Frequent examination of the vagina should not be made. In ordinary cases during the first stage, the woman should be up and encouraged to walk about the room, to sit or assume any comfortable position. During a pain she may stand beside the bed resting her hands upon something or kneel in front of the bed or chair. The standing position assists in the birth. The bladder should be emptied frequently, as a distended bladder retards labor and may even stop the womb contractions. The pains become more frequent and severe as the end of this stage approaches and each contraction is now accompanied by straining or a bearing down effort on the part of the woman, and as a rule the membranes rupture spontaneously about this time. An examination of the vagina should now be made with the woman in bed, and if the membranes have not broken and the womb is completely dilated as shown during the pain, they may be ruptured by pressing against them with a finger-nail during a pain. Sometimes we use every means to retain the membranes intact, but that is when protection for the child is needed for sometime longer. If the suffering is very severe, during this stage, fifteen grains of chloral hydrate, well diluted with water, may be given every fifteen or thirty minutes until sixty grains have been given. (This medicine should never be given to a person with heart trouble). I find one drop doses of the tincture of Gelsemium every fifteen to thirty minutes of benefit, especially if the womb does not dilate well, or the patient is very nervous. The patient may receive and can receive light nourishment during this stage.

[532 MOTHERS' REMEDIES]

Management of the Second Stage.—After the rupture of the membranes the labor proceeds faster and a termination may be expected within a reasonable time. There is a short lull in the pains, usually, after the waters have escaped and during this time the patient should remove her clothing and put on a night dress, and to prevent its being soiled roll it well up under the arms and retain it there. After labor it can be very easily pulled down and made comfortable for the patient. A folded, clean, sterile sheet is now placed about the body and extremities and held in place by a cord around the waist. The opening in the sheet should be in the right side, as this will allow the assistance being given as needed. The powerful force of the abdominal muscles is now brought into action; the force is best utilized with the woman lying on her back.

She should now be encouraged to bear down during the pains and she will be greatly assisted by pulling on a sheet or long towel tied to the foot of the bed, or by holding the hand of the nurse. A support for her feet frequently aids the woman. Pressing low on her back relieves her to some extent. In the intervals between the pains she should rest, do nothing, and be perfectly passive. It is now that an anesthetic may be used to relieve the suffering. She should not be put completely under its influence for that is not only unnecessary, but injurious. Chloroform when used should be given on a handkerchief opened and loosely held over the woman's face, and administered drop by drop on the handkerchief. The handkerchief should be placed over the face at the beginning of the pain and be taken away as soon as the pain is stopped. The woman inhales the chloroform during the pains and their sharpness is blunted. Given in that way it is not considered dangerous. It should only be pushed to unconsciousness during a forceps delivery, and even then it is not always necessary to render the woman unconscious. I have used the forceps without giving an anesthetic. They should be placed without causing any special pain, and assist in delivery without causing any more pain when the head is down low. Of course if the forceps must be used when the head is high up a greater amount of anesthetic is needed.

Dr. Manton, of Detroit, says:—"The dangers of anesthetics are the same when employed for obstetric purposes as in surgery, and then use should be governed by the same rules in each instance." As soon as the head begins to dilate the vulvar opening, the patient should be turned on her left side with her knees drawn up and her body lying diagonally across the bed, with the buttocks close to and parallel with the edge. This position allows the physician to give better assistance and is no harder for the patient.

[OBSTETRICS OR MIDWIFERY 533]

The physician with his hands thoroughly sterilized and with a clean sterilized gown, seats himself on the edge of the bed and watches the progress of the labor, ready to assist the woman at any moment. And at this time he can do much by words of encouragement and proper directions to the laboring woman how to use her pains so as to get the most from them; and also by manipulation of the soft parts and the head. The head advances more and more with each succeeding pain, and the perineum is put on the stretch, each contraction is followed by a resting pause during which the head slips back a little and relieves the perineum. Tear of the perineum is liable to take place when the head is about to escape through the vulvar opening, especially if the contractions are strong, the woman bears down forcibly and the interval between the pains is short, so that the head is forced out before the parts have time to completely dilate and soften. Here is where the physician's work comes in, by holding the head back and fully flexed (bent), chin upon the breast, and keeping the back of the head (occiput) well up towards the bone in front (pubic arch) until thc perineum is completely dilated.

The effect of the pains can be lessened, if necessary, also, by telling the woman to open her mouth and not to bear down during the pain for a few times. In this way the perineum will dilate properly and be torn little, if at all, and perhaps much future trouble for the woman saved. I always tell my patient why I ask her to do certain things in labor and I have never found any woman who, when able, was not willing to do as I asked. A torn perineum is not desirable, because even when sewn up immediately after labor, it may not unite thoroughly, and thus cause displacements of the womb in the future. A little time and care at the time of labor will save the perineum and every woman is willing to do her share when the conditions are plainly explained to her. It takes only a few minutes longer, and only a few more pains to bear. When the head begins to stretch the opening, the left hand of the physician should be carried over the woman's abdomen and between the thighs, her right leg being supported by a pillow placed between her knees, and this left hand presses the back of the head (occiput) forward and against the "pubic arch." The right hand may also press the head upward by being placed against the posterior portion of the dilated perineum. The edge of the perineum should now be closely watched. A small towel wrung out of a bowl of hot water placed handy on a chair, should be held constantly against the perineum to hasten the softening and dilatation of these tissues. Plenty of hot water and small towels should be at hand. The head advances with each pain and again recedes until the parts are properly dilated, and the perineum slips backward over the child's face.

[534 MOTHERS' REMEDIES ]

If torn, it should be sewed before the physician leaves, as it can be done easily and without pain to the mother. As the head of the child emerges, the anesthetic should be pushed, or the woman told to open her mouth and cry out. This lessens the pain and the child's head emerges slower, and the perineum is saved. The child's head should be received in the hand. After the head is born, there is a lull for a few moments. Then the shoulders rotate into the proper position and are easily born. There may then be a flow of watery fluid for a few seconds. Before this time the physician has examined to see whether the cord is around the child's neck, released it if it has been, and also cleaned out the child's mouth. The child usually cries a little about this time and it is soon seen whether it needs quick attention. The perineum should be guarded also while the shoulders are being born as it can be torn by them. The shoulders are generally born without any help. The child's head is held in the physician's hand. As soon as the body is born, the child should be laid upon the bed behind the mother's thighs, and the cord pulled down to prevent it pulling upon the after-birth. After the beating in the cord has ceased, generally from five to ten minutes have elapsed, the cord is then tied, tight enough so it will not bleed afterward, about one or one and one half inches (some say more) from the body and tied a second time an inch or so from the first ligature, and the cord cut between the two ligatures. Care should be taken so as not to cut a finger or toe of the baby. If the cord is very thick it is best to pinch it at the point of tying and the contents stripped away before the first ligature is applied. After the cord is cut it should be wiped off to determine that bleeding from the vessels has been permanently cut off, and if not it should be tied again. The child is now taken up by placing the back of its neck in the hollow between the thumb and forefinger, and the other hand over the backbone. It should then be placed in a warm receiving blanket, and put in a safe place.

Management of the Third Stage,—The contractions of the womb are renewed and with the second or third the after-birth may be expressed. The top (fundus) of the womb is grasped by the hand through the relaxed abdominal walls, and squeezed, and at the same time make a downward pressure. The after-birth is loosened from the womb and slides through the vagina and outlet, and it may be caught in a tray which has been placed between the patient's legs, or by the hand and given a few twists in order to roll the membranes together; while this is being done, gentle rubbing should be applied to the womb, when the membranes will slip out without tearing; no drawing on the cord should be done in delivering the after-birth.

From the time of the birth of the head to the delivery of the after-birth the womb must be controlled by the firm pressure of the hand on the abdomen. It is well for the nurse, when the after-birth is separating from the womb to follow the womb, throughout this whole stage, by keeping her hand upon it and if, while the physician is attending to the child, the womb softens and enlarges she should at once notify him. There may be bleeding within the womb. After the womb is empty, friction should be made over the womb whenever it softens at all in order to stimulate the womb to perfect contraction, and it should be kept up at intervals for one hour after the after-birth and membranes have been delivered.

[OBSTETRICS OR MIDWIFERY 535]

THE CHILD.

The eyes should be washed soon and normal respiration established. If the child does not breathe well, cold water may be sprinkled in the face and chest and if this fails, immersions in hot water at 106 degrees F., and sprinkling with cold water must be resorted to. If necessary, artificial respiration must be given. Slap the child on the back and move the arms up and down by the side a few times, or breathing into the child's mouth.

Another method.—Face the child's back, put an index finger in each arm-pit and the thumbs over the shoulders, so that their ends over-lap the collar-bone and rest on the front of the chest, the rest of the fingers going obliquely over the back of the chest. The child is suspended perpendicularly between the operator's knees. Its whole weight now hangs on the first fingers in the arm-pit; by these means the ribs are lifted, the chest is expanded and inspiration is mechanically produced. The infant is now swung upward till the operative's hands are just above the horizontal line, when the motion is abruptly, but carefully, arrested. The momentum causes the lower limbs and pelvis of the infant to topple over toward the operator. The greater part of the weight now rests on the thumbs, which press on the front of the chest, while the abdominal organs press upon the diaphragm. By these two factors, the chest is compressed and we get expiration, mechanically. After five seconds the first position is resumed again, and the lungs expand and fill with air. This process may be repeated several times until the breathing seems to be going naturally, and with delicate infants it should be the last resort.

