BETTER BABIES
AND THEIR CARE

BETTER BABIES
AND THEIR CARE

BY
ANNA STEESE RICHARDSON
NATIONAL CHAIRMAN OF THE DEPARTMENT OF HYGIENE, CONGRESS OF
MOTHERS AND PARENT-TEACHER ASSOCIATIONS

NEW YORK
FREDERICK A. STOKES COMPANY
PUBLISHERS

Copyright, 1914, by
Frederick A. Stokes Company

All rights reserved, including that of translation into
foreign languages
SECOND PRINTING

TO
THE ONE HUNDRED THOUSAND BABIES
THE ONE HUNDRED THOUSAND MOTHERS
THE ONE HUNDRED THOUSAND HELPERS
WHO HAVE TAKEN PART IN BETTER BABIES CONTESTS
THIS BOOK IS DEDICATED
BY A MOTHER WHO KNOWS WHAT
BETTER BABIES, BETTER MOTHERS, BETTER HELPERS
MEAN TO THIS AND FUTURE GENERATIONS

PREFACE

It was in January, 1913, that the Woman’s Home Companion sent Anna Steese Richardson to Denver, Colorado, to report a Baby Health Contest held in connection with the National Western Live Stock Exposition. There she found babies being examined for physical and mental development, and scored for points by standards of weights and measurements very much as live stock is scored at agricultural fairs.

Mrs. Richardson’s journalistic instinct told her that here was a big constructive work, at its very beginning, and that its spectacular possibilities would make attractive “copy” for a magazine. But before she left Denver for New York she had begun to think of something much bigger and more important than what the babies could do for the magazine, and that was what the magazine could do for the cause of better babies.

As a result of this trip, the Woman’s Home Companion adopted as its own special charge the work now known all over the world as the Better Babies campaign. This has quickly become a widespread movement for education in parenthood. Pride of parenthood brings fathers and mothers to the Better Babies Contests. Parental love holds them there to watch their babies examined by physicians and to learn how the condition of their children can be improved by intelligent care and feeding and sanitary environment.

The results are so far-reaching that one hesitates to put them into words, for fear they may seem overstated. After a little more than one year of hard work, the Better Babies Bureau of the Woman’s Home Companion, under the directorship of Anna Steese Richardson, has become a tremendous machine for aiding in the reduction of infant mortality, and for raising physical, mental, and moral standards among children.

Naturally, the starting-point for much of this work has been the fair—state, county, and local. These widely advertised contests have been a sort of blare of trumpets to attract attention. But above and beyond this element has been the quiet and persistent growth of the work among board-of-health officers, medical societies, club women, church organizations, physicians, nurses—in fact, among all bodies of men and women especially interested in child welfare. The fostering and furthering of this work, which has progressed beyond all expectations, has been Mrs. Richardson’s chief joy and pride during a year of almost unbelievable endeavor.

The author of this book is a keenly interested and intelligent observer. While she has gathered into the book much that is of real scientific value, contributed by physicians, nurses, psychologists, and social workers, still the chief usefulness of the volume, it seems to me, lies in the fact that it is a message from one mother to other mothers, and is written in the language that all mothers can understand.

The woman who writes it has had not only the actual experience of bearing and rearing her own children, but she has had the rare privilege of corresponding with mothers from every point in the United States, of witnessing many of the Better Babies Contests, and of studying not only what is the matter with the sick baby, but why the well baby is well.

Gertrude B. Lane
Editor, Woman’s Home Companion.

March 26th, 1914.

CONTENTS

BETTER BABIES
AND THEIR CARE

BETTER BABIES AND
THEIR CARE

CHAPTER I
PREPARATION FOR MOTHERHOOD

MOTHERHOOD A PROFESSION WHICH REQUIRES TRAINING—PRENATAL INFLUENCE AND HYGIENE—MATERNITY CLOTHES

Maternity is woman’s exclusive profession, the only one of which progress and science cannot rob her. It is also her highest profession, for, compared to motherhood, art and science dwindle into insignificance.

Successful motherhood, like genius in any art or profession, is founded on efficiency and joy in the chosen work, and the greater of these is joy. She who is merely efficient can reduce the mountains which rise in the pathway of the mother; joy in motherhood can remove them. For joy casts out doubt, fear, and all sense of burden. The woman who finds joy in maternity is absolute mistress of the domestic and social situation. Through it she commands the love and reverence of the husband to whose eyes she has opened the wonders and the mysteries of parenthood. For her the doors of the divorce court never yawn. For her motherhood entails no sacrifice. She has no regrets for a career cut short by marriage, because she finds in maternity the same supreme satisfaction of accomplishment which comes to the successful lawyer, financier, writer or artist.

Motherhood, like any other profession, requires preparation. For many generations the world has held that the maternal instinct and the ability to rear children were born in woman. It has been discovered that the maternal instinct, like many others, needs encouragement, while the ability to bring up children requires development or practical training. The phrase, “a born mother,” has rather fallen into disrepute. We are beginning to realize that one “born mother” in a thousand is not enough to leaven the maternal mass. And out of this discovery has risen a demand, which comes largely from women themselves, for education in motherhood, practical, sincere preparation for woman’s exclusive profession.

Perhaps the day will come when each college for women will have its endowed chair of motherhood, when the care and feeding of infants will be taught in our normal and high schools for girls. At present, certain colleges offer a course in psychology which prepares young women to guide, mentally and spiritually, the children they will some day bear. In a few city schools, particularly in the congested districts, girls are now taught how to bathe, dress and feed infants, largely for the purpose of having the message of sanitation and hygiene carried home to the tenement house mother.

