HEALTHY CHILDREN 
 
 S. JOSEPHINE BAKED 
 
Class. 
 Book. 
 
 7?Tn 
 
 
 foffiMttF ]4&o 
 
 COPYRIGHT DEPOSIT. 
 
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HEALTHY CHILDREN 
 
 A Volume 
 
 Devoted to the Health 
 of the Growing Child 
 
 BY 
 
 S. JOSEPHINE BAKER, M. D., D. P. H. 
 
 Director, Bureau of Child Hygiene, Depart- 
 ment of Health, New York City. 
 
 Consultant in Child Hygiene, United States 
 Public Health Service. 
 
 Former President American Child Hygiene 
 Association. 
 
 Lecturer on Child Hygiene at Teachers Col- 
 lege, Columbia University, New York 
 University and Bellevue Hospital Medi- 
 cal College. 
 
 Member American Medical Association. 
 
 Fellow New York Academy of Medicine. 
 
 THE FEDERAL PUBLISHING COMPANY 
 
 MINNEAPOLIS, MINNESOTA 
 1920 
 
\ 
 
 «£ 
 
 Copyright 1920 
 
 by the 
 
 federal Publishing Co. 
 
 Minneapolis 
 
 Minn. 
 
 FEB -2 132! 
 
 u 
 
 g)C!.A605651 
 
3 
 
 TO 
 
 MY FATHER 
 
 AND 
 
 MY MOTHER 
 
 THIS BOOK ON 
 
 HEALTHY CHILDREN 
 
 IS LOVINGLY AND 
 
 GRATEFULLY 
 
 DEDICATED 
 
PREFACE 
 
 For many years the health of the baby and 
 the health of the child of school age have re- 
 ceived attention from the public health author- 
 ities, and particularly in our large cities there 
 have been many opportunities for individual 
 instruction of mothers in the care of little 
 babies or older children. It is only recently, 
 however, that the health of the child between 
 two and six years has received any attention. 
 This period of life has come to be known as the 
 "preschool age." It is the time when the 
 child is past babyhood, yet is not old enough 
 to enter school. 
 
 This book deals with the health problems 
 of the preschool age child, but because during 
 this age period the child is particularly sus- 
 ceptible to many of the contagious diseases and 
 to many of the more common infectious dis- 
 eases, a large part of the book has been given 
 up to a discussion of methods of controlling 
 these diseases and caring for them at home. 
 This consideration of illness, however, should 
 not be allowed to outweigh the realization of 
 the importance of prevention of disease and 
 methods whereby children may be kept well. 
 It is the purpose of the book to accentuate 
 health, not disease, and to show the mother 
 how she may give the child of preschool age 
 
PREFACE 
 
 the same health care that is now so freely avail- 
 able for the baby. It cannot be too strongly 
 emphasized that this book is not intended to 
 convey information which can be used in place 
 of the expert care of a physician. In every 
 case of illness a doctor should be summoned at 
 the earliest possible moment and his advice 
 and directions followed in detail. In order, 
 however, to explain how health may be main- 
 tained, it is necessary for the mother to know 
 something of the early symptoms of the com- 
 mon diseases, how they may be prevented, 
 and the care that will shorten their course 
 and give the doctor the most intelligent type 
 of aid. 
 
 As aids to child training and to lay the 
 foundation for education, we have had a 
 marked contribution made to the period of 
 preschool life by Froebel, who gave us the idea 
 of the kindergarten, and by Montessori, who 
 has made practical many unique and valuable 
 ideas in the training of the young child. In 
 health matters, the child from two to six has 
 received little, if any, attention and it is 
 hoped that this book will help mothers to 
 understand the importance of this period of 
 life and give them the information to make 
 healthy childhood continuous with healthy 
 babyhood. 
 
 VI 
 
PREFACE 
 
 As far as possible, technical terms have 
 been avoided, but occasionally it has been 
 necessary to use them. A glossary will be 
 found in the back of the book, containing ex- 
 planations of the less understandable terms or 
 words. Because health is affected by so many 
 factors, it has been found necessary to repeat 
 certain details under various headings. In 
 studying any particular subject, every refer- 
 ence to it should be read so that there may 
 be more complete understanding. There is 
 nothing difficult, nor need unusual methods be 
 applied, in order to keep children well. Any 
 effort, however slight, that is applied in that 
 direction, will inevitably result in a finer and 
 better developed race. 
 
 S. JOSEPHINE BAKER. 
 
 VI i 
 
CONTENTS 
 
 Chapter I. Physical and Mental Development 
 Height and weight; development of special senses: speech- 
 stuttering or stammering; touch, taste, hearing, smell, sight. 
 Muscular development: play and exercise. Influence of en- 
 vironment Pages 1-28 
 
 Chapter II. Personal Hygiene 
 Location of the home; fresh air and ventilation; effect of bad 
 air; heating and temperature. Clothing: outer clothing, under 
 clothing, night clothing, shoes. Bathing: cold baths, warm baths. 
 Sleep and quiet ; night terrors. Hygiene of the nose and throat ; 
 adenoids, enlarged tonsils. Care of the teeth: temporary teeth; 
 permanent teeth. Care of the eyes and ears Pages 29-73 
 
 Chapter III. Training for Good Habits 
 Regularity. Training the bladder; bed wetting. Training 
 the bowels; constipation. Thumb-sucking. Nail-biting. Mastur- 
 bation Pages 74-87 
 
 Chapter IV. Foods and Feeding 
 Food elements. Types of food. Value of certain foods at 
 different ages. Foods to be avoided. General rules for feeding. 
 Idiosyncrasies with regard to food. Sample diets. Diet in 
 illness. The child who will not eat. Causes of lack of appetite, 
 and results. Types of poor appetite. Management of loss of 
 appetite Pages 88-112 
 
 Chapter V. Malnutrition 
 Causes, symptoms, care and treatment Pages 113-120 
 
 Chapter VI. The Nervous Child 
 Causes, symptoms, prevention and treatment. Chorea (St. 
 Vitus Dance). Habit spasm Pages 121-137 
 
 Chapter VII. Common Diseases of Childhood 
 Causes, symptoms, prevention and treatment of coughs, colds* 
 croup, enlarged glands, tonsillitis, earache, hiccoughs, headache, 
 worms, hives (urticaria) Pages 1S8-16& 
 
 IX 
 
CONTENTS 
 
 Chapter VIII. Infectious and Contagious Diseases 
 Early symptoms of infectious diseases. Symptoms, method of 
 infection and home care of measles, German measles, scarlet 
 fever, chickenpox, mumps, whooping cough, diphtheria, tuber- 
 culosis. Contagious eye diseases: simple conjunctivitis, acute mu- 
 copurulent conjunctivitis (pink eye). Contagious skin diseases: 
 ringworms, scabies (itch), impetigo, pediculosis (head lice, body 
 lice) Pages 163-194 
 
 Chapter IX. Accidents and Injuries 
 First aid; bruises, cuts, burns, sprains, strains, broken bones, 
 nosebleed. Insect bites and stings. Foreign bodies in the 
 throat, eyes or ears Pages 195-213 
 
 Chapter X. The Children's Medicine Chest 
 
 Type of medicine closet. Special rules. List of articles recom- 
 mended. Description of simple remedies for home use 
 
 Pages 214-225 
 
 Glossary Pages 226-230 
 
 x 
 
ILLUSTRATIONS 
 
 Frontispiece Page 
 
 Height and Weight Chart 5 
 
 Pattern for Child's Rompers 39 
 
 Child's Romper and Creeper 40 
 
 Good Posture 51 
 
 Mouth Breather, Showing Presence of Adenoids 64 
 
 Undernourished Child 183 
 
 Method of Applying Tourniquet 184 
 
 Method of Applying Strips of Adhesive Plaster 
 to bring Edges of Wound together 196 
 
 Method of Bandaging Sprained Ankle 197 
 
 XI 
 
HEALTHY CHILDREN 
 
 CHAPTER I 
 
 PHYSICAL AND MENTAL 
 DEVELOPMENT 
 
 The entire period of childhood is one of 
 growth. There should be a normal, even de- 
 velopment of the child's mentality and an 
 equally regular development of the organs of 
 the bod} 7 , the bones and the muscles. 
 
 During the first year of life the needs of the 
 baby are mainly physical. As the child grows 
 older, its life becomes much more complex and 
 its mental as well as its physical needs demand 
 attention. The period under five years of age 
 is one of very rapid growth. There is probably 
 no other time in the life history of the in- 
 dividual when both body and mind are so 
 responsive to environment and impressions, 
 and when so much can be done to build up 
 good health as during the preschool age. 
 During this time the child is both mentally and 
 physically extremely sensitive to its surround- 
 ings. It is keenly receptive to all impressions 
 and suggestions. Everything that concerns its 
 daily life leaves some impression, therefore it 
 is of the utmost importance that during this 
 time the child's surroundings, associates and 
 
HEALTHY CHILDREN 
 
 training tend toward normal mental and 
 physical development. 
 
 While the needs of the child during this 
 period may seem, and are to a great extent, 
 rather diverse, it is a satisfaction to know 
 that there is nothing that pertains to proper 
 development of child life that is not within 
 the reach of every family. It is particularly 
 important during the preschool age that the 
 child should live in decent and clean surround- 
 ings, with as much fresh air as possible 
 throughout the twenty-four hours. It is es- 
 sential that the food be of the proper kind, 
 and given at regular intervals, and that the 
 clothing be suitable. The regular practice of 
 personal hygiene is more important than at 
 any other time of life, except during babyhood. 
 Included in this is the care of all the organs 
 and functions of the body. Sleep, rest, recrea- 
 tion, proper bathing and hygiene of the eyes, 
 ears, nose, throat and excretory organs, such 
 as the skin, kidneys and bowels, are of im- 
 portance. Not only are such surroundings 
 and personal hygiene of the first importance 
 at this time because of their immediate effect 
 upon the child, but this is the period of life 
 when health habits can be formed which will 
 last as long as the child lives and which make 
 all the difference in after life between poor 
 
PHYSICAL AND MENTAL DEVELOPMENT 3 
 
 health or semi-invalidism and good health, and 
 a life that is a satisfaction and a joy. 
 
 Increase in Height and Weight i^ 
 
 The best method we have of determining 
 normal physical development is regular in- 
 crease in height and weight. These bear a 
 definite relation to each other. The child who 
 shows a normal balance between its height 
 and weight, and an increase in both these 
 points in proper ratio, is a normally developed 
 child, and, in the majority of instances, its 
 nutrition is good. Some children, however, 
 grow very rapidly as far as height is concerned 
 but do not make a corresponding gain in 
 weight. When a child weighs less than it 
 should for its height, it is almost always an 
 indication that there is something seriously 
 wrong with its nutrition. The health of the 
 child depends upon its proper nutrition. 
 Nutrition, as we shall see later, is the result of 
 proper hygienic surroundings and the right 
 kind of food, which is properly digested and 
 used by the body in promoting normal growth. 
 It is important, therefore, to know in every 
 stage of the child's development whether or 
 not it is well nourished. The simplest and 
 easiest way for the mother to determine this is 
 in the relation between height and weight of 
 the child at a given age. There are many 
 
HEALTHY CHILDREN 
 
 other symptoms of undernourishment, which 
 will be discussed later. The particular one 
 which has to do with growth is the most 
 important. 
 
 In giving tables of heights and weights, it 
 must be remembered that the average child 
 is being considered. All tables of this kind are 
 made up from the results of examinations of 
 large numbers of children of various nationali- 
 ties, living under conditions of both city and 
 rural life. It is perfectly possible that a well 
 nourished child may differ to some extent 
 from the standard given as the average for a 
 child of its age. It is safe to say, however, 
 that this difference will not amount to more 
 than ten per cent in either direction, therefore 
 a child need not be considered undernourished 
 or lacking in proper development unless it is 
 at least ten per cent below the average weight 
 in relation to its height and age. 
 
 Children should have their height measured 
 each six months and should be weighed once a 
 month. It is wise to keep a chart of the 
 child's weight. Such a chart may be made 
 like the one illustrated on the next page. 
 On this should be placed, in the appropriate 
 column, a dot showing the child's weight on a 
 given date. When the child is weighed the 
 following month a dot should be placed in the 
 next column and a line drawn between the two 
 
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 MONTHS 
 
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 SQNnOd NI JLH9I3M 
 
HEALTHY CHILDREN 
 
 AVERAGE HEIGHTS AND WEIGHTS OF WHITE CHIL- 
 DREN, BOYS AND GIRLS, UNDER SIX YEARS OF 
 AGE, BY MONTHS, AS FOUND IN NEW YORK CITY. 
 
 Age 
 
 Under 1 month. 
 
 1 month 
 
 2 months. . . . 
 3 
 4 
 5 
 6 
 7 
 8 
 9 
 
 10 
 11 
 12 
 13 
 14 
 15 
 16 
 17 
 18 
 19 
 20 
 21 
 22 
 23 
 24 
 
 BOYS 
 
 Average 
 Height 
 Inches 
 
 21% 
 
 22 
 
 23% 
 
 24 
 
 24% 
 
 25% 
 
 26% 
 
 26% 
 
 27% 
 
 27% 
 
 28% 
 
 28% 
 
 28% 
 
 29% 
 
 29% 
 
 30% 
 
 30% 
 
 30% 
 
 31% 
 
 31% 
 
 31% 
 
 31% 
 
 32% 
 
 32% 
 
 33% 
 
 Average 
 Weight 
 Pounds 
 
 8% 
 10 
 
 11% 
 
 13% 
 
 14% 
 
 15% 
 
 16% 
 
 17% 
 
 18% 
 
 19% 
 
 19% 
 
 20% 
 
 20% 
 
 21% 
 
 21% 
 
 22% 
 
 22% 
 
 23% 
 
 23% 
 
 24% 
 
 24% 
 
 25% 
 
 25% 
 
 26 
 
 26% 
 
 GIRLS 
 
 Average 
 Height 
 Inches 
 
 20% 
 
 21% 
 
 22% 
 
 23% 
 
 24% 
 
 24% 
 
 25% 
 
 26% 
 
 26% 
 
 27 
 
 27% 
 
 27% 
 
 28% 
 
 28% 
 
 29% 
 
 29% 
 
 29% 
 
 30% 
 
 30% 
 
 31 
 
 31% 
 
 31% 
 
 32 
 
 32% 
 
 32% 
 
 Average 
 Weight 
 Pounds 
 
 8% 
 9% 
 11 
 
 12% 
 13% 
 14% 
 15% 
 16% 
 17% 
 17% 
 18% 
 19% 
 19% 
 20 
 
 20% 
 21% 
 21% 
 22% 
 22% 
 23 
 
 23% 
 24% 
 24% 
 24% 
 25% 
 
PHYSICAL AND MENTAL DEVELOPMENT 
 
 Age 
 
 BOYS 
 
 Average 
 Height 
 Inches 
 
 Average 
 Weight 
 Pounds 
 
 GIRLS 
 
 Average 
 Height 
 Inches 
 
 Average 
 Weight 
 Pounds 
 
 25 months. 
 
 26 
 
 27 
 
 28 
 
 29 
 
 30 
 
 31 
 
 32 
 
 33 
 
 34 
 
 35 
 
 36 
 
 37 
 
 38 
 
 39 
 
 40 
 
 41 
 
 42 
 
 43 
 
 44 
 
 45 
 
 46 
 
 47 
 
 48 
 
 49 
 
 50 
 
 51 
 
 52 
 
 33% 
 
 33% 
 
 34% 
 
 34% 
 
 34% 
 
 34% 
 
 34% 
 
 35% 
 
 35% 
 
 35% 
 
 35% 
 
 36% 
 
 36% 
 
 36% 
 
 36% 
 
 37 
 
 37% 
 
 37% 
 
 37% 
 
 38% 
 
 38% 
 
 38% 
 
 38% 
 
 38% 
 
 39 
 
 39% 
 
 39% 
 
 39% 
 
 26% 
 
 27 
 
 28 
 
 28% 
 
 28% 
 
 28% 
 
 28% 
 
 29% 
 
 30 
 
 30% 
 
 30% 
 
 30% 
 
 30% 
 
 31% 
 
 31% 
 
 31% 
 
 31% 
 
 32% 
 
 33% 
 
 33% 
 
 34 
 
 34 
 
 34% 
 
 34% 
 
 35% 
 
 35% 
 
 35% 
 
 35% 
 
 32% 
 
 33% 
 
 33% 
 
 33V 9 
 
 33% 
 
 34 
 
 34% 
 
 34% 
 
 35% 
 
 35% 
 
 35% 
 
 35% 
 
 35% 
 
 36% 
 
 36% 
 
 36% 
 
 36% 
 
 37% 
 
 37% 
 
 37% 
 
 38 
 
 38 
 
 38% 
 
 38% 
 
 38% 
 
 39% 
 
 39% 
 
 39% 
 
 25% 
 
 25% 
 
 26% 
 
 26% 
 
 26% 
 
 26% 
 
 28% 
 
 28% 
 
 28% 
 
 29 
 
 29% 
 
 29% 
 
 30% 
 
 30% 
 
 30% 
 
 30% 
 
 30% 
 
 31% 
 
 32 
 
 32% 
 
 32% 
 
 32% 
 
 32% 
 
 32% 
 
 33% 
 
 34 
 
 34% 
 
 34% 
 
HEALTHY CHILDREN 
 
 
 
 BOYS 
 
 GIRLS 
 
 Age 
 
 Average 
 Height 
 Inches 
 
 Average 
 Weight 
 Pounds 
 
 Average 
 Height 
 Inches 
 
 Average 
 Weight 
 Pounds 
 
 53 moi 
 
 54 ' 
 
 55 ' 
 
 56 ' 
 
 57 4 
 
 58 ' 
 
 59 ' 
 
 60 ' 
 61 
 
 62 4 
 
 63 ' 
 
 64 ' 
 
 65 ' 
 
 66 ' 
 
 67 4 
 68 
 
 69 ' 
 
 70 ' 
 
 iths 
 
 39% 
 39% 
 40% 
 
 40% 
 
 40% 
 
 40% 
 
 40% 
 
 41 
 
 41% 
 
 41% 
 
 41% 
 
 41% 
 
 41% 
 
 42% 
 
 42% 
 
 42% 
 
 42% 
 
 43% 
 
 35% 
 
 35% 
 
 36% 
 
 37% 
 
 38% 
 
 38% 
 
 38% 
 
 38% 
 
 38% 
 
 38% 
 
 38% 
 
 39 
 
 39% 
 
 39% 
 
 39% 
 
 40 
 
 40% 
 
 41% 
 
 39% 
 39% 
 39% 
 40 
 
 40% 
 
 40% 
 
 40% 
 
 40% 
 
 40% 
 
 41 
 
 41% 
 
 41% 
 
 41% 
 
 42 
 
 42 
 
 42% 
 
 42% 
 
 42% 
 
 34% 
 
 34% 
 
 34% 
 
 35% 
 
 36% 
 
 36% 
 
 36% 
 
 36% 
 
 36% 
 
 37 
 
 37% 
 
 37% 
 
 37% 
 
 38% 
 
 39% 
 
 39% 
 
 39% 
 
 40% 
 
PHYSICAL AND MENTAL DEVELOPMENT 9 
 
 dots. A comparison can then be made with 
 the tables shown on pages 6, 7 and 8 showing 
 the height and weight of average children. 
 As the weighing progresses, it may be seen 
 at a glance whether there is a regular in- 
 crease in weight. The weight at any one 
 particular time is not the most important 
 point to notice. It is essential, however, that 
 there should be a regular and definite gain, and 
 if the weight is stationary for more than two 
 months, or if a loss in weight is shown at any 
 time, immediate attention should be paid to 
 readjustment of the child's life to more nearly 
 meet its needs. It will be noted that the in- 
 crease in height and weight is not so rapid 
 after the first year, An easy way to remem- 
 ber the right weight for a given age is that the 
 average gain amounts to about five pounds a 
 year from the first to the eleventh years. After 
 that a child will gain an average of ten pounds 
 a year until the time for growth is over. 
 
 The gain in height is not so regular. At 
 the end of the first year the baby should 
 measure about twenty-eight inches. Each 
 year thereafter, until the fifth, there should be 
 an average gain of four inches in height. 
 From the fifth to the tenth years the gain 
 Varies from two to three inches. The table 
 will show this increase more in detail. 
 
 / 
 
10 HEALTHY CHILDREN 
 
 DEVELOPMENT OF SPECIAL SENSES 
 
 While the term ' 'growth' ' commonly refers 
 to increase in size, the development of the 
 child includes its increase in mental power, 
 and increased activity and keenness of the 
 various functions. Some children show an 
 abnormally rapid development. There are 
 many instances of so-called ' 'infant prodigies" 
 where children learn to read and write and 
 even to grasp difficult mental problems at an 
 extraordinarily early age. Such children are 
 the exception, however, not the rule. Unless 
 the child shows unusual mental capacity and 
 the parents are able to control its development 
 with the utmost wisdom, it is better to con- 
 sider the period from one to five years of age 
 a time when the foundation is laid for good 
 health and good mental development, rather 
 than a time when the child is forced into 
 activity which will interfere with its oppor- 
 tunity for play, recreation, amusement and 
 for the normal training and development which 
 are the right of every child. There is no 
 absolute rule to show the exact progress and 
 development of the special senses in children 
 from one to five years of age. Because of the 
 great variation, we can speak of the subject 
 only in a general way. 
 
PHYSICAL AND MENTAL DEVELOPMENT 11 
 
 Speech 
 
 Ordinarily, at the end of one year, the baby 
 has learned to say a few words, and by the 
 time it is eighteen months old these words may 
 be put together into short sentences. The 
 little child, as soon as it learns to talk, almost 
 always uses its first words to ask questions. 
 The curiosity of young children is insatiable. 
 This is not a senseless curiosity, but a per- 
 fectly normal one, and speech offers the child 
 an opportunity to satisfy its thirst for knowl- 
 edge. Speech is used also as a means of ex- 
 pressing the child's own ideas, and the con- 
 stant use of speech for these two purposes 
 tends to develop it as a mode of expression 
 much more rapidly than is the case in the 
 development of the other senses. 
 
 It is necessary to urge some children to talk; 
 others talk incessantly, without urging. The 
 child who must be urged to talk may be simply 
 indifferent, but there is always the possibility 
 of a mental defect when speech has been 
 markedly retarded or is completely absent 
 when the child is two years of age. Under such 
 circumstances, only a thorough physical and 
 mental examination will determine whether 
 or not the child is simply backward or indif- 
 ferent, or whether there is some physical defect 
 which interferes with speech, or, possibly, some 
 
12 HEALTHY CHILDREN 
 
 mental defect. In a large number of in- 
 stances where mental defect is the cause of in- 
 ability to speak, there is a corresponding deaf- 
 ness, and the child's inattention and apparent 
 inability to hear may often be the first signs 
 noted. Careful attention should be paid to this 
 matter, because if deafness is present in addi- 
 tion to inability to speak, deafmutism should 
 receive early attention at the hands of a spe- 
 cialist. 
 
 Stuttering or Stammering 
 
 Stuttering, stammering or distorted speech 
 may be the result of some physical defect or a 
 marked nervous condition, or it may be the re- 
 sult of habit. Occasionally, a child's tongue will 
 be bound down to the floor of the mouth by a 
 tiny fold of mucous membrane, and this inabil- 
 ity to move the tongue freely leads to distort- 
 ed speech and difficulty in pronouncing certain 
 words. Such children have a tendency to lisp. 
 Letters like "s" cannot be pronounced clearly, 
 and there is a blurring over of many word 
 sounds. The treatment is simple. Any physi- 
 cian can make a small cut in the mucous mem- 
 brane, releasing the tongue so that it is freely 
 movable. The operation is not at all dangerous. 
 
 Stuttering and stammering sometimes start 
 as a purely nervous habit, because the child 
 has been unduly urged to talk or is of an 
 
PHYSICAL AND MENTAL DEVELOPMENT 13 
 
 extremely nervous disposition. As soon as an 
 effort is made to say anything, there is loss of 
 speech control, usually the result of some 
 emotional disturbance. Stammering or stut- 
 tering increases the more the child tries to ex- 
 press itself. A great deal may be done in 
 early life to correct this condition by teaching 
 the child to speak slowly and to accent dis- 
 tinctly every syllable of a word. Every effort 
 should be made to overcome the emotional 
 excitement and the nervousness. Such children 
 should never be forced into new experiences 
 that may be mentally disturbing. They should 
 be brought into contact with other children 
 for normal play, but great tact must be used 
 in handling them at all times. Particular care 
 should be taken to see that no one makes fun 
 of their infirmity. In a great number of cases 
 constant attention to slow speech and calming 
 all nervousness will cure stuttering and stam- 
 mering. However, if the habit becomes estab- 
 lished and continues until the child is five 
 years old, it is probable that special treatment 
 will be necessary, and this can be carried on 
 only by someone who has made a special 
 study of the subject. 
 
 Touch, Taste, Hearing, Smell 
 
 All of these functions develop first in baby- 
 hood, but are not keen until the child is past 
 
14 HEALTHY CHILDREN 
 
 eighteen months of age. Up to that time 
 they have a very limited relation to the child's 
 life, but after the baby passes the age of 
 eighteen months, if it is normally developed, 
 it begins to make conscious effort to use these 
 special senses in order to widen its understand- 
 ing of its environment. 
 
 The function of touch in young children is 
 peculiarly acute. Madame Montessori has 
 taken advantage of this idea in her method of 
 training children, and it has been found pos- 
 sible to develop this sense in very young 
 children to a remarkable and hitherto un- 
 thought-of degree. Up to the time a child is 
 five years of age, it is possible to cultivate the 
 delicate sense of touch so that it may become 
 an important aid throughout life. It is easily 
 blunted, if neglected. The child should be 
 encouraged to tell the shape of various articles 
 by feeling them rather than by looking at 
 them, to tell the texture of materials by the 
 sense of touch, to distinguish between soft and 
 hard substances or between smooth and rough 
 materials, to determine the texture of plants, 
 trees and growing things, as well as the texture 
 and character of all familiar, material sur- 
 roundings. This opens up a wonderful method 
 of training children to be observant, interested 
 and of delicate comprehension. Children who 
 have their sense of touch developed to this 
 
PHYSICAL AND MENTAL DEVELOPMENT 15 
 
 extent have acquired something that will add 
 immeasurably to their future pleasure in life. 
 
 Taste and smell are not acutely developed 
 during early child life. Children have marked 
 prejudices with regard to certain articles of 
 food, and these prejudices frequently relate to 
 taste. Thus rnilk, which may be very much 
 disliked as a drink, will often be taken when 
 prepared in the form of soups, custards or ice 
 cream. Eggs, when distasteful if eaten alone, 
 will be eaten if disguised as part of some 
 pudding or custard. On the whole, however, 
 the sense of taste is not particularly keen and 
 children will put into their mouths things which 
 would be considered distasteful to an adult 
 with a normally developed sense of taste. 
 Little children do not mind eating mud, clay 
 or even more repulsive things. Fine taste is 
 largely the result of cultivation in later years. 
 
 The sense of smell in young children is not 
 well developed. They rarely are sensitive to 
 disagreeable odors or appreciative of delight- 
 ful ones. If the sense of smell is totally 
 lacking, that is, if the child is unable to dis- 
 tinguish that the rose has perfume or that 
 anything is distinctly repulsive or has a bad 
 smell, it is probable that there is some marked 
 nasal catarrh or nasal occlusion, due to adenoid 
 growths. 
 
16 HEALTHY CHILDREN 
 
 Sight 
 
 Early development of sight has mainly to 
 do with distinction between light and dark- 
 ness, recognition of people who are well known, 
 such as father, mother or nurse, or distinguish- 
 ing bright colored objects. Red is probably 
 the first color that is noticed by the baby, and 
 bright colors have an unusual attraction 
 throughout childhood. It is not until the 
 baby is about two years old that it begins to 
 appreciate objects in their proper relation to 
 each other. 
 
 Muscular Development 
 
 The condition of the child's muscles is large- 
 ly dependent upon its nutrition. Muscular 
 tissue develops more rapidly when it is used, 
 and the constant restless activity of the normal 
 child usually results in firm, hard and adequate 
 muscles. Children who are not well nourished 
 suffer from extreme bodily fatigue and their 
 muscles are apt to be flabby and soft, but in a 
 child who is living under the right conditions 
 and who is well nourished, the muscular tissue 
 can be felt all over the body, well rounded and 
 firm, and the child will be active without 
 fatigue. 
 
 During the first two or three years of life 
 there is little conscious control of the muscular 
 
PHYSICAL AND MENTAL DEVELOPMENT 17 
 
 development. Learning to walk is probably 
 the first expression of conscious muscular con- 
 trol and after the child finds that it can control 
 the movement of its legs and feet, it begins, 
 usually by itself, to learn to control the move- 
 ments of other parts of the body. Little 
 children also have the power of complete re- 
 laxation. This is shown in the way in which 
 they fall. A child running along the street 
 will stumble and fall at full length, only to 
 jump up again and run on as strongly as 
 before. In all probability, such a fall would 
 seriously injure an adult, and certainly there 
 would be a nervous shock. This ability to 
 relax the muscles completely becomes less as 
 the child grows older and becomes more tense 
 and more conscious of its muscular movements. 
 Every effort should be made to allow free 
 muscular development. Loose clothing of 
 every kind, including loose shoes, utter free- 
 dom of motion of the arms and legs, provision 
 of opportunities for play which involve use of 
 the muscles of the body, are all essential. Left 
 alone, children will develop their muscular 
 tissue without supervision and there is little, 
 if any, danger of muscular strain in a healthy 
 child who lives the average normal life, with 
 regular hours of sleep and play, and the 
 proper kind of food. Muscular exercise tends 
 to make all organs of the body function in a 
 
18 HEALTHY CHILDREN 
 
 proper manner. The sedentary child, or one 
 who is brought up much indoors, suffers 
 readily from constipation, indigestion and 
 similar troubles. Often the only thing that is 
 necessary to correct this condition is to pro- 
 vide opportunity for free outdoor play. 
 
 Play and Exercise 
 
 The normal child has an inherent instinct 
 for play. One of the pathetic effects of city 
 life is the provision that it has been necessary 
 to make for supervision of play for young 
 children. Ordinarily there are only two points 
 about which we need concern ourselves in 
 this connection: the first is that the children 
 have a place to play where they can do so with 
 safety and the other is that their play is not 
 vicious. They may safely be trusted to de- 
 velop for themselves the type of play which 
 most interests and amuses them, and that 
 type is usually the one which does them most 
 good. Outdoor games should be encouraged. 
 Except in very stormy or extremely cold 
 weather, the child of preschool age should be 
 out-of-doors the greater part of the twenty- 
 four hours. Games of childhood are tradi- 
 tional. They pass from one generation to the 
 next as regularly and inevitably as life itself. 
 No one knows how the old nursery games are 
 passed down from child to child, but, generally 
 
PHYSICAL AND MENTAL DEVELOPMENT 19 
 
 speaking, the games of the children of today 
 are not at all unlike those of their parents, 
 their grandparents or even back into the pre- 
 ceding generations. 
 
 Except in unusual instances, children do 
 not have to be taught any special games, but 
 one marked characteristic of very early child- 
 hood should always be borne in mind. Lack 
 of understanding of this characteristic is more 
 common among the well-to-do than among 
 those less blest with worldly goods. Little 
 children do not care for expensive mechanical 
 toys. They have a creative instinct and want 
 to make their own games and their own play. 
 The imagination of the little child has no 
 limits. An old packing box or piece of cloth 
 that can be made to serve as a tent holds 
 undreamed-of possibilities of happiness. Nine- 
 tenths of the normal games of early childhood 
 exist only in the imagination of the child, and 
 if any aid at all is desirable to help children 
 play, it is the kind that cultivates the imagina- 
 tion rather than retards it by furnishing toys 
 which are warranted to go by themselves and 
 which do not need any help from the child. 
 A normal child can have infinitely more fun 
 out of an old box which is dragged along the 
 street by a string to serve as a doll carriage 
 than it can get out of the most perfect mechan- 
 ical electrically-propelled train that was ever 
 
20 HEALTHY CHILDREN 
 
 made. Children as well as adults grow by 
 expression and in their play they have the 
 opportunity to express themselves quite natur- 
 ally, without the restrictions which bear so 
 heavily upon them when they are closely 
 associated with the world of adults, therefore 
 toys for children should be of the simplest. 
 Such things as heaps of sand where they may 
 dig to their heart's content, boxes or blocks 
 which cannot be injured but which may be 
 used by the children to form any object which 
 their imagination desires, and, above all, wide 
 and unrestricted play space, are all that are 
 needed to make the average children healthy 
 and happy. Initiative and the power of ex- 
 pression are marvellously stimulated by this 
 kind of play and are almost always retarded, 
 if not killed altogether, by manufactured play 
 and toys that have had done for them all that 
 the child would wish to do for itself. 
 
 During the preschool age there should be no 
 formal children's parties. If birthdays must 
 be observed, it should be in the simplest man- 
 ner possible, preferably with outdoor play and 
 some very simple refreshments, such as ice 
 cream or custard, in addition to the birthday 
 cake. It is far better, however, for children 
 of this age not to have the stimulation that 
 comes from forced play and the emotional 
 excitement that almost always attends parties. 
 
PHYSICAL AND MENTAL DEVELOPMENT 21 
 
 There is also the possibility of the spread of 
 infection. It is a well-known fact that con- 
 tagious diseases always increase after the 
 holiday periods. The gathering together of 
 children in parties and entertainments is one 
 of the best known methods of spreading in- 
 fection. As little children are so particularly 
 susceptible to contagion, children's parties 
 should be extremely rare. The emotional ex- 
 citement is also very bad for young children. 
 Up to the age of five years the emotions are 
 not definitely under control and many children 
 have had the basis of nervous disorders in 
 later life firmly established as a result of the 
 excitement and artificial life connected with 
 being entertained frequently in early child- 
 hood. 
 
 Another word of warning should be uttered 
 against having children "show off." The pre- 
 cocious child is always a bore to everyone but 
 its parents. The pleasure that normal children 
 can give is delightful, but the precocious child 
 has not a fair chance, because its parents put 
 it in a position where it is unwelcome to 
 others and where it readily acquires that 
 type of egotism which is of all attributes the 
 most distressing that can be found in child- 
 hood. Little children should never be urged 
 to recite, to dance or "show off" in any way 
 before others. The nervous excitement is 
 
22 HEALTHY CHILDREN 
 
 extremely bad for the child and certainly 
 nothing can be worse than the development of 
 this egotism. 
 