After the breathing has been established the child should be wrapped in a warm flannel with hot water bags or cans near it, and left until the mother has been cared for. Infants at birth are covered with a white greasy substance, vernix caseosa, or cheesy varnish; it is removed by applying olive oil, vaselin or fresh lard, and afterward rubbing the skin gently with a soft cloth. The eyes and mouth should be washed out with pure warm water—or a saturated solution of boric acid, used. Separate squares of soft linen being used for this purpose. If the baby is born too soon or is very small, weak and undeveloped, it should be given an oil bath, only, and then wrapped in cotton wool and kept at a temperature of not less than 80 degrees F., for ten days or two weeks.

[536 MOTHERS' REMEDIES]

To a fully developed child the first bath may be given at once. Have everything ready before beginning, a foot tub, warm soft towels, warm water, castile soap, olive oil or vaselin, small squares of muslin or linen, dusting powder, a dressing for the navel and clothing, the latter consisting of a diaper, a flannel band, a shirt, long woolen stockings, a loose long sleeved flannel petticoat and a simple soft white outside garment, the two last, long enough to more than cover the feet. The infant should be wrapped in flannel and only the part which is being bathed at the moment should be exposed. The eyes are first bathed separately and with different cloths, and afterward the face, no soap being used; the head is then washed with warm water; very little soap should be used with infants as it is more or less irritating, and it is likely to injure the fine texture of the skin. Next, one should carefully clean the parts behind the ears and the crevices of the neck, arm-pits and joints and those between the buttocks and the thighs, and it is well to notice if all the natural openings are perfect; finally the baby is put down into the tub of warm water at about 96 degrees F., and washed off, with the head and back firmly supported with the left arm and hand during the bath. The baby is lifted out in a minute of two, held face downward for a moment and rinsed off with clean warm water. It is then wrapped in a warm towel and flannel and dried by patting, not rubbing. It is best to do all this on a table, instead of on the lap, and it should be large enough to hold a bath tub, every thing necessary for the bath and a pillow upon which to place the baby. Everything then can be done without stooping and with greater comfort to the child. Powder should not be used except where there are signs of chafing, when stearate of zinc is the best to use.

The navel is then dressed. A hole is cut in the center of a square of sterilized lint or linen which is slipped over the cord and folded about it; the cord is then laid toward the left side, and over it is put a small sterilized cotton pad which is held in place by the flannel bandage and just tight enough to hold. The binder may be kept on by sewing it smoothly with half a dozen large stitches, thus doing away with any danger of being injured from the pins. A binder should only be tight enough to hold the dressing for the navel. After the cord drops off the looser knitted band should be used. The infant is not bathed in the tub again until after the cord has been dried up and ready to drop off, which usually occurs on the fifth or sixth day, although it may not drop off for nine days. The cord should not be redressed in the meantime. (See Baby Department for further directions).



THE MOTHER.

The first duty of the physician, following the third stage of labor, is to see that the womb is well contracted and control of this organ should be continued for at least one hour after delivery. This generally prevents excessive loss of blood. If necessary to promote womb contraction one teaspoonful of ergot can be given. After the womb has been kept in a state of contraction, the room should be rid of all evidences of labor and the woman made comfortable. The buttocks and thighs which have been soiled during the labor should be bathed with warm water and soap and the external genitals sprayed with an antiseptic solution, then dried with sterile gauze or cotton, the dressing applied to the vulva and the temporary bed removed, her night dress pulled down and the patient thus lying in a clean, comfortable bedding. The woman may then have a cup of weak tea, hot milk or broth and be left to rest; but during the first sleep the womb should be carefully watched lest it relax and serious, if not fatal, bleeding occur. In a normal confinement the dressings need not be changed, as a rule, oftener than six times in twenty-four hours, for the first few days. As soon as convenient after the first toilet is finished the physician sterilizes his hands and with the patient on her left side introduces one finger into the rectum and the thumb into the vagina to discover the condition of the perineum. Washing out of the vagina is not necessary as a rule.

[OBSTETRICS OR MIDWIFERY 537]

The binder is considered indispensable, and should be made of unbleached muslin and wide enough to extend from the pubic (bone) to the breast-bone, and long enough to go around the patient's body and slightly lap. The binder should be pinned or sewed tightest in the middle, but it should not be so tight as to press upon the womb and crowd it backward or to either side. It acts as a splint to the muscles and assists in resting them to their natural condition.

Rest.—Complete rest of the body and mind is essential to the well being of the lying-in woman. She is better off without any company, and should see no one except her family for the first week or two. Outside visitors should be prohibited. The lying-in room should be kept free from noise and confusion, and the patient should be protected from annoyances of every kind. She should remain lying on her back for a few days and immediately following delivery she should not have a pillow for her head. Sleep is very necessary and desirable, and mild medicines should be given to produce it, if necessary. It is best not to sit up in the bed until the womb shall have had time to become smaller, and has resumed its natural position behind the pubis. Among the upper classes, when it takes the womb longer to regain its normal size, three weeks is a good rule to go by before sitting up in the room, and she should remain in her room until the end of the fourth week. Among healthy women of the laboring class, whose muscular system has not been injured by "culture" and social excesses, the womb and appendages regain their normal proportions more rapidly; but even they should remain in bed two weeks.

AFTER-PAINS.—Women who have borne children frequently suffer from the after-pains, occurring at irregular intervals, for two or three days and they may give rise to much distress. A few drops of spirits of camphor on a lump of sugar will often give relief when they are not severe. Also a drop of tincture of blue cohosh taken every two or three hours is valuable.

THE BLADDER.—If the patient is not able to pass urine it should be drawn once in eight or twelve hours or oftener if required. A No.7 rubber catheter is best. After it has been used, it should be sterilized by boiling and then kept in a bichloride solution (1-2000). It should be washed off with boiled water again before being used to remove the bichloride solution and greased with sterile oil. The parts should be exposed to pass the catheter, the labia separated by the finger and thumb, and the opening of the urethra and surrounding parts bathed clean with an antiseptic solution; unless you are clean decomposing discharges from the vagina may be introduced into the bladder and a cystitis set up. The care of the bladder is very important. It is not so sensitive after the labor and the woman may have urine when she does not think so. Sometimes she passes a little after trying and then thinks there is no more in the bladder. Even the attendants are deceived sometimes. I once had a case where the mother was the nurse. At each visit I inquired as to the amount of urine passed. I was told each time it was sufficient. She suffered severely the second day in the evening. I went to see her and against the protests of the mother I used the catheter and took away an enormous quantity of urine. In such cases the bladder should be emptied slowly to save the woman from shock.

A physician cannot always depend upon the patient's knowledge of her condition even in such matters and sometimes even the nurse is at fault.

[538 MOTHERS' REMEDIES]

THE BOWELS.—There should be a movement of the bowels the second or third day, and a soap and water enema containing a small teaspoonful of spirits of turpentine and one-half ounce of glycerin, will usually be sufficient. Later cascara cordial, castor oil, etc., may be used. Should the breasts be much swollen and painful and fever arise, saline laxatives are needed for two or three days, such as citrate of magnesia, rochelle salts, hunyadi water or seidlitz powder may be given.

Care of the Breasts.—Careful attention should be given them from the first. The nipples should be bathed after labor, with an antiseptic lotion (bichloride, 1-2000), dried and then covered with castor oil, a small square of clean sterile gauze being laid over each to protect the clothing. Bathe the nipples before and after each nursing with a warm saturated solution of boric acid and dry them carefully. The breasts may be supported by a binder, made of a strip of muslin sufficiently wide to extend from above to well below the breasts. If they are heavy and sagging place a layer of cotton at the outer border of each breast and they should be raised toward the middle line, the binder being pinned only tight enough to hold without pressing upon them. The breasts should not be pressed upon by anything. Shoulder straps can be pinned or sewed on the binder if it has a tendency to slip down. Should the breasts be much swollen relief can be obtained by massage with warm olive oil and by the use of a breast pump. The tips of the fingers only should be used in giving massage and the stroke should be light, from the circumference to the center. Roughness and pressure must be avoided.



INFLAMMATION OF THE BREAST, Abscess; Broken Breast.—This usually results from germs. The breast inflames, the milk tubes are choked and distended, there may be fever. There is sometimes severe local pain, hard swelling and an abscess forms and if this breaks it is called broken breast.

[OBSTETRICS OR MIDWIFERY 539]

Treatment, Preventive.—Support breast with a binder. The milk should not be allowed to accumulate and cake. The breasts and nipples should be kept clean and dry. Breast pump should be used if necessary to get out the surplus milk. If the lumps continue and are painful, put cold applications to the breast. Have child nurse at the other breast. If it continues and will suppurate, apply moist heat, such as fomentations or poultices, and then open thoroughly. Poke root makes a splendid poultice for caked breasts. I have great faith in it. At the same time I give of the tincture one drop doses every hour. It is a splendid remedy and the poultice and remedy frequently stop the trouble. Inflammation of the breasts sometimes occurs in babies, generally in the first weeks. The swelling can be reduced by mild rubbing with warm carbolized oil used every day. Do not rub hard enough to hurt the baby. After the rubbing, absorbent cotton with carbolized oil should be applied and cover all with a thick layer of cotton held on with adhesives. If the breasts form pus they must be opened.

