The external parts should be washed very gently with a soft cloth or sponge. This should be done under the bedclothes, so as not I96 FURTHER ATTENTION TO THE CHILD. to expose the parts to the air. The parts may be dried by a soft cloth carefully pushed against them, being careful not to rub so as to irritate them. The bandage mentioned in a former part of the •chapter may now be put on. It should be fastened with pins and only moderately tight. Some writers and go to work about the ninth day. It is among these we find the most cases of diseases of the womb. It is mistaken economy for a woman to go to work soon after confinement. She will save in doctor's bills many times as much as she would make by her labor. The woman should be very careful to protect her 202 LINGERING LABORS. person from cold, as the system is peculiarly sen- sitive at this time, and rheumatic affections are liable to be brought on by exposure within a few weeks after confinement. LINGERING LABORS. It sometimes happens that when everything is right, that is, the child is presenting in a natural manner, the labor is tedious. This may be because the child is unusually large, or because the pelvis of the mother is smaller than the average, yet cap- able of transmitting the child, or because the soft parts may be unusually tense. In such cases the patient and attendants are apt to become discouraged and frightened even, think- ing that something is wrong, and that the labors never will come to an end without danger to mother and child. Remember that such cases are not unfrequent, and that nature will bring all around in time. The attendants should do everything they can to en- courage the patient and divert her mind from her case. Do everything you can to gain time, for time is the element which cures in this case. The parts slowly relax, and every pain adds to the progress though it be ever so little. When the pelvis is small, the bones of the child's head being soft, are pressed together and have even been known to overlap each other, but so gradual is this process that the child is not injured. The head may appear very much out of shape when born, PECULIARITIES OF BABIES. 203 but a few days will bring it all right, and no appre- hension need be felt. It is these lingering cases where the pains are great and do not seem to advance the progress much, that chloroform judiciously administered by a competent physician will do much toward lessen- ing the suffering. PECULIARITIES OF BABIES. The average weight of male children at birth is about seven and one-third pounds ; the average of female children is six and two-thirds pounds, and for both sexes about seven pounds. There is one case on record of a child weighing seventeen and one-half pounds at birth, the duration of labor being only four hours. Another, which weighed seven- teen pounds and twelve ounces, but was delivered by instruments. Sometimes they weigh but three or four pounds and live and do wrell. The average length of new born infants is about twenty inches, the male averaging an inch longer than the females. The size of the child seems to be governed to some extent by the age of the mother. The aver- age weights increase up to the twenty-fifth year, and diminish after the thirtieth year. The first child of a woman is always smaller at birth than children born afterward. It mav be interesting to know the sizes of the unborn child at different stages of its growth and development. Properly speaking, the human being is an embryon until the end of the fourth month of 204 PECULIARITIES OF BABIES. pregnancy, after which it is called a foetus until birth, after which it becomes aninfant, which name is appropriate until two years of age, when child- hood begins. At the third week the embryon is from one-sixth to one-fourth of an inch in length. At the eighth week it is about an inch long. At the third month it is about two and one-half inches long and weighs about one ounce. At the end of the fourth month it becomes a foetus and is from one to five inches long and weighs about five ounces. At the seventh month the foetus is about fourteen inches long and weighs from two to three pounds. The natural and usual position of the foetus in the womb is with the head downward. This is proba- bly because the head is the heaviest part. In cases of twins one may be with the head downward, the other with the head upward. A curious, but well-established, fact may be men- tioned in this connection. From the breasts of infants of both sexes there generally may be pressed out a fluid which differs but little from ordinary milk. The quantity is variable, from a few drops to two drachms. It is found at birth, or in two or three days after and continues two or three weeks, sometimes longer. The use of this milk is unknown. In another place I made mention of the caul, or membrane which sometimes envelopes the child at birth. There were formerly curious superstitious notions entertained concerning it. It was consid- ered not only as a very lucky circumstance for the PECULIARITIES OF BABIES. 205 •child itself, but it was believed that any one who possessed this membrane would be secure from danger and good fortune was sure to attend him. For this reason midwives sold the caul at enormous prices to lawyers, " as an especial means of making them eloquent," and to sailors as " an infallible preservative against drowning." I am not sure but a remnant of these superstitious beliefs still exist in portions of our country. Chapter IX. THE TENDER SHOOT. INFANT MORTALITY. Statistics show that out of one thousand children born one hundred and fifty die within the first year and one hundred and thirteen within the next four years. One-tenth of the children born die within one month of birth. Mote die in large cities than in the country or smaller towns. There must be some preventable causes for much of this frightful mortality. Many children die from causes which may be traced to the parents. We can not expect, as a rule, healthy children from unhealthy or ill-matched parents. Children are frequently born with important internal organs imperfectly developed, due to some taint in the blood of father or mother, or some more remote ancestor. Or these weaknesses may be due to some great agitation of the nervous system of the mother during pregnancy or to imperfect nourish- ment of the mother. Such cases are only avoida- ble by observing the directions laid down in former chapters. There are a great many causes of death which begin to operate only after birth, the large majority of which, there is good reason for believing, are avoidable. Many die from attempting to bring them up by hand. This is generally but not (206) BATHING THE INFANT. 207 always avoidable. Many die from the diseases peculiar to children, as scarlet fever, croup, etc., but all diseases are more fatal among children, because of the delicacy of their systems. A very large proportion die from disorders of the digestive system, owing largely to improper feeding and nursing. Of 11,382 children under twelve years of age treated at the dispensary in New York City during three years, 3,243 had some affection of the organs of digestion. Dr. Ballard, of England, showed by statistics that in five years there were in that country 314,242 deaths of children under one year of age, and of this number 277,852 were caused by disorders of the digestive organs. BATHING THE INFANT. A baby should be washed all over daily in water of an agreeable temperature. To ascertain the proper temperature let the nurse put her bare elbow in the water, and whatever is not too hot nor too cold, as judged in this way, will be about right. If she decide upon the temperature by her hands, she may get the water too hot, because the hands are accustomed to bearing higher temperatures than any other part of the body. Never use strong soap. Castile soap or some mild toilet soap ought to be used. The brand known as " Ivory Soap " is ex- cellent. If the washing be done every day as it ought to be, very little soap need be used unless the water is hard. Rain water ought to be used if possible to obtain it. Ordinarily a small quantity of water and a soft 208 CLOTHING OF INFANTS. cloth or sponge are all that is necessary, but it is a good plan to give the child a complete immersion in a tub of water once a week. Care should be taken not to expose the body to drafts. In cold weather a part ought to be exposed at a time, and washed and wiped dry immediately, and while a tub bath is used the room ought to be tight and warm. After the child is dressed the room may be ventilated again. The ears should be carefully wiped dry inside with a soft cloth. Care should be taken also to wipe the parts under the arms and about the gen- ital organs dry. No soap should be allowed to remain upon the skin. CLOTHING OF INFANTS. Infants are very susceptible to the influence of cold. Statistics show that severely cold spells of weather are accompanied by increase in the death rate among infants. The body of the child should be kept warm by clothing, and by the vital heat of the mother or nurse rather than by a warm atmos- phere. It is nonsense to talk about hardening children to the cold by insufficient protection. That was once a common idea, but is not believed now by sensible people. The clothing should be of the kind which, at the same time it secures warmth, should secure light- ness.. Light, soft flannels are best next the skin, with muslin or calico for outer garments. When the long dress is exchanged for a short one, the feet and legs should be protected by soft woolen PURE AIR AND LIGHT FOR INFANTS. 209 stockings (or cotton ones in summer), which should extend above the knees. The clothes worn during the day should not be worn at night. The clothes should fit loosely and easily and be cut with high necks and full length sleeves and be fastened by buttons or tape rather than by pins. PURE AIR AND LIGHT FOR INFANTS. Pure air is especially important for infants. Rooms should be well ventilated, and by well ven- tilated I mean that they should have free access of fresh outside air, and free exit of foul air with no currents or drafts. If there be an unavoidable draft anywhere the infant should be kept away from that part of the room. Children born in summer should be carried out daily when the weather is dry and those born in winter should be taken out after two months on mild days. They should never be kept out long at a time, and should have extra clothing if the weather be at all chilly. Babies should not be taken upon long journeys in wagons or carriages in severe weather, no matter how well they may be wrapped. They ought not to be carried out on wet days nor when the wind is very strong. Damp atmos- phere is frequently a cause of lung diseases. A strong wind may cause the child to suspend breath- ing for a time and thus produce dangerous results. A mother or nurse ought to be careful about breathing directly in a child's face. It may inhale a considerable quantity of the air which has been r4 2IO SLEEP OF INFANTS. once breathed and which, of course, is unfit to be breathed again. Kissing of babies on the mouth is not good as you can not kiss them without breath- ing directly in their faces. Kiss a baby on the cheek or forehead, never on the mouth. Light is indispensable to the health and develop- ment of children. The full glare of light in the face of very young babies is, however, injurious to their eyesight. They should not be brought sud- denly to a bright window, or before a lamp. A thin veil should be worn, but not too close to the child's face, when out of doors, until it is at least four months old. SLEEP OF INFANTS. Infants should pass the greater part of day and night in sleep, and this they will do if they be in good health. The older they get the less sleep they will take, but until the sixth year they need at least twelve hours sleep at night, and from one to five or six hours in the daytime. It is not proper, therefore, to wake a child in the morning, or at any other time, except for good reasons. Babies are not unfrequently killed by being over- lain by their mother, and on this account some physicians have advised that they should never sleep in the bed with the mother. But, as Dr. Napheys observes, "it must be remembered that an infant keeps warm with difficulty even when well covered, and that contact with the mother's body is the best way of securing warmth." For this reason the baby should sleep with its mother. SLEEP OF INFANTS. 211 Dr. Napheys then quotes the following rules, given by a physician of reputation, for preventing an infant from the accident of being overlain : " Let the baby while asleep have plenty of room in the bed. Do not allow him to be too near, or, if this be unavoidable from the small size of the bed, let his face be turned to the opposite side. Let him lie fairly, either on his side or on his back. Be careful to ascertain that his mouth be not cov- ered with the bedclothes. Do not smother his face with bedclothes, as a plentiful supply of air is as necessary as when he is awake. Never let him lie low in the bed. Let there be no pillow near the one his head is resting on, lest he roll to it and 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 lace 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. Never entrust him at night to a young, giddy or thought- less servant. A foolish mother sometimes goes to sleep while allowing her child to continue sucking. The unconscious babe after a time loses the nipple and buries its head in the bedclothes. She awakes in the morning, finding to her horror a corpse by her side ! A mother ought, therefore, never to go to sleep until her child has stopped sucking." After the third month it matters little where the child sleeps, provided it has plenty of clothing to keep it warm and does not lie where there is a 212 SLEEP OF INFANTS. draft. It should be remembered that a child upon a feather bed will be much warmer with the same amount of covering than one on a hard mattress. This should be taken into consideration when the covering is put on. Sometimes children are made entirely too warm by placing them on feather beds, even when the covering is light. A straw or shuck mattress with a soft comfort or blanket over it is better for any person to lie on, except in very cold weather. The clothing of the child's bed should be fre- quently changed and aired. This is even more important with children than with adults, since they are more susceptible to foul exhalations and secretions. A child should early be accustomed to sleeping alone in the dark. Children are not, as a rule, naturally afraid in the dark. They are made so by improper training of mothers and nurses. It is an almost universal custom to rock babies to sleep. It is not necessary. If you do not begin it the child will not expect it. They quickly learn the habit and then it is difficult to break up. Some- times, however, infants are very irritable on account of ill health and one must resort to almost every means to quiet them. Everybody knows that it is much easier "to spoil a child" than to train it properly. It is easier to give advice in this case than to follow it. NURSING. 213 HABITS OF CLEANLINESS. On this subject I wish to quote the words of Mrs. Alice B. Stockham, M. D. : "Habits of cleanliness can be taught every child. The clumsy diaper can be dispensed with by the time it is three or four months old. Let the mother practice holding out her baby immediately after nursing it, and it will easily be taught to urinate at this time and also have a passage from the bowels at a stated time in the morning and evening. The actual comfort secured to mother and child through this condition more than repays for the labor and patience in se- curing it. Teach your children to be cleanly. 'A dirty child is a mother's disgrace.' When a child begins to creep and walk the diaper must be pinned tight enough to be injurious in order to keep it in place, and then, too, the amount necessary at this time to absorb the secretions, spreads the legs apart. The bones being pliable actual deformity often results." NURSING. The first food of the child should be the mother's milk, and this should be the only nourishment for the first six months, and in most cases for the first year. There is no need of arguing this question. It is the universal testimony of scientific men and physicians. But, notwithstanding all the counsel of competent advisers and the results of experience, we find women who desire to shrink from the re- sponsibility of nourishing their own children. Of course, the mother can not always nurse her own 214 WHEN NURSING IS IMPOSSIBLE. child. There are often good physical reasons why she can not, or ought not. When she can not, the next best thing is to have the child nourished by a wet nurse. Where this is impossible, the only thing that is left to do is to feed them artificially prepared food, or as we generally say, "bring them up by hand." The foundling hospitals of the world are striking proofs of the inefficiency of the latter method. Statistics show that where these foundlings are wet-nursed the proportion of deaths is about one-third, and where they are fed by hand the proportion is from one-half to three-fourths. WHEN NURSING IS IMPOSSIBLE AND WHEN IMPROPER. Severe cases of sore nipples are but temporary hindrances to nursing. The condition of the nip- ples should be observed before confinement and measures taken, as designated in a former chapter, to prevent soreness. When this has been neglected or the measures have been ineffectual, it is neces- sary to nourish the infant artificially for a time. But after an infant has been fed for several days with a spoon or bottle it will often refuse to nurse. The cases, however, in which it is impossible to apply the child to the breast a few hours after delivery are not common. Treatment for ulcerated and fissured nipples will be given in a succeeding chapter. If the mother have consumption in a rather advanced stage, or if she be very sick from any cause, she should not attempt to nurse her child. WrHEN NURSING IS IMPOSSIBLE. 215 A temporary weakness need not induce a mother to wean her child or procure a wet nurse. It is often possible by proper care and judicious doctor- ing to restore her strength while the child is nurs- ing. Nor is it necessary in all kinds of sickness to take the child away from the breast. It is only where there is considerable exhaustion of the vital powers, or where there is danger of communicat- ing the disease to the child. It should be remem- bered that milk from a mother who is so sick as to be unable to take nourishing,food, lacks the prop- erties capable of nourishing the child. When there is inflammation of one of the breasts it is necessary to restrict the child to the other. When the inflammation disappears the first milk should be removed by a breast-pump and not given to the child. It may be necessary in some cases where the mother is not in the best of health, yet not actually sick, to let the child nurse less frequently and feed it once or twice a day with artificially prepared food. If it be necessary to give the mother medicine which would act through the milk upon the child (for it is well known that many medicines affect the quality of the milk), it will be proper to feed the child for a day or two on artificial food, while the milk is drawn off with a breast-pump and thrown away. 2l6 STATED TIMES FOR NURSING. STATED TIMES FOR NURSING. A baby may be nursed too often. It should not be given the breast every time it cries. It as fre- quently cries from being over-fed as from being hungry. " For the first month he should be suckled about every hour and a half; for the second month every two hours, gradually as he becomes older increasing the distance of time between until at length he has the breast about every four hours." It may be found best ,to vary somewhat from the rule here laid down, but as a general thing, I think it is about right. Says Dr. Chevasse: " It is sur- prising how soon an infant, at a very early age, may, by judicious management, be brought into good habits ; it only requires, at first, a little deter- mination and perseverance; therefore a nursing mother ought at once to commence by giving the child the breast at stated periods, and she should rigidly adhere to the times above recommended." I have before me a little pamphlet entitled " How to Feed the Baby." The author, C. E. Page, M. D., gives the history of an experiment tried upon a baby somewhat as follows : The child was al- lowed to nurse but three times a day from the hour of its birth, was weaned at the age of four months, and at the age of nine months was taking daily one and one-third pints of cow's milk and nothing more. He claims that the child grew and thrived and never had a moment's sickness of any kind and was never cross and fretful. He says : " I do not expect that, because of my own successful experi- STATED TIMES FOR NURSING. 217 ment—perfect and complete as it is in itself—every- one will be induced to adopt the system at once. My own faith is by no means based upon this one experiment, nor indeed is it by one iota increased thereby." He thinks the great cause of diseases in children is over-feeding. He says the fat they store up is an unnatural and diseased condition : that fat babies are not healthy babies ; have not as much muscle, and are not as strong as lean ones : that if a child is allowed to eat but three times a day it will not take more than it ought to at one time, and if the habit is formed at the start, it will not desire food at other times. He brings up a great deal of argument in sup- port of these views, and claims to have seen the experiment tried in many other cases successfully. He does not recommend weaning the child so soon as he did in the case mentioned, but says he did that in order to ascertain by measure the proper daily ration. I give his views to my readers for what they are worth. I think that most writers- and medical men will agree that babies are more often fed too much than too little. I am afraid, however, that if my readers try the plan of three meals a day for an infant they will be compelled by the cries of the child to abandon it. I might give here the history of a baby now nine months old which I have had occasion to observe every day of her life. She was apparently born hungry, would cry and fret continually until a little food was given her, then she would become quiet for a short time. The mother's milk did not come \ 2l8 STATE!) TIMES FOR NURSING. for about three days. She was put to the breast frequently, but seemed to get no satisfaction from the nursing. A little cream, warm water and very small quantity of sugar was given her, allowing her to suck it from a rag. When the mother's milk came she nursed five or six times in twenty- four hours, and had several rather severe spells of colic during the first three weeks, which were re- lieved by catnip tea and milk of asafcetida. After this she was allowed to nurse whenever she seemed to be hungry. She had no more spells of colic and was, everybody said, the best baby they ever saw. She never cried nor fretted, did not have to be rocked to sleep and would wake up and lay for a long time looking around, cooing and smiling. She is very fat and heavy, and everybody thinks she is the picture of perfect health. It seems to be perfectly natural for children to eat oftener than adults. Of course they may be- come accustomed to only three meals a day, and so may adults become accustomed to but one meal a day, but whether this be the best is a question. I have tried the one meal, the two and the three- meal plan on myself, and find that the three-meal plan is the best. The frequency of eating is largely a matter of habit. The young of all sucking ani- mals nurse frequently and are usually apparentlv fatter than the adults, certainly healthy. If babies are subject to frequent attacks of colic or are very fretful, and nursing does not seem to relieve, but rather increase the difficulty, by all means withhold food from them for considerable periods of time INFLUENCES. 