^RY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY Ol avaan tvnouvn 3nioio3w jo Aavaan tvnouvn 3noiq3w jo Aavaai VRY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY Ol avaan tvnouvn snidiosw jo Aavaan tvnouvn snidiosw jo Aavaai 3 Q. RY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF avaan tvnouvn snoiosw jo Aavaan tvnouvn snoiosw jo Aavaai RY OF MEDICINE NATIONAL LIBRAR 3NI3I03W JO AdVIJSri TVNOUVN D TTTTSESD WIN H090I£98fc 1881 WS2X 08 S/V\ NLM052511110 ■^oiQ3w jo Aavaan tvnouvn 3NOia3w jo Aavaan tvnouvn VTIONAl LIBRARY OF MEDICINE LtlONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL 2 *■___ THE MOTHER'S GUIDE IN THE MANAGEMENT AND FEEDING OF INFANTS. JOHN M. KEATING, M.D., LECTURER ON THE DISEASES OP CHILDREN AT THE UNIVERSITY OF PENNSYLVANIA, VISITING OBSTETRICIAN TO THE PHILADA. HOSPITAL, VISITING PHYSICIAN TO ST. JOSEPH'S HOSPITAL, FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADA.,___ _ ETC. ETC. PHILADELPHIA: HENRY C. LEA'S SON & CO. mi Entered according to the Act of Congress in the year 1881, by HENRY C. LEA'S SON & CO., in the office of the Librarian of Congress. All rights reserved. COLLINS, PRINTER TO WILLIAM V. KEATING, M.D., Late Professor of Obstetrics, Jefferson Medical College. Dear Sir : I have been urged by some young mothers, who have placed themselves and their children under my guidance, to give them a little book. To you I am indebted for what I know, and if there be anything of practical good in the pages that follow, it surely adds to my satisfaction that their publication reflects as much your professional worth, as it gives occasion to the expression of filial gratitude. With great respect, J. M. KEATING. Cor. Twenty-Second and Locust Sts., Philadelphia. (iii) ".....For wealth cannot buy judgment, and education is no guarantee against foolish indulgence. We know that a child may be in reality starving, although fed every day upon the richest food, for he is nourished not in proportion to his capability of digesting what is given to him. If, therefore, he be supplied with food Linsuited to his age, the result is the same, whether he live in a palace or a cottage."— The Wasting Diseases of Children, page 132, Eustace Smith, M.D., London. (iv) CONTENTS. Introduction........9 PART I. GENERAL MANAGEMENT FROM BIRTH TO DENTITION. CHAPTER I. Care of the infant after birth—Its washing—Attention to the navel—Treatment of ulceration of the navel—The cloth- ing of an infant — Appearance of a healthy new-born babe—The early training of an infant—Its nursing—The mother's milk—The importance of giving attention to the quality of the milk—Injurious effect of alcohol when'used habitually to give milk—Laxatives for mother and child— Wet-nurses, the cases in which they are a necessity . 15 CHAPTER II. Bottle-feeding—The choice of milk—The great importance of the milk being fresh—How to keep it so—Milk can become a carrier of disease—Greater care required during (v) vi CONTENTS. the hot weather—The preparation of the milk for food— The use of gelatine—The use of farinaceous food—Its preparation—The choice of foods—The child kept regular by their alternation—Condensed milk—The importance of water for infants ....••• 27 CHAPTER III. The bathing of infants—The temperature of the water—Its value in summer—The skin—The mild eruptions—The character of clothing ...... 44 CHAPTER IV. Choice of a nursery—The temperature of the room—Methods of heating—Evil effects of cold—Ventilation—Importance of personal contact with the mother—Light and sunshine— Importance of good plumbing — A child should live in fresh, pure air—Care of an infant when out-of-doors—Pre- caution to be insisted upon—Importance of a reliable child's nurse ........ 49 CHAPTER V. The changing of infants—The character of healthy passages —Use of ointments—Action of the kidneys—Looseness of the bowels—Improper diet or over-feeding often the cause of sore mouths—Attention to the breasts—Treatment —Intestinal catarrh—Symptoms—Use of castor oil—Nasal catarrh ....... 61 CONTENTS. vn PART II. GENERAL MANAGEMENT DURING DENTITION. CHAPTER I. The most important period of a child's life—Time of cutting the teeth—Lancing the gums—Importance of fresh air, and purity of food—Avoid the use of opium in any form —Convulsions—Treatment . . . . .71 CHAPTER II. Importance of noting the symptoms with care, and of record- ing them—The use of medicines—Only to have recourse to drugs in the absence of a physician—Restlessness and sleeplessness of a teething child — Convulsions — Treat- ment ......... 81 CHAPTER III. Croup—Its cause—Treatment—The use of emetics—Drugs to be used in the absence of a physician—Avoidance of popular medicines—Constipation—How to prevent it. 90 CHAPTER IV. Catarrhal diarrhoea—Description of the condition—Treat- ment and dietary—Cholera infantum—Its cause—Neces- sity of immediate change of air—Importance of bathing— Treatment—Food of a child in its second year . . 99 Vlll CONTENTS. PART I I I. MANAGEMENT AFTER EARLY DENTITION. CHAPTER I. Change of diet for a child after dentition — What to begin with—Importance of great care in the selection of food— Out door exercise to be encouraged—Importance of early training in its bearing upon the management of children in sickness ........ 107 CHAPTER II. Food of a child in its third year—Avoidance of uncooked fruits—Change of air in summer—How to choose between the country and the sea-shore—The country preferable for infants—Benefits from sea air in disease—Mothers should nurse their babes—Conclusion . . . . 11S INTRODUCTION. It is my desire in sending forth this little work to supply a want which seems to be daily growing, in proportion as the good old monthly nurses of the last generation are passing away,—the old nurses who, though veritable tyrants in the household, held their sway as such by the inexhaustible treasury of experi- ence that gave them a position scarcely secondary to the doctor himself. If there be one tendency more striking than an- other in the present age, and I almost wrote, on this side of the Atlantic, it is that towards concentration in almost everything connected with our living. The young man slaves himself in early life, that he may accumulate and enjoy wealth, not as his fore- fathers in old age, but in the prime of his early man- hood; here we have the concentration of labor. That his retirement may come earlier, he risks all in the 2 10 THE MOTHER'S GUIDE. grand masterly effort. In our own profession we see the same, and coming, as it does, nearer home, it is more striking. Experience need no longer be gained by the gradual accumulation of the well-sorted facts of a lifetime; that which took our grandfathers years to store from large and extended practices, we gain in a short time by walking the wards of our well- stocked hospitals—general hospitals, special hospitals, or well-attended dispensaries. Compressed pills have taken the place of potions; active principles and con- centrated extracts have succeeded the more crude drugs; inhalations and hypodermic medication have shortened the period which our ancestors devoted to suffering. Everything must be done at once, and all things, if possible, at the same time. Science, in all its branches, has grown like the mustard-seed, and to follow the trunk to the extrem- ity of but one of its branches is about as much as the intellect of an ordinary mind is capable of do- ing, with any prospect of ultimate success; but just as this branch depends entirely upon the trunk for support, just so important is the thorough grounding with the fundamental rules governing health and life, INTR OD UCTION. 11 necessary for advancement and perfection in any branch of study. Should such be neglected, what is to be the natural result,—the neglect of details. It is the observing of details, and the fixing of such facts, that constitute the trunk of the tree of knowledge. It is not my intention to discuss this subject further than so far as it relates to the object before us, and I may therefore say at the outset that those who would bring up the healthiest children, with the least possible trouble to themselves, are those who will study in Nature's own workshop, and draw their own conclusions from their own knowledge gained by their own experience. Each mother should be a judge of what is good or bad for her own child, and each nurse should remember that her duty is simply that of substitution of the mother. A nurse's duty is therefore not one which can be directed by scien- tific rule, but simply to watch nature, and see that her laws are not transgressed. This experience can- not be learned from books; it cannot be learned from lectures; it can only come from a daily repeti- tion of the duties of the nursery. No woman, how- ever much she may read and study, can learn from X2 THE MOTHER'S GUIDE. it to hold a baby, or to wash a baby, or even, I may say, to dress or feed a baby. Nature, with its universal regard for the preserva- tion of life, has planted in every mother that one, and most important element, the untiring affection for her offspring which makes every care a pleasure, and stores, unconsciously to her, the experience which from day to day accumulates for the benefit of her child. So important do I deem it for the future welfare of a new-born child, for the comfort of the mother, and even for the happiness of the household, which naturally hinges on both, to have a monthly nurse who thoroughly understands infants, and who is in sympathy with the duties that devolve upon her, that I cannot help impressing my convictions upon future mothers, or those who are to advise them in their selection, of the importance of choosing wo- men of cheerful disposition, of pleasing appear- ance, and of practical experience, to be their substi- tutes during hours when they are unable to give their personal attention to their new-born children. If the demand for such were made imperative, I am INTR OD UC TION. 13 sure the supply would be greater than it is at present. But unfortunately much misapprehension seems to exist in this country as to the care of the young, not so much, I may say, as regards the proper treatment as the want of a better understanding of the requirements of a new-born babe. Our artificial surroundings, or some other equally potent cause, has developed the necessity for artificial feeding; our luxurious and over-heated dwellings have raised the question of proper clothing, and the rapid advance- ment of science has taught us the value of early treat- ment, to eradicate the tendency to inherited taint. It will be my endeavor to make this matter simple and easy to understand, and to give instruction that I hope will bear good fruit. For this purpose, I pro- pose to divide this little work into three parts, con- sidering first the requirements of an infant from birth until the cutting of its first teeth, then during the period of dentition, and, finally, those of a child after its third year. 2* PART I. GENERAL MANAGEMENT FROM BIRTH TO DENTITION. CHAPTER I. Care of the infant after birth—Its washing—Attention to the navel—Treatment of ulceration of the navel—The cloth- ing of an infant — Appearance of a healthy new-born babe—The early training of an infant—Its nursing—The mother's milk—The importance of giving attention to the quality of the milk—Injurious effect of alcohol when used habitually to give milk—Laxatives for mother and child— wet-nurses, the cases in which they are a necessity. Immediately after the birth of a child, it should be wrapped in a warm, soft blanket, placed on its right side, and after the superficial glance given it by the doctor has shown its appearance to be satisfactory, it may be given to an attendant while the nurse is busy with the mother. Care should be taken to wash out of its mouth accumulated mucus, and it is necessary 16 THE MOTHER'S GUIDE. also to wash the face, especially the eyes, with a soft sponge and tepid water to prevent the secretions that have collected, giving rise to catarrhs, that are so troublesome to treat in infants. After the mother is made comfortable, and everything has progressed satisfactorily, the child should be taken by the nurse into the adjoining room, which has been previously warmed, and then carefully examined by the medi- cal attendant before he leaves the house. The navel string, if it has not been done before, should be freed from the gelatinous matter and securely re-tied. It is then to be thoroughly cleansed, using vaseline or oil to remove the caseous secretion that envelops it, no crack nor crevice be allowed to retain a trace of the matter; the hair, the ears, the folds of the joints lubricated in their turn, after which a good washing with the best white Castile soap and warm water will leave the skin soft and clean. It is neces- sary then to dry it thoroughly with a soft old linen towel, and powder it well with either plain starch powder, or starch powder scented with a small quan- tity of orris-root. The navel string must then be enveloped in a small linen rag greased with benzoated oxide of zinc ointment, turned upwards upon a com- press and kept in position by means of a flannel binder, which should not be made too tight. The ATTENTION TO THE NAVEL. 17 object of this latter is to give support as well as warmth, and when it is not too tightly applied, is certainly of great value; it is not an absolute neces- sity, many physicians do not advise it, and some believe in its application only for a few days after birth. The navel string separates usually in about a week, and sometimes it takes longer; it should be allowed to drop off, and if in the mean time it is offensive, put a drop or two of carbolic acid in the water that is used for its washing. It is well to retain a compress over the navel until it is entirely healed, using the slight pressure that the binder affords; in this way a rupture is avoided which is liable to be caused by straining or cough- ing, and also that most tedious and sometimes dan- gerous affection, an ulcerated navel, is prevented. After the navel string separates, should there still be some discharge, the nurse must seek its cause, and, if it be due to an ulcerated surface beneath, however small, this should be touched daily with a pointed crystal of blue stone. The compress should be well greased with zinc ointment, or some cosmoline can be used instead. In our changeable climate it is certainly well to use a small and thin flannel binder for at least some months, for the one cardinal point in the manage- 18 THE MOTHER'S GUIDE. ment of infants is to keep them comfortably warm, especially about the body, as they lack at that early period the heat-making qualities of older children. It is most important that the infant's clothes should be light in weight, warm, and loose; especially should this latter be attended to as regards the abdo- men, for no doubt many infants are forced to vomit their milk after nursing from the pressure of tight bands and clothing. It seems scarcely necessary for me to state that pins are no longer to be used with children; safety pins of all sizes and kinds can now be had, and they can be replaced by stitches when necessary. Every one knows the scarlet appearance of a healthy new-born child after a good washing and drying has thoroughly established the skin circula- tion, and the soft, peach-like feeling of the skin, with the delicate hair that soon falls off, has been a theme for many a poet. This redness of the skin gradually disappears in a few days, and often when it has been well marked, a sign of a delicate skin in a child, there will be left a rash, which is of no consequence. Vogel tells us in his classical work, that "as re- gards the attitude and movement of the child, the new-born is always apt to assume that bodily position which it occupied in the uterus. The back is bent a REGULARITY IN NURSING. 