MOTHERS' REMEDIES. 1. Sore Breasts, a Never-Failing Remedy for.—"Take a pint of raw linseed oil and four ounces tincture of camphor, mix and apply a cloth saturated in the liniment to the affected parts, taking care that the whole surface of the inflamed parts is covered with the liniment. When the breasts become swollen or painfully inflamed, apply the liniment often to prevent gathering." Even if they have gathered it is an excellent outward application. It allays pain, is extremely soothing and seldom fails to effect a cure.

2. Swollen Breasts, an Herb Treatment for.—"Chamomile flowers one ounce, marshmallow roots one ounce, bruise and boil in one quart of water down to a pint. Foment the breast with this liquor as hot as can be borne; and then place the flowers and roots in a cloth and apply as a poultice."

3. Sore Breasts, a Hot Poultice for.—"Apply hot pancakes made of sour milk, saleratus and wheat flour, large enough to cover affected parts. Keep them changed often enough, so they will not be cold. This is an excellent remedy to steam out the inflammation." This is an old tried remedy and one to be relied upon. The steaming relieves the swelling and inflammation and gives relief quickly.

4. Caked Breasts, Fresh Hops for.—"Fry one pint of fresh hops in a half cup of lard until the lard is a rich brown, then strain, set away to cool and use as a salve."

5. Sore Breasts, a Poultice of Peach Leaves for.—"Take enough peach tree leaves to mix well with meal and water to the consistency of a poultice." This poultice should be applied hot, but should only be used in cases where the breast has matter or pus in it.

MOTHERS' REMEDIES.—l. Sore Nipples, a Good Wash for.—"Brandy and water mixed together and put on the nipples will harden them but should be washed off before the child nurses. If they are cracked, apply glycerin with starch, or arnica ointment."

2. Sore Nipples, Good Family Ointment for.—"Four ounces of white wax, one ounce bayberry wax, three ounces of spermaceti, one pint olive oil. Mix briskly over a slow fire, taking care to stir it briskly until cool." This is an excellent ointment for mothers when troubled with sore nipples; it moistens the skin and forms a coating. It is good for dry, scurvy, chapped hands, blotches on the face and all sores which require a mild ointment, but should be assisted with internal remedies when the case requires it.

[540 MOTHERS' REMEDIES]

The Lochia.—By this term is meant the discharges from the womb and soft parts after labor. They are mixed with blood at first and contain dark clots, mucus, shreds of the after-birth and pieces of the membrane. They become paler in color from the end of the third to the sixth day. After this the color is yellow, greenish and contains pus and fatty cells, with a little blood. This discharge varies in different women. In those who menstruate freely and do not nurse they are usually copious; when decomposed, they smell badly and the odor is penetrating. The flow may cease entirely between the second and sixth week. It is increased by exertions at about the time the patient begins to move about.

Diet.—This should consist at first of liquid, unstimulating food, given in small quantities and frequently. If the baby does not nurse, the liquids should be restricted. Some women on the first day can take milk, milk toast, or if desired, dry or buttered toast with coffee, tea, weak cocoa, according to the patient's taste. Water may be given if desired. On the second and third days, simple soups or any of the following may be added to the dietary: Meat broths, beef tea, soft boiled or poached eggs, raw or stewed oysters (no vinegar or spices) and some simple dessert, such as boiled custard or junket. During the next few days, chicken (white meat), scraped beef or mutton in small quantities, baked potato, rice and cereals may be given and by the end of the week a gradual return to the ordinary diet may be made. Should there be any tendency to constipation, the bowels should be opened by a simple enema (as before stated) or glycerin enema, etc.; or by one or more doses, 2 drams, of the compound licorice powder repeated in three or four hours, if necessary; or a half ounce of castor oil, or a half glass of hunyadi water. Cooked fruits for the constipation may also be given.

Bleeding After Delivery, Post-Partum Hemorrhage.—Bleeding from the womb occurring six hours after delivery is called post partum and after that time, is known as puerperal child-birth bleeding or hemorrhage.

Causes.—A relaxed condition of the womb, the retention of clots or parts of the membranes, etc., in the womb, a full rectum or bladder, fibroid tumors, deep tears of the cervix.

Symptoms.—If the bleeding is profuse, the pulse is fast, the woman looks pale, anxious and feels cold, restless, gaping, usually it comes from a relaxed, softened and enlarged womb.

[OBSTETRICS OR MIDWIFERY 541]

Treatment.—In severe forms no time must be lost in securing contraction of the womb and the method employed for expelling the after-birth should be employed to expel clots. Grasp the womb over the abdomen, employ firm but gentle kneading, pressing downward. The pillows should be removed, the foot of the bed elevated twelve to eighteen inches, a preparation of ergot given by the mouth or hypodermically in the thigh. If these measures fail the hand and arm should be sterilized and inserted in the womb, all clots, etc., removed and pressure made over the abdomen on the womb while the hand is still there. This pressure and presence of the hand close the bleeding vessels in the womb. The hand should remain, while the kneading goes on externally, on the womb.

This kneading should be kept up until the womb contracts. The hand can then be removed from the vagina, while gentle kneading is slowly kept up over the womb. The womb should be closely watched for hours after. Bleeding very seldom occurs again, but it might. If the bleeding is more of an oozing, an injection of very hot water, 120 degrees F., through a long douche nozzle, directly into the womb cavity may be given. This is very effective for any kind of bleeding. Lemon juice or boiled vinegar can be added to the injection. Everything used must be perfectly clean or child-bed fever may be caused by these measures. After the womb has thoroughly contracted, it is sometimes of benefit to place a rubber bag filled with cold water over the pubic bone to prevent subsequent relaxations of the womb. Weakness can be met by hypodermics of whisky or brandy and strychnine, one-thirtieth of grain, injected hypodermically to stimulate the heart.

Pulse and Temperature.—The temperature may rise one to one and one-half degrees without the case being abnormal. The pulse falls after labor, ranging between sixty and seventy. A rise of temperature, a rapid pulse, a flushed face, a chill, pain or tenderness of the abdomen, and abnormal increase or decrease of the discharge, bleeding, or offensive odor of the discharge should cause suspicion of child-bed (puerperal) fever. This is a grave condition and results from infection which has taken place during labor or afterward. The septic matter may be carried in on the fingers or instruments by the physician or attendants, etc. The most usual sources are unclean hands, instruments and clothing which come in contact with the woman's genitals. The attack is usually ushered in during the second to the fourth day by a chill, or chilly sensations, etc., rise of temperature, rapid pulse, accompanied by headache and a feeling of weariness. The discharge may be increased at first, but later diminished and may cease; or it may be abundant, frothy and of a very fetid odor. Secretion of milk may fail, the bowels are usually constipated, pain in the abdomen develops.

Treatment.—If the interior of the womb is smooth, a single antiseptic womb injection should be given; if it contains foreign material or is rough, it should be scraped and then a douche given. This must be done carefully and with absolute cleanness. Turpentine stupes should be placed hot on the abdomen for the pain, or where cold feels more grateful the ice bag or cloths wrung out of cold or ice water should be applied over the abdomen, and covered with several thicknesses of flannel and changed as soon as they become heated. Medicines to relieve the pain may be given. Hot and cold sponging may be given to reduce the temperature, a little alcohol can be added to the water or the cold or hot pack may be used.

[542 MOTHERS' REMEDIES]

Diet.—This should be nourishing and supporting, and at first, liquid and consist largely of milk; but concentrated broths, jellies, and liquid beef, peptonoids, are useful. Stimulants should be given in these septic conditions. From one to two ounces of whisky may be given every three to four hours in the form of milk punch and, if possible, as much red or port wine also. Women in this condition can stand this treatment. Salines (salts) should be given to keep open the bowels.



CONVULSIONS. (Eclampsia).—All forms of convulsions may occur during pregnancy. They may occur during pregnancy and during labor. These are usually the result of kidney trouble. The attacks occur most often during the last three months of pregnancy. Their frequency is one to three hundred to one to five hundred cases. It occurs oftener in the first pregnancy, three to one.

Treatment.—Inhalation of chloroform to control the convulsion. Morphine in one-half grain dose can be given if no chloroform is handy. Place the patient in a hot water or vapor bath, or wrap blankets wrung out of hot water around her, and pile the bedding on until a profuse sweat is started. The sweating aids in eliminating the poison. Change the hot wet blankets as often as necessary. If the convulsions do not cease the womb must be emptied of its contents. If the convulsions occur during labor they should be treated in the same manner. The mortality then is about seven per cent. Chloral hydrate in thirty to sixty grain doses in three ounces of water may be injected into the rectum if the other remedies fail.



MILK LEG.—This is due to infection. It usually arises from an extension of a blood clot (thrombosis) of the womb or pelvic veins, to the thigh (femoral) vein, resulting in a partial or complete obstruction of the vein. It may come in less frequent cases, from a lymphatic infection.