219 and try other means of relieving or quieting them. Sometimes a few drops of warm water will satisfy the apparent craving for food. It is not the best plan to attempt to quiet a child with food unless you are pretty sure that the want of food is what is making it uneasy. In the case of the child I men- tioned it was evidently the want of food that made her cry, and not having sufficient food for several days she nursed too much when the milk did come and thus brought on the colic. There are great differences in babies and the treatment suitable for one will not always do for another. While plenty of suitable food is necessary to healthy growth it must be held in mind that a child will not starve in a day, nor even in two or three days if no food be taken in that time ; so do not think you are saving its life by continually feeding it. You may in some cases save life by withhold- ing food. INFLUENCES AFFECTING THE QUANTITY AND CHAR- ACTER OF THE MOTHER'S MILK I have already hinted at the fact that mental states of the mother may affect the milk, also that medicines act upon the child through the milk. Especial care is therefore necessary in the first place, to prevent these violent emotions and pas- sions, and to abstain from medicines; and in the second place to forbear nursing the child in case the first conditions can not be avoided. The kind of solid food, provided it be sufficient in quantity, and the mother be healthy, does not 220 INFLUENCES. affect the character of the milk to any considerable extent. It is a fact, however, that certain articles, such as acids, and fermentable substances, when eaten by the mother, often disturb the digestive organs of the child, causing colic and bowel com- plaints, without effecting any change in the milk which can be recognized by chemical analysis. The amount of liquid food taken by the mother affects the quantity and quality of the milk in a considerable degree. While nursing, the mother has an increased desire for water, and if she is not supplied with it in sufficient quantity, the milk will be diminished in quantity and impaired in quality. Violent mental emotions often stop the secretion of milk for a short time entirely. " The last drop of milk is the richest," is often said of the cow, and it is scientifically correct, but according to Flint this is not true of the woman. If the milk be retained in the breasts beyond an ordinary period, it alters in character. The longer it is retained the weaker it becomes. The milk is the richer then the oftener it is removed. In those cases where the mother is all right and in good health, but the amount of milk does not seem to be sufficient for the child, it ought to be applied oftener to the breast. In cases where it is not thought best to allowr the child to nurse for a short period, the milk ought to be drawn in the meantime and thrown away. A woman is not apt to menstruate during the first nine months after pregnancy, and rarely ever TOO MUCH OR TOO LITTLE MILK. 221 becomes pregnant again before the expiration of that time. Should a woman menstruate while nursing, the milk will usually become less in quan- tity, and changed in quality so as to affect the digestion of the child, causing colic and diarrhea. If conception take place while the woman is nurs- ing, the milk is also affected in quantity and quality. When pregnancy is known to exist, it is a common custom to wean the child, and with apparently good reasons. TOO MUCH OR TOO LITTLE MILK. The quantity of milk furnished by a healthy woman varies much, but on an average it has been estimated at from two to three pints every twenty- four hours. The quantity increases with the growth of the child up to about the end of three months. A healthy child will consume about two and a half pints of milk in twenty-four hours. There are occasional cases of women who have an excessive amount of milk. In some cases it oozes away constantly, keeping the clothing wet. The quality of the milk under such circumstances is poor and watery. A cloth wrung out of cold water and applied to the breasts, and diminishing the quantity of drink, are common remedies. In bad cases a good physician should be consulted. Sometimes the constant oozing away of milk is not from an over-supply, but from inability to retain the milk. On the other hand there are many cases of wo- man who have habitually an insufficient quantity 2 22 BRINGING UP BY HAND. of milk. Such cases are more numerous in cities among the poorly-fed and hard-worked classes. Indigestion may be a cause of insufficient secretion of milk. In many cases the flow may be increased by applying the child more frequently. Attention should be paid to the general health. Proper food in sufficient quantities, proper outdoor exercise, and fresh air will have a favorable influence. Al- coholic drinks, as ale or porter, are sometimes given to increase the flow of milk. This is not advisable, for although they do increase the quan- tity of milk, the effect upon the system of the mother and upon the child is injurious. A little artificial food ought to be fed to the child every day in cases where the mother's milk is scanty. This brings us to the subject of artificial feeding, or— BRINGING UP BY HAND. When it is impossible. for the mother to suckle her own child, and a wet nurse can not be pro- cured, it becomes necessary to use some other food. The milk of the cow seems to be the best adapted to the child, but it must not be given in a crude state. It is too strong and will not agree with the stomach. The following is given by a good au- thority as a substitute for mother's milk: New milk, the produce of one healthy cow, warm water, of each equal parts ; table salt, a few grains ; lump sugar, a sufficient quantity to slightly sweeten it. The milk itself ought not to be heated over the fire, but should be warmed by the water. The temper- BRINGING UP BY HAND. 223 ature should be that of the mother's milk, which is from ninety to ninety-five degrees Fahrenheit. There are many kinds of artificially prepared food for infants, among which arrowroot, flour, tapioca and other substances which contain a large percentage of starch, figure prominently. Now, it has been ascertained that up to six months of age the child can not digest starchy food, as the saliva which is necessary to convert the starch into sugar is not secreted in sufficient abundance. After the sixth month a small proportion of starchy food may be added to the milk. Then arrowroot, tapi- oca, baked flour and sago may be given in small quantities, gradually increasing them. What Will agree with one child often will not agree with another, and what will agree with the same child one time will not at another time. Artificially-fed infants generally get along well enough in the winter time, but during the hot weather of summer are more liable to diarrhoea, colic and other disturbances of digestion. It is necessary then to watch closely the effects of the food and lessen the quantity for a time. Some- times a change from diluted milk, as given above, to cream, water and sugar is a good one. The quantity of water added to the cow's milk may be gradually decreased until about the tenth month, pure milk may be given with the addition of a small amount of starchy food. A little ani- mal food, as beef tea or meat broth of any kind may be given sometimes for a change, after the teeth have begun to appear. The effect should be 224 BRINGING UP BY HAND. carefully watched, however, and if any disturb- ance of digestion result it should be at once discon- tinued. When the milk and water disagrees it sometimes happens that a little meat broth will prove beneficial. Eggs may sometimes be given, but they should be carefully cooked. The proper way is to place an egg in boiling water and set the vessel off the fire. In two minutes examine the egg by breaking the shell at one end. If the white is just turned to a milky consistence it is done. If the white is hard it should be rejected. A little of the white and yolk may be mixed and added to the milk and water preparation. In trying any new kind of food a very minute quantity should first be added to the preparation of milk and water already used and then gradually increase it if no bad effects are observed, or if the bad symptoms already existing begin to disappear. The child should be made to take its food slowly. Feeding with a spoon is not a good way. In the act of nursing the child not only gets its food slowly, but the saliva is mixed with it and diges- tion is more perfect as a consequence. A nursing bottle is the nearest approach to the natural method of feeding. But objection is made by many late authorities to the common white rubber nipple, because of the white lead that is used in the manufacture of the rubber. The lead gets into the system of the child and poisons it, they say. Whether this be so or not, it may be well to use something else. "Any glass bottle of a conveni- ent shape and size, with a few folds of soft linen WEANING. 225 pierced with a small hole, and adapted to the mouth in the form of a nipple, will answer every purpose." Mrs. Dr. Lozier says : " I have known a very good artificial nipple to be made of a fine sponge, with cambric linen covering it. A small quill stitched in thoroughly is passed through the center nearly to the linen cover, and by fitting the sponge over the top of a small-sized bottle it an- swers a good purpose." It is very important that the bottle and artificial nipple be kept scrupulously clean. Every time after using they should be scalded out with hot water. It is well to keep two bottles, then one may be cleaned while the other is in use. It is best to form a habit of cleansing the bottle imme- diately after using. Never give an infant alcoholic liquors, tea, cof- fee, chocolate, salty meats, pickles or highly spiced food of any kind, not even in the smallest quan- tities. WEANING. When the child is about a year old it should be weaned. The time of weaning should depend upon circumstances. Twelve months is about the average time. It may be best to wean a few months earlier or wait a month or two longer. It should not take place immediately preceding or during warm weather. If the mother's health is not good weaning should take place sooner, but if the mother gets sick in hot weather the child should not be weaned, but a wet nurse should if possible be obtained. 15 226 WEANING. Weaning should be a gradual process, occupying several weeks. The amount of spoon food should gradually be increased and the amount of nursing gradually diminished. A little artificial food may be given at the age of six months and occasionally thereafter until the time of weaning, observing the directions for preparing artificial food given on the preceding pages. Solid food ought not to be given until the child has several grinder teeth. After weaning the food of the child may be varied, but until two years of age good, fresh cow's milk should form a large proportion of the food. Fruits and green vegetables should be given in very small quantities at a time. The skins, seeds and other hard parts of fruits should be first re- moved. Many raw fruits, as apples, are apt to produce colic, because of the air carried into the stomach and the fermentation which may take place if digestion is not rapid and perfect. Care should be exercised in giving raw fruits, especially in warm weather. None but perfectly ripe and sound fruits should be given. Children naturally desire sugar, even at an early age, and it is good for them if properly given. They may get too much at one time, causing colic and diarrhoea. Candy is sugar changed slightly by heat, and is often mixed with many injurious substances, such as white clay and various coloring matter, some of which is poisonous. It is often made of glucose or grape sugar, which is not as sweet as cane sugar. Instead, then, of giving children candy let them have occasionally a little TEETHING. 227 pure white sugar. But until the child is old enough to manage a lump of sugar without danger of get- ting choked the sugar had better be put into the milk or other food, or in the form of a "sugar-teat." If the weaning be done gradually there will be little danger of trouble with the breasts. The " drying-up " of the milk may be hastened by rub- bing the breasts once a day with a mixture of sweet oil and spirits of camphor. The mother should drink as little as possible during this time. The breasts should never be drawn, as this will increase the secretion of milk. When it is desired to complete the weaning, that is when the child has been allowed the breast for the last time a good deal of trouble may be saved by putting a bitter substance of some kind upon the nipple which will create a disgust for it in the child. A very little quinine or aloes .will do no possible harm to the child and will be effectual in completing the process of weaning. TEETHING. The teeth make their appearance at different periods in different children. They generally be- gin to appear at the age of seven months, some- times as early as the fourth month, sometimes not until the eighth month. The lower teeth appear a little earlier than those of the upper jaw. There are some exceptional irregularities in the order in which the teeth appear, but usually it is about as follows: Between six and eight months after birth four 228 TEETHING. middle front teeth appear, two above and two below. At the end of twelve months there are four more front teeth, one in each side, above and below. At the end of eighteen months there are four grinder or back teeth, one in each half of each jaw. At .the end of two years there are four canines, or •" eye-teeth" and " stomach teeth," and at the end of three years there are four more grinders. These constitute the twenty temporary or milk teeth. There are said to be some very rare cases of children being born with teeth and also cases of persons who never cut any teeth. King Richard III., of England, it is said, had teeth when born. Shakespeare makes the Duke of York, Richard's nephew, say: " 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." The permanent, or second set of teeth, begin to replace the others from the sixth to the eighth year, and all except the last grinders, or wisdom teeth, have usually appeared by the thirteenth year. The wisdom teeth come about from the seventeenth to the twenty-first year. Healthy children rarely ever have much trouble in cutting their teeth. With some the irritation is so great as to cause various troubles of indigestion and sometimes convulsions. There is always more ■or less fretfulness, feverishness and thirst. Pres- sure upon the gums relieves to some degree the irritation, hence it is customary to give the child a rubber ring to bite. In some rare cases it may VACCINATION. 229 be necessary to lance the gums. This can be done by any one. A sharp pocket knife will answer. Take hold of the gum with thumb and finger of the left hand and press the knife down until it grates on the tooth with the right hand. Says Sozinskey in his admirable work, " The Care and Culture of Children : " " There can be no valid objection pre- sented against this operation. It causes little pain and generally affords relief speedily. If there is any tendency to convulsions, it is criminal to delay the performance of it one minute." VACCINATION. Says Dr. Napheys: " If observation and expe- rience ever taught anything, they have taught the protective power of this operation against the most loathsome and one of the most fatal diseases that ever afflicted the human race. And that mother who is careless and indifferent in this matter, neg- lects for her children a means of preventing dis- figurement and saving life, compared with which all other means are scarely worthy of mention." The testimony of medical men in favor of vac- cination is almost unanimous, and I will not stop here to argue the question. The child should be vaccinated at an early age if the health permit, within the first three months if possible. A relia- ble physician should be called upon to perform the operation, not that it is a difficult one, but he will have better opportunity of procuring pure and good virus, and can give the advice necessary in the case. Do not wait until there is small-pox in the 230 EXERCISE FOR INFANTS. neighborhood, but when the child is about three months old, see that it is vaccinated. When the child is three years old have it vaccinated again. It is well to vaccinate about every five or six years through life. No matter if it did or did not " take " the first time. To be on the safe side, vaccinate often. When so simple an operation can, with almost absolute certainty, secure immunity from so loathsome and dangerous a disease, there is no excuse for not having it done. EXERCISE FOR INFANTS. The only exercise a very young infant gets is that obtained when it is picked up and carried about, and when it kicks with its legs and throws its arms as it lies on its back. It is a good plan to take the child from its cradle occasionally, place it on its back on a pillow, and carry it about the room. Until it is about three months old, it will not be able to maintain itself in a sitting posture. In carrying a child then before this power is acquired, its back ought to be supported. The common practice of lifting babies high in the air, is not to be recommended. There is dan- ger of letting them fall, besides it is necessary in doing this to grasp them very firmly, and this may injure the delicate body. Some persons go so far as to throw a baby up and catch it as it comes down. This is to be condemned. Brain diseases may be produced by the quick motion and by the concus- sion in falling, to say nothing of the danger of let- EXERCISE FOR INFANTS. 231 ting the child slip through the hands and fall on the floor. When the child is old enough to creep and walk it will usually take plenty of exercise if left to its own inclinations. It does not need to be taught to walk—it will teach itself. Only let it alone and keep articles which would injure it, if it fell against them, out of its way. A child should never be lifted by taking hold of its arms. Dislocation of the shoulder and fracture of the collar bone have been produced by lifting children in-this way. In case assistance is given in learning to walk, the child should not be held by the arms. The proper way to lift a child or support it when it is trying to walk, is by placing • the hand on each side of the chest immediately beneath the armpits. Objections have been made to perambulators, or baby carriages. It is claimed that they have a tendency to make a child crooked and round- shouldered. Perhaps if used too frequently and too long at a time there is danger, but I think if used properly they are a good thing. Babies enjoy riding in them, and they certainly are a great relief to mothers, as carrying a heavy baby is very fatiguing. Chapter X. BUDS AND BLOSSOMS. BOYS AND GIRLS. Both the boy and the girl are, or should be, objects of the mother's special care from infancy until they are past the age of puberty, which usually occurs about the fifteenth year. When I have treated the subject of the care of girls up to this age, I shall have arrived at the place of begin- ning, for there the girl becomes a woman, and it ► was at this point I began in Chapter III. This chapter will be devoted to a discussion of the care of youth from the age of infancy until they have become men and women. Every mother should certainly be anxious that her children grow up to be noble men and women. The schools can do much, but parents, and espe- cially the mother, can do more towards developing to its highest degree the germ of manhood which exists in each child. Children should not be allowed to grow up like weeds. They require con- stant watching and careful training. Time and money spent in this direction will prove a good investment. If you wish a child " to bring your gray hairs in sorrow to the grave." let him grow up under the influences of the streets, take no thought of his actions, and have no care of his education ; but if you wish him to be the comfort (232) DIET OF THE YOUNG. 233 and solace of your old age, do all in you power • while he is young " to train him up in the way he should go." Says Dr. Sozinskey : "Through the haphazard method of rearing children commonly ollowed, parents too often prepare for their own lips a cup fuller of bitterness than the waters of Marah, for to them children who are defective, in either their physical or mental nature, are more or less of a curse." The mind and the body should be educated to- gether. Both require constant attention. Intelli- gence and sound judgment are required to train children either physically or mentally. Do not be above receiving advice, then, from books. Send your children to school, but do not trust to the school-teacher to train them. Teachers do the best they can, but they have not the same oppor- tunities that parents have. Work, if possible, in harmony with the teacher. In the following pages I have given some hints which may be of inestim- able value if heeded. They are not my wisdom, but simply my statement of the wisdom of many who have been successful in the art of training and caring for children. DIET OF THE YOUNG. Children and youth should have plenty of whole- some, nourishing food. In our large cities we sometimes see examples of children who are poorly fed, the food being insufficient in quantity and poor in quality. Among this class we find many pecu- 234. DIET OF THE YOUNG. g;liar diseases and deformities which are unknown in the country or among the well-fed population. I do not believe children will eat too much if left to their own inclinations. They should not be prompted by parents, or enticed by improper lux- uries. Never urge a child to eat. Place before him wholesome food, in sufficient quantity, and let him eat all he wants. If he does not want to eat, do not force food upon him either by advice or com- mands. By wholesome food I mean what is generally wholesome for the adult members of the family. I would make an exception, however, of tea and coffee and all stronger drinks. No person should ever take stimulating drinks until after the age of puberty. I have known parents to offer babies tea and coffee, thus training them in a habit which they will find almost impossible to break off when older. I do not believe that tea and coffee are injurious to adults except to some persons, but that they are injurious to children is well established. Children do not need stimulating food. Hence, pickles, highly-spiced meats and other highly seasoned ar- ticles should not be placed before them. The simpler their food the better. On the other hand, children should be provided with good, sweet cow's milk in abundance. Most children like to drink milk, and in most cases it agrees well with them. If good milk is provided, they will rarely ever desire tea or coffee. A child may take a " notion " to drink tea or coffee merely ibecause he sees older persons drinking them, and DIET OF THE YOUNG. 