 Opportunities for proper play accentuate the 
 great advantages the country child or the child 
 of sensible parents has over children in the city 
 and children who are the victims of over-in- 
 dulgence and over-care. Old clothes that can- 
 not be hurt, torn stockings and worn out 
 shoes, bruises and bumps, and the oppor- 
 tunity to get throughly dirty with mud pies 
 and sand piles, all belong to the right of 
 childhood. Cleanliness and order can and 
 should be insisted upon, in their proper place, 
 but for the greater part of the day the child 
 should be looked upon as a little, growing 
 animal and allowed free expression of its play 
 instinct. 
 
 INFLUENCE OF ENVIRONMENT 
 
 Environment consists of all the external 
 surroundings and conditions that affect the 
 development of the person and increase, modi- 
 fy or change the inherited qualities of the 
 individual. It is reassuring to know that, 
 although we may not be able to choose the 
 type of inheritance we would like, and may 
 have to take that which does not accord with 
 our desires, yet we can to a very large extent 
 control our environment, and we can choose 
 
PHYSICAL AND MENTAL DEVELOPMENT 23 
 
 and maintain a proper environment for our 
 children. The time when environment has 
 the greatest effect upon the development of 
 the individual is during early life. In human 
 beings, development of the young covers a 
 far greater period of time than it does in the 
 life history of any other species of animal, 
 consequently fathers and mothers have a very 
 great responsibility in seeing that, during the 
 entire period of development, their children 
 have the right surroundings and the right in- 
 fluences. 
 
 During the prenatal period and in infancy, 
 the baby's environment is its mother and her 
 relation to the child is mainly one of protect- 
 ing it from harm and supplying it with nourish- 
 ment. It is extraordinary, however, to re- 
 alize how early in life the child's mind begins 
 to develop and to receive impressions from its 
 surroundings. The whole process of education 
 is largely dependent upon taking advantage 
 of our experiences in the past and modifying 
 our behavior in the future to accord with 
 them. The formation of habits in early in- 
 fancy is so important a matter that the 
 mother and father are entirely responsible for 
 determining whether the baby's habits shall 
 be good or bad. Throughout the entire life 
 of the child the right kind of environment or 
 surroundings is of the utmost importance. 
 
24 HEALTHY CHILDREN 
 
 When they are proper, the child will develop 
 into a person with good habits and fine char- 
 acter, and in this way any desirable inherited 
 traits may be intensified. On the other hand, 
 any inherited traits of undesirable type will 
 become more pronounced if they are not 
 corrected by proper training and proper en- 
 vironment. 
 
 Proper training and environment are those 
 influences which develop in a child the habits 
 of self-reliance, clear thinking, receptive mind, 
 truthfulness and independent, honest action. 
 Many books have been written on the subject 
 of proper child training. It seems to be the 
 consensus of opinion that training for good 
 habits must begin at the time of birth. Parents 
 have no right to impose arbitrary standards 
 upon their children after the latter have reach- 
 ed a reasoning age, until the reason for the 
 action has been explained to them. It is far 
 better and wiser to make instructions to 
 children consist of a series of positive state- 
 ments, such as "Do this" and "Do that" 
 rather than to have the child's life made up 
 of a series of "Don'ts" which are arbitrary in 
 character, and which are never accompanied 
 by any explanation. More and more, as we 
 study the psychology of the child, we come to 
 the conclusion that most of the training of 
 children should begin with the previous train- 
 
PHYSICAL AND MENTAL DEVELOPMENT 25 
 
 ing of their parents. Often it is the faults of 
 the parents, reflected in their management of 
 the children, which cause the formation of 
 many bad habits, and create the antagonistic 
 spirit which leads to disregard of the rights of 
 others and bad character formation. 
 
 It is well to remember that we cannot 
 bequeath to our children the education and 
 training we have acquired, except in so far as 
 we may give them the benefit of it by making 
 it part of their environment. Our whole 
 civilization is made up of the experience of 
 former generations which has been handed 
 down through ages. We inherit culture and 
 the various things that make up what we call 
 i 'civilization' ' in the same way that we in- 
 herit property, but such things are ours only 
 so far as we avail ourselves of them and 
 reflect them in our conduct. Each generation 
 can use the best that the preceding generations 
 have had to offer and through these environ- 
 mental influences develop its own individuality 
 in the best possible manner. 
 
 The kind of family environment that is best 
 for the child does not depend upon money, 
 social prominence or material luxury. History 
 is full of examples of children born of the most 
 obscure parents who have, in spite of their 
 handicaps — I would rather say because of 
 them — risen to positions of acknowledged em- 
 
26 HEALTHY CHILDREN 
 
 inence. This does not mean that an environ- 
 ment of hardship is always necessary in order 
 to develop genius. It is not probable that 
 anyone becomes creative because of environ- 
 ment. It is necessary that he must have 
 ability, as a matter of direct inheritance, but 
 it is always possible that the ability might 
 never have been developed if the child had not 
 been brought up in the right environment. 
 What are called great advantages for children 
 are sometimes disadvantages. It is possible 
 for an environment to be "too good." It is 
 quite conceivable that a child may have a diet 
 that is of the most luxurious type, yet it may 
 be extremely bad for its health. On the other 
 hand, a diet of the utmost simplicity and 
 economy may be planned that will furnish all 
 the necessary elements of food to promote the 
 best type of health and growth. The child 
 who is never made to mind, who is allowed to 
 follow its own will, rarely has its character 
 developed in the right direction. It is true 
 only too often that children of wealthy 
 parents have all ambition stifled and all initia- 
 tive destroyed because they have no stimulus 
 to be anything other than they are. On the 
 other hand, a certain amount of hardship in 
 life, coupled with what seem to be disad- 
 vantages and difficulties, often proves a 
 stimulus to the development of proper char- 
 
PHYSICAL AND MENTAL DEVELOPMENT 27 
 
 acter. This does not mean that poverty is 
 necessarily good in itself, or that wealth is 
 necessarily bad. It does mean, however, that 
 children should not be brought up in idleness 
 or luxury, but should have their daily tasks, 
 should be made to feel responsibility for their 
 attitude toward life, should have a relation- 
 ship of understanding with their parents, and 
 live in an atmosphere where traits of honesty, 
 decency and true culture are common. If 
 these traits occur in a family there need be no 
 apprehension, but rather a feeling of having 
 bequeathed a fine heritage and a still finer 
 environment to the child. Often it is better 
 for the child if there are minor hardships to 
 be overcome and it is wise, even from early 
 babyhood, for the child to be surrounded by 
 an environment which must be met with 
 initiative and a certain amount of exertion. 
 In individual instances, the poor boy or girl 
 from the country who has had to work hard 
 to cope with all the difficulties of frontier or 
 country life may not outstrip the wealthy boy 
 who has been brought up in the city, but, 
 generally speaking, that kind of early environ- 
 ment stimulates self-reliance and the ability 
 to conquer difficult circumstances. Moral and 
 mental development, including ideals, moral- 
 ity, responsibility, habits and thoughts, as 
 well as the type of religion we adhere to, and 
 
28 HEALTHY CHILDREN 
 
 the political party to which we belong, are 
 almost entirely the results of environment in 
 the early years of life. The great Cardinal 
 Newman said: "Give me a child until he is 
 seven years old and I care not who trains him 
 afterwards." Whatever happens to us later in 
 life, of one thing we may be sure : that is, that 
 every incident of our environment and train- 
 ing, from the time we were conceived until we 
 pass out of childhood, influences our future 
 lives. 
 
CHAPTER II 
 
 PERSONAL HYGIENE 
 
 Personal hygiene includes the proper care 
 of the body and its organs so that they may 
 function and develop in a normal manner. 
 Proper personal hygiene is dependent to a 
 great extent upon the right kind of surround- 
 ings, and the normal development of the 
 young child will result not only from the care 
 that is given to the body, but also from the 
 opportunity the child has of living in a clean, 
 decent and wholesome environment. 
 
 Location of the Home 
 
 The location and general character of the 
 house where the child lives depends upon so 
 many factors that often it is difficult to pro- 
 vide the growing child with exactly the right 
 housing environment. Whenever there is a 
 choice, however, between a crowded city and 
 the more open country, or between a roomy 
 house and a limited apartment, the country 
 and the house should always be chosen. 
 
 There are many advantages in city life for 
 children, and statistics have proven only too 
 frequently that country children are not 
 better developed nor more free from disease 
 or physical defects than city children. This 
 is because, as a rule, city children have re- 
 
 29 
 
30 HEALTHY CHILDREN 
 
 ceived more attention not only from their 
 parents but from the community in order to 
 offset the evils of city life, whereas in the 
 country it has been thought that the fresh air 
 and opportunities for outdoor recreation com- 
 pensated for many defects in feeding, regular 
 hours and proper attention to the care of the 
 skin and the right kind of clothing. These 
 statements are generalities, of course, because 
 individual cases can be cited with the object 
 of proving that country life is the normal one 
 for children. Certainly, no one can seriously 
 question this statement. The physical restric- 
 tions of city life are not only burdensome for 
 parents, but they are distinctly harmful for 
 children. Nevertheless, so much depends upon 
 the child's immediate surroundings and en- 
 vironment that there is no reason why children 
 in cities should not have perfect health. This 
 may require attention and care, and a great 
 deal of effort may be necessary to give to the 
 city child the things that come quite naturally 
 to the country child, but, all things considered, 
 the country child has the greatest natural 
 advantages. 
 
 Growing children should always have the 
 opportunity for plenty of play space. As a 
 general thing, this is possible only when the 
 family occupies a detached house with a yard 
 or even a greater amount of ground. In ad- 
 
PERSON AL HYGIENE 31 
 
 dition, the house affords greater opportunities 
 for proper ventilation and plenty of sunshine 
 in the living rooms. The noise, dirt and odors 
 of the city streets are absent. Pure, clean milk 
 and green vegetables are, or should be, fresher 
 and more easily obtainable. With the same 
 amount of care and attention given to the 
 child's life, there is little doubt that the 
 country can be shown to have enormous ad- 
 vantages from the point of view of health. 
 
 Fresh Air and Ventilation 
 
 Growing children need fresh air in abun- 
 dance. It is absolutely essential for their 
 health. By fresh air is meant not an outing 
 of an hour or so each day, but outdoor life as 
 completely as possible for the entire twenty - 
 four hours. Certainly, the child of preschool 
 age should be able to have most of its recrea- 
 tion in the fresh air except in extremely cold 
 or very stormy weather. In all country 
 climates and where it is possible to have a 
 sleeping porch, the child should be trained to 
 sleep outdoors from the time it is a few weeks 
 old. A porch, preferably one that is above the 
 ground floor, can easily be changed to a sleep- 
 ing porch. It should be built up on two sides 
 and open on the other two. A roof or awning 
 over the top is advised. The child can be 
 undressed indoors, and, in cold weather, may 
 
32 HEALTHY CHILDREN 
 
 wear a warm wrapper while going out to bed 
 on the sleeping porch. Sleeping bags made of 
 a steamer rug or heavy woolen blanket will 
 be found useful. These are made by folding 
 the blanket once over and sewing it across one 
 end and partly up one side, leaving an opening 
 at the upper part of the side and across the 
 top. Snap fasteners should be sewed on this 
 opening, and, after the child has been placed 
 in the bag, the latter can be brought together 
 over the shoulders and down the side. Small 
 openings may be made, if desired, so that the 
 hands may be put through. In very cold 
 weather a woolen cap or bonnet is essential, 
 and some warm type of underclothing, such as 
 flannel petticoats or nightdrawers, with knit- 
 ted socks, should be added. The face is left 
 uncovered but the other parts of the body 
 should be kept warm and the amount of bed 
 covering used should be just sufficient for this 
 purpose. 
 
 If, for any reason, the child cannot sleep 
 out-of-doors, the bedroom should be well 
 ventilated. The windows should be open all 
 night. In order to avoid a draft, a window 
 board or window deflector may be used. This 
 may be made at home, and the purpose of 
 its use is to allow free ventilation without 
 drafts. With the window board, the air comes 
 in between the upper and lower sashes; with 
 
PERSONAL HYGIENE 33 
 
 the window deflector, the air comes directly 
 into the room, but is deflected so that there is 
 no direct air current. A good form of ventila- 
 tion for the sleeping room, particularly in 
 climates where there are high winds, is to 
 take out one of the upper panes of glass and 
 cover the opening with unbleached muslin. This 
 will give excellent ventilation without draft 
 or marked lowering of the indoor temperature. 
 There should be plenty of bed clothing, and 
 with young children it is permissible to use 
 hot water bottles if there is a tendency for the 
 feet to be cold. The bed should be placed so 
 that there is no direct current of air blowing 
 across it. If necessary, screens should be used. 
 
 Effect of Bad Air 
 
 The human body is usually quite adaptable 
 to its surroundings and people who habitually 
 live in badly ventilated rooms become so 
 accustomed to the close air that they do not 
 seem to notice it, while people coming into the 
 same room from outdoors will be almost 
 stifled. The bad effect of such vitiated at- 
 mosphere is particularly marked in children. 
 Children kept indoors in poorly ventilated 
 rooms are almost always pale, underdeveloped 
 and anemic. Usually they suffer from mal- 
 nutrition, have a poor appetite and are apt 
 to have indigestion. They are almost always 
 
34 HEALTHY CHILDREN 
 
 constipated. Marked irritability and lack of 
 concentration, with restless sleep, are all in- 
 dications that the child is not getting enough 
 air. It is probable that sleeping in badly 
 ventilated rooms promotes the growth of 
 adenoids and enlarged tonsils. Certainly, there 
 are few physical defects or varieties of ill- 
 health in children that cannot be caused by 
 lack of fresh air. 
 
 Heating and Temperature 
 
 The type of heating and the temperature of 
 rooms are closely associated with ventilation. 
 In the construction of new houses or where 
 there is any choice, the best system of house 
 heating is steam or hot water. Open fire- 
 places are excellent, particularly for sleeping 
 rooms, as they not only provide heat, but 
 serve as a means of ventilation. The ordinary 
 closed stove is probably the worst type of 
 heating we have. The oxygen in the air is 
 used up rapidly and no method is provided in 
 the heating apparatus for renewing the air. 
 Certain forms of jacketed stoves, however, 
 aid in proper ventilation. Heating by means 
 of gas stoves or oil stoves is particularly bad, 
 especially in bedrooms. They should be used 
 only where the ventilation is free and adr 
 equate, and then only for short periods of 
 time. . The temperature of the house during 
 
PERSONAL HYGIENE 35 
 
 the day should not at any time be over seventy 
 degrees, preferably sixty-five. The sleeping 
 rooms should range from fifty to sixty degrees. 
 In very cold weather the temperature may 
 be lower than this, provided the bed clothing 
 is adequate. 
 
 Clothing 
 
 The clothing of children as well as adults is 
 worn for several purposes: first and primarily, 
 for protection and warmth; second, for the 
 sake of appearances, for modesty and to ex- 
 press attractiveness or beauty. There are 
 other minor reasons for wearing clothes, which 
 are dependent upon the kind of clothes that 
 are worn, therefore, in dressing children, there 
 should be some knowledge on the part of the 
 mother of the properties and principles of 
 different clothing. 
 
 Notwithstanding the impression to the con- 
 trary, the majority of children are clothed too 
 warmly. Within the past five years there has 
 been an increasing tendency on the part of 
 intelligent parents to use washable materials 
 for dresses for girls and suits for younger boys 
 throughout the entire year, providing the 
 necessary outer wraps to meet the needs of 
 the outdoor temperature. It is not too much 
 to say that far more harm is done to children's 
 health by too much clothing than by too 
 
36 HEALTHY CHILDREN 
 
 little. The body becomes overheated, with 
 resultant tendency toward taking cold and 
 lowering the general vitality. The proper way 
 to dress children is for the temperature of the 
 day, not for the time of year. Generally 
 speaking, with our houses at a temperature 
 of sixty-five to seventy degrees during the 
 winter, the type of clothing worn indoors by 
 the child at that time should be no heavier 
 than when the outdoor temperature registers 
 the same figure. The outdoor clothing in 
 winter can be as heavy as desired, and should 
 afford complete protection to the child's body, 
 head, hands and feet. In hot weather, clothes 
 should be light and few in number. Except 
 for the mere purpose of covering the body, 
 clothing is a burden to children when the 
 temperature goes above eighty degrees. Stock- 
 ings, hats and caps are not necessary during 
 the hot weather, except that some light form 
 of straw hat may be worn as a protection from 
 the sun. In cold weather, the child's legs 
 should be covered. The fashion of having 
 growing children wear socks throughout the 
 winter, leaving the greater part of the legs and 
 knees exposed, is an extremely pernicious one. 
 The blood vessels supplying the legs lie very 
 close to the surface at the knees and exposure 
 of this delicate part of the body may easily 
 result in lowering the entire body temperature. 
 
PERSONAL HYGIENE 37 
 
 The practice cannot be too strongly con- 
 demned. 
 
 The two most important principles of cloth- 
 ing children are, first, that there shall be com- 
 plete freedom of action for the body, and no 
 constriction of any of its parts; and, second, 
 that the kind of clothing should have the 
 property of protecting the body from too 
 great a loss of heat, and that it should be of a 
 type that will absorb moisture from the body 
 surfaces and prevent too rapid evaporation of 
 the secretions of the skin. 
 
 The young and growing child should not be 
 restricted in any way by its clothing. Up to 
 the age of six years it is possible to dress boys 
 and girls almost exactly the same way. All 
 clothing should be suspended from the should- 
 ers, never from the waist line. The best type 
 of garters are those that have straps from the 
 shoulders. Round garters should never be 
 used. 
 
 The main function of clothing is to keep the 
 body warm and protect it, and it does this by 
 virtue of its power to retain or allow the 
 evaporation of the natural body heat. Warmth 
 of clothing does not depend upon weight, but 
 upon the way in which it is woven. Air is a 
 poor conductor and a thin layer of air next to 
 the body acts as a protection against the loss 
 of body heat. Loosely woven goods which 
 
3S HEALTHY CHILDREN 
 
 may retain air in its meshes is warmer than 
 closely woven fabrics. Woolen goods are 
 usually loose in texture, therefore wool is one 
 of the warmest fabrics to be used for clothing 
 in cold weather. Wool has certain undesirable 
 qualities, however. When worn next to the 
 skin it may cause marked irritation. It also 
 has a tendency to shrink when washed, and 
 thereby loses its porous qualities. Woolen 
 undergarments are not advised for children. 
 Frequently it is difficult for older people to 
 change their habits in regard to the wearing 
 of wool, but there is no reason why babies and 
 young children should wear it, except in very 
 cold climates, and even then a mixture of wool 
 and cotton is preferable. Loosely woven mesh 
 cotton shirts are best for children at all ages. 
 They are cheaper, more easily washed, gen- 
 erally more comfortable next to the skin, and 
 if they are of the right loosely woven texture 
 they give sufficient warmth and allow of ab- 
 sorption. In every way they have been shown 
 to be more healthful and their use is advised 
 in early infancy If material softer than plain 
 cotton is desired, a mixture of cotton and silk 
 or silk alone may be used. All of these are 
 preferable to wool. In cold weather the valu- 
 able qualities of air as a non-conductor of heat 
 must be remembered. Several thin loosely 
 woven garments are warmer than one heavy 
 
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PERSONAL HYGIENE 41 
 
 one, as they allow for layers of air between the 
 garments. For the same reason, several thin 
 blankets on a bed will give more warmth than 
 one heavy one. 
 
 TYPE OF CLOTHING 
 
 Outer Clothing 
 
 Under three years of age the most con- 
 venient outer garment is the romper. This is 
 a one-piece suit, made perfectly plain, with 
 drawers and waist in one. They should be 
 made of washable material. Later, bloomers 
 with blouses or smocks are suitable for girls, 
 except for formal occasions, while boys may 
 wear loose, washable blouses and trousers. 
 
 Underclothing 
 
 During the entire period between two and 
 six years of age, the underclothing should 
 consist of a shirt, preferably of cotton, muslin 
 drawers, soft waist with shoulder straps, but 
 no bones, garters attached either to bands 
 which pass over the shoulders or to the lower 
 border of the waist. 
 
 Night Clothing 
 
 For the child under six, nightdrawers are 
 advised. They may be made with or without 
 feet attached. The type with feet is advised 
 for cold weather. In the summer ordinary 
 
42 HEALTHY CHILDREN 
 
 pajamas may be used. There is no difference 
 in the night clothes for the boy and the girl. 
 When going to bed, the day shirt should be 
 changed for a clean one which is worn only at 
 night, or the child may, at as early an age as 
 one year, sleep without an undershirt. 
 
 Shoes 
 
 For the child under two years, sandals or 
 moccasins are the best type of footwear. They 
 should not have any rough seams on the inside, 
 and should be made with soft soles and no 
 heels. After two years of age, the shoes may 
 have a thin, light weight, flexible sole, but 
 heels should not be allowed until the child is at 
 least ten years of age. Shoes for young children 
 should always be of a soft material and suf- 
 ficiently large to allow the foot full and easy 
 movement. The size should be at least one 
 inch longer and half an inch wider than the 
 foot. The toes should be broad and square. 
 Except in cold weather, children should wear 
 low shoes. In winter, high shoes are advised, 
 and may be either buttoned or laced. They 
 should never be stiffened at the ankles unless 
 on a physician's advice. As children grow 
 older and their play becomes more vigorous, 
 a heavier type of shoe may be necessary, but 
 the principle of no heels, no stiffening in the 
 tops and sufficient length and breadth must 
 
PERSONAL HYGIENE 43 
 
 be adhered to. For outdoor wear, rubbers or 
 arctics must be provided for wet and cold 
 weather. It is most important that the child's 
 feet should not be wet, and they should always 
 be examined when the child comes indoors, and 
 shoes and stockings changed at once, if 
 necessary, 
 
 BATHING 
 
 The pleasure of personal cleanliness can be 
 impressed upon children at an early age, and 
 such a habit will persist throughout life. Any- 
 one who is familiar with children, however, 
 knows that the bath can be made either a 
 pleasure or a dreaded experience. There is a 
 great lesson in the attitude of the small boy 
 who will go swimming day after day, even 
 when forbidden, but who will protest vigorous- 
 ly when asked to take a bath in a tub. Prob- 
 lems of this sort may be found in every phase 
 of child care. A thing is distasteful and hard 
 when we are forced to do it, but becomes a 
 pleasure and a joy when we do it voluntarily, 
 and in the nature of play. Every mother 
 should understand thoroughly the eternal 
 principle involved in Tom Sawyer's experience 
 with whitewashing the fence. As long as it 
 was work that had to be done, he was com- 
 miserated with and considered a badly used 
 person, but when he conceived the bright idea 
 
44 HEALTHY CHILDREN 
 
 of lauding it as a particularly interesting occu- 
 pation, and offered to allow the other boys to 
 do it if they would pay him a price, immedi- 
 ately it became play of the highest order. 
 Teaching children to keep clean, therefore, 
 needs a thorough understanding of child 
 nature. It must be remembered that the boy 
 who takes a swim does so for the pure joy of the 
 swimming, not for the purpose of keeping 
 clean, whereas he looks upon the bath only as 
 a means of keeping clean, and there is no 
 pleasure attached. The effort to make children 
 like to bathe must begin in early babyhood, 
 and as soon as the child is able to take any 
 part in the process of bathing, he should be 
 encouraged to do so. Floating toys are a 
 help in this direction. Allowing the child to 
 soap itself and to splash about to its heart's 
 content, makes the bath a pleasure instead of 
 a task. 
 
 For purposes of cleanliness, there should be 
 at least two warm tub baths a week, and if the 
 child has been playing very hard and getting 
 dirty, it may be necessary to have a cleansing 
 bath every night. In addition to the evening 
 warm cleansing bath, the habit should be 
 established of having a cool sponge bath every 
 morning. Up to the time the child is six or 
 seven years old, the mother or nurse will have 
 
PERSONAL HYGIENE 45 
 
 to help with the bathing. After that time, the 
 child should be able to take the bath by itself. 
 
 Cold Baths 
 
 The cold bath is stimulating, and is best 
 taken in the morning. The child should stand 
 in a tub of slightly warm water and be bathed 
 briskly with water at a temperature of sixty- 
 five degrees/ The body should then be rubbed 
 with a coarse, dry towel. The action of the 
 cold water on the skin constricts the super- 
 ficial blood vessels and sends the blood to the 
 internal organs, thus stimulating them. 
 Breathing is increased in frequency and depth 
 so that the blood gets more oxygen and the 
 nervous system and the mental faculties are 
 stimulated. In certain children this proper 
 reaction does not take place. If there is any 
 blueness of the lips or fingers, if the child 
 shivers and seems tired and weak, if the skin 
 does not show the proper pink color, the cold 
 baths should be omitted. 
 
 Warm Baths 
 
 The warm cleansing bath removes the sweat 
 and waste matter from the skin, promotes 
 bodily vigor and increases resistance to disease. 
 It is more soothing in its effect than the cold 
 bath, therefore it should generally be given at 
 night. The water may be of a temperature of 
 
46 HEALTHY CHILDREN 
 
 ninety-five to ninety-eight degrees. Until the 
 child is about three years old, it is best first 
 to wash the face and head with a wash cloth 
 well rubbed with soap. The soap should then 
 be rinsed off and the body soaped thoroughly. 
 The child should then be placed in the tub and 
 the body well rubbed with a fairly coarse wash 
 cloth. The warm bath should not last over 
 five minutes. Unless the child is very vigorous, 
 it is best not to have the bath last more than 
 three minutes. The warm bath has a markedly 
 sedative effect upon the nervous system. Im- 
 mediately after the bath at night, the child 
 should be put to bed. 
 
 If the feet or extremities are found to be cold 
 after the bath, they should be rubbed briskly, 
 and, if necessary, a hot water bag may be used. 
 If cold feet are more or less chronic, a warm 
 salt foot bath at night is advised. This can be 
 prepared by adding a handful of ordinary rock 
 salt to a basin of water. The feet should be 
 bathed and rubbed for three minutes, then 
 given a brisk rubbing with a coarse towel. All 
 baths should be given in a warm room, where 
 the temperature is from seventy to seventy- 
 five degrees, and after the bath the child 
 should be dressed immediately or put to bed. 
 
 Soap, towels and wash cloths should be pro- 
 vided for each child in the family. They may 
 be of a distinct color for each, and may be 
 
PERSONAL HYGIENE 47 
 
 marked with the name, but should not be used 
 for any other purpose. 
 
 SLEEP AND QUIET 
 
 Rest and quiet are essential throughout the 
 period of bodily growth. At the time when 
 great structural changes are going on in the 
 child's body, it is absolutely necessary that a 
 large part of every twenty-four hours should 
 be set aside for physical and mental adjust- 
 ment. During the waking hours, certain parts 
 of the body have brief periods of repose. There 
 is a definite rest period between the heart 
 beats. In winking the eyes, there is a brief 
 period of rest. Muscular activity and nervous 
 activity are not constant, but only during the 
 period of sleep is there a cessation of all vol- 
 untary movements, which include all of the 
 actions and movements of the body controlled 
 by the will. Digestion, respiration, heart 
 action and the functions of the body that are 
 not controlled by conscious action go on, but 
 at this time the body generally has a chance 
 to recuperate. It is during this period that 
 the child gets the complete rest that is ab- 
 solutely essential if it is to remain in good 
 health. Grown people may govern their hours 
 of sleep according to their individual needs and 
 desires, each person being practically a law 
 
48 HEALTHY CHILDREN 
 
 unto himself. With children, a fixed period 
 must be adhered to. 
 
 Late bedtime, with irregular sleeping hours, 
 are particularly harmful to the child. Early 
 rising has its merits, but is entirely wrong if 
 early bedtime also is not insisted upon. Up 
 to the third year the child should sleep twelve 
 hours at night and should have at least one 
 nap of two hours duration in the daytime. 
 From three to six years, there should be not 
 less than ten hours sleep at night, with a two- 
 hour nap in the daytime. If for any reason it 
 is impossible to have the nap in the afternoon, 
 the length of the night sleep should be in- 
 creased accordingly. There should be a fixed 
 time for going to bed and nothing should be 
 allowed to interfere with this schedule. A 
 seven o'clock bedtime is late enough for any 
 child under six years of age, and in the winter 
 the bedtime may be as early as six- thirty. 
 The best time for the nap is in the afternoon, 
 preferably soon after lunch. It should be 
 arranged for sufficiently early so that there 
 will be a definite period between the end of 
 the nap and bedtime, otherwise it will be prac- 
 tically impossible to make the child go to sleep 
 again. In general, it is easier to get the child 
 to take a nap in the afternoon than in the 
 morning, when it is refreshed after the night's 
 rest. 
 
PERSONAL HYGIENE 49 
 
 Even if the child does not sleep, the daily 
 habit of the rest period is advisable, and there 
 should be a quiet two hours every afternoon, 
 with no boisterous play. This is one of the 
 times w T hen the mother may have her own 
 particular quiet companionship with her child, 
 reading stories or playing simple quiet games, 
 which do not involve any muscular activity. 
 
 To have comfortable and proper sleep at 
 night, the room should be weH ventilated, with 
 a temperature not above sixty degrees. It is 
 well to accustom the child to sleeping on a 
 fairly firm bed. Pillows may or may not be 
 provided, but if they are they should be thin 
 and firm. The last meal of the day should be 
 taken at least one hour before bedtime, and 
 should always be light in character and easily 
 digested. The child should be put to bed in 
 loose, comfortable night clothing. The bed 
 clothing should be warm enough, but without 
 much weight. It should be placed loosely over 
 the child and may be pinned on either side 
 with large safety pins which are made for the 
 purpose. It is best, in the beginning, to ac- 
 custom the child to going to bed by itself. 
 While there is great temptation to have a 
 story hour just before bedtime, or perhaps a 
 little extra coddling by the mother, this should 
 preferably be done in the afternoon. The child 
 should be placed in a darkened, cool room, in 
 
50 HEALTHY CHILDREN 
 
 a comfortable bed, then left alone. Children 
 soon learn that they are expected to go to 
 sleep at this time, and there really is no dif- 
 ficulty with a child who has been well trained 
 in this respect. It is a habit, though, that 
 / may easily be changed, and if the child finds 
 that it can have company by crying for it, it 
 will cry every night until it gets what it wants. 
 Disordered sleep is almost always an indica- 
 tion that something is definitely wrong, either 
 physically or in the training of the child. The 
 physical causes of bad sleep may be poor 
 ventilation, so that the child is restless and 
 irritable, and does not get enough fresh air to 
 breathe, or generally bodily discomfort due to 
 tight clothes or bed clothing too tightly tucked 
 in, or wrinkled sheets. Indigestion, due to 
 eating too rapidly or to improper food, is fre- 
 quently a cause of wakefulness. Children who 
 have enlarged tonsils and adenoid growths 
 sleep badly. They are almost always restless, 
 turning from side to side in bed and frequently 
 crying out in their sleep. A somewhat similar 
 condition may be noted when a child has 
 worms. Here we may have gritting of the 
 teeth, picking at the nose and extreme rest- 
 lessness. Inability to go to sleep at the proper 
 time is usually caused by too much excitement 
 at bedtime. The child should be perfectly 
 quiet after supper, and there should be no 
 
Good Posture 
 
PERSONAL HYGIENE 51 
 
 romping games or excitement of any kind. 
 All playing should be done during the day- 
 time, and supper and bedtime should be 
 quiet and undisturbed. 
 
 Sleep sometimes is delayed by fear on the 
 part of the child. Often we can trace this fear 
 back to fright or to some story that the child 
 has heard. There can be nothing more repre- 
 hensible than for a mother or nurse to control 
 a child by reciting some fear-compelling story. 
 It is not at all uncommon for children to be 
 told that if they do not go to sleep, either for 
 the nap or at night, or if they do not do cer- 
 tain things, a giant or some ferocious animal 
 will come and carry them off. Such stories 
 make a deep and lasting impression upon the 
 imagination of the little child, and when they 
 are in the dark, by themselves, the fears return 
 in such hideous proportions that self-control 
 is out of the question. The way to meet this 
 condition is by means of prevention, but if the 
 harm has already been done, the child's con- 
 fidence must be won, and the utmost tact and 
 care used in reassuring it as to its safety. Such 
 children should never be punished or treated 
 harshly. They should be told they are safe, 
 that no harm can possibly come to them, and 
 this must be repeated until they believe it. 
 
 The proper treatment for other forms of 
 disordered sleep consists in removal of the 
 
52 HEALTHY CHILDREN 
 
 cause. Attention to the presence of physical 
 defects and their correction, a quiet hour be- 
 fore bedtime, a well ventilated room, proper 
 feeding and the correction of any constipation, 
 comfortable bed clothing, and, if necessary, a 
 hot water bag at the feet, are often all that are 
 needed. It must be remembered that going 
 to sleep at night is largely a matter of habit, 
 and the cultivation of this habit must be 
 followed in a regular and orderly manner. The 
 child should not be taken up after it has once 
 been put to bed unless to have its bowels 
 move or to pass urine. After this has been 
 done, it should be returned to bed, the room 
 made quiet and dark, and the child should be 
 left alone. Some children have learned to sleep 
 with a dim light in the room. There is no 
 particular harm in this, provided the light is 
 shaded, nor is there any reason why the 
 blinds of the windows should be closed. Chil- 
 dren as well as adults dislike to feel that they 
 are shut in. Under no circumstances should 
 there be a glaring light or one that shines in 
 the face of the child. 
 
 NIGHT TERRORS 
 
 Children from two to six years of age some- 
 times have what are known as "night terrors/ ' 
 The child will go to sleep as usual and then, 
 several hours later, will awaken suddenly with 
 
PERSONAL HYGIENE 53 
 
 startled cries. The child is almost frantic with 
 fear and apprehension, and if old enough will 
 often call loudly for help. Sometimes it takes 
 a long time to quiet children when they awaken 
 in this way. The attacks may be repeated for 
 many nights in succession, or there may be 
 definite intervals between them. 
 
 Cause 
 
 Night terrors have the same cause as any 
 kind of disordered sleep. The reason why a 
 child awakens suddenly may be simply an 
 acute attack of indigestion. Any other physical 
 abnormality that would cause bad dreams 
 would produce the same effect, and the habit 
 is soon established. Some of the most com- 
 mon causes of night terrors are the presence 
 of adenoids or enlarged tonsils, acute indiges- 
 tion or some local irritation, such as pin worms. 
 Over excitement is very apt to result in this 
 sudden fright at night. 
 
 Treatment 
 
 The treatment of night terrors consists in 
 removal of the cause and placing the child in 
 good physical condition. Light diet before 
 going to bed is extremely important and every 
 effort should be made to see that the child is 
 comfortable. 
 