19 little outwardly, the head flexed upon the chest, and the limbs are bent upon the body. When a child lies quietly, sleeps soundly and uninterruptedly, and is tolerably active when awake, then it may be satis- factorily concluded that it is in excellent health." If possible, the mother is to be allowed to sleep for several, perhaps three or four, hours before she again goes through fatigue—that incidental to nurs- ing. It is not advisable during this short period to feed the infant, but it is better to wait its applica- tion to the breast; the habit of giving a little "sugar and water" or catnip tea, cannot be too forcibly de- cried. It establishes a precedent which will entail hours of wakefulness upon those surrounding the newly arrived, for an infant is a creature of habit, and unless it be taught from birth to nurse by the clock and to become accustomed to the monotonous routine of the nursery, the household will know no peace. Have a clock in the room and teach, from the hour of its birth, the infant to sleep until each nursing hour arrives, and do not under any circum- stances allow it to expect a "little more" to keep it quiet if it has not taken its full supply at the time prescribed. A little firmness early in life will estab- lish a golden rule that has no exceptions. At first, of course, the mother may have no milk, 20 THE MOTHER'S GUIDE. but the watery substance secreted, acts as a purgative to the child, and will discharge from its intestines the accumulation that has collected there, and in that way prepare for the digestion of that to come. There is no fear of a child starving to death should its food be scanty for a day or two, as some mothers imagine. It is well also from the start to teach the babe to nurse less frequently during the night, and in this way there will be a period of rather longer duration when the digestive organs can rest from their labors. The importance of sleep to the mother, in its bear- ing upon her health, and consequently upon her milk, both in its quantity and in its quality, cannot be overrated, and on that account the babe should be kept by the nurse in a room near by, and brought to her at the stated hour for nursing; directly after birth it will have to nurse more frequently—perhaps every two hours, or even every hour and a half—also during the night, as it gets very little at a time, and it will help to excite a good flow of milk. But in a few days, when the supply becomes equal to the demand, it is well to have it brought to its food about eleven P. M., after the mother has taken a good bowl of gruel, or a full glass of milk, and then not let it return till two, and again at six. The child should be made to nurse the breasts alternately, for no habit is more easily ac- THE QUALITY OF THE MILK. 21 quired or attended by more suffering to the mother, than the refusal of an infant to nurse from one side; and after each nursing the nipples should be washed with a weak solution of soda, and thoroughly dried. Few mothers seem sufficiently impressed with the importance of their own condition upon the charac- ter and quantity of milk supplied to their infants. Milk is not a fluid that remains forever the same, not- withstanding the material out of which it is made; it is like the blood itself in the fact that it is nutritive or not according to the supplies given for its man- ufacture, to proper elaboration of the food, and to nervous influence. Convulsion in babes has fol- lowed immediately after their application to the breast of a mother, or nurse, who has received some sudden shock, or who has been unduly excited by anger or grief. As I write this, I have a little patient whose food was suddenly changed to poison by the grief of its mother from the sudden loss of an older child. Then, again, certain kinds of food give the milk qualities not naturally its own; or the con- ditions known as " biliousness," which means the re- tention in the blood of certain poisonous materials which should be thrown off as bile, will impart to the milk its properties, and make it act as a purge or emetic upon the nursing babe. Frequently the child's 3 I 22 THE MOTHER'S GUIDE. digestion is said to be at fault, when, in reality, it is the mother who is to blame. Dr. Day, in his late work on children, speaks forcibly of the necessity for mothers to remember 1 their duties towards their offspring. "Late hours lead to fatigue, to excitement, and to stimulating and improper diet, which are sure means of causing j them to have unhealthy offspring," and he might have extended this remark to nursing mothers in its bearing upon their milk. As the habit seems so prevalent of taking stimu- j lants—as beer, porter, or wine, to " give milk," I may be allowed to quote the following from an excellent article recently written on this subject.* " Alcohol, beer, porter, and wine are largely used, under the belief that the lacteal secretion is increased by their influence; but increase in quantity does not mean improvement in the nutritive properties of that secretion upon which the child depends. " There can be no greater mistake than to imagine because a woman is nursing, she ought, therefore, to live freely, and that porter or fermented liquor should enter into her diet; and I may lay down, as a general principle, that the mother who requires * See London Practitioner for February, March, April, and May, 1881. Article by Thomas M. Dolan. DIET OF THE MOTHER. 23 porter or beer to stimulate her for her duties, had better dispense with the office.....The milk is rendered irritating to the child ; it is no longer the bland nu- tritious food it should be, and the weak, delicate stomach of the nursling surfers from the introduction of a foreign substance." The author tells us that the true way of encourag- ing the flow of milk is not by spurring it on by false stimulation, but by supplying those materials from which it is formed. Milk, the ideal food, should be used freely in a nursing woman's diet; gruels, chocolate, eggs, and vegetables of all kinds; but vinegar, tomatoes, and acid fruits are best avoided, unless experience has proved them harmless. Should the appetite fail, a wineglass of Hoffs malt may be taken before each meal; and frequently, if there be exhaustion attending nursing, an egg beaten up with sherry, in a glass of milk, will help tide over the day, if taken at lunch time. But after all, a healthy appetite, brought about by exercise in the open air, followed by a hearty meal of bread, butter, and milk, is the true secret of health in both mother and child. It is well for nursing women to occasionally take an aperient, such as a teaspoonful of Husband's mag- nesia, or the effervescing citrate of magnesia, to keep 24 THE MOTHER'S GUIDE. themselves regular, or to eat freely of vegetable diet, and take exercise in their stead. More active purga- tives, such as most of the pills, and even castor-oil, may act on the child through the milk, and give rise to colic. An enema is in many instances most val- uable; or even a glass of cold water after rising in the morning. It may be necessary to give to the new-born child a laxative should the early milk of its mother not have (as it should), the proper effect, and for this purpose a teaspoonful of sweet oil or castor oil and glycerine, half of each, is useful; a little brown sugar, in peppermint water, may be substituted. All mothers should nurse their children. If, per- chance, this cannot be accomplished, the family physi- cian is the proper one to decide the matter, and to declare what other means should be adopted. This brings us to an important subject, and one to which I would call special attention. The question cf wet-nurse is a difficult one to decide. There is no doubt that after the mother's milk nothing can act as a substitute better than that of a good wet-nurse. But, unfortunately, the latter is, as with all treasures, hard to find. There are so many other considerations connected with her choice, that from the outset great difficulties at once arise. As a rule, she is obliged to accept the position for THE CHOICE OF A WET-NURSE. 25 poverty's sake, and the sudden transition from the lowly surroundings and meagre diet to that of the most important personage in an affluent household, will soon destroy the very great merits that have caused her selection. Her milk must agree with the child; and there are as many kinds of milk as stom- achs to receive it. She must be about the mother's age, and therefore naturally is about as inexperienced; she must be watched and guarded as the sacred cows of India; watched in her diet, in her habits, in the control of her feelings; and the question often arises whether or not it is better to have an experienced nurse at once, and feed from the bottle, than to trust to one who requires so much supervision in the many duties that devolve upon her. If the child is born in the fall, and can be taken to the seashore or the country before the heat of the following summer, and a good, reliable, experienced nurse can be obtained, certainly the balance would favor hand-feeding; but if, on the contrary, the child should be obliged to remain in town, and suffer from the early summer heat before it is well started in life, and especially when there is a question as to the fresh- ness of the milk it is likely to obtain, there seems to be a strong argument in favor of the wet-nurse. The doctor is certainly the proper person to decide, and 3* 26 THE MOTHER'S GUIDE. such matters should be placed in his hands. With delicate children, or those who inherit a tendency which it becomes the duty of the parent to eradicate from the start, without doubt a wet-nurse is not only an important person, but a necessity, and no consid- eration should stand between the comforts of a house- hold and the requirement of the child. Bear in mind the old adage that the "boy is the father of the man;" the neglected taint of the babe may be the seed of disease for generations to come. Under no circumstances should a mother attempt to choose for herself a wet-nurse; there are so many considerations to be followed, diseases that may be transmitted, taints that may be intensified. The quality of the milk has to be tested, its quantity, and the condition of the woman's child, that only the doc- tor can properly decide. To him alone should such matters be intrusted, and therefore it is not requisite for me to spend time upon a subject which properly does not belong to this book. I have seen so many children thrive upon bottle-feeding, where care is taken, that I feel firmly impressed with the view that only in exceptional cases are wet-nurses desirable; these are with delicate infants, those who are born be- fore their full term, where the mother's condition has given them feeble constitutions, or where previous chil- dren have proved the existence of an hereditary taint. CHAPTER II. Bottle-feeding—The choice of milk—The great importance of the milk being fresh—How to keep it so—Milk can become a carrier of disease—Greater care required during the hot weather—The preparation of the milk for food— The use of gelatine—The use of farinaceous food—Its preparation—The choice of foods—The child kept regular by their alternation—Condensed milk—The importance of water for infants. Taking it for granted that it has been decided to attempt bottle-feeding, or at least to associate bottle- feeding with nursing, should the mother have defi- cient milk, let us consider the details that will make the trial a success. As a rule, it may be said that if, after the child has reached the age of three or four months, that is to say, is well started in life, it be- comes necessary to supply its demand by bottle-feed- ing, it is better to wean it at once. It will thrive better, and its food will be less apt to disagree. It is not necessary for young mothers to know what is the composition of milk, or in what this variety differs from 28 THE MOTHER'S GUIDE. that. In this country we use only cows' milk, and therefore asses' milk, and goats' milk, scarcely deserve the space their discussion would occupy. Let me im- agine that my reader is a young mother, with her first babe, a child which seems ordinarily strong and active; the mother has not an abundant supply of milk, and the doctor tells her that she had better partly feed her child, especially at night. She must provide her- self with a nursing-bottle holding about eight ounces, the half of which is a large meal for a child of four to six weeks old; the black rubber jvipple is to be preferred, and there should be several in the house, so that they can be kept thoroughly soaked and clean. The next important step is to select the milk. The principal qualification—I was about to say the only one of importance—is that it should be fresh. With us in Philadelphia, and, in fact, in all our cities, fresh milk could be very readily supplied to all, as our large and well kept dairies are so soon brought in contact with us by means of the perfect railroad facilities. But, unfortunately, the worst thing that could happen to milk, as far as the delicate stomach of an infant is concerned, is the jolting and churning it gets in transit, which often gives it a cheesy flavor but a few hours after it has left the dairy. A young mother lately mentioned to me, QUALITY OF COW'S MILK. 29 when I was inquiring particularly about the milk— when the cause of her infant's vomiting seemed un- accountable—that the milkman was particularly re- liable, and one most firmly impressed with the im- portance of pure, fresh "one cow's" milk for the child, but that, nevertheless, the milk had often a buttermilk smell; upon testing with litmus, it was found to be acid. In summer it is impossible to keep it perfectly sweet until it reaches town, in many cases, notwithstanding the greatest care, un- less it be sealed in air-tight jars, which is now done with excellent results. But even with this precau- tion, I have known it to turn; and especially is this the case when too much reliance has been placed upon the exclusion of air, and the jars have been kept too long. All good, fresh country milk from grass-fed cows, or those carefully fed during the winter months on proper food, should be sweet, that is, alkaline; and if it seems best to bottle-feed a child, each bottleful should be tested with blue litmus paper (to be obtained at any drug store), and tasted by the mother before giving it to the child. The blue paper should retain its color, and not turn red. Upon this rests the success of hand-feeding children; it is the one rule to bear in mind. If your babe is worth anything to you, no labor on 30 THE MOTHER'S GUIDE. your part to be watchful in this will be wasted. You should know your milkman, and interest him spe- cially in you and your child. Your husband should manage to visit his dairy, see the cows, and question as to their feeding; see that they have comfortable and clean quarters; that they do not water from stag- nant ponds or streams into which goes the drainage of the yards. If the milk of a single cow can be kept for you, let it be done, by all means. But this matter is not nearly so important as that the milk should be kept in a milk-house supplied by a fresh stream, and in pails carefully scoured. Some cows are noted for their milk agreeing with infants, and should the farm from which your milk supply comes have such a one, try and secure that for your own use. Do not be economical in this matter; a few extra dollars spent during the few months of early feeding in securing this end, will save you many a sleepless night, and many a heartache. The milk should be kept in cans used especially for that purpose, and they must be thoroughly scoured. See that the milkman has such, and also be careful that your own are scalded and washed daily with a little soda or wood-ashes. Another problem now arises: that is, how you should treat the milk after you get j it. If supplied to you once daily in the morning, it MILK A CARRIER OF IMPURITIES. 31 is well to see that it is as sweet as it should be, without being skimmed; to see that it is the morning milk of that day, and then at once make pure food for the day's use, and then keep it in a cool place, away from any danger of contamination by cellar smells or gases of any kind. It should be kept apart from meat and vegetables. Milk has a wonderful property of absorbing deleterious matters, and when thus tainted, will impart to those drinking it the germs of disease. It is only necessary to glance over the medical jour- nals of the day, and especially those of England, where great care has been taken in the study of this subject, to see how frequently scarlet fever and typhoid fever have been transmitted from one household to another by simply the absorbing properties of milk. That which has come from farms where the farmer's family has suffered from these diseases, has often brought the infection to children in the city, and often the bad drainage of milk-houses, or where their water supply has been infected by the sewerage of the dwelling where typhoid has occurred, has car- ried the contagious germs of this disease. In the early spring, even before the severe heat of summer has set in, it is well to make the food from the milk as soon as it arrives. Of course, in mid-winter this is not so obligatory. Let me again pause to impress 32 THE MOTHER'S GUIDE. a most valuable point: do all things gradually with infants; never change abruptly, unless some urgent cause exists; but if you wish to alter the diet or the character of the clothing, do so, with as little shock as possible. The sudden change from cow's milk to condensed milk might be harmful, or from long clothes to short ones. It must be constantly borne in mind, and especially by those who imagine that all the little details of a work of this sort are superfluous, that a single curd may give rise to inflammation of the lining membrane of the stomach and intestines, that will cause death in a few hours, or in a teething child may produce a convulsion that will not take long to prove fatal. The greatest heats begin about the ioth or 15 th of May, last a few days, then a cool wave—probably a storm —sets in, and a return, with all the intensity of our proverbially hot summer about the 1st of June; from this time, until the cooler nights of August, the bottle-fed child will require the greatest care. At that time its digestion will be weaker, its powers of resistance less; its secretions will be more easily dis- turbed, and what would merely cause slight vomit- ing in mid-winter might, from the almost paralytic condition of the nervous system, cause a fatal diar- rhoea. Heat-stroke and cholera infantum are condi- THE PREPARATION OF FOOD. ^ tions almost analogous, and their cause should never be allowed to exist. I say purposely that their cause can be prevented, because I have so often seen children, whose parents were watchful, thrive upon artificial feeding during the summer weather, the reason being that they were kept cool by proper clothing and frequent washing, not over-fed, and the food they received was prepared with unusual care. Until a child has reached the third or fourth month, the diet should be nothing but milk. Arrowroot, corn-starch, prepared wheat, and all other preparations of the