When the egg falls out of the ovary it falls into the tube which carries it into the womb. This tube you will remember is called the fallopian tube. The ovule or egg is now in the cavity of the womb where we will leave it for the present.

THE FUNCTION OF THE WOMB.—While these changes are going on in the ovary, the womb is also preparing itself for its share of the work. The lining or internal surface of the womb is composed of mucous membrane, much the same as the interior lining of the mouth and throat. This lining becomes congested with blood, and is so intensely swollen at the time when the ovule or egg reaches the womb, that it is ready to rupture and bleed all over its surface. Just whether it will rupture and bleed, depends upon whether the egg is going to grow into a child or not. If it is not going to grow into a child, it immediately bleeds freely, and continues to bleed, until the whole lining of the womb and egg is passed out into the outer world. This takes four or five days and constitutes "menstruation." After menstruation is over, the womb begins again to prepare itself for the coming of the next ovule or egg, and as this occurs every twenty-eight days, menstruation is commonly termed the "monthly periods."

WHY MENSTRUATION OCCURS EVERY TWENTY-EIGHT DAYS.—The reason why the womb does this every twenty-eight days is because it is impossible to tell just when the womb will be called upon to nourish and support a child. If it did not get rid of the old blood, it would not be in a healthy condition to nourish and take care of a baby, nor would its interior be ready to supply new fresh blood for the growth of the infant. Hence nature constructs and builds a new "nest" in the interior of the womb each month. It very much resembles the new home into which the bride and groom, go to begin housekeeping.

When you told your little girl the story of life, you particularly drew her attention to the important fact that every living thing is created by the union of a male and female principle, and, therefore, has a mamma and papa. This applies to trees, flowers, vegetables, fish, animals, birds, insects,—every living thing, including human beings. We have seen that the ovule from the ovary is the female egg, or principle. It is the part the female contributes toward the future child. Before a child is possible, however, the ovule must meet the egg from the male.

THE MALE OR PAPA EGG.—The male or papa egg is called a "spermatozoa." It reaches the interior of the womb through the lower opening, which you will remember opens into the vagina. Emphasize to your daughter that the female ovule or egg, and the male egg, or spermatozoa, are minute objects, so microscopically small that a hundred million of them could comfortably lie upon a ten-cent piece.

THE FUNCTION OF THE SPERMATOZOA.—God gave the male spermatozoa the power to move. To watch them under the microscope you would imagine you were looking into a bowl of water, in which there were hundreds of little fish all squirming around. But the most wonderful thing about them is, they can only move in an upward direction,—they seemingly cannot move downward, or sideways. If you think for a moment you will understand why God gave them this marvelous property. When the male semen is deposited in the female vagina, there are thousands of these minute, living, moving spermatozoa in it. The womb is above the vagina, and the female egg is in the womb, consequently, to reach this egg, the spermatozoa must travel upward. To travel in any other direction would be fruitless energy. There is only one female egg, but there are thousands of male eggs, or spermatozoa; it is easy, therefore, to comprehend how one of these spermatozoa should exactly be in line with the female egg in its upward path, since there are so many of them. It is only necessary that one should meet the female egg in order to impregnate it.

The shape of the male principle, or spermatozoa, is exactly like a little tadpole, and you no doubt recall that a tadpole has a minute tail, the movement of which enables it to swim around. So has the spermatozoa, and by the incessant movement of this microscopic tail they all move upward as soon as discharged by the male. I told you that God gave the male-germ life. It is necessary now to explain the character of this life. It is very brief; it is estimated that they are active for two hours, and then become inactive, or die. The best way to explain the brief activity to your daughter, is to liken the spermatozoa, to a mechanical toy, which is wound up to go for a certain time. After it runs out it becomes inactive; this is exactly what happens to the little human tadpole. If during this brief life none of them has happened to reach the female egg, pregnancy does not take place and menstruation occurs. On the other hand, if this were not so,—if these spermatozoa were active for a longer period, pregnancy would almost be certain to take place every time the womb was not already occupied with a pregnancy.

TELL THE WHOLE STORY.—When a mother reaches this stage of the wondrous tale she will be asked by an innocent girl,—"How do these spermatozoa get there?" or, "You have not told me where these tadpoles came from" or, "I don't understand how these spermatozoa got into the vagina" or, "I don't know why you call these the male egg when they are in mamma." It does not matter how it is expressed, the intent is plain enough. I have said, that an innocent girl will ask this question, the implication being that one who is not innocent will refrain from asking this question. A girl who knows the answer will not ask, because, if she is familiar with this subject before her mother thinks it wise and proper to tell her, she obtained her information from a source which, most likely, insinuated a suggestive, or evil, meaning into the explanation, consequently she would be afraid, or ashamed, to ask the question. An innocent girl, on the other hand, would rightly ask for information which is obviously kept back, and which she has a right to know, since a complete, and intelligent understanding of the story depends upon the elucidation asked. If it is proper to tell part of the story, it is essential to tell all of it. Tell it in your own words in this way:

When God conceived the human race He ensured its perpetuation by designing a method whereby this would be rendered possible: He did more; He wisely decided that the function, involving the very existence of the human race, should be attended with a sentient gratification. He further instilled into the fundamental economy of mankind, sex attraction, which is involuntary, undeniable, and unquenchable. If God conceived the means and the method, no human mind in possession of its faculties should see evil where it does not exist. It was by Him designed that the male organ of reproduction should deposit its germinating fluid in the vagina of the female, and this is accomplished by a union of species.

The one set of reproductive organs is a complement of the other, and essential to the other. It is by this act that the male spermatozoa is enabled to complete the function of fecundation.

If now we assume the male and female element to have met and united, menstruation does not take place. The egg or embryo (the future child) begins to grow, and it remains in the womb for two hundred and eighty days from the day when the male and female egg met. It is quite natural for an intelligent girl to ask her mother to explain, "How a baby can live in there for such a long time," or "What makes it grow if it does not get anything to eat or drink."

HOW THE BABY GETS ITS NOURISHMENT IN THE WOMB.—These questions can be answered in this way. While the baby is in its little comfortable home it gets everything it needs. You are in your home now. If you wanted a drink, what would you do? Wouldn't you go to the water faucet and draw a glass of water? The water comes to you through a pipe, right into your home, you don't have to go out of the house to get it. And if you wanted light when it is dark you would turn on the gas and light it. It, too, comes into your home through a pipe. Now baby gets its air; and food, and all it needs to drink in just that way. There are two little pipes which go into its nest or home, and then into the baby's body at the navel, and through these pipes fresh blood runs in and out. When mother breathes, her blood sucks up oxygen from the air in her lungs, and the blood carries oxygen to every part of her body. In this way, all parts are supplied with the proper quantity of air. Now the baby is simply a new part of mamma as long as it is in its nest in her body, so it too gets air in this way. When mother eats, the food is taken into her stomach and it is there changed into liquid and so prepared, that when it passes into the intestines, the part of the food that is good for her, is sucked up into the blood, and the blood carries it to every part of her body. It distributes whatever is needed to all parts, and as the baby is a part, it gets its share. The other pipe carries the blood back again, out of the baby for new supplies, and as this is going on all the time, there is no danger of the baby starving in any way, or at any time.

When your daughter understands this, show her how important it is that mothers should be in good health, otherwise the baby will not get good food, it will not be properly nourished and will be born a poor, little sickly child. Little girls, consequently, should try to eat properly, exercise regularly, and do everything their mothers tell them, so that when they become mothers, they will be able to nourish their babies and not bring into the world poor little starved infants.

GIRLS MUST NOT BECOME MOTHERS.—We have previously stated that girls can become mothers when they have reached the age of puberty. God did not intend, however, that girls at the age of twelve or fourteen should become mothers, because their bodies are not strong enough, nor are they fully grown, nor have they the experience, to undertake the physical task and responsibility of bringing a baby into the world. We know this from experience, because we have seen the sickly babies such girls have, and we have seen how much these girl mothers suffer, and how they ruin their health, by trying to do what God did not intend they should do. Even the trees teach us this lesson. An orange tree will bring out buds, which would develop into oranges, when it is two years old. The experienced farmer, however, will pluck these buds off, and will do so every year, till the tree is five years old. If he allowed the tree to bear fruit during its young years, the oranges would not be good, or sweet, or large; so he waits until the tree has grown and is strong and healthy, when its fruit will be large and sweet. An orange tree of this type will have better fruit, and will continue to produce this good variety for many years. A tree allowed to bear fruit when two years old will never have first class oranges, nor will it continue to have, even poor oranges, as long as the other.



CHAPTER XV

PREPARING FOR MOTHERHOOD

Menstruation—Irregular Menstruation—Changes in the Quantity of the Flow—How the Womb is Held in Place—Symptoms of Menstruation—Menstruation Should Not be Accompanied with Pain—Don't Give Your Daughters Patent Medicines or "Female Regulators"—Take Your Daughter to the Doctor—Leucorrhea in Girls—Bathing when Menstruating—Constipation and Displaced Wombs—Dress and Menstruation—Absence of Menstruation, or Amenorrhea—Treatment of Amenorrhea—Painful Menstruation, or Dysmenorrhea—Causes of Dysmenorrhea—Treatment of Dysmenorrhea—Sterility in the Female—Conditions Which Affect the Fertility of Women—Climate—Station in Life—Season of the Year—Age—The Tendency to Miscarry—Causes of Sterility in the Female—Displacement of Womb—Diseases of Womb, Ovaries, or Tubes—Malformations—Lacerations—Tumors—Leucorrhea—Physical Debility—Obesity—Special Poisons—"Knack of Miscarrying"—Miscarriage—Cause of Miscarriage—The Course and Symptoms of Miscarriage—What to do when a Miscarriage is Threatened—Treatment of Threatened Miscarriage—Treatment of Inevitable Miscarriage—After Treatment of Miscarriage—The Tendency to Miscarriage.