54 HEALTHY CHILDREN 
 
 HYGIENE OF THE NOSE AND THROAT 
 
 The bacteria which cause contagious diseases 
 nearly all gain entrance to the body through 
 the mouth and nose. If the child is in a 
 healthy, normal condition, breathes properly 
 through the nose, and has a mouth that is 
 clean and well cared for, the danger of con- 
 tracting contagious disease is greatly reduced. 
 The nose is the proper organ for breathing. 
 Before air is received into the lungs, it should 
 be clean, moist and slightly warm. The nasal 
 passages are lined with mucous membrane, and 
 this is covered with fine cilia or hairs. When 
 the air passes through the nostrils, these cilia 
 act as fine sieves or filters, and take out of the 
 air practically all of the irritating dust. The 
 mucous membrane lining the nose is also well 
 supplied with small blood vessels which lie 
 very near the surface. As the air goes through 
 the nasal passages, it is warmed by its contact 
 with these blood vessels. Although the nasal 
 passages lead directly back to the upper part 
 of the throat or pharynx, their surface is quite 
 irregular, giving a large area that comes into 
 contact with the inhaled air. This mucous 
 membrane normally secretes a certain kind of 
 moisture, so that the air in this way becomes 
 moist. When air is breathed through the 
 normal nose, we have it properly warmed, 
 
PERSONAL HYGIENE 55 
 
 cleaned and of the right degree of moisture. 
 When air is breathed through the mouth, it is 
 taken into the lungs without this change. 
 
 Care of the Nose 
 
 Normally, the nose does not require any 
 special care during childhood, except to see 
 that it is kept clean. The child should be 
 taught at an early age to use a pocket hand- 
 kerchief and how to blow the nose. A certain 
 amount of mouth breathing may be caused 
 not by any real obstruction of the nasal pas- 
 sages, but by a nose that is so filled with mucus 
 that the air cannot pass through the nostrils. 
 It is not wise to wash out the child's nose. 
 During the first two years the mother will 
 have to urge the child to blow its nose and 
 give a good deal of assistance. After that 
 time the child who is properly trained should 
 blow its own nose when it is necessary. 
 
 CARE OF THE THROAT 
 ADENOIDS 
 
 When air is breathed through the nose, it 
 passes directly into what is known as the 
 "pharynx" or upper part of the throat, from 
 which it passes into the larynx, then into the 
 bronchi or breathing passages of the lungs. In 
 young children the pharynx is small. The 
 space in it, in relation to the size of the person, 
 
56 HEALTHY CHILDREN 
 
 is less than in adult life. In nearly all children 
 there may be found in the pharynx a small, 
 soft mass of tissue which is called an "adenoid" 
 and sometimes is referred to as the "third 
 tonsil/ ' In some instances the adenoid growth 
 is so small that it does not cause disturbance 
 nor obstruction, and its presence may be con- 
 sidered normal. Occasionally, however, the 
 tissue composing the adenoid grows to abnor- 
 mal size, thus blocking the air passages, and 
 preventing the air from passing through the 
 nose. Adenoids are much more likely to 
 obstruct the nasal passages in early childhood 
 than they are later. They increase in size up 
 to eight or ten years of age. After that the 
 pharyngeal vault grows more rapidly in size, 
 and the adenoids tend to shrink, so that, 
 generally at about the time of adolescence, or 
 from fourteen to sixteen years of age, the 
 obstructive symptoms of the adenoid growth 
 disappear. By this time, however, great harm 
 may have been done if the adenoid has not 
 received proper attention. (See illustration 
 opposite page 64.) 
 
 Causes of Adenoids 
 
 While adenoid growths are apt to occur in 
 any child, no matter how well cared for it may 
 be, they are found more frequently among 
 children whose hygienic surroundings are im- 
 
PERSONAL HYGIENE 57 
 
 proper. One of the commonest causes of their 
 production is lack of fresh air and proper 
 ventilation. The air in sleeping or living 
 rooms is apt to be too dry or overheated. 
 Adenoids frequently result from the use of 
 pacifiers or from thumb-sucking in infancy. 
 Lack of proper nutrition may also be a pre- 
 disposing cause. 
 
 Symptoms 
 
 The most prominent symptom is that of 
 mouth breathing. The appearance of a child 
 who cannot breathe through its nose is so 
 characteristic that, once seen, it is rarely for- 
 gotten. Owing to the reduced amount of air 
 that is taken into the lungs, the child generally 
 has a sunken, narrow chest, with shoulders 
 protruding forward. The face has a pale ex- 
 pression and a generally stupid look. Fre- 
 quently there are dark circles under the eyes, 
 and many indications of undernourishment. 
 Sometimes there is nasal catarrh, with con- 
 stant discharge from the nose. Such children 
 are particularly susceptible to infectious 
 diseases of all kinds and seem to have little, 
 if any, physical resistance. The mentality 
 may seem impaired and in some instances the 
 child is retarded mentally, and sometimes is 
 considered to be mentally defective. There is 
 
58 HEALTHY CHILDREN 
 
 impairment of the senses of smell, taste and 
 hearing, with liability to earache and infection 
 of the inner ear. Colds and bronchitis are 
 common. Frequently there are enlarged glands 
 in the neck, and the child is susceptible to sore 
 throat. 
 
 Prevention 
 
 This includes attention to the hygiene of 
 the child. Care must begin in infancy. Fresh 
 air, proper food, attention to the hygiene of 
 the mouth and nose, outdoor sleeping, plenty 
 of exercise in the open air are important. 
 Direct contributing causes, such as the use of 
 a pacifier and thumb-sucking, must be cared 
 for in infancy. 
 
 Treatment 
 
 Adenoids do not require attention unless 
 secondary symptoms are shown. When there 
 is any obstruction, however, in the nasal 
 breathing, if the child suffers from earache or 
 nasal catarrh, or if any marked symptoms of 
 the presence of adenoids are shown, the re- 
 moval of the adenoid is advised. There are 
 sometimes reasons why this operation should 
 not be performed. The child should be ex- 
 amined by a competent physician and his 
 advice followed. 
 
PERSONAL HYGIENE 59 
 
 ENLARGED TONSILS 
 
 The tonsils are two masses of lymphoid 
 tissue, situated one on either side of the throat 
 at the back of the tongue. Ordinarily they 
 may be seen quite readily, particularly if a 
 tongue depressor is used, or if the child says 
 "ah." In the normal child, a small amount of 
 tonsillar tissue is present, and the mere fact 
 that the tonsils are large is not an indication 
 for their removal. The tonsils should receive 
 attention only when they are so enlarged that 
 they obstruct the throat or when they are 
 diseased, and so become a menace to the 
 general health. Enlargement of the tonsils 
 occurs early in life and usually reaches its 
 height between the eighth and tenth years. 
 After that time there is a tendency for them 
 to become smaller and rarely, if ever, is there 
 any added growth after adolescence. The over- 
 sized tonsil or one that is diseased, however, 
 should be removed early in childhood, because 
 of the danger that may result from its presence. 
 
 Causes 
 
 The causes of enlarged tonsils have not been 
 definitely determined. There is known to be 
 some relation between enlarged tonsils and 
 frequent attacks of tonsillitis and a rheumatic 
 tendency. Poor hygienic surroundings, partic- 
 ularly lack of fresh air and improper ventila- 
 
60 HEALTHY CHILDREN 
 
 tion, are contributing causes. Enlarged ton- 
 sils are frequently associated with adenoid 
 growths and also with septic or unclean con- 
 dition of the mouth, due to decayed teeth. 
 
 Symptoms 
 
 When the tonsils are sufficiently large to 
 cause obstruction of respiration, adenoid 
 growths are usually present also. In such 
 cases, mouth breathing results, with all its 
 accompanying conditions. Speech is apt to 
 be thick and full, the child snores in its sleep, 
 anemia and malnutrition result, and the facial 
 expression of the child changes. When the 
 tonsils are diseased, attacks of tonsillitis and 
 sore throat are common. There may be in- 
 fection of the middle ear. The germs of 
 diphtheria, influenza, scarlet fever and tuber- 
 culosis commonly find their resting place in 
 diseased tonsils and gain entrance to the body 
 in that way. Thus, the possibility of con- 
 tracting infectious diseases is greatly increased 
 and the presence of the tonsils, particularly 
 when they are associated with adenoids, lowers 
 the bodily resistance to such an extent that 
 the child is constantly "catching" some form 
 of disease. 
 
 Treatment 
 
 In cases of very large tonsils, causing ob- 
 struction, or in instances where the tonsils are 
 
PERSONAL HYGIENE 61 
 
 diseased, complete removal is the proper treat- 
 ment. The relief after operation for removal 
 of both adenoids and enlarged tonsils is usually 
 marked. The habit of mouth breathing may 
 continue for a time, and the child should be 
 watched carefully and instructed after such 
 an operation, to see that the proper method 
 of breathing is re-established. 
 
 CARE OF THE TEETH 
 
 An unclean mouth, with decayed teeth, 
 gives the most perfect condition for the growth 
 of bacteria. The cavity in a decayed tooth 
 affords darkness, moisture, warmth and food 
 — all the factors that are necessary for suc- 
 cessful bacterial growth. Decayed teeth are 
 the most widespread of the physical defects 
 found in childhood. Examinations made in 
 the schools of the country show that from 
 seventy-five per cent to ninety per cent of the 
 children have one or more decayed teeth. 
 Usually, by the time the second teeth have 
 appeared, the proper opportunity for preven- 
 tion of tooth decay has passed, to a great 
 extent. Sound teeth are of such vital impor- 
 tance to the future health and development of 
 a human being that no effort should be too 
 great to secure proper preventive measures as 
 soon as the first tooth appears. 
 
62 HEALTHY CHILDREN 
 
 Temporary Teeth 
 
 The temporary teeth are twenty in number, 
 ten each on the upper and lower jaws. They 
 appear at about the following ages: 
 
 Month 
 
 Teeth and Location 
 
 5 to 8 
 
 Two lower central incisors. 
 
 8 to 12 
 
 Two upper incisors. 
 
 12 to 18 
 
 Four lower lateral incisors. 
 
 12 to 18 
 
 Four front molars, two each on upper and lower jaws. 
 
 18 to 24 
 
 Four canine teeth, two on upper jaw known as "eye 
 
 
 teeth"; two on lower jaw, known as "stomach 
 
 
 teeth." 
 
 24 to 30 
 
 Four back molars 
 
 Usually the lower teeth appear before the 
 upper ones. 
 
 The importance of the care of these tem- 
 porary teeth is not generally recognized. 
 Mothers who are careless pay no attention to 
 this matter, feeling that, as the child is to lose 
 these teeth so soon, it is useless to spend 
 money on their care or preservation. The per- 
 manent teeth are directly under the temporary 
 ones, and decay of the first set is apt to spread 
 so that the second set is infected and the latter 
 decay almost as soon as they appear. Too 
 early extraction of the temporary teeth causes 
 the jaw to change its shape, and the second 
 teeth, instead of replacing the first ones 
 
PERSONAL HYGIENE 63 
 
 ■ '..■., , , . 
 
 normally in their proper positions, are pushed 
 to one side, grow in crooked or by their 
 crowding alter the shape of the jaw. 
 
 Permanent Teeth 
 These are thirty-two in number, sixteen on 
 each jaw. The time of their appearance is 
 about as follows: 
 
 Years 
 
 Teeth and Location 
 
 5 to 6 
 
 6 to 7 
 
 7 to 8 
 7 to 9 
 9 to 10 
 
 10 to 11 
 
 11 to 13 
 
 12 to 15 
 17 to 23 
 
 First molars. 
 
 Lower central incisors. 
 
 Upper central incisors. 
 
 Lateral incisors. 
 
 First bicuspids. 
 
 Second biscuspids. 
 
 Canines. 
 
 Second molars. 
 
 Third molars (wisdom teeth.) 
 
 The first or ' 'sixth-year' ' molars deserve 
 special consideration. Generally they appear 
 before any of the temporary teeth have been 
 lost through natural causes, and as a result 
 they are often mistaken for temporary teeth 
 and allowed to decay. They come in directly 
 back of the second molars of the first set of 
 teeth. They are the most important teeth we 
 have for grinding purposes, and their loss 
 leads to decided impairment of the function 
 of the teeth, besides contributing to the pro- 
 duction of misshapen jaws. It has been 
 
64 HEALTHY CHILDREN 
 
 startling to discover, in examining the children 
 who are entering school for the first time, that 
 seventy-five per cent of the sixth-year molars 
 are decayed almost as soon as they appear. 
 This is another reason why early instruction 
 in oral hygiene or care of the first teeth as- 
 sumes so much importance. Normally, the 
 first teeth will drop out or can be removed 
 with a very slight pull as soon as the per- 
 manent teeth that are behind begin to push 
 their way through the jaw. 
 
 Causes of Tooth Decay 
 Two main causes of tooth decay are un- 
 cleanliness of the mouth and teeth, and putre- 
 faction of food in the mouth. The decay is 
 caused by the action of the bacteria on food 
 particles, producing an acid which acts upon 
 the enamel of the teeth, dissolving out the 
 lime salts and starting the first step toward 
 decay. The habit of mouth breathing due to 
 nasal obstruction, improper feeding of soft 
 foods, eating of sweets, and particles of food 
 of all kinds left in the mouth and between the 
 teeth, hasten decay. 
 
 Symptoms 
 
 The results of tooth decay are so numerous 
 
 that it is difficult to mention all of them. 
 
 Toothache is usually the symptom which first 
 
 calls our attention to the need of care of the 
 

 Month Breathing Due to the Presence of Adenoids 
 
PERSONAL HYGIENE 65 
 
 teeth. It is, however, nothing more than a 
 warning. Sore or decayed teeth, or a jaw 
 from which teeth are missing, cause the child 
 to chew its food very little, if at all, and to 
 swallow it in that condition. The result is 
 that the child has indigestion, resulting in 
 anemia and malnutrition, with all the symp- 
 toms that go with those conditions. Another 
 direct effect of bad teeth may be the occur- 
 rence of ulcerated teeth or gum boils. The 
 lymph glands in the neck may become en- 
 larged and inflamed. Decayed teeth form 
 an excellent breeding place for germs. The 
 child is apt to contract infectious diseases, and 
 the improper chewing of food, with resulting 
 malnutrition, leads to lack of bodily resistance 
 to disease. Such children are apt to.be irri- 
 table, nervous, extremely restless and there is 
 no doubt whatever that in some instances 
 where the child is almost incorrigible, the 
 cause is the continued nervous irritation from 
 badly decayed teeth and constant toothache. 
 Headache is sometimes caused by improperly 
 cared for teeth. 
 
 Prevention of Decayed Teeth and Jaiv 
 Malformation 
 
 During the period of pregnancy the mother 
 can do much to assure good teeth to her child. 
 She should eat not only wholesome, nourishing 
 
66 HEALTHY CHILDREN 
 
 food, but food containing a proportion of 
 lime salts which are so essential in the proper 
 formation of bones and teeth. Cereals, whole 
 wheat bread, milk and eggs, are all needed for 
 this purpose. Absolute cleanliness and care 
 of the mouth of the child should be begun in 
 earliest infancy. As soon as the first teeth 
 appear, they should be washed after each 
 feeding. For this purpose a soft linen cloth or 
 piece of absorbent cotton should be wound 
 around the little finger of the mother or nurse. 
 This should be dipped in a solution of soda 
 bicarbonate (baking soda), one teaspoonful to 
 a pint of water. The mouth does not need to 
 be washed out, but the teeth should be 
 cleansed carefully. From the time the child 
 is two years old, a soft toothbrush should be 
 used for this purpose. By the time the child 
 is three years old, it should be able to use the 
 toothbrush itself. The teeth should be washed 
 night and morning, and, if possible, after the 
 noonday meal. 
 
 Many methods of brushing the teeth have 
 been advocated. One consists in brushing 
 the upper and lower sets separately with a 
 circular motion of the brush, and one in brush- 
 ing the teeth directly up and down. In either 
 method, care should be taken to see that the 
 inside of the teeth is brushed as well as the 
 outside. 
 
PERSONAL HYGIENE 67 
 
 One of the best ways to clean the teeth, and 
 at the same time help to make them stronger 
 and firmer, is the use of some food which re- 
 quires thorough chewing. At one year the 
 child may be given dry crusts of bread and 
 zwieback. For at least two meals of the day 
 there should be some article of food which the 
 child must chew thoroughly. It is probable 
 that the reason why primitive races had good 
 teeth was that they had to do their tooth 
 cleaning in this manner. Their food was not 
 prepared in the careful way in which ours is, 
 and the chewing of tough food not only kept 
 the teeth in a cleanly condition, but made 
 them strong and less likely to decay. 
 
 If it is at all possible, the child should be 
 taken to the dentist at least once every six 
 months after the first teeth appear. At that 
 time the dentist can see whether the gums and 
 teeth are in good condition, whether there is 
 any possibility of the jaw becoming malformed, 
 and if there is any slight corrective work to 
 be done. The small expenditure that is re- 
 quired for such care will be repaid many 
 times in later life. The condition of the second 
 teeth depends so largely upon the first teeth, 
 and the type of habits the child has acquired 
 with regard to the hygiene of the mouth, that 
 no effort can be considered too great to keep 
 
68 HEALTHY CHILDREN 
 
 the first teeth in good condition and to 
 establish proper habits of mouth hygiene. 
 
 EYES AND EARS 
 
 The ear itself should receive no particular 
 attention, except the care that is essential for 
 cleanliness. Under no circumstances should 
 an attempt be made to clean out the ear with 
 any instrument, whether of metal or wood. 
 The outer ear should always be kept clean, but 
 the ear canal should be left alone. The most 
 common affection of the ear in childhood is 
 earache, which is referred to in the chapter on 
 "The Common Diseases of Childhood.' ' Deaf- 
 ness, however, is such a serious matter that 
 there should be some consideration of the 
 hygiene of the ear, particularly as it relates to 
 care of the nose and throat. 
 
 CAUSES OF MIDDLE EAR DISEASES OR 
 DEAFNESS 
 
 Adenoids and enlarged tonsils, with result- 
 ant chronic catarrh, are contributory causes 
 to disease of the middle ear. There are two 
 fine tubes, known as the "eustachian tubes," 
 which run directly from either side of the 
 throat to the middle section of each ear canal. 
 In any acute inflammation of the throat or 
 pharynx, or in cases of diseased tonsils or 
 adenoids, there is the possibility of some in- 
 fection going through the eustachian tube to 
 
PERSONAL HYGIENE 69 
 
 the middle ear and causing middle ear disease. 
 Neglected colds also may be a cause of some 
 inflammation of the middle ear. 
 
 Symptoms 
 
 Earache is referred to elsewhere. The early 
 signs of deafness may be the result of inflam- 
 mation of the middle ear and consequent 
 rupture of the eardrum, or it may be the result 
 of wax that is imbedded in the outer ear canal. 
 Usually it is manifested first by the child's 
 inattention. Frequently this is thought to be 
 stupidity when in reality it is inability to hear 
 properly. Occasionally, children will show this 
 condition by the attitude of straining to hear 
 when spoken to. There may be some impair- 
 ment of speech. 
 
 Prevention 
 
 Attention should be paid to all hygienic 
 measures of child life. Any attack of earache 
 should lead to examination of the child to 
 determine the presence of adenoid growths or 
 enlarged, or diseased tonsils. These should 
 receive immediate attention. 
 
 Treatment 
 
 Treatment of deafness can be outlined only 
 by a qualified physician, and on the first 
 symptoms or indication of any deafness the 
 child should be taken to a doctor at once. It 
 
70 HEALTHY CHILDREN 
 
 may be that the only treatment necessary will 
 be removal of the wax from the outer ear. 
 However, if there is actual impairment of 
 hearing, due to disease or as the result of 
 disease of the inner ear, specialized care should 
 be given as early as possible. 
 
 CARE OF THE EYES 
 
 Infectious diseases of the eyes are considered 
 under the chapter on "infectious contagious 
 diseases." Ordinary hygiene of the eyes, how- 
 ever, is important in prevention of eyestrain 
 and its early correction and to detect defect- 
 ive vision. 
 
 CAUSES OF DEFECTIVE VISION 
 
 In early life the causes of defective vision 
 are eyestrain or some abnormal condition of 
 the eye. 
 
 Symptoms 
 
 The symptoms of eyestrain and defective 
 vision in early life are so closely related that 
 they may be considered together. The child 
 may complain of discomfort or even pain in 
 the eyes, particularly if it has been playing at 
 a game which requires close vision. The eyes 
 may itch, smart or burn. There may be in- 
 crease in the tear secretion so that the eyes 
 water frequently. The conjunctiva or white of 
 the eye and the inner surfaces and edges of the 
 
PERSONAL HYGIENE 71 
 
 lids may become congested, red and inflamed. 
 Sometimes there is sensitiveness to light. 
 Books and toys are held close to the eyes and 
 there is evidence that the child does not see 
 clearly. Occasionally the only symptom noted 
 will be that the child is frowning. Reflex or 
 indirect symptoms of eyestrain are headache, 
 nausea, indigestion, car sickness, dizziness, 
 nervousness, outbursts of temper, twitching 
 of the facial muscles, sometimes stuttering or 
 stammering, and there may be impairment of 
 the general health. Some cases of under- 
 nourishment can be traced to continued eye- 
 strain. 
 
 Prevention of Eyestrain 
 
 In young children the eyes should be shielded 
 from strong light. When they begin to read 
 books, those with large print and unglazed 
 paper should be used and they should never 
 read in a dim light or by artificial light, unless 
 the latter is placed in such a position that the 
 rays will come over the child's left shoulder. 
 It is not necessary to wash out the child's eyes 
 daily, but after playing in a dusty place or if 
 there is the slightest sign of inflammation of 
 the eyes, it is well to wash them out carefully 
 with boric acid solution. This can be done by 
 having the child sit in a low chair, with head 
 bent back so that the child is looking directly 
 
72 HEALTHY CHILDREN 
 
 at the ceiling. A perfectly clean piece of gauze 
 or absorbent cotton should be wet with boric 
 acid solution and held about two inches above 
 the eye, then squeezed gently, The excess 
 solution may be wiped off lightly, but the eye 
 should not be rubbed. If any sign of eye- 
 strain develops, the child should be taken to an 
 oculist at once. Defective vision in later life 
 may often be prevented by the use of properly 
 adjusted glasses during the early years. 
 
 Treatment of Defective Vision 
 
 If defective vision is found to exist, the act- 
 ual treatment must be left entirely to the 
 physician. 
 
 Squint (Cross Eye) 
 
 The eyeball is held in place in the eye-socket 
 by means of small muscles. Occasionally one 
 of these muscles will become contracted so 
 that the eyeball will be pulled in that direc- 
 tion, thus causing what is known as ' 'squint' ' 
 or ■ 'cross eye." This condition is not uncom- 
 mon in young babies but tends to disappear in 
 later life. If it continues after the third month, 
 prompt attention should be given to it. Squint 
 usually results in overstraining the eye that 
 has normal muscles, and also results in poor 
 vision in the affected eye. Occasionally, squint 
 may be corrected by the use of proper glasses 
 
PERSONAL HYGIENE 73 
 
 prescribed by a competent oculist. In other 
 cases, a slight operation, which consists in 
 cutting the contracted muscle, may be neces- 
 sary. This cannot be decided, however, by 
 anyone but a physician who has had an op- 
 portunity of examining the child. 
 
CHAPTER III 
 
 TRAINING FOR GOOD HABITS 
 
 The establishment of proper and regular 
 habits in any child begins at the time it is 
 born. A baby soon learns that if it cries to be 
 taken up and its wish is gratified, it can 
 get anything it wishes by crying for it, and the 
 habit is established. For the immediate com- 
 fort of both mother and child, as well as for the 
 future good of the child, proper habits should 
 be established as early as possible in infancy. 
 Reference is made here particularly to physi- 
 cal habits. Mental habits, and those which 
 have to do with proper mental training and 
 discipline, are considered elsewhere. 
 
 REGULARITY 
 
 The most important single item in training 
 a child to maintain good health is regularity. 
 The time and number of baths each week 
 should be outlined, and the schedule adhered 
 to. Meals should be at definite and regular 
 hours. The child should go to sleep at a stated 
 time and get up at a regular time. If naps 
 are necessary, as they always are for children 
 of preschool age, the child should have its nap 
 at a definite hour each day. It is not neces- 
 sary to make life a matter of sheer routine, by 
 planning out a time table for the child and 
 
 74 
 
TRAINING FOR GOOD HABITS 75 
 
 following it, for after a very short time the 
 habit of regularity becomes so fixed that it is 
 not irksome or hampering in any way, and 
 without question the child expects certain 
 things at certain hours of the day, and learns 
 to meet them. Such training lays the founda- 
 tion for excellent mental habits and is the best 
 beginning we can make toward the right kind 
 of discipline. 
 
 TRAINING THE BLADDER 
 
 A beginning can be made in teaching the 
 child to control its bowels and bladder at as 
 early an age as six weeks to two months. A 
 very small chamber or a small, deep dish with 
 wide, spreading edge, should be selected. For 
 the purpose of training the bladder, the 
 mother should sit in a chair and place the 
 chamber in front of her, holding the child over 
 the chamber with its back resting against her 
 knees. This should be done at least four times 
 a day, at regular intervals. In addition, the 
 baby should be placed over the chamber the 
 last thing at night, and if it is awakened for a 
 night feeding, the opportunity may be taken 
 to repeat the procedure. 
 
 Training the child to pass its urine in this 
 way is a much more difficult task than train- 
 ing the bowels, but if persisted in and kept up 
 regularly, it frequently is possible within a 
 
76 HEALTHY CHILDREN 
 
 few weeks to train the baby so that it knows 
 exactly what is expected of it, and when placed 
 on the chamber it will pass its urine. Even 
 if such training does not begin at the very 
 early age mentioned it should never be neglect- 
 ed beyond the eighth or ninth month, and if 
 begun at that time it is almost always possible 
 to train the child so that, by the time it can 
 run about, it is able to control its bladder, and 
 to make known when it wishes to pass urine. 
 
 BED-WETTING 
 
 With proper training, a child should learn to 
 control its bladder by the time it is a year old. 
 Occasionally, however, there are cases where, 
 with the best of training and perfect control 
 during the daytime, the child seems unable 
 to avoid wetting the bed at night. Occasion- 
 ally, children have good habits in this regard 
 until they are four or five years old, then 
 suddenly begin the habit of bed-wetting. 
 
 Causes 
 
 When a child continues to urinate at night, 
 notwithstanding all efforts that have been 
 made to control the habit, the cause is usually 
 beyond its control and consists of some 
 physical defect or irritation. It may be that 
 the child is suffering from enlarged tonsils or 
 adenoid growths, which prevent proper breath- 
 
TRAINING FOR GOOD HABITS 11 
 
 ing and cause extreme restlessness throughout 
 the night. Chronic constipation, pin worms or 
 some other irritation around the genital organs 
 are also exciting causes. Wrong feeding, that 
 is, food taken late at night or too much liquid, 
 contributes toward the habit of bed-wetting. 
 
 Treatment 
 
 The establishment of good habits is the 
 most important and first method to be fol- 
 lowed. The child should be taught to have 
 regular times for passing the urine throughout 
 the day, and should be placed on the chamber 
 at such regular intervals. It may be neces- 
 sary to do this as often as once every hour in 
 the beginning of the treatment, but the in- 
 terval can be lengthened later to once every 
 three or four hours. In every instance, how- 
 ever, the child must be placed on the chamber 
 the last thing at night and once or twice 
 during the night. The diet should be adjusted 
 so that the child has no liquids after four p. m. 
 Supper should be very simple, consisting of 
 easily digested foods such as cereal with butter 
 but no milk, some crackers or toast, and 
 stewed fruit. If physical defects are found to 
 exist, they should be removed. The suspicion 
 that pin worms may be present should be in- 
 vestigated and proper treatment given. Con- 
 stipation must be corrected, and it may be 
 
78 HEALTHY CHILDREN 
 
 necessary to have an examination made of the 
 child to see if there is any irritation about the 
 genital organs. If other methods fail, raising 
 the bed at the foot should be tried. Blocks 
 may be placed under the foot of the bed so 
 that it is raised four or five inches. The child 
 should sleep without a pillow, so that the head 
 may be distinctly iower than the rest of the 
 body. 
 
 Sometimes bed -wetting is caused by the 
 child habitually lying on its back. An easy 
 way to correct this tendency is to take a long 
 strip of muslin and tie a knot in the center. 
 The strip should then be placed around the 
 child's body so that the knot comes directly 
 in the middle of the back. It should be tied 
 loosely so that there will be no constriction. 
 When the child falls asleep and attempts to 
 lie on its back, the knot immediately makes 
 it uncomfortable and causes it to turn back 
 on its side. 
 
 A child should never be punished for this 
 habit. There is no doubt that children so 
 affected suffer mentally from this failing and 
 would gladly control themselves if they could. 
 If, after all possible methods have been tried, 
 the bed-wetting still continues, a certain 
 amount of moral suasion may be used. Even 
 in such cases, however, it is better not to use 
 it in the nature of penalties, but rather in the 
 
TRAINING FOR GOOD HABITS 79 
 
 nature of rewards. The child may be told 
 that it may have certain things it wants or 
 that it may do certain things it considers 
 desirable, if the habit is controlled. When all 
 home measures fail, the child should be ex- 
 amined carefully by a competent physician to 
 determine whether there is any physical cause 
 for the continued habit. 
 
 TRAINING THE BOWELS 
 
 Training the bowels is not as difficult as 
 training the bladder. Constipation is extreme- 
 ly common in infancy, and if allowed to con- 
 tinue it becomes almost chronic during child- 
 hood and later life. There are few bodily 
 conditions which cause so much ill health as 
 constipation. The failure of the body to get 
 rid properly of these waste products leads to 
 a kind of self-poisoning which is always re- 
 flected in some type of ill health. Learning 
 to have the bowels move regularly is one of 
 the cardinal points in the training of child- 
 hood. The training may easily be begun when 
 the child is not over six weeks of age. 
 
 At that period the average child will have 
 from two to three bowel movements a day, 
 therefore the training can take place at the 
 same time that the child is placed on the 
 chamber to pass its urine. At first no results 
 will be noticed. The child will not under- 
 
80 HEALTHY CHILDREN 
 
 stand what is expected of it, and in all prob- 
 ability the bowels will not move. The main 
 point is to establish the habit of putting the 
 child on the chamber at exactly the same 
 time each day, preferably immediately after 
 breakfast, before the afternoon nap and the 
 last thing in the evening. The training hours, 
 once established, must be adhered to strictly. 
 If the bowels do not move after the first week 
 or two of this schedule, it is permissible to use 
 a small soap or gluten suppository. These 
 will almost always stimulate the bowels to 
 move, and if used only at the time the child is 
 placed on the chamber, it will soon learn just 
 what is expected at this time. Ordinarily, after 
 a few weeks, it will not be necessary to use a 
 suppository and the child will have a perfectly 
 normal movement. without it. 
 
 CONSTIPATION. 
 
 Causes 
 
 Neglect of a regular time for bowel move- 
 ments is the most ordinary cause of constipa- 
 tion. The next most prominent cause is the 
 wrong type of feeding. The child does not get 
 enough coarse food to eat — that is, whole 
 wheat bread, cereals or fibrous vegetables. 
 Frequently, children do not have enough 
 variety in their food, and not enough liquid. 
 Occasionally, a child is getting too much milk. 
 
TRAINING FOR GOOD HABITS 81 
 
 Some parents have the idea that because milk 
 is a very nutritious and wholly desirable food 
 for young children, it may be given to the 
 exclusion of other articles of food. That is 
 not so, and the child from two to six years of 
 age should not receive over one and a half 
 pints of milk a day as the maximum. The 
 remainder of the diet should be made up of a 
 varied assortment of other types of food. 
 Occasionally, children from two to six years 
 of age suffer from constipation because the 
 toilet seat is not adjusted to suit them. The 
 seat may be too high and they cannot rest 
 their feet against anything that will give their 
 adominal muscles an opportunity to aid in the 
 process of expulsion of the bowel contents. 
 
 Treatment 
 
 Chronic constipation cannot be cured by 
 the use of drugs or the continued use of 
 enemas. These may be used as emergency 
 measures and on the doctor's advice, but con- 
 tinued use of any laxative or cathartic 
 medicine or enemas tends to weaken the 
 natural power of the bowel to expel its con- 
 tents, and ultimately makes the constipation 
 much worse. 
 
 If it is necessary to use medicine for the 
 relief of constipation, milk of magnesia in tea- 
 spoonful doses from one to four times a day is 
 
82 HEALTHY CHILDREN 
 
 advised for very young children. A mixture 
 of rhubarb and soda is a mild laxative, and 
 may be given in teaspoonful doses four times 
 a day. Compound licorice powder, a teaspoon- 
 ful dissolved in a quarter glassful of water, is 
 an excellent cathartic when given at night. 
 Castor oil or calomel should be used as a 
 cathartic only at the beginning of acute illness 
 or when there is an indication of general con- 
 stitutional disturbance. All these drugs, how- 
 ever, are subject to the limitations mentioned 
 above, and should be used for a short time 
 only, or in the presence of acute illness or 
 some other condition of emergency. 
 
 Other adjustments in the child's life that 
 are necessary to correct constipation are in- 
 dicated by the causes. A regular time for 
 going to the toilet is of the first importance. 
 The diet should be adjusted to suit the in- 
 dividual needs of the child. More rough food, 
 such as cereals, whole wheat bread and fresh 
 vegetables, should be given. The child should 
 have fruit, preferably orange juice or prune 
 juice, every morning, with stewed fruit at the 
 evening meal. The amount of milk taken each 
 day should be controlled with reference to the 
 needs of the child, with an allowance of one 
 and a half pints between two and six years of 
 age. The diet should be varied. A special 
 toilet seat should be built for the child, which 
 
TRAINING FOR GOOD HABITS 83 
 
 can be adjusted to its growth. In addition to 
 these measures, regular and systematic exer- 
 cise outdoors will be found one of the greatest 
 aids in controlling the habit of constipation. 
 
 THUMB SUCKING 
 
 Thumb sucking is a habit which is usually 
 acquired in early infancy. The habit is harm- 
 ful and every effort should be made to correct 
 it. 
 
 Causes 
 
 The causes are mainly those of habit and 
 possibly a nervous tendency on the part of 
 the child. 
 
 Results 
 
 If begun in early infancy, thumb sucking 
 will often cause a misshapen mouth and jaw. 
 The upper jaw is apt to protrude, the lips 
 become soft and flabby, the teeth may be 
 irregular and the constant sucking tends 
 toward the formation of adenoids and en- 
 larged tonsils, with resultant mouth breathing. 
 In addition, the habit is a filthy one, in that 
 the child's thumb may be dirty and thus 
 convey infection to the mouth. Some children 
 suck a finger instead of a thumb, but the results 
 are the same. Occasionally, young children 
 have the habit of sucking a piece of bed 
 clothing or their own clothing, or some other 
 
84 HEALTHY CHILDREN 
 
 object. Such cases vary little, either in their 
 results or treatment, from thumb sucking. 
 
