Childliood mMi LIBRARY OF CONGRESS, Cliap. Copyright No. Shell._-__W_i_G UNITED STATES OF AMERICA, INFANCY AND CHILDHOOD BY FRANCES FISHER WOOD / fi^ t NEW YORK AND LONDON HARPER & BROTHERS PUBLISHERS 1897 Copyright, 1897, by Harper & Brothers. All rig/its reserved. CONTENTS CHAP. PAGE I. Preventable Diseases 1 II. The Young Babe 12 III. Regularity in Feeding 24 IV. System in Sleeping 31 V. Rational Dress 45 VI. Digestive Disorders 53 VII. Sense-develorment 60 VIII. Rational Feeding 66 IX. Sterilized Milk 75 X. From Infancy to Childhood .... 92 XI. Normal Obliquities 102 XII. Value of ]\Iilk as Food 110 XIII. Contagious Diseases 119 XIV. Variation op Rules 128 XV. The Nursery 132 XVI. To Avoid Self-consciousness .... 139 XVII. The Nursery-Maid 146 INFANCY AND CHILDHOOD INFANCY AND CHILDHOOD CHAPTER I PREVENTABLE DISEASES Sir Joseph Fayrer reports that in Eng- land preventable diseases kill 125,000 per- sons a year, and entail a loss of labor from sickness estimated at $40,000,000 per annum. The Prince of Wales, when presiding at the Hygienic Congress of August, 1891, said : " If these diseases are preventable, why are they not prevented ?" Statistics showing a steady decrease in the relative number of deaths prove that each year a larger proportion is prevented. In England the death-rate in 1660 was 80 per thousand ; in 1690 it fell to 2 INFANCY AND CHILDHOOD 42 per thousand ; in 1750 to 35 per thou- sand ; in 1850 to 25 ; and in 1890 to 18 per thousand. That is, in England the ratio of deaths to population was nearly five times as great in 1660 as it was in 1890. The average duration of human life has doubled since the time of the Eoman Empire, and to-day the mortality from all diseases is in Italy as great as it was in England a century ago. The greatest decrease in the death-rate AYas in the seventeenth centur3\ Then Europe, emerging from the superstition of the dark ages, first conceived the possibil- ity of natural causes for disease and death. That era marked, in England at least, the beginning of public sanitation. People be- gan to entertain the idea that cleaning the streets was more effective to stop the plague than the prayers which they had been wont to offer to the images of their patron saints. The second great advance in the preven- tion of disease has been inaugurated within PKEVENTABLE DISEASES 3 the past twenty years. The faint concep- tion of the seventeenth century, that disease might have a natural cause, culminated in the now recent discovery of what that cause really was. With the acceptation of the germ-origin of disease, public sanitation and medical science began to pass from indefinite, general measures for the prevention of dis- ease to more and more definite and specific safeguards ; and the public health of the past decade has been indicated by further decided and still increasing diminution of the death-rate in all civilized countries. That preventable diseases are still in great measure not prevented is due to the fact that the vitally important and growing knowl- edge of germ-infection, and the great laws under which these factors are operative (which is reducing the practice of medicine from a blind art to an exact science), are not as yet accepted in practice except by the better educated members of the medical pro- fession. Even in their hands it is limited in 4 INFANCY AND CHILDHOOD usefulness because not supplemented by sim- ilar knowledge on the part of the patients whom they attend. A physician is not in- vited or permitted to prevent disease in the families which he attends. He is usually not called until acute disease has already fastened on his patient. He is consulted about the cure, and not called for the pre- vention of disease. A certain class who insist on being face- tious, even when facing death, add to the current stock of feeble jokes about the phy- sician's self-seeking, the assertion that pre- ventable diseases are not prevented because such a course would be suicidal to the physi- cian himself, limiting his income, and finally depleting the ranks of the profession. While it is true that with the decrease of disease a smaller percentage of men Avill be needed in the medical profession, such decrease, unfort- unately, must be too gradual to affect men already in practice, and in future can operate only to call fewer and better men to the PREVENTABLE DISEASES 5 medical profession. To these men the change of work from the cure to the prevention of disease cannot but be wholly beneficial. Their ranks once purged of charlatans and ignorant pretenders, who thrive on the super- stitious fears of patients in the grasp of acute and chronic disease, the profession would be greatly raised in the general estimation, and its Avork would become in reality vastly more important to the community. The very idea of the prevention of disease presupposes a comparatively large body of skilled and scientific medical advisers — men Avho prate not of symptoms, of potencies^ and of cures, but who, in cases under their watchful eyes, can anticipate and therefore prevent acute illness. A physician will not then be called in an emergency (merely as a last desperate resort), but will be consulted regularly by every family, not about scarlet- fever and diphtheria, but as to diet and dress, exercise and education, and will be called upon to adjust all the vital details of daily 6 INFANCY AND CHILDHOOD life that make sound health. ^N'ot only will many men be needed, but their work will be less exhausting and more satisfactory to themselves and to the community than un- der the present system. A true physician unites with the brain of the scientist the heart of the humanitarian. In the prevention of disease he, as a scientist, feels all the mental exhilaration of conquest, while as a humanitarian he experiences the highest degree of happiness in being able to confer the greatest possible benefit upon present and future generations. The world's work in the future prevention of disease must come under three great heads. The first of these in point of time, and possibly of importance, lies in scientific discovery by original investigators in the fields of biology and hygiene. The second lies in the appropriation of these results by the medical profession, and in their practical application in every possible direction. The third lies in an extension of the knowledo^e PREVENTABLE DISEASES 7 possessed b}^ these two classes (and at pres- ent almost limited to them) to the community at large, especially to the mothers, without whose co-operation a physician is powerless to enforce his principles. The purpose of the present work is to as- sist in the prevention of disease in this last direction. It makes no claim to original scientific investigation ; and for the physician so much which is technical and exact has already been written upon the same subject that he has no need of popular works bearing upon it. But the books which are so valuable to professional men are too abstract and tech- nical, or too voluminous, for the general pub- lic. There is hence an urgent demand for reliable information, simply presented, which may be easily comprehended by unscientific people, especially by mothers ; they, when it is brought to their knowledge that much of the disease current among their children may be prevented, earnestly desire to learn how to begin working towards that prevention. 8 INFANCY AND CHILDHOOD Such information is not intended to make the mother independent of the physician, but rather to lead her to appreciate the fact that only the soundest medical advice, supple- menting her most intelhgent and earnest efforts, can diminish the amount of illness prevalent in her family. The slight knowl- edge she may gain cannot make her inde- pendent of the scientific skill of her physi- cian, but is necessary merely that she may be able to co-operate with him to produce the desired immunity from illness. That the mother's influence is so important an element in the prevention of disease arises from the fact that most of the successful work in that line must be done with chil- dren under five ; and that after fifteen years of age it is not only too late to begin, but almost too late to produce any appreciable and permanently favorable effect upon the general constitution, by that time thorough- ly established in disease tendencies. After puberty the greater part of the work done PREVENTABLE DISEASES 9 by the physician must be in the treatment rather than for the prevention of illness. The size, general health, physical strength, nervous force, and power of endurance of any child is practically determined before he is five years old. Indeed, it is determined in a great measure before he is born ; but dur- ing the first years of life the susceptibility to improvement is at its maximum, and heredi- tary strength may then be increased or hereditary weakness modified to a degree that is never afterwards possible. The united power of the mother and of the phy- sician to influence the future physical condi- tion and vitality of a child is practically limited only by the general public ignorance which exposes a child to outside danger and infection, from which it has been with much effort successfully guarded at home. Here, too, in public hj^giene the scope of woman's influence is increasing, and it is to be hoped that, once educated to a conception of the hygienic conditions that should pre- 10 INFANCY AND CHILDHOOD vail in the home, she will widen her influ- ence to extend and improve general legisla- tive measures for the protection of the gen- eral public. She can thus not only guard her own children, but at the same time protect the children of mothers less accurately in- formed of the dangers of infection. The time must come when contagious dis- ease Avill be considered a crime, either of the individual or of the community by whose carelessness it is propagated. During the last century the responsibihty for disease was universally placed upon the Almighty, who was thought to send it either as a pun- ishment or as a warning of sin. During the present century we have transferred the re- sponsibility largel}^ from the Creator to his creature, the microbe. It is to be hoped that the coming twentieth century will con- vince mankind of the error of both these views, and that we may learn to place the burden upon neither the infinite nor the in- finitesimal, but to realize that it is too petty PKEVENTABLE DISEASES 11 for the one as it is too vast for the other, being of exact size to fit the shoulders of the genus homo. When we as individuals and as members of the community accept the full personal responsibility for all diseases and deaths except those resulting from acci- dent and old age, we shall have gone a long way towards general physical regeneration. CHAPTER II THE YOUNG BABE The care of the new-born child is really less difficult than at first would appear. It is quite as important to know what not to do as what to do for its comfort. Most mothers and nurses try to do too much, di- recting their efforts, however, in lines where they are not only wasted, but are positively injurious to the feeble recipient. A young babe is an uncomplicated being ; the latent, intricate organization of adult life is with it still inactive. When a guest of maturer years enters our household we need, in order to make him comfortable, to learn his habits, his tastes, his prejudices. But an infant comes to us without any habits or tastes or prejudices. It has eyes, but they see not; THE YOUNG BABE 13 ears, but they bear not ; tongue, but it ques- tions not ; bands, but they meddle not ; feet, but they go not into mischief. The new-born child has but two sets of organs in conspicuously active operation — the respiratory and the digestive. As the lungs work independently of any outside aid, we may be allowed to consider a child during the first few months of its life as practically an incorporate stomach ; and we shall be safe in limiting our contributions in the way of attention to that organ. The majority of mothers consider this view a base libel, and are not slow to proclaim that every mother's child of them all is from the very first manifestly more than a stomach ; that every child loves to sit up and look around, to see visitors and to be dandled ; that it shows its will-power in its determina- tion to be carried, held, or rocked ; that it knows full well w^hen it desires to be fed, and equally well w^hen it desires not to sleep. But all this is, on the face of it, really 14 INFANCY AND CHILDHOOD absurd. An animal, human or brute, is born with but one instinct fully developed — that of hunger. Whatever else a very young child knows or desires has been artificially communicated by the attendants, who have forced upon it taste and desires unsuited to its immaturity. If 3^ou would know at what age a child should begin to sit up, wait un- til natural, healthy development prompts it to sit. It will creep when the proper time comes, and walk when its limbs are suffi- cientl}^ strong, and the power of equilibrium is adequately established in its feeble brain. If a child is surrounded with the proper de- gree of light, warmth, and air, and if its stomach is properly taken care of, we may rest assured nature will do the rest. A child should literally be intelligently let alone. It should not be handled, or held, or rocked, or amused, nor should its attention be attracted in any way. For the first five or six months it should lie quietly in its bed, or basket, be regularly fed, and as regularly THE YOUNG BABE 15 encouraged to sleep. It will of course get tired. Therefore it needs occasional turning, with change of position, and a gentle rubbing of the limbs or back. A good rule is to stroke the little body for a few minutes, and to change its position every time the baby needs to be made dry. The natural rapid growth of infancy makes the flesh tingle and the limbs ache, and frequent rubbing with the palm of the hand promotes future health as well as present comfort. To man}^ mothers it seems impossible to follow this simple rule of leaving a child alone, to be influenced by favoring natural conditions. To such it is only necessary to say that it has been successfully accom- plished in many cases even in America, where babies are seemingly unusually trouble- some, while such abstinence from meddling is the accepted rule in many other countries. That American babies seem to need so much diversion and entertainment cannot be as- cribed to the climate, for the Indian pap- IG INFANCY AND CIIILDHOOD pooses are invariably left to themselves, except when dressed or fed. Nor can it be a race characteinstic, for in England it is con- sidered very injurious to permit a child to sit — that is, to bear its weight upon its spine — before it is six months old. The true cause probably lies not in the children at all, but in the recognized restlessness and nervous- ness of American mothers, who, by expend- ing their fiercest energy in injudicious at- tention to their children, perpetuate in the coming generations this nervous tendency, so highly undesirable, because ever fatal to the highest physical vigor and the best men- tal development. Many a child languishes for lack of the few things that are really necessary to be done, but that are neglected in favor of unsuitable attentions lavished upon it onl}^ to its detriment. In order to preserve for a young babe the proper conditions of light, warmth, and air, and yet to lift and carry it as little as possi- ble, it is necessary to have for its first nest a THE YOUNG BABE movable bed. Any basket with the sides and bottom carefully protected and padded will serve, but the most convenient is the regular dog-basket, with a hood on one side. This, w^hen properly draped, serves to ex- clude draughts, w^hile the drapery may easily be readjusted to vary the degree of light. If a child occupies a stationary crib, it must be moved from its bed w^henever its room is aired or cleaned, or is needed for other pur- poses. But when such a basket is used, the child and bed together may be changed from one room to another, or from one part of the room to a darker or lighter corner, or to a cooler or warmer one, as convenience or comfort may suggest. Most important of all, a mother, without confining herself to the nurserv, can keep the infant under her own eye while engaged in her ordinary daily occupations. Even though she does not per- sonally feed and care for her baby, she can thus superintend and criticise the nurse's efforts. 