Symptoms.—They may develop at any time between the tenth and thirtieth days or even later. These are general feelings of weariness, stiffness and soreness of the leg, especially when it is moved. There may first be pain in the region of the groin; or pain from the ankle to the groin and followed by swelling. The skin of the leg becomes markedly swollen, white and shiny. Later there is pitting on pressure, but not at first, because the skin is extremely stretched. Fever may accompany the attack, but it will subside long before the swelling of the leg has disappeared.

The vein may be felt as a hard lash-like cord, a red line of inflammation marking its course along the inner and under side of the thigh. The disease may last weeks, depending upon the severity of the trouble. The affected leg is disabled for a number of months after recovery. Recovery takes place as a rule. Absorption of the clot takes place, or the vessel remains closed, and another (compensatory) circulation is established.

[OBSTETRICS OR MIDWIFERY 543]

Treatment.—The patient should lie in bed with the leg elevated and swathed in flannel or cotton wet with some quieting lotion. The following is a good lotion:—

Compound Soap Liniment 6 ounces Laudanum 1-1/2 ounces Tincture Aconite Root 1/2 ounce Tincture Belladonna 1/2 ounce

Wet the flannel or cotton with this. After the acute symptoms have passed the following ointment may be put on the leg:—

Ichthyol 45 grains Iodide of Lead 45 grains Chloride of Ammonium 10 grains Alboline 1 ounce

The parts should not be rubbed lest a clot be loosened and travel in the general circulation and thus endanger life.

Diet.—Should be supporting. Salts for the bowels.

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ALL ABOUT BABY

QUESTIONS AND ANSWERS

Preparation, Outfit, Nursing, Formulas for Preparation of Milk for Bottle-Fed Infants; Weaning, Teething, Diet Through Childhood, All the Baby Diseases, etc., from the Best Medical Authority, Infant Hospitals and Nurses.

How long does pregnancy usually last? Two hundred and eighty days.

How can the time be reckoned? Count back three months from the first day of the last menstruation and add seven days to the date thus obtained. To be more accurate, you should add only six days in the months of April and September, five days in December and January, and in February four days.

What time of pregnancy does the form begin to change? It changes a little the first two months. It is flatter and lower down. After the third month there is a progressive enlargement.

What is quickening, and when first felt? It is a motion, of the foetus (child) in the womb, imparted to the abdominal walls, and is felt from the sixteenth to the twentieth week. It has been said to have occurred earlier in some cases.

Can you foretell twin pregnancy? Not to a certainty.

Can a mother influence her child as to character and temperament before birth? Authorities differ very much upon this point. The child inherits the physical characteristics of its parents. The frame of the mother's mind, some think, can be given in some degree to her offspring.

Will nervousness be inherited by the child? Not invariably; if the mother is fretful, irritable, cross, repining, etc., her child may be puny, cross and irritable, etc.

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Do you believe in influences transmitted before birth (parental influences?) All must admit that there is a great deal in heredity, and the characteristics of parents are shown in their children.

Can a mother mark her baby? This is another disputed question.

When should the family physician be informed of the woman's condition? The first month.

Why? So that the woman will know how to live properly, and also that he will be given the urine twice each month to examine. This is for her protection and is necessary, because anything that may be wrong with the kidneys can be corrected much easier, and diet, etc. can be arranged to prevent future trouble.

What kind of diet should a pregnant woman have? She should eat only healthy articles of food. Stimulating, highly seasoned, rich, greasy foods should be avoided. Constipation is frequently present and the diet must be chosen with reference to that also. She should not restrict herself to one line of diet unless it is necessary.

Should she take a daily bath, if so, what kind and when? Yes, if it does her good. The pores of the skin should be kept open so that the kidneys will have less work to do. Spray and baths should be taken cold or lukewarm. Hot baths or Turkish baths are to be avoided. The time should be at the woman's convenience. Morning is preferable, if she does not feel the need of sleep.

Should she take a daily nap and when? Yes, one or two hours in the forenoon, and also in the afternoon.

Should she take exercise? Yes, exercise is necessary. This promotes the proper circulation of the blood, favors rest and sleep, relieves the "blues," tones the whole system, gives her good wholesome air and makes everything look better. It should not be violent. Slow walking and riding in an easy carriage. She should not ride a horse, run, jump, dance, or do any jerky or violent exercise; no heavy lifting or reaching up.

What about clothing? The clothing should be perfectly loose and comfortable. Garters and corsets are injurious, especially when the pregnancy has reached four or five months. The weight of the clothing should be borne by the shoulders instead of the hips. Special waists can be made for pregnant women. There should be no pressure on any part, especially on the womb and breasts.

What is the meaning of the word enciente? The Roman women were accustomed to wear a tight girdle about their waists which was called a cincture. This they removed when they were pregnant. They were then said to be incincta, or unbound. The term enciente is derived from this, and is frequently used to indicate pregnancy.

What are the main symptoms of miscarriage? Pain and bleeding.

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Does it usually come on suddenly? Not as a rule. There are premonitory symptoms such as bearing down feeling in the pelvis, backache, frequent desire to pass water, a discharge from the vagina, and sometimes a little bloody flow.

At what period is it most common? Between the ninth and sixteenth weeks when the after-birth is forming.

What are the causes of miscarriage? Diseases of the womb, disease in the father, constipation, falls, over-exertion, violent emotions, such as shock, fright, anger, blows on the abdomen, over-lifting, reaching up, sewing on machine.

What is the first thing to do? Lie down, rest and send for a doctor.

Is it ever possible to stop it? Yes, and often.

Do the breasts need any special care? The nipple, if much drawn in and small, should be "pulled out" once or twice daily. It will do to rub sweet oil on the breasts every evening in order to relieve the tightness and discomfort, especially after the pregnancy has advanced some months.

Are there any diseases to which a pregnant woman is more subject? None. The kidneys need more watching.

Can any dentistry be done during pregnancy? Not if it makes her very nervous; but toothache can cause more harm from a diseased tooth than if it were treated carefully.

Why do pregnant women suffer from "varicose" veins? The enlarged womb presses upon the veins and thus obstructs the return flow of the blood. It is not so common during the first pregnancy.

Can anything be done for this trouble? The woman should lie down a good part of the time if possible, and also wear a perfectly fitting elastic stocking. They can be had of any size and length. The limb should be measured for them.

Does oiling and massaging the body do good? Some women claim it does; it certainly puts the muscles in better condition and strengthens the muscles of the abdomen which have so much part in the labor.

What is the morning sickness and are all women subject to it? Nausea and vomiting without any cause. No; many escape it entirely.

At what period of pregnancy does it usually occur? During the early months it is more frequent and troublesome.

How long does it usually last? Usually three or four months, but it may last during the whole pregnancy.

What can be done for it? In some cases arranging the diet to prevent and cure constipation relieves it. For fuller treatment see this heading under Obstetrics.

Does it ever endanger life? Not often, but a physician should be called if it is bad.

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Can any strict rules be laid down for this trouble? No, but the food should be as concentrated as possible; egg-nog, ice cream, a bit of rare steak, etc., raw oysters, gruels, meat broths, etc., if liquids are well borne. It is surprising how little will keep up some women during pregnancy.

When and how often should the urine be examined? From the beginning and twice each month, and every week after the fifth month.

When should the nurse be called? Long enough before the expected time to get everything ready.

What is lightening? It is caused by the womb sinking down lower in the pelvis the last month, and this lightens the pressure upon the diaphragm and lungs.

What are false pains? They occur during the last few weeks of pregnancy at irregular intervals and are usually in the abdomen.

What is the bag of waters? It is a sac containing the fluid in which the child floats while in the womb. The amount of fluid varies from a pint to a gallon or more. When it ruptures there is a sudden flow of liquid, more or less continuous flow. It may occur at the very beginning of labor and is one of the signs of labor.

What are the other signs of approaching labor? A profuse discharge of mucus from the vagina, and this may be tinged with blood. The "show" pains begin generally in the back and are quite regular, one every twenty minutes or half hour. (Dilatation of the womb).

How should the baby be first washed? See Obstetrics.

What clothing should be put on? See Obstetrics chapter.

Care of the eyes.—Wipe the eyelids with clean gauze and water. If there has been much discharge from the vagina during pregnancy, the child's eyes should be washed cleanly and also one or two drops of the one per cent solution of silver nitrate should be put into each eye as a preventive. (See Obstetrics).

How often should the baby's bowels move? Two or three times daily for the first week, and then once or twice a day.

What is the appearance of the stool? It is soft, yellow and smooth and should not contain any lumps.

How about the urine? It should pass from six to ten times a day, and it should be colorless.

What is the average weight of a healthy baby? Seven to seven and one-half pounds.

Does it lose any weight during the first week? Yes, generally a few ounces, then it begins to gain at the rate of four to six ounces each week.

Should the newly-born babe have its eyes exposed to the light? The eyes are very sensitive, and the sun or artificial light should not be allowed to shine on them. The first day the baby is deaf, but his hearing develops and becomes very acute so that he is very much disturbed by sudden, sharp noises.

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What is the "soft" spot on a baby's head? This is called the "fontanelle." Do not touch this spot. This closes in time. At six months of age the fontanelle is somewhat larger than it was at birth because the brain expands faster than the boney matter deposited around the edges in the skull bones. After this another deposit of bone goes on more rapidly than the growth of the brain substance, and by sixteen or eighteen months the opening should be entirely closed.