 NAIL BITING 
 
 This habit usually begins when the child is 
 two or three years of age. It is more common 
 in nervous, shy children, who may acquire the 
 habit as a means of covering embarrassment. 
 It may be acquired, also, as the result of copy- 
 ing the habit in others. Once acquired, it 
 persists even into adult life, if strenuous efforts 
 are not made to control it. The results are 
 shown in badly disfigured nails and 'fingers. 
 At times the biting goes on to such an extent 
 that the nails are almost completely bitten 
 away, and may even become badly infected. 
 The habit is so disfiguring that every effort 
 should be made to control it at as early an age 
 as possible. 
 
 Treatment 
 
 The treatment of thumb sucking and nail 
 biting should be wholly mechanical. The use 
 of bitter drugs on the ends of the fingers has 
 not been found to be successful, and their long 
 continued use may easily result in upsetting 
 the child's digestion. 
 
 For very young children, round aluminum 
 mits which fasten over the child's hands are 
 sometimes used, but they are not as good as 
 a form of elbow cuff. The aluminum mits 
 
TRAINING FOR GOOD HABITS 85 
 
 prevent the child's putting its fingers into its 
 mouth, it is true, but at the same time they 
 also prevent its playing or using its hands for 
 any other purpose. The safest mechanical 
 restraint is an elbow cuff which is made by 
 taking a piece of cardboard from four to six 
 inches long and from six to eight inches wide, 
 depending upon the size of the child. The 
 cardboard should be rolled into the form of a 
 cylinder and the edges pasted or sewed 
 together. Adhesive plaster may be used for 
 this purpose. The cardboard should be stiff 
 enough so that the cuff will not bend, and the 
 cuff should fit loosely over the child's elbow, 
 reaching a point midway between wrist and 
 elbow at the lower edge and midway between 
 elbow and shoulder at the upper edge. It 
 should be fastened to the child's dress with 
 safety pins. This type of cuff allows the child 
 to use its hands with perfect freedom, but 
 does not permit it to bend the elbows so that 
 its fingers can reach its mouth. This method 
 of restraint should be carried on both day and 
 night until the habit is completely controlled. 
 
 MASTURBATION 
 
 Masturbation or self-excitement of the 
 sexual organs may occur even in early infancy. 
 At that time it is comparatively easy to control. 
 When it occurs in later childhood, however, it 
 
86 HEALTHY CHILDREN 
 
 may prove to be exceedingly difficult to deal 
 with. 
 
 Causes 
 
 The causes of masturbation in young chil- 
 dren are usually physical. There is almost al- 
 ways some irritation about the genital organs. 
 In the boy this may be due to a constricted 
 foreskin or in the girl there may be some 
 adhesions present. Occasionally the irritation 
 caused by pin worms will make the child begin 
 the habit of masturbation. Usually children 
 are quite unconscious of the habit, except that 
 it gives them a more or less pleasurable 
 emotion. Older children may consciously copy 
 the habit from others, but before five years of 
 age it is probable that in some wholly in- 
 nocent way the child observes a certain amount 
 of pleasure to be obtained from friction of the 
 genital organs, and thereafter repeats the 
 process. 
 
 Symptoms 
 
 The child may be noticed handling the 
 genital organs or may be seen to rub the lower 
 part of the body against some article of 
 furniture or the act may be accomplished by 
 the child simply rubbing its thighs together. 
 Usually the face becomes slightly flushed, 
 followed by some perspiration, and invariably 
 
TRAINING FOR GOOD HABITS 87 
 
 the child is more or less fatigued and often 
 drowsy afterwards. 
 
 Treatment 
 
 The treatment consists in very close observa- 
 tion. If the friction is carried on with the 
 hands, the aluminum mits may be used. Such 
 children should be kept under constant obser- 
 vation throughout the day. At night they 
 should be put to sleep with a pillow between 
 the legs. Attention must be paid to any 
 physical defect or local irritation that may be 
 present, and the doctor should be consulted 
 if there is any possibility of adhesions being 
 present in the girl or tight foreskin in the boy. 
 There is no medical treatment for this habit. 
 
CHAPTER IV 
 
 FOODS AND FEEDING 
 
 A child's health depends almost entirely 
 upon its nutrition, and nutrition to a great 
 extent is dependent upon the amount and kind 
 of food the child eats. The science of feeding 
 babies has received a large amount of attention 
 for many years, because it has been realized 
 that the baby's life may be dependent upon 
 the selection of the proper food. After the 
 weaning period, however, less attention has 
 been paid to the matter, notwithstanding the 
 fact that during the preschool age period we 
 must lay the foundation for health in after 
 life, and that any wrong feeding or under- 
 nourishment during that time will affect the 
 nutrition and growth of the child in a manner 
 that cannot be corrected later. 
 
 Adults need food for two purposes : replacing 
 waste tissue and supplying energy. Children 
 need food for these purposes, and, in addition, 
 for the promotion of growth. The child's 
 need of proper food for those purposes far 
 exceeds that of the adult, and in proportion 
 to its size, the child requires for the main- 
 tenance of proper bodily nutrition three times 
 as much food as the grown person needs. 
 
 In order to determine what types of food 
 and feeding are best for the growing child, 
 
 88 
 
FOODS AND FEEDING 89 
 
 it is necessary to understand something of the 
 characteristics of the foodstuffs themselves. 
 All foods contain one or more of the following 
 elements: fats, protein, carbohydrates (starches 
 and sugars), mineral matter and water. 
 
 Fats 
 
 Fats in food furnish energy and heat for 
 the body. They serve the same purpose as 
 fuel does in a stove or furnace. While some 
 fat is stored in the body for the protection of 
 the muscles or as a reserve which is drawn 
 upon for any unusual effort or when extra 
 bodily heat is essential, the main use is to give 
 warmth to the body and to provide necessary 
 energy. Because of their heat-giving quali- 
 ties, it may readily be seen that the fats are 
 more acceptable and digestible in cold than 
 in warm weather. They are found mainly 
 in butter, cream, cheese, oils, nuts and in 
 certain kinds of meat and fish. 
 
 Protein 
 
 Protein in food forms the body structures; 
 that is, it builds the tissues, such as the bones 
 and muscles. Also, it replaces waste tissue that 
 has been used up in the exercise of energy. 
 Protein is of great importance in promoting 
 growth. It occurs in lean meats, fish, eggs, 
 milk, grain such as oats, wheat and rice, and 
 
90 HEALTHY CHILDREN 
 
 in the fleshy vegetables, such as beans, peas 
 or lentils. 
 
 Carbohydrates 
 
 Carbohydrates are taken into the body 
 chiefly in the form of sugars and starches. 
 They are heat and energy-producing foods, 
 and are essential for growth. The starches 
 occur in certain vegetables like peas, beans, 
 potatoes and corn, and in the various forms 
 of grain. Sugar occurs in its natural form, 
 also in fruits and in many other foods. 
 
 Mineral Matter 
 
 Mineral matters are used mainly in build- 
 ing up the mineral tissues of the bones and 
 teeth. They are extremely important to 
 the growing child, just as they are important 
 in the diet of the pregnant woman. They 
 occur in a large variety of foodstuffs such as 
 the cereals, milk and eggs. They occur also 
 in common salt, and may be found in certain 
 vegetables such as spinach, cabbage and 
 celery. 
 
 Water 
 
 Water is contained in food in order to hold 
 the particles in suspension or to dissolve them. 
 In the body, water forms a large part of all 
 of the tissues and is essential to sustain life. 
 It acts also as a diluent and a means whereby 
 
FOODS AND FEEDING 91 
 
 waste products may be carried off from the 
 organs and tissues of the body. It is present 
 in practically all foodstuffs. 
 
 Great advances have been made recently in 
 the consideration of types of foods that best 
 promote growth and nutrition. It seems to 
 be determined that certain kinds of food, 
 although appetizing and hitherto considered 
 of great nutritive value, have in reality very 
 little to recommend them except their taste 
 and the fact that they satisfy the appetite. 
 Recent investigations have demonstrated the 
 presence of what are known as "vitamines" 
 in certain kinds of foodstuffs. Vitamines 
 are those principles in foodstuffs which fur- 
 nish a certain element that is absolutely es- 
 sential for growth and nutrition. These vita- 
 mines have certain qualifying names: that 
 is, there are the fat soluble vitamines which 
 are contained in certain kinds of foods. They 
 are especially abundant in butter-fat, milk, 
 the yolks of eggs, cod liver oil or any other 
 oil or fat of animal origin and in the leafy 
 and some other vegetables. They are also 
 found in kidneys, sweetbreads and liver. 
 Some article of food containing these vita- 
 mines must be present in the diet if proper 
 growth and nutrition are to be maintained. 
 The second type of vitamine is known as the 
 water soluble vitamine. It is found par- 
 
92 HEALTHY CHILDREN 
 
 ticularly in milk, eggs, whole wheat, tomatoes, 
 turnips, the green, leafy vegetables such as 
 lettuce, cabbage, cauliflower, spinach and the 
 tops of beets and turnips, and the juicy fruits, 
 such as oranges, lemons and grapefruit. 
 
 There is a third vitamine, known as the 
 1 'antiscorbutic vitamine/' This is the type 
 of vitamine or health-giving principle which 
 prevents scurvy and which is found in cer- 
 tain types of fresh foods such as milk, some 
 vegetables, fruit juices and the juice of to- 
 matoes. In infancy, the juice of canned to- 
 matoes or the juice of oranges may be used 
 to prevent scurvy. This is not necessary 
 if babies are breast fed or fed on fresh, raw 
 milk, but is essential if the milk is pasteurized . 
 After infancy, when the child is getting other 
 foods, the use of some definite antiscorbutic 
 food is not so essential as it is in infancy, 
 nevertheless some of these foods must be 
 included in the regular dietary. This is one 
 of the reasons why milk, fresh vegetables and 
 fresh fruits are so important for the growing 
 child. 
 
 The great importance of mineral matter, 
 particularly calcium, in foodstuffs, should be 
 emphasized. These salts are essential not 
 only in building up the bones and teeth but 
 they have a favorable influence on the body 
 in general and are necessary for the main- 
 
FOODS AND FEEDING 93 
 
 tenance of good health. They are found in a 
 large variety of vegetables. When the latter 
 are cooked in water for any length of time, the 
 salts are usually extracted and remain in the 
 water in which the vegetables were boiled. 
 This water, therefore, has great nutritive value 
 and should never be thrown away but used in 
 some form of cooking. It may be made palat- 
 able when used as the foundation for gravies 
 or soups. 
 
 Proper diet for any growing child, there- 
 fore, must contain not only the actual food 
 constituents in a reasonable balance, so that 
 the needs of growth may be met, but it must 
 also contain the foods in which the vitamines 
 are found, otherwise the child will be under- 
 nourished and underdeveloped. The proteins 
 of cereals and meat are important, as are 
 the starches of certain tubers and fleshy 
 vegetables. The fats of vegetable origin 
 will furnish heat and energy to the body, 
 and all of them are needed for proper 
 development. It cannot be emphasized 
 too strongly, however, that any diet con- 
 sisting simply of meat, potatoes or other root 
 or fleshy vegetables and cereals will not main- 
 tain the proper and regular nourishment of 
 the body, particularly that of the growing 
 child. Such foods must have a liberal ac- 
 companiment of the two main types of food- 
 
94 HEALTHY CHILDREN 
 
 stuffs that contain the vitamines: first, milk, 
 and second, the leafy vegetables. 
 
 TYPES OF FOOD 
 
 Milk 
 
 Milk in itself is an almost perfect food, and 
 when necessary it can be taken alone and will 
 sustain life. There is no time in the life his- 
 tory of the individual when the use of milk 
 should be neglected. It is the most nearly 
 perfect food that we know anything about 
 and is the only perfect food for the baby or 
 child. 
 
 Milk is essential for the diet of the growing 
 child, but it must not be used to the exclusion 
 of all other foods. There is a certain tendency 
 to rely too much upon milk as a proper diet 
 for young children. Even in infancy it is 
 well to supplement the milk diet with some 
 other types of food after the baby is from six 
 to eight months old. From one to two years 
 the child should have at least one quart of 
 milk a day, and from two to six years, one 
 and a half pints. If the milk that is used 
 comes from Jersey cows, it should have part 
 of the cream removed before it is used. If 
 more than this amount of milk is given, the 
 child is apt to be satisfied with the milk diet 
 alone and to lose its appetite for other foods. 
 This should not be allowed to occur. One 
 
FOODS AND FEEDING 95 
 
 and a half pints of milk a day is absolutely 
 necessary, and can be given partly in the form 
 of fluid milk — that is, a glassful between meals 
 and at night — and the rest can be given either 
 in small amounts with meals or in the form 
 of soups, ice cream, junket or cooked with 
 vegetables. The milk given to young chil- 
 dren should never be ice cold, although it 
 must be kept cold in the home from the time 
 it is received until it is used, and should never 
 be above fifty degrees Fahrenheit in temper- 
 ature, 
 
 Cereals 
 
 The cereals given to young children should 
 be well cooked. Although there are on the 
 market many types of cereals that are ad- 
 vertised as already cooked, they should be 
 cooked again for two or three hours. A fire- 
 less cooker is excellent for this purpose, as 
 the cereal can be prepared the night before 
 and will be ready for use the following morn- 
 ing. Dry cereals are not advised for young 
 children. They do not contain an amount of 
 nourishment equal to that of the cooked 
 cereals and their bulk is apt to satisfy the 
 child's appetite so that it will not eat other 
 and more nourishing foods. The best kinds 
 of cereals for young children are oatmeal, 
 hominy, farina, corn meal, the wheat foods 
 
96 HEALTHY CHILDREN 
 
 and rice. The latter should not be polished 
 white rice but the so-called brown or natural 
 rice. 
 
 Meats 
 
 Young children should not have meat more 
 than once a day; in fact, it is perfectly pos- 
 sible to fill all the requirements of a mixed 
 diet if meat is given not more than three 
 times a week. The best kinds are beef in 
 the form of roast or beefsteak, lamb roasted 
 or lamb chops or well cooked chicken. It is 
 important that the child should be taught to 
 chew all meat thoroughly. In this way the 
 food is subdivided into small portions before 
 it reaches the stomach and therefore is more 
 readily digested, and the process of chewing 
 is excellent for strengthening and cleaning the 
 teeth. 
 
 Fish 
 
 Fish should never be served to a child on 
 the same day with meat. Nearly all fresh 
 fish that are caught in local waters are recom- 
 mended. It should always be broiled or 
 boiled, never fried. 
 
 Eggs 
 
 Eggs should not be used at the same meal 
 with either fish or meat, but, unless the child 
 has some marked idiosyncrasy to eggs and is 
 
FOODS AND FEEDING 97 
 
 unable to eat them, one should be included in 
 the diet every day. It may be either cod- 
 dled, poached, scrambled or soft boiled (two 
 minutes), or it may be cooked in the form of 
 custard or other food. 
 
 Vegetables 
 
 Particular stress must be laid upon the 
 value of the leafy vegetables in the diet of the 
 growing child. These, with milk, form what 
 are called the " protective' ' foods, without 
 which growth and proper nourishment are 
 impossible. When vegetables are cooked, the 
 water in which they have been boiled should 
 be saved and used to make soups and gravies. 
 The following list of vegetables may be used 
 for young children: lettuce, celery, spinach, 
 well cooked cauliflower, Brussels sprouts, 
 Swiss chard, asparagus, string beans, carrots, 
 peas. Potatoes may be given once a day. 
 They are best baked or boiled with their skins 
 on, although mashed potatoes may be used 
 occasionally for variety. 
 
 Bread 
 
 Some form of bread should be included in 
 each meal, but children under six years of 
 age should never eat bread that is less than 
 twenty-four hours old. Toast, crackers and 
 zwieback may be used by way of variety. 
 
98 HEALTHY CHILDREN 
 
 Fruits 
 
 For young children great care must be 
 taken that fruits are eaten only in season and 
 when not either green or overripe. Apples 
 are best when baked or made into apple 
 sauce. Whole berries should not be used 
 until the child is over four years old, although 
 the juice of berries may be given after one 
 year. Peaches, cherries and grapes may be 
 given in moderation, but only when perfectly 
 ripe. A good rule is to use fresh fruit in 
 the early morning and stewed fruit at night. 
 Orange juice or the juice of canned tomatoes 
 may be considered a standard article of diet 
 to be used throughout the year. 
 
 Soups 
 
 Children may eat most varieties of plain 
 soups, including meat broths, vegetable purees 
 and cream soups made with milk and the 
 water left from cooking vegetables. 
 
 Desserts 
 
 Sweets in moderation are a necessary part 
 of the diet of the growing child. It is better 
 however, to give them with meals in the form 
 of desserts, and for this purpose the best types 
 of sweets are cooked fruits, simple puddings 
 made with milk, such as bread pudding or 
 
FOODS AND FEEDING 99 
 
 rice pudding, baked or boiled custards, junket 
 or ice cream. A small amount of sweet choco- 
 late or plain sugar candy may be given for 
 dessert after the child is three years old. 
 
 Foods to be Avoided 
 
 During the preschool age there are certain 
 foods which are harmful. They have very 
 little nutritive value and are too rich and 
 heavy for the delicate digestive organs of 
 young children. General types of food to be 
 avoided are pork in any form, including ham 
 and sausage, corned beef, veal, game including 
 duck, salt fish, sauces and any highly spiced or 
 over-seasoned food, fried foods, raw celery, 
 radishes, cucumbers, green corn, raw to- 
 matoes, rich cakes or puddings, pastry or hot 
 breads. Children under six years of age 
 should never drink tea or coffee. 
 
 GENERAL RULES FOR FEEDING 
 
 In childhood, as in infancy, regularity in 
 feeding is of the greatest importance. 
 
 While three meals a day for the growing child may be taken 
 as a basis, during early childhood there may be an additional 
 lunch either in the middle of the morning or the middle of the 
 afternoon, consisting of milk or cocoa with crackers or bread. 
 
 Meals should be given at regular hours each day and the 
 routine should never be interfered with. Up to the age of six 
 years, the child should have its hearty meal or dinner in the 
 middle of the day, with a light supper at night. 
 
 After the age of two years, it is better to have the child sit 
 at the family table. It is understood, however, that when this 
 
100 HEALTHY CHILDREN 
 
 is done the child's diet should be adhered to absolutely. When 
 it seems necessary there is no real reason why a child should not 
 eat alone, but the habit of eating with the family, observing 
 proper mealtime habits and learning to do without foods that are 
 available, is splendid training. Also, it is helpful for the mother 
 who has to prepare her own meals not to have separate and ad- 
 ditional ones to prepare for the child. 
 
 There is far more harm done by overeating in childhood than 
 by undereating. Care must be taken to see that the amount of 
 food the child gets is adjusted to its needs and not merely to its 
 appetite. 
 
 All children need less fats in summer than in winter. During 
 the hot months the amount of fats and meats eaten should be 
 reduced. 
 
 All children need water. Every child should be required to 
 drink at least two glassfuls of water a day between meals and may 
 be allowed one glassful with meals. Water with meals should 
 not be allowed simply to wash down the food but should be taken 
 throughout the meal to dilute the food and make it easier to 
 swallow and digest. 
 
 All food should be chewed thoroughly. A child should not 
 be allowed to bolt its meals. 
 
 Idiosyncrasies with Regard to Food 
 
 Some children are unable to eat certain 
 types of food. This does not mean that they 
 dislike the food but that it disagrees with 
 them. Usually the types of food that may 
 produce certain forms of illness in sensitive 
 children are eggs, certain kinds of fruit (par- 
 ticularly berries), cereals and fish. The pro- 
 duction of the illness may not have anything 
 to do with the purity or freshness of the food 
 but it is an indication that the child has some 
 peculiar reaction to the particular type of 
 food and is unable to eat it without suffering 
 
FOODS AND FEEDING 101 
 
 from attacks of hives or sudden and acute 
 attacks of vomiting or diarrhoea. If it is 
 certain that the food is fresh and properly 
 prepared, the child should not be again urged 
 to eat it unless on the advice of a physician. 
 
 SAMPLE DIETS FOR CHILDREN FROM ONE TO SIX 
 YEARS OF AGE 
 
 Twelve to Eighteen Months 
 
 6 :30 to 7 :00 a. m. Juice of one orange or 
 
 Two tablespoonfuls prune juice or 
 Two tablespoonfuls pineapple juice. 
 
 7:00 to 7:30 a. m. Two or three tablespoonfuls of cereal, such as 
 oatmeal, hominy, farina, cream of wheat or 
 wheatena, made very thin and served with 
 milk and a small amount of sugar. 
 Glass of milk (eight ounces). 
 
 11:00 a. m. Glass of milk (eight ounces). 
 
 Cracker or piece of zwieback or piece of stale 
 bread with crust. 
 
 1 :30 to 2 :00 p. m. One article to be selected from each of the 
 following groups: 
 
 1. Beef juice, two to four tablespoonfuls. 
 Coddled egg. 
 
 Scraped beef, one tablespoonful. 
 Mutton or chicken broth, one cupful. 
 Minced chicken, one tablespoonful. 
 Vegetable soup, one cupful. 
 
 2. Bread, zwieback or cracker. 
 
 3. Baked or mashed potato, rice. 
 
 5:30 to 6:00 p. m. Cereal and milk. 
 
 Zwieback or stale bread, toasted. 
 
 10:00 p. m. Glass of milk (eight ounces). 
 
 Note — Raw fruit juice should not be given at the same meal 
 with milk. It should be given either one-half hour before or one- 
 half hour after such meal. 
 
102 HEALTHY CHILDREN 
 
 Eighteen to Twenty-four Months 
 
 6:00 to 7:00 a. m. Two ounces of orange juice or 
 
 Pulp of six stewed prunes or 
 
 Two tablespoonfuls baked apple (strained) or 
 
 Two tablespoonfuls pineapple juice. 
 7:00 to 8 :00 a. m. Three tablespoonfuls of cereal with milk and a 
 small amount of sugar. 
 
 Glass of milk (eight ounces). 
 
 Piece of toast or bread, buttered. 
 11:00 a. m. Milk (eight ounces). 
 
 Cracker, zwieback or bread. 
 1 :30 to 2 :00 p. m. One article to be selected from each of the 
 following groups: 
 
 1. Beef juice, two to four tablespoonfuls, with 
 
 bread. 
 Egg, soft boiled, poached or coddled. 
 Scraped beef, one tablespoonful. 
 Mutton, chicken or beef broth, one cupful. 
 Minced chicken, two tablespoonfuls. 
 Vegetable soup, one cupful. 
 Lamb chop. 
 
 2. Bread, zwieback or cracker. 
 
 3. Boiled rice, small baked potato, spinach, 
 
 well cooked carrots, fresh peas. 
 
 4. Cornstarch pudding with milk, rice pudding, 
 
 baked custard, junket, two tablespoonfuls 
 pulp of baked apple or pulp of six prunes. 
 5 :30 to 6:00 p. m. Cereal and milk. 
 
 Zwieback or stale bread, buttered. 
 Stewed fruits. 
 10:00 p. m. Milk (eight ounces). 
 
 Note — Raw fruit juice should not be given at the same meal 
 with milk. It should be given either one-half hour before or one- 
 half hour after such meal. 
 
 Two to Four Years 
 
 7:00 a. m. Juice of one orange or 
 
 Pulp of six stewed prunes or 
 
 Two tablespoonfuls of baked apple or 
 
 Two tablespoonfuls pineapple juice. 
 
FOODS AND FEEDING 103 
 
 8:00 a, m. Cereal of medium thickness, four tablespoon- 
 
 fuls with milk and one teaspoonful of sugar. 
 Egg, soft boiled, poached or coddled. 
 Toast or stale bread, buttered. 
 Glass of milk or cup of cocoa. 
 
 10:30 a. m. Glass of milk (eight ounces). 
 
 One slice of bread, cracker or zwieback. 
 
 1:30 p. m. One article each from groups 1, 3, 4 and 5 or 
 
 2, 3, 4 and 5: 
 
 1. Chicken or beef broth, vegetable soup, milk 
 
 soup made with a little potato or celery. 
 
 2. Egg (poached, coddled, boiled or scrambled), 
 
 tablespoonful of minced beefsteak, lamb 
 chop, roast beef, broiled steak, chicken, 
 fresh broiled or boiled fish. 
 
 3. Baked, boiled, creamed or mashed potato, 
 
 rice, macaroni. 
 
 4. Two tablespoonfuls of fresh or canned 
 
 vegetables such as peas, string beans, 
 spinach, asparagus tips, squash, stewed 
 celery. All these vegetables should be 
 well cooked. 
 
 5. Rice or bread pudding, junket or custard, 
 
 apple sauce or baked apple. Two table- 
 spoonfuls of plain vanilla ice cream, once 
 a week. 
 
 5:30 p.m. Cereal with milk toast or stale bread, lightly 
 
 buttered. 
 Egg, poached, soft boiled or coddled. 
 One cup of milk or cocoa made with milk. 
 Custard or stewed fruit. 
 
 Note — Raw fruit juice should not be given at the same meal 
 with milk. It should be given either one-half hour before or one- 
 half hour after such meal. 
 
 In this age group a cupful of milk and bread or a cracker may 
 be given in mid-afternoon or at bedtime, if the child seems 
 hungry. Give an egg at only one meal a day. 
 
104 HEALTHY CHILDREN 
 
 Four to Six Years 
 
 7:00 a. m. Juice of one orange or 
 
 Baked apple or 
 
 Stewed prunes. 
 
 (Fresh fruit may be given in season, except raw- 
 apples, which should only be eaten later in 
 the day. Fresh berries in small amounts may 
 be given.) 
 
 Cereal with milk and one teaspoonful of sugar. 
 
 Glass of milk or cup of cocoa, made entirely 
 with milk. 
 
 Bread or toast with butter. 
 
 Egg, soft boiled, poached, coddled, scrambled 
 or omelette. 
 
 10:30 a. m. Glass of milk (eight ounces) and bread. 
 
 1:30 p. m. Select one article from each of groups 1, 3, 4, 
 
 5, and 6 or 2, 3, 4, 5 and 6: 
 
 1. Chicken, beef or mutton broth, vegetable, 
 
 pea or bean soups or thick milk soups, 
 strained before using. 
 
 2. Chicken, lamb, lamb chop, roast beef, 
 
 beefsteak, minced beef, fish broiled, 
 boiled or baked, egg poached, soft boiled 
 or coddled. 
 
 3. Vegetables in season, except green corn, 
 
 egg plant or raw vegetables such as rad- 
 ishes, cucumbers or tomatoes. 
 
 4. Potato, baked, boiled or lightly mashed. 
 
 5. Bread and butter. 
 
 6. Stewed fruit, peaches, prunes, apricots or 
 
 apples, cookies or ginger snaps, plain cake, 
 rice, tapioca, cornstarch or bread pud- 
 ding, junkets or custards, ice cream (not 
 oftener than once a week), jam, jelly, 
 honey, dates or figs. 
 
 5:30 p. m. Cereal with milk and sugar or 
 
 Milk toast or 
 
 Thick soup such as pea or cream of celery or 
 Egg, coddled, poached, boiled or scrambled. 
 
FOODS AND FEEDING 105 
 
 Cocoa made with milk, or a glass of milk (eight 
 
 ounces). 
 Bread and butter. 
 Plain pudding, cookie or ginger snap, stewed 
 
 fruit. 
 
 Note: Raw fruit juice should not be given at the same meal 
 with milk. It should be given either a half hour before or a half 
 hour after such meal. 
 
 Give an egg at only one meal of the day. 
 
 Diet in Illness 
 
 During illness the amount of food given 
 should be reduced. In case of vomiting or 
 diarrhoea, it is best to give nothing except 
 plain water or milk for the first twelve hours. 
 As proper diets vary for different diseases, the 
 directions of the physician should be followed 
 in every instance, but if the matter is left 
 to the family, there are certain principles that 
 may be used as a guide. 
 
 In general, liquid or semi-liquid diets are 
 advised in every instance where there is a 
 high temperature. These may take the form 
 of milk, simple milk soups, cereal gruels made 
 thin with milk, broths, custards, milk toast, 
 junket and ice cream. The sick child usually 
 has little or no appetite, therefore the food 
 should be served not only at regular intervals 
 but it is very necessary that it should be 
 served in a tempting manner. Often the 
 child who will not drink milk at all from a 
 large pitcher and glass may be induced to take 
 
106 HEALTHY CHILDREN 
 
 it when it is served on an attractive tray and 
 the child itself is allowed to pour the milk 
 from a small pitcher into a tiny glass. Chil- 
 dren are particularly responsive to the dainti- 
 ness with which food is served. This is a 
 fact which is often not recognized. Investi- 
 gation has shown in large numbers of instances 
 that children go without breakfast simply 
 because it is not served in an appetizing man- 
 ner, therefore, where it is necessary to stimu- 
 late the appetite, the importance of present- 
 ing the food in an attractive manner must 
 not be overlooked. 
 
 THE CHILD WHO WILL NOT EAT 
 
 One of the most difficult problems that con- 
 front the mother is that of the child who re- 
 fuses to eat various kinds of food. Such a 
 child may be finicky and eat only certain 
 things. Usually there is no appetite at meal 
 times. The child will absolutely refuse some 
 kinds of food and occasionally will drink 
 nothing but milk, or, on the other hand, it 
 may refuse milk entirely. There may be an 
 appetite between meals but not at meal 
 times. Such children have to be coaxed con- 
 tinually and tempted to eat by means of 
 bribes and presents. Sometimes these chil- 
 dren seem to be well nourished ; at other times 
 their bad food habits react upon their health 
 
FOODS AND FEEDING 107 
 
 to such a degree that they are markedly 
 undernourished. 
 
 Cases of lack of appetite or refusal to eat 
 certain kinds of food are more apt to be found 
 among the families of the well-to-do than 
 among those who are poor. Children who 
 are pampered, over-cared-for and over-in- 
 dulged frequently suffer seriously from under- 
 nourishment simply because their food habits 
 are bad, whereas children whose appetites 
 and tastes have not been so constantly 
 catered to will frequently get the best value 
 from their food, even though the food itself 
 may not be all that could be desired. 
 
 Causes of Lack of Appetite, and Results 
 
 Lack of appetite may be caused by the 
 onset of acute illness and is common through- 
 out any illness, particularly one that is ac- 
 companied by a rise in temperature. Such 
 loss of appetite, however, is almost always 
 sudden in occurrence and the cause is known 
 within a day or two. A more chronic lack 
 of appetite may be caused by a continued 
 state of poor health or as a result of poor 
 sanitary surroundings and lack of personal 
 hygiene. Children who live in rooms without 
 proper ventilation, who do not play enough 
 outdoors or get wholesome exercise, almost 
 always have a poor appetite. 
 
108 HEALTHY CHILDREN 
 
 Loss of appetite may be caused by some 
 definite physical defects, such as the presence 
 of adenoids or enlarged tonsils. Chronic con- 
 stipation is a common cause, while decayed 
 teeth and aching teeth will not only make a 
 child timid about eating but will cause it to 
 swallow its food without proper chewing. 
 This leads to indigestion and consequent lack 
 of a desire for food. Too-long-continued 
 reliance upon milk as the chief article of food 
 and too much milk in the day's diet are com- 
 mon causes of lack of appetite for other foods. 
 The great majority of cases where children 
 are finicky about their food or refuse to eat 
 are simply the results of bad food habits, bad 
 training or over-indulgence. 
 
 Types of Poor Appetite 
 
 Generally speaking, any normal child should 
 be able to eat any kind of food. There are 
 certain exceptions to this general rule, how- 
 ever. Some children may have an extreme 
 distaste for one or another kind of food, and 
 when it is evident that the child refuses to 
 eat because of an active dislike, the use of 
 this food should not be urged. Marked 
 cases of food idiosyncrasy which have been 
 referred to elsewhere should also be sufficient 
 reason for avoiding the particular kinds of 
 food which produce the symptoms. In gen- 
 
FOODS AND FEEDING 109 
 
 eral, however, the ordinary type of lack of 
 appetite or objection to certain kinds of food 
 is where the child will not eat any breakfast 
 but becomes hungry in the middle of the fore- 
 noon and is given something to satisfy its 
 appetite. At meal times the child will almost 
 invariably refuse some kinds of food and some- 
 times will refuse to eat at all. 
 
 Management of Loss of Appetite 
 
 Milk feeding should not be continued be- 
 yond the normal weaning age of nine months, 
 except upon the special advice of the phy- 
 sician in attendance. After nine months the 
 child should have less milk, and other foods 
 should be added to its dietary. If the milk 
 feeding is continued beyond this time the 
 child may learn to depend upon it and this 
 fact, combined with the excessive amount of 
 milk taken, will drive away appetite for other 
 food. Improper hygienic surroundings must 
 be corrected and the child's personal hygiene 
 outlined carefully. Physical defects must be 
 corrected and care taken to see that the 
 bowels function regularly. If, after all these 
 matters have been attended to, the child 
 still refuses to eat properly, it is probable that 
 the difficulty lies in bad feeding habits. The 
 real problem mothers have to meet, therefore, 
 is that of the finicky child who will not eat 
 
110 HEALTHY CHILDREN 
 
 plain, nourishing food, craves sweets and 
 requires to have its appetite stimulated. Such 
 children commonly eat between meals and 
 have candy when they desire it. The question 
 of how to bring such children back to the nor- 
 mal routine of life is not a medical one but de- 
 pends upon the right kind of mother and her 
 firmness of purpose. 
 
 The first thing to be done is to establish 
 proper feeding habits. The mother must fix 
 firmly in her mind the fact that she must not 
 waver in her purpose for one moment, that 
 if she truly and honestly desires her child to 
 be fed properly, she must persist until she 
 has accomplished her object. There is ab- 
 solutely no danger for the ordinary child who 
 is not ill if it goes without food for from 
 twenty-four to forty-eight hours, and, further- 
 more, every mother should remember that 
 appetite is a normal condition and the child 
 will eat as soon as it becomes hungry. 
 
 First of all, the meals must be regular. In 
 the morning the child should have a whole- 
 some, plain breakfast set before it. There 
 should be no coaxing to eat; in fact, the best 
 method is to have the whole family deliber- 
 ately ignore the child and pay no attention 
 to whether it is eating or not. If it refuses 
 its food, that fact should cause no comment. 
 During the morning, however, when the child 
 
FOODS AND FEEDING 111 
 
 asks for extra food, it must be refused and the 
 child should have nothing to eat until the 
 noonday meal. At that time a simple din- 
 ner should be served. If the child still re- 
 fuses to eat, no further notice should be taken 
 of the matter, and at supper time the same 
 routine should be followed. If the child goes 
 without food altogether during the first day, 
 there is hardly a chance in the world that it 
 will refuse it the second day, and usually one 
 twenty-four or forty-eight hour period is all 
 that is necessary to make a success of the 
 plan, but there must be no letting down of the 
 bars afterwards. Once the habit of three 
 regular meals a day has been established as 
 the proper basis, nothing should be permitted 
 to interfere with this routine. 
 