cereals, should be avoided as a diet, because, owing to the peculiarities of the diges- tive organs of infants, the secretions in the intestines that are used to digest such substances, and also those of the salivary glands having the same action, —ferments that change them into grape-sugar,—are wanting in infants of this tender age, and it is only later, during early dentition, that these secretions gradually come in small amounts. In very young infants, who are from the first bottle- fed, the food should consist simply of milk, diluted with about half water, and a small quantity of white sugar; and should there be any evidence of indiges- tion, such as vomiting of curds, or a sour smell, a teaspoonful or two of lime-water to the bottle will 4 34 THE MOTHER'S GUIDE. correct it. Of course, you must satisfy yourself that the milk has not been diluted beforehand ; or again, should its appearance show it to be over-rich in cream, it is well to add, for very young babes, an extra quantity of water. As soon as the morning milk arrives, it is well to prepare the food for the day; to do this for an infant of the age about which we have just been speaking, add a pint of boiling water to a pint of the milk; put in a small pinch of table salt, and slightly sweeten with pure loaf sugar, and strain. Put this food, now pre- pared, away in the refrigerator, in a clean pitcher, well covered, and at each feeding time take from it the quantity required, put it into the nursing bottle, with a teaspoonful of lime-water, and then place the bottle in hot water, and allow the milk to be heated for the child. The food should be always given at the same tem- perature, and on this account, and also to find out whether or not it runs readily from the bottle, should each bottle be tasted before it is given to the child. A couple of inches square of Cooper's sheet gelatine, previously soaked in cold water, can be added to the boiled water, or the Russian isinglass can be used in its stead, though it is much more expensive. I quote the following from the excellent little book THE PREPARATION OF FOOD. 35 of Chervasse; it is bad advice, and should not be followed. " A good plan is for the nurse-maid to have a half-pint bottle of new milk—which has been previously boiled—in the bed, so as to give a little to him in lieu of the breast. The warmth of the body will keep the milk of a proper temperature, and will supersede the use of lamps, of candle-flames, and other troublesome contrivances." Advice such as this only leads to mischief; a child needs no food during the night, except its regular meal, and the giving of a "little, in lieu of the breast," is simply to encourage a habit which is most pernicious. Get a small sick-room refrigerator, or, if you cannot afford that, make a butter-kettle serve the purpose ; put it in the window of the next room, and when the babe needs a bottle, do as was done in daytime, heat a fresh one for each feeding. It should be made up fresh each time, and no bot- tle should ever, under any pretext, be heated over; four ounces, or one-half of an ordinary nursing bottle, is sufficient for one meal, and the nurse or mother should always taste the food, to see that it is in good condition, and also that the nipple is not stopped up before giving it to the child. If a child is to be entirely bottle fed, it can be fed at first every two hours, and then it is well to increase 36 THE MOTHER'S GUIDE. the amount of water to a little over one-half, gradually increasing the milk, as the digestion grows better, and the child stronger. Let me impress another fact, which is constantly overlooked; after a child has nursed, it should be placed upon its right side or back ] and kept perfectly quiet; if placed on its left side, the weight of its liver pressing upon a full stomach will often cause it to vomit, and if danced or exhibited to admiring friends, its action will be surely disgrace- ful. As cow's milk coagulates in large, and, there- j fore, indigestible, curds, which differs from mother's milk, it is customary to delay this process by adding lime-water or a little bicarbonate of soda or potash to the bottle. A teaspoonful of the former is enough for one feeding, or a couple of grains of either of the latter. It is also necessary to allow the child to nurse slowly. Dr. Eustace Smith recommends the following : "A useful addition to the breast milk, where an addition is required during the first few weeks of life, is a mixture of cream with diluted whey; one tablespoon- ful of fresh cream is added to two of whey, and the mixture is diluted with two tablespoonfuls of hot water. This may be given from the feeding-bottle every three or four hours. The whey should be made fresh in the house, as required, by adding prepared USE OF FARINACEOUS FOOD. 37 rennet to new cow's milk, in the proportion of a tea- spoonful to a pint of milk, after which the curd is removed by straining through muslin." I have said, only a few paragraphs back, that the only true food for infants was milk, and urged the importance of avoiding farinaceous food as a diet. I said this advisedly, because we so often hear of the attempts at feeding babes with corn-starch and such like, with such bad results. We are taught in our works on physiology that to feed an infant exclusively on starchy food is little better than to expect it to thrive on saw-dust or shavings; and the daily experi- ments that are made in our poor-houses and alleys show this reasoning to be pretty nearly correct. At the same time I will make a statement that will be an apparent contradiction, which is, that it is neces- sary, after a child is a few weeks old, to add one of these very substances, indigestible in itself, in small quantities, to make the food easier of digestion, just as the ostrich eats stones, and smaller birds sand, for the purpose of trituration. It is well known that this tendency of cow's milk to form large curds can be obviated by adding some substance which thoroughly distributed throughout the milk, will prevent its coag- ulating in large pieces. Arrowroot, barley water, or 4* 38 THE MOTHER'S GUIDE. oatmeal water, and, in fact, various other substances of the kind, will be useful for this purpose. It is well to pause here, and dwell upon the pre- paration of these foods and their choice. Perhaps the best one to begin with is the barley. Get a pack- age of Robinson's barley, finely powder some of its caked contents, and take a teaspoonful. Thoroughly mix this with a little cold water, so that it will not get lumpy, and then add a pint of water, and set it to boil. Do this in the morning, as was done with the first mentioned milk food. Let it boil for at least half an hour, even an hour, over a fire so reg- ulated that in that time it will have boiled down to half a pint, (the directions on the package say eight or ten minutes, which is not nearly enough,) then strain, and add, stirring it carefully, to a pint of the fresh milk, a pinch of table salt, a little sugar, and put in the cold to use, warming up each bottleful as it is required. If the bowels of the child are inclined to be loose, you may substitute rice, which has also a constipating effect, soaking a full teaspoonful of rice in cold water for half an hour, draining it off, and then adding the water to boil. If, on the con- trary, the bowels are costive, you may use oatmeal: get the Bethlehem oatmeal, which comes pulverized, prepare it as the other. In most cases, the choice of ; food is an experiment; with one child the barley j AVOID OVER-FEEDING. 39 food will agree best; with another the oatmeal; with some, the cracked wheat, or the prepared wheat. The test is, if it remains sweet upon the stomach; if, on the contrary, the child frets soon after food, it is a sign that it fails to agree. An experienced nurse can regulate a child's bowels by its food in this manner; and by thus holding the control of the balance, save the injurious effects of laxatives, injections or astringents, that are both physically and morally irritating. Mothers should learn that milk has to curdle in the child's stomach; it is in that way in which it is di- gested, and therefore they must not be alarmed, and consider it a sign of disease, when, from some such cause as over-feeding, or tight clothing, or jolting, the child regurgitates in small flakes what it cannot hold; loosen the clothing, and keep the child quiet, are all that is necessary, and be careful next time not to let it take " too much." But if the food is vomited in large curdled masses, and there is gagging, and the child seems to suffer from colic, and especially if the bowels show irritation by straining, or the passage of curds, or diarrhoea, then at once change the food. In this country, and also abroad, the use of con- densed milk has gradually received the sanction of those who have been interested in the feeding of babes. Owing to the impossibility of obtaining 40 THE MOTHER'S GUIDE. the kind of milk we want at the sea-shore,—salt grass-fed cows are not the kind to give the proper food for infants,—and also the great difficulty of obtaining sweet milk for those who remain in town in sum- mer, condensed milk is most valuable. The Eagle Brand (Borden's condensed milk) is to be preferred, and in many ways it is often easier digested by infants than the fresh cow's milk. The great mistake so often made is to prepare it too strong. Remember it is a most concentrated preparation, and experience has shown that a small teaspoonful is amply sufficient for a meal of four ounces of " bottle." It does not curdle in large masses, and therefore more closely re- sembles mother's milk; and when the directions on the can are thoroughly carried out, of keeping it cool and well closed, it will agree well. It needs no sugar, but sometimes it may be advisable to add a table- spoonful of cream to the bottle, if the child seems not to thrive well. The condensed milk may be diluted with weak barley water, prepared as before directed. As the child grows older, a change of food will frequently become a necessity. In many cases, when an infant is feeble, and does not seem to thrive pro- perly upon the various preparations that have been recommended, it becomes important to make use of other means for its nutrition. As for the choice of CHOICE OF PREPARED "FOODS." 4I the many babies' " foods" that are found in the mar- ket, much depends upon the medical attendant. The experience of one may have taught him to use "Hardt's;" another will suggest "Ridge's." In some cases, " Nestles" will agree well, when used to slightly thicken the milk, and in others the various well-known preparations of the cereals, as prepared wheat, farina, and such like, will do better. The English use Savory and Moore's infant food, and it has certainly received high encomiums. They can all be used according to the directions sent with them, but it should be remembered that, for young infants, those between two and five months, the bot- tle food should be of the consistency of cream ; after that age, it is well to gradually make it thicker until it resembles gruel, but still let it run freely from the bottle. A child fed upon one of these may make of it two meals a day; the other, and the last bottle, at night, should be of milk and barley water. Probably the best of all these " foods" is that known as " Mellin's infant food," an English preparation, made after the formula of Liebig. What is known as " Horlick's" preparation, is the same made in this country. Either of the latter are most valuable for an infant at any age; a teaspoonful in the bottle of milk that has 42 THE MOTHER'S GUIDE. been scalded by boiling water, can be used with deli- cate children, and will often prove an important ad- dition. My advice is, if a mother cannot bring up her child on cow's milk or condensed milk, she must de- pend upon the advice of her physician in the choice of what to resort to next; she should not undertake further responsibility. Before closing this chapter, I wish to state the impor- tance of giving a child water to drink. Frequently, a child seems to crave water; it forms the greater part of its food, and a teaspoonful of it, occasionally, will often satisfy a fretting babe. Water serves as many purposes to a child, as to an adult; it aids the func- tions of secretion and excretion ; it does for the body internal as for the body external; it cleanses, dis- solves, and thereby purifies. But it should be pure of itself. It is well for all households to have a large filter, from which all the drinking water should be taken. No child is by nature cross or fretful. The pla- cidity of infancy, and the happy disposition of child- hood, are evidences of good health. Every mother may rest assured that what is usually attributed to temper, is in reality the expression of pain, and a cause will surely be found, if carefully PREPARATION OF FOOD. 43 and intelligently sought for. Irregularity in nursing, or faulty management, may make an infant irritable. Use as little sugar as possible for infants; its fer- mentation will cause colic, and the taste acquired for it will be a difficult one to overcome. Season all food with salt; it aids digestion. CHAPTER III. The bathing of infants—The temperature of the water—lis value in summer—The skin—The mild eruptions—The character of clothing. As this little work is mainly written for those who are desirous of informing themselves of details that only the most lengthy visits from their doctor would permit him to impart, and also for those who are de- sirous of gaining all the knowledge possible in a nut- shell, I shall endeavor to take up, seriatim, all the aspects of my subject, and will now proceed to discuss the bathing and washing of infants. The washing of the new-born babe was considered with care, for the same scrupulous cleanliness is re- quired throughout the infant's life. Every child should be thoroughly washed twice a day, in the morning and in the evening. It is usually the custom to give the morning bath about nine or ten o'clock; in summer earlier, after the digestion of the early nursing has been complete. It is necessary to have a small tub or a large china basin, well filled with tepid water; the room should THE BA THING OF INFANTS. 45 be warmed to summer heat, and carefully guarded against draughts. It is well to wet the head first, and then to use freely, soap, either the best white Castile or oat- meal, washing with a soft sponge or piece of flannel, every hidden crease and crevice, as the retention of materials that are so apt to collect, is frequently the cause of many of the eruptions or crusts of young children. The infant should be placed in the tub, for no doubt by this means a certain amount of absorption of water takes place, to supply in part the demand which nature is constantly calling for. As the child grows older, it should remain longer in the tub, and when withdrawn, thoroughly dried—not fiercely rubbed—and carefully powdered. Many persons think it only sufficient to sponge off a child, but this is incorrect; a child will thrive better and grow stronger and healthier by the daily bath. It is not advisable, nor, in fact, admissible, to use cold water. An infant is too tender and delicate to bear any shock, especially of this kind. But once more, I may impress the necessity of gradually ac- customing it to cooler water, until, when it reaches the age of two years, it will bear, with pleasure, its plunge in water, at the ordinary temperature of the room. Never force a child, even a babe, if it 5 46 THE MOTHER'S GUIDE. dislikes the water; place it in a light blanket, and allow it gradually to become thoroughly immersed, and in that way babies will learn to delight in their bath, and it will make them vigorous, and give them good digestion. After its bath, it should be nursed or fed, and then allowed to sleep—a sleep which will be sweet and sound. If possible, I would advise every mother to bathe her own child; in many ways it is beneficial; it teaches the mother the tastes, habits, and peculiarities of her little one, and it teaches the j child, from its very birth, to rely upon her, and the extent of her affection for it. The washing at night need not amount to a bath, a thorough sponging will be all that is required. In the heats of summer it is well to frequently sponge the child off during the day, and for this pur- pose a small quantity, perhaps three or four tablespoon- fuls of ground salt, sea salt, that comes in boxes for the purpose, should be thrown into the water. Should the infant be feverish, a half a teacupful of good cider vinegar or some Cologne water in the bath, will be valuable; but never permit the child to soak in the water of its bath; it is then weakening; sponging off is all that is required. We have been speaking of infants enjoying perfect health, or those ■ who are slightly debilitated by the heats of summer. GOOD EFFECTS OF BATHING. 