When should the baby be given the second tub bath? Not until the cord has dropped off.

How and when should this be given? The room should be warm. The head and face should be washed first and dried; then the body soaped and the infant placed in the tub with its head and body well supported by the hands. The bath should be given quickly with no special rubbing, drying with a soft towel. (An hour after feeding).

What should be the temperature of the bath? One hundred degrees F. for the first few weeks, later ninety-eight F. After six months ninety-five F.; during the second year from eighty-five to ninety degrees F.

What should you use in giving the bath? Soft, clean sponges or smooth cloths. There should be separate pieces for each eye, for the head, face and buttocks.

What are the objections to sponges? They are very apt to become dirty and are hard to keep clean.

When should the daily bath be omitted? In the case of infants who are delicate and feeble, when the bath seems to harm them; in all forms of acute sickness, unless the bath is directed. In eczema and many other forms of skin diseases a great deal of harm is often done by soap and water or water baths.

How should a genuine bath be given? If possible the bath should be given in front of an open fire, in a room where the temperature is from seventy to seventy-two F. and the draughts kept off by a large screen. Have everything at hand with which to give the bath. A folding rubber bath-tub is the best, next a papier-mache one; or if tin must be used, put a piece of flannel in the tub to protect the baby from the tin. If necessary place the tub on a low table, place another low table to the right of the one on which the tub sets, and on this table should be the baby's basket containing a soft brush, different sizes of pins in a pin-cushion, several threaded needles, a thimble, squares of soft linen, absorbent cotton, wooden tooth-picks, a powder-box and puff, or a powder-shaker containing pure talcum powder, a box of bismuth subnitrate, one of cold cream, a tube of white vaselin, a dish containing castile, ivory, or pure French soap should be placed by the basket on the table; also a cup containing a saturated solution of boric acid; two cheese-cloth washcloths, a soft towel, a thermometer to test the water, several toothpicks on which a little absorbent cotton is twisted, and the rolled flannel band. Then a basin containing warm water, 98 to 100 degrees F., also one with cold water. The baby-clothes should be hung on a rack close at hand.

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How to take care of a sore navel.—If it looks red or has a thin discharge coming from it, wash it carefully twice a day with saturated solution of boric acid; or if pus is there use a 1-5000 solution of bichloride of mercury. Use for a dusting powder one part of salicylic acid and nineteen parts of starch on it. It needs a physician's attention if it does not soon heal.

Do any physicians advocate a daily bath before the cord drops off? Yes; but not a full tub bath.

When does the cord drop off? In from five to ten days.

Does soap hurt a baby's skin? Some doctors claim it does.

Is it necessary to use a powder after the bath? No, if all moisture is removed, there is no need of powder. The skin can be kept cleaner and healthier without it.



GENITAL ORGANS.

When is circumcision needed? Usually when the foreskin is very long and very tight, so that one must use force to push it back, and always if it produces local irritation.

How should you clean the genitals of a female child? Use good absorbent cotton and warm water, with a solution of boric acid if necessary, about two teaspoonfuls to a pint of warm water. This should be done once a day.

Is the hood of the clitoris ever too tight? Yes, and it needs to be loosened and kept so, or it will produce irritation and sometimes convulsions.

How should you wash the genitals of a male child? In infants and children, this should be attended to daily. The foreskin should be pushed back and the parts washed with absorbent cotton and water. Tight foreskin and unclean parts induce trouble and bad habits.



TREATMENT FOR SORE EYES.

How should a newly-born baby's eyes be treated? They should be kept clean with a soft cloth and warm water. Do not use the same piece of cloth for both eyes.

Should redness and pus appear in the eye or eyes a few days after birth, what should be done? Use a piece of soft linen or absorbent cotton and wet it in a solution of boric acid or salt (one-half teaspoonful to one pint of water, warm) and wash out the eye or eyes, and if pus appears, use a stronger solution of boric acid (ten grains to eight teaspoonfuls of water.) If the lids stick together grease them with vaselin from a tube and rub in at night. If the sore eyes are severe send for a physician as it may be the beginning of ophthalmia neonatorum.

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MOTHERS' REMEDIES.—1. Sore Eyes, Mothers' Milk for.—"There is nothing as good as mother's milk." This is very soothing and healing and seems to work better than medicines in small babies.

2. Sore Eyes. A Nurse from New York sends the following remedy for.—"Take a cup of water that has been boiled and cooled and dissolve in it one teaspoonful boracic acid powder. Bathe the eyes thoroughly and often." A nurse in New York state, gives this recipe, and says she has been a nurse for several years and has never had a case of sore eyes which did not heal with this treatment.

How is washing out the baby's mouth done? Use a swab made by twisting some absorbent cotton upon a toothpick. The folds between the gums and lips and cheeks may be gently and carefully cleaned twice a day unless the mouth is sore.

If a baby cries while nursing, what is the cause? It may have a sore mouth. What is thrush or sprue? Patches looking like little white threads or flakes appear inside the cheeks.

What is the cause of sore mouth? It is usually due to uncleanness and carelessness. It may come in delicate babies without any special reason. Babies who suck a "pacifier" or a rag with sugar in it are very apt to have the disease. Bottle-fed babies get it because of uncleanness of the nipple and bottle.

Should the baby continue to nurse? Yes, but the mother should thoroughly cleanse her nipple with a solution of boric acid after each nursing.

What should be done for it? It should be washed before and after every feeding with a solution of baking soda or boric acid of the strength of one even teaspoonful to twenty-four teaspoonfuls of water, or listerine, one teaspoonful to twenty-four teaspoonfuls of warm water, can be used. (This will be treated more fully later under diseases). A solution of borax (twenty grains to eight teaspoonfuls of water) can be applied every two hours with a camel's hair brush. Borax, sage and honey are good old remedies.

Should the scalp have special care at birth? It should then and afterward be kept clean to keep scurf from accumulating. It should be wet before the body is immersed in the bath. The hair should always be dried carefully; brush first with a soft towel and then with a fine, smooth hair-brush. Never use a comb on an infant's head.

Should any dressing be put on the scalp? No, for if the hair is washed and brushed, the oil from the scalp will keep it soft, glossy and healthful.

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QUESTIONS AND REMEDIES FOR SORE MOUTH. CANKER. THRUSH.

Explain more about thrush or sprue? It is an inflammation of the mouth where small particles looking like milk curds appear on the tongue, gums and cheek. This is really a more severe type of sore mouth, and is of a fungus origin.

Causes of sore mouth. Uncleanness, failing to keep the mouth—especially of bottle-fed infants—and the nipples and bottles, clean. Babies who are allowed to suck a "pacifier" or rag with sugar on it. Thrush is parasitic in origin and is always due to uncleanness in bottles, nipples and the mouth, and is commonly associated with the stomach trouble. Diarrhea frequently goes with it.

(See Mothers' Remedies for Sore Mouth, Canker, etc., in general department).

PHYSICIANS' TREATMENT for Thrush. Severe Sore Mouth. 1. Boric acid in a saturated solution (five teaspoonfuls to a pint of distilled water) is a specific for it.

Dr. Tuley, of Louisville, Ky., says:

2. Powdered Borax 8 teaspoonfuls Strained Honey 3 teaspoonfuls Mix thoroughly.

3. Glycerin 1 ounce Distilled water 1 ounce Boric Acid 2 drams

4. Golden seal diluted one-half with boiled water makes an excellent mouth wash. Also a weak solution of alum. Use a piece of absorbent cotton or soft linen on your little finger or small round piece of wood and dip in solution and apply. Dr. Douglas, of Detroit, advises the use of a soft brush. This should be boiled after using.

5. In Mild Cases of Sore Mouth.—The medicines need not be as strong as for thrush. One teaspoonful of boric acid or baking soda to a pint of boiled water is usually sufficient; wash after each nursing or four or five times a day.

6. Powdered Borax 1 teaspoonful Powdered Sugar 4 teaspoonfuls

Put a pinch on the tongue every two or three hours. The child's tongue will work it around. This avoids the pain from washing, etc.

7. Another Mouth' Wash.—

Borax 1/2 teaspoonful Tincture of Myrrh 1/2 teaspoonful Glycerin 1 teaspoonful Boiled water enough for one ounce.

Apply gently to the inside of the mouth several times a day in thrush or any form of sore mouth or gums. Use a camel's hair brush.

[552 MOTHERS' REMEDIES]

WHAT CARE SHOULD BE GIVEN THE DIAPERS?

A diaper should never be used more than once without washing. It should be removed as soon as it is wet and placed in a covered pail in the bathroom, etc., and washed at the first opportunity. Pure white soap only should be used, and the diapers should be thoroughly rinsed and boiled. Dry them in the sun and air and never before the nursery fire. They should be warmed before they are again used. Unclean, soiled diapers frequently cause chafing.

Should a baby cry while passing urine? No; it may be too acid, alkaline, too little of it or too concentrated, or have sand in it. Examine the diapers.

How about bands for the baby? Straight pieces of flannel, twenty-two by five inches or wider. They may be knitted.