 The rules for teaching children to eat are 
 simple, but must be adhered to absolutely: 
 
 1st: The meals must be attractive. A child should not be 
 asked to sit down to a slovenly table or a badly prepared 
 meal. 
 
 2nd: The meals must be regular. Breakfast, dinner and sup- 
 per must be at exactly the same time each day. If this 
 is impossible for the rest of the family, it should be made 
 possible for the child. 
 
 3rd: The food that the child ought to eat should be placed be- 
 fore it. There should be no comment whatever upon 
 whether or not it is eaten. 
 
 4th: There must be no eating between meals. 
 
 5th: Candy should not be allowed except as a dessert after the 
 principal meal of the day. 
 
 6th: The food should be varied. Children dislike monotony 
 in food even more than adults do. 
 
112 HEALTHY CHILDREN 
 
 7th: The child should not be required to eat any food that it 
 actually dislikes, but before this is determined upon, a 
 trial should be made. 
 
 8th: A child should not be allowed to eat food that makes it 
 ill. 
 
 9th: From two to six years of age, one and a half pints of milk 
 a day is sufficient. Part of this should be given plain 
 and part in the form of cocoa, milk soups, custards, ice 
 cream, junkets or cooked with vegetables. 
 
 10th: The mother must remember that upon her, not upon the 
 child, depends the success or failure of the effort to estab- 
 lish proper food habits, and she must remember, first, 
 last and all the time that if the cause of the loss of ap- 
 petite is ill-health, the condition must be treated, but if 
 the child is in normal health it will make no difference if 
 it goes without food for one or two days, and that as soon 
 as it is hungry, nature will assert itself, and the child 
 will eat. 
 
CHAPTER V 
 
 MALNUTRITION 
 
 Malnutrition is the most serious underlying 
 cause of disease. It results in lack of resistance 
 in the individual. Undernourished children 
 are particularly susceptible to infection. Be- 
 cause the lack of resistance predisposes to 
 disease and because disease frequently re- 
 sults in lowered vitality, it is sometimes diffi- 
 cult to discover whether the malnutrition 
 is the underlying cause of the disease or 
 whether the disease is direct cause of the mal- 
 nutrition. It is necessary for children to be 
 well nourished if they are to resist disease and 
 grow up with a normal physique. 
 
 Malnutrition in childhood is alarmingly 
 widespread. Statistics show that from 
 twenty to twenty-five per cent of all children 
 in the United States, not only in the cities 
 but in the rural districts as well, are seriously 
 undernourished. Its occurrence in childhood 
 and during the period of growth interferes 
 with the proper development of the body and 
 the bodily organs and this retarded develop- 
 ment makes such a lasting impression upon 
 the child's whole physique that it is rare that 
 full health is regained in later life. (See illus- 
 tration opposite page 183.) 
 
 113 
 
114 HEALTHY CHILDREN 
 
 Causes 
 
 It is a popular impression that malnu- 
 trition is caused by lack of food. There is a 
 difference between chronic undernourishment 
 and starvation. While lack of food un- 
 doubtedly will cause a type of undernourish- 
 ment, the common cause is not insufficient 
 food as much as it is the wrong kind of food, 
 and irregular feeding. Therefore, under- 
 nourishment is found among the rich as well 
 as among the poor, for there is little differ- 
 ence in the results between the pampered, 
 over-indulged child of well-to-do parents who 
 is fed largely on the wrong kind of food, such as 
 sweets and pastries, and the poor child who 
 cannot get the proper food to eat and who 
 buys cheap candies and inferior ice cream 
 with the few pennies at its disposal. 
 
 While wrong feeding is the basis of a large 
 number of cases of malnutrition, the fact must 
 not be overlooked that undernourishment in 
 childhood may result from undernourishment 
 in infancy, due to lack of proper prenatal care 
 or to the acute digestive diseases during the 
 first year of life. Malnutrition is due also 
 to insanitary surroundings, improper home 
 environment and disregard of personal hy- 
 giene. Lack of ventilation in sleeping rooms 
 and too much play indoors will result not only 
 
MALNUTRITION 115 
 
 in lack of appetite but also in definite dis- 
 turbance of the nutrition of the body. In- 
 sufficient rest, interrupted or too short sleep- 
 ing hours, late bedtime, nervous excitement, 
 evenings spent in close, ill-ventilated rooms 
 watching exciting moving picture shows, and 
 over-fatigue of any type are direct causes of 
 malnutrition. Physical defects of all kinds 
 will interfere with the proper nourishment of 
 the body, the most prominent of these being 
 adenoids, enlarged tonsils, defective vision 
 and decayed teeth. 
 
 Symptoms 
 
 The most common method of detecting mal- 
 nutrition is by determining the rate of growth 
 of the child and the relation of its weight to 
 its height. The principle is generally ac- 
 cepted that any child who is ten per cent 
 below the normal average weight for its 
 height is undernourished. However, owing 
 to certain racial and family characteristics, 
 this is not always a true test, consequently 
 other symptoms have to be looked for and 
 are readily observable. 
 
 The undernourished child has a character- 
 istic appearance. Usually the face has a 
 drawn, tired expression. There are apt to 
 be dark circles under the eyes, the skin may 
 be pale or of a dusky color, the child's whole 
 
\ 
 
 \ 
 
 116 HEALTHY CHILDREN 
 
 body droops, the shoulders are pushed for- 
 ward, chest sunken, and the shoulder blades 
 in the back are apt to protrude. There may 
 or may not be some curvature of the spine, but 
 usually, in standing, the child throws most of 
 its weight on one foot, so that it leans to one 
 side. Almost always there is bad posture 
 with prominent abdomen and what is known 
 as a "slouchy" attitude. The muscles are 
 soft and flabby, while the hair usually loses 
 its lustre and is dry and brittle. Other 
 symptoms which have to do with the con- 
 dition of the child may be observed readily. 
 Frequently there is excessive nervousness, 
 with disturbed sleep. There may be twitch- 
 ing of the muscles. The appetite is apt to 
 be diminished, and the child shows marked 
 preference for particular types of food, re- 
 fusing all others. Undernourished children 
 rarely show any marked vitality. They act 
 as if they were nervously exhausted, do not 
 want to play and are unwilling to make any 
 effort. There is a marked amount of lassi- 
 tude and fatigue. Any action requires an 
 amount of initiative they are unable to sum- 
 mon. Such children are constantly subject 
 to disease, particularly those of an infectious 
 nature. 
 
MALNUTRITION 117 
 
 Care and Treatment 
 
 In order to have effective treatment, it is 
 necessary to interest the child in its own prog- 
 ress. In school children this can be done by 
 means of competition between the various 
 members of the class, to see which will pro- 
 gress most rapidly in weight and general 
 health. With children of preschool age, com- 
 petition is not so easy to bring about, but even 
 with very young children the sense of per- 
 sonal pride may be brought out in many in- 
 stances. Each child should have its height 
 measured at least twice a year and should 
 be weighed each month. A personal weight 
 chart, similar to the one illustrated else- 
 where in this book, should be used to make 
 an individual record of each case. Progress 
 is the thing to be desired, therefore, the weight 
 curve must have an upward tendency. Any 
 loss of weight or stationary weight for a 
 period longer than one month shows that the 
 type of care given is not suitable. 
 
 All insanitary conditions must be eliminated 
 and careful attention paid to the personal 
 hygiene of the child. Many cases of mal- 
 nutrition have been cured by having the child 
 sleep outdoors or in a room w T ith the windows 
 wide open. Other cases have responded im- 
 mediately to a course of treatment which in- 
 
118 HEALTHY CHILDREN 
 
 eluded a midday nap or enforced rest for at 
 least two hours a day. Play may have to be 
 restricted to a great extent, particularly if 
 the child is over-active and emotional, and 
 throws itself with all of its energy into every 
 game. Physical defects found to exist must 
 be corrected. Late hours and attendance at 
 the movies must be avoided. The child 
 should have from ten to twelve hours sleep 
 at night and two hours rest in the daytime. 
 Meals must be regular and consist of plain, 
 wholesome food. Feeding between meals is 
 not essential unless the child is not gaining. 
 Then an additional meal of crackers and milk 
 or cocoa may be given in the middle of the 
 forenoon or afternoon and again at night, but 
 this should not be allowed to take the place 
 of the regular meals, and if it interferes with a 
 proper appetite at mealtimes, it should be 
 discontinued . Occasionally, undernourished 
 children may have the full value of their food 
 more apparent if they are given five small, 
 regular meals a day rather than three hearty 
 ones. 
 
 There should be a rest period of a half to 
 one hour after each meal during which time 
 the child should lie down out-of-doors or in a 
 well ventilated room, and remain perfectly 
 quiet. Sweets between meals should be for- 
 bidden. There is no harm in the sweets 
 
MALNUTRITION 119 
 
 themselves; the difficulty is that they usually 
 take away the child's small appetite and make 
 it impossible for it to eat the nourishing diet 
 it needs. Plain candy may be given after 
 meals, but not at any other time. In the 
 dietary, emphasis should be placed upon a full 
 pint and a half of milk a day, plenty of cereals, 
 fresh vegetables, particularly the leafy types, 
 and fruits. Children of preschool age should 
 never, under any circumstances, be allowed to 
 drink either coffee or tea. This is particularly 
 true in regard to the undernourished child. 
 There is another class of undernourished 
 children that does not respond to any of these 
 types of care. Usually, detailed study will 
 show that the difficulty is with the emotional 
 life of the child. There are instances where 
 children are undernourished, pale and lacking 
 in proper development and the cause is simply 
 the excessive nervous reaction of the child to a 
 disorganized family life. Parental neglect, 
 family discord and an unhappy environment 
 result inevitably in worry and unhappiness to 
 children. Even without harsh punishments, 
 the child can suffer intensely from a sense of 
 general lack of harmony in its environment. 
 Such children are shy and introspective, and 
 inevitably become undernourished. Removal 
 of such a child to a proper environment will 
 result at once in marked improvement. 
 
HEALTHY CHILDREN 
 
 The proper way to deal with malnutrition, 
 therefore, is first to find the cause, that is, the 
 place where the child's life is departing from 
 the normal, and then to do everything pos- 
 sible to remove the discordant or improper 
 environment or factors and place the child 
 in a position where it may lead a normal, 
 wholesome life. 
 
CHAPTER VI 
 
 THE NERVOUS CHILD 
 
 Prevention and care of nervous diseases oc- 
 curring during childhood are important for 
 two reasons: First, because the nervous child 
 suffers intensely from its affliction and second, 
 because nearly every type of nervousness in 
 adult life can be traced to its beginning in 
 childhood. Anyone who has suffered from a 
 nervous disorder knows that such a handi- 
 cap stands in the way of normal mental and 
 physical development and that it is likely to 
 make life almost unbearable at times. Much 
 of this suffering during adult life is unnecessary 
 and can be prevented in childhood. Also, the 
 methods of correcting nervousness after it has 
 been established are much more simple and 
 effective in early life than they are later. 
 
 The nervous system of a child is exceedingly 
 complex. It is unstable and easily affected. 
 Prevention of nervous disorders in childhood 
 really begins during the prenatal period, for 
 if the expectant mother is neglected and poorly 
 nourished during the months before the baby 
 comes, the probabilities are that the child will 
 suffer from lack of vitality and that it will 
 be affected by nervous and emotional dis- 
 orders. This is one of the reasons why proper 
 prenatal care is so essential. 
 
 121 
 
122 HEALTHY CHILDREN 
 
 Causes 
 
 The causes of nervousness generally may 
 be traced to the period of earliest infancy. 
 Few young babies are naturally nervous, and 
 almost always the trouble is with the parents. 
 Fathers and mothers who are nervous, ir- 
 ritable, over-anxious, over-indulgent or sub- 
 ject to outbursts of temper or irritability, will 
 nearly always have nervous children. Even 
 in earliest infancy, the baby is extremely 
 susceptible to its environment. If the father, 
 mother, nurse or any other member of the 
 family who comes into intimate, daily con- 
 tact with the baby, is nervous and temper- 
 amentally highstrung, the condition will react 
 upon the child. 
 
 The causes of nervousness in infancy as well 
 as in early childhood are either physical or 
 emotional. The physical causes are mainly 
 indigestion, anemia or malnutrition. After 
 the child is over two years of age, other physi- 
 cal causes such as defective eyesight, with 
 resultant eyestrain, adenoid growth and im- 
 pacted or decayed and painful teeth, may be 
 considered predisposing causes. The emo- 
 tional causes, however, seem to be the more 
 important. Even before they are able to 
 express themselves, children are extremely 
 sensitive to emotional reactions. Sudden 
 
THE NERVOUS CHILD 123 
 
 fright and unexpected noises, being awakened 
 suddenly, violent jouncing up and down, or 
 being danced about, too little sleep, late bed- 
 time, over-handling and over-fatigue, all lay 
 the foundation for nervous disorders. Lack 
 of understanding of the child and consequent 
 nagging and arbitrary rules tend toward the 
 formation of the habit of self-suppression in 
 early life, and to emotional outbursts later. 
 Children are essentially imaginative beings. 
 They live in a world of their own. Their 
 fears, sorrows and disappointments are far 
 more keenly felt and more real than any we 
 know in adult life. The child lives in the pres- 
 ent, while the adult has the future in view, 
 therefore any lack of understanding of the 
 child's fears, or, what is far more criminal, the 
 cultivation of such fears, often has serious and 
 far-reaching effects upon the child's whole life. 
 Parents are to blame if they suppress the 
 child's natural instincts. Particular empha- 
 sis should be placed upon fear as a cause of 
 nervousness in later life. Many cases of 
 nervousness have their starting point in a 
 sudden fright or in a story told to frighten 
 a child. The harm that may be done by 
 threatening a child that some terrible thing 
 will happen to it is almost beyond comprehen- 
 sion. In the case of the more serious nervous 
 diseases, definite causes can be traced, and 
 
124 HEALTHY CHILDREN 
 
 these will be considered later, but in the case 
 of the ordinary functional nervous disorders, 
 or what is commonly called "nervousness," 
 it is deplorably true that the fault is usually 
 with the child's surroundings rather than with 
 the child itself. Fathers and mothers must 
 realize that it is largely within their power to 
 determine whether or not a child will be 
 nervous or calm and well-poised. 
 
 Symptoms of Nervousness 
 
 The symptoms of nervousness in children 
 or in adults are many and varied, and not all 
 of them occur in each instance. Each case 
 must be judged by itself. In general, how- 
 ever, there are two main types of the nervous 
 child to be considered, but it must be remem- 
 bered that symptoms of both types may occur 
 in the same child. The first type is that of the 
 over-excitable child. Such a child may be 
 robust and well nourished, or it may be anemic 
 and show signs of undernourishment. The 
 most predominant symptoms are those which 
 have to do with the emotional side of life. 
 Such children are excitable and given to sud- 
 den fits of anger or temper. They are ex- 
 tremely irritable and have frequent outbursts 
 of loud, shrieking laughter. There is a con- 
 stant hunger for excitement. In their play 
 they are apt to be quarrelsome and dicta- 
 
THE NERVOUS CHILD 125 
 
 torial and always want to assume leadership. 
 Such children are apt to hold themselves with 
 muscles rigid. They are over-anxious for 
 praise and will do almost anything to gain it. 
 They cannot stand blame. Sometimes they 
 have a tendency to be cruel, especially to 
 animals, and they may be very deceitful. 
 
 The second type is that of the shy, emotional 
 child. This type shuns people and does not 
 want to play or associate with other children. 
 They are easily startled or shocked by any 
 sudden noise. They may be morose and ec- 
 centric in their behavior. Sleep is often dis- 
 turbed. Such children may be peevish and 
 irritable, but usually their predominating 
 symptoms are those of over-shyness. They 
 are apt to hesitate and find it difficult to 
 adjust themselves to their environment. They 
 do not care to play with other children, and 
 often are either afraid or unable to recite in 
 school. Such children usually lack decision, 
 and they are rarely, if ever, able to decide 
 what they want to do or to take any definite 
 action. Usually their fear is extreme. They 
 distrust themselves and are abnormally afraid 
 of the dark and of animals. They find diffi- 
 culty in getting to sleep at night, and do not 
 want to sleep alone. The shy, reserved child 
 has day dreams, preferring to be by itself and 
 indulge its imagination. Such children rarely 
 
126 HEALTHY CHILDREN 
 
 tell the results of these day dreams or the 
 things they think about. We all have en- 
 countered the nervous child who constantly 
 makes up long stories about occurrences that 
 never have happened, but which, neverthe- 
 less, are very real to the child. 
 
 Nervous children may be either bright or 
 dull. The excitable type is apt to be over- 
 precocious. Frequently they are extremely 
 brilliant along certain lines, and it is not 
 unusual to have such children considered as 
 "prodigies." Parents constantly put them 
 forward so that they may show off their bril- 
 liancy. However, their powers of endurance 
 are poor and while they may readily excel 
 in some one direction, they are rarely able to 
 excel on all points. They put into their play 
 or other activities every particle of strength 
 they have, holding nothing in reserve. 
 
 Prevention and Treatment 
 
 Prevention of nervousness should begin in 
 the prenatal period. Even when the baby 
 is born in normal, healthy condition, however, 
 there should be no relaxation of preventive 
 measures, and they must be continued 
 throughout infancy. Mothers must realize 
 how fragile and unstable the baby's nervous 
 system is. The ordinary noises of the house 
 need not be stilled; in fact, it is much better 
 
THE NERVOUS CHILD 127 
 
 to have the baby grow accustomed to normal 
 noises from the beginning. Sudden fright and 
 unexpected noises or sudden awakening of the 
 baby by means of unusual sounds or move- 
 ments to attract its attention are extremely 
 harmful. The habit of dancing babies up and 
 dow r n and awakening them from sound sleep 
 for any purpose other than feeding, must be 
 avoided. The proper routine of the child's 
 life is essential as a preventive of nervousness. 
 The hours of sleep and regularity of the daily 
 routine are immensely important in this re- 
 gard. Over-handling should be avoided. All 
 possible physical causes of nervousness must 
 be removed. In little babies, improving the 
 nutrition and preventing the occurrence of 
 physical defects by means of fresh air and 
 general hygiene are of importance and these 
 measures must be continued as the child 
 grows older. Eyestrain, decayed teeth and 
 adenoid growths should not be allowed to de- 
 velop. Sometimes worms are an exciting 
 cause, although it is usually easy to determine 
 this point as the nervousness lasts only as 
 long as the worms are present. 
 
 If possible, nervous children should sleep 
 outdoors. At all events, they should be in 
 the fresh air as much as possible. Rest is par- 
 ticularly important. The nervous child should 
 have not only its full number of hours of rest at 
 
128 HEALTHY CHILDREN 
 
 night, but should be required to take at least 
 one nap during the daytime. Normal exer- 
 cise should be encouraged, but over-stimulat- 
 ing and over-exciting play is harmful. It 
 should be unnecessary to state that a child 
 under six years of age should not be taken 
 to the movies. The influence of moving 
 picture shows on children may be of two 
 kinds — the physical effects of late hours, bad 
 air and overcrowding are obvious. In ad- 
 dition, the emotional effects must be con- 
 sidered. While some of the moving pictures 
 have much to commend them and are adapted 
 for children, the vast majority are unsuited 
 for the young, impressionable child. When 
 the over-stimulation of the emotions is added 
 to the late hours and bad environment, there 
 can be no question whatever that the child 
 under six years of age should not be allowed 
 to see the general type of moving pictures 
 or to be in any place where such pictures are 
 shown. Late hours must be avoided in any 
 case. 
 
 Mothers and fathers must learn that they 
 have much to be responsible for in the pro- 
 duction of nervousness in their children. The 
 child with a normal nervous system and calm, 
 well-poised attitude toward life, reflects its 
 home environment. The child should never 
 be nagged. Harsh and arbitrary rules simply 
 
THE NERVOUS CHILD 129 
 
 incite resentment in the child. If its emotions 
 are not expressed at the time, they are felt 
 nevertheless and when they are suppressed 
 they are apt to be much more destructive to 
 the child's future well-being than if they re- 
 sulted at the moment in outbursts of temper 
 or in obstinacy and refusal to obey the orders 
 or commands given. 
 
 The question of preventing nervousness is 
 strongly allied to the whole matter of dis- 
 cipline during childhood. Two things must 
 be remembered : first, that the nervous system 
 of the young child is very unstable; and, 
 second, that all children are imaginative. 
 The over-excitable child needs a particularly 
 calm environment and wise direction of its 
 exuberance and activity along proper lines. 
 The imagination of such children should never 
 be suppressed or laughed at. They should 
 never be accused of lying or trying to deceive 
 when they are simply expressing a l 'flight of 
 fancy." It is not difficult to distinguish be- 
 tween a direct lie and a ' 'flight of fancy." 
 When the child comes running in and says 
 that it has met a great big bear on the road, 
 there is no intention to deceive, for to the 
 child's imagination some little dog has assumed 
 the aspect of a bear and the story the child tells 
 is very real and vivid to it. Such a child 
 should have the truth explained but this 
 
130 HEALTHY CHILDREN 
 
 should be done in a tactful way that will not 
 create antagonism. Children's fancies are 
 only too easily suppressed and the tendency 
 to mold all children into a common type, and 
 to suppress their instincts and imagination 
 and self-expression, results not only in much 
 unhappiness to the child at the time but often 
 in distinct loss of the power of expression that 
 it might be able to display in later life. 
 
 Play should not be boisterous or quarrel- 
 some. It should be properly directed and 
 should have a result. Children like to do 
 things with their hands, and constructive 
 play can be arranged just as easily as the 
 destructive kind. Children love competitive 
 games for this reason. They like to play ball 
 or to make mud pies or play house or do any- 
 thing of that kind that appeals to their 
 imagination and has a result. Aimless play 
 or play with toys that are already made and 
 that require no aid from the child is unsatis- 
 factory and may even be harmful. Children 
 should be taught to make their own toys and 
 to be satisfied with the simplest equipment pos- 
 sible. Over-indulgence is responsible for far 
 more nervousness than lack of indulgence in 
 this respect. The child who is always forced 
 to provide its own amusements and to make 
 its own playthings in all probability will have 
 a far finer nervous temperament and be better 
 
THE NERVOUS CHILD 131 
 
 able to meet the world on its own terms than 
 the child who has had everything done for it, 
 and who has never had an opportunity to exer- 
 cise its constructive ability. Creative imagin- 
 ation in children should be encouraged. If it is 
 not allowed its normal outlet, it may result in 
 much harm and lead the natural impulses 
 to take the form of introspection, shyness and 
 the breaking down of character, so that the 
 child becomes indecisive and morbid. 
 
 Nervous children should never be punished, 
 and rarely, if ever, should they be blamed. 
 If they have been taught to fear anything, 
 every effort should be made to reason with 
 them calmly and to explain that the thing or 
 occurrence they fear should not be feared. 
 Children are susceptible to reason at an un- 
 usually early age. There should be no arbi- 
 trary "do's" and "don'ts," but as soon as the 
 child is old enough to talk, it has a right to 
 know why it is required to do certain things. 
 On the other hand, there must be no wavering 
 or lack of firmness on the part of the parents. 
 Once the child has been told to do a certain 
 thing and the reason therefor has been ex- 
 plained, instant obedience must be expected, 
 but nothing unusual or arbitrary should be 
 asked for, nor should the child be required to 
 do things merely to vent the displeasure or 
 temper of the parents. The tasks that are 
 
132 HEALTHY CHILDREN 
 
 given the child to do should fit its capacity. 
 The relation of the parents to the child should 
 be one with the definite object of cultivating 
 its self-reliance and making it a responsible, 
 intelligent human being. This cannot be done 
 if the father and mother continue to make the 
 child feel its dependence. Every new human 
 being has a distinct right to a life of its own, 
 and while the early years of that life must 
 necessarily be dependent upon someone else 
 for guidance, the object of that guidance 
 should not be to make the dependence con- 
 tinue but rather to build up in the child the 
 ability to make its own decisions, to tell the 
 difference between right and wrong, be pre- 
 pared to take a proper attitude toward life, 
 respect the rights of others and to be able to 
 adjust itself to its environment in later life. 
 Inability to get on with people or to meet 
 events as they occur during life is probably 
 the cause of more real unhappiness than any 
 other thing that can occur to us. 
 
 While emphasis has been laid on the harm- 
 fulness of nagging, punishment and arbitrary 
 action, it must not be forgotten that almost 
 equal harm may be done by over-indulgence. 
 The spoiled, pampered child is not only apt 
 to be extremely nervous but usually is unable 
 to adjust itself to its environment and may 
 lead a life of great unhappiness. The over- 
 
THE NERVOUS CHILD 133 
 
 indulged child is far more apt to become the 
 neurotic of later life than the child who has 
 had difficulties to overcome. 
 
 Neurasthenia, nervous breakdown, hyster- 
 ical attacks and the lack of self-confidence that 
 leads to inability to get on in the world nearly 
 always are the result of wrong training dur- 
 ing early child life. 
 
 CHOREA (ST. VITUS DANCE) 
 
 Chorea is not commonly found in children 
 under five years of age. Usually it is associ- 
 ated with the early years of school life and 
 there has been an impression that the nervous 
 strain of school life is one of the predisposing 
 causes. Probably this is true in part, never- 
 theless it is unlikely that a child who is per- 
 fectly normal on entering school will develop 
 so severe a nervous condition simply as a 
 result of school routine or school pressure. 
 As the basis of all nervous diseases is laid in 
 early life, we must consider that the main 
 predisposing causes of chorea occur during the 
 preschool age. 
 
 Causes 
 
 Chorea may be due to a variety of causes. 
 Sometimes it is exceedingly difficult to trace 
 any one thing that may be considered the 
 main predisposing factor. In general, how- 
 ever, prolonged nervous fatigue or over-ex- 
 
134 HEALTHYCHILDREN 
 
 citement during the first few years of life, 
 long continued undernourishment with anemia 
 and chronic intestinal indigestion, are the 
 common predisposing causes. The possibil- 
 ity of chorea being a manifestation of rheu- 
 matism must not be overlooked. 
 
 Symptoms 
 
 The symptoms of chorea are quite character- 
 istic, and once seen, they are not easily for- 
 gotten. Usually they begin with a marked 
 amount of restlessness, the child is unable to 
 sit still, there is constant shuffling of the feet 
 in walking about, and it is impossible to co- 
 ordinate the muscles or guide the hands and 
 feet in the right direction. There is marked 
 inability to control the movements of the arms 
 or legs. The child may reach for an article 
 on the table but the hand will not touch the 
 article but will grope around before the child 
 can make it grasp the thing that is sought. 
 Children will often knock things off the table 
 when trying to grasp them. The movements 
 seem to be extraordinarily clumsy and the 
 child is quite unable to control them. There 
 is apt to be marked twitching of the face, and 
 occasionally grinding of the teeth. The head 
 jerks convulsively from side to side and some- 
 times the whole body will move with a series 
 of loose, more or less convulsive gestures. 
 
THE NERVOUS CHILD 135 
 
 The constant motion of every part of the body, 
 with the twitching, jerking and uncoordi- 
 nated muscular efforts, is characteristic of 
 chorea. There are, in addition, certain emo- 
 tional disturbances. The child usually mani- 
 fests marked irritability of temper, is unable 
 to control its emotions and will laugh or shriek 
 loudly and have outbursts of crying when 
 there is little or no cause. 
 
 Prevention 
 
 Prevention of chorea consists in prevention 
 of nervous diseases in general. The child 
 should be kept in as good physical condition 
 as possible, and if there is the slightest ten- 
 dency toward nervousness, the hygienic sur- 
 roundings must be of the best. Such children 
 should not be sent to school at an early age 
 but should be supervised carefully until all 
 emotional strain is relieved before being al- 
 lowed to engage in competitive effort in school 
 work with other children. Physical defects 
 should be remedied, if they are present, and 
 every effort made to build up the child's nu- 
 trition. Normal, wholesome but limited ex- 
 ercise, with plenty of fresh air and sleep, is 
 essential. 
 
 Treatment 
 
 When this disease has already occurred, the 
 best treatment is to put the child to bed and 
 
136 HEALTHY CHILDREN 
 
 keep it as quiet as possible. Medical care 
 is essential, owing to the possible effect that 
 chorea may have upon the heart, also for the 
 prompt cure of the disease itself. The doctor 
 should be summoned without delay, therefore, 
 if any unusual twitching or convulsive move- 
 ments are noticed in the child. 
 
 HABIT SPASM 
 
 Habit spasms have a certain resemblance 
 to chorea, as far as the symptoms are con- 
 cerned. The characteristic difference that 
 may be noted, however, is that in habit spasms 
 the convulsive movements are always around 
 the face, tongue or head, that is, they are 
 above the neck, while in chorea the entire 
 body is involved. 
 
 Causes 
 
 Habit spasms usually occur in nervous 
 children. There is no definite organic cause, 
 but they are more apt to occur in children who 
 are undernourished and who are suffering from 
 some form of physical defect. They are more 
 common among children of school age because 
 they are in a sense a form of imitation. If one 
 child in a class-room is affected, within a short 
 time a large number of others will begin to 
 have similar convulsive movements of the 
 head, face and neck. 
 
THE NERVOUS CHILD 137 
 
 Symptoms 
 
 The child will make sudden grimaces, 
 twitching the mouth, closing the eyes, with a 
 pronounced frown, show the teeth, jerk the 
 head from side to side and there may even 
 be twitching of the individual muscles of the 
 face. 
 
 Prevention 
 
 Prevention of habit spasms consists in main- 
 tenance of good health in the child and remov- 
 ing all causes of nervous diseases. 
 
 Treatment 
 
 Children found to have habit spasms should 
 be kept entirely isolated so that imitation of 
 the condition may not be taken up by other 
 children. Complete rest and the estab- 
 lishment of normal habits are necessary. 
 The disease, may tend to become chronic and 
 if the condition persists medical advice should 
 be obtained. 
 
CHAPTER VII 
 
 COMMON DISEASES OF CHILDHOOD 
 
 COUGHS AND COLDS 
 
 Colds are one of the commonest ills of 
 childhood. They range in severity from the 
 simple running of the nose, with perhaps slight 
 congestion of the eyes, to a condition known 
 as "bronchitis," where there is a great deal of 
 constitutional disturbance, a cough and the 
 presence of fever. It is always possible for 
 a slight cold to become a more severe one; 
 therefore a cold, however simple it may seem 
 to be, should never be neglected. Some chil- 
 dren seem to have a predisposition to colds, 
 and from fall until spring are scarcely ever 
 free from excessive discharge of mucus from 
 the nose. While the treatment of colds is of 
 great importance, their prevention is more so, 
 and everything possible should be done to see 
 that the child is put in such healthy condition 
 and lives in such a normal manner that it will 
 not "take cold." 
 
 Causes 
 
 Anything that lowers bodily resistance or 
 vitality predisposes to disease, and children 
 who are not robust are the ones who fall 
 easiest victims. Such children are easily 
 
 138 
 
COMMON DISEASES OF CHILDHOOD 139 
 
 weakened by attacks of colds and bronchitis, 
 and as a result they seem less healthy. In 
 fact, it is sometimes difficult to tell whether 
 the colds are the cause of the lowered vitality 
 of the child or the lowered vitality is the cause 
 of the colds. Such a vicious circle must be 
 broken into and the best way is to begin to 
 fortify the child during babyhood. 
 
 Prevention 
 
 Unless the child reacts well, cold baths are 
 not advisable, but at the age of one year it is 
 good practice to give a quick, cold sponge 
 over the neck and shoulders of the child im- 
 mediately after the warm bath. The cold 
 bathing of the neck and shoulders must be 
 practiced every morning and should be con- 
 tinued not only throughout childhood, but as 
 a permanent habit. It is one of the best 
 preventives of cold that we know. 
 
 Proper feeding also is a safeguard against 
 colds, as it is against all diseases. The cloth- 
 ing of children will be considered' in another 
 chapter, but may be mentioned here as it has a 
 distinct bearing upon the production of colds. 
 Probably there is no class of children who "take 
 cold" more readily than those who are habit- 
 ually overclothed. After they have been 
 playing in warm rooms, or even outdoors, and 
 have become superheated, they sit down to 
 
140 HEALTHY CHILDREN 
 
 cool off, with resultant chill to the body. It 
 is probable that an excessive amount of 
 clothing causes more illness than too little 
 clothing, although a child who is habitually 
 cold because of insufficient clothing and who 
 always has cold hands and blue lips needs 
 equally vigorous attention. The happy mean 
 lies in dressing children when indoors in winter 
 in the same weight clothing they wear in mild 
 summer weather. When outdoors, the differ- 
 ence should be made up by the thickness of 
 the outer wraps. Wool underclothing, by 
 inducing perspiration, is not as healthful as 
 cotton or a mixture of cotton and wool or 
 silk and wool. 
 
 Overheated and badly ventilated rooms are 
 also productive of colds. Fresh air and good 
 ventilation are the best preventives. While 
 certain types of head colds are due merely 
 to congestion, others are due to direct in- 
 fection and for this reason a person suffering 
 from cold should not come into intimate 
 contact with other people, particularly chil- 
 dren. A child should never use a pocket 
 handkerchief belonging to anyone else, and 
 everyone, during the act of coughing or sneez- 
 ing, should hold a pocket handkerchief over 
 the mouth. The infection is probably carried 
 in little droplets that come from the mouth 
 during the act of coughing or sneezing. If 
 
COMMON DISEASES OF CHILDHOOD 141 
 
 anyone happens to be near enough, the breath- 
 ing in of these particles may cause a cold. 
 They do not, however, float in the air unless 
 it is in the dust. For this reason children, 
 particularly very young ones, should not be 
 taken outdoors on very windy or dusty days, 
 nor should they be permitted to remain in 
 rooms that are being swept or dusted. This 
 is one of the reasons why the child's room 
 should not have a carpet, but rather rugs that 
 may be taken out easily, and a hardwood 
 floor that may be kept clean. Other common 
 means of "taking cold" are sitting in drafts, 
 playing on the floor in a room that is not 
 properly heated, wearing wet stockings or 
 shoes and sudden changes in temperature 
 without corresponding changes in clothing. 
 
 Treatment of Colds 
 
 If a cold does occur, there are various 
 methods of treating it which will probably 
 give relief and which will usually stop it within 
 a short time. First of all, the child should be 
 given a good cathartic, preferably a table- 
 spoonful of castor oil. For a day or two the 
 diet should be light and readily digestible, 
 consisting of milk, cocoa, cereals, custards, 
 milk toast, eggs and well-baked white po- 
 tatoes. If the child is very hungry, additional 
 food in the shape of vegetables may be added. 
 