47 Should the child be ill omit the bathing—especially if it has cold—or if there is a tendency to diarrhoea from indigestion or cold. In these circumstances, it should be well cleansed, and then thoroughly dried and rubbed into a glow by the hand. Cold baths for infants have been recommended for cholera infantum, but as their use is never indicated until this dreaded disease has resisted other treatment, and in all such cases your doctor should be at hand, it will not be necessary for me to enter into their dis- cussion. The function of the skin in infants, as well as in adults, has a most important bearing upon health, although a healthy child has very little perspiration, its skin should be soft. The washing of a child is not merely for cleansing purposes, but the tonic effect to the nervous system which the slight irritation gives, is most valuable; and also the reddening of the surface aids the free circulation of blood, and helps it to carry the impurities that accumulate to the organs that excrete them, as the blood is the carrier of the cinders that result from the burnt-up tissues, as well as that of the fuel to keep up the fires of life. The red gum which occurs in blotches, the pearly white granular eruption, and what is ordinarily known as nettle-rash, are the usual frequent eruptions found 48 THE MOTHER'S GUIDE. in infants, due to some derangements of the digestive organs. Of course, their appearance is not alarming; they may be simply looked upon in many cases as " cautionary signals," suggesting a change, for a day or so, in diet, or attention to the child's secretions. Instead of the powder after its bath, a little vaseline may be substituted, not enough to come off on the clothing. Frequently the flannel shirt, which every infant should wear throughout the year in this change- able climate, will keep up the irritation; and if this be the case in midsummer, the time of year when such eruptions are more likely to exist, a fine linen undershirt can be worn beneath the gauze flannel. CHAPTER IV. Choice of a nursery—The temperature of the room—Methods of heating—Evil effects of cold—Ventilation—Importance of personal contact with the mother—Light and sunshine— Importance of good plumbing.—A child should live in fresh, pure air—Care of an infant when out-of-doors—Pre- caution to be insisted upon—Importance of a reliable child's nurse. Not the least important consideration in the man- agement of young children is the choice of a nursery or sleeping-room. For an infant, it is well to have it as near as possible to the sleeping apartment of the mother; it should be light and airy, and the furniture so arranged as to preclude draughts. It is well, possibly, in our Philadelphia houses, to make a sleeping-room for a child, of the third story front room, or if there is more sunshine in the back building, use it. If possible, ventilate through an- other room. I would certainly recommend that all furnace-heat be abolished in an infant's sleeping- room ; the heat would better come from an open fire- place, using wood, or an old-fashioned air-tight wood consuming stove which can be lighted in a moment, 5* 5o THE MOTHER'S GUIDE. so as to bring up the temperature in the early morn- ing at the bath hour. They burn little wood, and the ashes keep their heat for a long time. If your house has a furnace, use it to keep up the general temperature of the house, the halls, etc., and if you are obliged to use it in the nursery, keep a basin of water near it, well filled, or use one of the many patent arrangements now to be had to keep the air moistened. The hot air should be deprived of its dust, and should be moistened as it enters the room. Shut off the furnace at night, and see that the room is well ventilated through the adjoining room, and the child carefully guarded from draughts. An opening for ventilation, near the ceiling, is a most important ad- dition to a nursery, or if this cannot be arranged, it is well to keep one of the windows down from the top, a couple of inches, day and night. Every nursery should have a thermometer placed in a conspicuous place, not near a door or a window, nor, again, near the heater; the nurse should always keep the tem- perature of the room about 68° or 700. Of course, there is no trouble about keeping a young babe warm, and as the child grows older, it is well to adopt some means that will insure its being kept covered, and not depend upon the nurse waking in the " wee hours," when nervous depression, lowered vitality, a nude child, and bitter cold will combine. IMPORTANCE OF WARMTH. 51 In speaking of a sleeping-room for an infant, the above remarks had reference to one who is bottle-fed at night; a nursing child should be kept in the room adjoining that of the mother, or by her bedside. I believe that the warmth of the body aids sleep, and that children should be most judiciously clothed both by night and by day. Dr. Tanner tells us: "the maxim which says 'keep the head cool, and the feet warm,' should be borne in mind." Also, " of all predisposing causes of disease, there is prob- ably none more powerful than cold," but the clothes should be '' sufficiently loose to allow of perfect free- dom of motion." How often will the warmth of a nurse's arms lull a babe to sleep, when an obstinate and irritated nervous system has rebelled against the cruelty of loneliness and neglect! Mothers should bear in mind that many a child pines away for want of the warmth that comes from contact of the body of its healthy nurse or mother. Nature requires this coddling of the young, and when art steps in to make unfashion- able what it demands, the battle that is fought can end but in one way. This has been truthfully assert- ed as one of the many causes of the enormous mor- tality amongst foundlings and illegitimate children. Caress and fondle your babe; give it the warmth of 52 THE MOTHER'S GUIDE. your own body; lull it to sleep, when its sleep time comes, and teach it from its birth that the pains of early life are assuaged by warmth of love in its mo- ther's lap, and that those of its later years are soothed by its memory. The mother, who hushes her babe to sleep, gives the only anodyne that nature intended for it, and to put it in the cradle and let it cry itself insensible, in order to avoid "spoiling," not only spoils the child, but the man. A well ventilated room is not necessarily a cold room; there seems to be an impression that fresh air and warm air are incompatible. Such by no means is the case, and it is a fatal mistake to so chill the room of a sleeping infant as to give it colder air to breathe at night, than that which entered its delicate lung tis- sue by day, a mistake that may often give rise to fatal croup. Vitality, that is to say, the heat-making pro- perties, are below the normal while the infant sleeps; its pulse is slower, its respirations less, and when you add to this the peculiarity of the night atmosphere, or that of the hours just preceding dawn, a something —what it is, we know not—that depresses the nervous system to its lowest point, it makes the importance greater of good warm clothing, light in weight, but warm in texture, and a careful regulation of the room temperature at that time. Crises in illness occur most CLEANLINESS AND FRESH AIR. 53 frequently in the night hours, and then also are record- ed the greatest number of births and deaths. Do not, on the other hand, make your child too warm, as the sudden checking of perspiration is a frequent cause of catarrhs and diarrhoea. Every nursery should be well aired daily, well dusted, and carefully swept. It is well to have as little furniture as possible in an infant's sleeping-room, as the more there is in the room, the more points there will be for dust to col- lect ; and these impurities, containing we know not what, are most injurious to the delicate mucous membranes of children. If one wants to see how much evil dirt can do, it is only necessary to visit some of the alleys and courts where the poor are hud- dled together; sore eyes and sore mouths, innumera- ble, are warnings to those who are apt to underesti- mate the value of soap, water, and brooms. A child should live in the fresh, pure air; if the climate is such that its great variation precludes an out-door life, science has taught us how to turn our abodes into conservatories for these delicate young plants; we can give them a pure, well-tempered at- mosphere, and keep it constantly changing, with plenty of light and sunshine. There is one important matter which deserves so 54 THE MOTHER'S GUIDE. much attention as to demand consideration in a little work of this kind. It is that of the proper drainage of houses. Whether or not bad drainage is a cause, or the cause of typhoid fever, is not for us to decide; but that improper plumbing, with its result, the escape of gases and sickening odors, does vitiate the atmosphere, in which a babe and its nursing mother live and de- pend upon for their health and strength, is a fact that no one will dare deny. A bad odor may not in itself be a deadly one, but it will nauseate and sicken, and thus be a destructive agent; it will retard growth and development; it will prevent the proper diges- tion of food ; it will act as an irritant to the nervous system, and it will render a child, even an infant, as well as an adult, susceptible to the deadly influence of taints of heredity, or of acquired diseases. By lowering vitality, you disarm a child in the presence of disease and disorder; you take from it its power of resistance, and you make yourself guilty of the evils that befall your child by the neglect of those pre- cautions which should be essential accompaniments of all the arrangements that are obviously introduced for your own comfort. Every parent should person- ally interest himself in the drainage and ventilation of his own house; study the requisite for the proper THE AIRING OF INFANTS. 55 introduction of fresh pure air, and the exclusion of that which is foul; it is the one and only way to keep disease from his door, and he may rest assured that if he does not do it himself, no one will do it for him. Have no stationary washstands in your chil- dren's sleeping apartments, and be careful that the overflow pipe of your bath tub is so well trapped that it will not allow a jet of foul air to play into the face of your child, when it is of an age to discard the nur- sery tub. While speaking of the effect of fresh air and its great importance, it is timely to say a few words about the taking of children out into the open air. After a child has reached the age of about six weeks or two months, it is well to wrap it up warmly, and let the nurse take it out for a walk. I mean by this that the nurse should carry the child, and not use a baby-carriage. Of course, after the spring weather has well set-in, and the child is old enough to be kept out of doors several hours of the day, there will be no objection to the baby-carriage. The warmth of a nurse's arms, the gentle exercise that the child gets by the slight mo- tion, will be greatly beneficial. But I must confess that I do not believe, speaking for the winter months, that the walk is good for infants who have a bright and well-ventilated nursery,except when the weather is 56 THE MOTHER'S GUIDE. still and clear, and not too cold, and then care should be taken to cover the child's face with a veil, that the air breathed may be somewhat warmed. It is a mis- take to think that, never mind what weather, unless it be stormy, an infant should be taken out daily, to get "hardened." The time for this process will come to all children soon enough; it is better to be sure that, when such time does come, the foundation structure is of a healthy kind, sound lungs, good muscles, and a thick covering of fat. A child that breathes fresh pure air, drinks heartily of good sweet milk, and sleeps soundly, is gradually accumulating the resisting power to disease, and is far healthier than one who is dragged out day after day, to withstand changes of temperature, to inhale air saturated with moisture, and to run the risk of laying seeds, or of vitalizing those already there, of catarrhal diseases. No child is made healthy by such exposure; healthy children are often made delicate by it, and when exceptions do occur, it is when an infant has been blessed with a remarkably healthy inheritance. Let it not be understood that a child should not live out-of-doors in certain months of the year; the remarks just made were intended for infants up to the fourth or fifth month; and we only referred to those particular months which in our city are proverbially CA TA RRHS O F CHIL DHOOD. 57 accredited with producing catarrhs. The catarrhs of childhood are caused by sudden changes of temper- ature, of clothing, and of the moisture in the air which they breathe; now all these conditions can be brought about as well in-doors as out; and, therefore, let no mother imagine that, because she keeps an in- fant in the house it will not catch cold; carelessness will always be followed by evil effects, and it is only the careful and thoughtful mother that sees her child grow free from disease. We have a most trying climate to deal with, and the great uncertainty and rapidity of the weather changes makes it difficult to guard against them. It is well for every one who has charge of young chil- dren to read daily in the paper the Signal Service re- ports, and often the shades of "Old Probability" will act as a guardian angel to their little ones. I saw from my window, on a cold, rainy afternoon, this winter, a woman taking her babe in her arms to the Dispensary of the Children's Hospital, ostensibly for treatment. She was well covered herself to pro- tect her from rain, but the little one was left out in the wrapping, as the shawl was not big enough to go around two. Mothers will read this about the heart- less woman, and blame her for her thoughtlessness, and yet how often have we not seen, in the bitter 6 58 THE MOTHER'S GUIDE. days of midwinter, the nurses who are in charge of the infants, probably of the readers of this little book, collected together in a public park or square, discuss- ing some interesting piece of gossip, while the baby- carriage, with its tender little occupant, stands, by the half hour, braving the cold winds. That is the rea- son that I object to baby-carriages in winter, for if the nurse was obliged to carry the child, matters would assume, undoubtedly, a different shape. I have no doubt that many an unaccountable case of croup, bronchitis, or pneumonia, and many a sudden death from congestion of the lungs in a child—the idol of its mother—would be explained, could the trees and branches tell the tale. There is another matter that is appropriate to this chapter, and one often and often neglected. When a nurse, during her walk, takes the babe to visit some of the elderly ladies of the family, all of whom are interested in the child, and in its mo- ther, and thereby prolong the visit by asking in- numerable questions, and endeavoring to discern resemblances, she is apt to remain in the over-heated house (and all our houses are so in winter), with the child swaddled in wraps without number; this is wrong. The infant should be unwrapped, its cap taken off, and if the visit be even for a short time, a CARELESSNESS OF NURSES. 59 great risk will be avoided. But after all, though I endeavor to point out to the careful mother where her attention should especially be called, the sum- ming up of advice upon this subject, is to be care- ful in the selection of the nurse to whom you trust your child. How often do we see an infant guarded like the tenderest flower, watched at every breath, protected from draughts and contagious diseases, given to a young giddy girl to take out daily, heed- less of consequences, to carry where she will. She may stand talking with a newly turned-up cousin in the street, over a sewer-inlet. She may join a party of girls from her town in the Square, who have come to "air" a family with Whooping-cough, or for aught the mother knows, she may (and often does) visit some friend in the neighboring alley, whose children have just recovered, or died, from a very severe attack of scarlatina, measles, or varioloid. Be as careful in the selection of your child's nurse as you were of your monthly nurse. Choose a woman of middle age always for your first baby; after that your own experience will supply the deficiency ; get one with the best recommendation for truth, cleanli- ness, and conscientiousness, and one, if possible, who has had children herself, or who has had expe- rience with them. Having once secured such a trea- 60 THE MOTHER'S GUIDE. sure, place your confidence in her, treat her well, and economize in whatever else you may, to pay her well. A good table and a good nurse form the great lubricators of a household; they will bring strength, health, and happiness to all; this is where the best economy lies. CHAPTER V. The changing of infants—The character of healthy passages —Use of ointments—Action of the kidneys—Looseness of the bowels—Improper diet or over-feeding often the cause of sore mouths—Attention to the breasts—Treatment —Intestinal catarrh—Symptoms—Use of castor oil—Nasal catarrh. To young mothers, one of the most difficult, and at the same time important, duties to attend to, is that connected with changing their infants. It is well for them to know beforehand the character of the pas- sages of a child, what constitutes their healthy appear- ance, and how far deviations from this condition can be compatible with health. The movements of a healthy infant are at first dark, from the discharge of those matters that have accumulated in the intestine. The early milk will purge them of this, and then the appearance will gradually assume a yellow color; the movements will not be formed until about two or three weeks, when they will begin to get so, in part, by degrees. An infant, up to three or four months, has usually from four to five in twenty-four hours. Of 6* 62 THE MOTHER'S GUIDE. course, this greatly depends upon so many conditions, its food, its condition in life, the time of year, etc., that the only test is the condition of the child itself; if it remains strong, with firm flesh; if it sleeps and nurses well; in fact, if it thrives, no uneasiness should be felt in regard to more frequent movements. They may change in color, and become greenish, without disorder, but they should not become liquid. They should have little odor, no mucus, and no curds. Occasionally an infant may, from a slight cold, or from a little indigestion, have a passage containing both mucus and curds, or either one, and the next movement may be perfectly normal. No treatment is required for such cases, except perhaps in a bottle- fed child, it may be well to change its food; for in- stance, if barley-water be used in its food, add a small quantity of the wheat food to it; do not do this unnecessarily, but tvatch the child, that a change may be made, if the condition persists. An infant must be changed at once, or it will be- come chafed, and especially is this the case, if the bowels are free, or if the water it passes is highly col- ored ; the brick-dust deposit which infants frequently pass gives rise to great irritation. The cry of an in- fant that is thus scalded \s peculiar, resembling the sudden sigh produced by the shock of cold water. A TTENTION TO AN INFANT. 