18 INFANCY AND CIIILDIIOOD By this method she may also experience the greatest of all maternal enjoyment — that derived from watching the daily devel- opment of her child. Also, she can at the same time, Avithout interruption or fatigue, conveniently sew or read, write or study, re- ceive visits, or direct her household affairs. Outside Avork, either of a social or a business nature, should be undertaken by no Avoman during the first six months of her infant's life. She herself needs, and has by the rights of maternity earned, that amount of rest from either nervous or physical over- strain. Furthermore, years of a mother's devotion later in life can ncA^er compensate a child for neglect during the first fcAV months. After the sixth month a child usually be- gins to teethe. Voluntary muscular action is then more frequent. Feeble beginnings of individual Avill-power are manifested. The babe gradually recognizes the world outside of itself. It is no longer merely an animated THE YOUNG BABE 19 stomach ; other faculties and functions start into activity. All this varied development makes increas- ing demands upon the nervous system, react- ing upon the physical nature, and immediate- ly manifesting themselves in a checking of the phenomenally rapid growth to be noted during the first six months of every healthy child's existence. If the precious first six months have been properly used, the devel- opment of the second six months is not less rapid, although it expends itself in other directions than in purely physical growth. This, however, should normally take place, without any disturbing elements or violent check. But if the first half-3^ear has not been employed to build up the maximum of ph\^sical strength, and to train the child into normal, healthful habits, the second half-year is confusion worse confounded, and in too many cases records the death of the child. Habit rules us all, but is absolute master of the unresisting infant. A baby is a natu- 20 INFANCY AND CHILDHOOD ral autocrat, recogniziDg no authorit}^. It is in vain that the mother tries to induce it to sleep at the proper time, or strives to hush its cries when the desired food is not forth- coming. What she cannot accomphsh, how- ever, the simple power of habit can bring about without a struggle. If the child is fed at absolutely regular periods, it will be hungry then and at no other time. If it sleeps day-by-day by the clock, sleep it must when the hour strikes, whether it will or no. Even the stomach can be trained into the habit of digesting the maximum amount of food necessary for the full nutrition and growth of the body ; and when so trained, it possesses marvellous power to carry on its accustomed work under such temporary ir- ritation or derangement of the general sys- tem as would render a child with a weak stomach seriously if not violently ill. The first six months of life, therefore, form the mother's golden opportunity. If she do not then lay well the foundation, the whole THE YOUNG BABE 21 superstructure must betray this primary de- fect. Then and then only will all the ele- mentary forces of nature be on her side. Later some elements, if not all, will be against her. If she neglect the child at first, or leave it to the untrained care of a nurse, she will, as a penalty, certainly spend many times six months during its later life in nurs- ing it in illness or caring for it in invalidism. Complaints of even the moderate expenditure of money and time necessary to establish an infant in sound health during the first year of existence come from many parents who ungrudgingly give a hundred times as much to the same child in its twentieth year of life, and this because they fail to realize that that first year w\as really more important in determining the success of its future life than the whole nineteen which followed. What ^ve must do, we can do. If a woman is seri- ously ill, she can and does lay aside her reg- ular occupations. If she goes abroad for a hal: ear, she returns to find that neither 22 INFANCY AND CHILDHOOD her home nor the American continent has been revolutionized during her absence. If a mother recognized the real necessity for such a sacrifice, she would find that she could easily give six months of superintend- ence to the early life of the child, especially since she need not by so doing relinquish the quieter, less exhausting occupations that may be carried on inside her home, and must sacrifice only such social excitement or heavy professional duties as exhaust her strength and rob the child of her care. The emphasized importance of the first six months of life arises not from the fact that there are any unusual clangers to be ex- pected during that period, for in the ordina- ry course of events diseases culminate rather in the second half-year. But the first six months are the most valuable in any scheme for the prevention of disease. Precisely dur- ing this period is laid the foundation for the habits of digestion and sleep, which, if well established, will carry a child safely through THE YOUNG BABE 23 the remainder of the first year, and will also influence for good the whole of his subse- quent life. The majority of children seem to flourish until they begin to teethe ; then the slight irritation and physical disturbance of this process reveal any original weakness of the constitution — a weakness in many cases increased by unscientific care during the earlier period. Differing from the popu- lar opinion, all the best medical authorities agree that "teething" never causes disease; but it often betrays weaknesses hitherto un- suspected, which have resulted from poor feeding, over-excitement, or improper cloth- ing, and which existed before and up to the time when teethin^^ began. CHAPTER III REGULARITY IN FEEDING The popular notion that the second sum- mer is the most precarious period of a child's existence is absolutely disproved by all statis- tics. Four times as many children die in the first year of life as in the second, and with each month's existence a normal child's hold on life is strengthened. If a baby is steadily deteriorating in physical condition, the sec- ond summer is, of course, more dangerous than the first, but if, as the result of proper care, the child is following in all its powers and proportions the more natural rule of ac- celerated growth manifested throughout the whole animal kingdom, the second summer finds its chances of life and of freedom from disease very much more favorable than they KEGULARITY IN FEEDING 25 were during the first year. During the sec- ond half of the first year a mother should in no wise relax her vigilance in the care of her baby ; although if the first half has been judiciously used, the increased vitality, the greater powers of endurance, and the estab- lishment of the regular habit of sleep will permit her to maintain an equal degree of caution while devoting to the work less time and effort. Teething is a natural operation, and ought to take 2^kice in a child as easily and as nor- mally as in other young animals, which at worst suffer but a few days' irritation of the gums, and refuse a few of the usual feedings rather than endure the discomfort caused by mastication. If a baby is accustomed to awake at all hours of the night, and to sleep at any hour of the daytime, then even the slight irritation of teething interrupts or al- together prevents its sleeping. But if it has during several months slept soundly all night and napped regularly each day, the habit will 26 INFANCY AND CHILDHOOD have become too strong to be broken by any slight pain. In one case the restless child grows weaker day by day for want of ade- quate sleep ; in the other, the rested child, even though teething, grows stronger every day, because still enjoying its regular amount of sleep. The same principle applies to food. A child that is injudiciously fed throughout the night, and given nourishment irregularly whenever it cries during the day, suffers in consequence from impairment of its digestive powers, and becomes susceptible to germ in- fection throughout the mucous lining of the alimentary canal. Such a child, while it suffers from chronic hunger caused by the craving of the general S3^stem for adequate nourishment, yet never at any one time ex- periences the wholesome acute hunger of normal health, and therefore, when teething, alternately refuses food or consumes it so vo- raciously that each feeding only serves to ag- gravate the stomach trouble already existing. KEGULAKITY IN FEEDING 27 Its flesh, already too white and soft from malnutrition, now wastes away so readily as to convince the mother more firmly than ever that teething is a " disease." The dis- eased condition in reality existed previously, and the soft white fat was, to more experi- enced eyes, one of its manifestations. When a really Avell-fed, well-nourished child begins to teethe, habit induces it to take a due amount of food, even though the nipple does hurt the sore gum, or the piece of bread does touch the tender spot over the pricking tooth. The child, in short, must eat, because its hunger is so acute and habit so strong. My own baby, reared in the routine here advised, had t\velve teeth when a year old, sixteen teeth at sixteen months, and the en- tire set at two years of age. During that time he refused not a single meal, and lost no night of sleep. His first three double teeth were through before it was suspected that he was cutting one. Such a record is the rule rather than the exception with chil- 28 INFANCY AND CHILDHOOD dren who have been reared by the proper sj^stem. With this explanation, the emphasis laid on the first six months of life will not seem unduly exaggerated, and the details of the care necessary to produce such results as described wall seem to mothers to be of suf- ficient importance to be dwelt upon at length. As the new-born babe has no regular es- tablished habits, the operations of sleeping and eating at first naturally tend to interfere with one another. When the child should feed, it is often asleep ; and w^hen it should sleep, it persists in being hungry. The al- most universal injunction given in medical w^orks is never to interrupt a child's sleep for any purpose whatsoever, not even for feeding. But this rule, if strictly carried out, absolutely precludes any regularity ei- ther in sleeping or eating. An infant does not distinguish night from day. It will quite probably sleep four or five hours at mid-day. REGULARITY IN FEEDING 29 and desire to remain wide awake and de- mand frequent feeding all night. Both for the comfort of the mother and the health of the child it is of course necessary that the latter should learn the difference between night and day, and be induced to sleep at the proper time. This lesson can best be taught by indirec- tion. The question of feeding should, de- spite the verdict of the learned doctors, have first consideration. Throughout the animal kingdom the necessity for food is the primal and all-absorbing instinct. From the very first a child should be fed equal quantities of food at absolutely regular periods, even though he must be awakened from sound sleep to receive this amount. And from the beginning a child's stomach should enjoy at night an interval of rest, even if this interval is at first not longer than five hours. If the mother begins when her babe is young enough, it requires but a few days to estab- lish this useful habit. Those few days will 30 INFANCY AND CHILDHOOD be clays of weariness to the mother and dis- tress to the child, but that first victory will render all the other subsequent educational battles easier. One such successful contest may, indeed, become also the basis of a sound system of future discipline, the ef- fects of which will endure as long as the child lives. Many important advantages grow out of this first rational habit of regular meals when it is once firmly established. The baby is no longer found asleep when it should eat. Periodic hunger, resulting from a regular habit of feeding, will soon waken him at the proper time. His stomach, ac- customing itself to the new routine, de- mands food at the usual time, and is not clamorous at any other period. Since it is not overfed at one time and underfed at an- other, the stomach learns to desire and to assimilate all the food required by the sys- tem, and thus the body accomplishes the maximum amount of growth. CHAPTER IV SYSTEM IN SLEEPING It is not wise to attempt to teach a baby more than one thing at a time. Neither the mother's strength nor the child's endurance should be taxed to carry on several contests at once. All forces may wisely be concen- trated on the vital points, one after another. It will require some days after the baby submits to regular feeding to ascertain just how much it can assimilate each time it eats, and what is the best interval to maintain between meals. During this experimental period, even though the hours of sleep do not receive especial attention, the hours of feeding Avill of necessity determine to some extent tlie periods of rest. If sufficiently well fed, a babv even a month old can 33 INFANCY AND CHILDHOOD easily go without food from 11 p.m. to 5 A.M. And when once convinced tliat no food will, in any event, be forthcoming be- tween these hours, it will usually fall into the habit of sleeping soundly during this time. Should it prove impossible, even af- ter weeks of patient experiment, to induce the child to sleep these six hours without food, it may be considered as positively proven that the food it consumes during the day is not sufficient for the demands of its system. If it has been fed regularly every two hours during the day from 5 A.M. to 11 P.M., it has had ten meals, and this should be enough to carry any child through the other six hours of fasting, un- less the food is essentially deficient in quan- tity or quality, or both. Therefore, if after persistent trial the baby cannot be made to sleep at night without feeding, its food should at once be the subject of consulta- tion between the mother and her physician. As almost all