MENSTRUATION

We have explained in the previous chapter what menstruation is, its frequency, its significance and its origin. There are a number of its common characteristics with which the mother and daughter should be acquainted.

IRREGULAR MENSTRUATION.—Menstruation may occur once (the first time) and fail to recur the following month or for a number of months. This need cause no alarm as long as the general health remains good. It will come again in its own time. Nervousness may cause a suspension of menstruation. This is quite common in school girls who are driven too hard at school, whose sleep is interfered with, whose appetite is poor and who are allowed too many social indiscretions, as parties, dances, etc., where late hours are observed, all of which should be put aside until school life is over. Sometimes menstruation will temporarily stop if the girl goes away from home on a visit.

Sometimes the quantity will be greater than at other times, and a very scant flow, after it has been free and regular may cause apprehension. Various causes may be responsible for a decrease, catching cold, sitting on cold steps or cold ground, wearing damp clothes, nervousness, mental worry, physical exhaustion, insufficient food and exercise, and anemia, may cause it. For these reasons a girl should be exceedingly careful of her health, she should guard against catching cold. Do not change the underwear until certain that the weather is far enough advanced in season to justify such a change. She should not become exhausted or worry. In all cases of suppression, or of increased flow, a physician should be consulted at once, and girls should be instructed to tell their mothers of any change in the character of the "periods," as soon as it occurs. Mothers should instruct their daughters to rest the first day of their monthly flow, and all during the menstruation they should refrain from any unusual activity. Even play should be moderated and abstained from entirely if there is any pain. In order that the girl fully appreciates why these rules are laid down, it is advisable to explain just how the womb is held in place in her body.

This appears to the writer as being a particular important point. A girl must not be expected to give these matters the serious consideration they merit unless she thoroughly understands the reasons why. An explanation, in the form of even an intelligent talk, will soon be forgotten. If, however, a definite, concrete picture, is impressed upon her; if she actually sees in her mind the process that is going on, she will understand why it is necessary to do as she is told. If the mother will therefore assure herself that the daughter actually knows what is being accomplished in her womb at the menstrual period, she will carry out the instructions more faithfully.

HOW THE WOMB IS HELD IN PLACE.—The human uterus, or womb, is held in its proper place in much the same way as a clothes pin sits on a clothes line. The heavier part is the upper part, and that part is held in place partly by resting on the rectum behind, and the bladder in front. When menstruation occurs, the body of the womb becomes much heavier because of the increased amount of blood in its interior. This added weight increases its liability to tip over, and if any extra strain or effort is made at this time it will become tipped, or as the physician calls it, displaced. If a womb becomes displaced, every menstruation afterward will be painful and prolonged,—sometimes excessively so. A displaced womb becomes congested and unhealthy. It causes leucorrhea or a chronic discharge, makes a nervous wreck of the woman, results in sterility and frequently in a dangerous operation. There are, therefore, ample reasons for watchfulness and care on the part of the growing girl.

SYMPTOMS OF MENSTRUATION.—After menstruation is established there should be no actual pain at each period. There are, however, certain undefined feelings,—premonitory symptoms,—which may be explained in the following terms:—A day or two before the date on which the menstruation is expected, the girl will appreciate that "her sickness" is coming. She will not, or should not, complain of pain, but will state that she has a bearing down feeling, is a little more nervous than usual, has no desire to go into company, and wants to be more or less her own entertainer. The "sick" period usually lasts four or five days. The second day is the most important.

MENSTRUATION SHOULD NOT BE ACCOMPANIED WITH PAIN.—If any actual pain accompanies menstruation, either before or after it is established, the mother should at once take the daughter to the family physician. Menstruation is a natural, physiological act and should not be accompanied with actual distress or pain. It is astonishing how many mothers will allow their daughters to suffer needlessly, for months and years, because of the mistaken idea that "since the pain is there, it must be," or because she—the mother—suffered, so also must the daughter suffer. There is no more unfortunate mistake, and many a girl's health and happiness has been blasted because of this misbelief. The cause of the pain is, in a vast majority of the cases, a very simple one, and can be removed in a very brief time.

Should the menstrual period last too long, be too frequent, or be in any way not what it should be, consult your physician. If you are not sure of "what it should be," or if you have any doubt, ask your doctor. Don't let any false pride or feeling of modesty on your part, or on the part of your daughter, dictate your policy under such circumstances. Don't take the advice of your friends or neighbors in a matter so vital. It is too important, and they are not qualified to "guess" any more than you are. Don't, if you have any respect for yourself, or love for your child, begin dosing her with the advertised patent medicines and "Female Regulators" for which so much is claimed, and which seem to "just suit" your daughter's case at this particular time. Take her to the doctor, whose advice you value (or you should not have him as a family physician), who has no interest at stake except to help you and your child, and whose fee is no more than the price of one of these bottles of advertised poison. He is the only one qualified to speak with authority on such a momentous subject, and you will never spend a dollar to better advantage. Warn your daughter not to speak about "her sickness" to other girls.

Especial attention should be paid to cleanliness during this period. The mistaken idea that bathing of any kind at this time may have disastrous consequences is responsible for much of this neglect. If proper care is taken warm sponge baths, in a warm room, will not cause any trouble. Unpleasant odors can be avoided by sponging the parts with a warm solution, into which a mild antiseptic is put, upon changing the cloths.

LEUCORRHEA IN GIRLS.—It has been stated above that a displaced womb may cause leucorrhea or a discharge. It must be remembered that leucorrhea, or "whites," may occur in girls as well as in married women. It can also result from catching cold during the menstrual period. Another mistaken idea is that girls should not take douches for fear of injuring the hymen. This is erroneous, and while they are entirely unnecessary in a vast majority of cases it is sometimes absolutely essential to douche in order to cure leucorrhea. When they are given, it is advisable to use the small nozzle that comes with every douche bag set.

CONSTIPATION AND DISPLACED WOMBS.—When the picture is fresh in the mind of the girl, of how the womb is held upright in her body, the mother should speak to her about the serious results that may occur from constipation. If the rectum is full of hardened feces the womb will be pushed out of place, and if under these circumstances straining is necessary to empty the bowel, and if this condition is habitual, constipation may be the actual cause of displacement of the womb.

DRESS AND MENSTRUATION.—It is also an opportune time to demonstrate to what extent serious results may follow mistakes in dressing. The habit of permitting growing girls to constrict the waist, to bind and pull the abdomen by too tight garters, or too tight corset, is wrong, and no mother should permit it. In another part of the book, this matter is taken up more fully, but if it is explained to the girl while she is considering the subject of menstruation, she may more quickly and more fully appreciate its significance.

ABSENCE OF MENSTRUATION—AMENORRHEA.—The absence of menstruation after it has been established, does not, as a rule, indicate any disease of the womb or female sexual organs. It is to be regarded merely as a symptom and can be, as previously stated, safely ignored if the general health is good. If the general condition is poor, and the quantity and quality of the blood deficient, it is a provision of nature to suppress menstruation in the interest of the general health. For this reason it is safe to disregard the amenorrhea and build up the bodily strength. This explains why some girls pass the usual age of puberty and show no signs of menstruating. They are poorly developed sexually, through deficiency of blood. If, on the other hand, a girl should have all the symptoms of menstruation every month, but no flow, she should be examined by a physician to determine if there is any obstruction to the escape of blood. Total absence of any symptoms of menstruation extending into adult life, may indicate an absence of the sexual organs. During the first year after puberty it is quite natural for menstruation to be irregular; after the function is thoroughly established there are many causes that may be responsible for its temporary absence.

CAUSES OF AMENORRHEA.—Any condition or circumstance which reduces the general health or impoverishes the quality or quantity of the blood and weakens the nervous system, will result in a stoppage of the monthly periods. Among these are insufficient food and exercise, overwork, overstudy, exposure to cold, sitting on cold steps or gold ground, wearing damp clothes, bathing in cold water at the beginning of menstruation, powerful emotions, as great fright, anger, anxiety; acute diseases, such as typhoid fever, cholera, the infectious skin diseases; chronic diseases such as Bright's disease, heart disease, consumption; anemia and chlorosis are very common causes. Obesity or an overfat condition will cause an early suppression of the menses which may result in a fruitless marriage. Displacement of the womb and other local disorders frequently result in scanty or delayed menstruation. Anxiety lest pregnancy may occur in the newly married may cause a delay in the periods. A radical change of climate or sometimes a visit to the country, or changed circumstances may stop the flow for the time being.

TREATMENT.—The treatment of amenorrhea, or absence of menstruation, will depend on the underlying cause. A careful investigation should be made into the mode of life and the hygienic surroundings of the patient. Her general health and her mental condition should be inquired into. If the patient is not in good health, or is not obtaining exercise in the open air, or if she is a victim of mental worry or of domestic unhappiness, or if any sufficient cause exists for the amenorrhea it must be removed before any treatment may be expected to relieve the condition. If the patient is a married woman the possibility of pregnancy should always be borne in mind, and no radical treatment instituted until this has been excluded. If the absence of menstruation is dependent upon defective development of the sexual organs we cannot expect much from any treatment. The amenorrhea from exhaustive diseases will usually correct itself with, or soon after, the establishment of convalescence. In diseases which tend to death, as in consumption, heart disease, etc., the function is never reestablished. A very common habit of most people is to regard the absence of the monthly periods as the cause of their ill health. It is not, it is the result of the ill health. Get rid of the bad health and the menses will take care of themselves. That form of amenorrhea which is the result of change of climate or surroundings will regulate itself as soon as the victim becomes acclimated or reconciled to the change, or returns home if the visit is of brief duration.