63 If chafing exists, and even if the movements are numerous, it is well not to wash an infant every time it is changed; dry it well, and thoroughly grease with vaseline, or well-prepared mutton-tallow, or zinc ointment. It is well anyhow to do this always at night. A few hours' treatment of this sort will save much pain and trouble. Avoid, if possible, using rubber-sheeting in the diapers for habitual use, it will act on a child as rubber boots on a man, caus- ing an excessive secretion of perspiration, and keep- ing the parts soaked in it. Another important point is never to allow soda or indigo blue to be used in the diapers, as they both greatly irritate the skin. Remember the importance of the kidneys acting properly in a child ; frequently they get clogged by the brick-dust material, and will need the immediate attention of the doctor, when an absence of secretion is noticed. In the absence of a physician, three or four drops of sweet spirits of nitre, in a tablespoonful of water, will be needed. Having had our attention called to the condition of an infant in health, it is well to consider also those conditions that give rise to disorder of the bowels; how to recognize them, and their remedy. Dr. Che- vasse tells us that looseness of the bowels in infants is due to " improper food, over-feeding, teething, cold; 64 THE MOTHER'S GUIDE. the mother's milk, from various causes, disagreeing, namely, from her being out of health, from her eat- ing unsuitable food, from her taking improper and drastic purgatives, or from her suckling her child when she is pregnant." Dr. Ellis speaks of the great importance of diet as a cause of the various digestive disorders of infants, and impresses upon mothers the importance of care as a prevention from them. He but repeats the advice given by all writers. Cow's milk is no more potent cause of catarrh of the intestine than mother's milk, that has been poisoned by her own faulty secretions. Often the cause lies in the want of proper caution on the part of the mother, not only as to the milk she gives her child, but as to the breasts themselves that it nurses. Soreness of the nipple will often produce the same condition of the mouth of the infant, and a neglected sore mouth, of however little importance at the outset, may be, and often is, a most sure cause of sour stomach and intestinal catarrh. The mother should not only see that the child's mouth is kept thor- oughly cleansed, washing it, if there is the least evi- dence of white deposits, or small ulcers, with a solu- tion of borax in rose water, but she should also wash her nipples before nursing thoroughly with a little bi- carbonate of soda water made very weak, and do the MILD INTESTINAL CATARRH 65 same after nursing, drying them well with a soft towel. If from any cause the nursing hour is passed, and the breasts have been allowed to remain well filled for some time, it is well to press out the first milk that comes, and not to give it to the child ; the newest made will be the richest and the best. These just enumerated, together with the other statements quoted, are the most frequent causes of slight diarrhoea in children at this tender age. A child that passes curds by the bowels, should be watched with caution. Its food should be changed, and given more diluted, and less frequently; and if the conditions persist, the undigested material that remains, should be expelled from the intestines by some slight laxative. The condition may arise if the child seems to be weak and drooping, and especially is this the case in summer, or in children constitu- tionally weak, from sheer debility. If such be the cause, the infant will show it by languor; there will be no evidences of acute catarrh, no fever, and no violent pain. A small pinch of pepsin (the best ob- tained from a reliable druggist) in a tablespoonful of water, with four or five drops of the best port wine, given about ten minutes before nursing, will often be a great aid. Remember the importance of regulat- ing the diet. If a child seems not to desire its food, 66 THE MOTHER'S GUIDE. do not press it, let nature work her own cure. A 'healthy child will have a healthy appetite ; if it refuse its food, it is because it is not in a condition to digest it. Then try another preparation for a bottle or two, it may take that, watch the result, and thus the use of medicines, which should only be last resorts, are avoided. Before having recourse to medicine, try a tea- spoonful of lime-water, or a little bi-carbonate of soda, or a teaspoonful of soda mint. If from sour stomach or acid and curdled passages, it is deemed well to use a laxative, and especially if you I notice a whitish fur upon the child's tongue, you may use a teaspoonful of Murray's fluid magnesia, repeated once or twice, watching its effect. It will counteract acidity, and relieve the intestines of their unhealthy < contents. But occasionally from some change in the milk, it may be from a change in pasture of the cow, or some slight functional disorder of the child from cold, there will be colic, with a change in the char- acter of the passages; they will be more watery, cur- dled, and contain slime. This is an evidence of catarrh. There is pain and the child is restless; there may be some fever, or the skin will be dry, and the child will cry and draw its knees up. The atti- tudes will show that the pain is intestinal. Let a tea- THE USE OF LAXATIVES. 67 spoonful of castor-oil float upon some hot water, and when it has cooled sufficiently, skim off the oil, and give it by the spoon. Should the passages be white or grayish, it is better to make the following, and give it instead :— Take about as much of the powdered rhubarb, or grate it yourself from the lump of rhubarb, as will cover a dime, and add it to a tablespoonful of boiling water, with a drop of essence of peppermint and a little sugar, strain through a handkerchief and cool sufficiently, and give every half hour a teaspoonful of this till two or three doses have been given. You may also make an allspice poultice for the babe's abdomen. Soak its feet in warm water, and dimin- ish the nourishment, or at least do not let the bottle be given for some time after the medicine. If you are in the country, a little spiced syrup of rhubarb will answer equally well; it is the same thing, only the other is fresher and home-made. It is better to give your child a small dose, and repeat it if necessary,- than, by giving large doses, add to the irritation present, and thus take days to again recover the balance. After an attack of this sort, especially in warm weather, it is well to give the pepsin tonic before mentioned for several days; and if you find the milk still disagrees, try small quan- 68 THE MOTHER'S GUIDE. tities of condensed milk well diluted with the barley, rice, or flour food. I am opposed to giving meat juice or broths to infants of such a tender age, unless they are specially ordered by the doctor; he alone will understand the requirements for their use, and he will give the necessary directions about them. If your child is ill enough to need them, the doctor should be called at once. A little weak gum-arabic water is often, for a day, an excellent substitute for milk in cases where dieting is required to check a watery diarrhoea, or even the toast water in many cases is invaluable, especially in older children. Slight colds are so frequent in infants in this cli- mate, whether from the rapid changes of temperature or the overheating of our houses, but more frequently I fear from the mode of heating—the use of furnaces— that a few words of advice in regard to them will not be out of place. In infants the commonest variety is that of nasal ca- tarrh. Mother forgets that the delicate skin of the scalp is as easily influenced by outside impressions as that of the body; and where they will envelop the child thoroughly in innumerable wraps, they will let its head receive the draught from an open door or in the passage from one room to another, to gratify a few intimate friends by a sight of the baby, the little one MILD NASAL CATARRH. 69 will receive its fever chilling blast from this cold world. The result is that its breathing will become difficult through the nose; it will have to breathe through the mouth, and so in sucking there will be constant threatened suffocation. Of course the sense of hun- ger will cause it to cry, and the difficulty will be aggravated. The treatment is simple. The advice of Dr. Meigs should be followed : let it wear a flan- nel cap at night, there is nothing better. Grease its nose well with a little vaseline, mutton-tallow, goose grease, and if there is much stopping, a little sweet oil or glycerine will be found serviceable to the nos- trils. If the bowels show that the condition is not alone limited to the nose, but the passages contain a little slimy mucus and are disturbed, a small dose of oil will be indicated. A warm foot-bath and a good rubbing of the surface of the body with the warm hand will give great comfort. It is rare for infants of the age about which we are now writing to have the same catarrhal diseases of the chest, or croup, and therefore I will defer the consideration of this subject till we discuss the management of chil- dren during dentition. In children, the eyes form the great index of their condition of health. They are unusually bright and 7 70 THE MOTHER'S GUIDE. clear if there is fever, or they may be dull and droop- ing in serious disease. Their appearance should always be watched and noted. PART II. GENERAL MANAGEMENT DURING DENTITION. CHAPTER I. The most important period of a child's life—Time of cutting the teeth—Lancing the gums—Importance of fresh air, and purity of food—Avoid the use of opium in any form —Convulsions—Treatment. Although we may, for the sake of more thor- oughly exhausting our subject, and rendering more explicit the advice for the management of children, divide the periods of an infant's child-life into three parts: that before dentition, that during dentition, and that period when they may discard the bottle and substitute table food; in reality, the division cannot be made as regards a definite number of months ; the time of dentition is so uncertain. In the majority of cases, and, where exceptions ex- ist, the accompanying conditions are the same, the first teeth make their appearance about the sixth or seventh month, and by the time the child reaches the age of two and a half years, it has cut the entire 72 THE MOTHER'S GUIDE. number of its early teeth—twenty. Dr. Chevasse tells us that " dentition is the most important period of a child's life, and is the exciting cause of many infantile diseases; during this period, therefore, he requires constant and careful watching." It is this "constant and careful watching" on the part of the mother that will secure for her child the ineffable blessing of passing a period of so much risk, with a constitution unaffected by the dangers that threatened it, of beginning the battles of early child- hood with a nervous system strong, hearty, and re- sisting, and with digestive organs capable of receiving the stronger food that its rapid growth and muscular development requires. About the seventh month it will be noticed that the child becomes occasionally fretful; it is restless, and easily irritated; it will seize with avidity the nip- ple, and then as suddenly eject it, with evidence of pain; it will refuse, at times, the bottle, and then cry from hunger at the sight of it. Its sleep will be dis- turbed, it will suddenly cry out in it, in fact, it will show a marked degree of irritation which previously was foreign to it. By this time the secretions will have been established, the tears, the saliva, and those that are used for the digestion of starchy or farinaceous food, will also have appeared to some extent. CUTTING OF THE TEETH. 73 As it is usual for the two lower front teeth to appear first, though this is not invariably the case ; the gums will be found red and angry, and the child, after seizing upon the fingers and finding the pressure painful, will refuse to allow its mouth to be examined. If there is little or no constitutional disturbance, that is fever, present, the child's mouth will be moist, or even wet, and at times the secretion will be so exces- sive as to require an ever-changing of the bib. In a few days the child may again be quiet, nurse and sleep well; and once more the angry gums will swell, and the child become fretful and irritable. This is indeed a most anxious time for young mothers, and the advice given to be " constant and careful in their watching" seems to them meaningless and cruel. What is to be done ? Remember that nature's mode of relief in such cases is to cut the gum from beneath outwards, and that, while the child seems to seize frantically upon the nearest object, and bite hard upon it, its frantic effort tends towards its own relief by pressing the inflamed gum upon the sharp tooth that is pointing upwards. In a few days the inflam- mation will subside, and a minute hole or pin point will be seen, and through it will appear the pointed edge of the tooth. In the great majority of cases, in fact, the exception is so rare, that it passes from 7* 74 THE MOTHER'S GUIDE. the domain of such a work as this, the gums will need no lancing. If the babe is healthy and vigor- ous, and has reached this period without drawback, with but the little assistance that can be given by a watchful mother, it will cut its teeth, perhaps in pain, but no more serious disturbance. Remember nature's mode softens the gum, and keeps it well soaked in the secretions, and gives pressure, not constant and irritating, but firm and occasional. There are several methods of relieving the irritation—plenty of fresh air; if the bowels are rather inclined to be loose, letting them be that way, unless the diarrhoea should become excessive; warm baths at night to soothe; and careful guarding of the diet. Much has been said and written about lancing the gums. It is decidedly in many cases not only valu- able, but absolutely important, and especially is this the case when a child is cutting its large teeth. The tooth is covered by a dense covering or capsule which impedes its progress and causes the sharp under sur- face of the tooth to press upon the delicate mass of nerve tissue that lies beneath. A free incision, which may be repeated as often as the irritation shows itself, will certainly relieve the pressure by opening the cap- sule, and giving the tooth an opportunity to make its appearance. IMPORTANCE OF FRESH AIR. ^ Fresh air is vastly the most important thing for a teething child; it will give it vigor and power of re- sistance. If you live in the country during such a period—and it is to be hoped you do, for the child will certainly thrive better by it—keep the little one out in the air as much of the day as possible. If you remain in town, avoid the hot streets during the hottest hours of the day, but take your child to some public square, or to some suburban spot, or take it to drive; it is essential, and no one realizes the wonderful in- fluence exerted by such a change till they come to test it. A daily breath of air thus obtained will often enable a teething babe to pass a summer, even in a close, ill-smelling city, when keeping it in the house, be it ever so cool, would but tend to aggra- vate its condition. Keep its skin active by frequent sponging, and by all means dress the child to suit the weather, watching its changes. In the discussion upon the artificial feeding of chil- dren, enough was said to show how important was the most scrupulous care in the regulation of its diet. As the child has grown, and now demands food more suited to its requirements, it is necessary to gradually increase the strength of the preparation of its food. For instance, in the preparation of the barley-water, add two teaspoonfuls instead of one to the food re- 76 THE MOTHER'S GUIDE. quired for the day; and if the child will digest it, use two-thirds of milk in its preparation, instead of one-half. If the bowels should be too free, you can take a quantity of flour, wrapped in a linen bag, and boil for several hours, until it is quite hard; take a teaspoonful, which must be grated fine, from the in- terior, and use it instead of the barley with the milk, always adding the water which contains it, boiling, to the new sweet milk that has been left by your milkman. Should the child's digestion be weak, Mellin's or Horlick's food, in small quantities, may be given with condensed milk, and especially should this be used, if you have the least suspicion that the cow's milk is not of the proper kind. Nature's way of relieving the brain congestion which follows the irritation of a teething child, is by relaxing the bowels; this is the great safety-valve, and all mothers should know this, that they may encour- age, rather than check, such a condition. At times teething once begun is usually rapid, and one after another, usually in pairs, will the teeth appear; first the lower two, then the upper two, then the outside pair above and those below, and finally skipping for a time the space for the eye-teeth above and the stomach-teeth below, the larger ones will come in their turn. Usually from the sixteenth to the CUTTING OF THE TEETH. 