235 not because he likes their flavor. This same desire to imitate older persons leads boys into habits of smoking and chewing tobacco. One of the first things a child should be taught is not to do things simply because some one else does. A child should learn to know a child's place. If a firm stand is taken at once bv the parents, little trouble need be anticipated. It is no crime, nor cruelty, to deny a child of that which you know will injure its health. Children require very little meat, and an exces- sive quantity is injurious. As a general rule they do not like meat until after they are five years old. It should, therefore, never be urged upon them. The nitrogenous, or building-up food should be given more frequently in the form of milk and eggs than in the form of meats. I have said children should not be enticed to eat more than a proper quantity by improper luxuries. Ripe, raw fruits, or fruits well cooked and sweet- ened with pure sugar, are not apt to be injurious, and may be allowed in any reasonable quantity. But pies, cakes and candies ought not to be given freely to children. Limit them to occasional in- dulgence, and then in small quantities. A child, like an adult, may eat a sufficient quantity of plain food and then be tempted by the taste to eat an extra quantity of cake and pie, and thus bring on various disturbances of the digestive organs. Children should eat oftener than adults. In this respect some parents go to one extreme and some to another. In the one case they are allowed to "'piece" continually, and usually the "pieces" 236 DIET OF THE YOUNG. between meals consists of pieces of pie and cake.. In the other, they are compelled to wait from one meal to another, and then perhaps on certain occa- sions, made to wait until the older members have eaten, thus making a very long period between meals. If a child gets hungry between the regular meals, he will ask for something to eat. It is cruel to tell him to wait an hour, which to him may seem a day. Unless it be a very short time before a meal, give him a piece of bread and butter with some fruit, or some bread and milk. Do not give him a cake or a piece of pie. If he is really hun- gry he will relish the plain food, if he is simply desirous of some luxury, he ought not to have it except at regular meal times. Sweetmeats, if used at all, should form a part of, rather than an addition to, a regular meal. Children are apt to indulge too freely in fruits when they get them only occasionally. Good ripe fruits should be on the table at least one meal out of every three. If they have fruits frequently they are not apt to gorge themselves at any one time. Money spent in purchasing apples and other fruits is a good investment, for it may save many a doc- tor's bill. Boys and girls should not be allowed to eat green fruits. The best way to keep them from it is to furnish them with ripe ones. Children should be taught to eat slowly. Most Americans eat too fast. It is a habit very difficult to break. We learn it in youth to a great extent. I remember when a child at certain times hurrying through with my meals in order to get the sooner EXERCISE FOR CHILDREN. 237 to play. Instead of being reprimanded for it, I was at other times scolded for not eating fast enough. Children are often inclined to talk while eating, and parents are usually inclined to hush them up at such times. They should not be scolded for talking while at their meals. The talking pre- vents their eating too fast. They should rather be encouraged to talk while eating. The meal time should be a time of general conversation between parents and children. The more talking the better the digestion. The conversation should be of a cheerful nature and not upon solemn subjects. What I have said about the diet of children ap- plies without any particular change to both boys and girls from two years of age up to fourteen or fifteen. It should be remembered, of course, that as children grow older their diet should approach more and more like that of adults in quantity and quality of food and frequency of eating. Girls will not eat as much as boys of the same age, and they do not require as much. EXERCISE FOR CHILDREN. Children are by nature busy creatures. Action is a part of their very existence. Girls need as much exercise as boys, but they are generally more restricted, and this is one of the reasons women are not generally as stout and robust as men. Children should never be restrained in their ten- dency to exercise their bodies. If boys and girls are left to follow their own in- stincts they will take exercise enough. They need 238 EXERCISE FOR CHILDREN. cautioning only in regard to a few particulars. They should not sit on the damp ground or in a draft when warm with exercise, nor drink too free- ly of cold water. If a boy has been playing and has taken off his coat he should put it on when he sits down to rest. The danger of taking cold by being exposed to drafts when warm and not in motion should be impressed upon the minds of children. There are some rare cases of children, girls especially, exercising too severely. Girls have been known to rival each other in jumping a rope, for example, until one of them dies from the rupture of a blood vessel. There are some games and sports which may become injurious if indulged in too much. Jumping and wrestling are apt to strain the muscles or cause rupture. They should not be encouraged. There are many kinds of work which boys and girls can do as well or better than adults, but it is wrong to demand the whole or even a greater part of a child's time during the working hours. Chil- dren compelled to work in factories or in other places where six or eight hours a day are occupied even in light labor, are usually stunted in body and mind. The young person has to grow and develop physically and mentally, and this can not take place properly under such conditions. Children should be taught to work, and a little work ought to be required of them each day, as soon as they are old enough, but the greater part of their time should be devoted to play and mental improve- ment. "All work and no play makes Jack a dull EXERCISE FOR CHILDREN. 239* boy," is as true as it is old. Let girls be " tom- boys " if they will. Let them romp. There is no impropriety in their doing that which will develop muscle and bone and perfect their physical systems generally. Boys on farms should be taught to feed and care for animals and do a great many kinds of light work, but they should have their time also to go to school, to play and to amuse themselves with books, pictures, etc., in the house. Girls on the farm can be taught to do many kinds of work indoors and out, but they should not be compelled to drudge. It is more difficult to manage boys and girls in town than in the country, because there is less to be done which they can do and the association of so many brings many evils. But even in town there are many little duties about the house and many errands to run with which both boys and girls can be employed a small portion of their time. Parents often prefer to do work themselves. because they think they can do it better and get through with it sooner than children would. They think it easier to do the work than to take the trouble to teach the child to do it. Such persons should remember that simply getting the work done is not the object, but the training of the child. A little work done each day by children is for their good in several ways. While they are engaged in it they are out of mischief. They are learning habits of work which will be of value to them as long as they live. They are learning how to do* 240 HABITS. work which they may be compelled to do when they grow older. They are developing their mus- cles and all the parts of their bodies by the exer- cise which they might not otherwise take. Mothers, see that your children, both boys and girls, are taught to work and that they do a little, be it ever so little, work every day, but do not compel them to drudge from morning till night, as adults often must. Make almost any sacrifice rather than allow a young child to work all day from week to week in a factory. HABITS OF CLEANLINESS SHOULD BE TAUGHT. Children may be taught to hate dirt at a very early age. A child should be bathed every day by its mother or nurse, until it is old enough to bathe itself, and then a tub of water of agreeable temperature should be provided once a week in winter and two or three times a week in summer. Most children love to dabble in water. Let them have the privilege often. Boys often stay too long in the water while " in swimming," and sometimes they get drowned, but these facts are no valid reasons for prohibiting them from bathing in the running streams and clean ponds and lakes. Boys should be taught some of the simplest facts in regard to bathing and fre- quently cautioned concerning the dangers of deep water, rapids, etc. A boy may learn to swim in water not deep enough to drown him. Small boys ought not to go bathing near where the water is deep unless accompanied by older and larger per- HABITS. 24I sons. Swimming is a very desirable accomplish- ment. It not only affords a healthful exercise, but may often be the means of saving life. The following rules for bathing were issued by the Royal Humane Society of England: "Avoid bathing within two hours after a meal. Avoid bathing when exhausted by fatigue or from any other cause. Avoid bathing when the body is cool- ing after perspiration. Avoid bathing altogether in the open air, if after having been a short time in the water there is a sense of chilliness with numbness of the hands and feet; but bathe when the body is warm, provided no time is lost getting into the water. Avoid chilling the body by sitting or standing undressed on the banks or in boats, after having been in the water. Avoid remaining too long in the water, but leave the water immedi- ately there is the slightest feeling of chilliness. The vigorous and strong may bathe early in the morning on an empty stomach. The young and those who are weak had better bathe two or three hours after a meal. The best time for such is from two to three hours after breakfast. Those who are subject to attacks of giddiness or faintness, and those who suffer from palpitation or other sense of discomfort at the heart, should not bathe without first consulting their medical adviser." What has been said in regard to change of cloth- ing in Chapter II, applies to children as well as to adults. See that this is attended to. Have night- gowns or night-shirts for girls and boys to wear, 16 242 BED WETTING. and see that they take off their underclothes on going to bed, and put on the night-garments. HOW TO PREVENT CONSTIPATION. Teach children to form a habit of regular daily attention to evacuation of the bowels. You can explain to them the necessity of regular evacuation to prevent constipation, and warn them of the dan- ger of going too long without evacuations. Read again what is said on this head in Chapter II. In another place I shall discuss the remedies for constipation when it amounts to a disease. I wish to impress here simply the great importance of teaching early habits of regularity as a means of life-long prevention of this source of many evils. BED WETTING. Children are often addicted to this. Sometimes it amounts to a disease. Frequently it is a habit. They should be made to pass urine before going to bed, and not allowed to drink large quantities of liquids late in the evening. Children can not retain the urine as long as adults, nor men as long as women. It is wrong to scold or punish children for wetting the bed. When the precautions here given will not prevent it, see what is said on this point in a following chapter. The treatment in such cases will there be given. BAD HABITS. 243 BAD HABITS. Habits acquired in youth, whether good or bad, are rarely broken up in adult life, or, if broken up', it is with great effort. "Just as the twig is bent the tree is inclined," you know. The great import- ance then, of inculcating good and preventing the acquirement of bad habits in youth can not be overestimated. The use of tobacco is easily learned, and a very difficult habit to break. It is a difficult matter to prevent your boys from associating with boys who smoke and chew. Boys learn readily all sorts of evil things from their companions. The most powerful teacher a boy can have is another boy, or a group of boys, but this teaching is powerful in most cases for evil and not for good. Boys ought to be taught at an early age the facts con- cerning the use of tobacco and spirituous liquors. They ought to know that while older persons are often not injured and sometimes appear benefited by moderate indulgence in tobacco and alcoholic liquors that the universal testimony of physicians and men of science is that these articles are very injurious to youth. The filthiness of the tobacco habit ought to be forcibly impressed upon the young minds. They ought to be told that nearly all older persons who use tobacco wish they had never begun the habit in youth, but having begun they find it almost impossible to break it off. Boys ten years old are not too young to receive such advice and instruction. 244 BAD HABITS. I can see no harm in doing what I have known parents to do, that is, offering to give their sons a certain sum of money when they come of age, pro- vided they do not learn to use tobacco in that time. If they do not learn it before the age of twenty-one, .they are not very apt to learn it afterward. But the open habits of tobacco using, etc., are not so difficult to prevent as the secret habit of mas- turbation, or self-abuse. This is practiced by youths of both sexes. I do not believe, however, that it is so alarmingly prevalent as some writers would have us believe, and I know that many on arriving at a maturerage see the evil, and break themselves of the habit. Says Flint in his work on Theory and Practice of Medicine: " Many sensitive per- sons who have been addicted to self-abuse in early life, suffer greatly from the belief that their mental and physical powers have been irreparably injured. The evils, great as they sometimes are, are greatly exaggerated by popular works and lectures de- signed to excite fears for a mercenary end." Many writers greatly exaggerate not only their statements of the prevalence of this vice, but the consequences which result from it. Whether these men have a mercenary end in view I have no right to say, but it is certain that the advertisements we constantly see in the newspapers of men who pre- tend to treat diseases which they claim to arise from this practice, are wonderfully exaggerated, and that the authors of them are filling their pockets with money thus drawn from young men whose fears have been unduly excited. BAD HABITS. 245 Masturbation, or self-abuse, consists in applying friction to the genital organs by the hand until they are unduly excited. It is more common among boys than among girls. The effects of this unnat- ural excitement are first manifest upon the general nervous system, and then indirectly upon the or- gans of digestion, circulation, etc. Insanity is often traced to this cause. How do children learn this bad practice? In various ways. Sometimes as a result of not wash- ing the whole body; frequently dirt accumulates upon the genital organs and causes an itching. This directs the child's attention towards the or- gans and the hand is at first used to give relief. The pleasurable feeling thus produced is kept up until a habit is formed. Sometimes ignorant serv- ant girls who are left in charge of children teach them the practice to keep them quiet. More fre- quently the practice is learned from bad associates. Children in school teach it to each other. I need not enumerate the symptoms by which a masturbator is supposed to be known. They are obscure, and the ordinary person and even the physician, often can not determine whether or no, the child is addicted to the vice. They are ashamed to acknowledge it in most cases, so that question- ing is of little avail. It is a vice which does not produce bad effects immediately, but only when kept up for years does it show marked effects, and then the same symptoms maybe produced by other causes, as by worms in the intestines or by indi- 246 BAD HABITS. gestion from improper food. Its effects differ in different individuals. It is questionable whether it would be the proper thing to warn children of the habit before we are convinced that they are addicted to it. There are many who know nothing whatever about it, and of course are safe as long as they don't know. To tell them that there is such a thing, would, no doubt, in many cases, be equivalant to teaching them the practice. They might be told that it is wrong to handle those parts of the body without giving a reason why. Tell them that when they are older they will learn the reason why. Bearing on this point, I quote an opinion of an eminent man, the Rev. Lyman Abbott. He says : " Our children ought to be taught by their parents its [the sexual passion's] sacred significance and its value. They ought not to be left to learn about it from often immoral and always ignorant com- panions. They ought not to be punished for falling into a habit of self-indulgence against which they have never been warned. This strange, mysteri- ous desire, which always accompanies health and vigor and which prompts both to the purest love and the most beastial excesses, can not be eradi- cated, for God has planted it in man ; it should be early directed by the child's natural guardian and teacher." Among the indirect means of preventing this evil may be mentioned the following: Pay strict attention to cleanliness. See that the parts are kept clean from the earliest infancy. Employ no BAD HABITS. 247 ignorant servants. If necessary to leave a child long in the care of a servant, instruct the servant and show her the enormity of the offense of teach- ing your child such a habit. Such instruction, however, should be given cautiously. Don't antici- pate the actions of the servant. Do not tell her directly that she must not teach the child so and so, but tell her to watch him and prevent any han- dling of the organs, and to be careful herself not to handle the child's organs, lest a habit be formed. Keep the boys off of the street as much as possible. Let them be as seldom as possible out of your sight, or out of sight of some older person. Observe the character of the girls who associate with your girls, and keep a close watch generally over their con- duct. Have children sleep in separate beds and more especially be careful not to let your children visit the children of other families and stay all night with •them. In general keep a close super- vision over your children, at least, until they are twelve years old. These precautions will in most cases prevent the formation of the habit in early youth. Sometimes the habit is formed after the age of puberty. In such cases, little can be done to prevent the formation of the habit, but most young persons can then be forcibly impressed with the danger and be led by an effort of the will to break off the habit. But if children have been properly trained and guarded, have been furnished with plenty of harmless means of amusement, and have been made to do a small amount of work and study each day up to the age of puberty, there is 248 SLEEPING. little danger of their ever becoming victims to this terrible vice. The best way to keep the imps of mischief and evil away is to put on guard the an- gels of industry. If children have plenty to do that is harmless, they will have little time or incli- nation to do that which is evil. Try in every way possible to secure in your chil- dren good habits, such as punctuality, industry, truthfulness, neatness of dress, cleanliness of per- son, politeness, deference and respect for age. The way to do this is, in the first place, to set a good example. You must be yourself all that you would expect of your children. Frequent advice. frequently calling attention to their failures to ob- serve proper manners, frequent commendation when they do what is right will in time secure the result. Begin early to train, and keep training all the way up from infancy to manhood. The results will amply pay the trouble. SLEEPING. I have elsewhere stated that two children ought not to sleep in the same bed. It may not always be practicable to follow this advice, but there are good reasons for giving it. If one has learned a bad habit, the other is almost sure to learn it. If one is diseased in any way, the healthy one may be affected. Besides, the sick one may be restless and uneasy and thus disturb the sleep of the well one. There is a common notion that a child suffers if allowed to sleep with an old person, or that a weak SLEEPING. 249 person will affect a stronger one if they sleep to- gether. Whether there is any special influence" exerted by one over the other, I can not say, but it is certain that when two very much unlike in strength, sleep together, one will suffer from too much clothing and the other from too little. To sleep lying on the back is not a good habit. The abdominal organs press upon the large blood- vessels and check the circulation. Bad dreams and nightmares are often a consequence. If an infant be laid down on its side, rather than on its back, every time it goes to sleep, it is reasonable to suppose that a habit will be formed of sleeping on the side. Children should be required to go to bed eariy, whether they get up early or not. They should not be roused from sound slumber if it is late in the morning, but if they are simply dozing, and it grows late in the day, they had better be made get up. They may form a mere habit of dozing long after the sun is up. This produces habits of laziness. It is true they should have a great deal of sleep, but we should aim to secure this during the hours of darkness, hence the propriety of going to bed early. Children often take cold and thus bring on croup, sore throat, etc., by getting restless in the night and throwing off the bedclothes. The restlessness may be produced by being covered too warmly, or by eating too much before going to bed, or by other causes. It would be well to make night clothes for children in such a manner that if the bedclothes are thrown off they would not be exposed in any 25O CARE OF THE TEETH. part of the body to the air. A night-gown might be made all in one piece, just as though stockings, drawers and shirt were all in one and opened in front or back and secured by buttons. Such a garment made very loose will be very comfortable and may be the means of saving life by preventing the taking of colds. This is a hint worthy of con- sideration. CARE OF THE TEETH. I said nothing about the care of the teeth in the chapter on general hygiene, preferring to speak of it here, because if one does not begin to care for the teeth early in life there is little hope of keeping them in sound condition. It is, to me, an unexplainable fact that teeth often begin to decay and ache before they get their growth. It seems to be true, that while some per- sons may take extra care of their teeth from the first, they will decay at an early age, while with others they will remain sound and perfect without any care up to old age. Writers have sought to explain why teeth decay among civilized nations. Some claim that it is because our food does not contain the elements for their nutrition. Others, that it is because we eat sweet food and sour food, and cold articles and hot articles, and do not keep them clean. Some writers tell us that savage nations always have sound teeth. This is not true. Many instances of decayed teeth are seen among savages. Others again, maintain that our teeth decay because we do not use them enough, our food being prepared by cooking and being finely CARE OF THE TEETH. 