young children are fed too SYSTEM IN SLEEPING 33 much in quantity, the quality of the food is, in ninety cases out of a hundred, the ele- ment requiring investigation. If, however, this unbroken night's sleep is once accepted as a rule by the child, we should begin at once gradually to lengthen the time at both ends. The child should not be fed a minute before five o'clock, even if it is awake, and when it does not awake on time it should be allowed to sleep on as long as it will. In this way it will it- self, gradually and without any struggle, in- crease the hours of rest. The daily rule for sleeping and eatmg for the average child is that it should, when one month old, be fed every two hours from 5 A.M. to 11 P.M., sleeping from that time un- til 5 A.M. again. At three months it should be fed every two and one-half hours from 5 A.M. to 10 P.M., sleeping from 10 p.m. to 6 A.M. At six months it should be fed every three hours from 6 a.m. to 9 p.m., sleeping from 9 P.M. to 6 a.m. At one year of age a 34 INFANCY AND CIIILDIIOOD child should be fed at seven, ten, two, six, and nine o'clock. The first and last meals should be given to the child in bed, from the bottle, while the other three meals should be fed from bowl and spoon, in order to be- gin the weaning process. During the fast of the night there should be always ready by the bedside a thorough- ly clean nursing bottle filled with water that has been boiled. If the baby is w^akeful, fretful, or hungry, allow him to nurse from this. A few sw^allows will suffice to calm him. The ordinary heat of the chamber will render the water warm enough for a child in health. If the infant is delicate or ill, the drinking-w^ater must be warmed to 98° Fahrenheit in a cup of water placed over an alcohol-lamp on the table. Some- times w^hen a baby is breast-fed it will not drink even water from a nursing- bottle, in which case it is necessary to moisten its mouth as often as it cries with a fine, soft, white cloth saturated with water. An older SYSTEM IN SLEEPING 35 child should be fed with water from a spoon. Water the child must have, and in abundance, during the troublesome nights, when the habit of sleep is not yet established and the desire for night meals is not thor- oughly overcome. Besides this most important sleep at night, regular day naps must be established as soon as possible. A new-born babe should, and usually does, sleep most of the time ; but if it is of a nervous temperament, there is danger, as it grows older, that it Avill fall into the habit of catching short naps at odd moments, and of indulging in no profound, lasting rest during the Avhole day. By the time a child is three months old it should have formed the habit of sleep- ing from ten to twelve hours at night, and of napping at least two to two and one- half hours twice during the day,. The in- tervals after the 10 a.m. and 3 p.m. feed- ings are the most favorable times for these rests. 36 INFANCY AND CHILDHOOD In 111}^ experience with my own baby this habit of regular clay naps was the most diffi- cult to establish. It required only three or four days to accustom the child to regular feeding, and but two nights' struggle to teach him to submit to the inevitable and to agree to consider the night as the time for sleep. But it was only after several weeks of unre- mitting effort that any regularity in day naps was established. By adhering to the first principle of leaving a baby quietly in its bed, one is debarred from the usual method of rocking or singing the child to sleep. What- ever lessons were taught had to be imparted as he lay in his basket. The child would sometimes fall asleep not more than half an hour before the time for the bottle, and when awakened by the periodic hunger, would have had insufficient rest ; or he would fall asleep while nursing before he had taken the requisite amount, and must needs be aroused to finish the meal. We were finally obliged, whenever he was fed, to resort to the expe- SYSTEM IN SLEEPING 37 (lient of deliberately keeping hira awake until lie had consumed the usual amount, and at other times, as far as possible, to prevent his napping between the regular hours of sleep. When the hour for a nap arrived he was given his usual bottle, after which he was quietly and soothingly stroked down his back, sides, and limbs, and then turned over to lie on his stomach. The inside of the basket was darkened b}^ the adjustment of the drapery, quiet was enforced in the sleeping -room, and he was left to sleep — to which the bottle, the rubbing, and the comfortable position soon Avooed him. It was from the first easy to induce him to sleep, but diffi- cult to prolong the sleep for any consider- able period. By leaving him on his face during the length of time desirable for him to sleep, and saying '* Sh !" whenever he awoke or called out, he in time imbibed the idea that it was sleep or nothing during those hours, and therefore he yielded again to the inevitable. 38 INFANCY AND CHILDHOOD It was rather a weary time, that period of discipline, for no nurse could be trusted to exercise the degree of firmness and gentleness necessary to obtain the desired result without injury to the child. Yet it certainl}^ proved time well spent; for after he was ten weeks old one had only to turn him over on his face when the hour for sleep arrived, and leave him entirely alone. It was absolutely cer- tain that he would be asleep in five minutes, and would sleep for a fixed length of time. For ever}^ hour spent in the initial train- ing, innumerable hours of labor which would later be consumed in rocking the child to sleep are saved to the mother, to say nothing of the gain to the child in a nervous way — of dropping asleep quietly, resting so pro- foundly, and sleeping so long. Our great scientists tell us that with all the superficial differences between the civil- ized and savage man only one divergence is vital — the savage thinks and plans for the present, the civilized man thinks and plans SYSTEM IN SLEEPING 39 for the future. The mothers of the past who resorted to any expedient, however irrational, wdiich rendered the w^ork of the present mo- ment easier, reverted to the methods of the savage. The scientific mother of to-day, who takes present pains in order to avoid future trouble, who increases the labor of to-day in order to diminish the sum total of effort necessary for the training of her child, thereby marks her system as one in har- mony with the highest type of civilization. A strict method of discipline is of course possible only w^ith a child who is compara- tively well. Rules and regulations must be held in abeyance through any severe illness ; but the nearer we can approximate to regu- lar habits, even with a sick child, the better it is for the child. By establishing strict daily rules and by maintaining a wholesome system of nourishment, sickness wnll be the rare exception for a young child, and while ill health may be allowed to modify regular rules, it need not abolish them. 40 INFANCY AND CHILDHOOD The weak point in any system of home discipline hes with the parents. It has been said of Herbert Spencer's theory of educa- tion that it would be absolutely perfect if only the parents were perfect. Yet a good system feebly enforced is, in so far as it is enforced at all, certainly superior to a poor system. Twice when lecturing upon the training of children to an audience of wom- en, I have, after the lecture, been approached by one of my hearers, who in each case made almost the same criticism upon Avhat had been said. Though the two women were unknown to each other and in cities far apart, each said virtually the same thing. Both suggested politely that however ad- mirable the lecture might be in its general scope, it could not be valuable to more than a small portion of the audience, since it was addressed to those only who possessed in- domitable will power ; and that while all would probably acknowledge the wisdom of my suggestions, few could be steadfast SYSTEM IN SLEEPING 41 enough to follow them out against inevita- ble opposition. To which stricture I can, in connection with the present subject, say that if a mother clearly recognizes her lack of will-power, never is the time more propitious for her to begin to exercise what little she has than with the infant a few weeks old who has none at all. Perchance by that ex- ercise her own too feeble will-power may be induced to keep pace with the growth of that of her child. In any event, it is her only hope for supremacy, and, therefore, is an opportunity that should be eagerly em- braced. Sound, restful sleep, both by night and by day, is more easily induced if from the first the child be taught to lie on its stomach and face. The only necessary precaution against suffocation is the provision of a smooth, fiat, somewhat hard hair mattress without a pil- low. The advantages of this position are many. Some one has said that half the 42 INFANCY AND CHILDHOOD diseases of infanc}^ result from keeping the stomach too cold, and the other half from overheating the spine. By adopting the position suggested as the uniform one dur- ing the hours of sleep, the stomach and ab- domen are kept so warm as to prevent col- ic and stomachache, and materially to aid the digestive process, while the spine and back of the head are no longer overheated by the increased temperature of the sleeping child. It may be a coincidence merely, but it is at least a significant one, that all the children the writer has known to rest habit- ually face downward have been unusually sound sleepers, and have enjoyed more than average good health. It is surprising to see how early a child will discriminate and show preference for the face position, and how readily it accom- modates itself to this attitude. A child from eight to ten weeks old will already have learned to turn its head from side to side to obtain the relief of a change of position. SYSTEM IN SLEEPING 43 A young baby on its back is as helpless as a turtle in the same position ; its one possi- ble motion is the throwing out of legs and arms, and each such movement uncovers the child and exposes it to draughts. Placed on its face, a babe two or three months old will not only rest itself by frequent changes of the position of all portions of the body, but, since it is powerless to reverse itself, it can- not get uncovered nor lapse into any un- wholesome cramped position. It is quite otherwise when the infant is lying flat on its back. This position not only invites in- digestion, but it also causes bad dreams and night frights, and promotes the dangerous habit of mouth-breathing. The first basket for a child should be made up with but one sheet, which will serve to cover and protect the mattress. Over this the child should lie between wool- len covers. The ideal bedclothes for a baby are small camel's-hair blankets, which weigh 44 INFANCY AND CHILDHOOD almost nothing, and yet are sufficient, one under and one over the child, for even the coldest Aveather. A small square of heavy double-faced Canton flannel laid under the child, between the night-dress and napkin, will prevent any wetting of the under blan- ket. CHAPTER V RATIONAL DRESS To be ideally comfortable and well, a child should, during the first year of life, be cloth- ed entirely in silk and wool. Knitted silk shirts in summer and wool in winter, with socks of the same material, make, with the napkin, one complete cover for the little body. Harsh, heavy, or coarse flannels should never be placed next the delicate skin of a young baby. The underwear that an adult finds grateful for its pure w^oolly roughness may so irritate an infant as to induce serious ner- vous trouble. We may now, however, obtain at moderate cost dainty knitted woollen shirts or flannel stockinet of such exquisite texture as to feel soft to even the rose-leaf delicacy of a new-born baby's skin. The garments 40 INFANCY AND CHILDHOOD that are worn over this should be made in princesse style, now known as the Gertrude pattern, Avithout bands or strings, and but- toned behind, so that they can all be put on together. The inside dress should be of wool. Canton flannel as a material for in- fants' clothes is altogether an abomination. It is heavy and stiff and thick, but never Avat-ra. Cambric skirts and waists are entire- ly unnecessary^, and, in such degree as they add weight and bulk, are really injurious. The garment worn immediatel}^ under the dress may be of silk-warped flannel, which will answer the requirements of warmth and yet will not show too deep a yellow through the thin dress. The dress itself, for comfort as well as beauty, may wisely be made of w^hite China silk. For a young baby, in cold weather, two garments are needed between the under-shirt and the dress. These should be made, one of Jaeger white stockinet, and the other of silk-warped flannel. Neither one should be KATIONAL DRESS 47 more than long enough to cover the feet. These materials are so beautiful that thej will require no embroidery or trimming. Simple feather-stitching will be sufficient to render both garments lit for a princess; and yet they will not cost as much and will be more durable than the usual long, heavily embroidered flannel skirt, and the longer, rauch-betrimmed cambric abomination called an over-skirt. Properly apparelled in the silk and woollen clothing, a baby has every garment as soft and warm as his own delicate flesh, and cannot be irritated or hampered by his dress, at least. Silk-warped flannel skirts and white China silk dresses have an extravagant sound, and undoubtedly seem quite bej^ond the purse of many, who yet really spend double the amount that would be needed to purchase these articles on garments that are at once inartistic and unhealthful. The layette usu- ally provided for a child is a barbarism. It is elaborate, yet not beautiful ; expensive, but 48 INFANCY AND CHILDHOOD not useful ; troublesome to make and keep in repair, and yet not comfortable for the wearer. White China silk costs from fifty cents to a dollar a yard. The dress, like the flannel under-garments, may be made entirely plain, and, at most, should not be more than forty inches long. The expense of such a dress is not more than half that of the ordinary hid- eous over-embroidered gown, which is beyond home skill to make or home talent to launder. On the subject of napkins a word remains to be said. The most expensive is not here the best. Cotton napkins are much to be preferred to linen ones. The linen allows the moisture to pass through and to saturate the clothing. The cotton absorbs and retains it. Of course the baby should not be allowed to remain wet after his condition is discov- ered ; but even the brief time that must oc- casionally elapse before he receives proper attention makes the fact that Avet linen is RATIONAL DEESS 49 much colder than wet cotton of no small im- portance. Put the extra money that linen napkins would cost into a larger number of cotton ones. It is almost impossible to pre- pare too many. Habit is a great helper in keeping the baby dry, just as it proves to be in making him sleep and eat. If for a few weeks an infant is changed promptly every time he requires it, he will learn to grunt and fuss significant- ly whenever he is wet, conveying as clearly as if by word that he