77 twentieth month a child will cut its eye and stomach- teeth. The object of a child sucking its thumb is to increase the secretion in the mouth, and thus soften the gums; for this purpose, it is valuable, but not otherwise, as it will simply, if persisted in—and it is a most difficult thing to check—cause the teeth to pro- ject as the child grows old. If possible (it is often a difficult thing to do, as it seems hereditary), teach the child to substitute something for it, a rubber-ring, or a chicken bone, or even better, the small bone of a boiled ham, which is slightly salt, and, there- fore, will be in great demand, or, as I have often seen, a wet Turkish-towel wash rag, which is rough, will supply the water a child craves, and keep it quiet as long as there is any moisture left in it to suck. Occasional pressure by the finger will often greatly aid, and spare the infant many days of pain. If there be much inflammation, a piece of ice, wrap- ped in a napkin, will please the child ; but as a rule, the intense cold causes them to refuse it. The child requires plenty of water; its food is thicker than it was before, and the secretions that are fully estab- lished, leave a demand for water by depriving the tissues of it. Sometimes it is recommended to give the child a piece of tough rare beef to bite upon; but this will invariably sour its stomach, and it is 78 THE MOTHER'S GUIDE. well to avoid it; it is far better to give the knuckle of a loaf of baker's bread, or well dried toast. A very bad habit, but one which is occasionally permitted, especially when a child has not been well trained from the beginning of its early career, and thereby has acquired an irritability of temper not its own, is to allow the child to cut its teeth upon the mother's breast; to allow it to sleep by its mother's side throughout the night, that it may satisfy itself whenever sufficiently conscious to either draw the breast, or to make use of the mother, in lieu of its thumb. Such a habit, it seems scarcely necessary to say, should not be tolerated for one moment; it is injurious to the mother, and equally so to the child. An infant should never sleep in the same bed with its mother, unless under the sanction of the doc- tor, and then for reasons of which he is the better judge; it should have, if the mother keeps it in her own room, its own crib or cradle next to hers. How important it is for a mother to remember that a child's cry does not always proceed from pain, or from hunger. Uncomfortable positions, badly ar- ranged clothing, flies in summer, or mosquitoes, are as irritating to infants as to us, if not more so. They are powerless, poor little things, and their cry is nature's call for relief. If a child cries in its sleep, USE OF THE LANCET. 7g turn it over upon the other side, or on its back; smooth its clothes, and the chances are that, what you mistook for colic was nothing but a want of change of position. An infant that cries from teeth- ing, will soon show by its actions that the suffering part is in the gum; one that suffers from colic will not let you be long in ignorance of the situation of its ache, if you watch it carefully. Its face will be drawn up, and become red and congested; its hands will be firmly clenched, and its knees will be bent upon the body, its breath will be sour, and the force of its cry will cause a watery secretion, with small flaky curds, to dribble from its mouth, the sourness of which will be partly the cause of the distorted countenance. The custom of invariably feeding a child as soon as it cries cannot be too much con- demned ; a mother should watch her babe, study its cry, and interpret from it and its gestures the true cause, that she may at once give relief. Unfortu- nately, there is nothing that will at once give ease to a painful gum except the lancet, but unless the irri- tation seems great, and the child is prevented from sleeping and nursing by it, and its digestion is greatly disturbed, it is better to wait, and leave it to nature. Some mothers find that they can soothe a child by rubbing the painful gum, dipping the finger into a 80 THE MOTHER'S GUIDE. little syrup or glycerine, that the child may permit them to do it. But hard rubbing, which one is most tempted to give, seems but to add to the inflamma- tion, and it is better to use the glycerine, which helps to moisten, and let the child suck or bite the finger at its will. A warm foot-bath, or a teaspoonful of water, with a few drops of glycerine, or probably a soft rag soaked in a water slightly salted with a few grains of table salt to suck, are the simplest and best palliatives that a young mother can use. CHAPTER II. Importance of noting the symptoms with care, and of record- ing them—The use of medicines—Only to have recourse to drugs in the absence of a physician—Restlessness and sleeplessness of a teething child—Convulsions—Treatment. I think there is no greater mistake than the con- stant recourse to family medicine chests upon the slightest excuse. If the child is ill enough to need medicine, it is time to send for the doctor, and one visit from him may often save great anxiety, and save the child's life. A teething child is a study in itself. Everything, however little it seems in itself, bears directly upon so important a point as the correct diagnosis; parents should remember that the care- fully-recorded observations on their part, together with the appearance and condition of the child at the time of the physician's visit, are what he depends upon for his diagnosis and treatment. The physician must know the character of the passages, their number; the condition of the child's skin, whether it always remains as it is at his visit, or whether its head per- spires at night (a sign of debility); whether it cries out suddenly at night; whether or not it rolls its 8 82 THE MOTHER'S GUIDE. head from side to side. If so, its gums must be lanced at once; all these matters are often questions of life and death, and if the mother be constantly and truthfully watchful, she may by it save her child. It is often difficult, indeed, for a mother to tell when her child really needs medicine, unless she has had the experience of other children,—not so much with the use of purgatives, but such that are directed to allay nervous irritation. Symptoms may often ap- pear of great severity, when, in reality, they are mat- ters of little consequence, and will pass off readily with only a little care. The child will frequently have fever, and a few drops of spirits of nitre in water given occasionally will be all that is required; or a small dose of oil or magnesia will relieve it by the following day. When you are in the country, or even at a dis- tance from a doctor, it is well for you to have always several articles which may be needful. Get your druggist to put up a half-dozen or more one-grain bromide of potassium powders. Get also some powdered alum, and half-dozen one-grain calomel powders. You had better also have a couple of ounces of milk of assafcetida. Of course, from what has been said in the previous chapters, you have already supplied yourself with a quantity of lime- IMPORTANT MEDICINES. 83 water, which may be useful. Some bicarbonate of soda, and also some soda mint, together with mus- tard, castor-oil, rhubarb in lump, essence of pepper- mint, and magnesia; all of these are essential in every household. Have a bottle of glycerine; it is useful for many purposes; also some of the best pep- sine which your druggist can get for you, and if you go to the seashore, or at a distance from home, be sure to have a good stock of the packages of " food" al- ready mentioned. Get some syrup of ipecac., syrup of squills, and some syrup of lactucarium (the French), and a large bottle of vaseline, which must be kept in a cool place. As we study some of the disorders that are consequent upon teething, or at least those that are frequent at this age, we will speak of the value of the above, and how and when to use them. I^et us take an example, and endeavor from it to form a guide in cases that may be similar; but I may pre- mise by saying that the most important quality for a mother to possess is judgment,—never to do too much; best to do too little, and what she thinks best at the right time. This can only be gained in the rough school of experience. Suppose your child is cutting its first teeth, and has become irritable, sleepless, and you have tried everything with patience, and still have foiled to give relief. You have daily taken it 84 THE MOTHER'S GUIDE. out into the fresh air, kept its nursery bright and cheerful by day, and still have failed to promote sleep. You have given a warm bath at night, rub- bed it, but still the child cannot be pacified. You may then try one of the bromide of potassium pow- ders ; a grain of the salt dissolved in a teaspoonful of water, and repeat, if its effect has not been decided in a couple of hours. For a child about seven or eight months of age, who has not been accustomed to the use of medicine, this will have a very quieting effect; if the first dose seems to utterly fail, give the second in a half teaspoonful of the syrup of lactuca- rium, with a half teaspoonful of orange-flower water. When you finally get the child sleeping quietly in your lap, gently introduce your finger into its mouth, feel for the most swollen portion of the gum, and by gradual, but firm pressure, endeavor to aid the tooth that is endeavoring to force its way up; a little strat- egy will thus save much pain the following day. A half teaspoonful of camphor-water, or ten drops of a reliable elixir of the valerianate of ammonia can be added to the above, or given separately, in a tablespoonful of water, if the child is very restless; but be careful you do not disorder the stomach. Do not use opium in any case, unless specially ordered by your doctor; there are at times strong reasons JUDICIOUS USE OF DRUGS. 85 why it is harmful, and no mother is capable of judging. Even a few drops of paregoric are most harmful, for two reasons: the one that its use once begun, will have to be kept up; and the other, any thing that will tend to dry up the secretions, as opium does in any form, will increase the disorder, instead of diminishing it. Nevertheless, your physician may find that opium in one form or another is necessary for the child, you must, therefore, not think that be- cause all books say imperatively that it must not be given that it is always harmful; it is a dangerous drug, in the hands of the ignorant, and a most po- tent weapon in the fight against disease, when prop- erly handled. I have dwelt at length upon this, because I have seen the effect of merely mentioning opium or calomel in the presence of one who is well read in popular medicine. Choose your doctor with care; give him all your confidence, and allow him to guide you and your children through life, thoroughly knowing your constitutions and peculiarities, and you will certainly fare better than one who is constantly changing from one doctor to another, and placing no confidence in his opinion, and Utterly disregarding or interfering with his directions. The early teeth—the front teeth—do not give rise to symptoms from nervous irritation that are, in most 8* 86 THE MOTHER'S GUIDE. cases, so severe, as do the molars. Fortunately, by the time—perhaps at the age of one year—that the back teeth begin to show themselves, you have had sufficient experience to understand the temperament of your child, or at least you will know whether or not it cuts its teeth hard. If it has suffered much with the front teeth, and seems to be of an intensely nervous or excitable temperament, it is well to tell your physician when you can feel the gum rising in any part, or getting tender, that he may lance it early. It makes little difference if these back gums have to be lanced several times; if the child seems to worry a great deal, it is certainly better to have it done; it will relieve the congestion, if nothing more. In such cases, the "ham bone" will often do won- ders, and as a child at this age will enjoy its toys, it should have an abundance of them, such as large round shells, spools strung on a single string, and such things that can be sucked and bitten at pleasure, without harm; it will be its own doctor in most cases. It is well for a mother to know that her child is more liable to certain affections during the period of dentition than at any other time, and that the disor- ders that occur are likely to show themselves by the rapid production of symptoms referring to either the nervous system, the lungs, or the bowels. CON VUL SIONS. 8 7 One of the principal effects upon the nervous sys- tem has already been mentioned, and due stress laid upon its relief, that of great irritability, sleeplessness, and impairment of its nutrition from the want of food, or the improper digestion of that which it has taken. But the evil effects may go on still further, and cause, with a suddenness that makes it all the more horrible, a convulsion. A convulsion in a child at this age is an evidence of some local irritation, such as the presence of some- thing indigestible in the stomach or bowels; or it may be due to the tremendous tension that has been caused by the passage of a tooth through a hard and resist- ing gum; it is like an explosion which comes on sud- denly, and may pass off with little evil consequences. In an older child, it is the same as a chill in an adult, and may be the starting point of some of the eruptive fevers. Whatever may be its cause, the treatment must be immediate. As soon as you see a child which has previously been, to all appearances, in full health, but perhaps slightly irritable, begin to twitch about the forehead, and turn its eyes upwards, with that never-to-be-forgotten side-stare,—plunge its body in hot water, clothes and all, if you have no time to strip it, but see that the water is not too hot; test it with your hand; apply cold to the head. If the 88 THE MOTHER'S GUIDE. tongue is coated in the least, give at once one of the calomel powders, or you may do this before, while the bath is preparing. Be careful about giving an emetic; the question of its use is one of the most difficult things to decide upon. If you recall that your child has been slightly nauseated; if there has been some gagging beforehand, or if you know of anything having been swallowed that would give rise to irritation, then an emetic, such as a teaspoonful of syrup of ipecac., given at once, and repeated every ten minutes, if the child can swallow, or let your finger gag it; it may save its life; but if this treatment be used for one who has no such cause, it will have no such effect, the vomiting will only increase the trouble. Feel the child's gums, and if you find that pressure upon one part gives rise to an aggravation of the attack, that point should be lanced at once. But in all cases, the hot bath, and the calomel powder, and the cold to the head will be of great service, and will not interfere with the treatment of the doctor when he arrives. If the doctor does not come at once, you can give the child, after you have taken him out of the bath, and five or ten minutes will suffice for it, an enema of a small rubber syringeful, holding a couple of ounces, a tablespoonful of the milk of assafcetida, in some tepid water, and repeat the calomel every half hour until four doses have been given. TREA TMENT OF CONVULSIONS. 89 Wrap the child in a blanket after its bath; sur- round it with hot bottles, or get the cover from your kitchen range, wrap it up well in flannel, and place it at the back; be careful that you do not overdo it, by using too great heat. As soon as the child re- covers from the attack, give at once a powder of bro- mide of potassium, or if the babe is a year old, you can give two at once, of one grain each. A free ac- tion of the bowels will follow the calomel, and your child may be saved. It is well to add a tablespoon- ful of mustard-powder to the bath, as it will aid its action. If your child has become conscious, you can get its skin into a glow by rubbing; but you must re- member that its digestion has been greatly weakened by the shock, and therefore be very careful of its food; it is better to give as little as possible for some hours; let it have water if it wishes it, or you can dissolve the white of an egg in a tumblerful of water, add a little sugar and a dessertspoonful of orange- flower water, and give that as the only drink until the child is decidedly out of danger of relapse. CHAPTER III. Croup—Its cause—Treatment—The use of emetics—Drugs to be used in the absence of a physician—Avoidance of popular medicines—Constipation—How to prevent it. Children about the age that covers the period of dentition are most liable to attacks of croup. In our climate there is a tendency to catarrhs, from its ever- changing character, the whole year round; but as a rule, the time when a special tendency seems to exist is when the seasons change, we often hear of the " prevailing" catarrh, the bronchitis, that all are suf- fering from. Its prevalence, no doubt, in great part depends upon the carelessness in regard to clothing, and the fashions that permit, or in fact imperatively demand, a refined sort of cruelty to be practised upon young children. A child that is shortened too early in the spring, or one who is sent out, because the weather has become warm, in lighter clothes, or again one that has been ailing, has been made particularly susceptible, by the depressing influences of the fretting incident to teething, exposed to draughts or breathing of air which is chilling, or sat- CROUP. 