251 divided we do not need to masticate it much. It seems to be a law of nature that a part disused in time disappears or dwindles in size or becomes weaker. But, notwithstanding, it is a fact that sometimes all that we can do is of no avail to prevent decay of the teeth, yet there is no doubt that a great cause of their decay is want of cleanliness. Particles of food left between the teeth decompose and act upon the enamel. Acids affect the enamel. If the teeth be brushed two or three times a day with a soft brush and water, much decay might be prevented. Another cause is over-hot and over-cold drinks. These may cause the enamel to crack and allow the food to penetrate the inner substance, and cause its decay. Cracking nuts and biting thread with the teeth tend to crack and wear the enamel. Children then, as soon as they get their second, or permanent set of teeth, should be taught to form a habit of cleaning them regularly every day, and should be warned against the danger of using their teeth for cracking nuts and biting hard substances. Impress upon their minds the advantages of having good sound teeth through life. Good teeth add to the beauty wonderfully, and who does not desire to escape the horrors of toothache? A stiff tooth- brush ought not to be used, as it injures the gums. Once in a great while the teeth may be polished by putting on the brush a little powdered charcoal. Avoid all tooth powders and other preparations which are sold for the purpose of cleaning the teeth. 252 MENTAL CULTURE. EFFECTS OF RAPID GROWTH. Says Dr. Fothergill, an eminent English physi- cian: "Rapid growth is a great tax upon the system, the more so that it is not unseldom accom- panied by loss of appetite and even a feverish con- dition. Under these circumstances the growth goes on at the expense of the material of the body ; hence the listlessness, the rapid emaciation, the tendency to disease." This writer thinks that consumption often orig- inates at this period, and that we can not be too careful to see that children have good, easily di- gestible food, good air, warm clothing and be not taxed with labor while growing. There is a belief among eminent authorities at present that consumption is caused often by want of proper proportions of fat in the food. Dr. Foth- ergill thinks children while growing should not be denied fats. Plenty of cow's milk, cream and all, since cream is fat, should form a large share of their food. Good fresh butter is a palatable and wholesome form of fat. Children should not be denied butter. MENTAL CULTURE. I said at the beginning of this chapter that parents should not trust to the teacher entirely to give the proper education to children. There is much that parents can do to supplement the teach- er's work. The parents' part of mental education, moreover, should begin long before the ordinary school age. You may begin to educate a child MENTAL CULTURE. 253 from the moment of birth, not only mentally, but morally and physically. I have given some hints in regard to its physical education in what has been said about the feeding, exercise, etc., of infants. The best moral education it can receive is to be taught obedience to parents and respect for the rights of others. An infant a few weeks old may manifest a willfulness of disposition and have fits of anger, which traits may be repressed or encour- aged by parents. It begins to observe objects almost as soon as born, and it is then its mental education begins. The parents may aid very much here by furnishing the child at a very early age with a variety of playthings, for the child acquires its ideas of form by observing forms, and it learns to observe by observing. The education at an early age should be largely of the nature of amusement. What is known as the kindergarten (garden of children) system of educating children is based upon this principle. A great deal may be done by parents from day to day, asking children questions about their play- things. The faculty of language is not only thus developed, but observation and memory are stimu- lated. The simple question, "What did you do to-day?" stimulates the child's memory, for his mind is at once set to work to recall the past. His answer educates in the use of language. If he mispronounces a word, correct him, and make him repeat it correctly. The question, "What is this?" when you take up or point to some object is a means of educating 254 MENTAL CULTURE. in language. When the child gets older the ques- tion, " How many?" may be asked, and still later, "What is the color?" "What is the shape? " of this or that object. When should children be sent to school? It depends somewhat upon the strength of the child. I should say never before the age of six years, and in cases of very precocious and weakly children not before eight or nine. Children are often sent to school simply to get them out of the way at home. This is wrong. Going to school is almost a necessary evil. I say necessary evil, because there are many objections to the common mode of educating children together in school. The teach- ers are not always what they should be, the air of school-rooms is not the purest, the confinement so many hours at a time is not good for physical development, the child is in danger of learning much that is evil from bad schoolmates. These are some of the objections to school education. But on the other hand, children learn much in school they never would learn at home ; they learn much by coming in contact with other children. A child who has never gone to school up to the age of eleven or twelve years will be very green and awkward. He must learn the ways of the world, and the school is the place. He must go into society sooner or later anyhow, and it is better that he be fortified by home training to withstand the temptations of society and be initiated into the world at an early date. Parents might do much towards the school edu- MENTAL CULTURE. 255 cation of their children by watching closely the progress they make in their studies and giving a little help here and there. The parent ought to know something of the teacher's mode of instruc- tion and government. Schools should be visited. Teachers should be questioned and a mutual un- derstanding ought to exist between parents and teachers. It ought to be much to the child's ad- vantage to have educated parents, but often parents who have the knowledge and ability, leave all the instruction to the teacher. The father is usually away from home a good deal, and too busily en- gaged in his special work to pay any attention to his children. The mother is often too much en- gaged in visiting, in fancy work, in reading the last novel, or in some other less important business than training children. A great reform is needed here. People generally do not realize the great importance of rearing children properly. Men and women ought to live their lives over in their chil- dren. No pleasure ought to be greater than that of training and watching the development of their offspring. Every child has a right to an educa- tion. It is cruel to withhold it. If you can not train, or have your children trained, properly, you ought not to have children. Where the need of jails and penitentiaries, of poor-houses, of criminal courts, if all children were properly trained? Think of it, parents; you are responsible in a large measure for whatever of crime and pauperism and suffering the next gen- eration will experience. 256 MENTAL CULTURE. As soon as the boys and girls are old enough to read, they should not be stinted in books and papers. The way to stimulate a desire to read and to learn is to provide plenty of material of the kind the child can comprehend. In these days of cheap books and papers there is no excuse for the ordinary fam- ily for not providing the children with material of this kind. No better investment could be made. Better wear plainer clothes, have less expensive furniture, buy less candy and other unnecessary luxuries than to stint your children in books and papers. Many a man spends for tobacco and cigars more than enough in a year to pay for all the books and periodicals his children would need. Here is an argument for the wife to use with her husband if he says he can not afford to buy books for his children. Many a woman puts more money in clothes than is really necessary to a neat and tidy appearance. Could not some of it be invested in material for the mental growth of the children ? Books and periodicals furnished in abundance afford not only a means of mental culture, but by making home pleasant and attractive, they keep boys off the streets and thus prove a means of moral culture. There are many intellectual games which amuse and instruct children, and are thus the means of keeping them at home, and of developing their minds. There are many games in fact, with which grown people often waste much valuable time, and which ought to be the almost exclusive prerogative of children. Among these are checkers, chess, and MENTAL CULTURE. 257 many games with cards. It does not look well to see a couple of big stout men sit down in a corner grocery or saloon and spend hours playing check- ers. One would think they could find something more profitable to do and which would, at the same time, afford as much rest and recreation from their ordinary labors. But to see a couple of children anywhere from ten to fifteen years of age amusing themselves in this way on a rainy day in the house, seems eminently appropriate. They can not study all the time, the weather will not always permit them to play out of doors, they should not work all the time, and it is dangerous for them to be idle. There is no necessity for teaching children games with ordinary playing cards, and there are many good people who have a holy horror of them : therefore, I would advise that checkers, chess, dominoes, backgammon and games with author. natural history, geography and literature cards be substituted for such games as euchre, cassino, whist, etc. A great deal may be learned, and at the same time much valuable information be imparted, by some of the new games with cards on the princi- ples of the well known " authors." Parents should use judgment in selecting play- things for children, boys especially. He is not wise who buys toy pistols, guns and firecrackers for boys. There is scarcely ever a Fourth of July or Christmas passes, that some boy is not killed or seriously injured by such playthings. There is no intellectual culture connected with using such playthings, and while there are so many harmless 17 258 MENTAL CULTURE. modes of amusing, many of which at the same time afford a good intellectual drill, the former should be discarded. Children who display a love and a talent for any special study, ought to be encouraged in that study in every way. Boys sometimes at an early age show a natural disposition to study animals. Do not repress their desire to collect specimens of insects, or bird's eggs. Instead of scolding them, buy them books on natural history. Does a boy show a disposition to use tools? Let him have tools. He will educate himself in a great measure, in that which he will be the best adapted for when a man. I have stated that children should have a variety of playthings. I wish to dwell a little upon this subject. Anything which causes a child to think tends to develop his mind. Children are naturally busy-bodies. They must be thinking of what they are doing. Any kind of a toy almost may serve as a stimulus to thought. But children soon tire of one thing. They need frequent change of occu- pation. They may be greatly delighted with a certain toy and in a short time it ceases to interest them, but if something else is substituted for a time and they tire of that, they will return to the first with renewed interest. Hence, the necessitv of a great variety of playthings to keep them con- stantly amused and occupied. " But the expense of furnishing so many toys," says some one. I answer that costly toys are not needed. Children, in fact, are more often pleased MENTAL CULTURE. 259 with what costs nothing at all than with the most costly objects. Any man with a little ingenuity can construct many little articles which will greatly delight children. A very young child will be inter- ested in blocks of wood, clothes pins, a bunch of keys, paper weights, strong sea shells, spools or buckeyes on a string, a strap of leather, a slipper, a pasteboard box, etc., in fact any article which can not hurt the child and which the child can not break or tear, will amuse and instruct him for a time, and after he has gone the round, he will be amused again by the same objects. Even destruc- tible articles may be given them, provided they are of no value and can not hurt the child, as old news- papers, advertising pictures and pamphlets. Short pieces of the smooth limbs of tree sawed and trimmed so that no sharp edges are left, make good playthings. As the child gets older, corn cobs, sets of blocks of all sizes and shapes, bundles of twigs or sec- tions of branches of trees, gourds, cards and pict- ures of all kinds, rag dolls, balls, marbles, animals made by putting sticks in potatoes to represent legs, ears, etc., and cheap metal and wooden toys may be furnished. Nothing delights little girls more than to plav keeping house, even if they have nothing more to represent a house than a few boards or brickbats laid around on the ground and a few old broken dishes for furniture. How easy for a father to make a small house, large enough for two or three children to get into. Let it be made of very thin 2CJO MENTAL CULTURE. boards and in sections so that it can be taken apart and laid away. Three "walls" made of boards with small windows cut in them, and two pieces, or one, for a roof. These sections to be so constructed that they may be keyed together to make them hold in their places, could be made by any man with a little constructive talent. A mechanic could make one at a very small cost. Now, I imagine some mother smiling as she reads this, but nevertheless I am convinced that children who have the advantages of a great variety of in- teresting playthings will develop more perfectly in body and mind, will be less trouble to parents, and that all necessary outlay of money and time in this direction will be amply rewarded. Parents should observe that there is frequently a great difference mentally, not only between boys and girls, but between individuals of the same sex. Some learn very rapidly and are not inclined to take enough physical exercise. Such should not be urged to study, but should be encouraged to romp and play more. Others, again, are not in- clined to mental exertion and need constant stimu- lation in that direction. Much may be done for this latter class by frequently calling attention to their books, asking questions as to their progress, and by praising their efforts. Says Prof. Sizer: "Girls usually learn faster than boys, become excited by the praise bestowed upon their excellence in scholarship ; hence the extra exertion of the brain and nervous system, and the extra sedentary habit which still closer appli- MENTAL CULTURE. 26l cation to study involves, shatter their constitutions at a very early age. Your fat, awkward, red-faced girl, who loves the bracing breezes, enjoys fun and frolic, and likes to sport in the open air more than she likes books, is not likely to be injured by the above influences. If she be rightly trained her mind will ripen at sixteen, and at twenty she will be a good scholar. On the other hand, the little, delicate, susceptible girl with thin, sharp features, expanded forehead, large, intelligent eyes, with a strong endowment of the love of approbation, is the very one to be driven by praise and encourage- ment almost to madness in mental activity. She bends soul and body over her books, becomes a prodigy in education, and her friends, misguided teacher and all, lavish praises on her educational superiority, which serves still more to inflame her brain and add fuel to that fire which is consuming her vitality and preparing her for the tomb." The mental powers of children are increased by telling them stories. All children delight to hear stories. The stories, of course, should be innocent; no blood and thunder tales of murders and robberies, but fairy tales and stories about animals and his- torical facts in the form of stories. When they get old enough to read, such books as " Grimm's Ger- man Stories" and "Anderson's Fairy Tales " may be put in their hands. The Youth's Companion, St. JVicholas, Harper's Young People, are among the periodicals which I would recommend for chil- dren old enough to read fluently. These periodi- cals are filled with good and pure literature adapted 262 CHILDREN AND MONEY. especially to the wants of young people. They are filled with stories of an innocent nature and with scientific and historical facts, told in a simple man- ner. Pictures are another excellent means of edu- cating the mind, and these periodicals contain the best efforts of the best artists in the line of picture- making for the young. FRIGHTENING CHILDREN. Never do it. Nothing can be worse for them. Never use fear as a means of discipline. Never punish a child by shutting him up in a dark room, or attempt to secure obedience by telling him that some bad man will get him, or that something ter- rible will happen. A child is naturally brave and has no sense of fear, unless it be taught him. Never scare children for fun. A recent writer has said, "it is like tickling them with a needle; it is all pain and no pleasure." An injury is wrought upon the delicate nervous system of the child by frights, and if they are scared frequently in early life they are apt to be cowards all their days. CHILDREN AND MONEY. Children should early learn the value of money. How can they learn its value unless thev have the privilege of handling and using some of it? Small sums should be given children and let them buy some of their toys and playthings. If they make a bad investment let them abide by the conse- quences. They will do better next time and thus learn how to make purchases. Whenever possible AGE OF PUBERTY. 263 children should be made to appreciate the value of money by requiring them to earn it by doing some simple work. Give a boy a cent or a nickel for running an errand and he will appreciate the money much more than if simply given him, and will do the work more cheerfully and with greater alacrity. You may advise him as to how to spend it, but advise simply, do not command. If he spends it foolishly criticise him kindly. He will be more careful next time. AGE OF PUBERTY. There is very little difference physically between boys and girls, except in regard to the forms of the sexual organs, up to the age of ten years. Up to the age of eleven or twelve boys are taller and heavier on an average than girls. After ten years of age girls grow more rapidly than boys, and in two or three years surpass them in height and weight. Boys then gain, and become taller and heavier than girls. Shortly after the twelfth year boys and girls begin to differ considerably in physi- cal and mental character. These differences have been given in Chapter I. The period when the sexes begin to develop and show the wide difference between male and female and when the sexual organs become capable of fulfilling the end designed in their creation, is called the age of puberty. Then the boy becomes a man and the girl a woman. This change takes place gradually, and the time varies in different individuals and in different climates. In this lati- 264 AGE OF PUBERTY. tude it comes usually about the fifteenth year; a little earlier in hot climates and a little later in cold climates. It is also a little earlier in the female than in the male. A few cases of girls becoming pregnant at nine, ten and twelve years of age are recorded. The period of puberty is marked in males by important physical changes. Hair begins to grow about the genital organs, under the arms, and beard appears on the face. The boy's shoulders get broader, his larynx enlarges, the vocal cords get longer, and as a consequence his voice has a lower pitch. The sexual organs increase in size. Semen is secreted by the testicles, and erections of the penis occur. Sometimes, in sleep, spontan- eous emissions of semen occur, usually accom- panied with voluptuous dreams. Young men are often much alarmed at this, especially if they have, in early boyhood, been guilty of self-abuse. They are too bashful to consult a physician, or speak of it to any one, and finding the advertisement of some quack doctor, or reading some of the works alluded to in the first part of this chapter, they imagine that they are ruined for life unless they proceed at once to doctor themselves. They should know that these emissions are, nearly always, nat- ural and healthy, and nothing need be done, unless they occur oftener than once a week, or are fol- lowed by considerable depression. In case they are too frequent, or are attended with bad symp- toms, the family physician should be consulted. The avoidance of a very soft bed and too much AGE OF PUBERTY. 265 covering, plenty ot exercise, and the avoidance of anything likely to excite sexual passion, will do much toward preventing a too frequent occurrence of these emissions. Mothers may not feel inclined to speak of such matters to their boys, but the boys ought to know it. There will be no harm in a boy of that age reading this book. In the boy who now becomes a man, there are marked mental changes. He becomes more shy and bashful in the presence of the opposite sex, yet he begins to be attracted towards them. He is apt to be romantic in thought, and develop ambi- tious plans and ideas. In other words, he ceases to be a boy in mind, and begins to think and act moreand more like a man. More might be said on this point, but I have only space to call atten- tion to the fact that mothers should recognize this change in their boys, because their conduct towards them should be governed thereby. The boy is now a man, and he should be treated as a man, and not as a boy. He has ideas of what is honorable and right, and his honor and sense of right can be appealed to should he stray from the path of duty. When yet a boy he could be made obey, without much rea- soning. Now he must see the reason, or necessity for obeying. He now needs to be advised rather than commanded. Now is the time, provided a love of books has been created in him when a boy by proper training, when books will make a strong impression upon him. See that only the best liter- 266 AGE OF PUBERTY. ature falls in his way, remembering that you can only shut out the bad literature by putting in the good. If you are not well versed in a knowledge of the literature of the day, or have not a consid- erable acquaintance with books, ask the advice of some one who is thus posted. The period of puberty, is, perhaps, in females more marked upon the mental than upon the phy- sical nature, yet there are important changes in the body. The pelvis becomes considerably larger, fat appears more abundantly in all parts of the body, giving roundness and plumpness to the form. The breasts and hips especially show this enlarge- ment. The external genital organs become larger, and hair appears around them as in the male. The womb becomes considerably larger, the ovaries enlarge, and the process known as menstruation begins. Menstruation will be discussed as a sep- arate subject. The mental changes which take place in the female at puberty, are best described in the lan- guage of another: "The once light-hearted girl inclines to reveries ; she seeks solitude ; her mother surprises her in causeless tears ; her teacher dis- covers an unwonted inattention to her studies, a less retentive memory, a disinclination to mental labor; her father misses her accustomed playful- ness ; he, perhaps, is annoyed by her listlessness and inertia. What does it all mean? What is the matter with the girl ? " Mother, teacher, father, it is for you to know the answers to these questions. You have guarded AGE OF PUBERTY. 