w^ants and expects to be relieved from discomfort. Among the habits which materially con- tribute to the maintenance of good health, and which should be early established, is that of regular movements of the bowels. It is possible to accustom even very young babies to using the chair — some experienced nurses maintain at as early an age as two or three months. But even if it is possible, it is prob- ably undesirable for any baby under six months of ao-e either to sit on the chair or to 50 INFANCY AND CHILDHOOD be held in an upright position over it. It is possible that less harm results from the usual method of using the napkin than from this constant disturbing and handling. But some- where between the ages of six months and a year, according to the strength and physical development of the individual, this habit of cleanliness may usually be established with- out injury to the child and with less difficulty than at any later age. The mother or nurse should, however, take the Avhole burden of the lesson upon herself, and not lay any part of it upon the baby, for w^hose feeble brain the task of remembering or indicating the necessity for the chair is an unwise strain. The whole aim of the first six months should be to make the body grow and to keep the brain quiet. A child less than a year old must never be disciplined in the sense of being expected to make a conscious mental effort. It should be trained only so far as habit, and not con- scious effort, aids us, and then only in those RATIONAL DIIJ:SS 51 physical functions, such as sleeping and eat- ing, which are with the child purely animal. That is, we must not at this immature age keep the child on the chair for any length of time, or endeavor to impress upon his mind the necessity of emptying bowels or bladder at that particular moment. We should rather shoulder the responsibility ourselves, and so carefully time our efforts that they coincide with the natural inclinations of the baby, thus making the lesson physical rather than mental. All disciplinary efforts for the first two years of life should be in the line of estab- lishing and strengthening physical habits. At the same time we must make every effort not only not to encourage, but actuall}^ to retard, any complicated mental effort. It would be better to delay the formation of the habit of using the chair until the end of the first or the beginning of the second 3^ear than to impose on the child any sense of responsibil- ity, or to encourage it to any conscious effort 52 INFANCY AND CHILDHOOD to communicate its wants. If we can so ac- curately anticipate the child's wants as to hold him over the chair for a minute just at the right time, and have the inspiration to continue this practice with judicious regular- ity, then the physical comfort alone will in most cases induce the child to respond to one's efforts. CHAPTER VI DIGESTIVE DISORDERS For any obstinate form of irregularity of the bowels medical advice must be sought. Of the two extremes, diarrhoea is from the medical standpoint the more serious, and de- mands more immediate attention. But for a thoughtful mother, concerned for the ulti- mate welfare of her child, both are equally signiJScant, and convey wider lessons than are usually mentioned in connection with either. While the medical treatment of these troubles in their various manifestations must needs be left to the phj^sician, the discussion of their ultimate consequences occupies an important place in any scheme for the prevention of disease. Diarrhoea, in nearly all its forms, from the 54 INFANCY AND CHILDHOOD most simple to the most serious, is now be- lieved to indicate an excess of noxious mi- crobes somewhere in the intestinal tract, and points directly to grave errors in the method of feeding. It also demands prompt treat- ment by which these microbes may be washed from the digestive organs. The mother should make it her most imperative duty to accept the first w^arning of this kind, and to rectify mistakes in feeding before re- peated attacks of the same nature impair the integrity of the mucous membrane of the part upon which the microbes have fastened. It is a matter of perhaps twenty-four hours to clear the system of microbes at the first attack, while it may require months or years to restore the organ to its normal condition after it has once been injured by the repeated attacks of these germs. To nourish the child while this reparatory process is going on is a problem too often beyond the power of mater- nal affection or medical skill to affect. Constipation teaches an entirely different DIGESTIVE DISOKDEKS 55 but hardly less important lesson. It usually indicates that the child receives too little nourishment, or nourishment which is too concentrated. It may sometimes in a degree be temporarily even a favorable sign. A child whose diet is changed from food which contains injurious germs to good germless food will usually become constipated for the very lack of this dangerous irritation which the microbes produced upon the intestines. Any sudden impetus to more rapid growth, whereby the body assimilates a larger pro- portion of the food taken, may also be the cause of constipation. It needs careful study and discrimination on the part of the moth- er to ascertain whether the constipation is chronic and deleterious, or whether it re- sults from conditions which are temporary onl}^ and will in the end even prove favora- ble. If the constipation is chronic, and shows evidence of increasing, a change of food is as important to the well-being of the child as it was in the case of diarrhoea. If it is merely 56 INFANCY AND CHILDHOOD temporary, patience and tlie application of simple remedies will soon correct the trouble, and demonstrate conclusively that this was simply the precursor of an improved condi- tion. In case of constipation, from what- ever cause, it is wise to increase to the point of toleration the daily amount of water that the child consumes. If a child is over a year old it should be taught to drink from a cup, but even a young babe should be given water from a spoon or bottle several times a day. In addition to this, a movement of the bowels should be artificially induced, either by glyc- erine suppositories or oil - and - water injec- tions at a regular hour each day. This re- sponsibility should rest on some one person, either the mother or a trustworthy nurse, and must never be omitted or varied if the constipation is to be overcome. Among the physical aids for the cure of constipation are vigorous out-of-door exercise for older children and abdominal massage for babies. DIGESTIVE DISOKDEKS 57 The habit of drinking daily a quantity of water is one that is valuable in many ways. Its importance is seldom sufficiently empha- sized. It is not enough that the child should take an occasional glass of water, or that the babe should be given a spoonful as a rarity. But the habit of water-drinking is essential to the well-being of every child. Most chil- dren will occasionally ask for water at meals, or will take a swallow of ice-water when they see others drinking, or will enjoy water with lemon, or fruit, or jelly, or sugar, or flavored Avitli tea or coffee ; but water pure and simple it seldom occurs to a child to demand, or to a mother to offer, although of all foods this one is the most important, and no other contributes so directly to the health and growth of the child. The tiniest baby should be given a teaspoonful of water many times during the day ; and if at night it takes water from a nursing-bottle, it will require during several hours no other nourishment. A child tw^o years old may with advantage 58 INFANCY AND CHILDHOOD drink at least a pint of water every twenty- four hours, and a child from three to four years old will not infrequently consume a quart of water in the same time. All water fed to a child should have been boiled, and must be kept in a bottle or carafe that can be closely stoppered. It should neither be warmed nor cooled, but should be given to the child at ordinary temperature as it stands in the living-room. It should always stand within sight of the infant, and within reach of an older child. Where it is necessary to go down-stairs or into another part of the house in order to obtain a drink for the child, it usually has no drink at all except at such times as its thirst becomes intense. It is not necessary or advisable to give water to a child during meals, but at other times it may safely be allowed to drink as often and as much as it will. It may even be encouraged to increase the amount, if the water that is used has first been boiled and DIGESTIVE DISORDERS 59 is of the proper temperature. We cannot of course force a child to drink, nor is it pleas- ant to over-urge such a necessary operation. But by having water always at hand we may make drinking easy, and by providing a pretty cup, or making some merry play, we can go farther and make the drinking of plain water really attractive until the habit is firmly fixed, when it will regulate itself. CHAPTER VII SENSE-DEVELOPMENT There is a conviction prevalent that a child which is left so completely to itself as the method previously described would indicate Avill, at least during babyhood, be slow and dull, and will feel bored for lack of interests. But in reality the undisturbed child, while serene and sweet, is in every waldng moment also unusually and uniformly active and gay. He discovers and interprets gradually and naturally both the small ego and the great non-ego ; and since he discovers them from the standpoint of his infant observation, not forced prematurely from the point of view of the adult mind, he will find in the process endless amusement without disturbance or excitement. The sense of touch is the last of the human SENSE-DEVELOPMENT 61 powers to be wiped out by the on-coming of death ; it is also the first to develop in the new-born infant. The first sensations of this outer life are usually not agreeable to the new-born child. His feeble wail, a protest against the wide unknown, seems to invite our compassion, and usually tempts the at- tendants to offer injudicious petting. If, however, the first feeble sense of touch is used to give the child a point of contact with the new world, a baby even a few hours old, unless it is in pain, will be comforted if it is allowed to clutch in its tiny fist the finger of some friendly hand. The prehensile powers of a baby are- pro- portionately much greater than those of a mature man. Many children, when only a few weeks old, are able to sustain their weight by hanging by the arms. Through this abil- ity to grasp and liold whatever comes in con- tact with their curving fingers comes their first self-taught lesson, and their first means of diversion and investifj^ation. 03 INFANCY AND CHILDHOOD To the first sense of touch the average child a week old adds a feeble consciousness of the sense of sight, and begins to follow mov- ing objects with his eyes, or to observe any- thing that is shining or bright. At the age of a month it will turn its head and follow mov- ing sounds. When six weeks old a child will begin to distinguish, not by sight, but proba- bly by touch or smell, its attendants one from another. When ten weeks old it will so far in its feeble brain have formulated the fact of friendly attention that, if well cared for, it will no longer cry or wail unmeaningly or indiscriminately whenever it feels hunger, pain, or discomfort, but will grunt and scold, with cheerful and evident confidence that its wants will be considered as soon as made known. Some children at this age will fasten the eyes upon the person who usually attends to such necessities, cooing and chattering in a seeming effort to convey by the inarticu- late language of infancy their personal wants. When it was eleven weeks old, one of these SENSE-DEVELOPMENT 63 JLicliciously neglected babies was heard to laugh out so loud as to frighten himself ; and another at the same age was proved to notice, distinguish, and show preference in colors, indicating great pleasure in dull blue, and dis- tress and physical discomfort at bright pink. At three months of age one child passed in- fantile judgment upon musical tones, scream- ing with apparent rage whenever the sharp tones of a hand-organ rose from the street, but cooing and laughing with deliglit when- ever a fine piano in an adjoining room was touched. Before this age the average child has also discovered himself. First he finds his hands, and they afford him many a day's amusement and furnish valuable lessons in natural history. He discovers successively that they move, that they belong to him, and finally, more wonderful still, that they move at his own volition. These movements are at first aimless and without purpose, but the gradual effort to convert them into in- tentional motions entertains many a baby G4 INFANCY AND CHILDHOOD for days or weeks. The discovery of the head furnishes perhaps the greatest Avonder and amusement to the child, since, unaided by the sense of sight, he must explore that region with the help of the half -trained hands alone. As the little fingers wander round and round the tiny dome, a look of interest and comprehension will gradually replace that of astonishment, and this transi- tion marks another distinct epoch in the nat- ural mental development of the child. When we entertain and amuse an infant we do not help in its essential development, but rather hinder its normal growth. We excite and w^eaken it ; but nature teaches and strengthens the infant mind. A child three months old, already observing a differ- ence in sounds and in colors, and formulat- ing, even though feebly, the personality of those around him, faces literally the whole world of material sensations, and will gain more new information by his own unaided SENSE-DEVELOPMENT 05 perception than either the father or mother could possibly acquire in a much longer time without an attack of nervous exhaustion. We cannot prevent this natural, rapid devel- opment, nor would we wish to do so ; but we need to avoid with the utmost care either interfering with or accelerating its progress. All the environment of a child should remain as nearly as possible the same day by day. 