91 urated with dampness, will most certainly, if predispo- sition exists, suffer for it. There is undoubtedly a hereditary predisposition to such attacks, and it is said that in families where there lies a consumptive taint, croup is most prevalent. Certain it is that in some families the children never have croup, and in others it is most frequent. An attack of croup in itself may be a harmless, but alarming affection; but it is the danger of a more severe catarrh—a bron- chitis—that renders it so important a disease. A child that is teething may droop for a few days; it will show some slight evidences of cold, its bowels may be disturbed, or it will be restless at night, and slightly feverish by day. A watchful mother will note this, and keep her child well guarded; she will reg- ulate its bowels, will give a few drops of spirits of nitre in some sweetened water; she will see that its skin is kept well acting by warm clothing, and fre- quent sponging; and she will also be careful that it does not get overheated. But occasionally the attack will be sudden; a child will wake in the night with a hoarse dry cough, it will be restless and feverish, or the paroxysm will become intense, and require imme- diate relief. If such be the case, give at once a warm bath, or instead, saturate a large sponge in hot water, bearable to the hand, and place it upon the child's 92 THE MOTHER'S GUIDE. throat, renewing it frequently. If still no relief be obtained, give a teaspoonful of syrup of ipecac, and to this may be added as much glycerine. The nausea which will result will relieve the attack. It is well then, if possible, to examine the child's throat, and see if it be merely red, with no whitish deposit of membrane. Give it a dose of castor-oil, and during the night let it frequently drink from a tumblerful of water, slightly sweetened, containing a teaspoonful of sweet spirits of nitre. Should the cough be clear and ringing, and be not muffled and hoarse, the im- mediate relief of the symptoms will end the attack. Should it, on the contrary, be dull, muffled, and husky, send at once for your doctor. Rub the chest well with vaseline or mutton-tallow, and avoid the further use of ipecac, or squills, till you get medical advice. Syrup of ipecac, is certainly a most harmless rem- edy in most cases, and an exceedingly valuable one, but it is an irritant to the stomach, and that is why it nauseates, and causes immediate vomiting. Mothers forget this, and they will frequently, with very little cause, without the trial of simpler means, give their children at once a dose of ipecac, or squills and ipecac, if the least echo of a croupy sound reaches their ears. Squills have the same effect, and when ENLARGED TONSILS. g3 these drugs are combined, they are, in appropriate cases, most valuable. If your child seems inclined to croup, or you no- tice that its voice is deeper and more sonorous as the evening comes on, give it a good rubbing, especially about the throat, with well-prepared mutton-tallow if you can get it, or vaseline. The odor of ammonia and turpentine, which are usually recommended in stimulating liniments, is not pleasant to an infant, and the irritability caused by their use will sometimes do more harm than good. If the child is about a year old, and you notice that there is enlargement of the glands under the angle of the jaw, feeling like kernels, and the voice is thick, it is a sign that the tonsils are enlarged. To those that live in the country far from the doctor, I would recommend the addition of two articles to their medicine-chest: tinct. of the root ot aconite, and the following liniment:— B> Chloral hydrat. 5j- Liniment, saponis f§iv.—M. Sig. For external use. Chloral Liniment. The aconite should be labeled such, marked poison in large letters, and kept carefully by the mother under lock and key. In a case of the condition just mentioned being present in a babe of a year or more, 9 94 THE MOTHER'S GUIDE. and as this condition is usually found in children of about two years, four teaspoonfuls of water may have one drop of the aconite added, and a teaspoonful given every three hours until the four are taken. This medicine is most efficacious; but as it must be given with great care, owing to its poisonous nature, no mother, except she live at a great distance from the doctor, should take upon herself the responsibility of its administration. The chloral liniment is most soothing to children; a little of it rubbed about the neck in these cases, or a small quantity gently rubbed on the abdomen of a teething and fretful babe, will often quiet it when everything else has failed. A mother may notice that the attack of croup fails to give rise to the very severe croupy symptoms which I have just mentioned as so characteristic; the child will be languid and drooping, the voice will be muffled and husky, with an occasional croupy bark, there will be a labored effort at breathing, and the respirations will become jerking and blowing, especially as the air leaves the chest. If you have lived near a railroad and have watched a freight locomotive pull a heavy load of cars up grade, you will remember the almost lifelike labored panting, with the last puff always prolonged. When a child breathes that way it is ill, and its danger BRONCHITIS. 95 is great; it shows that the catarrhal inflammation has settled deeper in the chest; it points to the first stages of a bronchitis, which in time—and it takes but a very short while—may proceed to pneumonia. Immedi- ately soak the child's feet in hot water with mustard, wring out flannels in water which will bear your hand and apply them to the chest on front and back, and place over it a layer of oiled silk, and keep, the child well covered. You can give the child half a teaspoon- ful of the spirit of mindererus (liq. ammonise acetatis), of your medicine chest, in a couple of tablespoonfuls of water, and repeat in two hours—in fact every two hours till your doctor arrives. In these cases, unless the cough be very severe and racking, and the child seem to suffer greatly from its tightness, it is well not to give either the ipecac, or squills, for fear of disor- dering the digestion. Such a case may be protracted, and anything that will debilitate will have an evil influence on the disease. On the contrary, the great- est care should be taken that the child receives and digests that which is most nourishing. If in these cases milk is found not to digest readily, a more con- centrated food would be the barley water with cream; less of it is required, and the child should be allowed to drink plenty of water, or egg-water with some sweet spirits of nitre in it. 96 THE MOTHER'S GUIDE. The bowels rarely escape in a catarrh so severe, and therefore a small dose of oil at the outset will be a valuable aid. In lieu of the hot flannel to the chest, a light mush poultice may be used ; it can be made of corn meal or flaxseed meal, very thinly spread, and covered over with oil-silk as directed. Never let the substance of the poultice come in con- tact with the skin, as sometimes is done, but use an old soft linen handkerchief. Two poultices should be made, one for the front and another for the back, with shoulder-straps to connect them, and a little mutton-tallow introduced into each poultice, to keep it soft. Change at least every three hours; never let it get cold nor hard, as it then, in either case, would be worse than none. Let me impress upon all mothers the importance of avoiding the use of the various patent cough mixtures that are so freely sold for the little ones. Even those of recognized merit, such as "brown mixture," or " Coxe's hive syrup," are never to be used without the doctor's advice ; they all contain substances that may imperil the child's life; the too universal custom of jumping at straws, and "just trying" what some one said cured her cousin's child, and which has brought with its recommendation that, if it "does no good, can do no harm," has sent many a little one to its long rest. CONS TIPA TION. 9 7 Before concluding this subject, it may be well to consider the cause of constipation in infants, and its prevention and treatment. As a rule, constipation is found most frequently in bottle-fed children, and especially does it follow the use of condensed milk. In many cases, when this is not the cause, it is due to a want of the secretions of the intestinal glands, and a consequent hardening of the masses that should be expelled, in a soft, pulpy con- dition. An accumulation at times takes place low down in the bowels, owing to an anatomical arrangement peculiar to infants, and this can be relieved by an in- jection of tepid Castile-soap suds, with the addition of a quantity of sweet or castor-oil. Sometimes an injection of simply a tablespoonful of sweet-oil will be sufficient, or a small suppository of cocoa butter may be substituted. It is not only unwise, but bad practice, for mothers to continually dose their infants for this condition; the constant use of purgatives, even castor-oil, not only will increase the derangement and debilitate the child, but will be invariably fol- lowed by a constipation more obstinate than ever. If the babe be fed upon condensed milk, a tea- spoonful or more of cream may be added to the bottle; if, on the other hand, the farinaceous foods be used, those that are laxative, as oatmeal or cracked 9* 98 THE MOTHER'S GUIDE. wheat, should be given occasionally. Instead of lime-water, use a little bicarbonate of soda in the milk, or the fluid magnesia, before-mentioned, may be substituted occasionally. A substitute for this preparation can be made by adding a half-a-teacup. ful of boiling water to a teaspoonful of Husband's magnesia, allowing it to settle and strain; the mag- nesia water thus made can be given in tec spoonful doses as required. The child's abdomen should be thoroughly rubbed and kneaded at least once daily, using firm, but gentle pressure; at the same time a small quantity of warm sweet-oil or cod-liver oil can be used in the rubbing. One of the most important things to bear in mind is that regular habits will frequently cure this condition; when the child is old enough, it should be placed in its chair at the same hours each day, and it is well to begin this practice as early as possible. CHAPTER IV. Catarrhal diarrhoea—Description of the condition—Treat- ment and dietary—Cholera infantum—Its cause—Neces- sity of immediate change of air—Importance of bathing— Treatment—Food of a child in its second year. The disturbances of the bowels during the period of teething, are dependent greatly upon the time of year. In winter, the disturbing cause may be a slight catarrh from cold, and the evidences will be passages containing mucus, slimy, with straining, and also at times, pain. Under such condition should food of the same strength and character as has been given, be still persevered with, it will undoubtedly remain undigested, and give rise to attacks of pain, or even to convulsions, in a delicate child. Should such be the case, when you notice the change in the movements, at once give a small dose, a teaspoonful of castor-oil; rub the child's abdomen with mut- ton-tallow or vaseline, or, if the weather be severe, you can use a flannel binder, with great advantage. If the passages get green and offensive, or become mixed in their appearance, it is better to give the IOO THE MOTHER'S GUIDE. child a dose of rhubarb, in the manner previously explained, or take one of the one-grz\x\ calomel powders, divide it into six parts, and give one of these on the child's tongue every half hour during the evening, followed by a dose of castor-oil. The secre- tions of the child, which are faulty, will be improved by it, and if you take care not to overload its stom- ach, but give sparingly of food for twenty-four hours, and freely dilute what you give, all will be right. But the intense heat of summer weather, aided by the evil effects of town air, which seems to be most harmful to a teething babe, will frequently cause it to have a number of very fluid passages, sometimes nothing but water, which will soak into its napkins, and leave only a spinach-like green material, in small flakes upon it; this, when sudden and very severe, is what is called, ordinarily, cholera infantum. If such an attack threatens, take your babe at once out of town,—go to the seashore, if possible. A few hours may make every difference in the world, and chil- dren that appear almost at death's door, will often revive at once with the fresh breezes of the sea. Go to the country, if you cannot do this, or take your child upon the river, and keep in' the open air all day. Change the diet to the preparation of flour food, as spoken of before in Part I.; let the child CHOLERA INFANTUM. IOI drink freely of rice water, or gum-arabic water, and allow it to have cracked ice, small pieces in its mouth at a time; give them frequently, as the child will crave water, to supply that which is lost, and give a small quantity at a time. Port wine and brandy may be given, well diluted; the former, if old and good, can be given in /4 THE MOTHER'S GUIDE. It is a great temptation at this period, when a little one is able to express its wishes and insist upon their fulfilment, to give it table food, to let it drink from its father's coffee cup at the table, or to give it "just a taste of tea." Avoid this and you will see your child thrive. Let the child's meal hours be as regular as before; give it an extra quantity of food if it wishes in addition to the quart and a pint that it has taken, in early infancy in the twenty-four hours; you may in- crease the amount of milk, if necessary, and at the age of two years, if the milk be fresh and good, you can give it pure, without dilution or addition. Make your food stronger—that is to say, use more of the farina- ceous articles, that have been previously well boiled and strained, in its thickening, but avoid the slice of bread, or even the bread and milk, or the crackers, as they will surely upset it. Keep the child out of doors, and see that it gets in addition to a good night's rest, the midday nap that it requires. At the age of seven or eight months the child should, at stated times, be lifted and put in its chair; this will insure regu- larity in its bowels, and teach it to be regular and cleanly in its habits. About the age of ten months a child will begin to feel its feet, and as soon as it is "shortened" it will occasionally make attempts to stand. Do not encourage this, but place your child GROWTH. io5 on a rug on the floor and let it strengthen its muscles by its own endeavors, and when the bones are able to bear it and the muscles strong enough to aid in its support, it will make its own attempts to stand by a chair. This is the age when children are difficult to keep covered at night, and you should see that the ventilation of the room is such as to prevent draughts and yet give pure air. Your child will now be to you more than a mere living thing; its intelligence will begin to develop; it will lisp its few first words that are golden to you; it will receive those early impressions from you that will mark its future ca- reer ; it is the real first dawn of day, and from this moment the mother ceases to be alone the nurse, and becomes to it the embodiment of all that constitutes perfection in its life. 10 PART III. MANAGEMENT AFTER EARLY DENTITION. CHAPTER I. Change of diet for a child after dentition—What to begin with—Importance of great care in the selection of food— Out-door exercise to be encouraged—Importance of early training in its bearing upon the management of children in sickness. The positive assertion in the last chapter that chil- dren, during the teething age, should depend entirely upon child's food—milk,—may seem arbitrary to those who have seen children table-fed from the time when they can walk, and apparently digest well. The mistake is often made to take the exception for the rule, and these cases are frequently brought forward into prominence, while those who suffer and droop are left unheard of. As it was impossible to lay down a definite time when children begin to cut their teeth, so it is equally impossible to say when they end the process, and therefore the children, whose manage- io8 THE MOTHER'S GUIDE. ment we may now discuss, may be those who have not passed their second year. After a child has cut twelve teeth, it may be well, at whatever age it is, to begin gradually to test its digestion