As a general routine treatment, good wholesome food, regular hours, fresh air, sunlight, and judicious exercise, with such other measures as may be suggested by the condition of the blood and nervous system, are the indications in the way of treatment. Anemia and chlorosis (poor blood) should be treated by the administration of iron in some form. Obesity should be reduced by diet, exercise, and such other treatment as may be found efficient and not detrimental to health. Overwork, mental and physical, should be stopped, and sedentary habits changed to a more active out-door life. The acute suppression from exposure to cold, wearing of damp clothes, sitting on cold stones or cold or damp ground, sea bathing in very cold water, is very often associated with an acute inflammation of the womb itself and calls for rest in bed, laxatives to open the bowel, hot application to the lower part of the abdomen and a teaspoonful of Hayden's Viburnum in a glass of hot water every four hours until relieved. The use of the sitz bath is frequently successful if taken at night followed by a laxative and a hot drink.

PAINFUL MENSTRUATION—DYSMENORRHEA.—Most, if not all, victims of painful menstruation are of a nervous temperament. Dysmenorrhea is simply one symptom of the general nervous condition. The nervousness may be acquired or it may be the result of heredity. In girls it has been found to be an accompaniment of the overwork and worry of school and student life. Girls who suffer greatly from it while in school are entirely free during vacation from school.

There is a type of painful menstruation known as neuralgic dysmenorrhea. This is simply a local expression of a general neuralgic tendency. It comes under conditions which favor neuralgias in other parts of the body. Girls and women affected with this type of dysmenorrhea are often anemic, hysterical, and not infrequently the victims of malaria, rheumatism, or other diseases which tend to impoverish the blood and reduce nerve vitality. The pain resembles neuralgia elsewhere. It comes and goes, it may last a brief time or a long time, it may be very mild or very severe. The pain bears no fixed relation to the flow, it may proceed, accompany or follow it.

Mechanical dysmenorrhea is that form in which a mechanical impediment exists to the escape of the menstrual fluid. The internal canal may be too small, displacement, growths, either inside or out of the womb, faulty development, or frequently simple congestion will act as an obstruction and cause pain from tension. The pain accompanying mechanical dysmenorrhea is very different from the neuralgic type. It comes on gradually, increases slowly until it is very severe and stops suddenly. A gush of blood from the womb announces the fact that the obstruction has been overcome and the womb has emptied itself; as soon as this occurs the pain ceases.

In the mechanical variety there are frequently clots in the menstrual flow. Inasmuch as this type may be caused by imperfect development of the womb, it is common to find that pain has characterized the monthly periods from the time of the first menstruation. It may, however, as stated above, be caused by growths which had their beginning at a later period.

TREATMENT.—For the neuralgic variety the treatment should be general. The whole object is to build up the general health. Fresh air, sunlight, out-door exercise, plain, substantial food, regular hours, pleasant surroundings, and such medication as may be indicated, should be the course to follow. The bowels should be kept regular and digestion aided in every way possible, if necessary by rest from school, or work, or by a change of air and scene. If the patient is inclined to malaria she must take quinine and live in a locality free from that tendency. If rheumatic she should take the remedies advised in that disease and avoid colds, wet clothes, or sitting in cold, badly ventilated rooms, churches or theatres. If there are no distinct evidences of special tendencies, general tonics may be given to advantage. These should consist chiefly of iron, arsenic, phosphous, nux vomica, cod liver oil, etc.

The treatment of mechanical dysmenorrhea of course implies removal of the cause. As this necessitates operative procedure, or at least an examination by a physician, it is best left in his hands.

STERILITY

Sterility means the inability to become a parent. A woman who is sterile cannot become a mother. She is for some reason unable to have a baby.

A childless union is frequently the cause of much unhappiness. There is something lacking in the expression "a childless home." It seems a paradox, as home is inherently associated with children and happiness. It has been stated that one out of every eight marriages is barren. The average time which elapses after marriage and the birth of the first child is seventeen months. Physicians agree that if a woman goes over three years after marriage without having a baby her chances of having one are small. If children are desired, and they usually are by childless parents, every effort should be made within the first three years to ascertain the cause of the sterility, and if it can be rectified. The barrenness may be dependent upon some physical defect which will quickly respond to the proper medical treatment. It is well to remember, however, that the defect is not always the woman's. In every six childless marriages about one is due to sterility in the husband. The age of the greatest fertility in women is between twenty and twenty-four years. It is rare to find a barren woman between these years. Nature evidently intended that the duties of maternity should be assumed between the twenty and twenty-fourth year. If married before the age of twenty the statistics prove that barrenness exists in one woman in every twelve. If married after the twenty-fourth year the chances of having children decreases with the age of the woman.

If a mother goes for three consecutive years without becoming pregnant the chances are that she will have no more children. Consequently if other children are desired it is unsafe to rest upon the assumption that a woman will again be a mother simply because she has been one in the past. Many conditions could, and may, have occurred since the last pregnancy (and may be as a result of that pregnancy) to change her natural fertility into a condition of temporary sterility. An examination should therefore be made before too long an interval elapses and the facts learned. It will usually be found in such cases that a displacement or laceration, or at most, some cause easily remedied is immediately responsible for the apparent barrenness.

CONDITIONS WHICH AFFECT THE FERTILITY OF WOMEN

CLIMATE.—It is a well-known fact that more children are born in southern regions than in northern countries. It may be asserted, therefore, that climate affects the fertility of the race.

STATION IN LIFE.—Children are more numerous among the poor than among those who are wealthy and enjoy the luxury of riches. This condition cannot, however, be construed as a true expression of fertile efficiency. It is more a comparison of ethics, and when we express it thus we are giving it its most charitable name.

SEASON OF THE YEAR.—The spring of the year, being more favorable to fecundity, exerts an influence over the increase of population. Nursing mothers are as a rule sterile until after weaning time. This is not always so however, and the possibility of pregnancy taking place while nursing a baby, and before menstruation is reestablished must be reckoned with as it occurs quite frequently.

AGE.—Age may be said to affect the fertility of women inasmuch as sterility is the natural and proper condition before menstruation is established and after menstruation ceases.

THE TENDENCY TO MISCARRY.—Because a woman has never given birth to a living child is no proof that she is sterile. Many women have the ability to conceive but for some reason they have acquired the misfortune, or the "knack," of miscarrying. This is a condition of the gravest significance and will be considered at length in its proper place.

The influence of a temporary separation has had excellent results in a great many historical cases. Where the married couple seem to be lacking in some one or other of the emotional or temperamental qualifications, it is advisable to suggest a temporary separation. When this period has expired and they resume marital relationship the element of novelty, acting as a stimulus, quite frequently reestablishes a fertility that was seemingly suspended, or awakens it if conception has never previously taken place.

There are a great many cases on record where, conditions having remained the same, women have become fertile after years of seeming barrenness. It is impossible to explain, or to satisfactorily understand these cases. It is quite common to note cases in which women have never become pregnant until a number of years after marriage, even when the desire to have children existed. There is one case on record of a woman married at eighteen, but although both herself and her husband enjoyed habitual good health, conception did not take place until she was forty-eight years of age when she bore a healthy child. Women should not, therefore, become easily discouraged in the hope of having a baby, especially when they have a clean history, and a healthy body. The conditions may change and may become favorable when hope is about to die.

CAUSES OF STERILITY IN WOMEN

Inasmuch as it is necessary to consult a competent physician in all cases of sterility, it is not necessary to go into detail regarding each possible cause, other than to explain how each may produce barrenness. It will be observed that a competent physician is specified and advised in these cases. This is very important because many advertising, or "quack" doctors, particularly solicit these kind of cases. They are not competent to be trusted with such cases and will likely effect more harm than good. A woman should not hesitate to consult the best available medical authority if she is a victim of sterility. There is nothing to be ashamed of. It is a perfectly proper medical situation and should receive the best medical advice and investigation. The following are the more frequent causes of absolute sterility.

(A) Displacement of womb.

(B) Diseases of womb, ovaries or fallopian tubes.

(C) Malformations.

(D) Lacerations or tears of mouth of womb.

(E) Tumor.

(F) Leucorrhea.

(G) Physical debility.

(H) Special blood poisons.

(I) Great obesity.

(J) Anemia.

(K) Self-abuse.

(L) Habitual alcoholism.

(M) Lack of moderation in the marital relations.

(N) Certain diseases may be associated with barrenness: cancer, diabetes, consumption, Bright's disease, etc.

(O) Certain temperamental conditions may be associated with barrenness: lack of affinity, frigidity.

THE KNACK OF MISCARRYING

DISPLACEMENT OF WOMB.—In many instances the primary cause of the displaced womb was some energetic, muscular effort, made while the victim was yet a girl,—probably before menstruation began. Whatever act first caused a slight tilting of the womb, must necessarily have been an unusual physical effort, and as girls are getting more and more strenuous we may look for more trouble in this direction in the future. Inasmuch as a slight tilting of the womb gradually gets worse it is a reasonable expectation to believe that sterility is a natural sequence to displacement. The girl may have been the victim of painful menstruation which was neglected, because not quite painful enough to compel medical relief, which is sought for only as a last resource unfortunately under the circumstances. Intercourse may also have been more or less painful,—a condition which again is mistakenly and imprudently borne in silence and left to take care of itself. But when persistent sterility faces her, the woman seeks medical assistance and her trouble is discovered. As the displacement is found to be the cause of her sterility, its correction, which is a comparatively easy medical problem, not only cures the barrenness but happily relieves her of the menstrual distress and all other pain.