267 this girl through years of helpless infancy and thoughtless childhood. At the peril of her life, and of what is more value than life, do not now relax your vigilancfe. Every day the reaper Death reaps with his keen sickle the flowers of our land. The mothers weep, indeed ; but little do they real- ize that it is because they have neglected to cherish them, as was their duty, that the Lord of Paradise has taken them back unto Himself." The period of puberty in both males and females should not be hastened, but deferred as long as possible. As has been stated, the usual age is from fourteen to fifteen years, varying with certain con- ditions, some of which may be controlled. It is earlier in warm climates, and in those persons of nervous and bilious temperaments. These are in- fluences, of course, we can not control. But habits of life have much to do with it, and these we can control to a great extent. An indoor life, seden- tary habits, too much study, highly seasoned food, stimulating drinks, as tea, coffee and alcoholic liquors, irregularities in sleeping, and whatever stimulates the emotions, as reading sensational stories and papers, dancing, theater-going, much conversation on courtship, marriage, etc., all have a tendency to hasten the development of the sexual function. As a proof that the above influences are active we have only to note the fact that puberty occurs earlier in youths brought up in cities and in large towns than in those brought up in the country. It is not a good sign to see an occurrence of puberty earlier than the usual average time. It 268 AGE OF PUBERTY. shows a weak and excitable constitution. Those who develop early, usually decay early. With girls especially is this period a critical one, as most mothers know. By overtaxing their phys- ical and mental powers the foundation for lifelong. disease may be laid. Says Dr. Eastman, of In- dianapolis : "I am asked, ' Why so many weakly girls?' I answer, why this buckram red-tape of our schools, which, like the sausage mill, is annihi- lating the identity of muscles and sinews brought within the revolution of their grinding cylinders. How cruel to overtax the brains of girls, at the critical age (between ten and fifteen), rendering them unfit for the physical duties of life, while their projecting shoulder-blades suggest the sprout- ing of angels' wings, and mark their progress to- ward the spirit-land." It is at this period that seeds of consumption, scrofula, hereditary insanity or other taints of con- stitution seem to gain force by the new excitement of the system, and sometimes rapidly grow and develop, carrying the victim speedily to the grave. If the girl passes this period in safety she stands a fair chance of living many years. Too much care can not be taken to prevent exposure to the weather, or to other causes which would impair vitality, at this time. Some of the peculiar dis- eases incident to this period will be discussed in another chapter. MENSTRUATION. 269 MENSTRUATION. The term menstruation is applied to the periodi- cal flow of blood, or a bloody fluid, from the womb. This fluid itself is called the menses or catamenia. All of these words are derived from a Greek word meaning month, and refer to the fact that this flow occurs naturally every twenty-eight days, which constitutes a lunar month. Many other words are used among the people to express the same idea. Among these are monthlies, monthly sickness, courses, grannies, spells, periods and flowers, but perhaps the most common way of expressing it is to use the phrase "become unwell." Menstruation, physiologically, is nothing more nor less than the periodical ripening and casting off of an ovum, or egg, from ovary, attended with a discharge of a bloody fluid from the womb. In other words, it is the laying of eggs. If one of these eggs is fecundated by the male element it remains in the womb and is hatched into a new being. If not, it is cast off as waste matter. This egg is very small, not more than yi-g- of an inch in length. There is nothing strange about this when we know that all living beings come from eggs, or germs. A seed of a plant is an egg. Birds and many lower animals are hatched from eggs out- side of the body of the parent, but man and most of the higher animals are developed from eggs hatched within the body of the parent. In birds, if the egg is not fecundated by the male before 270 MENSTRUATION. it leaves the body of the female, it can not be hatched. The question may be asked, if the higher ani- mals other than man produce in the same way why don't they menstruate? To this we may answer, they do. All female mammals, or animals which produce their young alive, experience periodical excitements known as "heat," or "rut," and in monkeys there is at this time a slight discharge resembling the menses of the human female. This period of "heat" is simply the excitement pro- duced by the ripening and throwing off of an egg, or eggs, although it is not usually attended with a flow of blood as in the human female. The menstrual flow is not always the same in all women even within the limits of health, neither in time of appearance, time of continuance, or quan- tity of the discharge. Sometimes a periodical dis- charge of mucus from the genital organs precedes for a few months the regular menstrual flow. Some- times, also, after the first regular menstruation the woman goes several months without another period and then comes the second flow, after which they become quite regular. In most cases it begins reg- ularly every twenty-eighth day and lasts about three days, but sometimes the interval is twenty- seven days, sometimes thirty, and in some few cases each interval is two months. Sometimes the flow lasts four or five days, or even longer, and sometimes less than three days, and the women are seemingly in good health. As a rule these periods occur every month regularly from puberty MENSTRUATION. 271 until what is known as the change of life, unless interrupted by pregnancy. This change of life, or menopause, as it is sometimes called, also varies in time, but usually it occurs between the ages of forty-five and fifty. Parents are sometimes alarmed when their daughters arrive at the age of fifteen years, if the menses do not appear. So long as the girl seems in good health and spirits and natural in every other way there need be no alarm. Time will bring all right. As before stated, however, too great care can not be taken about this time. Hard study should be prohibited, plenty of sleep should be enjoined, gentle exercise only should be taken, but sufficient of that, and plenty of good nourishing food. The mother should prepare the mind of her daughter for the change which is about to occur. Serious results have been caused by ignorance on the part of the girl. Girls are sometimes badly frightened at the unexpected appearance of a bloody fluid from their genital organs, and imagine some- thing awful has occurred. Ashamed to say any- thing about it to any one, they have been known to wade in cold water and wash themselves and their clothes and, in some instances, taking a cold which resulted in death. It is criminal for a mother not to explain this thing to her daughter. Besides en- dangering their lives, ignorance of this fact places girls in exceedingly embarrassing positions. It is true that in some communities young girls know much about these matters, having learned from their companions, but this is not the proper way 272 HYGIENE OF MENSTRUATION. for them to get the information. Much that is evil is taught at the same time, and wrong ideas are often conveyed. If a mother is too timid to impart such instruction to her daughter, she should place before her books which will give the needed in- struction, or request some married lady friend whom she can trust to give it. If a woman be in good health her menses will usually be quite regular, to the very day and some- times to the very hour. If they vary a few days, and no inconvenience is felt, there need be no alarm. Cold retards and heat hastens ovulation, hence in the spring the periods may come a little sooner, and in the fall a little later. No anxiety need be felt, either, if after they have appeared once they do not recur until the second or third month. Irregularities are not uncommon at first. So long as no symptoms of ill health occur there need be no alarm. If, on the contrary, there be headaches, pain in the back, fever, exhaustion, nausea, or nervousness, something should be done to bring on the courses. The treatment of such cases will be given in another chapter. HYGIENE OF MENSTRUATION. Menstruation in a state of perfect health is not attended with pain or any other great disturbance of the system. There are, however, few women who do not have more or less pain, fever and headache during their periods. In some it is attended with great pain. These cases will be noticed in the proper place. The point to be HYGIENE OF MENSTRUATION. 273 noticed here, is the care of the person during the menstrual period. There is no doubt that many of the diseases of women are brought on by want of proper management at these times. During the whole time of the flow there should be rest of both body and mind and perfect protection from expos- ure. It is the opinion of the highest medical authorities that labor or exposure at these times is fruitful of much subsequent suffering. But here a proper regard for health seems to conflict directly with the necessities and customs of society. There are few comparatively who can afford to rest and protect themselves properly under the present con- ditions of society. What then shall be done? It is a problem which can only be solved completely by revolutionizing entirely the social customs of the day. I wish to devote a page or two to a dis- cussion of this question. Dr. Edward H. Clarke, in two works, "Sex in Education" and "The Building of a Brain," has portrayed in a powerful manner the evils which result from improper man- agement of the mind and body during the men- strual periods in girls. He shows conclusively that girls suffer more from attendance at school than boys and the sole or principal reason being, that while they have more ambition to excel in their studies than boys, at the same time they have not the physical endurance, caused by the periodical interruptions of the menstrual flow. In other words, the mental labor exacted from them is inconsistent with their physical ability during at least one week out of every four. While the body 18 274 HYGIENE OF MENSTRUATION. is undergoing peculiar changes which make a drain upon the vitality, there should not be another drain imposed upon it, by great exercise of the mind. Rest of mind and body are necessary, while the function of ovulation is going on. Dr.William A. Hammond, who is acknowledged as standing in the very front rank among the physi- cians and surgeons in the United States, wrote the following letter in reply to several questions asked by Dr. Clarke. I give the questions and letter in full: " It falls to my lot to see a good many young ladies whose nervous systems are exhausted, and thus rendered irritable, by intense application to studies for which their minds are not suited. Only a few days ago a mother brought her daughter to me to be treated for spinal irritation, with all its accom- panying, nervous derangements; and I find, upon inquiry, that this girl of sixteen, who could not spell correctly, was compelled to study civil engi- neering and spherical trigonometry,—subjects not as likely to be of use to her as a knowledge of the language of Timbuctoo. In my opinion, schools such as the one this girl went to do more to unsex women than all the anomalies who prate about the right to vote, and to wear trousers. Now for your questions. " ' i. Is one sex more liable to suffer in health from attendance in school than the other?' " Undoubtedly, every physician in a large city, who has had experience with school boys and girls, knows that the latter suffer more frequently and HYGIENE OF MENSTRUATION. 275 severely. In country schools, where the attendance is only for a short time of the year, and for a few hours each day, and where the pupils have to walk two or more miles to get to school, the difference,. though existing would probably be not so distinctly marked. " l 2. Does the advent of puberty increase the liability, and, if so, more in one sex than the other?' " Puberty being a much more complex process in girls than in boys, the former are more liable to disease at this time ; and this liability is increased by whatever tends still more to exhaust the nervous system, such as mental application or anxiety. " I have repeatedly seen cases in which the flow of the menses had been suddenly stopped by the anxiety induced by the necessity of learning a school lesson. " ' 3. In the education of girls, should any atten- tion be paid to the catamenial week ? ' " The utmost possible care. People who are very careful to avoid draughts of cold air when they are overheated, pay no attention whatever to their daughters at a time when the system is peculiarly liable to disease. I have known of cases in which girls menstruating, and wishing to go to balls, have been instructed by their mothers to stop the func- tion by putting their feet in ice cold water; and in two of these cases epileptic convulsions were the result. A large number of the cases of epilepsy in women which come under my care are directly the result of menstrual disturbances, due to inatten- tion and imprudence. 276 HYGIENE OF MENSTRUATION. " '4. Is the nervous system any more liable to suffer from excessive study at puberty or during the catamenial week than other parts of the organism?' "Yes. My experience is decidedly to this con- clusion, and the results are hysteria, spinal irrita- tion, chorea, epilepsy, catalepsy, neuralgia, wry neck (torticollis), cerebral congestion, cerebral anaemia, nervous exhaustion and, occasionally, acute inflammation of the membrane of the brain." — William A. Hammond. Dr. Clarke received similar replies from many leading physicians, and the same questions ad- dressed to a large number of leading teachers throughout the country elicited replies the tenor of nearly all of which were that girls suffer from being compelled or allowed to go to school and work under the same conditions as boys.* Now, I had always, until I came to consider this question from a physiological standpoint, been in favor of the co-education of the sexes through the entire school course. I am still in favor of boys and girls under twelve or thirteen years of age going to school together, but after this time the * Since writing the above I have found an article by Dr. Mary Putnam Jacobi, the eminent lady physician of New York City, in which she takes grounds opposed to the views of Dr. Clarke. She thinks his conclusions are somewhat forced ; that the statements he makes are somewhat exaggerated ; that statistics may be mis- leading and are of little value unless made on a very large scale. She says that her own observations have been different from the statistics he gives. Here, then, we have two eminent authorities differing materially in their views. I am inclined to agree in the main with Dr. Clarke. In such cases it is at least wise to be cautious. Let the daughters be closely watched. HYGIENE OF MENSTRUATION. 277 differences in the physical natures of the two are so great that I seriously doubt the propriety of educating them in the same classes. From a moral standpoint it is better to educate the sexes together, because the association of young men and women tends greatly to the benefit of both, a question which I can not stop to discuss here, but from a physiological standpoint it is not desirable for the reasons given. The demands of society are such that it is scarcely possible for a married woman or a maiden who has passed the school age, to act precisely as she should during her menstrual periods, but I would urge upon all women who may read this book to see to it that they do no heavy work, either physically or mentally, and that they stay within doors, or at least close to home, during this period. This is more especially to be enjoined upon those who suffer greatly at these times. Chapter XI. SOME OF THE ILLS OF WOMEN. SEX AND DISEASE. As almost every one knows, there are certain diseases peculiar to each sex, others common to both, and still others which are liable to afflict one sex more than the other. Those of the first class are due to differences in physical structure, those of the last class mainly to differences in occupation and habits of life. Women are liable to more dif- ferent diseases than men, for they may have nearly all that men may have and many which men can not have, yet in spite of this fact women stand as good a chance in the race for life, take it altogether, as men. Women are more often sick than men, but their sicknesses are not so often fatal. From the nature of their occupations they are less liable to death from accident or intentional violence. A large proportion of the diseases of females might be prevented if women could be made to follow hygienic laws. A considerable proportion of the regular medical profession and a large army of quacks thrive by treating, or pretending to treat, the preventable diseases of women alone. Were directions similar to those given in this book fol- lowed for several generations of women, the occu- pations of a large number of physicians would be gone. (278) CONSTIPATION. 279 I propose in this chapter to notice briefly some of the more common diseases of women. I shall point out the causes, the principal symptoms, and give a simple home treatment, but I do not wish it to be understood that this book is to usurp the place of the regular family physician. A good home doctor book ought to aid rather than interfere with die intelligent physician's work, by rendering his advice and medicine more effectual. The prescriptions here given are standard ones in the medical profession, and in nearly all cases can be filled by any common druggist. They are also mild and comparatively harmless, so that it is not likely that any one will do more harm than good with them. There are many medicines which are very valuable yet comparatively harmless, others of value must be used with caution. I would not advise the use of the latter class, unless given by a reliable physician. CONSTIPATION. I place this first on the list of diseases of women, because it is not only one of the most easily pre- ventible, but because it is one of the most common and most liable to cause other diseases. It is more common among women than among men for va- rious reasons. The principal cause of constipation in both sexes is the neglect to attend regularly to the demands of nature. Women are more liable to neglect this than men, and one of the principal reasons of this is that the majority of water-closets are repulsive, 28o CONSTIPATION. either from insecurity from observation or from filth and bad odors. In a pamphlet written by a leading physician of Indianapolis, Dr. Joseph East- man, I find the following quoted from Prof. Good- ell : "Where in the country, and for that matter in cities also, is not to be found the privy, made up of rough boards rudely spiked together, with cracks wide enough to destroy all privacy ; with a door without a bolt, and generally hanging by one hinge ; with a crescent-shaped hole for a window ; and with its sole article of furniture a barrel of rasping corncobs? When is it even sheltered from the rude blasts of winter, or not poisoned by noisome stench, acrid vapors, and unclean flies? After such an unsightly but truthful picture, can we wonder that the calls of nature are looked upon as grievous dispensations of Providence, hateful duties which are to be put off until driven to them by sheer necessity, which knows no law ? " The writer adds : " The title of doctor means teacher, and no feeling of delicacy should deter us from teaching, when- ever occasion presents, that water-closets should be so arranged as to invite rather than repel." Another cause of constipation in women is their want of exercise. This can not be said of the majority of women perhaps, but it is true of a large number, especially in cities. They sit too much on sofas and cushioned chairs. A frequent change from a sitting to a standing posture, and frequent movements of the body to give the abdominal muscles exercise and thus aid in carrying the mate- rial of the bowels downward is necessary. CONSTIPATION. 28l A large number of persons of both sexes bring on constipation by not eating a variety of food, and by eating too much bread and meat, and not enough of watery vegetables and fruits. In another chapter will be given the properties of the different foods as to the effect on the bowels. Constipation is very apt to be a condition of the pregnant state. The pressure of the enlarged womb in some degree paralyzes the intestines and lessens their size. The liver is apt to be torpid from the disturbances of pregnancy, and this is another cause, since bile is a natural purgative. There are many remedies for constipation, some being more effectual on some persons, and some on others. The main point is to avoid using any strongly purgative medicines. Medicines should be used only as a last resort, and then only the mildest, and these should be used with caution. After trying a diet consisting largely of fruits and watery vegetables for a few days, if no beneficial results are obtained, resort must be had to medi- cines. If the patient has gone several days without action of the bowels, it is necessary to do some- thing to bring on an action, and then try to keep them open. A syringe ought to be in every family, but as I have stated in another place, one should not use it too much, lest a habit be formed of mov- ing the bowels in that way. But a half pint of tepid water with a little salt or soap suds, will usually start an action, then if a very mild physic, as a small dose of castor oil, or epsom salts, be 282 CONSTIPATION. taken, and this followed up by a loosening diet and strict attention to regularly visiting the water- closet, most cases will be brought right. I have found that a teaspoonful of cream of tartar with a little sugar stirred in a glass of water and drank every day, for several days, will often produce good results. Sometimes very simple remedies are effectual, as drinking every evening a glass of water in which a tablespoonful of Indian corn meal, or wheat bran, has been stirred. Eating an apple or an orange before breakfast each morning is sometimes suffi- cient. Sometimes one or two glasses of cold water drank before breakfast will be effectual. Knead- ing the abdomen with the hands every day for a few minutes is good. A cloth wrung out of warm or hot water and applied to the abdomen over night has been recommended. The cloth should be secured in place by a dry one over it, going around the waist, and should be worn every night for a week or more. If the bowels have not had a movement for a long time, the material becomes so compacted that sometimes even a syringe will do no good, and it is necessary to use a scoop to dig out the impacted material. However, if one persists in the use of the syringe it is rarely necessary to resort to the scooping process. A sniall amount of liquid mav be injected and kept in by an effort of the patient, and in ten or fifteen minutes a little more may be injected, and retained as long as possible, and then if this comes away and brings nothing, inject some CONSTIPATION. 