'New rooms, strange faces, unusual sounds or sights, should be avoided in order that he may learn to know the "I" and "not I" in their simplest forms, and with the minimum strain upon the nervous system. When about a year old a child enters into its first comprehension of the power and value of language, which is the door of intel- lectual life. With this acquisition it leaves babyhood behind and crosses the threshold into childhood. CHAPTER VIII RATIONAL FEEDING Of the many elements of caution that dur- ing the first year of life contribute to the good health of the child, care in feeding is the most important ; perhaps more important than all the other elements combined. In considering, as we shall, one kind of food only, we do not desire to ignore the fact that there are other foods which have in many cases proved valuable, and upon which chil- dren have been successf ull}^ reared. Sterilized milk is, however, now recognized as the hest artificial food for children, and where we can obtain the best it is manifestly unwise either to consider or to use an inferior article, even though it may have intrinsic worth. The general insufficiency of the breast- NATIONAL FEEDING 67 milk of the mothers of the present genera- tion, and the tremendous drain that lactation makes upon the average woman, put the natural food of infants in many cases out of the question. It is universally acknowledged that good breast-milk is superior to any other food for an infant ; but we must at the same time recognize that not one mother in ten can or ought to nurse her child for more than the first few weeks of its life. There- fore artificial food must be discussed not as a mere substitute, but as the general rather than the exceptional food for infants. Be- fore the discovery of sterilized milk many a mother, at the risk of her own health, and in spite of the fact that lier milk was insufficient for the demands of the child, still persisted in nursing it, rather than incur the perplexi- ties and dangers of the old system of bottle- feeding. Now, however, with the use of steril- ized milk, there is no longer danger of any sort, and perplexities may, by an exact sys- tem of feedino^, be reduced to a minimum. G8 INFANCY AND CHILDHOOD Good breast-milk agrees with all children, and all except those essentially diseased thrive upon it. Good sterlized milk, properly pre- pared, proves its similarity to mother's milk in nothing so much as in the fact that it, too, agrees with all children, of whatever age or condition, unless they are so acutely ill that all milk must for a time be abandoned. In such rare cases a change to water, barley- water, gum-arabic water, or beef-juice for a time long enough to clear the intestinal tract of the collection of microbes is all that is necessary ; twent3^-four to fortj^-eight hours are usually sufficient. The feeding of the sterilized milk may then be gradually re- sumed by using in the barley-water a very small quantity of the milk, increasing it by a spoonful at each feeding, until the average proportion of milk and water is again at- tained. Great pains have been taken to collect sta- tistics on this particular point, and in every instance where good, rich, thoroughly ster- RATIONAL FEEDING 69 ilized milk has been reported persistently to disagree with a child, some grave defect in the manner of administering it has been detected. In one case laid down as an argu- ment against sterilized milk, the baby was fed while lying fiat on its back, through a nipple in which the hole was so large as to allow a rapid stream of milk to flow down the child's throat and almost to strangle it. Naturally milk taken w^ith such rapidity violently disagreed w^ith the child. In other cases the milk w^as found to be administered quite cold, or too hot, or not properly diluted ; or it was taken from a bottle that had been too long opened ; or it was fed through a flexible rubber tube whose interior uncleaned surface polluted the milk as it passed. Many children just taken from a breast whose milk is thin and unnutritious crave and will rap- idly swallow an equal quantit}^ from the bot- tle ; whereas this milk, which is many times richer than the former food from the breast, should of course be given in smaller quanti- 70 INFxiNCY AND CHILDHOOD ties. If given in equal bulk it will inevitably make a cliikl ill. It is not, however, steril- ized milk that should in such cases be con- demned, but the breast-milk, whose insuffi- cient richness taught the child to demand a quantity sufficient to produce chronic dilation of the stomach, and to create an abnormal appetite. Having made notes of thousands of cases, I have yet to find one child who w^ould not thrive on sterilized milk if prop- erly administered. There is, therefore, no need to discuss other foods, since what is acknowledged to be the best is always available, unless the child is so ill that it can digest no food at all. The ad- vantage of breast-milk over even sterilized milk arises from the fact that there is less room for error in its administration. Nature prepares the food of the breast, and Nature teaches the child the method of obtaining it. She leaves no room between the breast and the mouth for mistakes of any sort. Good sterilized milk is as germless and safe as RATIONAL FEEDING 71 good breast-milk, but in its administration there is room for stupidity and carelessness that may neutralize its good qualities. Each detail in the preparation and administration of the bottle is of infinite importance. And, reasoning backward, the mother may be ab- solutely certain that if the effects are not good the preparation is defective. Some children do not thrive even upon the best food, whether it be artificial or from the breast. In ninety out of one hundred such cases the cause lies in the system of general management, which has resulted in an over- stimulated nervous system. A baby is, and should be, solely an incorporate stomach. The digestive processes should be the main object of its existence, and nothing else should interfere with this operation, or de- tract from the strength put into it A child less than a year old, if it is over-excited and over -entertained, continually diverted and amused, cannot properly digest its food. And 73 INFANCY AND CHILDHOOD when once it is thus over-stimulated, the ar- tificial craving for excitement is established as a habit, and the child demands or seems to require a continuation of the activity which is undermining its physical strength and impairing its digestion. In such a con- dition it is, of course, of no use to change the food, or to hope to find anything that will nourish the child. It is even wiser to reduce rather than increase the quantity given, since the amount of undigested food in the intes- tinal tract determines the degree of danger. If it is not too late for any remedy, the only one that can possibly contribute to the re- turn of digestive power is one that will in- duce less nervous activity. The child should be kept in a quiet, darkened room, under the care of one person, the mother if possible, and the best medical advice should at once be procured. The dangerous nervous disturbance with babies comes from too much handling, over- excitement caused by a child's seeing too RATIONAL FEEDING 73 many strangers, and the too early stimula- tion of the organs of sight and hearing ; little or irregular sleep ; and too many, too early, or too noisy out-of-door excursions. It is a condition more easy to avoid than to cure. Its most serious result is the shattered ner- vous system, which the children who survive these attacks carry throughout life. Some mothers, having by lack of care in artificial feeding, or by over-excitement of the nervous system, impaired the child's nat- ural digestive powers, hope to avoid the con- sequences of their own carelessness by the employment of a w^et-nurse. This practice is, however, becoming more infrequent, and, it is to be hoped, will soon be obsolete. With the present improved and entirely safe methods of artificial feeding, there is no case where its dangers are not less than those in- curred by the employment of the average wet-nurse. An ideal w^et-nurse may exist, but is never to be found when an emer- 74 INFANCY AND CHILDHOOD gency demands. It is always dillicult, and in large cities impossible, to trace the ante- cedents of the women who apply for such positions. There is a strong chance that they are diseased, almost a certainty that they are immoral, and no hope that they will give the child any judicious or systematic training. Any one who has had experience with this class knows only too well the impossibility of restraining them in drink or diet, and no one can be certain that they will not dose the child to secure a night's sleep for themselves. The natural and inevitable risks that a baby encounters in its first 3'ears of life are multi- plied many times whenever a wet-nurse is employed, and it is an unusual combination of circumstances that can justify a mother in incurring such unnecessary dangers. CHAPTER IX STERILIZED MILK One-fouktii of all the deaths in the United States are of children under one year of age ; and nearlj^ one-half, in round numbers 400,000, are of children under five. In cities this proportion rises during the warmer part of the year, until one-half of all the deaths are of babies less than twelve months old. The majority of these children die of dis- eases caused by germs introduced into the system in the uncooked milk and water, which constitute the sole diet of many in- fants, and the principal food of all young children. Intestinal diseases, counted non- contagious, carry off by far the greatest number. Experience has proved that these troubles may be modified, or in many cases 7b INFANCY AND CHILDHOOD entire!}^ eliminated, by the use of germless food. By feeding the child only milk that has been sterilized, and water that has been boiled, we cease to feed the disease and be- gin to nourish the child. Sterilized milk is comparatively a new dis- covery, and the difference between its use and abuse is not 3^et distinctly defined in the public mind. The apparent simplicit}^ of its production has misled many physicians, as well as mothers, into applying the name to an article which possesses none of the vir- tues of sterilized milk. American investigation on the subject has been extremely crude, and so far is still to- tally inadequate as a basis for sound conclu- sion. Fortunately, in Europe the subject has received due consideration. German scien- tists especially have given much time to the investigation of the effects of various kinds of milk in the intestinal diseases of children. Also Tyndall, Lister, and Pasteur have care- fully studied milk in all its natural phases of STERILIZED MILK 77 composition and decomposition. They have gone to the very foundation, having them- selves taken the milk from the cow, under varying degrees of atmospheric impurity, and carefully noted in each case the favorable or unfavorable environment; and they unani- mously declare that all milk from a healthy cow is absolutely pure and germless as it flows from the udder, but that its composi- tion, its animal heat, and its exposed surface, all combine to render it a most favorable medium for the cultivation of bacteria. On the other hand, the atmosphere of the ordi- nary stable, swarming as it is with germ life, at once furnishes in plentiful measure the microbes, which, coming in contact with the milk, instantly begin to multiply at an ap- palling rate. In any common stable milk cannot remain free from infection even while it is flowing from the udder to the pail. Koch, Escherich, and their celebrated co- workers have supplemented the investigation of milk in its natural condition by valuable 78 INFANCY AND CHILDHOOD studies of the germ life ^yhich is found in the intestinal tract of an infant, and have noted its variation in health and disease. They conclusively demonstrate the poisonous ef- fects of impure and germ-laden milk upon the delicate digestive organs of a child. All these scientists conclude that there is no strictly pure milk except that taken di- rectly from the udder of the cow; that the milk delivered in cities, whether twelve, twenty-four, or thirty-six hours old, is swarm- ing with microbes ; and that it varies only in the degree of its dangerous properties. Therefore they declare that all milk fed to children and invalids should first be care- fully sterilized in order to destroy its count- less bacteria, which otherwise would be in- troduced directly into the system. In Germany the danger of using unheated milk is so clearly comprehended that legal enactions regarding it are becoming every year more stringent, and it is already diffi- cult for a traveller in that country to procure STERILIZED MILK 79 a glass of milk that has not first been steamed or boiled. In America the necessit}^ of ster- ilization is not so generally recognized, nor, if we may judge from the reports in medical journals, have the results been so exception- ally good. The inconsiderable proportions to which infant mortality has been reduced in the public institutions where even partially ster- ilized milk is used indicate, however, what blessed results might be hoped for if the milk supply was controlled by judicious leg- islation, and the quality and condition as it is delivered to consumers regulated by law. Contrary to the more mature opinion of European authorities, an American ph3"sician will occasionally affirm that sterilizing milk renders it less digestible, because it coagu- lates the albumen. Cooking meat and eggs coagulates the albumen, but we do not there- fore conclude that meat and eggs should be eaten raw. On the contrary, it is known that cooking meat renders it more digestible, pro- 80 INFANCY AND CHILDHOOD vided alwaj^s that it is not overdone. So in like manner the digestibility of sterilized milk depends upon the degree and duration of the heat which is applied. Milk that is swarming with microbes cannot be sterilized without prolonged heat applied on successive days. But fresh milk can be freed from germs w^ith such a moderate application of steam, that when once the milk is re-aerated it is difficult to distinguish it from the new milk of the milking-pail. Sterilized milk has usually been recom- mended as especially valuable in diseases of the stomach and bowels. Its highest value is not, however, as a medicine, but rather as a food. Favorable as are the results of its use for sick babies, its best work is always with children of average health and heredity. Its chief value is not in the cure, but in the pre- vention of infantile disorders. These, as a rule, attack those only whose vital powers have through some form of malnutrition been reduced below par. STERILIZED MILK 81 The artificial foods that preceded sterilized milk in popular favor were all defective in one or the other of two ways — they were either unsafe or unnutritious. Those of the first class, comprising nearly all sorts of milk diet, furnished the proper and natural ele- ments of nutrition, but were dangerous be- cause they contained such abundant germ life that the child who took them was sel- dom well and often violently ill. Those of the second class included the patent baby- foods and condensed milk ; they eliminated the elements of danger arising from bacterial infection, but failed to furnish sufficient nour- ishment to meet the demands of a growing child. Each class avoided the danger of the other, only to incur as great a danger pecul- iar to itself. Milk as a food furnishes all the elements necessary to life and growth. Now that it also can be made free from germs, it is, when properly prepared, an ideal food, and its dis- covery has revolutionized the whole system 63 INFANCY AND- CHILDHOOD of infant dietar3^ It is above all others the food which appeals to the common-sense of mothers. It is not artificial or mysterious in its composition. Sterilization is merely a method of restoring milk to its natural germ- less condition, and retaining as far as possi- ble its normal elements of nutrition. The process is simple, and the tests of its efficacy are easily applied without scientific training. The common belief that the ^Drimary ob- ject of sterilizing milk is to prevent it from souring is misleading. Milk that is in dan- ger of becoming acid before it can be