142 HEALTHY CHILDREN 
 
 If there is a tendency toward a cough, the 
 neck and chest may be rubbed well twice a 
 day with camphorated oil. The rubbing is 
 really the valuable part of this treatment and 
 should be carried on until the skin shows a 
 healthy glow. If there is any distinct cough, 
 with rise in temperature above one hundred 
 degrees, a mustard plaster or flaxseed poultice 
 should be placed on the chest. If the nose 
 is stopped up, a little white vaseline inserted 
 gently into the nostrils will give some relief. 
 Nasal sprays or douches should not be given 
 by anyone who is not thoroughly trained, as 
 much harm may be done when they are given 
 carelessly. 
 
 One of the quickest means of relief for any 
 obstinate cough, or in cases where the child 
 has lost its voice because of congestion of the 
 larynx, is the use of the so-called "croup 
 kettle." If one is not available, an excellent 
 substitute may be made by taking an ordi- 
 nary pitcher, filling it with boiling water, and 
 putting into it compound tincture of benzoin 
 in the proportion of one teaspoonful to a pint 
 of water. Then a towel should be placed over 
 the top of the pitcher, leaving a small opening 
 at the lip. The child should be instructed to 
 breathe deeply of this steam while the pitcher 
 is held close to its face. The best time for 
 this steaming is while the child is in bed, 
 
COMMON DISEASES OF CHILDHOOD 143 
 
 wrapped up warmly, and later exposure to 
 change of temperature should be avoided. 
 
 One of the simplest medicines that may be 
 Used is brown mixture, which may be bought 
 at any drug store. It can be given in half- 
 teaspoonful doses every three hours to a child 
 of one year, and in teaspoonful doses every 
 three hours to a child of six years. 
 
 If the simple measures outlined here do 
 not suffice, or if there is any rise in temper- 
 ature above one hundred degrees, a physician 
 should be called. 
 
 If a cold tends to become chronic, it is 
 probable that there is some local congestion 
 or irritation in the nose or throat, and an 
 examination should be made by a physician 
 to determine if there are adenoids or enlarged 
 tonsils present. Each case should be judged 
 individually but if the adenoids or enlarged 
 tonsils are interfering with respiration, or if, 
 in the opinion of the physician, they are the 
 cause of the chronic colds, their removal is 
 advised. 
 
 CROUP 
 
 Croup is an acute spasm of the larynx, ac- 
 companied by a harsh, brassy cough, noisy 
 and difficult breathing, and occasionally by 
 signs of partial suffocation. It is not common 
 in young babies, rarely appearing before six 
 
144 HEALTHY CHILDREN 
 
 months of age. The vast majority of cases 
 occur when the child is from three to six years 
 of age. There seems to exist in some children 
 a predisposition to croup, which may be a 
 family trait. If there is one attack, there are 
 apt to be others. Sometimes the attacks 
 occur three or four nights in succession; again, 
 there may be a long interval between them. 
 
 Cause 
 
 The immediate exciting cause of croup seems 
 to be exposure to cold or some form of in- 
 digestion. Large adenoids and hypertro- 
 phied tonsils are often predisposing causes. 
 
 Symptoms 
 
 During the day the child may exhibit some 
 slight difficulty in breathing and older chil- 
 dren may have a hoarse, rather hollow and 
 barking cough. This becomes increasingly 
 worse toward evening, although the child may 
 finally go to sleep. The attack itself gener- 
 ally comes on about midnight. The child 
 awakens suddenly, shows great difficulty in 
 breathing, with loud, noisy inspirations, a 
 characteristic sound which, once heard, is 
 rarely forgotten. The child appears to be 
 in great distress. The lips may be blue and 
 sometimes there seems to be imminent danger 
 of suffocation. The pulse is rapid; occasion- 
 
COMMON DISEASES OF CHILDHOOD 145 
 
 ally there is slight fever, although the temper- 
 ature rarely goes above one hundred two 
 degrees. Sometimes the child is quite pros- 
 trated, but it must be remembered that this 
 disease is never fatal, although it is always 
 alarming. After the attack subsides, the 
 child usually falls into a refreshing sleep and 
 seems quite well again the next day. There may 
 be recurrent attacks of croup for two or three 
 nights in succession, then they may stop for 
 weeks, or even months. 
 
 Prevention 
 
 A child with a tendency to croup should 
 be kept in the open air as much as possible. 
 If it can be accustomed to cold bathing, so 
 much the better. In any event, the neck 
 and chest should be sponged with cold water 
 night and morning. If adenoids and enlarged 
 tonsils are present, t heir removal is advised. 
 As digestive disturbances often cause croup, 
 care must be taken to see that all food 
 the child eats is readily digestible. In in- 
 fants, too rich milk or too frequent feeding 
 may be the cause, and the feeding interval 
 should be lengthened and the milk diluted. 
 For older children, tonic treatment may be 
 necessary. 
 
146 HEALTHY CHILDREN 
 
 Treatment 
 
 When an attack occurs, the best remedy is 
 syrup of ipecac. This may be given in doses 
 of thirty drops every fifteen minutes for a baby 
 from six months to a year old, and one-half 
 to one teaspoonful every ten to fifteen minutes 
 for a child of two years. The doses should be 
 repeated until vomiting occurs. If vomiting 
 does not occur after two or three doses, the 
 child should be given a teaspoonful of white 
 vaseline or two teaspoonfuls of goose grease. 
 Hot flaxseed poultices or hot fomentations 
 should be placed around the child's neck. 
 If there is much difficulty in breathing a croup 
 kettle should be used. If a regular croup 
 kettle is not available, an ordinary tea kettle 
 may be made to serve the purpose. It should 
 be two-thirds full of water, which must be 
 boiling vigorously when the kettle is taken 
 from the stove. It should then be placed on 
 a chair close to the bed, and a canopy ar- 
 ranged over the bed. This may be done by 
 raising an umbrella and draping sheets over 
 it so that the child is under a tent. The spout 
 of the kettle is then inserted through an open- 
 ing in the sheet and the child allowed to 
 breathe the moist and steaming air. Such 
 treatment as this usually loosens the cough 
 and if vomiting occurs it almost invariably 
 
COMMON DISEASES OF CHILDHOOD 147 
 
 relieves the spasm. If the attack recurs dur- 
 ing the night, the treatment must be repeated. 
 The next day the child should be kept in bed 
 and it is advisable to give the syrup of ipecac 
 in five-drop doses every two hours during the 
 daytime in order to relax the spasm of the 
 larynx. 
 
 ENLARGED GLANDS 
 
 Enlarged glands, usually located in the neck, 
 are fairly common in childhood, particularly 
 in undernourished children and in those who 
 are suffering from some degree of infection. 
 The terms " strumous' ' and " scrofulous* ' were 
 formerly used to describe such a condition, 
 but they have very little meaning in them- 
 selves and it is more exact to consider the 
 real causes which lead up to the presence of 
 enlarged glands. 
 
 The glands of the neck are situated mainly 
 in three localities : a row of them follows the 
 front boundary of the large muscle of the 
 neck. These are known as the anterior cervi- 
 cal glands. Another row, which follows the 
 posterior boundary of the large muscle of the 
 neck, are known as the posterior cervical 
 glands, while directly beneath the jaw there 
 are numerous glands which are known as the 
 submaxillary or sublingual glands. Ordina- 
 rily, these glands cannot be felt. When any 
 
148 HEALTHY CHILDREN 
 
 infection occurs, particularly through the 
 mouth, the glands in the neck are apt to ab- 
 sorb some of the infectious material and 
 become inflamed and enlarged. 
 
 Symptoms 
 
 The glands increase in size so that they can 
 be felt readily as small, hard nodules just 
 beneath the skin. If they are simply in- 
 flamed, they will be painful to the touch as 
 well as swollen. This inflammation, however, 
 may go on to the point where pus forms, in 
 which case the skin over the gland becomes 
 slightly discolored, and if left untreated the 
 pus in the gland burrows through the skin, 
 usually appearing on the outside of the neck. 
 In some instances the pus burrows toward the 
 inside and the opening may be in the child's 
 throat. 
 
 Cause 
 
 Enlarged glands are usually due to the 
 presence of some infection. They are com- 
 monly associated with decayed teeth. What 
 is known as an ulcerated tooth, or the forma- 
 tion of a gum boil at the root of a tooth, 
 frequently results in an enlarged and painful 
 gland and occasionally in an infected gland 
 which forms an abscess with pus and finally 
 ruptures. In some infectious diseases the 
 
COMMON DISEASES OF CHILDHOOD 149 
 
 glands enlarge, and they may occur in under- 
 nourished or anemic children. Frequently, 
 infection of a gland does not go beyond the 
 point of making the gland swollen and tender, 
 but occasionally they become acutely pain- 
 ful, much swollen and tend to "break down," 
 that is, the contents become cheesy masses of 
 pus. 
 
 Treatment 
 
 When the cause of infected glands is bad 
 teeth, the treatment is obvious. The teeth 
 should be cared for properly, mouth hygiene 
 should be practiced 'and necessary fillings and 
 extractions should be made. Usually the 
 glands will get entirely well as soon as the 
 cause is removed. If the swollen glands are 
 the result of an ulcerated tooth, treatment 
 should be begun at once so that the pus from 
 the tooth abscess will not burrow through and 
 force an opening on the outside of the neck. 
 When this happens, permanent scarring of 
 the neck usually results. 
 
 Enlarged tonsils should be removed as a 
 precautionary measure in the prevention of 
 infected glands. If the glands are already 
 inflamed, however, it is wiser to wait until the 
 inflammation has subsided before having the 
 tonsils taken out. The nutrition of the child 
 should receive attention. The early home 
 
150 HEALTHY CHILDREN 
 
 treatment of inflamed glands is, first, to paint 
 them with tincture of iodine. This may be 
 repeated every two or three days, but should 
 be stopped for a week or two if the skin be- 
 comes sore. The glands should not be rubbed 
 or irritated in any way. If the inflammation is 
 at all acute, application of an ice bag or cold 
 compresses is advised. If the skin over the 
 glands becomes red and much swollen, and if 
 tenderness is present, it is probable that the 
 glands will have to be opened. This should 
 be done only by a physician. In order to 
 determine the exact cause of enlarged glands 
 and to secure proper treatment, the advice 
 of a physician should be sought at the earliest 
 possible opportunity. 
 
 TONSILLITIS 
 
 This is a general constitutional disturbance, 
 with high fever, rapid pulse and a moderate 
 amount of prostration. It may or may not 
 be accompanied with pain in the back or 
 limbs. The local symptoms are manifested 
 by sore throat. Examination shows the ton- 
 sils reddened and inflamed, with small white 
 patches appearing over their surface. 
 
 Treatment 
 
 Because tonsillitis may so closely resemble 
 diphtheria, there should be no delay in ob- 
 
COMMON DISEASES OF CHILDHOOD 151 
 
 taining medical advice when any child is 
 ill with a sore throat. Before the doctor 
 comes, however, it is advisable to give the 
 child a dose of castor oil or calomel in doses 
 of one-tenth of a grain every fifteen minutes 
 for ten doses or until one grain in all has been 
 taken. This should be followed by a saline 
 cathartic. If the child is old enough to 
 gargle, it may do so with a solution of one 
 teaspoonful of salt to a glassful of hot water. 
 Cold compresses or an icebag on the head 
 often affords some relief. Medical treatment 
 and local treatment of the throat can be pre- 
 scribed only by a physician. 
 
 EARACHE 
 
 Earache is not at all uncommon during 
 childhood. It is exceedingly difficult to diag- 
 nose, except in older children, as younger 
 ones are rarely able to tell the location of the 
 pain. 
 
 Cause 
 
 It is caused generally by repeated coughs or 
 colds or the presence of adenoids. It com- 
 monly follows some of the infectious diseases, 
 particularly scarlet fever. In such instances, 
 we have an acute infection of the ear. Ear- 
 ache at any time may be an indication of more 
 serious ear trouble, and therefore should re- 
 ceive medical attention at once. 
 
152 HEALTHY CHILDREN 
 
 Symptoms 
 
 Very young children appear quite ill, but 
 for no marked reason. Usually there is a good 
 deal of drowsiness but the sleep is restless, 
 the child tossing about from side to side and 
 constantly moving its head. Older children 
 may put their hands up to the affected ear, 
 thus indicating the seat of the pain. Younger 
 children, however, rarely do this. A child 
 who is old enough to talk will usually say 
 that its head hurts or its ear aches. The 
 pulse invariably is increased in frequency and 
 the temperature may rise as high as one hun- 
 dred five degrees Fahrenheit. 
 
 Treatment 
 
 The first step in the treatment of earache 
 is relief of the pain and quieting the child's 
 discomfort. Hot compresses are best. These 
 usually give more relief if they are dry. One 
 of the following may be used: a hot water 
 bag, care being taken to see that it is not hot 
 enough to burn the child, or a square, rather 
 flat bag filled with salt and placed in the oven 
 until thoroughly heated. If nothing else 
 is available, a saucer may be heated in the 
 oven, covered with cloth and placed at the 
 side of the child's head. The ear should be 
 irrigated with hot boric acid solution every 
 
COMMON DISEASES OF CHILDHOOD 153 
 
 three hours. Usually the pain may be con- 
 trolled fairly well in this way, but, owing to 
 the serious results that may follow earache, 
 a physician should be summoned and his 
 advice followed from the beginning of the 
 illness. The trouble in the ear may subside 
 entirely or it may increase to the point where 
 the eardrum is punctured. If this occurs 
 there is almost immediate relief and a distinct 
 fall in temperature. There may be a dis- 
 charge from the ear, which tends to become 
 chronic. In such cases the ear should be irri- 
 gated carefully with boric acid solution once 
 each day so that it may be kept as clean as 
 possible, 
 
 HICCOUGHS 
 
 Hiccoughs are a succession of spasms of the 
 diaphragm and consist in more or less regular 
 interruption to the rhythm of breathing, with 
 a sharp, gulping sound occurring in place of 
 the normal respiration. In young children 
 hiccoughs may be persistent and alarming. 
 Frequently the condition occurs without any 
 appreciable cause and there may be repeated 
 attacks. Sometimes the cause will be found 
 to be a slight attack of indigestion. Not un- 
 commonly it is a result of too rapid eating. 
 Occasionally special articles of food, particu- 
 
154 HEALTHY CHILDREN 
 
 larly those that are highly seasoned, very hot 
 or very cold, will excite an attack. 
 
 Treatment 
 
 Treatment should be directed toward re- 
 moval of the cause and prevention of the 
 spasm. When the attack is caused by in- 
 digestion, the child may be given a quarter- 
 teaspoonful of soda bicarbonate (baking soda) 
 in a quarter-glassful of water or a teaspoonful 
 of rhubarb and soda mixture diluted with one- 
 quarter glassful of water. If any article of 
 food is known to disagree with a child and to 
 produce hiccoughs, its use should be avoided. 
 
 For the attack itself, effort should be di- 
 rected toward holding the breath long enough 
 to interrupt the spasm of the diaphragm. 
 This may be done in older children by teach- 
 ing them to inhale very slowly until the lungs 
 are filled with air and then to hold the breath 
 as long as they can, finally exhaling the air 
 in an equally slow manner. Usually, one or 
 two repetitions of this breathing exercise will 
 stop the hiccoughs. The old idea of taking 
 nine swallows of water without breathing has 
 the same principle and is easily applicable to 
 children who cannot be made to hold the 
 breath in any other way. 
 
COMMON DISEASES OF CHILDHOOD 155 
 
 HEADACHE 
 
 Headache in young children may be a 
 simple matter, due to some exciting cause, 
 or it may be a symptom of a serious disease. 
 If the headache does not respond to treat- 
 ment within twelve hours, and if any other 
 symptoms of illness, such as fever or increased 
 pulse rate, arise during that time, it is probable 
 that the headache is a symptom of more 
 serious disease and the doctor should be 
 summoned. 
 
 Simple headache in children may be due to a 
 variety of causes, of which indigestion and 
 chronic constipation are probably the most 
 common. Playing too hard and too con- 
 tinuously, late hours with over-excitement, 
 too frequent attendance at the movies, par- 
 ticularly at night, over-confinement in badly 
 ventilated rooms, eyestrain of any kind, over- 
 exertion in hot weather, nervous instability, 
 impacted or decayed teeth, adenoids and nasal 
 catarrh, are common causes. 
 
 Symptoms 
 
 The child usually complains of pain in its 
 head. This may be localized in some one 
 spot or the whole head may ache. Occasion- 
 ally there will be pain on turning the head 
 from side to side. Usually there is a good 
 deal of prostration, the child is unwilling to 
 
156 HEALTHY CHILDREN 
 
 get up, does not want to play, objects to 
 strong light and occasionally complains of 
 nausea. There may or may not be vomiting. 
 These symptoms vary in severity, ranging 
 from simple pain in the head to complete 
 prostration and what seems to be serious 
 illness. 
 
 Prevention 
 
 Prevention of headache consists in removing 
 the underlying cause. This may be lack of 
 ventilation in the sleeping room, too little 
 outdoor play or lack of exercise. In some 
 cases over-excitement, late hours and too 
 frequent attendance at the movies, with the 
 close air and constant eyestrain, must be 
 guarded against. Particular attention should 
 be paid to the digestion and to the condition 
 of the bowels and special effort made to avoid 
 constipation. If there is any question of 
 eyestrain, the eyes should be examined by a 
 competent oculist. If the child is subject to 
 headache, the routine of its life must be out- 
 lined carefully. There should be sufficient 
 sleep, plenty of outdoor play and a light, 
 readily digestible diet. 
 
 Treatment 
 
 Treatment will depend upon the cause, and 
 usually it is easy for the observant mother to 
 
COMMON DISEASES OF CHILDHOOD 157 
 
 know why a child has a headache. The gen- 
 eral treatment consists in complete rest in a 
 cool, dark room. Cold cloths or icebags 
 should be applied to the head and the child 
 should be given a cathartic, preferably castor 
 oil. In some cases a hot foot bath will afford 
 relief, and if indigestion or constipation is the 
 cause, colon irrigations are frequently bene- 
 ficial. Drugs should not be given, except 
 under the doctor's orders. The only excep- 
 tions to this rule are soda bicarbonate or 
 rhubarb and soda mixture, which will re- 
 lieve the accompanying indigestion. The diet 
 should be very light for at least twenty-four 
 hours, consisting mainly of liquid foods. 
 
 WORMS 
 
 Intestinal worms found in children are of 
 three kinds: tape worms, round worms and 
 pin or thread worms. The latter is the only 
 species found in babies. As the child grows 
 older, pin worms are still the common type, 
 although the round worm or tape worm may 
 also occur. All these varieties develop in the 
 intestines. It is not definitely known how 
 they gain entrance into the body, but it is 
 believed that the eggs from which they de- 
 velop are found on food that has not been 
 washed sufficiently or cooked before being 
 eaten. 
 
158 HEALTHY CHILDREN 
 
 The tape worm usually occurs singly. It 
 may be very long, ranging from fifteen to 
 twenty-five feet. Generally it is about one- 
 quarter to one-third of an inch in width, and 
 resembles a long piece of tape, cut into seg- 
 ments or pieces from one-half to one inch long. 
 These segments are joined together lightly. 
 They pass off with the bowel movements 
 separately or in small groups and are recog- 
 nized easily by their white color, size and 
 shape. 
 
 Round worms are white and closely re- 
 semble the common earth worm or angle 
 worm in appearance. They may be from 
 three to eight or even ten inches long. 
 
 Thread worms appear as little shreds of 
 white thread. They are from one-quarter 
 to one-half inch in length and are difficult 
 to distinguish except after careful observation. 
 Sometimes, on examination of the child's 
 rectum and the folds along the external 
 genitals, the presence of these tiny worms will 
 be shown. 
 
 Symptoms 
 
 There may be no symptoms except finding 
 the worms or their eggs in the stools. The 
 other symptoms which may occur are great 
 irritability and nervousness, disturbed sleep 
 or night terrors. Gritting of the teeth during 
 
COMMON DISEASES OF CHILDHOOD 159 
 
 sleep is not uncommon. Constant picking 
 at the nose, both when awake and asleep, is 
 usually a sign of some intestinal irritation. 
 There may be headache and loss of appetite. 
 Diarrhoea and colic are not uncommon. The 
 child will complain of itching of the rectum 
 and usually there are symptoms of indigestion 
 with accompanying bad odor of the breath. 
 Any or all of these symptoms may occur in 
 other conditions; therefore, the diagnosis can 
 be made only by the finding of the worms or 
 their eggs in the feces. 
 
 Treatment 
 
 Treatment of tape worm or round worm 
 is a matter for a physician to decide and the 
 use of special medicine cannot be advised. 
 In the case of the tape worm, it is important 
 to see that every part of it is removed, and 
 in the case of the round worms that they are 
 entirely eliminated. Both conditions are 
 serious enough to warrant obtaining the best 
 possible medical advice. 
 
 Pin or thread worms may be treated at 
 home. The best method is to give the child 
 a good cathartic, preferably castor oil or calo- 
 mel. Once a day the rectum should be irri- 
 gated thoroughly with the following solution: 
 one ounce of quassia chips boiled for ten 
 minutes in a pint of water, sufficient water 
 
160 HEALTHY CHILDREN 
 
 being added from time to time to keep the 
 final amount at one pint. The solution 
 should be strained and used while warm. 
 Absolute cleanliness of the rectum and ex- 
 ternal genitals is essential. 
 
 The preventive treatment of intestinal 
 worms is to see that the child's hands are 
 washed thoroughly before each meal and that 
 food is not eaten until it has been either 
 cooked or made perfectly clean. 
 
 HIVES (URTICARIA) 
 
 Hives occur as an eruption which may be 
 general all over the body or confined to some 
 one part of it. The eruption consists of 
 elevated white or pinkish spots surrounded by 
 marked redness. It is apt to appear rather 
 suddenly, and may persist for several days 
 or disappear within a few hours. It does not 
 leave any scars. 
 
 Cause 
 
 The cause is usually due to some form of 
 indigestion. Many people have what is known 
 as a marked idiosyncrasy to certain articles 
 of food. Fish is apt to cause attacks of hives, 
 particularly if it is not fresh. This is true 
 particularly of shell-fish such as crabs, lobster 
 and oysters. In some instances berries, espe- 
 cially strawberries, cause hives, while it is not 
 
COMMON DISEASES OF CHILDHOOD 161 
 
 uncommon in some children to see marked 
 attacks of hives as a result of eating eggs. 
 Certain drugs will produce this eruption. In 
 some persons no particular articles of food can 
 be discovered as the cause, and the attack 
 may be the result of eating food that is not 
 entirely fresh. 
 
 Symptoms 
 
 The most prominent symptoms are dis- 
 comfort of the skin caused by the inflam- 
 mation of the eruption and the intense itching 
 that accompanies it. This itching may be 
 so severe as to lead to loss of appetite, dis- 
 turbance of sleep and general irritability and 
 restlessness, particularly in young children. 
 
 Treatment 
 
 An active cathartic should be given at once, 
 preferably a dose of epsom salts or castor oil. 
 The diet should be extremely light and con- 
 fined to liquids for several hours or a day. 
 Soda bicarbonate in from one-quarter to one- 
 half teaspoonful doses, depending upon 
 the age of the child, or rhubarb and soda 
 mixture in appropriate doses, will be 
 found helpful. To relieve the itching, bran 
 or soda baths may be given two or three 
 times a day, with the water at a temperature 
 not above eighty-five degrees. The skin 
 
162 HEALTHY CHILDREN 
 
 should be patted dry, not rubbed, after the 
 bath, then covered with some dusting powder. 
 Ordinary talcum powder is excellent for this 
 purpose, but in the case of intense itching, 
 stearate of zinc powder will often be found to 
 give the greatest relief. 
 
CHAPTER VIII 
 
 INFECTIOUS AND CONTAGIOUS 
 DISEASES 
 
 There are always two factors to be con- 
 sidered in the occurrence of any infectious 
 disease: first, the presence of the bacteria or 
 germs that cause the disease; and, second, 
 the resistance of the individual. A certain 
 number of children are naturally immune to 
 various infectious diseases; others are ex- 
 tremely susceptible. In general, very young 
 babies are apt to be immune to these diseases. 
 This immunity begins to lessen at about the 
 sixth month, and the child becomes more and 
 more susceptible up to two or three years of 
 age. After that time, some children begin 
 to acquire natural immunity to some types 
 of disease, and this immunity increases until, 
 in adult life, the great majority of people are 
 immune to the ordinary infectious diseases. 
 For these reasons, it is natural to expect the 
 greater proportion of the infectious diseases 
 to occur in early child life, and this is borne 
 out by the statistics that have been gathered 
 in regard to the matter. It is probable that 
 eighty per cent of all cases of the common 
 infectious diseases occur in children under five 
 years of age. The greatest danger in con- 
 nection with these diseases does not come in 
 
 163 
 
164 HEALTHY CHILDREN 
 
 the ordinary course of the disease itself, but 
 rather as a result of the complications that 
 may occur. While good health in a child 
 will not prevent infectious disease, it gener- 
 ally causes the attack to be light, and in some 
 of the infectious diseases, notably tuber- 
 cuosis, good health seems to be the one thing 
 that will actually prevent development of the 
 disease. 
 
 Knowledge of how infectious diseases are 
 transmitted has been distinctly advanced 
 during the past few years. Formerly it was 
 believed that most of these germs were car- 
 ried through the air so that it was possible 
 to contract infectious diseases merely by 
 association with a person already infected. 
 Now we know that there are few of these 
 diseases in which the germs are air-borne, 
 and that the only way in which most of them 
 can be contracted is by intimate personal 
 association with the sick person. Such dis- 
 eases can be carried from one individual to 
 another, if the discharges from the nose, 
 throat or bowels of the patient are carried 
 on the hands or clothing. The main way by 
 which infectious diseases are transmitted is 
 through the spray that comes from the mouth 
 or nose of the infected person while coughing 
 or sneezing. Normally, the infectious ma- 
 
INFECTIOUS AND CONTAGIOUS DISEASES 165 
 
 terial is not carried through the air beyond 
 a distance of three or four feet. 
 
 Infectious diseases may be carried from one 
 person to another by people who are known as 
 "carriers." These are individuals who are 
 not themselves ill but who are capable of 
 harboring the germs of a given disease and 
 by means of coughing or sneezing, or through 
 the bowel discharges, transmitting the germs 
 to a third person. Diphtheria germs may be 
 carried in the throat of a perfectly well per- 
 son, while there are many instances on record 
 where typhoid fever germs have been found 
 in the bowel discharges of people who were 
 in apparent good health. 
 
 There is a superstition which still persists 
 in some parts of the country that everyone 
 must have all the commoner infectious dis- 
 eases some time during their lives, and that it 
 is better to expose children to measles, 
 chickenpox, scarlet fever and mumps in the 
 hope that the attacks will be light, rather than 
 to risk similar exposure in later life. Every 
 mother should understand that a child should 
 never be exposed needlessly to an infectious 
 disease. These diseases, while often looked 
 upon as necessary accompaniments of child- 
 hood, are quite avoidable in a large pro- 
 portion of cases. 
 
166 HEALTHY CHILDREN 
 
 In order to prevent infectious diseases and 
 to avoid epidemics in a community, it is neces- 
 sary to have proper health laws that are en- 
 forced. The sanitary and hygienic conditions 
 in any town should be maintained at the 
 highest standard. All persons who are ill 
 with an infectious disease should be quaran- 
 tined by the local health authorities until all 
 danger of transmitting the infection has 
 passed. The possibility of transmitting in- 
 fectious diseases by means of water, milk or 
 foodstuffs should lead fathers and mothers 
 to demand that the health authorities of their 
 towns provide a clean and pure water supply, 
 pasteurization of all milk that is not known 
 to be absolutely pure, and the sanitary and 
 hygienic handling of all foodstuffs. Green 
 vegetables, because of the possibility of their 
 being handled by persons who are infected, 
 may be a means of transmitting disease. 
 This is because these vegetables, in so many 
 instances, are eaten without having been 
 washed. Street dust may harbor these germs 
 and thereby infect vegetables, fruits or other 
 articles that have been exposed. The only 
 safe way is to see that such fruits and vege- 
 tables are washed thoroughly before they are 
 eaten. 
 
 Proper health laws in a community are 
 absolutely essential for the prevention of 
 
INFECTIOUS AND CONTAGIOUS DISEASES 167 
 
 epidemics and separate cases of infectious 
 disease. It is necessary also to carry out 
 certain rules with regard to the hygiene of 
 children for the purpose of avoiding, as far as 
 possible, contraction of any of these diseases, 
 and in order to keep the child in as good health 
 as possible so that, if the disease is contracted, 
 the attack will be light and complications may 
 be avoided. 
 
 Measures of prevention include everything 
 that tends to maintain good health and 
 strength and to build up a strong, robust 
 constitution in the child. Such measures of 
 personal hygiene should be commenced in 
 infancy and continued throughout childhood. 
 The most important preventive aid is fresh 
 air. It is well known that infectious diseases 
 reach their height in the winter months, 
 usually during February and March, and then 
 tend to grow less frequent. During the sum- 
 mer months they are practically unknown. 
 In all probability this is not because the germs 
 are more prevalent during the winter or be- 
 cause they develop better in the cold weather. 
 It is probably on account of the common 
 practice of keeping windows closed during the 
 winter and opening them in the summer. 
 Fresh air and sunlight are the greatest de- 
 stroyers of all germ life, and if they were as 
 readily available during the cold weather as 
 
168 HEALTHY CHILDREN 
 
 they are in the summer, it is probable that 
 infectious diseases would be no more common 
 in February than they are in July. This is 
 one of the reasons why children should have 
 the advantage of fresh air as much as possible 
 during the daytime throughout the year, and 
 their play should always be in well ventilated 
 rooms, when it is necessary to keep them 
 indoors. Sleeping rooms should have an 
 abundance of fresh air throughout the night. 
 
 Overclothing is also a matter to be guarded 
 against. Clothing for indoors should be little, 
 if any, heavier during the winter than during 
 the summer months, and in order to prevent 
 chilling of the body, care should be taken to 
 see that the outer clothing is sufficient for 
 warmth. Attention should always be paid 
 to wet feet, particularly during the winter 
 months, and children should never be allowed 
 to wear wet shoes and stockings. 
 
 A cool sponge bath daily with a warm tub 
 bath at least twice a week promotes elimi- 
 nation of waste material from the body and 
 thus has a great tendency to keep the child 
 in sound health. Good, wholesome food and 
 plenty of recreation are necessary. Special 
 attention should be paid to the care of the 
 mouth and teeth. The main point of entrance 
 for all bacteria to the body is through the 
 mouth. Decayed teeth are a breeding place 
 
INFECTIOUS AND CONTAGIOUS DISEASES 169 
 
 for germs. Attention to decayed teeth and 
 cleanliness of the mouth are of the utmost 
 importance in preventing individual infection. 
 The presence of adenoids and enlarged tonsils 
 also predisposes to infectious disease. 
 
 During the early years of life the mother 
 must control the health habits of her child. 
 By the time it is two or three years old, there 
 is no reason why it should not learn the kind 
 of health habits that will tend toward pre- 
 vention of infectious and other diseases, and 
 the following rules should be observed: 
 
 1st: The teeth should be brushed after each meal and on arising 
 in the morning. 
 
 2nd: The hands should be washed before each meal and after 
 going to the toilet. The fingernails should be kept ab- 
 solutely clean. 
 
 3rd: No toy, pencil or other article that has been used by 
 another child should ever be put into the mouth. Disease 
 germs are easily carried in that way. 
 
 4th: Each child should have a fresh pocket handkerchief every 
 day. He should not lend it to anyone and should not 
 borrow one from any other child. This handkerchief 
 should be held over the mouth when coughing or sneezing. 
 
 5th: A child with a cough or cold should be kept entirely apart 
 from other children and should not be allowed to come into 
 contact with them in any way until it has been determined 
 whether or not some infectious disease is about to develop. 
 
 6th: Each child should have its own drinking cup and towel, 
 both at school and at home, and these should not be used 
 by anyone else. 
 
 7th: A child should not be kissed on the mouth by anyone but 
 its mother, and she should not do this unless she has every 
 reason to know that she is in good health. 
 
170 HEALTHY CHILDREN 
 
 Early Symptoms of Infectious Diseases 
 
 Every mother should know the early signs 
 of the various infectious diseases, the main 
 symptoms and the length of time the child 
 should be kept isolated. Frequently children 
 have these diseases in so mild a form that a 
 physician is not sent for. Sometimes cases 
 that seem mild in the beginning later become 
 serious, so that in every instance a doctor 
 should be summoned at once if a child is ill. 
 
 All the common infectious diseases have 
 certain marked characteristics but there are 
 some cases where children simply develop 
 high temperature and where it is impossible 
 to decide whether or not the illness is of an 
 infectious nature. Young children are par- 
 ticularly susceptible to sudden rises in temper- 
 ature. This may be due merely to some 
 digestive disturbance, but because of the pos- 
 sibility of the disease being infectious every 
 child who is taken ill should be isolated at 
 once and kept apart from others until the 
 nature of the disease has been determined. 
 
 At the onset of any illness, it is wise to give 
 a good cathartic, preferably a tablespoonful 
 of castor oil or calomel in one-tenth grain 
 doses every fifteen minutes until ten doses 
 (one grain) have been taken. If calomel is 
 used, it should be followed in four hours with 
 
INFECTIOUS AND CONTAGIOUS DISEASES 171 
 
 a saline cathartic such as citrate of magnesia or 
 epsom salts. If the calomel is given at night, 
 the saline cathartic may be given next morning. 
 
 Children who have fever should be put on a 
 liquid diet at once and no solid food should be 
 given for at least twenty-four hours. Milk is 
 the best food to use and thin cereal gruels and 
 milk soups may be given in addition. The 
 child should drink plenty of water. It is best 
 to do this in a routine way, and a glass of 
 water may be offered to the child every two 
 hours and it should be urged to drink as much 
 as possible. A cool sponge bath will often 
 reduce the temperature and make the patient 
 more comfortable. Most important of all, 
 isolation must be insisted upon at the begin- 
 ning of an illness. This means keeping the 
 child away from everyone else in the house- 
 hold except the mother or the nurse. 
 
 Because of the nature of infectious diseases 
 and the fact that at any time complications 
 may occur which may prove dangerous, medical 
 attention should be obtained at the earliest pos- 
 sible moment. Except in the case of diphtheria 
 and whooping cough, there is no specific treat- 
 ment that can be directed toward the cure 
 of any of these diseases, and the medical 
 treatment should be left entirely to the phy- 
 sician. However, the mother should be in- 
 telligent regarding the nature of the disease 
 
172 HEALTHY CHILDREN 
 
 and should have a general knowledge of the 
 home care that is necessary. 
 
 MEASLES 
 
 This is the most common of the infectious 
 diseases of childhood. Few persons live to 
 adult life without having had it. In itself, 
 measles is not a dangerous disease. The main 
 difficulty lies in the complications; that is, 
 in serious bronchitis or pneumonia, which 
 sometimes occur. 
 