of more solid food, never omitting the milk diet to which it has been accustomed, and upon which it should depend for its main nourishment. Well-made broths of chicken, mutton, or beef, are valuable at this time as a change. One small meal of a finely-cut, rare mutton-chop, slightly seasoned, with the soft part of a slice of milk toast, or a soft boiled egg, may be given at first, very sparingly, at midday meal, or better still, the wing bone of a well-boiled chicken, with most of the meat, and all of the gristle cut off, which will amuse it, and pave the way. A small quantity of the well-chopped white meat of a thoroughly boiled chicken, not more than a teaspoon- ful, may be tested, and this can be followed by a mealy well-roasted potato, seasoned with butter and salt, and well mashed. Some well-boiled rice, with gravy of beef-juice, will do well for some. Beware of other food; a taste of this or that which happens to be upon the table, will only spoil the child, and only give you great anxiety by the subsequent disturb- ance of the bowels it will cause. The class of read- ers to whom this little work is especially addressed, are IMPORTANCE OF NURSING. IOg usually not those who can transmit to posterity a di- gestion that is at all powerful. Dyspepsia, difficult digestion, or in reality digestive organs that are inca- pable of assimilating heavy food, is the inheritance of fathers and mothers whose brains have been their means of livelihood. Those who earn their bread by the sweat of their brow, give to their progeny the same force and strength that will enable them to follow their parents' lead, and to draw comparisons from one rank of life to another is obviously wrong. The child of a far- mer, or of a laboring man, will eat its crust of bread and its potatoes with impunity, from the time it is able to toddle to the dinner table. But not only is this due to the powerful vigor of its inheritance, but to the fact that, in the great majority of cases, it has acquired powers of its own by the nursing of a healthy mother until it has passed through the treacherous pe- riod of dentition. There is no greater mistake than to reason from the children of the poor or laboring classes, that great care in diet and management keeps a baby delicate, and that exposure and carelessness in feeding, tends to "harden" it, and make it robust. The great axiom in the management of children is to give them just enough nutritious food, and to keep their 10* IIO THE MOTHER'S GUIDE. digestive system in good working order; strength saved is that gained in most cases; the stomach of an infant, like the muscles of an adult, can be encour- aged to do good work, but will resist being forced. What is true of the digestion, is equally true of the mind. " In childhood," says the late Prof. Edward H. Clarke, of Boston, in his admirable little work on "Sex in Education" [a book that every mother should read], "boys and girls are nearly alike. If they are natural, they talk and romp, chase butter- flies and climb fences, love and hate, with an inno- cent abandon that is ignorant of sex. Yet even then the difference is apparent to the observing. Inspired by the divine instinct of motherhood, the girl that can only creep to her mother's knees, will caress a doll that her toddling brother looks coldly upon." The age has now passed when the greatest tend- ency to convulsions exists; the teeth have been cut, and the child now requires but care in its food, fresh air, and plenty of it, good bathing in water that bears the temperature of its room, and plenty of chance to use its muscles by a play with its toys, and a romp with its father. Should the bowels, from over-feeding or confine- ment to the house in very inclement weather, become disturbed, you can give a teaspoonful of the water ADMINISTRA TION OF DRUGS. 111 from magnesia which has been scalded. To a child that is sufficiently sensitive to the taste of medicines, it is always better to give them pure, with no dis- guise, letting it know beforehand, and making the taking of them a matter of discipline. Children who have had powders given them in some favorite '' pre- serve," will, when they grow up, associate the two to- gether; besides, it will not only teach the child obedience to its parents' will, which it should feel to be a law, without exception, but it has often saved the life of many a little one who has only held a mastery over disease by the regularity with which the med- icine was given and taken. If drugs can be disguised for children, do it with the distinct understanding that the disguise or vehicle will not again be met as part of its food, or found on the table as a dessert, the reward of good behavior. Do not give mag- nesia with milk, or castor-oil with some delicious syrup, nor quinine on bread and butter. This de- ceit, if detected, which it surely will be, can only lessen the confidence of the child in its parents, and will weaken the force of their control in the future. I dwell long upon this matter, because it is so important; mothers are inclined to consider it cru- elty, and fathers apt to be weak, but when they see their child seriously ill, with the balance turning I 12 THE MOTHER'S GUIDE. against it, and feel that its life, so precious to them, hangs upon the action of a drug which has to be given by force, the full importance of early training, which, in their weakness, has been neglected, adds —more than words can describe—to the intensity of their pain. The gradual system of testing the digestion of solid food has now advanced so far that it will be safe, if the child is nearing its third year, and often by the time it has reached its second, to allow it to take two meals of solid food, such as before described, daily—in the morning, at breakfast, and at noon, or about two o'clock, at its dinner. For the former may be given some milk toast, or oatmeal mush, with a soft boiled egg, and a glass of fresh milk, while at eleven o'clock it should have its bottle of "food," then the nap, and after it wakes and is dressed for the afternoon, its dinner of mashed po- tatoes, mutton-chop, or as before suggested. As it grows older, it may again have a glass of milk, about six P. M., with some thinly-sliced bread and butter, and should it wake, as it will do, usually about five in the morning, another bottle of " food." A child of two and a half and three years will eat a hearty supper of bread and milk, and will then re- quire nothing more till about seven and a half the next DIETARY. „3 morning. A child at this age, whose supper has been a substantial one, should never be allowed to go to sleep at once, after eating it, but let at least an hour elapse, which can be occupied in preparing it for bed. Give it a good evening play, in which every child delights, and make its little mind happy, as the best preparation for a good sweet sleep. Regularity in eating is as important for the health of a child as for an infant, and the evil habit of allowing it, between meals, a crust of bread or a cracker, will eventually give rise to disorder. At the second year a child's bowels are moved about twice a day, and it is well that regularity as to the hour should be insisted upon; this in itself is a most important thing, as it will prevent a tendency to constipation, which is so annoying and frequent in many children. Let a child's play-room be stocked with health-giv- ing plants; let it be bright and cheerful. The exer- cise that will develop and make strong a growing child comes from the muscular strain involved in its play; the girl will attend to the wants of her doll, rocking it to sleep; the boy will use his father's cane for a horse, and fatigue thus induced will be fol- lowed by healthy sleep, and a good appetite. Do not teach your children to be grown-up men and women II4 THE MOTHER'S GUIDE. before they have cut their back teeth,—to be learned before they are able to digest solid food,—to be pro- digies before their brains have been sufficiently de- veloped to stand the consuming effect of an increased amount of over-stimulating blood. A child's educa- tion should come by intuition; its blocks, its pictures, will gradually develop its mind, its habits of order and regularity will early instil into it the necessity for practising the same as months or years go by. The little nursery rhymes will aid its memory, and the knowledge of the difference between right and wrong, should come to it by the force of example and gentle reasoning. CHAPTER II. Food of a child in its third year—Avoidance of uncooked fruits—Change of air in summer—How to choose between the country and the sea shore—The country preferable for infants—Benefits from sea air in disease—Mothers should nurse their babes—Conclusion. In the language of the nursery, a child that has reached its third year, is "raised." At this time it is no longer necessary to prepare for it bottle-food. It can even with regularity take its three ordinary meals ! a day, and if it breakfasts early, as it should, a glass of milk, with some bread and butter, can be given as a luncheon before its midday nap. A child at this age should drink a quart, or a quart and a half, of milk during the day; and it is well to give it early in the morning, at the breakfast, a cup of weak chocolate or " broma," made with milk, as a change. Simple vegetables, such as spinach, asparagus, beets, etc., can be given at dinner, and a baked apple, if its bowels are in good condition, or if there is constipation, will be an excellent occasional dessert. It is far better to make a rule never to give raw fruit to children, at n6 THE MOTHER'S GUIDE. this age. In our climate, what is ordinarily known as ripe fruit (in the large cities), has been picked green, for the sake of keeping it, and there is great risk in its use. In conclusion, there remain but a few words to be said regarding the advantage of change of air for children, and the choice between the country and the sea. Very often it is a difficult matter to decide, so many other considerations are to enter into the calculations of a household, especially the question of expense. It may be said that, ordinarily an in- fant thrives better, and is more free from the various catarrhal disturbances that are brought about by sud- den changes when away from the coast. Certainly, for one under a year, the place where it is surrounded by the greatest advantage is in the country, where it can get the best of fresh milk, and where it can be out of doors, and take its • midday nap in the cool shade. It is well to select a good farm, or an acces- sible boarding-house, in a healthy locality, and take the child there early in the season, before the intense heat of the latter part of June sets in. Should an infant, even at this age, be taken suddenly ill with diarrhoea, caused by the confinement and foul air of a large city, then the immediate change to the in- vigorating influence of the sea will at once help SEA-SHORE AND INLAND. 117 greatly to restore it. But ordinarily, it is better to avoid the sea-shore and the mountains for very young babes; all they require is fresh air, shade, and fresh milk, and freedom from sudden differences in temp- erature that are found between day and night, both in the mountains and on the coast. For a child in its second summer, when the back teeth are coming through, it is well, but by no means important, to spend the month of July by the sea, returning to the country by the first of August. The cooler nights of August are better spent in the inland, where there is less risk from the sudden changes of temperature, and the damp atmosphere of the coast. In choosing a place in the country, particularly for the month of August, great care should be taken to avoid swamp or marshy districts, on account of the malaria preva- lent in such places during that time of year. Young children are as susceptible to its influence as adults. After a child has reached its third year, even after the teething period has passed, it is well for it to have, if possible, a couple of weeks of the bracing sea air, or, where that is impossible, the equally invigorating climate of the mountains, such as the White Moun- tains, or the Catskill, or the mountains in Eastern or Western Pennsylvania. But the pure air and bracing climate of all these 11 u8 THE MOTHER'S GUIDE. places, whether the mountains or the sea-shore, will be of no avail, if the diet which the child receives is not of the proper kind. For an infant great care must be taken, especially at the sea-shore, to secure good milk, and if the least doubt is entertained about that supplied, at once use condensed milk as a substi- tute. But, after all, it will be seen by those who have read this little work, that the disorders of infancy are far more frequent amongst those children that are bottle-fed. It was intended that the only food for a babe should come from the mother herself; her milk alone possesses every element which her child re- quires. A mother's duty does not end with the birth of her child ; it is as much her duty to nurse it as to bear it. The best inheritance that a mother can give her child is health; to impart this, she must possess it herself. By thus attending to her own health, she will not only be the means of preventing disease, but she will impart strength to her offspring that will earn for her the gratitude of the generations to come. Smith on Children—New Edition—In Press. A COMPLETE PRACTICAL TREATISE ON THE DIS- EASES OF CHILDREN. By J. Lewis Smith, M.D., Clinical Professor of Diseases of Children in the Bellevue Hospital Medical College. Fifth edition, thoroughly re- vised and rewriiten. In one handsome octavo volume of about 900 pages, with illustrations. West on Infancy and Childhood—Lately Issued. LECTURES ON THE DISEASES OF INFANCY AND CHILDHOOD. By Charles West, M.D., Physician to the Hospital for Sick Children, London, etc. Fifth Amer- ican, from the sixth revised and enlarged English edition. In one large and handsome octavo volume of 678 pages. Cloth, $4.50; leather, $5.60. By the same Author—Lately Published. ON SOME DISORDERS OF THE NERVOUS SYSTEM IN CHILDHOOD. Being the Lumleian Lectures delivered at the Royal College of Physicians of London, in March, 1871. In one neat volume, small 12mo. Cloth, $1. Smith on the Wasting Diseases of Children. THE WASTING DISEASES OF INFANTS AND CHIL- DREN. By Eustace Smith, M.D., Physician to the N. W. London Free Dispensary for Children, etc. Sixth Amer- ican, from the second and enlarged London edition. In one very handsome octavo volume of 266 pages. Extra cloth, $2.50. Condie on Children. A PRACTICAL TREATISE ON THE DISEASES OF CHIL- DREN. By D. Francis Condie, Fellow of the College of Physicians. Sixth edition, revised and augmented. In one large octavo volume of nearly 800 closely printed pages. Cloth, $5.25; leather, $6.25. HENRY C. LEA'S SON & CO.—Philadelphia. Mitchell on Diseases of the Nervous System—Just Heady. LECTURES ON DISEASES OF THE NERVOUS SYSTEM, ESPECIALLY IN WOMEN. By S. Weir Mitchell, M.D., Physician to the Orthopaedic Hospital and Infirmary for Diseases of the Nervous System. In one very handsome 12mo. volume of 250 pages, with five lithographic plates. Extra cloth, $1.75. The cultivated, colloquial style assumed by the author, becomes the vehicle of a mode of thought and expression peculiarly feli- citous. Nor is the impression wanting that nowhere does the lo- cutor appear to better advantage than in those strong points upon which he has bestowed so much attention and care. In sum, we would not withhold from this charming little work its due meed of praise, regarding it as very olever—its cleverness, in many places, mingled with wisdom, as offering food for thought, and as being remunerative for its perusal.—Am. Journ. of Med. Sci., July, 1881. It is needless to say that these lectures are extraordinarily rich in acute observation and sound instruction. The reputation of the author is a guarantee of that, and no reader will be disap- pointed. Nor can too much be said in praise of the admirable style of his medical writings, and each of these lectures reads with the finished grace of a polished essay. Indeed, the book throughout is so fascinating a one that it could not fail to be read entire by every one who begins its pages.—PAi7a. Med. and Surg. Reporter, May 7, 1881. The book throughout is not only intensely entertaining, but it contains a large amount of rare and valuable information. We can commend it to all of our readers.—Maryland Med. Journ., May 1, 1881. Chambers on Diet and Regimen—Lately Issued. A MANUAL OF DIET IN HEALTH AND DISEASE. By Thomas King Chambers, M.D., F.R.C.P. Lond., Honorary Physician to H. R. H., the Prince of Wales; Consulting Physician to St. Mary's and the Lock Hospitals; Lecturer on Medicine at St. Mary's School,: Corresponding Fellow of the Academy of Medicine of New York, etc. In one handsome octavo volume of 310 pages. Cloth, $2.75. HENRY C. LEA'S SON & CO.—Philadelphia. "/f^v-. ICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDlClNE o s',n tvJouvn 3N,D,03w jo Aavaan tvnouvn 3NO.03W dO Aavaan TV ^C.NE NATIONAL LIBRARY OF MED.CNE NATIONAL LIBRARY OF Ml j-aan TVNOUVN 3NI D,03w do Aavaan tvnouvn SNiaiaaw jo Aavaan T> Y OF MEDICINE NATIONAL LIBRARY OF MED.CNE NAT.ONAL LIBRARY OF M ivaan tvnouvn SNomaw jo Aavaan tvnouvn 3N,D.a3w jo Aavaan i !Y Of MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL' LI BR AR Y Of > ivaan tvnouvn 3Ni3ia3w dO Aavaan tvnouvn 3noi<33w \q Aavaan Q . 3 \_ Q. >J\ * ^3 WS 80 K25m 1881 48631060R NLM 05551111 D NATIONAL LIBRARY OF MEDICINE