The treatment for displacement consist of placing medicated pieces of wool or cotton, called tampons, in the vagina in such a position as to hold the womb, as nearly in its proper place as is possible. After a time nature will so strengthen the ligaments that they will hold the womb and a cure is, therefore, affected. The length of time necessary to cure depends upon the length of time the displacement has existed. It may take, from two to four months. When the displacement is of long standing and is accompanied with more or less inflammation, adhesions sometimes grow between the womb and the adjacent organs. It is necessary to resort to surgery in such cases, but the result is always good and the danger practically nothing.

DISEASE OF THE WOMB, OVARIES OR FALLOPIAN TUBES.—Disease of the womb, ovaries, and fallopian tubes, which renders the victim sterile, is as a rule the direct result of infection. Such infection is conveyed by the husband to the wife. This is quite a common condition. The simple fact that such conditions exist leads us to hope that the time is not far distant when it will be compulsory for all participants in the marriage ceremony to submit to a thorough physical examination. By this means, and by this means only, will the innocent be protected. No one can conceive, unless he has been identified, as a physician, with one of the large metropolitan hospital clinics, of the extent of this class of disease, and of the frightful suffering caused, and innocent lives ruined, by infection conveyed in this way. It is a tragic corollary to the marriage vow "for better or for worse."

If a woman is fortunate enough to fall into the hands of an honorable physician, who will tactfully explain to her the serious significance of her condition and obtain her consent to treat her until she is cured, which in all probability will include a surgical operation, and will do so with diligence, without regard to the size of the bill, she will indeed be a lucky woman. It is from women who are suffering with such diseases,—most of them without the slightest idea of what ails them,—that the venders of advertised nostrums reap their fortunes, and it is from the same victims that most of the advertised medical "quacks" look for their blood-money. The great difficulty, however, lies in the failure of the woman to appreciate the seriousness of her condition, and as a consequence she fails to understands why it should take so long to cure her. She loses confidence in her physician, she buys certain "cures" recommended to her by Mrs. Busybody and later tries other physicians and ends by losing faith in herself. Meantime she grows worse and worse. There are thousands such. It may be here stated without fear of contradiction that if the public in general would repose more confidence in the medical profession, there would be much less suffering, much less sorrow, fewer regrets, fewer irresponsible "isms," and cults, because there would be fewer disappointed individuals to support them. If the medical profession would condescend to employ the tactics and devices of those questionable, fashionable agencies that claim the power to cure human suffering, it could quickly reap the profit and the laudation that it now escapes because it keeps the faith.

The way to be cured of any disease, if it is curable, is to engage a reputable physician and follow his instructions implicitly. Let him understand you expect him to see you through your trouble and let him know you have confidence in him. There isn't one physician in a thousand who will cheat you under these circumstances.

MALFORMATION.—Under this heading are all those cases of sterility resulting from imperfect generative organs. These are products of a failure on the part of nature to furnish or develop the structures participating in the propagation of the species. The entire generative organs are sometimes wanting. The womb may have failed for some reason to grow with the rest of the body, it remains (as it is known) as an "infantile womb." Occasionally the womb grows together, that is, it is solid instead of being a hollow organ. The mouth of the womb may be too small, representing what is called "a pin head opening." The natural opening is large enough to admit a lead pencil, a "pin head opening" would not be larger than the lead in the pencil. The latter condition is quite a common cause of sterility and is readily amenable to treatment. Most of the malformations which produce sterility are impossible to cure.

LACERATIONS OR TEARS IN MOUTH OF WOMB.—This subject is fully discussed on another page of this volume.

TUMOR.—A tumor may be so situated as to prevent conception, or it may involve the body of the womb constituting a reason in itself for sterility.

LEUCORRHEA.—Leucorrhea or "the whites" may be of such an acid character as to kill the spermatozoa in the vagina, or it may be of such volume as to render impregnation impossible. The treatment of this condition is discussed elsewhere.

PHYSICAL DEBILITY.—When the general health is bad, no matter from what cause, sterility usually exists. This lack of vitality may be due to chronic disease, or it may have been caused by a very severe acute illness, such as typhoid fever. One's mode of living, if unhygienic, may be responsible for continued bad health and a consequent sterility.

OBESITY.—Very fat women are usually barren. If a woman rapidly accumulates fat after marriage she as a rule does not have more than one or two children. Women often become stout immediately after the child bearing age ceases.

SPECIAL POISONS.—Certain special poisons in the blood cause sterility by producing miscarriage.

MISCARRIAGE

By the term "miscarriage" we mean that for some reason the progress of pregnancy has been interrupted and the fetus is expelled from the womb. A miscarriage or abortion (both terms meaning the same—the difference between the two terms is a technical one and need not concern us here) can occur any time after conception up to approximately the seventh month, when, if labor takes place, the child may be born alive. The condition would then be termed a premature labor. A miscarriage or abortion is an immature labor and implies an immature or dead child.

The condition is a serious one no matter whether it is attended with grave symptoms or apparently no symptoms. If it occurs shortly after conception, during the first few months of married life it is serious, if not in its physical consequences, it is in its significance, because it establishes the tendency to miscarry,—a tendency that may result in great mental distress because of the worry and fear it engenders, and of sorrow and heartache because it may blast the hope of parentage. Such a miscarriage may take place at once after conception. If so, the following menstruation may be delayed for a week or so and is then a little more profuse than is customary. This will be the only indication that a life has been sacrificed that the young wife may have, and frequently the significance of such an occurrence is never understood, yet the tendency to miscarry is nevertheless established, and a seeming sterility is apparently the fate of the woman. It is, therefore, of the greatest importance that extreme care should be taken to bring the first pregnancy to a successful consummation. A young wife should realize that she is apt to become pregnant at any time. Her conduct therefore should be such at least as not to harm the life principle with which she has been entrusted. To this end any excessive sexual activity should be strictly avoided.

CAUSES OF MISCARRIAGE.—Any strenuous physical effort must be guarded against. Included in such efforts may be the following: dancing, running, jumping, surf-bathing, sewing on a machine, sweeping, washing, house-cleaning, moving furniture, etc. Sometimes the primary cause of a miscarriage is to be found in some hygienic act, such as a hot bath, too prolonged or too many hot douches near the menstrual periods. A blow or a fall, even a fright or shock may cause a miscarriage. Anything that violently shakes or agitates the womb, which may at this time be irritable because of its condition, will be sufficient to excite it to contract and miscarry. Hence violent coughing or vomiting should be avoided if possible; horseback riding, jolting in a carriage, convulsions, hysterical crying, may also be the causative factors. Displacement of the womb by limiting its tendency to grow when pregnant, may cause it to miscarry. Very severe general diseases such as small-pox, pneumonia, etc., will cause the womb to empty itself. Disease of the fetus or the presence of syphilis in either of the parents will also have the same result.

THE COURSE AND SYMPTOMS OF MISCARRIAGE.—The cause of a miscarriage or abortion is much the same as an ordinary labor at term. Whatever interrupts the pregnancy causes the death of the fetus. The dead fetus acts as a foreign body and excites the womb to contract as it does during an ordinary confinement. The contractions open up the mouth of the womb and the fetus is expelled together with its membranes and after-birth. The significant and the most important symptom of a miscarriage or abortion is hemorrhage or bleeding from the privates. The flow of blood may not amount to much or it may be excessive and alarming; it may not be constant, it may come from time to time in the form of clots.

The next significant and important symptom of miscarriage or abortion is pain. The pain, like the flow of blood, may be only slight or it may be very severe, sometimes it is absent in very early miscarriage. As a rule the pain is severe when the miscarriage occurs after pregnancy has lasted for a number of months.

A miscarriage or abortion is said to be "complete" when the fetus with its membranes and after-birth is expelled clean and whole, or in other words when the womb empties itself completely. A miscarriage or abortion is said to be "incomplete" when some part of the embryo is left in the womb.

WHAT TO DO WHEN A MISCARRIAGE IS THREATENED.—When a woman, who is pregnant, begins to flow she should at once go to bed and keep perfectly quiet and send for a physician. A miscarriage is a treacherous condition and is so regarded by all medical men. It may not amount to much or it may, on the other hand, develop into a serious situation. The immediate danger is from hemorrhage; the ultimate or remote danger is sepsis or blood poisoning. The condition is one that can only be taken in charge by a qualified physician in whose hands we can safely leave the conduct of the case.

As a general rule it is quite safe to assert that a woman will not bleed enough at the beginning of a miscarriage to do any permanent harm. Consequently there is no occasion for unnecessary alarm. She must, however, as stated above, heed the warning and go to bed, keep perfectly quiet and send for a physician. If she fails to follow this advice it is quite possible that she may have a hemorrhage during the course of the miscarriage of a sufficiently serious character to endanger her life or from the effects of which she may suffer for the remainder of her life.

There is practically no danger during the course of or after a "complete" miscarriage. The danger which may ensue from an "incomplete" miscarriage is hemorrhage and a form of poisoning caused by the absorption into the system of putrifying products of the part of the dead embryo left in the womb.

There are a large number of cases of criminal abortion in which septic poisoning occurs caused by the utensils or instruments used in inducing the abortion. All of these cases are operative cases which must be attended to promptly to save life.

TREATMENT OF THREATENED MISCARRIAGE.—Not all of the cases of beginning miscarriage end in miscarriage. If the physician is sent for in time he can very frequently give directions that will, if carried out faithfully, avert the disaster. Success is more likely to attend those cases in which the trouble has been caused by some accidental injury, as a fall, or blow, or extra exertion. This is more especially the case if the woman has previously borne children, is healthy and in good condition and whose womb is known not to be diseased. In these cases there is a partial separation of the fetus from the wall of the womb, which causes the bleeding. The physician will direct that the woman be put to bed, in a quiet, darkened room. He will instruct the nurse to sterilize the external genital region: a sterile gauze dressing is then left in place. Some form of prescription will be given to diminish the patient's nervous fear and to allay any tendency on the part of the womb to contract. It is always essential and very important to save everything that passes from the womb during the course of a threatened miscarriage in order that the physician may know exactly just what the condition is. Each cloth, each clot of blood will have to be examined before the proper treatment can be pursued in safety.