used is already unfit to feed to infants. The im- portant object to be obtained by sterilizing is to destroy as soon and as thoroughly as pos- sible the bacteria, Avhich otherwise continue to feed upon the milk and to destroy the fat globules, the constituents containing the ele- ments essential for the nourishment of the babe. Most of the milk used for children is, even when fresh, deficient in fats, and the uninterrupted action of the germs renders it STERILIZED MILK 83 simply starvation rations for any growing creature. Any mother can test the sterilized milk she uses and discover if it fulfils the two requirements of an ideal food for infants. Without the aid of chemist or microscopist, she can determine if it contains adequate nourishment and is free from germs. By pouring a small quantity of the milk into a graduated test-tube, and setting it aside for twenty-four hours, she may learn just how much cream it will yield ; and by placing one of the bottles in the temperature of a living-room for two or three days, she can ascertain if the milk is sufficiently well ster- ilized. Most children are fed too much in bulk. The milk they drink is not rich enough to satisf}^ with any normal quantity, their healthy appetite. To approximate to good breast-milk, we must start with cow's milk that will yield one-fourth its own bulk in cream ; this, when diluted with an equal 84 INFANCY AND CHILDHOOD amount of water, will yield a food that is safe, nourishing, and entirely adequate to all the demands of a hungry stomach. Fed on ordinary city milk, many children slowly die of starvation, or become in time the vic- tims of chronic illness resulting from malnu- trition. An infant may be fed to repletion and yet be poorly nourished. Scores of even breast-fed babies are half-starved with- out ever having suffered from hunger. Mal- nutrition is indicated by late dentition, poor bone formation, a tendency to rickets, bro- ken sleep by night, general fretfulness by day, a susceptibility to colds, and a liability to catch all the prevailing diseases in conse- quence of lowered vitality. Immunity from disease is especially im- portant during the first year of life, since a child's power of resistance is then at the lowest ebb, and its susceptibility to infection at the maximum. Statistics prove that with every month of existence a child's hold on life is strengthened. Four times as many STERILIZED MILK 85 children die in the first as in the second year of fife. Good health means not present blessing* only for a baby, but every day's ex- emption from disease is so much increase in the surplus vital energy that shall render the child capable of resisting infection in future. And food is the agency by Avhich we must build up a strong foundation of permanent good health. The fact that one cannot produce perfect- ly sterilized milk at home is not an argu- ment against its domestic preparation, but is in reality the strongest of all pleas for a careful steaming of all the milk that is to be used in the famil3^ If the germs are so dif- ficult to destroy, so active and prolific, then the greater is the necessity for killing as many as possible before introducing them into the digestive system of man or child. Many mothers incur extreme and unnec- essary risk from the belief that when the milk is steamed it is thoroughly sterile; whereas if they realize that it is only par- 86 INFANCY AND CHILDHOOD tially sterilized, that the germs only, and not the spores, or seeds, are destroyed, they would exercise greater caution in its care and administration, and hence take fewer risks. With this qualification in mind, we may with clear conscience proceed to discuss the best methods of Jiome sterilization. First, the age and quality of the milk must receive careful consideration. During every hour in which the milk remains exposed to the at- mosphere, or is shaken b}^ the motion of trans- portation, it deteriorates, and the bacteria, which find lodgment in the milk almost as soon as it leaves the cow's udder, multiply in geometrical ratio. The common hay bacil- lus, found in all stables, and consequently in all milk, multiplies so rapidly that at the end of twenty -four hours its descendants number 10,000,000,000. These germs live upon the milk, and the microscope demon- strates that under their operation the fat globules composing the cream gradually dis- STERILIZED MILK 87 appear, few or none remaining after the fourth day. With sterihzed milk, on the other hand, no change is visible, even witli the microscope, except a tendency of the fat globules to coalesce, a process popularly known as condensation of the cream. There- fore in fresh milk we find few microbes and many fat globules ; in old milk, many mi- crobes and few fat globules. Cow's milk differs from mother's milk in that it contains more casein, or cheesy mat- ter, and less of the necessary fat. To restore the natural proportion we need to use milk rich in cream, as from the Jersey or Guern- sey cattle. The process of sterilizing milk is simple in detail and easy to describe. The burden of the work lies in the effort to maintain uni- form and absolute cleanliness throughout the whole process. Not only must visible dirt be abolished, but the cleanliness of every ar- ticle that is to be used must, even to the search- ing e3^e of the microscope, be unimpeach- 88 INFANCY AND CHILDHOOD able. We need first to discard any apparatus t]iat is complicated in structure, or has parts inaccessible to air and light ; and any instru- ment that might furnish a favorable nidus for the propagation of germs should be at once rejected. All bottles to be used either for steriliza- tion or nursing should be spherical in shape. Sharp corners in the interior of a bottle are difficult, if not impossible, to clean, and may at any time retain an invisible particle of milk, to become the focus of tyrotoxicom poison, which cannot but prove fatal to a child. Only short nipples that are easily in- verted are allowable. There is no virtue in sterilized milk if it must, in its passage to the child's mouth, flow through a long rubber tube lined with colonies of germs. ]^o sponges or brushes should ever be employed for cleaning the bottles, for after they are used they themselves furnish more germs than all our cleaning can remove. Every bottle emptied of milk should be rinsed in STERILIZED MILK 89 cold water, and then submerged in a pail of water in w^hicli has been dissolved an ounce of baking-soda. AVhen the day's collection of bottles is to be thoroughly washed, pre- paratory for refilling, it facilitates the pro- cess to have ready at hand a pail containing white castile soap dissolved in water, to which has been added a tablespoonful of ammonia. With this one may use a clean bit of cloth, tied to the end of a wire or stick ; or may shake in the bottle a piece of raw potato, small pebbles, sand, or rice grains. Cloth, potato, pebbles, or rice should, how- ever, not be used a second time. Whatever is employed must be renewed each day. After washing the bottles should be rinsed with boiled water, and then immediately filled with the milk to be sterihzed. The principle of sterilizing is simply to keep the bottles of milk in boiling water or live steam for long enough time to kill the germs. This may be accomplished with an ordinary tin boiler and steamer used for 90 INFANCY AND CHILDHOOD cooking, but is more conveniently done with some one of the numerous sterihzers which are offered for sale in large towns. Of these the best known are the Soxlet Sterilizer, in which the bottles are partially submerged in boiling water, and the Arnold Sterilizer, in which they are inclosed in a chamber of live steam. Both these sterilizers now come fur- nished with round-bottomed bottles, which are not only more easily cleaned, but are less readily broken by the repeated heatings, than the flat bottles. A variety of stoppers have been succes- sively used — rubber, cork, and cotton ; but for home use nothing equals for convenience and efficacy the double Soxlet cork of rubber and glass. . The initial expense is greater, but the saving of time and the superiority of result more than compensate for this expen- diture. The length of time necessary to sterilize milk depends upon its age, and varies with the apparatus that is used. The time, as STERILIZED MILK 91 given by various experimenters, runs from thirty minutes to three hours. It is wise in the beginning of the work for a mother to set aside one bottle every day to test the efficiency of the process. The test bottle should be placed in a room whose tempera- ture is from 40° to 70° Fahrenheit. If the milk turns within forty- eight hours, the steaming is insufficient. If the milk remains good for from two to three days, it is safe to feed to the child. Milk sterilized at home, if it will keep longer than this, has usually been over-heated, and thereby so much changed in composition as to lose some of its value as food. In diluting sterilized milk, one should al- ways use water that has been boiled ; for or- dinary drinking-water is one of the most favorable elements for the propagation of bacteria, and may any time add again to the milk just those germs which we have been at such pains to eliminate. CHAPTER X FROM INFANCY TO CHILDHOOD After a child is a year old the measures to be adopted for the prevention of disease and the preservation of uniformly good health can no longer be given in such simple and uni- versal rules. A young infant is an unreason- ing animal, and with it the physical condi- tions alone need to be considered. Its food is simple and simply administered; and be- yond the general desire for physical comfort and satisfaction, it expresses no preferences and conveys no criticism of our methods. But after it is a year old a child begins the differentiation towards a more complicated existence. After that age a child is no longer simply an animated stomach. It has already found its hands, and learned that FKOM INFANCY TO CHILDHOOD 93 they can clutch and grasp ; it has discovered its feet, and is fast learning the art of loco- motion ; it has become an apt pupil in the lesson of language, that instrument of all intellectual progress. It has formulated the ego ; and after the knowledge that " I am " is once defined it soon conceives the second lesson of "I want." Within a short time the "I want" is followed b}^ an ''I ought," and with this last conception the triple de- velopment of the ph^^sical, mental, and moral natures progresses. Kor in any considera- tion of childhood, from whatever standpoint, can these three simultaneous and interde- pendent lines of development be separately considered. If we discuss intellectual educa- tion, we find its success ever dependent upon the physical condition, and incapable of the highest attainment except in the presence of a normal moral sense. If we consider moral development, we find it inextricably complicated with that of the intellectual and physical natures. 94 INFANCY AND CHILDHOOD So in considering, as we at present aim to do, tiie measures that must be taken during childhood for the preservation of the best health and the practical elimination of in- fantile diseases, we find it impossible to consider the physical alone, but, even at the risk of seeming superficial, must touch, at least in many points, upon the mental and moral training of the child. Its phj^sical health is always dependent upon proper mental and moral training. Every physi- cian, for instance, encounters in his practice among children cases of illness whicli ter- minate fatally simply because the child is so wilful and undisciplined that his struggles against the prescribed and necessary course of treatment turn to the fatal issue the evenly balanced scales in which are weighed the alternatives of life and death. So the chronic habit of disobedience or deceit on the part of the child may neutralize the par- ents' best efforts for its physical improve- ment. And fretfulness, generally a result of FKOM INFANCY TO CHILDHOOD 95 disease, is not infreqnentl}^, when it becomes a fixed habit, also one of the causes of ill- ness, or at least of chronic ill heath. Any discussion, therefore, which deals solely with the physical precautions for the prevention of disease must be absolutely inadequate. To obtain the desired result it is necessary to touch upon mental education and moral training, at least as far as they are involved in home discipline and home amusements. It is also important that parents who would comprehend and enforce the necessary measures for the preservation of their chil- dren's health should be famihar with the standard scientific authorities, which form the basis for any valuable educational dis- cussion. Every mother who aims intelli- gently to train her child should be familiar with those works of Spencer, Preyer, Perez, and Froebel which treat of child nature and child needs. Without some such prelimi- narv reading, it is difficult for a mother Intel- 96 INFANCY AND CHILDHOOD ligentl}^ to follow any rules that may be laid down. Every child must, in many points, prove itself an exception to the general rule by failing to conform to the average stand- ard ; and in order to appreciate to what de- gree this divergency is vital, and in what sense it is unimportant, one needs to compre- hend what the average standard really is, and to be familiar with the scientific laws underlying any special rules for education. If a more perfect knowledge is desired, and if the parent would be competent to make rather than to follow rules, to go back to the first principles underlying all development either of individual or of race, this knowl- edge can be obtained in no way so well as by a general study of the fundamental the- ory of evolution. It is well understood among scientists, and now generally accepted by all intelhgent peoj)le, that a child closely approximates, in many of its attributes, to the lower animals. Children are neither angels spoiled in the FKOM INFANCY TO CHILDHOOD 97 making nor are they to be counted as illus- trations of natural depravity. The}^ are at first simply animals of a lower order in the scale of development, in whom the mental and moral qualities are nascent, and of whose present needs and future possibilities ^ve can obtain no adequate conception ex- cept by an intelligent study of the lower species which they resemble. Each individ- ual child follows step by step, in its personal growth, the path by which the race has pro- gressed to its higher destin}^ It begins life, prenatally, as an aquatic animal. Its first attempts at locomotion are, like those of its brute ancestors, made on all-fours, while it possesses naturally, during the first year of life, prehensile powers greater than it can ever afterwards attain without the training of an athlete, and equalled only by those of its cousin, the ape. The value of a knowledge of evolution in its relation to the education of a child is too many sided to receive here more than a pass- 98 INFANCY AND CHILDHOOD ing comment. But as it is, in at least one of its phases, the foundation upon which we must build our educational work, that phase, if no other, should command our careful consideration ; for the history of evolution alone can indicate which traits of a child's nature are permanently and increasingly