 Symptoms 
 
 The onset or first symptoms are those of cold 
 in the head. There mayJDe slight fever, inflamed 
 eyes with a good deal of watery secretion, 
 running of the nose, sneezing and coughing. 
 Frequently, the child will complain of the light 
 and will want to remain in a dark room. The 
 rash, consisting of small, irregular groups of 
 dull red, slightly raised spots, does not appear 
 until the third day after the first symptoms 
 begin, and usually it is first seen on the fore- 
 head and face, and then spreads rapidly over 
 the entire body. 
 
 Method of Infection 
 
 Measles is carried through the discharges 
 sprayed or thrown from the nose or mouth 
 in coughing, sneezing or spitting. There is 
 
INFECTIOUS AND CONTAGIOUS DISEASES 173 
 
 therefore no reason why it should be trans- 
 mitted if other children are not allowed in 
 the sick room and if all body discharges are 
 carefully burned or otherwise destroyed. 
 
 Home Care 
 
 A child who is sick with measles should be 
 kept in a cool, comfortable and well-darkened 
 room until the rash has disappeared and it 
 no longer dreads the light. Warmth and good 
 nursing are essential. Often light diet and 
 care are all that are needed to bring a case 
 through without complications. The child 
 must be kept isolated until all signs of the rash 
 have disappeared and there is no longer any 
 discharge from the nose and throat. 
 
 GERMAN MEASLES 
 
 This resembles measles somewhat but is 
 much lighter in form. 
 
 Symptoms 
 
 Frequently the child does not complain of 
 feeling sick at all. The initial symptom is the 
 rash, which occurs first on the face and then 
 spreads rapidly over the body. The rash may 
 resemble that of measles or scarlet fever. 
 Enlargement of the glands back of the ear is 
 the characteristic symptom to be noted. 
 These appear as rounded, irregular protuber- 
 
174 HEALTHY CHILDREN 
 
 ances and are somewhat tender. The eyes 
 may be slightly inflamed and a low degree of 
 fever may occur for a day or two. 
 
 Method of Infection 
 
 This very infectious disease is spread in the 
 same way as measles. 
 
 Home Care 
 
 The disease needs little treatment other 
 than good nursing and light diet to effect a 
 cure. 
 
 SCARLET FEVER 
 
 This is a serious disease, and although not 
 nearly as infectious as measles, it is one that 
 is rightly dreaded. 
 
 Symptoms 
 
 This disease usually manifests itself sud- 
 denly. The child may vomit or complain of 
 sore throat. Sometimes fever or a sharp 
 headache is the first symptom noted. The 
 rash, consisting of fine spots which are so 
 close together that it seems as though the 
 entire skin were a bright red, appears within 
 twenty-four hours after the child begins to 
 feel sick. First it breaks out on the neck and 
 upper part of the chest. The rash will last 
 from three to ten days and will then fade 
 
INFECTIOUS AND CONTAGIOUS DISEASES 175 
 
 gradually. Later, at a period varying from 
 two to three weeks, the skin of the body is apt 
 to scale off, sometimes in fine pieces and 
 sometimes in strips of considerable size. 
 
 Method of Infection 
 
 Scarlet fever is transmitted by the dis- 
 charges thrown or sprayed from the mouth 
 or nose in coughing, sneezing or spitting, and 
 by discharges from other parts of the body. 
 Because of its serious nature, unusual care 
 must be taken with all body discharges. Burn 
 them immediately or otherwise destroy them. 
 The mother or nurse who cares for the child 
 must be particularly careful in handling these 
 discharges. She should wash her hands fre- 
 quently jand always before touching food. 
 The clothing she wears in the sickroom should 
 always be changed and other clothing put 
 on before she comes into contact with other 
 people. 
 
 Home Care 
 
 Early and careful attention is of the first 
 importance in this disease. Good nursing, 
 light diet, plenty of water, extreme cleanli- 
 ness, with rest and quiet, are necessary. 
 There is always the possibility of serious com- 
 plications following scarlet fever. For this 
 reason it should never be viewed lightly and 
 
176 HEALTHY CHILDREN 
 
 a child with this disease should always have 
 medical care. 
 
 CHICKENPOX 
 
 Symptoms 
 
 Very often there are no early symptoms of 
 this disease, and the first thing noticed is the 
 rash. Occasionally there may be slight fever. 
 The rash, consisting of small, raised pimples 
 which later become filled with fluid, appears 
 usually on the second day. Within a few 
 days scabs form over the top of these raised 
 spots. There may be successive crops of this 
 eruption for a period of as long as ten days. 
 
 Method of Infection 
 
 Because the disease can be transmitted only 
 through the secretions contained in the erup- 
 tion, an infected child should be isolated and 
 kept absolutely away from other children 
 until all scabs have fallen off and the spots 
 are completely healed. 
 
 Home Care 
 
 Chickenpox needs no unusual care. Isola- 
 tion and the ordinary principles of nursing 
 must be carried out. Unless otherwise direct- 
 ed by the physician, the child need not be 
 kept in bed during the illness, but may play 
 about in a warm, well ventilated room. 
 
INFECTIO US A ND CO NT A GIO US DISEA SES 1 7 7 
 MUMPS 
 
 Symptoms 
 
 So characteristic is this common disease of 
 childhood that it is rarely mistaken for any 
 other. Its beginning may be sudden or 
 gradual. The child will complain of not feel- 
 ing well and of pain at the angle of the jaw. 
 The mouth may be dry, and the saliva sticky 
 and scant. There may be difficulty in open- 
 ing the mouth because of the stiffness of the 
 jaws, and, in many instances, actual pain is 
 felt at the sight of sour foods such as pickles. 
 The characteristic symptom, which is apt to be 
 very painful and may last several days, is 
 swelling in front of the ear. 
 
 Method of Infection 
 
 The infectious material of mumps is carried 
 by means of the discharges from the nose and 
 throat and the period during which the in- 
 fection may be transmitted lasts as long as 
 there is any swelling. 
 
 Home Care 
 
 Mumps in itself calls for no particular 
 treatment except nursing. However, if the 
 swelling is unsually severe, or if the child com- 
 plains of much pain, medical advice should be 
 sought and followed. 
 
178 HEALTHY CHILDREN 
 
 WHOOPING COUGH 
 
 Symptoms 
 
 The early symptoms of whooping cough are 
 usually those of ordinary cold in the head. 
 Later there is a persistent cough. The char- 
 acteristic "whoop" does not appear until 
 about a week after the onset of the disease. 
 Sometimes early in the disease, and almost 
 always later on, the main symptom that is 
 noted consists of spasms of coughing. During 
 these spasms the child appears to be choked, 
 usually takes hold of an article of furniture 
 or buries its head in its mother's lap. These 
 spasms may be quite violent at times, and 
 often end in attacks of vomiting. 
 
 Method of Infection 
 
 Formerly it was thought that the disease 
 was infectious during the entire "whooping" 
 period, but now it is believed that its most 
 infectious period does not last longer than two 
 weeks after the first appearance of the 
 "whoop." Because of the possibility of the 
 infection being transmitted for a greater 
 length of time, it is still considered necessary 
 to keep these children away from others dur- 
 ing the entire time that they are whooping. 
 The disease is spread by discharges sprayed 
 
INFECTIOUS AND CONTAGIOUS DISEASES 179 
 
 or thrown from the nose or mouth in coughing, 
 sneezing or spitting. 
 
 Home Care 
 
 The home care of whooping cough is diffi- 
 cult because the child should be kept out- 
 doors as much as possible. Fresh air is 
 one of the greatest helps we have in the treat- 
 ment of this disease, but at the same time the 
 infected child should be kept away from other 
 children. Children with whooping cough 
 should never be taken in public conveyances. 
 While the disease is usually considered a light 
 one, it must be remembered that it is apt to 
 be very dangerous when it occurs in young 
 babies. For this reason, whooping cough 
 should never be neglected but should receive 
 as careful attention as a case of scarlet fever. 
 
 DIPHTHERIA 
 
 Symptoms 
 
 The early symptoms are those of sore 
 throat, with a rise in temperature. The ton- 
 sils are the most common location of the local 
 symptoms. They may be red and swollen 
 and covered with a grayish patch. Diph- 
 theria may occur with the symptoms manifest 
 in the nose or larynx. Any pustular or 
 bloody discharge from the nose or any sore 
 throat is an indication that medical advice 
 
180 HEALTHY CHILDREN 
 
 is necessary. Diphtheria is such a serious 
 disease, if left untreated, that proper medical 
 care must be obtained at the earliest possible 
 moment. 
 
 Method of Infection 
 
 The disease is conveyed by discharges 
 sprayed or thrown from the nose or mouth 
 in coughing, sneezing or spitting and the aver- 
 age duration of the infectious period is about 
 twelve days. A person who has had diph- 
 theria cannot be considered well or ready to 
 be discharged from quarantine until the doc- 
 tor has made the necessary examinations and 
 determined that the nose and throat are free 
 from diphtheria bacilli. 
 
 Prevention and Treatment 
 
 This, the most dreaded disease of child- 
 hood, is the only one of the infectious diseases 
 in which we have positive knowledge of 
 methods of prevention and cure. Every 
 child who has a sore throat should receive 
 medical attention so that it may be deter- 
 mined as early as possible whether or not the 
 disease is diphtheria. Diphtheria antitoxin 
 should be administered only by a physician. 
 When it is given to children who are likely 
 to be or who have been exposed to the disease 
 it renders them immune for a period of about 
 
INFECTIOUS AND CONTAGIOUS DISEASES 181 
 
 three weeks. During that time there is 
 practically no danger of their becoming in- 
 fected. If the child has already contracted 
 the disease, there should be no delay in giving 
 the diphtheria antitoxin at as early a moment 
 as possible. If given thus early and in suffi- 
 cient amounts, it is an almost certain cure of 
 the disease. If it is used later, it frequently 
 shortens the attack but it is not always suc- 
 cessful. For this reason, immediate use of 
 diphtheria antitoxin in every case of diph- 
 theria or exposure to diphtheria is strongly 
 urged. 
 
 In recent years great advances have been 
 made in our knowledge of diphtheria. Schick, 
 an Austrian physician, in 1913 discovered a 
 test whereby it is possible to tell persons who 
 are naturally immune to diphtheria and those 
 who are not. The Schick test can be given 
 only by a physician. It consists in the in- 
 jection in the skin, usually just below the 
 fold of the elbow, of a small quantity of 
 diphtheria toxin. If the child is not immune, 
 there can usually be seen, in about three days, 
 a certain area of pigmentation or discolor- 
 ation at the site of the injection. If the child 
 is immune, there is rarely any discoloration 
 at this point. If it is shown that the child is 
 immune, it means that it will not contract 
 diphtheria. If it is not immune it means 
 
182 HEALTHY CHILDREN 
 
 that it is susceptible to diphtheria and may 
 contract it at that time, although later it 
 may become immune. 
 
 If a child is found not to be immune to 
 this disease, it is now possible for a physician 
 to give an injection of what is known as 
 " toxin antitoxin vaccine.' ' This does not 
 render the child immediately immune to 
 diphtheria but, after a period of a few weeks, 
 immunity begins to develop and it is believed 
 that thereafter the person having such in- 
 jection cannot contract diphtheria. The in- 
 jection of toxin antitoxin for the prevention 
 of diphtheria is as simple as vaccination 
 against smallpox, and it is hoped that its use 
 will become as universal. 
 
 TUBERCULOSIS 
 
 Tuberculosis is not an inherited disease; 
 that is, it does not descend from the father or 
 mother to the child. Children born of par- 
 ents who have tuberculosis are nearly always 
 delicate in physique and have what is known 
 as an "inherited tendency' ' which makes 
 them much more likely to contract the disease 
 than children born of healthy parents. Also, 
 the association of such children with fathers 
 or mothers who have tuberculosis makes it- 
 much more probable that they will become 
 infected. However, as long as we know that 
 
■ 
 
 
 T™ 
 
 Undernourished Child 
 
INFECTIOUS AND CONTAGIOUS DISEASES 183 
 
 children do not directly inherit tuberculosis, 
 it is possible to do a great deal in the way of 
 prevention by giving them unusual care in 
 regard to their health and by seeing that, as 
 far as possible, they are kept away from any 
 chance of infection. 
 
 Such delicate children, in fact all children 
 who are undernourished, should live almost 
 entirely outdoors. Sleeping outdoors should 
 be begun at an early age unless the weather 
 is very cold and stormy. If a sleeping porch 
 cannot be arranged, every effort should be 
 made to have one room in the house as nearly 
 open as possible and used as a bedroom for the 
 susceptible or undernourished child. There 
 should be no possibility of the child becoming 
 chilled, and as much bed clothing as may be 
 necessary should be used. Sleeping suits 
 made like nightdrawers or pajamas, with feet 
 attached, are the most comfortable as well 
 as the safest garments to be used, and a sleep- 
 ing cap is advised. If the body is kept warm, 
 it does not make any difference how cold the 
 air is, so unless the weather is stormy or un- 
 usually cold, children who are undernourished 
 or who are suspected of being susceptible to 
 tuberculosis should always sleep outdoors. 
 
 In general, these children should live out- 
 doors most of the daytime, and should have 
 practically no indoor life. Children of this 
 
184 HEALTHY CHILDREN 
 
 type need extra food. Three nourishing meals 
 a day and an additional lunch in the middle 
 of the forenoon and in the middle of the after- 
 noon are necessary. This extra lunch may 
 consist of a cup of cocoa or a glass of milk 
 with crackers or bread and butter. In cases 
 of marked undernourishment, or where the 
 child does not digest its food well, it is ad- 
 visable to give a cup of hot cocoa before going 
 to bed. Every effort should be made to see 
 that the child's nutrition is kept up to normal 
 and the methods outlined in the chapter on 
 "Malnutrition" should be followed. 
 
 CONTAGIOUS EYE DISEASES 
 SIMPLE CONJUNCTIVITIS 
 
 This is sometimes called "acute conjunc- 
 tivitis" or simply "inflamed eyes." 
 
 Cause 
 
 The cause is usually irritation caused by 
 dust blowing into the eyes or direct infection 
 from the use of a pocket handkerchief that 
 has been used by someone else who has in- 
 flamed eyes. 
 
 Symptoms 
 
 The child complains that the eyes itch and 
 the tendency is to rub them constantly. 
 There is a watery discharge and a feeling as 
 though there were some foreign particles in 
 
Method of Applying Tourniquet to Upper Arm to stop flow 
 
 of Blood from Wound in lower part of Arm. See page 
 
 198 for Instructions. 
 
INFECTIOUS AND CONTAGIOUS DISEASES 185 
 
 the eye. There may be slight pain, but this 
 is not common. The disease is easy to 
 recognize. The white of the eye and the 
 inner surface of the lids are red. The dis- 
 charge is usually watery like the flow of tears 
 but sometimes the lids are stuck together in 
 the mornings by a gummy exudate which may 
 be seen surrounding the eyelashes. 
 
 Treatment 
 
 The treatment consists in preventing the 
 spread of the disease by seeing that the child 
 uses only its own pocket handkerchief and 
 towel and that while the condition lasts there 
 is no close association between the affected 
 child and others and that the same toys are 
 not used by both. For the inflammation the 
 best form of treatment is to flush out the eyes 
 thoroughly with a boric acid solution. The 
 method of doing this has been described under 
 the section on "Prevention of Eyestrain" 
 in the chapter on " Personal Hygiene/' 
 
 PINK EYE OR ACUTE MUCO-PURULENT 
 CONJUNCTIVITIS 
 
 This is a serious disease of the eye which is 
 caused by a particular form of bacteria which 
 is known as the Koch-Weeks bacillus. 
 
186 HEALTHY CHILDREN 
 
 Symptoms 
 
 The child complains of great smarting and 
 pain in the eyes, sensitiveness to light and 
 keeps the eyes closed or blinks constantly. 
 There is a sensation as if there were sand in 
 the eyes. The white of the eye and inner sur- 
 face of the lids are very red and inflamed and 
 there is a discharge of pus mixed with mucus. 
 
 Treatment 
 
 This disease is extremely infectious and will 
 spread rapidly throughout a family or among 
 children if they are in close contact with an 
 infected child. Children suffering from this 
 disease should be kept entirely separate from 
 other children. If medical treatment is avail- 
 able, the child should be placed under the care 
 of a physician at once. If not, it may be 
 treated at home by flushing out the eyes with 
 boric acid solution every two hours. The 
 disease usually lasts for from ten days to 
 two weeks. 
 
 CONTAGIOUS SKIN DISEASES 
 RINGWORM 
 
 This is a contagious disease which occurs 
 generally on the face, hands or arms, but rarely 
 on the body. It is probable that children can 
 be infected by playing with cats or dogs who 
 have the disease. 
 
INFECTIOUS AND CONTAGIOUS DISEASES 187 
 
 Symptoms 
 
 Ringworm occurs as a small, round, raised, 
 reddish patch, usually on the face or hands. 
 These patches are generally round, although 
 they may be slightly irregular in shape. They 
 tend to grow quite rapidly and as they grow 
 the center of the patch heals, leaving a well 
 marked, reddish ring which is characteristic 
 of ringworm and gives it its name. There is 
 rarely any itching and the child does not com- 
 plain of the sore. Frequently there is only 
 one ringworm. There may be several, how- 
 ever, all growing at the same time but on 
 different parts of the face, hands or arms, 
 or there may be three or four in close connec- 
 tion with each other, and these may join to 
 form one large patch. 
 
 Treatment 
 
 Home treatment is common for this type 
 of case as it is not serious, although apt to 
 persist and to spread if not treated. It must 
 be remembered that the disease is very con- 
 tagious and children so affected should be 
 kept away from other children unless some 
 protective dressing is applied to the ringworm. 
 The simplest and best form of such dressing 
 is to paint the ringworm with tincture of 
 iodine, giving it one coating so that the skin 
 
188 HEALTHY CHILDREN 
 
 appears a light brown. This should be al- 
 lowed to dry and the ringworm then covered 
 with flexible collodion. This treatment may 
 be repeated every other day until the sore is 
 entirely healed. With this protective dress- 
 ing the child may go about as usual, with no 
 fear of transmitting the contagion to others. 
 
 SCABIES 
 
 This highly contagious disease of the skin 
 is sometimes known as the "itch." It occurs 
 more commonly among children who are not 
 well nourished and who do not live in sanitary 
 surroundings. It is transmitted by towels, 
 clothing, pocket handkerchiefs or prolonged 
 and close personal contact. It is not as in- 
 fectious as ringworm but is a far more difficult 
 disease to control and spreads much more 
 rapidly when once contracted. 
 
 Symptoms 
 
 The first thing usually noticed is a slight 
 eruption which appears between the fingers. 
 If examined carefully when it first occurs, 
 small white specks may be seen, and running 
 from them will be slightly raised white or 
 grayish lines from one-eighth to one-quarter 
 inch in length. These specks mark the points 
 where the tiny parasite which causes the 
 disease has burrowed under the skin. The 
 
INFECTIOUS AND CONTAGIOUS DISEASES 189 
 
 first symptom noticed by the child is one of 
 intense itching, and as a result the infected 
 place is scratched almost from the beginning, 
 so that within a very short time all that can 
 be seen are many pimples or pustules sur- 
 rounded by red areas, with sometimes a good 
 deal of inflammation and occasionally bleed- 
 ing as a result of the scratching. The skin 
 between the fingers is first affected, then the 
 back of the hands and the back and front of 
 the wrists. Later, the disease may spread 
 to the forearms and if untreated the eruption 
 may appear all over the body. The main 
 characteristics are the starting point of the 
 eruption between the fingers, the intense 
 itching and the gradual extension of the in- 
 fection. 
 
 Treatment 
 
 The home treatment of scabies consists in 
 scrubbing the eruption with a stiff bristle brush, 
 tincture of green soap and hot water. The 
 affected parts should then be dried carefully 
 and covered with sulphur ointment. When 
 the eruption is on the hands, the child should 
 wear white cotton gloves and not touch any 
 article that is to be used by any other person. 
 The treatment is to be repeated every other 
 day. In the meantime, the part should be 
 kept covered carefully with the ointment. 
 
190 HEALTHY CHILDREN 
 
 Usually the disease will heal within a very 
 few days as a result of this treatment. 
 
 IMPETIGO 
 
 This is a common skin disease which is 
 generally found in children who are under- 
 nourished and who do not live in good sanitary 
 surroundings. It is very contagious and often 
 the child will start with one sore appearing 
 on the face, and, by scratching this sore and 
 then scratching other parts of the body, there 
 may be successive crops of these sores grow- 
 ing in several places. Usually it is found on 
 the face and hands. It is infectious and may 
 readily be transmitted from one child to 
 another by means of pocket handkerchiefs, 
 towels, clothing, or any article that has been 
 handled by the infected child. 
 
 Symptoms 
 
 A reddish patch will form on the face or 
 hand of the child. This rapidly becomes in- 
 flamed and secretes a yellow fluid which dries 
 and forms a crust or scab. The scabs are 
 irregular in shape, with turned-up edges. 
 Around the edge there is a good deal of in- 
 flammation or redness of the skin. There is 
 rarely any itching but the sore itself is dis- 
 figuring and may be quite large. 
 
INFECTIOUS AND CONTAGIOUS DISEASES 191 
 
 Treatment 
 
 The sores should be soaked thoroughly with 
 tincture of green soap and warm water, and 
 the crust or scab removed gently. Zinc oxide 
 ointment should then be applied freely and a 
 thick coating left on. The sores should be kept 
 continually covered with the ointment but 
 need not be covered with any other dressing. 
 
 PEDICULOSIS 
 
 Head lice are common among the children 
 of our large cities. Because their occurrence 
 is so widespread, anyone is apt to become 
 infected, and even a well cared for child or 
 adult may acquire these head lice or pedic- 
 uli. The disease is classified as contagious 
 because it is so readily transmitted from one 
 person to another. It is not probable that 
 pediculi live long unless they are on the 
 human body, but it has been demonstrated 
 that they can be transferred readily from one 
 person to another by means of hats or other 
 articles of clothing which have been infected. 
 
 There are two common varieties of lice — 
 those which infect the head and those which 
 infect the body. They are quite different and 
 body lice are not found on the head, nor head 
 lice on the body. Body lice or what are now 
 known as "cooties" are comparatively rare in 
 
192 HEALTHY CHILDREN 
 
 this country, and the variety which commonly 
 infests the hair of children and adults are 
 those which live and grow on the hair or 
 scalp. 
 
 Symptoms 
 
 Usually the first symptom noted is that the 
 child is continually scratching the head. 
 Closer observation may show that there is a 
 certain amount of redness or even a slight 
 eruption on the back of the neck, sometimes 
 reaching for a considerable distance down 
 the back. The only positive assurance that 
 the condition exists is finding the actual bugs 
 or pediculi in the hair. These pediculi breed 
 very rapidly. First they deposit their eggs 
 in the form of whitish particles which are 
 closely adherent to the hair. These eggs or 
 nits hatch out at the end of six or seven days, 
 and in about two weeks the new pediculi are 
 capable of breeding more. The nits or eggs 
 are fastened to the hair by a gummy sub- 
 stance and it is not possible to detach them 
 unless this gummy substance is dissolved. 
 The ordinary location of the eggs or nits is at 
 the back of the head, behind the ears and just 
 above the neck. They may usually be seen 
 quite readily when the child's hair is lifted 
 up, and appear as small white particles which 
 closely resemble dandruff. 
 
INFECTIOUS AND CONTAGIOUS DISEASES 193 
 
 Treatment 
 
 The first object of the treatment is to get 
 rid of the live pediculi, and second, to see that 
 the nits are entirely removed from the hair 
 and destroyed. As long as any nits remain 
 there is always the possibility of reinfection. 
 There are on the market a large number of 
 solutions or cures for this condition. Tinc- 
 ture of larkspur is an excellent remedy, but 
 it is expensive. As it is a poison, it must be 
 handled with great care, and never left within 
 the reach of any child who may take it in- 
 ternally. Also, it is not safe to use it on the 
 scalp if there are any raw surfaces. If the 
 disease is in an early stage and its use can be 
 controlled, tincture of larkspur is a pleasant 
 solution to use and may be applied in the same 
 way as kerosene and sweet oil, which is the 
 ordinary home treatment. 
 
 In treating pediculosis, the hair should be 
 soaked thoroughly with the tincture of lark- 
 spur or with a mixture of equal parts of kero- 
 sene and sweet oil. This must be rubbed 
 thoroughly into the scalp, care being taken to 
 see that every particle of the hair is wet. 
 The hair should then be bound up loosely 
 on the head and the whole covered with a 
 towel which must be fastened in place and 
 left overnight. In the morning, the hair and 
 
194 HEALTHY CHILDREN 
 
 scalp should be washed thoroughly with hot 
 soapsuds. After drying, a fine tooth comb 
 should be used to see that all pediculi are 
 combed out of the hair and, in addition, that 
 as many as possible of the nits are removed. 
 Usually the latter will be found to be a 
 difficult process and it is probable that fur- 
 ther efforts will have to be made to loosen the 
 nits from the hair. This is best done as 
 follows: After the hair is dry, a clean fine 
 tooth comb should be wet either with vinegar 
 or a solution of one teaspoonful of potassium 
 carbonate in a pint of water. The hair must 
 be separated into fine strands and combed 
 carefully. This may have to be repeated 
 every day for several days and treatment 
 should not be stopped until it is absolutely 
 certain that none of the nits remain. 
 
CHAPTER IX 
 
 ACCIDENTS AND INJURIES 
 
 In every family of young children, numerous 
 occasions will arise where emergency treat- 
 ment or "first aid" must be given for minor 
 injuries or accidents. In the great majority of 
 instances, home aid is all that is necessary, 
 and with the supplies on hand that are enu- 
 merated in the chapter on "The Children's 
 Medicine Chest," this aid can be given. It 
 is wise to copy, in typewriting if possible, a 
 brief outline of the methods to be used in 
 dealing with these various emergencies. This 
 outline should be pasted on the inner side of 
 the door of the medicine closet where it will 
 be available at a moment's notice for reference 
 when the need is most urgent. 
 
 First Aid 
 
 "First Aid" is a term which refers to the 
 immediate help that can be given in any 
 emergency. Usually, the minor accidents of 
 childhood are not at all serious, although for 
 a short time they may be quite painful. 
 Nevertheless, there is always the possibility 
 that what seems to be a simple injury may 
 prove to be a serious one, and for that reason 
 the mother should know not only the things 
 to be done that will make the patient most 
 
 195 
 
196 HEALTHY CHILDREN 
 
 comfortable at the time but the kind of first 
 aid treatment that may be given that will 
 prevent further complications. 
 
 Bruises 
 
 Bumps and bruises are the most common of 
 all accidents of childhood. The normal, ac- 
 tive child is constantly falling. The ordi- 
 nary bump or bruise needs very little atten- 
 tion; in fact, it may be safely ignored in the 
 majority of instances, and it is unwise to 
 attach undue importance to such slight in- 
 juries. The normal child will forget all about 
 them a few moments after they have occurred, 
 and if the skin is not broken and there is no 
 danger of infection, the simple bruises and 
 bumps may be left untreated. If there is 
 marked swelling, however, or if the injury 
 has been extensive, it is well to use some 
 readily available methods of reducing the 
 swelling and preventing the discoloration 
 that sometimes comes with a severe bruise. 
 For this purpose, cold is the best application. 
 It may be applied by wringing out cloths in ice 
 water and placing them directly over the 
 affected part. They should be changed re- 
 peatedly so that the applications may be 
 kept ice cold, and such applications should be 
 continued for at least half an hour. At the 
 end of that time a more permanent dressing 
 

 Method of Applying Strips of Adhesive Plaster 
 
 to Bring Edges of Wound Together. 
 
 See Page 199 for Instructions. 
 
^ 
 g 
 ^ 
 w 
 
 to 
 
 
 
ACCIDENTS AND INJURIES 197 
 
 of a pad of gauze or linen, thoroughly wet 
 with witchhazel, may be applied. This should 
 be fastened with a bandage so that it may be 
 kept in constant contact with the bruise or 
 bump. 
 
 Cuts 
 
 Cuts may be made by some sharp instru- 
 ment, so that the edges are clean and readily 
 come back into contact with each other, or 
 they may be jagged, with rough edges and 
 more or less dirt may have been rubbed into 
 the wound. In order to avoid the possi- 
 bility of infection, it is well to allow the cut 
 to bleed freely for a moment or two. If the 
 blood flows evenly, very little will be lost dur- 
 ing this time, and the tendency is for the 
 wound to be cleansed in this manner. If the 
 blood comes in spurts, it is probable that an 
 artery has been severed. In that case the 
 blood should not be allowed to continue to 
 flow, but should be stopped as soon as pos- 
 sible. Long continued bleeding is harmful 
 in any case, and definite measures may have 
 to be taken to control it. 
 
 The first and easiest measure is to apply 
 pressure directly over the bleeding area. The 
 edges of the wound should be brought to- 
 gether and held firmly. If the bleeding is 
 slight, this will usually control it. A pad of 
 
198 HEALTHY CHILDREN 
 
 gauze placed tightly over a cut will also con- 
 trol the bleeding, provided sufficient pressure 
 is maintained. If the cut is deep and the 
 spurting blood shows that it comes from a 
 fairly large artery, pressure should be made 
 not only directly over the bleeding part but 
 also between the bleeding point and the cen- 
 ter of the body. For instance, if the cut is on 
 the finger, pressure should be applied by 
 winding a stout strip of muslin around the 
 finger at its base and holding it very tight for 
 a few moments. Bleeding of the forearm can 
 be checked by applying a tight bandage, 
 called a tourniquet, around the arm between 
 the bleeding point and the elbow. A deep 
 cut in the upper part of the arm may be con- 
 trolled by applying a tourniquet above the 
 bleeding point and near the shoulder. The 
 same principle applies to controlling bleeding 
 in the legs. Bleeding in any part of the head, 
 however, or in the trunk of the body, will have 
 to be controlled by direct pressure. This is 
 always best applied by means of a well- 
 folded pad of gauze or clean linen which is 
 placed over the wound after the edges have 
 been drawn together carefully, and which 
 is held in place by a tight bandage or strips of 
 adhesive plaster. (See illustration opposite 
 page 184.) 
 
ACCIDENTS AND INJURIES 199 
 
 While it is necessary to stop bleeding as soon 
 as possible, it is equally necessary to see that 
 the wound is cleansed thoroughly before it 
 is closed up. In ordinary cuts or scratches, 
 after the wound has been allowed to bleed for 
 a moment it should be washed out with clean 
 cold water and then with hydrogen peroxide. 
 If this is not available, boric acid solution is 
 an excellent substitute. A wound of any 
 kind must be kept perfectly clean, but unless 
 the dressing becomes much soiled, renewed 
 washing and cleansing will not be necessary 
 within at least twenty-four hours. If the 
 bleeding can be controlled and the edges of 
 the wound are clean-cut, they may be drawn 
 together tightly and held in that position with 
 strips of adhesive plaster at right angles to 
 the direction of the cut, with several layers of 
 gauze placed over it for the purpose of clean- 
 liness, and a bandage wound around the entire 
 dressing. As soon as the edges of the wound 
 begin to heal, it should be kept perfectly dry 
 and covered with a little boric acid powder 
 which, in turn, is kept in place with a gauze 
 or muslin bandage. Cuts or open wounds will 
 heal much more quickly under this treatment 
 than if ointments are used. (See illustration 
 opposite page 196.) 
 
200 HEALTHY CHILDREN 
 
 Burns 
 
 The important thing to remember about 
 burns is that the pain is due mainly to the 
 contact of the sore surface with the air, there- 
 fore the idea back of the treatment of burns 
 is to afford a protective dressing so that the 
 air may be excluded. Many household reme- 
 dies may be used for burns. Among the most 
 common is a mixture of baking soda and water, 
 applied as a thick paste. Flour will do, if 
 nothing else is available. Unsalted butter 
 or lard is excellent. Any perfectly clean, 
 unsalted grease will do in an emergency. One 
 of the best applications is sweet oil, or, if it is 
 available, carron oil can be recommended. 
 
 If the burn has been extensive and serious, 
 so that the body is involved, the clothing cov- 
 ering it should be cut away and never re- 
 moved forcibly. Soaking the burned parts of 
 the body in water will make it easier to remove 
 pieces of clothing, but care must be taken to 
 see that the parts are not injured again. 
 
 After the burned part has been well cov- 
 ered with any one of the remedies mentioned, 
 a dressing of soft gauze or absorbent cotton 
 should be applied, after which it may be 
 bandaged lightly. The dressings may be re- 
 moved every day, if they are soiled, or every 
 two days if there is little secretion, and the 
 
ACCIDENTS AND INJURIES 201 
 
 burn kept clean in order to avoid infection. 
 Dressings which adhere to the wound should 
 be soaked off with warm water and the oil 
 or other application re-applied. Extensive 
 burns are apt to cause serious shock to the 
 nervous system, and if there is any general 
 prostration following such a burn, the doctor 
 should be sent for. In the meantime, the 
 patient should be absolutely quiet, and stimu- 
 lants such as aromatic spirits of ammonia or 
 hot coffee may be given. 
 
 Sprains 
 
 What is called a ' 'sprain' ' usually results 
 when some ligament or tendon is subjected to 
 undue strain or to some sudden stretching 
 or even tearing of its fibers. The most com- 
 mon place for a strain to occur is in the ankle, 
 then the wrist. Sprains and strains in other 
 parts of the body are comparatively infre- 
 quent. 
 
 Usually the first sign noted is a sharp pain 
 and inability to use the joint that has been 
 sprained. Swelling around the point of the 
 injury follows very rapidly. Just as soon as 
 possible the affected part should be plunged 
 into very hot or very cold water, care being 
 taken, of course, not to have the water so hot 
 as to burn the flesh. Hot water is preferable , 
 if it can be obtained, but cold water will have 
 
202 HEALTHY CHILDREN 
 
 an almost equally good effect, and usually it 
 is more readily available. 
 
 While the hand or the foot is held in the 
 water, it should be rubbed gently and kneaded 
 and the water should be changed at frequent 
 intervals so that it may be kept hot or very 
 cold. This bathing should be continued for 
 at least half an hour. The ankle, wrist or 
 other joint that has been sprained should then 
 be wiped and placed in such a position that it 
 will not be used. It must be kept perfectly 
 quiet for at least twenty-four hours, and dur- 
 ing that time should be covered with a dress- 
 ing wet with either cold water or extract of 
 witchhazel. The main thing to remember is 
 that the dressing should be kept wet. An easy 
 way to apply such a dressing is to cover the 
 joint with folds of gauze and wrap a bandage 
 loosely around it. The foot or hand should 
 be held over a basin and the cold water or 
 witchhazel poured over the bandage until it is 
 thoroughly wet. This may be repeated when- 
 ever the bandage becomes dry, with a mini- 
 mum of disturbance both to the patient and 
 the dressing. 
 