When the miscarriage cannot be prevented it is called an "Inevitable miscarriage."

TREATMENT OF AN INEVITABLE MISCARRIAGE.—In these cases every precaution is taken, just as in a normal confinement, to avert blood poisoning. The hands, instruments, dressings, etc., are carefully rendered sterile and the whole field must be surgically clean. The physician will conduct the case as conditions justify and as the situation develops.

AFTER TREATMENT OF A MISCARRIAGE.—It is one of the many thankless tasks of a physician's life to insist on each patient staying in bed at least ten days after a miscarriage. The average woman and frequently the intelligent woman fails to appreciate the absolute necessity for this procedure. It is necessary and it is the physician's duty to insist on it being done in the interest of the woman. Many of the multitude of diseases of women are caused by disregarding advice on such occasions.

THE TENDENCY TO MISCARRY.—If a woman, for any reason, has had a miscarriage, her womb will tend to miscarry at the same period during a subsequent pregnancy. If the miscarriage should occur during her first pregnancy the tendency to miscarry will be greater than if acquired after she has had a baby.

This is one of the reasons why young wives often fail to have children. They "get rid" of the first one or two, because they are not ready to have children, or because they want some enjoyment themselves before they are tied down with a family. Having established the habit their womb has been educated to abort, and it will keep this habit up, much to their astonishment and chagrin.

Young wives should therefore faithfully follow out all the rules of the Hygiene of Pregnancy laid down by their physician, and which are given in detail in this book.



THE BABY



CHAPTER XVI

HYGIENE AND DEVELOPMENT OF THE BABY

What to Prepare for the Coming Baby—Care of the Newly-born Baby—The First Bath—Dressing the Cord—Treatment After the Cord Falls off—A Pouting Navel—Bathing Baby—Clothing the Baby—Baby's Night Clothes—Care of the Eyes—Care of the Mouth and First Teeth—Care of the Skin—Care of the Genital Organs—Amusing Baby—Temperature in Children—The Teeth—The Permanent Teeth—Care of the Teeth—Dentition—Treatment of Teething—How to Weigh the Baby—Average Weight of a Male Baby—Average Weight of a Female Baby—Average Height of a Male Child—The Rate of Growth of a Child—Pulse Rate in Children—Infant Records, Why They Should be Kept—"Growing Pains."

WHAT TO PREPARE FOR THE COMING BABY.—The physician should instruct the young wife just what to provide for the coming baby. The following list will be found useful as a general guide.

An ordinary clothes basket, padded and lined, is quite sufficient for the first month; or, a baby crib, which may be cheap or expensive as the individual taste dictates. The Taylor crib is probably the handiest and best one on the market.

Pin cushion;

Puff-box and puff;

Soap box containing pure castile soap;

Hair brush and fine comb;

Two wash cloths;

Four ounces of crystal boracic acid, a saturated solution of which is used for cleansing baby's eyes and mouth;

One pound of good absorbent cotton;

A flexible tube of white vaseline;

A bath thermometer;

A package of sterile gauze;

A half dozen baby towels, good quality;

A soft, white, good blanket,—one and one-half yards square;

One pair small blunt pointed scissors;

A package of the best safety pins;

Three or four dozen bird's-eye cotton diapers. First size, eighteen inches square. Second size, twenty-five inches square;

One yard of soft white flannel for belly bands; each band should be five inches wide, by twenty-four inches long.

Two silk and wool shirts;

Three flannel shirts (all shirts should be high necked, long sleeved, and open down the front);

Three Eiderdown wrappers;

Three Cashmere sacques;

Three pads for crib;

Six dresses;

Six petticoats (they should be thirty-three inches long from neck to hem; they should be turned up at the bottom for about four inches and should button there to keep the feet warm; if it is desired to use pinning blankets for the first two months in place of the petticoats, they should be made of soft white flannel with cotton bands);

Six night slips;

Six pair socks;

Two cloaks;

Two hoods;

One dozen bibs.

Simplicity, warmth, and freedom are the essentials in latter-day baby clothes. It is cheaper to make the clothes than to buy them. Excellent and accurate paper patterns can be obtained, giving the quantity of material necessary and suggesting the kind and quality best suited for the purpose. These patterns may be obtained from the Butterick Publishing Company in New York City.

CARE OF THE NEWLY-BORN BABY.—After the nurse has completed her duties with the mother after the confinement, she will prepare to give baby its first bath.

The bath should be given in a warm room. This is a matter that should receive more consideration than has been given it. Nurses do not as a rule attach much importance to this duty, while in reality it is a most important one. I have seen trained nurses make ready to give baby its first bath in rooms, during the night, that were not heated adequately. I am convinced that many babies have been victims of this careless habit to the extent of grafting on them the tendency to catarrhal colds and bronchitis because of undue exposure at this critical period. If one will remember that a baby has just been removed from an environment where the temperature was suitable and constant, to one in which it needs a large degree of artificial heat until such time as it may become accustomed to the change, one may appreciate the risk taken in exposing the child for even a short time. The mother should therefore warn the nurse not to undertake the baby's first bath until the temperature and other conditions are favorable. Many nurses and other individuals have the impression, without knowing why, that the baby should be cleansed and bathed immediately after birth. This is not at all necessary. If the conditions are not favorable, it would be far better to wrap the baby snugly in a warm blanket—first having put a diaper on—and place it in its crib with a hot water bottle near it and defer the bathing until the following forenoon. By that time the baby will be adapted to its new surroundings; its lungs will have become accustomed to the air which it is breathing for the first time; the mother will have been rendered comfortable; in other words, the conditions and the environment will be favorable for the baby and for a better performance of the duty.

The next important feature of the first bath is that it should be done in the quickest time consistent with efficient service. Only the necessary exposure should be indulged in. It is not necessary that the baby should be exposed to the admiring inspection of every member of the household—there will be plenty of time for that without risking the health of the child. A pan of water at a temperature of 100 deg. F. should be placed on a stool in front of the nurse. The nurse should have on a rubber apron, and on top of this, an ordinary apron and a warm bath towel laid over her knees. The child should be gently rubbed with warm sweet oil to remove the vernix caseosa (the greasy substance which is on all babies when born to a lesser or greater extent). Particular attention is to be given to all folds of the skin, as under the arms, in the fold of the neck, in the groin, behind the ears, etc., because in these parts the substance is thickest and if not carefully removed it will cake, and cause painful eruptions and sores, which may bleed and render the infant extremely uncomfortable. It is not necessary to expose the whole body at one time while applying the oil. The lower half may be covered with a warm soft towel while the nurse is oiling the upper part, and vice versa. After the body has been thoroughly oiled it should be cleansed with water at the proper temperature, in which pure castile soap has been dissolved. Absorbent cotton only should be used to wash the baby. All the washing is done with the baby on the nurse's knee; it is not put into the water.

The baby should be mopped dry with sterile gauze, or with a soft sterile towel, the cord dressed and the flannel band adjusted. It should then be completely dressed and put to the nipple and later to sleep.

DRESSING THE CORD.—The cord should be covered with powder and sterile gauze. The powder to use should be plain subnitrate of bismuth. If there is any reason to use another powder the physician will write a prescription for it according to indications. The subnitrate of bismuth will be found much better than any ordinary talcum or toilet powder, many of which do not make good dressing powders.

Very few nurses know how to dress the cord. It seems to be impossible to impress them with the need of frequent attention to the cord. Fresh powder should be put on every time the diaper is removed, every time the infant urinates, and at other times during the day. The cord should be kept absolutely dry. Putting on powder twice daily will not keep the cord dry and many nurses are too lazy to bother to do it oftener. You cannot make a mistake in putting on too much powder, you can make a serious mistake by not putting on enough. Every time the cord is powdered it should be lifted up, away from the skin of the abdomen, and the powder put below it. The cord should be slightly drawn out and the powder applied round its base where it meets the skin. Many nurses are afraid to touch or handle the cord—they find it easier to neglect it. The mother should see that the nurse dresses the cord at least five times every day.

APPLYING THE STERILE GAUZE TO THE CORD.—A piece of gauze, six inches square is taken, a hole is cut the size of a ten-cent piece out of the center, the cord is drawn through the hole, the gauze folded lengthwise over the cord and then sidewise, and this is held in place by the binder. This piece of gauze will adhere to the cord and will most likely be removed with the cord on the fifth day. If it should fall off, another piece may be put on in the same way.

If the cord does not fall off until very late it is because it has not been attended to rightly or because it was a very thick cord.

TREATMENT AFTER THE CORD FALLS OFF.—The stump of the cord should be powdered with the same powder used on the cord; a pad two inches square of sterile gauze and quite thick should be held over the stump for a number of days by the abdominal binder. This is used to prevent a possible rupture. After a week the size of the pad may be reduced, but a small pad should be used over the stump of the cord for a month or more.

A POUTING NAVEL.—If the stump of the cord should protrude, a piece of strong pasteboard, the size of a fifty-cent piece, should be wrapped in soft gauze and placed over the navel, over this a gauze pad, and if necessary this should be held in place by a strip of adhesive plaster, though the binder is usually sufficient if it is put on carefully. If this pad is held properly and worn for a month the tendency to protrusion or rupture will have passed away. These pads may of course, be removed when the baby is being bathed and put back again before the binder is applied.