dangerous, and which are only temporarily disagreeable. It is of vital importance that we should withhold our discipline, and be- come, if possible, blind and deaf to those natural, transient, and universal faults of childhood which, the theory of development indicates, will cure themselves. Of no less importance is it that we reserve our atten- tion and influence for those errors which grow with maturity, and that we stamp out with, unremitting energy any serious and permanently evil habits in their very in- ception. But until the parent is able him- self to distinguish a fault from a sin, a na- tural, healthy impulse from a depraved ten- dency, it is not possible that he can give FROM INFANCY TO CHILDHOOD V\) any vital assistance to the child he aspires to train. To illustrate : All children are noisy. I^oise is the natural expression of natural animal vigor, and is necessary to the healthful devel- opment of all young creatures. Therefore, while a noisy child must occasionally be re- strained, it should never be punished, nor should mere harmless noise be made to seem to the child a thing to demand reproof. More- over, we should even encourage this natural, healthful tendency by providing a time and place in which its indulgence may be unre- strained. Unfortunately, to most children noise is made to appear the unpardonable sin, than which no error of the most serious moral nature is more constantly reproved. Even those childish faults which seem to the mature mind to involve a serious moral question are seen, wdien judged by the com- parative standard of evolution, to be likewise temporary and unimportant. For instance, untruth does not, in a little child, usually in- 100 INFANCY AND CHILDHOOD dicate any moral obliquity. It either arises from the purely animal instinct of conceal- ment, or it is a result of inaccuracy of obser- vation or the outgrowth of an over- vivid im- agination. From whichever of these causes it orignates, untruth has a tendency to cure itself with the development of the intellec- tual powers, unless the direct heredity bias towards it is exceptionally strong. In any case, punishment for falsehood is of doubtful wisdom. It often gives a child who was be- fore simply imaginative its first clear-cut idea of what falsehood really is, and leads a child' naturally deceptive to cultivate more subtle forms of untruth. It is quite possible, and usually easy, to teach a child absolute truth- fulness by leading it kindly and gradually to distinguish between reality and the crea- tions of its own imagination. If, in addition to this, the young find unvarying truthful- ness in the older people about them, if they understand that their parents regard as sacred every promise made to them, then FROM INFANCY TO CHILDHOOD 101 their animal imitativ^eness will be the strong- est aid in cultivating the same quality of truth in them. Cruelty, selfishness, destructiveness, and violent physical manifestations of bad tem- per are among the evil tendencies which are strongest in childhood, and which have a natural tendency to correct themselves with increasing maturity. The majority of the faults of childhood, indeed, result from this predominance of the simple animal instincts; and if judiciously 'ignored or mildly corrected, will drop away, to be replaced by more desirable qualities, as quietly and inevitably as the petals of tlie fruit-blossom drift to earth wlien the heart of the flower forms the young fruit. CHAPTER XI NOEMAL OBLIQUITIES Out of consideration for the peace and comfort of the remainder of the family, it is often necessary to correct and sometimes to chastise the child for undue indulgence in even natural traits. But punishment should be tempered by the comprehension that sav- age instincts are, to a greater or less degree, normal in all children, and that they will of themselves constantly diminish in strength. It is also important to remember that the attributes which are most disagreeable in childhood are really the most valuable in maturity. The noisy, incessant activity of the child develops into the energy of the man. Destructiveness in the young is the elementary manifestation of the investiga- normjvl obliquities 103 tor's spirit. Troublesome obstinacy grows into perseverance ; and over - strong will- power, which often thwarts the parents' best efforts for the child's discipline, becomes, when properly trained, a most desirable quality in maturer years. Intentionally to diminish a child's power of resistance, his persistence, or the force of his will-power, is deliberately to rob him of the best capital he can ever possess. We may and must judi- ciously limit the exercise of these powers in order to make life with a strong-willed child endurable ; but the discipline is of temporary value only, and should be counted merely a convenience for ourselves. It can have no permanently valuable effect upon the child's future, except in so far as we convince his intellect, and demonstrate to his satisfaction the value of self-discipline. Among the traits which are not natural to childhood, which will, unless promptly elim- inated, increase rather than diminish with 104 INFANCY AND CHILDHOOD advancing maturity, are those arising from a too intense self-conscionsness — a trait which is foreign to healthy animal existence, and is one of the penalties we pay for our civil- ization. Among its manifestations we may note that of excessive bashfulness, or its counterpart, offensive boldness ; an eagerness for attention and commendation ; the demand for continual amusement or over-excitement ; and a chronic discontent or persistent f retf ul- ness. All these traits indicate an over-stimu- lation of the nervous system, and a preco- cious concentration of the childish mind upon itself. While disagreeable in the child, they are increasingly offensive in the man, and are always antagonistic to the highest per- sonal development. They should, therefore, at their first manifestation, receive the par- ents' most careful attention, and no pains should be spared to prevent their continued growth. There are also certain demonstrations of temper which are decidedly and increasingly NORMAL OBLIQUITIES 105 dangerous. The sudden, short-lived temper of the baby, with its natural animal protest against that which is displeasing, is, as we have said, transient and in no aspect serious. But the temper which manifests itself later, which is brooding, or sullen, or malicious and lasting, should at its very first demonstration be counted as a danger signal, indicating the necessity for immediate and constant re- pression. A strong analogy exists between the growth of the body and the development of the mental and moral natures. If the body is properly fed, it will seldom indicate any condition of disease ; and if a child is pro- vided with healthy, rational occupation, ab- normal conditions of mind and heart will rarely be indicated. "We are only now learn- ing the elements of the science of dietetics for children, and outside the kindergarten little or no attention has been paid to the occupations of children, which should in like 106 INFANCY AND CHILDHOOD degree keep the higher side of their natures in normal condition. A better understand- ing of the proper occupations which Avould help to maintain a child in a condition of sound mental and physical health must come through a better knowledge of what has been counted as abstract science. Only by the comparative methods of evolution can we understand and guide the development of a child's nature. Evolution, as it teaches of heredity and environment, of growth and decay, of indi- vidual and race progress, must, as we have indicated, guide the coming generation of parents into that wider, wiser knowledge which is the foundation of all effort tow- ards a more rational system of education. Each parent has his separate and individual work to accomplish in studying the heredity of his own children, and in anticipating and preventing the manifestations of recognized ancestral weaknesses. Variation is the universally recognized NORMAL OBLIQUITIES 107 condition of all living creatures, human and brute. It has ever been one of the prime factors in the development of the race, and is as purely scientific and impersonal as Kepler's laws of the motion of the planets. In discussing heredity, therefore, the phy- sician, recognizing the universality of the law of variation, simply seeks to ascertain what particular variation or combination of variations was peculiar to the immediate an- cestors of the child under consideration, who is their natural and inevitable exponent. No child is the child of its father and mother alone. It is the grandchild of four ances- tors, the great-grandchild of eight, and the great-great-grandchild of sixteen. It may revert to the individual idiosyncrasy of any one of these thirty ancestors, or even go further back and be most like some one of the multiplying numbers still more remotely removed. The responsibility for a child's deficiencies may not rest with either one of the two parents, and the remedy for these 108 INFANCY AND CHILDHOOD defects, which is in their hands, can only be found after careful consideration of the individual variations manifested in the an- cestors. We cannot prevent disease in childhood unless we know by this study of heredity what form of disease is most likely to attack the child, and therefore what part of the system requires special reinforcement. And before the best results can be attained, the w^ord and the idea of heredity must become as essential and as inoffensive to the parent as they now seem to the physician. The word heredity, for some inexplicable reason, is at present a proscribed one in al- most every doctor's vocabular}^ Physicians of the better class make a study of the indi- vidual heredity the basis of their diagnosis and prognosis in ever}^ case they are called upon to treat, but they often put the interrogations by which they obtain from the family of the patient the necessary data for a working the- ory without any direct mention of the word NOKMAL OBLIQUITIES 109 heredity, or any detailed explanation of its importance as bearing upon the case under treatment. Most of these men have learned from painful experience that the word hered- ity, to them of universal and therefore imper- sonal importance, conveys to the mind of the less scientific patient some ill-defined insinu- ation of physical taint or moral weakness. Until a clearer, cleaner idea of the impor- tance of evolution and its bearing on heredity is popularly prevalent, the parent cannot be- come an intelligent second to the physician's effort to improve the condition of the child. CHAPTER XII VALUE OF MILK AS FOOD As has been noted, the individual peculi- arities of children, which begin to manifest themselves as early as the second year of life, act as obstructions to any set of fixed rules for the management of their daily life. Uniformity of management is usually possi- ble with all healthy children under a year old, but after that period modifications must constantly be introduced, in order to shape these rules to the peculiar necessities of the child under consideration. As the child is no longer an uncomplicated being, the daily routine cannot be as simple or as rigidly ad- hered to as heretofore. First, modifications in feeding become nec- essary, tending to\yards greater variety, in VALUE OF MILK AS FOOD 111 which the preference of the child becomes an element of success. A child's wishes must not, however, be allowed to play too promi- nent a part in the selection of food. Certain definite principles of diet must be adopted and adhered to as the foundation for healthy- growth, and while the child's preference may to a degree modify them, it should not, as is too often the case, be permitted completely to overturn any rational system. It is universally recognized as a fact that the majority of people, both children and adults, eat too much food and demand too great a variety. Milk is the natural food of all young animals, and should, w^ith water, be the only article fed to the average child under a year old, and ought to be the prin- cipal diet of all children up to at least six years of age. The use of milk is sometimes too early abandoned under the plea that the child dislikes it. No young animal naturally dislikes milk. It is the normal and universal food of all 3'oung mammalia, and if it is re- 112 INFANCY AND CHILDHOOD pugnant to an}^ particular child, it must be because in that child has been cultivated an appetite for less wholesome articles of food — usually for meat. Milk might with advantage be used, to a much greater extent than is now usual, through all the period of rapid physical growth up to the time of maturit}^ Its im- portance as food for persons of nervous tem- perament of all ages is only now beginning to be understood. The difficulty of obtain- ing pure, fresh milk, at least in the centres of population, has limited its use and con- firmed many in the conviction that milk does not agree with them — a mistake w4iich has been fraught with serious results. The indulgence in an undue amount of meat, known to be injurious to the adult, is with the child absolutely fatal to any good re- sults. The American idea that meat three times a da}^ is necessary for the sustenance of life is positively disproved by facts, while the excessive restlessness and nervousness of VALUE OF MILK AS FOOD 113 the American people indicates clearly the penalty they pay for this error of judgment. Whole races of vigorous, healthy people have lived and worked and accomplished great things almost or entirely without meat, and in nearly every instance of the kind investi- gation proves that milk was the article sub- stituted for meat. We hear much of the oatmeal of the Scotchman. Dr. Johnson, indeed, defined oats as an article fed in Scotland to men and in England to horses, whereupon some one re- plied, " But where can you find such men or such horses?" But it is certain that an ex- clusive diet of oatmeal could never have in- duced such bone and sinew and brain as the Scotchmen boast of, unless it was taken al- ways with a liberal allow^ance of milk. In the Oriental countries where meat is proscribed by religious principles, rice or some other grain is commonly given as the staple food of the country. But it is neces- sary to remember that these people, like 114 INFANCY AND CHILDHOOD the Scotchmen, usually take their grain with milk. These Oriental people have attained not only good physical development, but have demonstrated such intellectual power and subtlety that in their eyes we of the Anglo - Saxon race appear as crude barba- rians. We need not go so far for illustrations of the virtue of milk as an article of diet. The medical profession of England and America recognize the easy digestibility, rapid assim- ilation, and non-exciting effects of milk by prescribing it almost universally as the sole diet in severe cases of fever or nervous pros- tration. In our medical journals are cited in detail, from the best authorities, instances of children who when upon a meat diet displayed violent or vicious tendencies, but when changed to a diet of milk passed rap- idly into such a gentle, non-irritable condi- tion that they seemed to have been born again. Every