283 more, and keep this up a half dozen times. The liquid softens gradually the impacted material, and after a while success will follow. Never give phy- sic in cases of this kind until an action has been secured by the syringe, and then only the mildest kinds. There are sold in bulk in most drug stores what are called " Improved Compound Cathartic Pills." From two to four are said to be a purgative dose. If one only be taken every evening for four or five days, good results will follow. Never use patent pills. The pills I here mention are sanctioned by the regular medical profession, and are no secret, their composition being given. The following makes a good pill for constipation : Rhubarb, castile soap and compound extract of colocynth, each half a drachm. Mix and divide into twenty pills. Take one each day or each alternate day. Here is another prescription which is very safe and reliable: Powdered turkey rhubarb and bicarbonate of potassa, of each one drachm. Triturate thoroughly in a mortar and divide into twelve powders. Take one each day. Almost any druggist can prepare these prescip- tions. If he can not fill the one, use the other. But, I repeat, do not use medicine if you can get along without it. Entirely too much purgative medicine is used. Many men have become rich manufacturing and selling purgative pills, and 284 DIARRHCEA. thousands are every year making themselves worse by using them. The habit of straining at stool is a very injurious one. Piles and prolapsus ani, or protrusion of the bowel, may be caused by inordinate efforts at stool. DIARRHOEA. This is more often a symptom or condition of other diseases than a disease of itself, but it some- times requires especial treatment. There are many causes of extreme looseness of the bowels. It is occasionally a condition of pregnancy. It is often a result of constipation. The hardened material of the bowels produces an irritation which causes the diarrhoea. Sometimes it is the result of undi- gested food. The important point in treatment of diarrhoea is, that it should not, in most cases, be too quickly checked. As a condition of some diseases it ought not to be checked at all, as is generally the case in typhoid fever. When it is caused by undigested food a physic will generally cure it by removing the irritating cause. Here, as in constipation, much may be done by proper attention to diet. Vegeta- bles and fruits should for a time be abstained from. Boiled rice, eaten with milk, is excellent. Boiled milk is also good. A diarrhoea may be caused by getting thoroughly chilled or by taking cold from a sudden lowering of the body temperature. The blood in such cases recedes from the surface. The feet should be put in warm water, if they are cold, and warm fomen- DEVIATIONS OF MENSTRUATION. 285 tations may be applied to the abdomen. Ginger tea or any warm stimulating drink will cause the blood to diffuse to the surface, and prove beneficial. The following prescription may be found useful in summer diarrhoea: Aromatic syrup of rhubarb, half a fluid ounce ; magnesia, fifteen grains; cinnamon water and camphor water, of each two fluid drachms. Mix, take in two doses three hours apart. In severe cases a physician should be called. DEVIATIONS OF MENSTRUATION. Proper menstruation, about every twenty-eight days, unless interrupted by pregnancy, is necessary to the health of the female from about fifteen to forty-five years of age, hence any considerable deviation from the natural condition must be treated as a disease. There are three long words which are used by physicians to express the principal deviations from normal menstruation. They are amenorrhea, dysmenorrhea and menorrhagia. The first applies to either the non-appearance, the sup- pression or the retention of the menstrual flow, the second applies to painful menstruation, the third to excessive menstruation. If in a female who has been menstruating regu- larly the menses do not appear at the regular time she has either conceived or there has been some disturbance of the system, as taking cold, which has caused their suppression. Many times if preg- nancy does not exist and nothing be done the menses will appear in a few days after the expected 286 DEVIATIONS OF MENSTRUATION. time. Sometimes slight causes, as fright or mental excitement of any kind, may delay them for a short time. Slight delays, if there be no fever, headache or other disturbance of the system, do not call for treatment. If, however, there be marked disturbances of the system, as indicated by flushed face, strong pulse, headache, pain in the side and back, nausea, loss of appetite, or sense of exhaustion, steps should be taken to bring on the flow. Usually soaking the feet in hot water with a little mustard in it, and drinking a half pint or more of ginger tea, and a mild physic will bring all right. A warm hip bath and warm poultices to the breasts should be used in case the menses had appeared and from taking cold they had suddenly stopped, also a physic should be given. Castor oil, epsom salts, senna tea and citrate of magnesia are all mild purgatives if not given in very large doses, and any one of them may be used. Read again what is said concerning menstrua- tion in the preceding chapter. Dysmenorrhea, or painful menstruation, is a very common trouble. The causes seem to be of two general kinds, physiological and mechanical. In the former case the nervous system and the circu- lation seem to be at fault, as a result of improper living in many ways. In the latter case there is some obstruction at the mouth of the womb, gen- erally caused by displacement of that organ. In the first kind the symptoms are about as fol- lows : Before the time for the flow the patient DEVIATIONS OF MENSTRUATION. 287 feels indisposed, with pain in the back, headache sometimes, and later by pains in the region of the womb similar to labor pains. The womb seems to be swollen and heavy, the pain being somewhat relieved by pressure of the hand over the abdomen. Sometimes the pain is of the nature of neuralgia, and some authors describe a neuralgic dysmenorr- hea. Sometimes a membranous cast of the inside of the womb comes away in fragments. This is called membranous dysmenorrhea. Where the cause is obstruction at the mouth of the womb, the symptoms do not differ greatly from those already described. The pain seems to be more in one place, and is apt to be spasmodic, as the blood may collect in the womb, and can only be expelled by vigorous contractions of that organ causing pain, and when the blood is forced out the pain ceases, until the womb fills up again. Whatever be the cause of painful menstruation, the woman subject to it should avoid being on her feet much for a day or two before the expected time begins, and remain quiet. Cloths wrung out of hot water and placed over the abdomen will often give much relief. The following prescription is simple, and has been found excellent: Spirits of camphor, one fluid drachm ; paregoric, two fluid drachms ; tincture of ginger, half a fluid drachm ; compound spirit of lavender, half a fluid ounce ; water enough to make two fluid ounces. Mix, and take a dessert spoonful every hour or two. Injections of hot water into the vagina have been recommended. No medicine seems to have any 288 DEVIATIONS OF MENSTRUATION. effect in preventing the recurrence of painful men- struation. Strict attention to-all the laws of health will tend to modify the attacks very much. Many women have painful menstruation until they become pregnant, and have no trouble afterwards. One thing should be avoided certainly, and that is the use of opium or morphine on such occasions, if for no other reason than the danger of contracting a habit of using these drugs, a habit more to be dreaded than the habit of using intoxicating liquors. Menorrhagia, or excessive menstruation, means that the amount of discharge is too great, or that it continues too long, or that the flow occurs oftener than usual. Sometimes all of these conditions are present. The causes are various. Sometimes it is attributable to over-excitement of the sexual organs. Some women have what is called a hem- orrhagic diathesis, that is, a peculiar constitutional tendency to bleeding, due to thinness of the blood. Standing too much upon the feet about the time of menstruation, may tend to increase the flow by determining the blood to the pelvis. General weakness and relaxation of the system, brought on by over-work or other causes, may produce it. The menstrual fluid is blood mixed with the mucus of the vagina. This mucus prevents the blood from clotting, unless there be an unusual amount of blood. The presence, then, of clots in the discharge indicates an unusual amount of blood. Sometimes this blood comes from humors or ulcers in the womb, and is not properly menstrual blood, DEVIATIONS OF MENSTRUATION. 289 which merely oozes out of the lining of the womb, from ruptures in the minute blood vessels. The loss of blood by profuse menstruation pro- duces symptoms similar to the loss of blood from any other cause. There is a paleness, exhaustion, probably headache, and other nervous symptoms. The patient should be kept quiet in bed. Warm drinks should be avoided and the room kept mod- erately cool. The feet and legs below the knees should be kept warm. The hands and arms should also be kept warm, that the blood may be drawn away from the region of the womb. Cloths wrung out of hot water may be applied to the feet and hands and frequently changed. Some recom- mend cloths wrung out of cold water to be applied to the abdomen. Cold lemonade, slightly sweet- ened, may be drank. A hot brick or bottle of hot water applied to the small of the back has been known to check profuse menstruation. If these simple measures fail and the discharge of blood be considerable, a competent physician should be sent for. Of course it is not necessary to check the flow entirely, but to bring it within proper bounds. If the flow has continued only moderately, but longer than the usual time, or if the amount is very great, accompanied with clots, and the woman feels weak and exhausted, then measures should be taken as above, before'a doc- tor is sent for. Occasionally there occurs what is known as vicarious menstruation. The blood, instead of coming from the womb, may come from various l9 29O THE WHITES. parts of the body. There may be, instead of the ordinary menstrual flow, an oozing of blood from the mucous membrane lining the nose, lungs. stomach, bowels or bladder. It has been known to flow from the eyes, ears, gums, armpits, nipples, from old scars, ulcers, tumors, and from the sur- face of the skin generally. Usually, however, the vicarious flow is from the stomach or lungs. This curious and apparently alarming phenomena is more apt to occur in nervous women in delicate health. It rarely, if ever, is dangerous. Nothing need be done except to bathe the feet in warm water, and put warm applications to the small of the back, unless the flow is excessive, in which case a physician should be called. THE WHITES. This is the most common name of a disorder which probably afflicts every woman more or less, at some time in her life. The medical names are leucorrhea and fluor albus, both terms meaning a flow of a whitish substance. The discharge varies much in consistence and appearance, and may come from the womb, or from the vagina. The general cause is irritation of the organs, fol- lowed by relaxation. Falling of the womb is often a cause of it. It is sometimes only a local symp- tom or expression of a general weakness of the en- tire system. It is apt to be common in those who have suffered many miscarriages, or have borne many children. Pessaries, or supports intended to keep up the womb, by their irritation, will, sooner THE WHITES. 29I or later, produce it. Habitual constipation and piles are sometimes a cause. It is a not unfrequent accompaniment of pregnancy. When the discharge is great and long continued, the patient becomes weak and loses flesh, the com- plexion gets dingy, and dark circles may appear under the eyes, all indicating general debility. As to treatment, more can be done by attention to the general health than by local applications. Injections of astringent substances generally give only temporary relief. When the flow is excessive an injection into the vagina of one or the other of the following mixtures may be given : 1. Alum, two drachms ; water, eightfluid ounces ; dissolve. Inject once or twice daily. 2. Tannic acid, one ounce ; glycerine, four fluid ounces ; mix, and dissolve by a gentle heat. Inject daily. If the woman be pale and weak from the dis- charge, a tonic like the following may be given: Tincture of chloride of iron, three fluid drachms ; dilute phosphoric acid, half a fluid ounce ; syrup of lemons, three fluid ounces. Mix. Dose, a des- sert spoonful once or twice daily. This is very agreeable to the taste and a good general tonic. Pregnant women troubled with whites should avoid sexual intercourse, take plenty of rest in a recumbent posture, and a warm hip bath occa- sionally. Strict attention to cleanliness should in all cases be enjoined. The discharges are sometimes irri- tating to the external parts, and may be the cause 292 ITCHING. of other troubles. It may be the cause of disease in the man if sexual intercourse is had at this time. ITCHING OF THE EXTERNAL GENITAL ORGANS. This is, in medical language, -pruritus of the vulva. It is not strictly a disease, but may be a symptom of a nervous disorder, or a result of un- cleanliness, or in some cases it may be caused by parasites, either the body louse, the crab louse, which attaches itself exclusively to these parts, or the common itch mite. This itching may occur in pregnancy and become very troublesome. In many cases the itching is only slight, or only felt after exertion, in warm weather, or after get- ting warm in bed, or before a fire. Sometimes the itching is so great that the person is almost crazed, and can not resist the desire to scratch and rub the parts. This gives only temporary relief and exag- gerates the trouble if continued. If it is caused by uncleanliness, an abundant use of castile soap and'water will be sufficient in a few days to effect a cure. If due to parasites, the first two mentioned may be destroyed by dusting the parts with a mixture of equal parts of calomel and pulverized white sugar; if to the itch mite, it may be destroyed by an application of sulphur and lard. The parts should afterwards be well washed with soap and water. Frequent warm hip baths are advisable when the itching is an accompaniment of pregnancy NEURALGIA. 293 NEURALGIA. The word neuralgia means nerve-pain. It con- sists in a pain in the nerve without inflammation of other parts. It is not a disorder peculiar to women, but women being more sensitive, are, perhaps, more inclined to it than men. At any rate, they seem to suffer more intensely. Neuralgia may affect any part of the body, and different names are given sometimes, when it affects different parts. Thus tic doloureux is neuralgia of the face ; hemi-crania, or 7nigraine, is neuralgia affecting one side of the head; sciatica, neuralgia of the hip and thigh; gastrodynia, neuralgia of the stomach; angina -pectoris is chiefly neuralgia of the heart. Tooth- ache is sometimes purely neuralgia, sometimes simply the pain produced by exposure of the nerve of the tooth to the air, or it may be pain from inflammation of the jaw bone or root of the tooth. The causes of neuralgia are various. Savage people rarely, if ever, have it, partly, perhaps, because of their out-door life, but mainly, I think, because of the less development of their nervous systems. Exposure to cold winds without sufficient clothing will undoubtedly produce it in persons who live mainly in-door lives. It may be due to bad condition of the blood owing to indigestion, want of exercise, constipation, and various other causes. It is often an accompaniment of the pregnant state. Overwork, mental worry, or anything that brings on a weakened state of the system may produce it. Hot applications will in most ordinary cases give 294 SICK HEADACHE. relief. These should always be tried first. A hot brick wrapped in flannel, a sack of hot salt or a bottle of hot water may be held against the part. I think moist heat better than dry, hence I would prefer the following: Wet a cloth thoroughly and hold it for a moment or two against a hot stove, then immediately apply it to the part, repeating the operation several times. Mustard draughts often afford relief. Electricity has been used with good results. A piece of paper saturated with chloroform and laid over the part is often efficient. The Chinese, it is said, use oil of peppermint applied to the part. Half of a cut lemon applied to the part has been known to give relief promptly. I would not advise women to take medicine in- ternally for neuralgia without the advice of a competent physician, and not then until he had made a thorough examination to find out the exact condition of the system. It is not sufficient that you send to a doctor asking for medicine for neu- ralgia. He should see and examine before he prescribes. By all means do not fall into the habit of using morphine, laudanum or opium to relieve the pain SICK HEADACHE. This name is applied to a pain in the forehead and through the temples, accompanied by sickness at the stomach and vomiting. Dr. Hartshorn says of it: " Sick headache is mainlv a neurosis (nervous disease), and vet the pain is not always of a neu- ralgic character. In some persons a hereditary FAINTING. 295 proclivity to it appears. Certain women, especial- ly, are subject to attacks every one, two or three weeks (though seldom at regular intervals) from puberty to cessation of menses. Relief of such attacks by treatment is often difficult to obtain. Early retirement to bed is mostly requisite." Much may be done for this trouble by a strict hygienic life. Strict attention to the bowels is necessary. Constipation should never be allowed. The woman should be careful to avoid getting much fatigued. Care in eating—never to overload the stomach is also important. The pain may often be much alleviated by having some one rub and gently pat the head and comb and brush the hair. Vomiting generally gives relief in an attack. If one feels very much nauseated the vomiting and consequent relief may be hastened by drinking a large quantitv of warm water or water and salt. It is much easier to vomit when the stomach is full than when it is nearly empty. The straining is not so great and greater relief follows. If the feet are at all cold, they should be put in hot water. Cloths wrung out of hot water may be applied to the stomach in severe attacks. FAINTING. During pregnancy women especially those with the first child, are apt to have occasional spells of fainting. It may be only a temporary feeling of faintness, without loss of consciousness, or it may amount to complete loss of consciousness. It is not so alarming as it would seem, although fatal results 296 DISPLACEMENTS OF THE WOMB. have occurred. If the woman be long unconscious the supply of blood is cut off from the child in the womb, and it may perish in consequence. It occurs in some woman but seldom, and the spells are very light; in others it may occur frequently and be very profound. Women who are known to be subject to these fainting spells should not be left entirely alone, as they may come on without any warning, and if something is not done serious results may follow. The treatment is simple and almost always successful, if resorted to promptly. The patient should never be raised up. The body should lie in a horizontal position on the back, the clothing loosened about the neck and chest, a little cold water sprinkled on the face and some hartshorn or smelling salts held to the nose. A few drops of brandy or whisky may be given. If the fainting does not amount to actual unconsciousness, nothing need be done except that the woman when feeling faint should immediately lie down. DISPLACEMENTS OF THE WOMB. The womb is so arranged in the pelvis that it is free to move up or down or sideways. It is sus- pended by ligaments, partly, and partly supported by the vagina, bladder and rectum. It floats, as it were, in the pelvic cavity, in the midst of the other organs. It undergoes remarkable changes during pregnancy, and returns to nearly its orig- inal condition. In the virgin it weighs only about an ounce, and at the end of pregnancy it weighs DISPLACEMENTS OF THE WOMB. 297 two pounds without its contents. It is forced down slightly by a cough or a sneeze, and moves up and down a little at every breath. The bladder, when full, pushes it backward, and the rectum, when full, pushes it forward. Tight clothing around the waist forces the bowels down upon it, and pushes it down or tends to bend it forward, backward, or sideways upon itself. The womb being thus easily moved, it is not strange that such causes as unnatural pressure by clothing from without, pressure by full bladder and rectum from within, and sudden jars and shocks to the whole body, accompanied with general weak- ness of the system, brought on by bad living, would tend to produce serious displacements. The prin- cipal kinds of displacements are prolapsus, ante- version and retroversion. The first means a falling down of the womb ; the second, a falling of the womb forward ; the third, falling of the womb back- ward. When the womb is bent or doubled on itself forward it is called anteflexion, and when folded backward it is called retroflexion. Sometimes the womb falls so low as to turn itself completely inside out, as a pocket in a coat may be turned inside out. This is called inversion. During pregnancy the womb, as we have seen, grows rapidly in size. It not only becomes a large sac, or pouch, but its walls become much thicker, so that it contains about twenty-four times as much tissue as before. This increase in size is called evolution. After the birth of the child there is a remarkable decrease, and in five or six weeks it 298 DISPLACEMENTS OF THE WOMB. has been reduced to nearly its original size. The decrease is called involution. But sometimes this change ceases before it has diminished to the proper size and it remains permanently quite large. This is called sub-involution. It is caused usually by the woman getting up too soon and going to work alter delivery. This condition causes often great distress and many subsequent troubles. Again, the womb may continue to grow smaller after it has reached the proper size. This is called super-in- volution. This affects the general health, and pro- duces a condition similar to old age. I can not enter here into a full discussion of the displacements of the womb. I could not give directions for home treatment that would avail very much. I have named and briefly described some of these displacements, more to impress upon the reader the importance of exercising great care in preventing their occurrence than with the hope of laying down a satisfactory treatment. But a few points may be noticed in connection with the symptoms and treatment of some of the forms of displacement. In all severe cases a competent physician should be consulted and his directions followed to the letter. When the womb has been displaced suddenly by violence of any kind there is always severe pain in that region, sometimes accompanied by fainting, flooding or vomiting. When it has left its position by degrees the symptoms are not strongly marked, the organs gradually becoming accustomed to their new positions. In falling of the womb there are DISPLACEMENTS OF THE WOMB. 299 apt to be dragging pains in the small of the back, with obstinate constipation, the patient having a desire to evacuate the bowels without success. The bladder may be much affected, making urination difficult. The " whites " is a frequent symptom, and sometimes profuse menstruation. The patient feels as if the contents of the pelvis were constantly about to escape downwards. All of these symptoms are generally relieved by lying down and increased by exercise in the erect position. The most essential point in treatment of falling of the womb is to remove all weight of clothing from the hips and abdomen. The clothes should be suspended entirely from the shoulders by fasten- ing them to a waist or by suspenders. A bandage made to fit the shape of the abdomen will afford great relief, but if worn long will do harm, because it relieves the abdominal muscles of their proper work, and as a consequence they degenerate from non-use and lose their power. By lying down and elevating the hips the womb will"slip back to its right place. Then put on the bandage and wear it for a short time in the erect position. Once each day apply passive exercise as follows : Let the patient lie upon her back with her feet drawn up. Let another person then knead and rub the abdomen with the hands, very gently at first, especially if there be tenderness. The force can be increased as the patient is able to bear it. This exercise should continue from five to fifteen minutes—not so long at first. In the course of a few weeks the abdominal muscles will have 300 DISPLACEMENTS OF THE WOMB. acquired more strength and then the bandage' should be no longer used, except when the woman is about to exert herself very much with work which requires her to be on her feet, then it may be put on for a short time. Much benefit may be derived from exercise of the legs while the patient lies on her back. Let her bend them upon the body and straighten them out again a number of times. Also when the legs are drawn up let an assistant hold the knees apart while the patient makes an effort to draw them together. These movements tend to strengthen the muscles of the lower part of the abdomen. The patient should avoid being on the feet long at a time, and take great care to live hygienically as to diet, bathing, exercise, etc. It must be remembered that a cure depends much upon the restoration and maintenance of strength and vigor of the entire body. Anything that will improve the general health will aid in curing all cases of womb displacement. When the womb has fallen forward, it rests upon the bladder and causes frequent desire to make water and a feeling of oppression in that part. Painful menstruation and sterility are common results of this kind of displacement. The womb, in this case, may usually be replaced by the patient herself, by lying upon her back and pressing firmly upon the belly just above the pubes, or at the lowest point of the abomen. It may be retained in place by a bandage having a pad pressing .upon this part. The same precautions in regard to use of a HYSTERIA. 