BATHING BABY.—A baby should not be put into water for a bath until after the cord has been off for forty-eight hours.

During the first few months the temperature of the water should be 98 deg. F. The temperature of the water should be taken with a bath thermometer; it should not be guessed at. A bath thermometer is an inexpensive commodity and it will be in daily use in many ways in a home where there is a baby—it should therefore be procured wherever possible. The room should be warm; there should be no draughts. The mother or nurse should cultivate the habit of bathing baby quickly and with system. Everything should be ready and at hand. A little salt in the water will tend to strengthen the skin; it will also relieve any superficial rashes or excoriations which may be on the skin. Four tablespoonfuls to a gallon of water will be sufficient. The sea salt sold in the stores may be used in lesser quantities.

By the end of the fifth month the temperature of the water may be reduced to 95 deg. F., and by the end of the first year to 90 deg. F. After the first year the mother should accustom the child to a quick sponge with cool water on the chest and spine immediately after the bath. This simple means, if kept up, will often prevent the development of colds and bronchial troubles so common to children in temperate latitudes.

The best time to give the warm bath is at night. In the morning a cold sponge bath is desirable. This should be given as described in the chapter on cold sponge or shower baths.

In certain children bathing seems to depress their entire system. They do not react well even to a warm bath. They remain blue or pale around the mouth and eyes; bathing should therefore be carefully undertaken with these children until such time as they acquire strength.

CLOTHING OF BABY.—The baby should wear a woolen shirt, with a high neck and long sleeves. The abdominal binder may be worn for the first three months. It is not necessary after that time. If worn longer the habit is acquired and chronic indigestion may ensue when it is ultimately taken off. If the baby is very thin it may be wise to leave it on, simply for its warming effect, for a few months longer. If the child is normal and healthy the binder should be left off permanently after three months. The band for the first four weeks should be made of plain flannel; after this period a knitted band with shoulder straps is the better article. All petticoats and skirts should be supported from the shoulders. Stockinet is a good material for diapers; it is soft, warm, and pliable.

Baby's feet should be warm always. Cold feet are frequently responsible for colic and gastro-intestinal troubles. A hot water bottle should be placed in the carriage if the weather is cold, but care should be taken to see that it does not touch the feet, otherwise it may burn them. The same measure may be adopted in the baby's crib if the feet are cold.

During the summer the outer clothing should be made of the thinnest quality of material possible, and the underclothing of the finest flannel or gauze. Body heat may be maintained during changes of temperature by extra outer wraps—not by dressing the baby in clothes that keep it too hot and uncomfortable all the time.

The main object to be attained in clothing the baby is to ensure a sufficient protection, but the clothing must be light, warm, loose, and non-irritating. Don't bundle up the arms and legs so that they cannot be moved; don't pin them so tight that the child cannot breathe properly and don't put the band on so that the child is in torture all the time from inability to move the abdomen.

BABY'S NIGHT CLOTHES.—The night clothing should be the same as that worn during the day, but it should be loose and of the lightest flannel material. For older children a thin woolen shirt (not the one worn during the day) and a suit of union clothing with feet is best.

The mistake must not be made to cover children too warmly at night. They can do with relatively less than adults. Too much covering will render the sleep restless, will encourage nightmare, and in older children will engender bad habits. Delicate children especially must not be over-covered at night.

For the first few months children should sleep in a darkened room.

CARE OF THE EYES.—The eyes should be cleansed for the first few days with a saturated solution of boracic acid. They should be protected from the direct light for two or three weeks after birth.

CARE OF THE MOUTH AND FIRST TEETH.—Boiled cooled water should be used to cleanse the mouth every morning after the bath. A soft piece of sterile gauze should used for this purpose. The mother must guard against using too much force in cleaning the mouth of an infant.

The milk teeth should receive attention. If they are allowed to become dirty they will become carious and cause bad breath and neuralgia. Teeth of this character are a menace to health because they harbor germs and in this way infect the mouth and cause stomach troubles. Teeth that are carious should be filled or removed.

CARE OF THE SKIN.—The skin of a baby, because of its delicate character, is susceptible to the slightest changes in the weather or to the condition of the digestive organs. Babies are frequently subject to rashes, intertrigo, excoriations, eczema, and other skin affections. It is much easier to prevent these conditions than to cure them. Cleanliness, not only in giving a daily efficient bath, but in every other respect, is essential. Castile soap only should be used, and no rubbing indulged in, simply mopping the parts with gauze well saturated with soapy water. All napkins should be removed as soon as soiled. If the skin is easily chafed the child should be bathed in salt water or water in which bran is mixed as explained in the chapter on bran baths.

The baby should be well powdered with a good quality of toilet powder. Ordinary starch, or talcum, or the stearate of zinc is suitable. Fat infants should be powdered in all the skin folds; otherwise they are sure to chafe.

CARE OF THE GENITAL ORGANS.—The mother should make it a habit to remove any dirt from the genitals of the baby during the morning bath. Fecal matter sometimes gets into the folds of the female baby; this should be removed promptly. In older female children, dirt and dust get into the genitals which often has to be removed carefully with a soft piece of cloth. An exceedingly chronic form of inflammation is often seen in poor children because of neglect of these parts.

In male babies the mother must daily push back the foreskin and clean under it. If this is not done the natural secretion will gather there and cause much trouble. If the foreskin is long, the child should be circumcised; if it is not long it must be pushed back daily for a number of weeks; otherwise it will contract and it may be necessary to operate on it at a later date. If this is not faithfully attended to the prepuce will become adherent, the child becomes nervous and irritable, and it may become addicted to self-abuse at a very early date—simply because the mother is derelict in the performance of her duty. If you are afraid to do your duty, don't neglect it, ask the doctor to show you just what has to be done and just how it should be done. You will find it to be a simple matter when you know how, as most things are.

AMUSING BABY.—Mothers should understand that it is not necessary to amuse a baby under one year of age. Their nervous systems are not ready for any such sport. To excite a baby to laughter is to subject it to a shock which may injure it. The healthy development of the brain of a child demands quiet and restful surroundings. It should sleep, eat, and be allowed to amuse itself in a natural way.

TEMPERATURE IN CHILDREN.—The normal temperature in a child varies more than it does in an adult. The rectal range may be between 98 deg. and 99.5 deg. F. and may be normal to that particular child. A rectal temperature of 97.5 deg. F. or of 100.5 deg. F. is of no importance unless it continues.

The best place to take the temperature in a child is the rectum and the next best place is in the groin. The temperature will always be from a half to a full degree higher in the rectum than in the groin. The thermometer should be left in the rectum for two minutes, and in the groin for five minutes.

The temperature in a child is a very fair guide as to the severity of the disease. It must be remembered, however, that a child will develop a temperature of two or three degrees from a very slight cause. It is not the height of the fever that is significant, but rather the duration of the fever that is important. A fever of 102 deg. F. in a child may only mean a slight indigestion which will wholly disappear after a laxative is given, while the same degree of temperature in an adult usually means something much more serious. The degree of the temperature therefore should not occasion unnecessary worry; if, however, it continues and if the child shows other signs of illness, it may be regarded as indicating an abnormal condition which should be immediately found out. A temperature of 100 deg. F. to 102 deg. F. usually means a mild illness, and one of 104 deg. F. or over, a serious sickness.

It is not advisable that the ordinary mother should possess a clinical thermometer. There are many occasions when a child will have a fever which should not cause any worry; if the mother gets the thermometer habit, she will many times occasion unnecessary calls of the physician only to learn that they are false fears.

THE TEETH.—There is no definite time at which the first teeth appear. They usually come between the sixth and eighth months. They may not, however, come until much later; or they may come earlier than the sixth month; and yet the child may be perfectly healthy. They come as a rule in the following order:

1. The two lower middle teeth, 6 to 8 months. 2. The four upper middle teeth, 8 to 10 months. 3. One on each side of two lower middle teeth, 8 to 12 months.

4. One on each side, above and below, back of above teeth (four in all), 12 to 15 months.

5. The next one on each side, above and below, back of those already in (four in all), 18 to 24 months.

6. The four back teeth on each side, above and below, 24 to 30 months.

At 1 year a child should have 6 teeth

At 1-1-2 years a child should have 12 teeth

At 2 years a child should have 16 teeth

At 2-1-2 years a child should have 20 teeth

They may not come in the above regular order even in well children. The upper front teeth may come first. If the child is sickly there may be marked irregularity in the order in which they appear. Twenty teeth comprise the first set.

THE PERMANENT TEETH.—This set consists of thirty-two teeth. They begin about the sixth year and they are usually not complete until the twentieth year. They appear in the following order:

First molars 6 years Incisors 7 to 8 years Bicuspids 9 to 10 years Canines 12 to 14 years Second molars 12 to 15 years Third molars 17 to 25 years

CARE OF THE TEETH.—The teeth should be given attention as soon as they appear. It is an excellent custom to wash the teeth and gums twice daily with a piece of clean absorbent cotton rolled round the finger of the mother and dipped in a saturated solution of boracic acid. This should be done up to the second year. After the second year a soft brush should be used and the teeth thoroughly cleaned morning and night with pure castile soap or a powder. The teeth of every child should be examined by a dentist every six months. All cavities should be filled with a soft filling. The milk teeth should not decay, but should fall out, or be forced out by the second set. A child should be taught to gargle early and a mouth wash should be used morning and night.

DENTITION.—As a general rule the process of teething is accompanied by some symptoms. There may be fever, restlessness, and loss of appetite; though in many cases there are absolutely no symptoms. Some children seem to teethe hard, others easily. The same child may have some teeth without pain, and with others it may suffer severely. The condition of the child at the time, its age, and the season of the year undoubtedly have an influence. Children who are sickly and puny may have much difficulty while teething.