How long should they be worn? The snug bands, flannel or knitted should be worn, not tight, three months; then if one is worn it should be loose. It may prevent rupture and bowel trouble.

Do you approve of rubber diapers as an outside covering? No, because they confine the dampness cause more sweating of the parts and may thus cause chafing, etc.

How large should a diaper be? A diaper should be twice as long as wide. They may be different sizes, eighteen by thirty-six inches, twenty-two by forty-four, or twenty-seven by fifty-four.



CHAFING.

Chafing is a very common trouble in infants. What causes chafing? A wet diaper left on too long; not drying the folds of the flesh properly; too much and too strong soap in the bath, or in the diapers when they are washed, or failure to wash the child clean.

Where are the places where baby is most likely to chafe? The buttocks, in the folds of the neck and in the groins.

How can you prevent chafing? Use very little soap; no strong soap; rinse the body carefully; dry thoroughly after rinsing; use clean diapers; use dusting powder in the folds of the flesh, especially in fat babies.

If the skin is very sensitive, what then? Do not use any soap, but use bran or salt baths.

How can you prepare a bran bath? Place one pint of wheat bran in coarse muslin or cheese-cloth bag and put this in the bath water. It should then be squeezed for five minutes until the water looks like porridge.

How is a salt bath prepared? One teaspoonful of common salt to each two gallons of water.

If the parts are chafed what should we do? Do not use any soap, and give only bran or salt baths or use pure olive oil and no water at all on the chafed parts. Dry the parts carefully with old, soft linen and dust them with a powder made of starch and talcum—equal part—with one-fourth as much boric acid, all carefully mixed together. Or use starch two parts and boric acid one part. Pure stearate of zinc powder is also good. Keep a little piece of soft linen between the folds of the flesh, so they will not be irritated by rubbing together.



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MOTHERS' REMEDY.—1. Chafing in Infants, Mutton Tallow for.—"Five cents' worth of mutton tallow, melted. Apply at night." If there is a tendency to chafe during the day, use talcum powder, putting the mutton tallow on at night when the child will be quiet, giving it an opportunity to heal.

How shall I take care of the buttocks to prevent chafing? This is the most common place for chafing, as it is so frequently wet and soiled; hence all napkins should be renewed as soon as wet and soiled and the parts always kept perfectly clean.

What is prickly heat, and how caused? Fine, red pimples appear, caused by excessive sweating and from irritation of flannel underwear.

How should I treat it? Muslin or linen should be worn next to the skin. The entire body sponged frequently with vinegar and water (equal parts) and plenty of starch and boric acid powder used; starch, two parts; boric acid (one part) should be put on.

(See Mother's Remedies under "Prickly Heat," General Department.)



CLOTHING FOR THE BABY.

The chest should be well covered with soft flannel, the limbs protected, but not cramped, the abdomen supported by a band, not too tight. The clothing should be neither too tight nor too loose. No pins should be used, but all bands should be fastened to the body. The petticoats should be supported by shoulder straps.

How should a baby be held during dressing? It should lie on the lap until quite old enough to sit alone. Draw the clothes over the child's feet and do not slip them over the head.

Why use the band, and how long should it be worn? It protects the abdomen, but its main use is to support the abdominal walls in very young infants and thus prevents rupture. The snug flannel band should not be worn more than four months. Then in healthy infants a knitted band may be used and worn up to eighteen months. If the baby is thin and the abdominal organs are not protected by fat, they may be troubled with diarrhea and need protection. In such condition, the band may be worn until the third year.



BABY'S FIRST WARDROBE.

Four to six dozen diapers (bird's-eye cotton), two to three shirts (wool), four flannel skirts, two white skirts (nainsook), two to four night dresses (outing flannel), six day dresses, two wrappers, six pairs of socks, four to six flannel bands, two flannel sacks, two shawls or afghans. The dresses to be worn after the first four or six weeks. Of course this can be less or more elaborate, according to the conditions and circumstances of the parents, etc.

[554 MOTHERS' REMEDIES]

What changes should be made in the clothing in summer? The thinnest gauze flannel undershirts should be worn, the outside garments to be changed for the changing weather. They should not be kept too hot in the middle of the day, while in the morning and evening extra wraps should be used.

Should older children go with bare legs? There is no objection, if they are strong and well, to doing this in warm weather.

What kind of underwear should be worn in cold weather? Next to the heaviest is thick enough.

Do children require heavy flannels? Not as a rule, as they usually live in the nursery and they sweat readily while playing. When they go out-of-doors, coats and leggings render thick flannels unnecessary.

Are many children too thinly clad in the house? Very few. The usual mistake is excessive clothing and too warm rooms. These cause them to take cold so easily.



GENERAL DRESSING FOR DIFFERENT SEASONS.

At night baby may have a warm sponge bath, a fresh band, shirt and skirt put on. In the winter he should sleep in a flannel nightdress and this can be made with a drawing string or button on the bottom so that he cannot expose his feet. In the summer he can wear a cotton night-dress and after the third month the skirt may be left off in very warm weather. By the time baby has entered his second month he may wear simple little "Bishop" dresses instead of his plain slips. At the end of the third month, the flannel band may be discarded, usually, and a ribbed knitted one used. The band should be of wool in the winter, and of silk and wool in the summer. It should be put over the child's feet when he is being dressed each morning, and be changed for a fresh one at night, if possible. If the baby is healthy he may begin going out in March, if the days are mild and there are no stormy cold winds. Begin by letting him stay out one-half hour during the warmest part of the day, then one hour, etc. When there is much melting snow he should not be taken out. In cold weather the baby's cap and cloak should be lined with flannel or lamb's wool. Woolen mittens should cover his hands. A veil is not necessary.

Cap for Baby's Ears.—If baby's ears stand out from his head a considerable distance, it can be corrected best when he is young. A skeleton cap is made for this purpose. This can be bought or the mother can make one out of thin lawn or pieces of broad tape. It should fit snugly in order to do any good and be worn for some time.

Drooling.—If the baby drools much he is apt to wet any little bib he may wear and take cold by having damp clothing next to his throat and chest. Cut a piece of material now made (Linite, by Johnson & Johnson) in the shape of a bib, and bind with tape. This can be worn underneath the bib.

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Short Clothes About the Fifth Month.—Short clothes should be prepared for the baby's wear at the beginning of the fifth month, and may consist of a shirt, knitted band with shoulder straps, flannel skirt made on a cotton waist, in summer or a flannel one for cold weather, and having a row of small flat buttons, on to which the white petticoat may be buttoned; a diaper, and a simple white dress. For summer, white cotton stockings should always be worn, woolen ones in the winter; and they should be long enough so that they may be pinned to the diaper. Moccasins or soft kid shoes should be the first kind worn. At night a baby (in short clothes) should sleep in a shirt, band, diaper and a night-dress of cotton in summer, and flannel in winter. The change to short dresses should not be made in very cold weather; and if the baby is born at such a time as to make it necessary, he may be put into short clothes as early as the end of his third or fourth month, rather than to wait until later and make the change in mid-winter.

Clothing in Summer.—Even in summer, the baby should have clothing which contains some wool. A mixture of silk and wool or cotton and wool may be used for the shirt, band and skirt. The band should never be left off; the shirt may be left off in the hottest weather and the long ribbed band with shoulder-straps may take its place, but the abdomen must be covered by means of the band. The nightdress should now be of cotton and the skirt left off at night, but the band and the thin skirt should be worn. Long, white cotton stockings reaching to the napkin should be worn all summer, and not short socks.

The head should be kept cool, therefore do not use a sunbonnet which shuts out all of the air. Muslin caps and light pique hats provide enough shade, if the baby-carriage has a parasol.

Creeping aprons can be used for babies. They are made of fine gingham and may be put over the dress or worn without one in very warm weather. Make them so as to button all the way down the back, and they sometimes have an elastic or draw-string run into the hem at the bottom of the apron so that the white skirts may be kept clean.

For early fall, two or three little jackets of light flannel or cashmere can be made; and the baby can wear one of these either over or under his white dress in the morning or evening when it is cool. The baby should be in the house by six o'clock unless the weather is exceptionally warm. In the fall, if he has been accustomed to having his nap on the piazza, in his carriage, a screen should-be placed around the carriage to protect him from any possible draught. After the first of October, in chilly days, he should have his nap in the house.

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Winter.—A year-old baby in winter should wear a medium weight wool shirt, knit band with shoulder-straps, a flannel skirt on a flannel waist, white skirt buttoned on to the waist of the flannel skirt, woolen stockings pinned to the diaper, laced shoes, a white dress of some cotton material and for very cold days, a little flannel, or cashmere sack. At night should be worn a band, shirt, diaper and flannel night-dress long enough to keep his feet warm. For an outing in the winter he should have on a light, but warmly lined coat; a wadded lamb's wool lining is best, but it is expensive, and flannel may be used. His bonnet should be lined with flannel; and leggings and mittens should be of wool.

First Half of Second Year.—A baby of this age may wear a thin gauze shirt with short sleeves, but he should wear under it the ribbed silk and wool band and also his flannel petticoat during the summer. Summer complaint is often kept off by such clothing.