301 bandage as given in falling of the womb should be taken here. The passive and active exercise and other means there suggested may be used. In backward displacement the symptoms will generally be more in connection with the lower bowel. Constipation will be a result, yet there will be frequent desires to move the bowels with- out success. The menses may or may not be dis- turbed. I shall not attempt to describe any special treatment for this form of displacement. The measures for improving the general health should be employed, and if the symptoms are severe, a good physician should be consulted. HYSTERIA. This is the medical term for a peculiar disease which manifests itself in a great variety of ways. The name hysteria is from a Greek word meaning womb, and was so given by the old physicians, because they thought disease of the womb was always the cause of it. Common people called it "hysterics," and there is a widespread notion that it is not a disease at all, but that the patients pre- tend only to the symptoms they exhibit. Hence, many people are offended if told that they have hysterics. It is as truly a disease as is neuralgia, but it is not always a disease of the body. Some- times it is a disease of the body, sometimes of the mind, and often of both. What is called a "fit of hysterics" may vary from mere uncontrollable laughter or crying, to a severe paroxysm, resembling an epileptic fit. Some- 302 HYSTERIA. times it is preceded by a sensation like that of a ball rising in the throat. This has been called the "globus hystericus." Physical hysteria, or hys- teria of the body, is, according to Dr. Beard, a disease of debility, and usually the result of some disorder of the sexual organs, along with a peculiar sensitiveness of the nervous system, or a weak condition of the blood ; and mental hysteria, or hysteria of the mind, is the result of some influence upon the emotions, and is a disease of the strong, full-blooded, non-nervous people. The symptoms are so various that it would not be practicable to attempt to give them here. No two persons are affected alike. It is, however, important that one be able to distinguish a hysteric fit from an epileptic convulsion. There is not com- plete unconsciousness in hysteria, but there is in epilepsy. The attacks in epilepsy are more sud- den ; there is foaming at the mouth, biting of the tongue and difficult breathing, all of which are absent in hysteria. These hysteric fits, when severe, often occasion great alarm, not only to the friends, but often to the physician when he does not understand their nature ; but they are comparatively harmless. Often threats or propositions to resort to severe measures, as cutting off the hair or touching her with a red- hot iron made in the presence of the patient will arouse her, although she seem to be unconscious. Women between the ages of fifteen and thirty are most liable to them. It is rare after the child- bearing period or before puberty. Women are the NERVOUSNESS. 303 common subjects, but there are occasional cases of hysteria among men. Since it is difficult for one not acquainted with this disease to tell what is the matter, an experi- enced physician should be called when a peculiar fit of any kind occurs for the first time. The old physician who has seen many similar cases can assure the friends that the patient is in no danger. provided he is convinced that it is a case of hysteria. Much exercise in the open air is very important for persons subject to hysteria. Mental excitement should be avoided. Regular employment of some kind ought to be enjoined. Reading exciting stories is not good for such persons. 0 NERVOUSNESS. Under this heading I wish to say a few words about a peculiar condition, which may hardly be called a disease, yet it is so widely prevalent and is the source of so much suffering, that it merits a special notice in a work of this kind. What is commonly called nervousness is more properly nervelessness, that is, in a certain sense a want of nerve power or force. It is not a want of nerve activity ; this is, at times at least, increased, but it is a feebleness or instability of the reserve nerve force which may be said to be the power be- hind all the actions of the system. It has been properly termed neurasthenia, a word which liter- ally means "nerve weakness." The nerves are easily excited to activity. In other words, they are irritable. 304 NERVOUSNESS. Now, since all the actions of the body, as circu- lation, digestion, etc., go on through the agency of the nerves, this irritability may produce many and various effects upon the body. Dr. Beard classifies the kinds of nervousness as follows: (i). Brain exhaustion, in which there maybe sleepless- ness, depression, morbid fears and impulses, feeling of fullness in the head, headaches, impairment of memory, inability to mental work, and lessening of will power. (2). Spinal exhaustion, which may be complicated with the other kinds, but specially known by tenderness and aching in the back, de- pression and indigestion. (3). Nervous dyspepsia, where the irritability is mainly in the stomach. (4). Sexual exhaustion, in which the sexual organs, and through them almost every pari of the system, is affected. (5). Traumatic exhaustion, that is, nerv- ousness from some severe injury or shock. (6). Hemi-exhaustion, where only the nerves of one side of the body are affected. (7). Hysterical ex- haustion, which I have noticed under the head of Hysteria. Nervousness is peculiarly characteristic of Amer- icans. There are many reasons for believing this. It is well known to physicians that less medicine is required to produce the same effect upon Amer- icans than upon any foreigners. It is known to all that intoxicating liquors and tobacco affect Amer- icans more than foreigners. The American people are handsomer, that is, they have more intellectual and refined appearance, as a rule, and this is the basis of beauty. They do more mental work, and NERVOUSNESS. 305 do it in less time. Our women suffer more in child- birth. All these, and many more facts, go to show that we are a people of sensitive nerves, or that nervousness is the great peculiarity of our people. I draw these points from a work entitled "Amer- ican Nervousness," by Dr. Geo. M. Beard. He is a scientific thinker and observer, and his arguments in that work are strong and conclusive. But what is the practical bearing of this subject of nervousness. It is this: Knowing that as a people we are peculiarly sensitive, we may avoid much suffering by a more strict attention to hygienic rules. We need to take more care of ourselves, because we are more delicately constructed. A high-bred American woman should not be expected to do the work of an Irish or German emigrant. I see, almost every day, an Irish woman, in all kinds of weather, going around town with two great buckets full of swill which she has gathered up from the back doors of houses, and carrying them three or four blocks to her home to feed her pigs. She appears healthy and strong. My wife could not do that, though she is just as healthy, and will live, in all probability, to be just as old. This nervousness does not shorten life, but makes life full of suffering for some persons. Those per- sons who have sensitive nerves, though they suffer much, enjoy much ; but if they took proper care of themselves they might enjoy as much and suffer a good deal less. Much of the suffering in this world is through fear of what may be the result of a disease or diseased condition. People should 20 3°6 NERVOUSNESS. have more knowledge of their physical and mental natures, which a study of physiology and hygiene would give them. Much of the great mental work of the world has been done by men and women who were what mav be called nervous people. They had only a small capital of reserve nerve force. George Eliot, Her- bert Spencer, Jonathan Edwards, Kant, Schiller, Bacon, Darwin, and many others might be cited as examples. Dr. Beard states an undeniable fact when he says: " The Indian squaw, sitting in front of her wigwam, keeps almost all of her force in reserve ; the slow and easy drudgery of the savage domestic life in the open air—unblessed and uncursed by the exhausting sentiment of love ; without reading or writing or calculating ; without past or future, and only a dull present—never calls for the full quota of her available force ; the larger part is always lying on its arms. " The sensitive white woman—prominently the American woman, with small inherited endowment of force; living indoors; torn and crossed by happy or unhappy love; subsisting on fiction, journals, receptions ; waylaid at all hours by the crudest of robbers, worry and ambition, that seize the last unit of her force—can never hold a power- ful reserve, but must live and does live, in a physi- cal sense, from hand to mouth, giving out quite as fast as she takes in—much faster oftentimes—and needing long periods of rest before and after any important campaign, and yet living as long as her Indian sister—much longer it may be—and bearing MISCARRIAGES. 307 age far better, and carrying the affections and feelings of youth into the decline of life." MISCARRIAGES. Having spoken of the causes and the dangers of miscarriage in another chapter, I have here to speak only of the symptoms and treatment. As before stated, the principal symptoms are pain and flooding. Pain is nearly always an accompani- ment. In early miscarriages it may not be greater than often accompanies menstruation. When pregnancy is more advanced there may be a chill followed by fever, rapid pulse, thirst, restlessness and sometimes sickness at the stomach and vomiting. Occasionally there is palpitation of the heart, coldness of the hands and feet, dimness of vision and an uneasy feeling in the lower part of the abdomen. Pain in the back and in the bladder are often symptoms. The breasts may be observed to become shrunken. The pains will be after awhile periodical and accompanied by more or less hemorrhage. In early miscarriages the ovum is usually expelled entire. In later mis- carriages the membranes are ruptured, the foetus expelled first and then the membranes and afterbirth. The latter often remains firmly at- tached to the womb for a varying period. Some- times, after the foetus is expelled, the pains cease and the woman may suppose all is well, but after a time, it may be several days, the pains return and usually with a great deal of hemorrhage. The afterbirth may undergo putrefaction and come 3o8 MISCARRIAGES. away in bits with dark and bad-smelling dis- charges. Blood-poisoning may occur by the absorption of the putrefied material. In the treatment of threatened miscarriage we must try to prevent it if possible ; if not, to conduct the patient safely through. In those women who are in the habit of miscarrying at about the same stage of pregnancy great care should be taken when that time arrives, that the woman do nothing that might cause action in the womb. She should lie down much of the time and avoid all excite- ment of whatever kind. The probable causes of former miscarriages should be inquired into and avoided if possible. If pains and hemorrhage have actually com- menced, often the miscarriage may be prevented by maintaining perfect quiet of both body and mind. The woman should at once take to her bed, lie on her back and not be covered too warm- ly. Her food should be of the lightest and most easily digesdble, and all stimulants and hot drinks be avoided. A physician should be called and the case plainly stated to him. He may be able to give something to quiet the contractions of the womb. The extremities should be kept warm. If the feet are cold a warm iron or brick should be placed against them. When the hemorrhage is great and the pains increase in frequency and severity, and there is a discharge of the waters, with dilation of the mouth of the womb, we know the foetus can not be saved, and the attention should be directed towards favor- HEMORRHAGE AFTER DELIVERY. ing its expulsion. Sometimes the foetus may be felt in the vagina, and can be hooked down with the finger. These cases should not be trusted in the hands of persons unskilled in diseases of women. Hence I will omit any further discussion, turning the cases over to the family physician, and end by quoting the following from Dr. Theophilus Parvin, concerning the after-treatment: "The patient should remain in bed at least a week after a miscarriage, for many a woman becomes a per- manent invalid from neglect of proper care at this time." HEMORRHAGE AFTER DELIVERY. When everything has progressed in a satisfactory manner until the birth of the child we have good grounds for believing that no subsequent difficulty will arise. But there are rare cases in which the womb does not contract, as it should. This con- traction closes the mouths of the blood vessels and prevents any serious hemorrhage. Sometimes women of little strength usually, develop an enor- mous degree of strength under temporary excite- ment, but afterwards relapse into a condition of total prostration. Sometimes enormous power is exerted by the uterus in expelling the child, and as soon as this is accomplished it falls into a con- dition of inertia, and is unable to contract suffi- ciently to close the vessels. In such cases death may ensue from rapid loss of blood. There is a great difference in individuals as to the amount of blood they may lose without danger. Some can lose a great quantity, others compara- 3ic CHILDBED FEVER. tively very little. The bleeding may be external or internal. The mouth of the womb being closed up by a clot or a portion of the afterbirth, may keep the blood in the womb. It is, of course, lost to the woman when it flows internally. The physician should remain for at least an hour after the birth of the child to attend to any case of this kind which might occur. Various means have been used to stop flooding. Physicians generally rely upon cold applications to the lower part of the abdomen, injections of cold water, and the admin- istration of ergot, which causes contractions of womb. Of late years many physicians use injec- tions of hot water (115 to 120 degrees Fahrenheit). Hot and cold water have the same effect in stopping hemorrhage, but warm or tepid water has an oppo- site effect, that of relaxation. I think cold appli- cations are objectionable, because they are apt to chill the body even when applied locally. The remedies recommended for profuse menstruation are applicable here. I would not recommend ergot to be given unless it be administered by a physician. But whatever is done should be done quickly, if the flooding be copious and exhaustion is apparent in the patient. CHILDBED FEVER. This is truly a dreaded disease, but happily much may be done to prevent its occurrence, and physicians have learned better how to treat it of late years, so that the mortality from it is not so great as in the past. CHILDBED FEVER. 3II As to the causes, there is much difference of opinion. From the fact that it occurs most fre- quently in cities and towns and in hospitals, espe- cially in those hospitals which have surgical pa- tients in the same building, and from the fact that many cases often happen in the same neighborhood among patients attended by the same physician, it is believed by some that it is a contagious disease, and may be communicated by the physician from one patient to another. Evidence seems to be in favor of the view that erysipelas, typhus fever, smallpox, measles, scarlet fever, diphtheria and some other diseases furnish a peculiar poison, which, if it enter the system of a woman just after delivery, will produce the disease known as puer- pal, or childbed fever. This is denied by some good authorities, but believed by many equally as good. The latter class advise that special precau- tions be taken by physicians. If they have been attending cases of any of these diseases, they should not immediately undertake to wait upon cases of confinement. Several physicians in Philadelphia decline all cases of confinement under circumstances of this kind. It is believed that it may also be con- veyed by the doctor from one patient suffering from it, to another woman whom he may attend in con- finement. Dr. Wark advises that a physician who had attended a case of childbed fever, should not attend a case of confinement inside of three months, and should take great pains in the meantime to purify his clothes and body by washing and the free use of disinfectants. 312 SLEEPLESSNESS. As a means of prevention it is of great impor- tance that the womb contract and be emptied of its contents soon after the child is born, and that the vagina be washed out by an injection of lime water, or weakened solution of carbolic acid. The disease usually begins about the second day after delivery, rarely later than the fourth day. The earlier it begins, the more dangerous it is likely to be. A chill of greater or less severity usually is the first symptom. The patient is de- pressed and anxious; the pulse is frequent and weak. Perspiration is often copious, but it does not lessen the fever. The discharge from the vagina (lochia) is almost if not entirely checked. The milk becomes* scant or disappears in the breasts. Great pain is felt in the lower part of the abdomen, spreading over the whole region, and frequently so great that the weight of the bedclothes can not be borne. The abdomen swells and becomes tight like a drum. A good physician should be called at the verv first indication of the fever. I shall not attempt to give any treatment here. I introduce the subject that my readers may be aware of the dangers of this disease, and be stimulated to greater exertion in preventing it and in calling in medical aid in time, should it unavoidably occur. SLEEPLESSNESS. This is not properly a disease, but a condition resulting from some disturbance to the natural ac- tions of the system. It may be a symptom of manv SLEEPLESSNESS. 313 diseases, and it often occurs in pregnancy. I intro- duce the subject here because many people resort to drugs in such cases, and do themselves vastly more harm than good. This is written, then, in a spirit of warning as to what not to do, rather than as advice as to what to do. If sleep has been less than usual for several days or weeks, more serious symptoms are sure to fol- low. Sleep is as necessary as food to keep the body m a proper condition. The person who has lost sleep to any great extent becomes irritable in body and mind, the appetite fails, the pulse be- comes more frequent, the strength diminishes, and serious diseases may be the final result. A person may sleep much, yet the sleep be so interrupted by frightful dreams that it is not refreshing. Drugs, except the mildest, should never be used to procure sleep unless in extreme cases of disease, and then only under the advice of a competent physician. There are many simple remedies which are often sufficient, and they should be tried first. A heavy meal eaten late before retiring is often the cause of sleeplessness, or of frightful dreams, but we must not conclude that eating shortly before going to bed will prevent sleep. On the contrary a small quantity of food before retiring often is very effective in inducing sleep. A warm bath taken before retiring is very often the most efficient. Gentle exercise in the open air is an excellent remedy for sleeplessness. Rubbing the body with the hands, and stroking the hair has a WORMS. There are about thirty species of worms which have been known to inhabit the human body. Many of these are rare, and some are confined to certain parts of the world only. Different species inhabit different parts of the body. It is only those which are found in the intestines of which I need to speak here. These are of two principal kinds, the flat or tape worms and the round worms. Tape worms are rather rare and rarely more than one inhabits the same person at the same time. Their history is peculiar. The animal is composed of many joints. In some of these joints eggs are produced. These joints break off and come away, a few at a time, with the discharges. These joints may be eaten by pigs. If they are the eggs hatch in the stomachs of these animals and the young worms make their way to the mus- cles, where they become encysted, that is, en- closed in a lime-like substance, and remain dor- mant until the flesh of the pig is eaten by man, when they develop in his stomach and intestines into tape worms. The meat of the pig which con- tains these cysts is called " measly pork." They can be seen as minute white specks. Thorough cooking kills the worms. The symptoms of tape worm are emaciation, de- pression of spirits, nervousness, disordered stom- ach, a tendency to diarrhoea, uneasiness and pain in the abdomen, itching of the nose and anus. But all of these symptoms may be produced by 336 WORMS. other causes, so that the only conclusive proof that there is a tape worm is the presence of joints of it in the discharges. The remedies are various. Turpentine is effec- tual, but has a peculiar intoxicating effect upon some persons. Pumpkin seeds are said to be quite efficient in removing them. Though tape worms are rather rare, they might be almost unknown if all meat that is eaten was thoroughly cooked. One species of tape worm is found in the immature state in mutton and beef, so that one should not only avoid raw pork, but raw beef and mutton. This applies not only to the pre- vention of tape worm, but to other parasites, especially the trichina, which sometimes proves as fatal. Children are mbre especially apt to be troubled with species of round worms. Of these there are two principal kinds, the lumbricoid, or white worms, and the thread or seat worms. The former are from five to fifteen inches long, and taper to a point at both ends. It is the commonest of body worms. It inhabits mostlv the small intestines, but may come up into the stomach, and even into the throat, and one case is recorded of one getting into the middle ear. These worms may exist in numbers in the intes- tine, and causes great irritation. When they get into the stomach nausea and vomiting may occur and the worms be thrown up. As in the case of tape worm, no positive evidence of their existence is known until they appear in the discharges. If COLIC. 