The degree of sickness varies quite considerably. There may only be, as stated above, slight fever, restlessness, with loss of appetite; or there may be, in addition to these symptoms, a pronounced fermentative diarrhea, which may lead to serious intestinal diseases; frequently there is a cough. This is more apt to be the case if the child is teething during the hot season.

TREATMENT.—When dentition affects the child's disposition it is a good plan to reduce the feeding in quantity and quality for the time being. If the child is bottle-fed, two ounces can be taken out of each bottle and one ounce of boiled water added. If the child is breast-fed, he should be given two ounces of warm, boiled water before each feeding, and the actual feeding time at the breast shortened.

Rubbing the gum over the erupting tooth with a clean cloth may aid in helping it through. If the child is very restless and has lost sleep, the cloth may be moistened with brandy and water. Lancing the gum, though it is seldom done now-a-days, is justified in a few cases. Teething is not the cause of actual disease as was once thought, but it must be remembered that a child whose vitality is reduced by fever, restlessness, loss of appetite, loss of sleep, and irregular bowels, is more susceptible to disease than when enjoying robust health.

Sometimes a child will have a fever for one or two weeks during a hard dentition. There is apt to be more or less intestinal indigestion and fermentation at this time and as a consequence actual intestinal disease may develop. To avoid such a possibility it is an excellent plan to give an occasional dose of castor oil to clean thoroughly the whole intestinal canal. This should be done irrespective of the condition of the bowel, because frequently a diarrhea is caused by retained fermenting products.

Mothers must not acquire the habit of attributing all symptoms to the teething process simply because the child is teething. It must be remembered that a child may get a disease, or an ailment, while teething, that has nothing to do with teething. If this is neglected, serious consequences may result. Many children have lost their lives by a mother's carelessness in this way. Be on the safe side, consult your doctor; let him assume the responsibility.

HOW TO WEIGH THE BABY.—The test of weight is one of the most satisfactory we possess as an indication of physical progress and health. It is not an absolute test, but it may safely be relied upon. The fattest baby is not necessarily the healthiest. A gradual and a uniform increase is a satisfactory growth. At birth a baby weighs, on an average, from seven to eight pounds, though some babies weighing less are equally healthy. The normal and customary gain is from four to six ounces every week after birth.

The baby should be weighed about the same time of the day each week, and before a meal.

The average weight of a male child at different ages is as follows:

Birth 7-1/2 lbs. 3 weeks 8 lbs. 1 month 8-1/2 lbs. 3 months 12 lbs. 4 months 13-1/2 lbs. 5 months 15 lbs. 6 months 15-1/2 lbs. 7 months 17 lbs. 9 months 19 lbs. 1 year 21 lbs. 1-1/2 years 23 lbs. 2 years 26-1/2 lbs. 3 years 31-1/2 lbs. 4 years 35-1/2 lbs. 5 years 40 lbs. 6 years 45 lbs. 7 years 49 lbs. 8 years 54 lbs. 9 years 59 lbs. 10 years 65-1/2 lbs.

A female child weighs about one-fifteenth less than a male child, as a rule.

Table showing the average height of a male child, at different ages:

At birth 20-1/2 in. 6 months 26 in. 1 year 29 in. 2 years 32-1/2 in. 3 years 35 in. 4 years 38 in. 5 years 41-1/2 in. 6 years 44 in. 7 years 46 in. 8 years 48 in. 9 years 50 in. 10 years 52 in.

THE RATE OF GROWTH OF A CHILD.—A child grows most rapidly during its first year—six to seven inches; from fourth to sixteenth, about two inches annually; thence to twentieth, one inch. Commonly, a child at two and a half years has attained half of its ultimate adult stature. The diseases of youth always accelerate growth.

PULSE RATE IN CHILDREN AND ADULTS.—Normal Pulse,—of new born, 130 to 140, per minute; first year, 105 to 115; second year, 106 to 115; third year, 95 to 105; fifth to twelfth year, 80 to 90; thirteenth to twenty-first year, 75 to 80; twenty-first to sixtieth year, 70 to 75; in old age, 75 to 85.

INFANT RECORDS.—A record should be kept by the mother of every child which would embrace exact data as to weight, diet, size, development of mental power, teeth, ailments, sickness, pains, etc., with dates and any information which would aid in recalling exact conditions. Such records are of the utmost value in a number of ways. They help in giving suggestions as to diet, general health, and mental qualities of the child in question, and they aid in furnishing what physicians call "past history," which past history has a very valuable significance in estimating the character and importance of sickness during later years.

Such a record is also of importance in comparing a child's development with what is regarded as standard development, and also with the growth and development of other children in or out of the family.

If a child should thus be found to fall seriously below the standard and yet not appear actually sick, a very thorough and routine investigation should be instituted to discover if possible the cause. Some error might thus be detected which might seriously affect the child's future growth and well-being.

The date of the closing of the soft spot on the baby's head should be noted, and if it is still open, when it should be closed, it might mean that the child has a serious brain condition. The soft spot should close between the eighteenth and twenty-fourth months. The family physician should be notified if the soft spot is open later than the second year, as he may want to investigate the cause.

Should the child be unusually backward in walking, and when it does so should limp and feel pain in the knees, it should be examined for any symptom of hip joint disease, of which these are the earliest signs.

If the child complains of so-called "growing pains," keep in mind that these are rheumatic and may need attention. There are no such pains as actual "growing pains," that is, pains caused by the child growing.



CHAPTER XVII

BABY'S FEEDING HABITS

Overfeeding Baby—Intervals of Feeding—How Long Should a Baby Stay at the Breast—Vomiting Between Feedings—Regularity of Feeding—Why is Regularity of Feeding Important—"A Baby Never Vomits"—What is the Significance of So-called Vomiting After Feedings—Mothers Milk That is Unfit for Baby—Fresh Air for Baby—Air Baths for Baby.

OVERFEEDING BABY.—Every nursing mother should have printed and hung up, so she may read it every time she nurses her child, the following motto: "DON'T OVERFEED BABY." Few, if any, babies die of willful starvation: many die as a result of overfeeding. Mistaken kindness and lack of judgment are responsible for one-half of all the troubles of infancy. Babies require much less than is constantly given them. The stomach of a baby at birth will not hold more than one ounce, which is two tablespoonfuls; and at two months it will not hold more than three tablespoonfuls; and at six months, six or seven tablespoonfuls. Read these quantities once again carefully and try to realize the significance of the smallness of them. A baby is just like a little pig; it will go on feeding as long as it is allowed. The baby does not reason; it has no judgment; it depends upon its mother's judgment. If the mother is false to the trust the baby overloads its stomach. A swollen, distended, overloaded stomach causes indigestion. A baby with indigestion is a colicky, fretty, sick baby. Overfeeding, therefore, is the beginning of lots of trouble to the mother, and needless pain and suffering and sickness to the baby. A simple matter, but it is one of the most difficult lessons nursing mothers have to learn.

Overfeeding is most apt to occur at night. Many mothers put the child to the nipple for its regular feeding and fall asleep; the child keeps on nursing at intervals until twice the proper quantity is taken; or she gives it the nipple or the bottle if it cries, without regard to whether it is the proper feeding time or not. The habit of overfeeding is very common in infants who are suffering from indigestion. They cry frequently, and are irritable most of the time; nothing seems to satisfy them but the nipple. Taking the warm milk into the stomach seems to allay the distress for the time being, so mothers get into the habit of quieting them in this way. The cry of the drinking man, whom we try to sober up, is: "Just one more drink and I'll quit." You give the drink and in a little while the demand is repeated. If the mother understood the seriousness of this practice of giving the child the nipple or bottle at irregular times, she would not do it.

Overfeeding an infant may lay the foundation for a lifelong ailment. The excess of food remains in the stomach or bowels undigested. If you remember that this mass of undigested matter is confined in a small space which is both warm and damp, it will be easily understood that putrefaction is the inevitable outcome. As a result of this putrefaction there are produced certain ptomaines and leucomaines. These poisons are carried through the body, causing "auto-intoxication" which upsets and irritates the child's nervous system and may cause very serious consequences, as it frequently produces sudden death from apoplexy and "heart failure" in the adult. These children are always restless, fretful, continually uncomfortable, sleepless and colicky. They lose weight, the stomach becomes distended and a gastritis or inflammation of the stomach results.

Frequently a mother with such a fretful baby, seeing her child getting thinner and thinner, will think that it is not getting enough to eat, and will proceed to add to the trouble by giving the child more to eat.

Mothers must therefore learn not to overfeed their infants; not to imagine that a failure to gain weight means the need of more food (if the quality of the food being given is wrong, will increasing the quantity of bad food do any good?); not to feed irregularly, no matter how insistent the child may be.

INTERVALS OF FEEDING.—The physician will give instructions regarding the feeding of the newly born baby for the first few days. After the first few days and up to the beginning of the third month, it should be fed every two hours from 7 A. M. until 9 P. M., and twice during the night between 9 P. M. and 7 A. M., when the regular two-hours' interval again begins for the following day. The two night feedings should be about 1 and 4:30 A. M.

After the third month, and up to the sixth month, feed every three hours and once during the night. From the sixth month until weaned, every three and one-half or four hours, and not at all during the night.

While it has been pointed out that regularity of feeding is absolutely essential, the above schedule is not to be regarded as an absolute guide. It is a general guide,—approximately it will be found correct in a large majority of cases. Each baby is a rule unto itself. The quantity of the mother's milk will dictate the interval after the first month and for each month as the baby grows. If a mother with no milk to spare, is nursing a big, strong, husky baby, the three-hour interval during the day may have to be shortened to two and one-half hours. As a rule, however, these exceptions are better regulated by attention to the time the baby is given at each nursing to fill its stomach.