Second Half of Second Year.—A baby of this age is too young to walk in the streets in the winter, and his feet cannot be protected from the damp and cold sidewalks by the usual roomy shoes. When in the go-cart instead of his carriage, his legs should be well covered, so that dampness and wind will not chill and give him a cold. A large bag having a draw-string at the top is an excellent thing to use for the lower part of baby's body while in the go-cart, and the strings should be drawn up and tied under his arms. This bag may be made of any material (warm) from eiderdown, cloth, flannel to felting; or it may simply be made of an old crib blanket and a small carriage robe placed over it. Baby's ears should be covered at this age on very cold days, when out. The baby girl should wear a lined bonnet, well covering her eyes. Tam O'Shanter caps of angora wool can be made and pulled down over the eyes for both girls and boys alike; or a soft felt hat with rosettes of ribbon lined with flannel sewed onto the elastic can be made for the boy to protect the head and ears.

By the time baby is two years old, diapers should be given up and little drawers used instead. It may be frequently necessary to use diapers at night for several months longer, although if the baby be taken up at ten or eleven o'clock p. m. he will frequently go all night without urinating.

First Half of Third Year.—Children of this age should be put into night-drawers, cotton ones in summer and flannel ones either with or without feet, in winter. Tiny overalls or "rompers" are now used a good deal for both boys and girls while at play.

Second Half of Third Year.—Now he can walk in the street for a little while each day, even in winter, having his legs protected by warm leggings and with small rubbers for his shoes when the walks are at all damp. Woolen leggings should be used.

Children should not be allowed to race about in their night-drawers and bare feet. They should also have little wrappers and bedroom slippers.

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What About the Nursery? The furnishings should be very simple. No unnecessary hangings or upholstered furniture. A large room, well ventilated and one in which the sun shines at some part of the day. The shades should be dark, but no extra hangings or curtains. Nothing should be allowed about the baby's crib but what can be washed. The air should be kept pure. There should be no plumbing, no drying of napkins or clothes, no cooking of food, and no gas burning at night. A small wax candle will do for all usual purposes.

What kind of heat is best? An open grate fire is best; next, heat from a Franklin stove. Steam heat is bad in a nursery. Never use a gas stove unless for a few minutes during the morning bath.

What should the temperature be during the day? From 66 to 68 degrees with the thermometer hung three feet above the floor. It should never be allowed above 70 F. At night, not below 65 F. during the first three months. After that it may go to 55 F., and after the first year it may go to 50 and even to 45 F.

Does the fireplace furnish enough ventilation? No, the principal ventilation must be from the windows.

How soon can you leave the windows open at night? Usually after the third month, except when the outside temperature is below the freezing point. How often should the nursery be aired? At least twice a day, after the baby has had his bath in the morning and also before putting him to bed for the night. This ventilation should be done thoroughly and the baby should be moved to another room. In the meantime, any time the child is out of the room it should be aired.

How can you ventilate the room at night? During the winter, while the baby is young, the sleeping room may be ventilated at night by opening a window in an adjoining room; or if the weather is not very severe, a window board may be used, or a frame on which has been tacked heavy muslin; this may be from one to two feet high and put into the window like an ordinary mosquito screen. In summer, a screen around baby's crib will furnish all needed protection from the open windows.

How does a room that is kept too warm affect the baby? He becomes pale, loses his appetite, has some indigestion, gains no weight, perspires very much and takes cold easily.

How early in baby's life may airing indoors be commenced, and how long continued? When the baby is one month old. For fifteen minutes at a time at first and may be lengthened ten to fifteen minutes daily. This airing may be continued in all kinds of weather.

Will the baby take cold? Not if the period is at first short and the baby becomes accustomed to it gradually. It is a cold preventive.

How should such an airing be given? The baby should be dressed with bonnet and tight coat and placed in a crib or carriage which should stand a few feet from the window; all the windows should be thrown open for baby's airing. Doors should be closed to prevent draughts.

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How soon can baby be taken out of doors? In summer when one week old, with eyes thoroughly shaded. In spring and fall usually in about one month; in winter, when about three months old, on pleasant days, and kept in the sun and out of the wind.

What time of day is best? A baby may go out almost any time in the early summer and early autumn between 6 A. M. and 7 P. M. In winter and early spring a young child only between ten or eleven and three.

Can this be done in all kinds of weather? When the winds are sharp and the ground covered with melting snow, and when it is very cold, the baby should not go out. If the thermometer is below 32 degrees F., a child under four month's should not go out. If below 20 degrees F., a baby under eight month's should not go out.

What care should be taken? The wind should never blow in the baby's face, its feet and legs should be properly covered and warm and the sun should never be allowed to shine directly upon its eyes either sleeping or waking.

Does this outing do the baby any good? The fresh air renews and purifies the blood, and this is just as necessary for its health and growth as proper food.

How does it show in the baby? The appetite is good, also the digestion. The child sleeps better and all signs of health are seen.

Is it better for the baby to be carried by the nurse in this airing? No, for it can be made more comfortable in its carriage and as well protected from exposure.

Is there any objection to a baby sleeping out of doors in the daytime? No, it needs only to be kept warm and out of draughts. A covered inclosed porch is a good place.

What can be done for a child that takes cold easily? The room should be kept cool when it sleeps, the clothing should be light so that he will not perspire so freely. Every morning the chest and back should be sponged with cold water, 50 to 60 degrees F.

How should such a sponge bath be given? The child should stand in a tub containing a little warm water, and a large bath sponge filled with cold water should be squeezed over the body two or three times. Follow this with vigorous rubbing with a towel until the skin shows quite red. This may be given at least at three years old. For infants the temperature should be 65 to 70 degrees F.



WEIGHING BABY FREQUENTLY.

Why is it necessary to weigh the baby regularly? To be able to tell how it is doing. This is especially necessary during the first year.

How frequently should this be done? During the first six months every week, and during the last six months at least once in two weeks; once a month during the second year.

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How rapidly should the baby' gain weight during the first year? During the first week it loses a few ounces, after this it shows a gain of four to eight ounces a week up to the sixth month, then two to four ounces a week, up to the twelfth month.

Do bottle-fed infants gain so rapidly? Very seldom during the first month, but after that with favorable air and circumstances, the gain is quite regular, and they may gain faster during the latter part of the first year, because the nursing baby loses weight at weaning time.

Why do they not gain so rapidly at first? Because it takes a few weeks for the stomach to become accustomed to cow's milk and until this is accomplished it is necessary that the milk be made very weak or indigestion will result.

What is a baby's average weight at birth? Seven to seven and one-half pounds.

How much should it be at different months at this average birth? At three months it should be twelve to thirteen pounds; at six months fifteen to sixteen pounds; at nine months seventeen to eighteen pounds; at one year twenty to twenty-two pounds. A healthy baby will usually double its weight at five months and at twelve months it will nearly triple its weight.

Should a healthy baby gain steadily in weight during the first year? He usually does, but not regularly in every week during the year. There are periods when most infants do not gain any weight. This is most often seen from the seventh to the tenth month and frequently occurs when the child is teething and sometimes in the very hot weather.

Is gaining regularly in weight a sure sign that the child is thriving normally? Not always, some infants' foods produce weight, but not strength nor development in other respects.

Can the regular gaining in weight guide us as much in the second year? The gain after the first year is not so continuous; interruptions occur during change of seasons, sometimes without any apparent cause.

How soon should a child hold its head up? During the fourth, and sometimes in the third month, as a rule. If the body is supported the head can be held erect.

How early does a baby notice things? During the second month he shows pleasure by smiling and will turn his head in the direction of a sound. They should be kept quiet, or their sleep will be broken.

What will it do at three months? It will recognize its nurse or mother, and will smile and "coo" when she approaches, and now for the first time the tear glands become active and the baby cries with tears. At this age when taken out he should lie out straight in a heavy folded blanket, or hair pillow, having a small thin pillow under his head; a hot water bag should be near his feet; a light woolen blanket or afghan should be put into the carriage and the baby placed upon it, then it should be carefully wrapped around him and the outer carriage robe tucked in. These wraps should be modified according to the weather. Babies should not perspire much for they will take cold readily; so the covering should not be too heavy.

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When does the baby laugh aloud? From the third to the fifth month.

When does it first notice toys, etc.? From the fifth to the seventh month. At four months he is able to hold his head without support. He begins to use his hands better. He will often grasp an attractive object; he will throw it on the floor and expect it to be picked up for him. And also frequently shows signs of fear at the end of the fourth month, and strangers will scare him. He can now be played with for a little time every day, but never before bedtime. The best time is after the morning nap. Do not toss him about, but be gentle with him or you will make him nervous and sleepless at night.

What is baby's condition at the fifth month? He is now a bright lively fellow, and may sit in a half upright position in his carriage or in his chair for a short time each day. When in his chair he should be tied in, a soft pad or pillow should be at his back to support him. He now enjoys exercise on a bed or in a large clothes basket, and may even have one toy at a time to play with. Do not shake rattles at him. It tires him. His naps now grow shorter gradually, but he should take two daily; a long one of two or three hours in the morning and about one hour in the afternoon. He should not sleep late in the afternoon, or he will not sleep as well at night. He now "drools." This is a sign of teeth coming, and baby will bite his fingers and put everything he can hold in his mouth. He may form the sucking habit now, and if he does, put a small toy in his hand, or dip his thumb in a solution of quinine or aloes. The habit of thumb sucking is an ugly one. Another way to stop it is to bind a piece of cardboard on the arm and long enough to reach a little above or below the elbow. Then the arm cannot be bent.