337 one or more be discharged there is good reason to think there may be more. It is supposed that these worms grow from eggs which get into the body through water which is drank or are taken in with vegetables. Among the symptoms which these worms produce are itching at the nose, grind- ing the teeth during sleep, bad or irregular appe- tite, and swelling of the abdomen. Convulsions are often produced by worms and even spasmodic croup. They have been known to ascend the esophagus and get into the windpipe, producing death by suffocation. The most certain remedy is santonin, but it must be used with care ; not more than half a grain once or twice a day should ever be given a child. A purgative should be given at the same time with whatever remedy used. Pink root and senna tea • are common remedies. Children are often dosed for worms when no worms exist. Unless pretty certain that they do exist, medicines for worms should not be given. The seat and thread worms are only about an eighth of an inch in length. They inhabit the rectum, or lower bowel, and may exist in great numbers. They cause itching and restlessness. Injections of lime water will destroy them. COLIC. By colic is generally meant severe pain in some part of the abdominal region. It is rather a symptom than a disease. There are several vari- eties. The only one which I need to speak of here 22 338 COLIC. is that most common in children, and especially in infants. It is known as flatulent or wind colic, the pain being caused by the distention of gases accumulating in the bowels and stomach. It is usually caused in infants by over-feeding. More food is taken than can digest and gases are formed by the fermentation of the undigested food. It is often caused in older children by eating green fruits, or a large quantity of fruits of any kind. Apples are very wholesome for children if eaten ripe and in moderate quantities at a time, but un- ripe and imperfect fruit and a gorge of them will produce sometimes very distressing symptoms. If we know the colic to have been produced by an overloaded stomach or from very unwholesome food, the first thing to be done is to give a prompt • emetic ; a teaspoonful of mustard in a little warm water will answer. This, however, can not well be given to an infant. Warm applications to the abdo- men are always beneficial. Kneading the bowels with the hands, as one would knead bread, is good. A mild physic, as castor oil, should be given if the pain is not speedily relieved. There is often an acid condition of the stomach. A little magnesia or lime water should be given. It will do no harm if it is not needed. Essence of peppermint, essence of cinnamon and tincture or extract of ginger are good to tone up the bowels and give relief to the pain. If the physic does not operate in about four hours and the pain be not completely relieved, an injec- CONVULSIONS. 339 tion of warm water and soap or salt and water should be given. In very young infants attacks of colic may usually be relieved by very simple measures. Warm appli- cations to the abdomen and a few drops of essence of peppermint on a little sugar will usually give relief. Much dosing of very young infants should be avoided. Great care should be taken to prevent colic in infants. Never over-feed, keep the bowels regular; don't allow a day to pass without one or more movements of the bowels. A little lime water added occasionally to the milk of artificiallv- fed infants will correct the acid condition of the stomach. CONVULSIONS. Convulsions, or fits as they are commonly called, are always alarming to people, no matter from what cause, although not necessarily dangerous. They may accompany teething, indigestion, whooping cough, worms, fevers, and many other affections. Sometimes the fit comes on without any prelimin- ary symptom, but usually there is restlessness in sleep, a rolling of the head, twitching of the limbs, clenching of the fists, and a snore-like breathing. The convulsion consist in involuntary muscular movements, rolling of the eyes, drawing back of the head, and frothing at the mouth. The mother and attendants must not get fright- ened and lose their wits, for whatever is to be done must be done quickly. Children rarely die in the first convulsion, and the patient may be saved from subsequent ones by prompt treatment. Put the 34° CHOLERA INFANTUM. child into water as hot as can be borne as soon as possible. If the water is ready you need not wait to take off its clothes. Let it remain in the water until a change takes place. If not a sufficient amount of water be at hand to immerse the child in, pour hot water down the back of its neck. Wrap in warm blankets as soon as taken from the bath. Send for a physician that he may ascertain the cause of the convulsions and prescribe against a return of them. CHOLERA INFANTUM. This complaint is more frequently called summer complaint. It is very fatal, especially in young children in large cities during the hot weather. It seems to be produced by the extreme heat, com- bined with the poisons which are apt to affect the atmosphere of towns and cities. In New York and Philadelphia the prevalence and mortality from it increased as the thermometer rose above ninety de- grees Fahrenheit in the shade. In the hottest week in July, 1866, over 1,200 children died in New York City from this disease. The symptoms are diarrhoea, vomiting, debility, refusal of food and sometimes stupor. At first the head may be hot and the abdomen swollen, but coldness and emaciation follows as the disease pro- gresses. Sometimes death results very soon from brain trouble ; in other cases the patient is gradu- ally weakened by the diarrhoea and inability to ap- propriate nourishment. It rarely occurs in children after the second year. THRUSH AND CANKER OF THE MOUTH. 34I The teething period is most liable to be the time of the attack. If a child is taken with diarrhoea and vomiting, and the head be hot, a physician should be sent for at once. In the meantime clothes wrung out of cool water should be applied to the head and a mustard plaster to the abdomen. Follow the doc- tor's directions as to diet, etc., to the letter. Insist that he sees the patient often until the danger be past. THRUSH AND CANKER OF THE MOUTH. Thrush, or "whitemouth," is very common among infants, but is rarely serious. After a day or two of inflammation of the mouth, with some fever, and, perhaps, nausea and diarrhea, there appear a num- ber of small whitish points, like specks of curdled milk, on the tongue and within the mouth. The trouble may last two or three weeks or longer. It is thought to be a minute vegetable growth. Canker of the mouth is a kind of ulceration which is most common in children from two to six years of age. It begins on the cheeks, gums or lining of the lips, and may reach the back part of the mouth. The ulcer is grayish, or yellowish- white with an inflamed border. It is quite painful. The saliva flows very freely. There is often fever, and the breath is offensive. It may last several weeks, or even months. It is rarely fatal. Chlorate of potash is a valuable remedy in both these cases. Dissolve as much as will in a little water, and give a half teaspoonful several times a day. Some mild physic had best be given. If the 342 NIGHT TERRORS. child is feeble, a doctor had better be called, that he may prescribe tonic treatment. "NIGHT TERRORS." I extract the following description and treatment of this condition from Dr. Hartshorne's "Essen- tials of the Principles and Practice of Medicine: " " Dr. C. West gives the following description of an attack, which is not very uncommon, occurring in infants or children under ten years of age: "A child who has gone to bed apparently well, and who has slept soundly for a short time, awakes suddenly in great terror, and with a loud and pierc- ing cry. The child will be found sitting up in its bed, crying out as if in an agony of fear, ' Oh, dear ! oh, dear ! take it away ! father ! mother!' while terror is depicted on its countenance, and it does not recognize its parents, who, alarmed by its shrieks, have come into its room, but seems wholly occupied with the fearful impression that has aroused it from sleep. In from ten minutes to half an hour, as the terror abates, it may become quiet at once and fall asleep ; but frequently it bursts into a fit of passionate weeping, and sobs itself to rest in its mother's arms. In some instances a quantity of limpid urine is voided as the fit passes off, but this occurrence is by no means constant. Usually the remainder of the night is passed in tolerably sound sleep ; two attacks do not occur in the same night. Seizures of this kind may come on in a great variety of circumstances, and accord- ing to the cause whence they have arisen, may con- NIGHT TERRORS. 343 tinue to return for many weeks together, or may occur but a few times. As far as I have had the opportunity of judging, they are never the indica- tions of primary mischief in the brain, but are always associated with some disturbance of the intestinal canal, and more or less obvious gastric disorder. In the majority of cases constipation of the bowels exists." " My experience with such cases confirms that of Dr. West, as indicating that these attacks do not prove disease of the brain. But the nervous sys- tem of a child so affected must be morbidly suscep- tible ; and signs of indigestion, constipation, or irritation of the bowels are not always present. " During the attack the child should be at once gently lifted up from the bed and either carried for a few moments or laid down in a different position. Washing the face softly with a rag dipped in cool or cold water may arouse thoroughly. If any medicine be suitable, it will be a teaspoonful or two of camphor water. Care is needed to prevent the attacks. Violent exercise and mental excitement are almost as apt to bring them on as indigestion or constipation. The bowels should, however, be kept open, as by fluid extract of rhubarb or senna, etc. Bromide of potassium is advised by Dr. S. Ringer in obstinate recurrent attacks. Some prac- titioners prefer chloral in from three to six grain doses. To promote tranquil sleep some one should remain with the child, if timid, for awhile after it goes to bed ; or a light should be left burning low. A child liable to night terrors ought to be allowed 344 EARACHE to finish its morning sleep undisturbed. Abundance of sleep is sedative to an over-excitable brain. Neg- lect of such precautions may convert a mere trans- itory functional disturbance into a serious attack of brain disease." BED WETTING (ENURESIS). Children sometimes have an inability to retaip the urine long at a time, generally due to a weak- ness of the nervous system. Much can be done to prevent bed wetting by withholding liquids, except in very small quantities, for some hours before bedtime, and by taking the child up to urinate after two or three hours sleep. The follow ing prescription is said to be excellent: Take benzoic acid, two drachms; cinnamon water, six fluid ounces. Mix. Take a teaspoon- ful three times a day. Bromide of potassium may be given in small doses to very excitable children. A quantity equal to half the bulk of a grain of Indian corn may be dissolved in a little water and given just before going to bed. EARACHE. This is rather common in children, and may be caused by inflammation, or be entirely neuralgic. When there is inflammation there is considerable pain in the ear, and soreness on pressure behind the ear and in the opening. After a day or two relief is given by a discharge of pus from the ear. Earache may generally be relieved by dropping CONTAGIOUS DISEASES. 345 into the ear three or four drops of olive or almond oil, with one or two drops of laudanum. When there is a discharge, the ear should be syringed out with soapsuds made of castile soap and warm water. Care should be taken not to use force in injecting the liquid. Turning the head to one side and pouring the liquid in with a spoon is just as good, the patient turning the head to allow it to run out again. CONTAGIOUS DISEASES. It is not my purpose to speak at length of small- pox, measles, scarlet fever, mumps, chicken-pox, and whooping-cough, but there are a few facts con- cerning each of these diseases which ought to be known to every mother. First of all I would say, no matter how simple the disease, I would never advise mothers to ex- pose their children to it, as some do on the ground that it is better to have the disease when young, and that the chances are great that they will have it some time in life. If proper hygienic measures have been adopted in a family the milder of the above named diseases, as measles, chicken-pox, mumps and whooping- cough, will not be severe anytime in life ; and, as to smallpox, if proper attention is given to vaccina- tion, as suggested in a previous chapter, little need be feared from that. As to scarlet fever, the disease is dangerous at any time, and great care should be taken to avoid it. Moreover, it is not very com- 346 CONTAGIOUS DISEASES. mon, and the large majority go through life with- out ever taking it. Smallpox or variola, is the most certainly con- tagious of all the so-called contagious diseases. The period of incubation, that is, the time between exposure to the disease and its beginning, is about twelve days. The symptoms begin much like those of an ordinary fever, and unless the disease is in the vicinity, it is difficult for the physician to decide as to its nature, until the eruption occurs. This appears about the third day of the attack. In the large majority of cases it does not occur a second time. It is said to have occurred in the same person three and even five times. Louis XV died of a second attack. If a person has been effectually vaccinated the liability to an attack is almost removed. If it does occur it is very much modified in severity and is then known as varioloid (variola, or smallpox like.) It was formerly a custom to inoculate for smallpox, that is, they gave the disease to the per- son by inserting the virus into his blood, the result being smallpox in a somewhat modified form. There may be some who do not know the nature of vaccination. I will explain briefly. Vaccinia, or cowpox, is the name of a disease affecting cattle. It was known more than a hundred years ago that cowpox was sometimes communicated from the cow to man, and it was a common notion that if a person once had cowpox he would never have smallpox. This led Edward Jenner, an En- glishman, to investigate the nature of cowpox. He CONTAGIOUS DISEASES. 347 made many experiments and learned that cowpox could be communicated to man by inserting into his blood a small portion of the virus or matter from the eruption on the cow, and that it could then be continued from one individual to another by successive transmissions in the same manner, and that in some way it effected a change in the condition of the individual so that he was not liable to take smallpox. When the virus from a small- pox patient is inserted into a healthy cow the animal is affected with cowpox and the virus thus obtained is used for vaccination. It is generally the custom now to vaccinate with virus obtained directly from the cow and not from arm to arm. Chickenpox, or varicella, is a very mild disease resembling varioloid. After a period of incubation of four or five days pimples form here and there over the body. There is very little fever and no danger to life. It is only necessary to avoid ex- posure to cold and to keep the bowels regular. It seldom affects adults. Measles is a very common disease. It begins in from ten to fifteen days after exposure to the con- tagion. There is slight fever and depression, with the symptoms of a cold in the head, running at the nose, redness and watering of the eyes, and a cough. About four days after the beginning of the fever the eruption appears. It is not so bright in color as scarlet fever. In about seven days the eruption disappears. It is rarely fatal when not complicated with other diseases, except in very young children. Some- 348 CONTAGIOUS DISEASES. times the attacks are so mild that an observer would scarcely know there was anything more than a common cold. It sometimes occurs the second time. Scarcely any treatment is necessary except to take care to avoid exposure, and to keep the bowels open. Active purgatives should be avoided. Let the patient drink plenty of liquids of any kind that are agreeable, either hot or cold. The eyes are apt to be weak for some days. The patient should not read or do work which requires close attention during convalescence. Whooping-cough is purely a contagious disease. It is most common in young children, but adults may have it. It seldom occurs the second time. It begins about six days after exposure to the con- tagion. There is some fever, and a spasmodic cough. For hours at a time the patient may be apparently as well as ever, when suddenly he be- gins to cough violently for several seconds or min- utes. The cough is peculiar, consisting of several short efforts at expelling the air from the lungs, and then a drawing in of the air through a con- tracted glottis, making a whooping sound, whence the name of the disease. This whooping is, how- ever, not always present, but the coughing is al- ways paroxysmal, that is, by spells. Vomiting often occurs during the coughing spells. The spells of coughing are sometimes so severe as to threaten death by exhaustion, but such cases are rare. The disease seldom lasts longer than six weeks, but may continue three or four months, or even a CONTAGIOUS DISEASES. 349 year. Unless complicated with some other disease as pneumonia, it is rarely dangerous. Mild cases need no treatment, except to avoid exposure to dampness and cold. When there is no fever, the child need not be kept in the house during mild weather. He will cough less if allowed to spend much time in the open air. Some kind of cough syrup may be given if the cough is tight and little phlegm appears. In severe cases, the following prescription may be used : Take syrup of ipecac, two and one-half fluid drachms ; syrup of squills, three fluid drachms ; mixture of assafoetida, enough to make two fluid ounces. Give one or two teaspoonfuls not oftener than every three hours. The mixture of assafoetida is made by rubbing one drachm of assafoetida grad- ually with four ounces of water until thoroughly mixed, then adding two fluid ounces of syrup of ginger. Mumps, or parotitis, is generally a very mild disease and lasts but a few days. The parotid gland, located in front of, and a little below, the ear, swells and becomes hot and painful. There may be considerable inconvenience in swallowing. This is particularly noticed in taking some sour substance, as a pickle, in the mouth. One or both sides may be affected, and sometimes there is con- siderable fever, with delirium, and great swelling of the sides of the face. The disease is never dangerous, unless, as some- times occurs, there is a change of the inflammation to another part. This occasionally happens. It 35° CONTAGIOUS DISEASES. changes to the breasts in the female, and to the testicles in the male. There are some rare cases where it changes to the brain, and death is said to have resulted. Care to avoid cold and dampness is important. A change of the disease is more likely to take place if the patient becomes chilled. A poultice of flax seed may be applied to the jaw in severe cases, and a mild physic be given. Scarlet fever, or scarlatina, is to be dreaded, as its results are very uncertain. There are three recognized varieties. The first, or simple variety, is the least dangerous, a majority of cases getting well. The second, or anginose (choking) variety, is more serious, and in the third, or malignant (violent, bad) variety, recovery is the exception. It affects children mostly, but seldom occurs in infants under three months old. It is generally considered contagious, but many who are exposed to it do not take it, and it sometimes occurs where its cause can not be found, there being no cases in the neighborhood. Sometimes one child in a fam- ily of children will get it, and the others escape, and sometimes all but one of the family of several children will have it. I once treated a genuine case of scarlet fever in a family of four small children, where all lived in one room. There were no cases of the disease within ten miles. The child recovered, and none of the others took the disease. It begins usually about five days after exposure to its cause. There is usually headache, pains in CONTAGIOUS DISEASES. 35 I the back and limbs, with some fever and soreness of the throat. On the second day the eruption appears on the face and neck, and gradually spreads over the whole body. It differs from measles in the eruption appearing sooner, being of a brighter red color, and not in patches, and not attended with symptoms of cold in the head, but with sore throat. On the appearance of such symptoms a physician should be sent for at once. If there are cases in the neighborhood great care should be taken not to expose children to the contagion, and a doctor should be called on the first appearance of a sore throat, and complaint of headache and pains in the back and limbs. Chapter XIII. WHAT TO DO IN EMERGENCIES. PRESENCE OF MIND. The person who can keep cool and take things deliberately will be of the most service to the suffer- ing in all cases of accidents and in every trying emergency. There is no use of screaming, rush- ing around wildly, and giving expression to feelings