HOW LONG SHOULD A BABY STAY AT THE BREAST?—Babies differ as to their method of feeding; some of them seem to like to nurse a moment or two and then look around; others seem to regard nursing as a serious business, and resent any effort to take the nipple away until they have finished. A baby should be taught to nurse methodically; it should not be allowed to play the nipple. Let it fill its stomach and put it down as quickly as possible. A mother will very soon know just how long it takes the baby to fill its little stomach, and when she finds this out she should time it by the clock. When the supply of milk is sufficient, and the child is strong, and nurses freely, eight to twelve minutes are sufficient. After it is taken away from the breast it must be left quiet till the next feeding.

Other babies, according to the ability they evince to nurse, even when the milk runs freely, require a longer time,—from twelve to fifteen minutes. The rule, however, is never to allow them to nurse so long that when they are taken away the milk runs out of the mouth. If this occurs, cut down the length of time they are at the breast, and always time the length of feeding by the clock,—don't guess at it.

CHILDREN WHO "VOMIT" BETWEEN FEEDINGS.—When a child habitually brings up food between feedings it is usually a symptom of gastric indigestion. In these cases it is advisable to add lime-water to each feeding, and to remove some of the fat in each feeding. If improvement does not follow remove more of the fat by removing some of the cream from the top of the bottle before shaking it.

Remove from the bottle four ounces of cream and shake before preparing the food from what is left. If the child improves after a few days remove only three ounces, then in a few days remove two ounces and later one ounce. After a time, sufficiently long to permit the stomach to become accustomed to the graded amounts of fat, the former diet of whole milk can be again resumed.

Never decrease the interval of feeding of a baby who is bringing up parts of its meal between feedings; it is frequently advisable to increase the interval. If a child is colicky and is bringing up lots of gas in addition to some food, one-half grain of benzoate of soda may be added to each ounce of food given and continued for a number of weeks if necessary. When the gas is located in the intestines and is not brought up, it must be made to pass downward. Attention to the bowels is of great importance in these cases and it may be necessary to peptonize the milk for some time. A reduction of the sugar and starch in the feeding frequently cures this condition. (See "Colic.")

There are children who continue to have symptoms of indigestion and who do not thrive despite various changes in the quantity and quality of the feedings. It may be necessary to obtain a wet nurse for them, as it is with "the delicate child." If a wet nurse cannot be obtained, or if the age will permit, a substitute may be tried. Borden's Eagle brand of condensed milk, canned, is probably the best substitute under these circumstances. Condensed milk should never be used as a continuous food; as a substitute, however, for a few weeks it is often invaluable. With an infant of three or four months it should be used at the beginning in the proportion of one ounce of the milk to sixteen ounces of plain boiled water or barley water. The proper quantity, whatever the child is taking (four or six ounces according to the age) at the time, can be taken from the sixteen ounces and fed to the child. As the symptoms improve the milk should be diluted less and less, 1 to 14, 1 to 10, and so on until the proper strength is reached. After the child has been on the condensed milk for a month it should be changed back to cow's milk, using of course a diluted formula until the child becomes accustomed to the change. Condensed milk, if used as a permanent food, will fatten babies, but their vitality is very deficient, the muscles flabby, and the resistance to disease exceedingly poor. They are apt to develop rickets and sometimes scurvy.

REGULARITY OF FEEDING.—One of the very first, and one of the most important factors in contributing to the good health and the comfort of a baby is absolute regularity in feeding. A regular interval of feeding is particularly essential during the first month of a baby's life.

Despite the explicit way in which young mothers are instructed in this respect, it is one of the disappointing incidents of the practice of medicine to observe how many of these mothers fail to heed the advice. We have personally tried to find an explanation for this astonishing carelessness, and have come to the conclusion that it is not due to intentional forgetfulness, but rather to an inexplicable failure to appreciate that the physician means exactly what he says.

If, for example, specific instructions are given to feed, or nurse, the child every two hours (and by "specific instructions" it is meant, that the physician takes time to explain in detail the instructions he gives—that the instructions are not incidental to the call, but part of the call;—that the advice is given not as a choice of what is desirable, but as an absolute rule to follow; and carefully explains why it is imperative to do as he says; and is satisfied the mother understands what he means) it would seem that there could be no possible reason why the directions should not be faithfully carried out. Yet such is not the case in many instances, and the excuses given by mothers for failure are so trivial and annoying that they show a failure to appreciate that they are dealing with a serious problem—a problem affecting human life. They fail to understand that fatal consequences may follow their negligence. They treat the baby problem exactly as they would a household incident, and as they do not consider it important whether the breakfast dishes are washed at 9 A. M. or at twelve noon, neither do they consider it important whether the baby is fed at 9 A. M. or an hour later. When mothers learn that the attention they must give their babies is essentially different from the attention they give ordinary household duties, the problem of raising children with success and comfort will be greatly simplified.

If the instructions are to feed the baby at certain intervals, do so at all hazards. To offer the foolish excuse that the baby was asleep when feeding time came, is no excuse at all; as a matter of fact the baby should be asleep at each feeding time, if it is healthy. Wake it and feed it, for, as will be shown later, it is the constant regularity that counts. It will be more difficult to institute regular feeding intervals during the first month, because a healthy baby is very difficult to wake up, even to be fed, during the first few weeks of life. It is absolutely essential, however, that it should be wakened: otherwise the tendency to overfill the stomach at the next feeding will lead to indigestion and colic.

WHY IS REGULARITY OF FEEDING IMPORTANT?—Because a baby's stomach holds a very small quantity, and experience has taught us that a baby will thrive better on small quantities given frequently, rather than large quantities at longer intervals. The smaller the baby, the smaller the quantity to begin with. Some babies weigh from five to seven pounds at birth, while others weigh from nine to twelve pounds. It would be unreasonable to expect a very small baby to be able to hold and digest as much as a very large baby. Considerable common sense and the exercise of some judgment is therefore necessary on the part of the uninstructed mother, as to just the right quantity to give. Fortunately, a little experience will enable the observant mother quickly to solve this important problem. Nature promptly furnishes the symptoms which will correctly guide her. Before considering the significance of these symptoms let us appreciate certain facts common to all babies, and we will more easily interpret the meaning of the special symptoms the baby will furnish.

First of all the baby never vomits. The ejection of food, therefore, is dependent upon a condition, not a disease. If milk runs out of its mouth immediately, or within a few moments, after a feeding, the explanation is that it was fed too much; it does not vomit, the stomach simply overflows. It is exactly like trying to put more milk into a cup after it is full,—it will not hold more, it overflows.

The significance of this symptom, therefore, is that the quantity of the feeding is wrong (it is not the baby's stomach that is at fault,—it is the mother's judgment). Reduce the quantity of each feeding and you will quickly cure it. If the milk does not overflow soon after a feeding, the baby will appear satisfied and will go to sleep, and will sleep until it is time for the next feeding. It may not do this, however. In half an hour, or a little longer, after the feeding, it wakes, it begins to fret and cry, and very soon it suddenly belches gas and ejects a mouthful of milk, after which it will rest quietly for a few moments, when it will begin fretting all over again. It may keep up this performance for an hour, or until the next feeding, and if so it is exhausted and unfit to carry on the digestive process. It is in these cases where most mothers make serious mistakes. This is the beginning of real trouble, and the family physician is the only one qualified to give advice under such circumstances. Remember the warning given regarding heeding the advice of every busybody just at this time. Your baby's health is at stake; maybe its life depends upon what you choose to do.

WHAT IS THE SIGNIFICANCE OF "VOMITING" AFTER FEEDINGS IN BABIES?—Let us examine the difference between the milk which overflowed immediately after the feeding and the milk which the baby ejects one-half hour or so later, and which is now being considered.

The first milk looks like ordinary milk (breast milk), or if the baby is being fed from the bottle, it looks just like the mixture in the bottle. It not only looks like what it took, but it smells just like it. Now examine the other; we find it looks like curdled milk, it is lumpy, and we immediately can tell that it is sour, because it smells sour and looks sour.

The explanation of the first overflow (immediately after the feeding) was the too great quantity; the explanation of the second overflow (one-half hour or so after the feeding), is the wrong quality of milk. The quantity was right because none overflowed right after the feeding, but the quality was wrong. Again, it is not the baby's stomach that is at fault,—it is the quality of the milk.

How do we know this? Because of what takes place in the baby's stomach during the one-half hour between the feeding and the time of the overflow of the sour milk. The quantity being right, why should the baby have any trouble if the quality is correct? It should not. Therefore by changing the quality (not the quantity as in the former case) we cure the trouble, thus proving the quality of the milk to be at fault.

What took place in the baby's stomach in the intervening half hour? The quality being wrong, the little stomach could not digest the mixture quick enough. Fermentation set in, gas was evolved, and as the stomach was full before the gas was manufactured (and as more and more gas is manufactured when food ferments), the stomach overflowed and out of the baby's mouth comes gas, and sour, fermenting, curdled milk. This process goes on until fermentation stops, or until the little stomach has just enough left to fill it and no more. But think what this is,—a sour mass of rotting, indigestible, curdled milk,—and that is what this baby is expected to live and thrive on.

Some babies seem to have trouble from the very first day of life. Either they will not retain the food, or the food fails to agree with them. If the baby is put upon artificial food at once, these troubles are, of course, not unexpected (because the right artificial food may not be first chosen for the particular baby), but it is not always the artificially fed baby that gives us trouble, and it is sometimes difficult to find the cause for such trouble in a baby who has had nothing but its mother's milk since it was born.