physician encounters deplorable VALUE OF MILK AS FOOD 115 cases of children three and four years old whose diet consists almost exclusively of meat, simply because their perverted appe- tites demand that article. In such extreme instances the most severe measures are justi- fiable in order to resume the natural and healthful method of feeding, to save the child's health if not its ver}^ life. We should permit it to become genuinely hungry by withholding all meat, or even all food, until it will consent to recommence taking milk. We ma}^ aid the child to overcome any tem- porary repugnance to milk by making it as palatable as possible. It may be aerated in a milk-shake, beaten in a cream- whip- per, flavored by 03^ster juice and renamed *' oyster soup," seasoned with any harmless essence, or made warmer or cooler, as the child may prefer. But milk it should have in some form, or be allowed no food at all. Variety is desirable, and even necessary, in the diet of all children ; but in seeking variety w^e should never lose sight of the 116 INFANCY AND CHILDHOOD main principle — that milk should be the chief and frequent article of diet, and meat, if not wholly excluded, admitted onl}'- as an occasional and non-essential part in the diet of any child under six 3'ears of age. Many children reach that age in superb health and with fine physical development without having known the taste of meat. The little one will naturally tire of milli if he is always given plain milk, milk, milk, without any change. But milk with oatmeal, milk with hominy, milk with cracked wheat, with cracked corn, Avith rice, with baked apples, seem in infantile judgment quite different dishes. There are also the various cream soups, made up without butter or seasoning beyond the natural pinch of salt. This also we may vary with a number of articles not taken with milk, but served in a different course, or offered as a separate meal. In a rational and healthful dietary for a child may be included those fruits and ber- VALUE OF MILK AS FOOD 117 ries that are not seedy or of too coarse a grain, such as peaches, sweet apples, straw- berries, oranges, and dates. People frequent- ly declare that their children, who are al- lowed to eat large quantities of the decid- edly injurious meat, cannot take the really wholesome, desirable fruit. But we may be assured that the child to whom fruit is injuri- ous has had his digestive organs brought into an unnatural condition by unw^holesome diet. It rarely happens that a healthy child cannot be educated to enjoy and digest a large quan- tity of fruit. One especially vigorous baby three years old took regularly a large saucer of stewed prunes after breakfast, an orange after dinner, baked apples after supper, and a fruit luncheon of raw apples and dates half way between meals, not only without injury, but with positively demonstrated advantage. As for the young child's dislikes in the matter of food, they are, of course, only the outgrowth of errors of judgment on the part of the parents. If a child has never tasted 118 INFANCY AND CHILDHOOD meat, or candy, or cake, or pie, he naturally can neither desire nor demand these undesir- able articles. If he has always had milk as his chief diet, it will be impossible for him to dislike it or refuse to take it, unless the milk fed to him has been at some time tainted or acid, and so has given him a temporary re- pugnance to its use. The milk that takes the place of meat must not, however, be thin in fats. It should show in the lactometer — a simply graded test-tube, easily procurable at any druggist's — at least twenty per cent, of cream. If milk of this qualit}^ is not obtainable, cream must be added to bring it up to this proportion. It is also of advantage to have the milk steril- ized before it is fed to the child, since this process not only guards the child, as it does the infant, against the danger of contagious diseases, but averts the danger of irritation in the intestines, and prevents all the various forms of stomach and bowel trouble which so frequently result from the use of raw milk. CHAPTER XIII CONTAGIOUS DISEASES The average parent is too apt to consider the milder contagious diseases of childhood simply as inconveniences, of only temporary detriment to their victim. But we must recognize the scientific fact that no disease ever leaves the physical system absolutely unimpaired. To this we must add the fact that with healthy children growth is con- stant, and that the arresting of that growth by any disease really diminishes, to just such a degree as it extends, the ultimate size and vigor of the child who suffers from the ill- ness. Contagious diseases, however harm- less they may seem, should never be know- ingly incurred ; for even their least injurious results are unknown quantities militating 120 INFANCY AND CHILDHOOD against the development of the child, while there is always risk of more serious manifes- tations whose evil consequences may extend through the whole life of the child, and seri- ously impair both its usefulness and happi- ness. Therefore it is only our plain duty to guard against contagious disease as long and as far as may be. This is now possible to an extent never before conceived of. We at present understand, to a degree at least, the nature of contagious diseases, and out of this knowledge we gain power to avoid or to abort the disease. After the determination of the germ ori- gin of contagious diseases, special experi- ments were instituted among bacteriologists to isolate the germ of each disease known or suspected to be contagious ; and as the mi- croscope revealed the fact that more diseases than had previously been suspected were of germ origin, and were contagious, a reclassi- fication of diseases was based upon this dis- covery. The most important item of the CONTAGIOUS DISEASES 121 reclassification was the removal of tubercu- losis, or consumption, from the non-conta- gious to the contagious list, since that dis- ease now claims more victims and causes a larger number of deaths than any other known. The most important result of all this re- cent bacteriological investigation has been the knowledge that contagious diseases are not incurred unless two conditions simulta- neously favor their inception. We must come in contact with the specific seed of any par- ticular disease, and we must furnish within the body, under conditions favoring its activ- ity, the proper soil for the propagation of the germ, or no contagion ensues. That is, we must have direct exposure to the disease germ, coinciding with such a debilitated condition of the system as shall render it susceptible to in- fection. Exposure to disease will not result in contagion if the sj^stem be in prime condi- tion ; nor will impaired physical vitality lead to the contraction of contao^ious disease ex- 122 INFANCY AND CHILDHOOD cept with direct exposure. Therefore it fol- lows that if with rational vigilance we guard against both these enemies, of which we are seldom forced to encounter more than one at a time, we shall safely resist any ordinary danger of contagious disease. With children the usual method leaves not only a loop-hole, but actually a large breach for the entrance of any chance infection. While adults are almost without exception offered only food that has been cooked, in which the germ life is therefore destroyed, many babies are fed entirely upon food which is literally swarming with microbes, any meal of which may contain germs of contagious disease and certainly will contain bacteria that will at least produce such irri- tation in the digestive tract as to induce a decided lowering of the vitality, thus making the child's system peculiarly susceptible to any contagion. Every drop of milk or water fed to a baby, and all the food given to a child, should be boiled or sterilized ; and CONTAGIOUS DISEASES 123 each child should be maintained in the best possible general health, not only for his present comfort, but also for his future pro- tection against infection. To determine just when a child is or is not in average good health is beyond the power of unprofessional skill, but periodic physical examinations by a competent physician will detect even slight departures from normal condition. When it is comprehended that such systematic examinations are both less trouble and less expense than the diseases which are thus anticipated and prevented, more of our children will be allowed the benefit of such preventive treatment. We have our valuable cows and our imported sheep frequently inspected ; even our trees and vines are yearly pruned and trained ; but our children rarely receive any scientific at- tention at all until the active presence of acute disease has impaired their health and threatened even their lives. The most conspicuous phenomenon of child- 124 INFANCY AND CHILDHOOD hood is growth. The lives of all living creat- ures are rhythmic alternations of growth and decay. In childhood growth predominates ; in old age decay is gaining the ascendency. 'Now the physical growth of the child is de- pendent upon the appropriation by its body of the proper material from outside itself, and is limited by the ability or fitness of the body properly to assimilate these materials. The elements absorbed by the system are taken as food into the digestive organs or as air into the lungs. Presupposing a supply of pure air and an adequate provision of nourishing food, such as has been suggest- ed in another chapter, the body's ability to utilize these materials marks its degree of health and its capacity for growth. To utilize to the best advantage these outside materials, food and air, two sets of functions, assimilation and elimination, must properly balance each other. Of all the mat- ter taken into the body through the lungs and stomach, a large proportion of it is CONTAGIOUS DISEASES 125 quickly eliminated ; much of it is given off through the skin and lungs in the form of moisture and gas, and part passes through the excretory system. But after maturity the amount of matter daily eliminated is necessarily quite equal to that directly ap- propriated, though not of course the same material, in the same period of time, since the extra amount appropriated in childhood for purposes of growth is no longer needed by the adult. A certain proportion, which has previously been assimilated, and has be- come an essential part of the physical frame, is later thrown off as effete matter, to give place to newer, fresher atoms, slowly but constantly forming out of the extraneous material regularly consumed by the body. Eating, breathing, and sleeping help the body in its reparatory process. Exercise and bath- ing assist in the equally essential process of destruction and elimination. A mother may, unaided, decide upon the quality of the material furnished to the 126 INFANCY AND CHILDHOOD body of the child. She may be entirely competent to judge of the relative values of the food and air which her children receive, but medical skill alone can determine if this material is properly appropriated by the various organs of the body. Malnutrition, which usually precedes and inevitably invites disease, is frequently unsuspected until act- ual acute illness demonstrates its existence. Diminished respiratory power likewise pre- cedes, sometimes for years, any recognized manifestation of chronic lung-trouble. The degree to which the respiratory power of the individual child varies from the normal cannot be measured except by professional skill; but a physican can, in ninety -nine cases out of one hundred, select by physical examination, months or even years before the manifestation of any active lung-trouble, the people who are most likely to be at- tacked by pulmonary disease. With children to be forewarned is to be forearmed. With them any temporary trouble easily develops CONTAGIOUS DISEASES 127 into chronic disease, while, on the other hand, they are happily more responsive to the pre- ventive treatment that would follow any first unsatisfactory indications. CHAPTER XIV VAEIATION OF KULES V During the second year of life a child is usually disposed to shorten its day naps. Two naps gradually give way to one, and even that one is, with increasing years, in- creasingly difficult to maintain. The care- ful tactics that will induce sleep in that com- fortable animal, a well-nourished baby, no longer suffice with an older child, who often persistently resists the inclination to sleep. It is the children of nervous temperament, who really need the greatest amount of rest, with whom it is most difficult to continue the daily naps after the second and third years. The incessant physical and mental activity of the growing child puts great strain on all its powers — such strain as even the most en- VARIATION OF KULE 129 ergetic adult would be incapable of endur- ing. If this activity is continued unbroken for the twelve or fourteen hours of a child's day, it cannot but become a terrible drain upon the constitution of even the most vig- orous child. The maintenance of regularity in day naps with all children under six years of age is, therefore, important enough to merit especial effort. The best rule at which to aim is of course to follow tlie practice of the first year, and at the regular time for sleep, either by day or night, to place the child awake in its bed, make it thoroughly comfortable, darken the room, and leave it to fall asleep by itself. But as the rule is less important than the object for which it was made, if we cannot by strictly adhering to it accomplisii our purpose, we must then adopt such modifica- tions as appear necessary to induce the child to sleep. An active child cannot be snatched from the floor and, after the brief interval required for the process of undress- 180 INFANCY AND CHILDHOOD ing, summarily deposited in its bed with any certainty that it will not continue its play from that point of vantage with as great hilarity as ever. Left to itself, the child be- comes every minute more wide awake, more nervously active, and less in condition for a restful night's sleep ; whereas if it is rubbed or bathed, and taken into the arms for a quiet story or soothing lullaby, it may after- wards be deposited in bed, if not asleep, at least so quieted and drowsy that sleep in- evitably results within a few minutes. If a child who requires an hour to fall asleep by itself will drop off in five minutes if rocked or sung to, it is manifestly better that the mother should lose her five minutes of time and the child gain its extra hour of sleep. It should always, however, be remembered that such aids to sleep are exceptions to or modifications of the ideal system, and are made to meet the personal idiosyncrasies of the individual child. In their adoption we must not lose sight of the general rule that VARIATION OF KULE 131 it is far better for the average child to fall asleep by itself, in the quiet darkness of its own room. A continuation of the regular habit of perfect rest once during the day, even, where sleep cannot be induced, a half-hour of ab- solute relaxation of the muscles and rest for the eye, ear, and tongue, is of the greatest advantage. To this habit man}^ older peo- ple undoubtedly owe the blessing of vigor- ous health coexisting with the power of con- tinued and exhaustin