 One of the best ways to keep the ankle quiet 
 is to place the leg between two pillows. At 
 the end of twenty-four hours the swelling 
 should have subsided to quite an extent. 
 Further treatment consists in massaging the 
 
ACCIDENTS AND INJURIES 203 
 
 joint twice a day. A little oil or vaseline 
 may be rubbed on the hand while this is being 
 done. 
 
 For slight sprains, the after treatment con- 
 sists in bandaging the foot with a strong mus- 
 lin bandage or wearing an elastic ankle pro- 
 tector, with high laced boots, the purpose 
 being to give the ankle support and at the 
 same time allow a certain amount of freedom 
 of motion. For more severe sprains, it will 
 probably be necessary to bandage the ankle 
 with adhesive plaster. While this may be 
 done after a little practice, it requires a cer- 
 tain amount of dexterity. Every mother 
 should ask her family physician to teach her 
 how to strap or bandage a sprained ankle. 
 She may never need this knowledge, but if 
 she should at any time, it will be found of 
 great value. (See illustration opposite page 
 197.) 
 
 The former treatment of sprained joints 
 consisted in keeping them perfectly quiet for 
 a long period of time. At the present time, 
 however, as soon as the swelling has subsided, 
 we believe that motion is the best treatment, 
 therefore, a reasonable amount of walking 
 about may be permitted, provided the ankle 
 is well bandaged. The massage should be 
 kept up at frequent intervals until the pain, 
 tenderness and swelling have disappeared. 
 
204 HEALTHY CHILDREN 
 
 Strains 
 
 A strain is simply a much lighter form of 
 sprain, and should be treated in the same way. 
 
 Broken Bones 
 
 Breaks or fractures in young children are 
 not of the same type as those found in adults. 
 The bones of very young children contain 
 much more animal matter than mineral mat- 
 ter, and are more flexible. Breaks, therefore, 
 instead of completely severing one part of the 
 bone from the other, are in the nature of what 
 we call "greenstick" fractures. The differ- 
 ence between the two may be illustrated by 
 taking a dry stick of wood and breaking it, 
 then taking a green twig and breaking that. 
 It will be found in the latter case that, while 
 the fibers may be drawn apart and injured, 
 the pieces of twig are not wholly separated 
 from each other. 
 
 Fractures may be of two kinds : The simple 
 fracture, where the bone is broken but with- 
 out marked injury to the tissue surrounding it, 
 and the compound fracture, where the bone 
 is broken and fragments of bone have pene- 
 trated through the flesh, thus causing both 
 a break and a wound. 
 
 The home treatment of fractures of any 
 kind, whether greenstick, simple or compound, 
 
ACCIDENTS AND INJURIES 205 
 
 consists in placing the part at rest until the 
 doctor can be summoned and the fractured 
 bone set back into its proper relation. In 
 order to keep the arm or leg perfectly quiet, 
 the patient should be put to bed and the in- 
 jured limb placed between two pillows. If 
 it is necessary to carry the patient any dis- 
 tance, a crude splint may be made by fasten- 
 ing a board or even a stick of wood, an um- 
 brella or a cane, to the injured limb. This 
 stick may be tied on to the leg by fastening a 
 handkerchief above and below the point of 
 fracture. Its only purpose is to keep the leg 
 as nearly motionless as possible. 
 
 It is not possible for an untrained person to 
 set a bone, therefore every effort should be 
 made to get a doctor at the earliest possible 
 moment, as neglected fractures may result 
 in serious deformity. 
 
 Nosebleed 
 
 Constant flow of blood from the nose may 
 be the result either of an abrasion in the mu- 
 cous membrane, which bleeds readily when 
 scratched, or it may be the result of a sharp 
 blow on the nose. Unless the bleeding per- 
 sists for a noticeable length of time, no par- 
 ticular treatment is necessary, as it usually 
 tends to stop of itself. The child should be 
 kept as quiet as possible. Sitting up is a bet- 
 
206 HEALTHY CHILDREN 
 
 ter position than lying down. The same prin- 
 ciple must be applied in stopping a hemor- 
 rhage of the nose as has been discussed under 
 the heading of treatment of bleeding as a 
 result of cuts. A simple way to apply pres- 
 sure is to take a piece of stiff paper about one 
 inch long and one and a half inches wide. 
 This should be folded twice so that there is a 
 sharp, folded edge. The paper with this edge 
 uppermost should be inserted between the 
 upper lip and the gums of the upper teeth, so 
 that the sharp edge presses against the blood 
 vessel directly in the center, at the point where 
 the inside lip joins the top of the gum. The 
 sharp edge of the paper should be held there 
 so that the pressure against the blood vessel 
 is continuous. If the child is kept perfectly 
 quiet while this is being done, the bleeding 
 will usually stop in about a minute. 
 
 Other methods that have been found valu- 
 able are to apply icebags to the back of the 
 neck, cold water on the nose itself, or, in the 
 absence of any other method, the nostrils 
 may be grasped firmly between thumb and 
 forefinger and held entirely closed. Packing 
 the nose with perfectly clean, sterile gauze 
 should be done only in case of great emergency. 
 If the bleeding persists, however, notwith- 
 standing everything that can be done to stop 
 it, such action is justifiable. In order to do 
 
ACCIDENTS AND INJURIES 207 
 
 this properly, a strip of sterile gauze about 
 one inch wide and one yard long should be 
 taken. The end of it should be grasped with 
 a small pair of forceps and the gauze inserted 
 far back into the nostril. The rest of the 
 gauze should then be pressed well back into 
 the nose, making a firm packing. This must 
 be done gently and without undue pressure. 
 The reason why the nose should not be packed 
 with gauze except in case of extreme emer- 
 gency is that it is exceedingly difficult to re- 
 move the packing and when it is removed, 
 the hemorrhage may return. If the packing 
 has been applied, therefore, it should be re- 
 moved by a physician. 
 
 After nosebleed, care should be taken to 
 see that the child does not blow its nose for 
 some time after the bleeding has stopped. If 
 the bleeding occurs with fair regularity, and 
 in the absence of any accident, it is probable 
 that there is some special bleeding point in 
 the nose that should receive attention. In 
 order to cure it, it will be necessary to take 
 the child to a physician and obtain proper 
 treatment. 
 
 Insect Bites and Stings 
 
 Children, as well as adults, vary in their 
 reaction to bites and stings of insects. Some- 
 times the swelling and reaction are quite ex- 
 
208 HEALTHY CHILDREN 
 
 tensive and the pain may be acute. The main 
 danger in insect bites is from the poisoning 
 which may result when the stinger of the 
 insect is left in the child's flesh or from the 
 bite or sting becoming infected afterwards. 
 This latter usually results from the itching 
 which is common after the bites of certain 
 insects and the fact that the child scratches 
 the bite and so infects it. 
 
 Usually mosquito bites are treated best by 
 applications of spirits of camphor or a moder- 
 ately strong solution of ammonia. There- 
 after, in the case of children, it is well to see 
 that the bites are kept as protected as possible. 
 This may be accomplished, if the bites are 
 on the legs, by having the child wear long white 
 cotton stockings. If mosquitoes are prev- 
 alent, long-sleeved, high-necked dresses are 
 advised. Every effort should be made to see 
 that the child is so cared for that the possi- 
 bility of being bitten by mosquitoes is reduced 
 to a minimum. Windows should be screened 
 and, if necessary, mosquito netting placed over 
 the beds and cribs. 
 
 Stings of bees need slightly different treat- 
 ment. An attempt should be made to re- 
 move the stinger at once. Usually it may 
 be seen as a tiny, round black spot, directly 
 in the center of the wound. Sometimes it can 
 be removed with the fingernails, although oc- 
 
ACCIDENTS AND INJURIES 209 
 
 casionally the use of a tiny pair of forceps is 
 necessary. Immediate relief from the sharp 
 pain may be obtained by applying cloths 
 dipped in ice water. Cloths wet with a 
 solution of boric acid are excellent as pro- 
 tective dressings. A solution of ordinary 
 baking soda, one tablespoonful to a cup of 
 water, can be used. A simple ointment, such 
 as zinc oxide ointment, is also an excellent 
 remedy. In young children the sting should 
 be covered with a protective dressing, so that 
 it may not become infected by scratching. 
 
 Foreign Bodies in the Throat 
 
 Very young children are apt to put every- 
 thing into their mouths. For that reason 
 there should be no loose or detachable parts 
 to their toys and they should not be given 
 anything to play with that they may put into 
 the mouth and swallow. If a foreign body 
 is swallowed, the mother should try to remain 
 as calm as possible, under circumstances that 
 are always distressing. If the child is fright- 
 ened and begins to cry, it is probable that the 
 foreign body will become more firmly lodged 
 in the throat. While action to relieve the 
 child should necessarily be quick, there should 
 not be any panic. 
 
 First of all, the child should be slapped 
 smartlv on the back between the shoulder 
 
210 HEALTHY CHILDREN 
 
 blades. Frequently this will dislodge the 
 foreign body. If not, the child should be 
 seized by the legs and held directly upside 
 down. At the same time several sharp, quick 
 blows should be given with the palm of the 
 hand, directly over the back of the child's 
 chest. These slaps should be sudden and 
 quick, and usually the first one or two will 
 dislodge the offending article. Sometimes, 
 however, it is necessary for the mother or 
 father to put a finger into the child's throat 
 to try to dislodge the foreign body. In such 
 case, care must be taken not to push it far- 
 ther down, but, if possible, to remove it a 
 little to one side so that it may be coughed up 
 readily. Remember that the tendency is al- 
 ways for a child to expel any foreign body that 
 is lodged in the larynx or windpipe. If it 
 gets into the epiglottis, or tube which carries 
 food to the stomach, it usually does not in- 
 terfere so much with the child's breathing 
 but causes distress because of the feeling of 
 pressure in the throat. In such instances the 
 article may sometimes be carried down 
 through the stomach and intestines if the 
 child is fed considerable quantities of soft 
 bread or mashed potatoes. This treatment 
 is particularly good when a child has swal- 
 lowed any sharp thing such as a fish bone or a 
 pin. With the soft bread (no crusts) or 
 
ACCIDENTS AND INJURIES 211 
 
 mashed potatoes the child should drink plenty 
 of milk. In this way the article becomes 
 covered with a mass of soft food which readily 
 passes off through the bowels. If the bowel 
 movements are watched carefully, the for- 
 eign body will usually be found within two or 
 three days. During the time this treatment 
 is being carried out, great care must be taken 
 to see that no cathartics are used, as they tend 
 to liquify the bowel movements and prevent 
 the formation of the large soft mass of food 
 that will protect the foreign body. 
 
 Foreign Bodies in the Eyes 
 
 Usually these consist of particles of dust, 
 and, occasionally, a small insect may be found. 
 First, the lower lid should be pulled down, 
 and, if the foreign body is seen readily, it may 
 be dislodged with the corner of a perfectly 
 clean handkerchief. Care should be taken 
 that the eyes are not rubbed hard. The child 
 should be instructed to blow the nostril on 
 the side opposite the injured eye, while the 
 other nostril is held tightly closed. If this is 
 not successful, rubbing the uninjured eye will 
 sometimes cause such a flow of tears that the 
 particle may be washed out. The injured 
 eye should never be rubbed. 
 
 A simple method of removing particles that 
 are under the upper lid is to draw the upper 
 
212 HEALTHY CHILDREN 
 
 lid well down over the lower one. The eye- 
 lashes of the latter then act as a brush to wipe 
 off the inner side of the upper lid, and the 
 offending particle may often be removed in 
 that way. With a little practice, one may 
 learn to turn back the upper eyelid over the 
 edge of a coin. It is well for the mother to 
 ask her doctor to teach her how to do this, as 
 often a foreign body that is lodged on the inner 
 side of the upper eyelid can be removed in that 
 way when it is impossible to do so by any 
 other method. 
 
 If, after trying these various methods, the 
 foreign body is still felt in the eye, the child 
 should be taken to a doctor, as it is possible 
 that it may have become imbedded in the 
 eyeball, from which it can be removed only by 
 a skillful physician. After any foreign body 
 has been removed from the eye, the latter 
 should be thoroughly flushed out with boric 
 acid solution every three hours until all symp- 
 toms of inflammation have subsided. 
 
 Foreign Bodies in the Ear 
 
 Usually, the only kind of foreign body that 
 gets into the ear is some small insect. The 
 treatment in this case is to drop four or five 
 drops of sweet oil or castor oil into the ear 
 canal. The oil should be slightly warm be- 
 fore it is used and may be put into the ear 
 
ACCIDENTS AND INJURIES 213 
 
 with either a teaspoon or a medicine dropper. 
 It should be left for about five minutes, the 
 child lying quietly, with the affected ear upper- 
 most. At the end of that time the ear should 
 be syringed gently with plain warm water and 
 a rubber ear syringe. The latter consists of 
 a small rubber ball with a short, pointed out- 
 let, and can be obtained at any drugstore. 
 While syringing the ear, the head should be 
 held sideways over a basin so that the water 
 will run out freely. No force should be used. 
 The oil will kill the insect, and the water will 
 cleanse the ear so that the foreign body will 
 usually come out with it. 
 
CHAPTER X 
 
 THE CHILDREN'S MEDICINE CHEST 
 
 A special medicine chest or wall closet 
 should be provided where the commoner rem- 
 edies and dressings so often needed for chil- 
 dren may be kept. 
 
 Type of Medicine Closet 
 
 The best kind of medicine closet is one that 
 can be hung on the wall. The suggested di- 
 mensions are twenty-four inches in height, 
 eighteen inches in width and seven inches in 
 depth. The closet should have two shelves 
 inserted, so that three spaces may be available. 
 A good rule is to have the lower shelf eight 
 inches above the bottom of the closet, to pro- 
 vide for tall bottles and boxes of dressings. As 
 the dimensions given above are outside meas- 
 urements, this will leave a total inside space of 
 about twenty-one inches. The second shelf 
 should be placed about seven inches above 
 the first, leaving a space of six inches above 
 the second shelf. These heights will be found 
 proper for ordinary medicine bottles. 
 
 The cabinet should be provided with a door 
 and a good lock, with a hook placed on the 
 outside, well up on one side, on which the 
 key may be hung. When placing the cabinet 
 against the wall, care must be taken to see 
 
 214 
 
THE CHILDREN'S MEDICINE CHEST 215 
 
 that it is hung high enough so that the children 
 cannot reach it. This is important, for little 
 children cannot be supposed to show dis- 
 cretion, and serious results may follow if they 
 obtain the medicines. 
 
 Special Rules for the Medicine Chest 
 
 1. All poisonous substances should be kept in blue bottles of 
 distinctive shape. As a general thing, druggists supply 
 poisonous substances in bottles of special type. Sometimes 
 they have knobs or projections over their surfaces, as well 
 as over the surfaces of the corks, which usually are of glass. 
 Sometimes they are diamond-shaped to distinguish them from 
 the ordinary round or square bottles. Whatever style is 
 adopted, it should be one that can be recognized by touch 
 as well as by sight so that, even in the dark, there will be no 
 possibility of mistaking the bottle that contains an external 
 or poisonous remedy for one that may safely be used inter- 
 nally. 
 
 2. Bottles which contain medicine that has been prescribed 
 by a doctor and only part of which has been used, should 
 never be saved. Such medicines are always prescribed for 
 a particular illness and for a particular person, and unless 
 the doctor states that the medicine will be good for other 
 uses, it should be thrown away after the illness is over. Do 
 not make the mistake of using for any illness a medicine that 
 has been used previously for an illness that may be consid- 
 ered similar, unless the doctor especially recommends it. 
 
 3. Before using any medicine taken from the medicine closet, 
 the label should be examined carefully. Never trust to 
 memory as to the general appearance of a bottle and always 
 find out the exact contents before using. 
 
 4. Keep all dressings and utensils on the lower shelf, together 
 with any unusually large bottles. On the next shelf keep 
 the remedies that are to be used internally, leaving the ex- 
 ternal remedies and any poisonous drugs for the top shelf. 
 
 The following articles and dressings are 
 recommended. These may vary from time 
 to time, to suit the needs of different families 
 
216 HEALTHY CHILDREN 
 
 but, in general, the list comprises the simple 
 remedies and supplies that will meet the needs 
 of most of the accidents and simple diseases 
 that commonly occur during child life. 
 
 List of Articles Recommended for the Medicine 
 
 Closet 
 
 Teaspoon. 
 
 Medicine glass, marked with teaspoonful and table- 
 spoonful doses. 
 
 Clinical thermometer. 
 
 Scissors. 
 
 Package of large safety pins. 
 
 Yard of sterilized gauze, in sealed package. 
 
 Five yard roll of adhesive plaster, one inch wide. 
 
 Small package of absorbent cotton. 
 
 One pound flaxseed meal in airtight box. 
 
 Package of prepared mustard leaves. 
 
 Hot water bottle \ These may be hung on the outside 
 
 Fountain syringe / of the medicine closet. 
 
 One-half pound boric acid powder. 
 
 One-half pound bicarbonate of soda (baking soda). 
 
 One ounce stearate of zinc powder. 
 
 Three ounces of grain alcohol. 
 
 Three ounces of camphorated oil. 
 
 Jar or tube of white vaseline. 
 
 One ounce of zinc oxide ointment. 
 
 Three ounce bottle of witchhazel. 
 
 Three ounces of carron oil (equal parts lime water and 
 linseed oil). 
 
 Two ounce bottle aromatic spirits of ammonia. 
 
 Two ounce bottle castor oil. 
 
 One hundred tablets of calomel, each containing one- 
 tenth grain. 
 
 Bottle milk of magnesia. 
 
 Two ounces syrup of ipecac. 
 
 Two ounces brown mixture. 
 
 Three ounces rhubarb and soda mixture. 
 
 Two ounces compound licorice powder. 
 
THE CHILDREN'S MEDICINE CHEST 217 
 
 Flaxseed Poultices 
 
 Although an old-fashioned remedy, flaxseed 
 poultices are still one of the best aids we have 
 in croup and the common colds that occur 
 during childhood. For croup, the poultice 
 should be placed around the neck, and for 
 colds they should be large enough to cover 
 the entire chest. They should be applied as 
 hot as they can be borne and allowed to re- 
 main only until they become cool. If used 
 during the daytime, and if the cold is a serious 
 one, the poultices may be renewed two or three 
 times. At night they should be taken off be- 
 fore the child goes to sleep. As soon as they 
 are removed, the chest and neck should be 
 rubbed well with alcohol or camphorated oil, 
 then covered with a piece of flannel or a layer 
 of cotton. 
 
 To make flaxseed poultices, take a pint of 
 water and bring it to a brisk boil. Sift flax- 
 seed meal gradually into the water, making 
 a thick paste. Lay a large oblong piece of 
 gauze or old linen on a clean table and spread 
 the flaxseed mixture on this to a thickness of 
 about one inch, covering an area large enough 
 to cover the child's chest or to go around the 
 neck. The edges of the gauze or linen should 
 then be folded over the poultice, making three 
 or four layers in the back, while in front there 
 
218 HEALTHY CHILDREN 
 
 is only the one layer of linen or possibly two 
 of gauze. 
 
 Mustard Leaves 
 
 For more serious colds or for cases of bron- 
 chitis or for acute stomach pains, mustard 
 leaves are valuable. Usually they come al- 
 ready prepared, with accompanying directions. 
 They are to be dipped in warm water before 
 being applied. Care must be taken to lift 
 up the edges of the leaves at frequent inter- 
 vals to watch the condition of the skin. The 
 leaves should be removed as soon as the skin 
 becomes well reddened and before it has had 
 a chance to blister. After the plaster is re- 
 moved, the skin may be dusted with talcum 
 powder or brushed lightly with olive oil, then 
 covered with absorbent cotton. 
 
 Boric Acid Powder 
 
 This may be used in the form of a powder, 
 as an antiseptic for open wounds, or in the 
 form of a solution. The latter has its main 
 use as an eyewash or as a mild antiseptic wash 
 for burns, cuts or where the skin is broken. 
 
 Boric acid solution is prepared by adding 
 one tablespoonful of boric acid powder to one 
 pint of water. Boil in a clean dish for five 
 minutes, adding water from time to time so 
 that the total remains about one pint. Pour 
 
THE CHILDREN'S MEDICINE CHEST 219 
 
 the solution into an absolutely clean bottle 
 that has been thoroughly scoured with hot 
 soapsuds and rinsed with boiling water. Keep 
 the bottle tightly corked. 
 
 Zinc Oxide Ointment 
 
 This is a good remedy for burns, scratches, 
 chafing and various forms of skin diseases, 
 including eczema. It should be spread thickly 
 on a piece of sterile gauze, then laid over the 
 sore. The dressing may be made complete 
 by fastening it to the skin with two strips of 
 zinc oxide plaster. The edges of the plaster 
 should be partly on the gauze and partly on 
 the skin, with the ends of the plaster strips 
 reaching beyond the gauze so that it may be 
 attached firmly to the skin, thus fixing the 
 dressing in place. Such a dressing should be 
 changed once each day in the early stages of 
 the sore. Later, it may be left on for two 
 or three days. 
 
 Stearate of Zinc Powder 
 
 This is one of the best dusting powders we 
 have for severe chafing, prickly heat, itching 
 of the skin or for use on any surface where it is 
 desirable to exclude moisture. The powder 
 is greasy and will adhere to the skin so that 
 the bodily secretions, such as urine, will flow 
 
220 HEALTHY CHILDREN 
 
 over the surface without causing any skin 
 irritation. 
 
 Witchhazel 
 
 Witchhazel is such a common household 
 remedy that every family will think of many 
 ways in which it can be used. It is excellent 
 for sprains of any kind and in cases of bumps 
 or bruises. Its best results are obtained when 
 it is applied in the form of a wet compress that 
 can be bandaged on so that the full value of 
 its soothing effects may be secured. 
 
 Canon Oil 
 
 This is probably the best remedy we have 
 for burns. It consists of equal parts of lin- 
 seed oil and lime water. The mixture does 
 not keep well, and, particularly in warm 
 weather, it is better to keep the ingredients 
 separate and to mix them as needed. It must 
 be shaken well so that a thick emulsion is 
 formed. This should be spread liberally over 
 the burned surface and covered with clean 
 gauze. Absorbent cotton should then be 
 placed over the gauze so that all air will be 
 excluded. 
 
 Aromatic Spirits of Ammonia 
 
 This may be used in any fainting attack 
 or in case of severe shock. For children under 
 
THE CHILDREN'S MEDICINE CHEST 221 
 
 five years of age, not more than one-quarter 
 teaspoonful in one-third glassful of water 
 should be given. This may be increased 
 gradually up to a teaspoonful for a child of 
 fifteen years. The dose may be repeated at 
 intervals of not more than one-half hour for 
 two or three doses. 
 
 Castor Oil 
 
 This universal household remedy should al- 
 ways be kept on hand. It keeps well in cold 
 weather, but in warm weather the supply 
 must be renewed from time to time. At the 
 first sign of any digestive disturbance in a 
 child, a dose of castor oil should be given and 
 all feeding stopped. Nothing but cool boiled 
 water should be given for several hours. Later, 
 milk and weak broths or cereal gruels may be 
 given. 
 
 The dose of castor oil varies slightly with 
 the age of the child. The average doses are 
 as follows: 
 
 Average Doses of Castor Oil 
 
 Under three months, one teaspoonful. 
 Three to six months, two teaspoonfuls. 
 Six to twelve months, one tablcspoonful. 
 
 The latter dose will usually be found ade- 
 quate for any child up to ten years of age. 
 It is best given as follows: 
 
222 HEALTHY CHILDREN 
 
 The glass should be washed out in very cold 
 water. Pour a small portion of orange juice 
 into the glass and follow with a layer of castor 
 oil. Complete with more of the orange juice. 
 If this is done carefully, the orange juice and 
 the castor oil will remain in three layers and 
 the whole dose can be swallowed without 
 tasting the oil. 
 
 In general, castor oil should not be used as 
 a regular remedy for constipation. While its 
 immediate effect is a loosening of the bowel 
 movement, its after-effect is to render the child 
 slightly constipated and its constant use tends 
 to take away from the bowels their power of 
 movement, therefore it should be used only 
 in case of an emergency or in acute illness. 
 
 Calomel 
 
 When it is found impossible for the child 
 to take castor oil, the next best remedy is 
 calomel, followed by some form of saline ca- 
 thartic such as citrate of magnesia or epsom 
 salts. Calomel may be given in cases of acute 
 indigestion or at the beginning of any attack 
 of fever, or if there are any symptoms of acute 
 illness. The doses of calomel are as follows: 
 
 Doses of Calomel 
 
 For children from two to five years of age, one-tenth 
 grain tablet every 15 minutes until 10 tablets have been 
 taken (one grain). 
 
THE CHILDREN'S MEDICINE CHEST 223 
 
 For children from five to ten years of age, one-tenth 
 grain tablet every 15 minutes until 15 tablets have been 
 taken (1^ grains). 
 
 Calomel should be taken in the late after- 
 noon or evening, and next morning the child 
 should drink a glassful of citrate of magnesia 
 or two teaspoonfuls of epsom salts, dissolved 
 in a glass of water. The citrate of magnesia 
 tastes like mild lemonade and children take 
 it readily. 
 
 Milk of Magnesia 
 
 For young children in particular, milk of 
 magnesia has a slightly laxative effect and 
 at the same time tends to correct any dis- 
 turbed condition of the stomach. The dose 
 is one teaspoonful, night and morning. 
 
 Syrup of Ipecac 
 
 This is the best medicine we have for croup. 
 It is used to cause vomiting. It may also be 
 used if a child has eaten anything that is 
 indigestible and it is desired to produce vomit- 
 ing in order to empty the stomach of its con- 
 tents. For this type of indigestion, one dose 
 of a half- teaspoonful is usually sufficient. If 
 syrup of ipecac is not available, vomiting may 
 be induced by placing one-quarter teaspoonful 
 of mustard or one teaspoonful of salt in a glass 
 of lukewarm water and forcing the child to 
 
224 HEALTHY CHILDREN 
 
 drink it. The doses of syrup of ipecac for 
 use in cases of croup are as follows: 
 
 Doses of Syrup of Ipecac 
 
 Under 6 months, 15 drops every 10 to 15 minutes. 
 
 6 to 12 months, H to 1 teaspoonful, repeated at 15 
 to 30 minute intervals. 
 
 1 to 5 years, 1 teaspoonful at Y% hour intervals. 
 
 5 to 10 years, 1 teaspoonful at 15 minute intervals. 
 
 Unless so ordered by the doctor, not more than three tea- 
 spoonfuls should be given. 
 
 Brown Mixture 
 
 This is an excellent cough mixture but 
 should not be used for too long a period of 
 time, as it contains a small amount of pare- 
 goric. It is excellent, however, for use in 
 ordinary colds. 
 
 Doses of Brown Mixture 
 
 Under one year, 10 drops. 
 1 to 2 years, 15 to 25 drops. 
 3 to 5 years, 30 to 40 drops. 
 5 years and over, one teaspoonful. 
 These doses should be given every three hours. 
 
 Rhubarb and Soda Mixture 
 
 This is one of the best remedies that can 
 be prescribed for the slight digestive disturb- 
 ances so often encountered in childhood. It 
 is best used in liquid form and may be bought 
 already prepared at any drugstore. Its use 
 corrects slight attacks of indigestion and con- 
 trols the formation of gas in the stomach. It 
 
THE CHILDREN'S MEDICINE CHEST 225 
 
 has a slight laxative effect and may be used 
 in mild cases of constipation. 
 
 Doses of Rhubarb and Soda Mixture 
 
 Up to 1 year, }/% teaspoonful. 
 1 to 5 years, one teaspoonful. 
 The doses noted above should be given after each meal, and 
 again at night. 
 
 Compound Licorice Powder 
 
 This is one of the best mild cathartics that 
 can be given to children, Its use is not ad- 
 vised until a child is about three years old. 
 
 Up to fcve years of age, the dose is one teaspoonful, which 
 should be mixed with sufficient water to form a thin paste, then 
 added to one-third glassful of cold water. It should be given 
 just before bedtime. 
 

 GLOSSARY 
 
 Anus 
 
 Lower termination of the rectum. The opening 
 
 through which the fecal matter is discharged from the 
 
 body. 
 Adhesions 
 
 An abnormal joining of one part of the body to another. 
 Adhesive Plaster 
 
 Cloth which has been impregnated with some substance 
 
 of a sticky character so that, when applied to the skin, 
 
 it will adhere closely. 
 
 Adolescence 
 
 The period of life between puberty and maturity, from 
 about fourteen to twenty-five years in men and twelve 
 to twenty-one in women. 
 
 Anemic 
 Bacteria 
 
 Bladder 
 
 Cilia 
 
 Deficient in haemoglobin or iron which normally is 
 found in the corpuscles or cells of the blood. 
 
 Germs. Bacteria are of many types, each usually 
 associated with some special disease, such as the 
 bacteria of typhoid, the bacteria of diphtheria, etc. 
 Many bacteria are entirely harmless and need be noticed 
 only when they occur in larger numbers than thirty 
 thousand per cubic centimeter of milk. The bacteria 
 which cause disease usually are known as "toxic 
 bacteria." 
 
 The organ which holds the urine from the time it leaves 
 the kidneys until it passes from the body. A thin sac 
 in the front part of the pelvis, just in front of the uterus. 
 
 Fine, hairlike processes or fine hairs such as are found 
 in the eyelashes or inside the nostrils. 
 
 Contagion 
 
 The communication of disease by immediate contact or 
 by the transmission of bodily discharges. 
 
 Contagious 
 
 Capable of being transmitted from one person to 
 another. 
 
 226 
 
GLOSS A R Y 
 
 Ear Drum 
 
 A membrane of the inner ear which receives sound 
 impressions, and from which the impression is trans- 
 mitted to the brain. 
 
 Emotion 
 
 Mental excitement. Arousing of the passions or sensi- 
 bilities. 
 
 Emotional 
 
 Pertaining to the emotions. 
 Enamel 
 
 The white, compact and very hard substance that 
 covers and protects the substance of the teeth. 
 
 Environment 
 
 The external surroundings and influences of life. 
 Eruption 
 
 Rash. A visible lesion of the skin, due to disease, and 
 
 marked by redness, prominence, or both. 
 Forceps 
 
 An instrument with two blades and handles for pulling, 
 
 grasping or compressing. 
 Foreskin 
 
 The prepuce. The fold of skin that covers the glans 
 
 or end of the penis in the boy. 
 Fracture 
 
 The breaking of a part, especially a bone. 
 Function 
 
 The special, normal or proper action of any part or 
 
 organ. 
 
 Genital Organs 
 
 The organs of generation or reproduction. 
 Genitals 
 
 Genital Region 
 
 That part of the body which contains the genital 
 organs. That part of the body where the genital organs 
 are situated. 
 Germs 
 
 See bacteria. 
 
 227 
 
GLOSS AR Y 
 
 Glands 
 
 Organs whose function is to secrete or secure some 
 particular fluid from the blood. 
 
 Hypertrophied 
 
 Enlargement or overgrowth of an organ or part. 
 
 Ice-Bag 
 
 A bag, made of waterproof material, filled with ice. 
 To be applied to any part of the body. 
 
 Idiosyncrasy 
 
 A habit or quality of body or mind peculiar to any 
 individual. 
 
 Immune 
 
 Protected against any particular disease. 
 
 Immunity 
 
 Condition of being immune or protected against any 
 particular disease. May be natural, i. e. pertaining to 
 the individual, or may be acquired by inoculation. 
 
 Infection 
 
 The communication of disease from one person to 
 another. This may be done through body discharges, 
 through immediate personal contact or the implanta- 
 tion of disease from without, such as infection through 
 the air by means of dust particles carrying infection. 
 
 Inoculation 
 
 Injection into the body of a serum or other substance 
 to prevent or cure disease. 
 
 Intestines 
 
 The membranous tube that extends from the stomach 
 to the rectum. 
 
 Intestinal 
 
 Pertaining to the intestines. 
 Larynx 
 
 The organ of voice. The upper part of the trachea or 
 windpipe. 
 
 Lesion 
 
 Any hurt, wound or local degeneration. 
 
 228 
 
GLO SS A R Y 
 
 Malnutrition 
 
 Undernourishment. A condition of the body charac- 
 terized by underweight, poorly developed muscles, 
 pallor, anemia, bodily fatigue and lack of bodily 
 resistance to disease. May be caused by the presence 
 of physical defects, insanitary surroundings, lack of 
 proper hygienic living conditions, over-excitement, 
 wrong kind of feeding, irregular feeding or underfeeding. 
 
 Massage 
 
 Scientific rubbing and manipulation of the body to 
 strengthen the tissues and restore tone generally. Acts 
 as a mild exercise for the patient. The movements 
 are from the extremities toward the heart, and consist 
 of kneading, beating, rolling and rubbing movements. 
 
 Mucous Membrane 
 
 Lining of the cavities of the body which connect with 
 the external air, as the nose, mouth, etc. 
 
 Nasal Passages 
 
 The nostrils. The openings of the nose, extending back 
 to the pharynx. 
 
 Neurasthenia 
 
 Nervous prostration. Depression due to the exhaustion 
 of nervous energy. A name for a group of symptoms 
 resulting from some functional disorder of the nervous 
 system, with severe depression of the vital forces. 
 
 Occlusion 
 
 The act of closing or state of being closed. 
 
 Oral 
 Pharynx 
 
 Pertaining to the mouth. 
 
 The cavity in the upper and back part of the throat 
 which is between the mouth, the nose and the oesophagus 
 or tube leading to the stomach. 
 
 Predisposition 
 
 State of the body rendering it especially liable to 
 certain diseases. 
 
 Protective Dressing 
 
 Any dressing that affords protection to any part of the 
 body. A dressing which covers a wound, affording 
 protection to the injured part. 
 
 229 
 
GLOSS A R Y 
 
 Pus 
 
 Matter given off from an open sore. The cream-like 
 
 fluid found in abscesses, due to breaking down of the 
 
 tissues. 
 Rash 
 
 See eruption. 
 Rectum 
 
 The lower end of the large intestine, terminating in the 
 
 anus. 
 Tonsils 
 
 Two oval bodies, one on either side of the throat, at 
 
 the opening of the pharynx. 
 Tourniquet 
 
 A bandage or instrument, used to exert pressure on an 
 
 artery and so arrest bleeding. 
 Undernourishment 
 
 See malnutrition. 
 Urine 
 
 The fluid secreted by the kidneys. 
 Ventilation 
 
 The supply of fresh air to any enclosed space, as a room. 
 Vitality 
 
 The principle of life. 
 Vital 
 
 Essential to life; pertaining to life. 
 
 230 
 
DESIGNED ENGRAVED 
 
 PRINTED 
 
 BUREAU OF ENGRAVING, INC 
 
 MINNEAPOLIS. 
 
 MINN.