Should the baby use an ivory or rubber ring to bite on when teething? A special cracker is now made in the form of a ring; it is quite hard and composed mostly of malt sugar and is intended for teething babies to bite on.

MOTHERS' REMEDIES.-1. Teething, What One Quebec Mother did for.—"Rub paregoric on the gums. This always eased my children."

2. Teething, Novel Canadian Method to Aid in.—"Put a thimble on your finger and when holding the baby rub his gums gently with it, and let him chew on it. This cuts the gums and starts bleeding when the baby doesn't think of it."

How early should a baby be able to sit and stand alone? At seven to eight months he is usually able to sit erect and support his body. He first attempts to bear the weight upon his feet at nine to ten months, and at eleven to twelve months babies can stand without assistance.

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When should a child walk without help? At twelve to thirteen months he attempts to walk. At fifteen to sixteen months the average child is able to run alone.

What conditions postpone this? Premature birth, a delicate constitution, or prolonged illness and especially chronic or digestive disturbances. Rickets is a common sign of late sitting, standing or walking.

Should you urge a child to walk? No; his muscles and bones may not be ready. He will walk soon enough if able.

How early does a child begin to talk? Generally a child can say papa and mamma at one year. The end of the second year the average child is able to put words together in short sentences.

If a child does not attempt to talk in two years, what should be suspected? Child may be a deaf-mute or mentally deficient. It is sometimes seen in children who are very backward.



SPECIAL CARE OF THE BABY.

Baby will be sensitive to light, even the first day. Do not allow the sun to shine in his eyes, or gas or electric light if that must be used. The baby's skin may change to yellow for a few days, but this soon passes away and frequently there is scaling. The fine soft hair usually comes out and is replaced later by a second growth. The open spot on the head should not be touched. When the head is out of shape or is swollen, this need not cause worry for it will soon disappear. Mold it a little. Do not allow the baby to lie in one position, as the soft skull may become flattened or all the hair rubbed off in one place. The baby sleeps about nine-tenths of the time, but he should be wakened regularly for his food and kept awake while taking it. This will soon become a regular habit to him, and he will wake of his own accord in a short time. Do not allow the baby to fall asleep nursing at the breast or while taking food in his bottle. He will not get enough nourishment and will want to nurse too often. Also if he is bottle-fed the milk is apt to grow cold and cause colic. He should be taught to nurse slowly and if he tries to nurse too fast the breast or nipple should be taken away for a minute, and then given again. The baby should nurse from fifteen to twenty minutes. A certain amount of crying is necessary for a baby if he is to be strong and healthy. It exercises his lungs. "Soothing syrup" should never be given to quiet him.

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THE CRY-HOW TO DISTINGUISH IT.

The cry of pain is strong, sharp, but not continuous, often accompanied by contractions of the features and drawing up of the legs. The cry of hunger is a continuous, fretful sound, after feeding or sometime before the next feeding. The cry of temper is loud and strong, accompanied by kicking or stiffening of the body, and, this should never be given away to from the first. The cry of a sick child is feeble and whining. Baby should not be rocked to sleep, nor carried about the room.

Baby's First Meal.—He should be placed to the breast as soon as the mother can have him. He will not get much milk for the first few days, but he should be given the breast four or five times daily. He needs what is then secreted and it is also good for the mother to try to nurse as soon as possible. The baby may be given a few teaspoonfuls of boiled water between nursing, but no teas. At the third day the milk is usually established, and the baby should nurse regularly every two hours up to 10 p. m., and twice at night. He should not sleep in his mother's bed, but have his own crib and be taken to her at nursing time. There is danger of baby being smothered sleeping with its mother, and it will not sleep so well. As a rule it is best to wash baby's mouth out before nursing, and the mother's nipple should also be wiped off with a little boric acid solution.

Baby's Bed.—As before stated, baby should sleep in his own crib, an iron or brass crib without rockers is best. A screen or plain white curtain of some wash material may be used to protect him against draughts. If this cannot be had, he may sleep while very young in a large clothes basket placed on two chairs. The crib should have a good woven wire mattress and a pair of heavy airing blankets should be placed on top of the crib, folded so as to fit the mattress; a square of rubber or any waterproof material should come next, then a cotton sheet, a quilted pad, a second sheet, a pair of wool crib blankets and a light counterpane. This should be removed at night and a comfortable afghan be used in its place. The pillow should be of hair, never of feathers or down, about one inch thick. The bed clothes should be aired thoroughly and the heavy airing blanket be washed occasionally and thoroughly dried and aired before it is again used. The blanket can hang on a line out of doors on a bright sunny day for an hour or two; in this way the blanket will be kept cleaner and will last comfortably until baby is three years old. The baby should never be put in a cold bed; warm the sheets before the fire just before putting baby in his bed (or crib) or place a hot water bag between them until they are warm. Now (second month) the baby is old enough to use his chair, not to soil his napkin. Place a small chamber on the mother's lap and hold the child on it, supporting his head and back. Do this exactly the same hours every day, morning and afternoon, directly after a meal. This training should be continued, as the position alone often goes a great way in helping to over-come constipation or any tendency to irregularity of the bowels that may exist. They cannot be taught not to wet the napkin until they are some months older.

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The baby needs water as much as any adult person. Boil a fresh supply daily and cool and keep it in a covered dish or bottle. A little,—four to eight teaspoonfuls,—should be offered to the baby between each meal. It can be given from a spoon, a medicine dropper, or taken from a nursing bottle, and either hot or cold. This aids in overcoming constipation and teaches a breast-fed baby to use a nursing bottle, which will be of much benefit should sudden weaning be necessary.

During the second month his meals should be given every two and one-half hours during the day, having eight meals in twenty-four hours of three to four ounces at each meal. At night he should be fed at ten and two.

Meals for the Third Month.—Baby should be regularly nursed or fed every three hours up to ten p. m. Then have one meal at two or three a. m., and nothing more until seven a. m. If bottle fed he should be given three and one-half to four ounces at each feeding.

Fourth Month.—If the mother is nursing her baby, it is a good plan now to teach him how to use the bottle. Some doctors advise one bottle feeding each day from the start, for, should the mother's milk suddenly fail, or should she be obliged to stop nursing for any reason, there will be no struggle, which would be very hard for the baby if it happened in hot weather. Also the gradual accustoming of the digestive organs to the cow's milk before weaning must be commenced and does away in some degree, at least, with the danger from indigestion from the cow's milk given regularly.

Fifth Month.—Night feeding should now be discontinued; he should be taught to sleep from ten p. m. to seven a. m. There may be a few nights of crying and a struggle when the night feeding is first stopped, but he will soon learn to sleep without waking for his meal. He should be fed every three hours until ten p. m., and if bottle fed he should be given five to six and one-half ounces at each meal, making six meals in twenty-four hours.

Sixth Month.—The baby sleeps about two-thirds of the time. He shows signs of increasing intelligence. The baby should now accustom itself to taking either condensed milk or only the best prepared foods once or twice daily. The mother may become ill or unable to nurse for some reason, or wish to take a journey, etc., and baby is then prepared for emergencies.

When the baby is seven months old he will need more exercise than a clothes basket will afford. An exercise pen should be made.

Teeth.—As soon as the teeth come they should be kept clean, otherwise they will decay, milk is likely to remain in the mouth, turn sour and gradually destroy the enamel of the teeth.

With a soft linen cloth or a piece of absorbent cotton dipped in a solution of boric acid wash out the mouth and teeth, twice a day at least, carefully. A soft brush may be used later when baby has eight or ten teeth, and a little finely prepared chalk may be put on the brush, if there are any specks on the teeth. The baby should have three meals in twenty-four hours of six or seven ounces at each meal, if bottle-fed.

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Eighth Month.—Baby should be allowed to creep on the floor a little or in his pen. It is good exercise and it will benefit him, but he should not be urged to do it. Many mothers give baby potato, etc., at this period; this is bad, as potato is hard to digest on account of having so much starch. Bread and cakes are also prohibited; convulsions are often caused by such food. Milk gruel and broths are enough for the baby and he will thrive using them. Baby should feed every three hours up to ten p. m., six and one-half to seven and one-half ounces at each meal.

Mosquito Bites.—If baby is bitten by mosquitoes wash the spot off with a little camphor water, soda water, or a wet compress of witch-hazel should be kept on the bite or boracic acid or soda solution. Keep the baby from scratching the part by fixing his hands; scratching will further poison the part.

Flies.—They often carry germs of disease on their legs and wings, and they frequently light on baby's mouth or on the nipple of the nursing bottle. Diseases can be contracted in this way. The windows should be screened. Everything that the fly has touched should be washed with some light antiseptic solution.

Ninth Month.—His long morning nap should be encouraged and he should sleep in the early afternoon. If the baby is heavy his little moccasin or kid shoes will not now support his ankles and he should have a shoe with a piece of stiffening at the side. The shoe should have no heels; laced shoes fit better and should be preferred. The baby (bottle-fed) can take seven to eight ounces of the proper food every three hours until ten p. m.