Until these two forms of training for motherhood are combined, the American girl must enter the profession of maternity without the sort of practical preparation which will insure efficiency and joy in her chosen work. What knowledge she now possesses is a smattering of what her mother has learned by experience, what the family physician imparts at odd moments, what she reads in books or magazine articles, and what she hears at lectures where a few valiant souls proclaim motherhood as a profession which requires the most thorough of training.

Preparation for motherhood must rise above the practical instruction in the care and feeding of infants which leads to efficiency. It requires a certain mental and spiritual adjustment of the woman to the environment and conditions of maternity. She who is obsessed by the fear of physical suffering which motherhood may entail, who regards the coming of a child as the end of her individual career, her social life, her personal pleasures, will be neither efficient nor joyous. Fear and doubt come between her and success. They even threaten her health.

Therefore, the first step in preparation for motherhood is the firm belief that it is a privilege, not a duty; a joy, not a sacrifice; an investment that will pay big dividends. Thus armored, the prospective mother enters upon the nine months of pregnancy insured against anxiety and ill-health. The joy she finds in carrying her child provides a splendid foundation for the child’s health. The woman who frets brings forth a nervous child. The woman who rebels generally bears a morbid child.

Science wrangles over the rival importance of heredity and environment, but we women know what effects prenatal influence works in children. And, knowing this, what a mystery that we do not mold each thought and act in the interest of the children whose up-bringing will be our real life-work! How strange that mothers do not realize that the burden of maternal and domestic duties can be lightened by prenatal care and character molding.

Science has done much for the modern mother. It has lessened the danger and the pains of childbirth. The once dreaded child-bed fever is now practically unknown. Disinfectants and sanitary care have reduced this danger to a minimum. Anæsthetics have reduced the strain and pain of labor. Physicians no longer withhold the anæsthetic until the hour when instruments or an operation make its use necessary; through the later stages of ordinary labor, the modern physician offers the alleviation of chloroform, and the mother comes through the ordeal with one-fourth the pain endured by her mother and grandmother.

Modern ingenuity also designs many comforts for the prospective mother, not the least of which is maternity raiment, including corsets and adjustable gowns. Why do not women avail themselves of all these aids? Largely because they are not educated for motherhood.

Medical science, through sanitation and hygiene, has lightened the mother’s burden in rearing her baby. It has proved beyond doubt that the child raised under sanitary and hygienic conditions, fed, bathed and clothed properly and trained to regular habits, can escape most of the ailments which were once counted as almost normal manifestations of the child’s growth.

Many of us can recall the day when a colicky baby was considered a dispensation of Providence, not a proof of maternal ignorance or carelessness; when convulsions during teething were regarded as “natural”; when “summer complaint” was accepted as a normal feature of baby’s second summer; when children were actually exposed to whooping-cough, measles and chicken-pox, so they would have these juvenile ailments and be done with them!

To-day, unless a baby is born with some inherited weakness or chronic disease, science teaches how to protect the child from ordinary ailments—colic, convulsions, summer complaint, and contagious diseases. This is the day of preventive medicine, particularly in the care of infants. Prevention lightens the burden of motherhood. When young women are trained to ward off illness in children, not to nurse them through illness, motherhood will mean what it should mean to women—Joy.

Start your maternal career right by preparing your body and your mind for motherhood. Start your baby right in life by studying sanitation, hygiene, the care and feeding of infants. Know your business as a mother, and motherhood will have no terrors for you.

Remember that your own physical condition and the health of the baby you will bring into the world depend largely upon your mental attitude. Cast out all fear of childbirth and all dread of maternal duties and sacrifices. Fretting, grieving, or rebellion will not purchase immunity from maternal duties. Rather it will increase them. The child will be born and laid in your arms to be fed, cared for, and reared, whether you weep or smile through the months of pregnancy. Self-control, cheerfulness and love for the little life breathing in unison with your own will practically insure you a child of normal physique and nerves.

Physicians and scientists may regard stories of prenatal influence which float through open nursery doors as “old women’s tales”; but we women who have borne children know the price babies pay for maternal self-indulgence, mental abnormalities, bitterness, hysteria.

I recall one woman of my acquaintance whose self-consciousness amounted to an affliction. She was super-sensitive, self-effacing, apologetic, always afraid that she was not wanted. One day when speaking of her futile efforts to correct the tendency, she explained that she had been an unwelcome child. Her mother had rebelled throughout the period of pregnancy. She had nursed her child in bitterness of spirit. Later in life she learned to cling to her daughter for companionship as well as material care, but the girl never outgrew those unfortunate prenatal influences.

Another girl, sixth in the family, was carried and nursed by her mother through times of financial stress, when one more mouth to fill was a hardship. As soon as the child could toddle, she developed a passion for running away. She grew up absolutely devoid of family instinct, filial affection and womanly sense of responsibility. While very young, she eloped with her first suitor, rather than remain under the parental roof. She was never dishonest or immoral, but she was born hating her home and indifferent to her parents.

Still sadder is the case of a mother who gave way to hysteria and hideous paroxysms of anger throughout the period of pregnancy. Though physically sound herself and married to a man without taint, this woman brought into the world a child who never developed mentally beyond her second year. To-day this mother, now a self-supporting widow, never leaves the institute for feeble-minded children, where her daughter is safest and happiest, without the throbbing thought, “Why did no one warn me of what I was doing to my child?”

On the other hand, when maternity is accepted as a privilege, and love instead of bitterness reigns in the prospective mother’s heart, the babe is born tranquil, normal, healthy. Returning to the phrase, efficiency in motherhood, it is good business to bear normal children.

In this day, the woman who frets, rebels and weeps during pregnancy commands little sympathy and practical help from her husband and family. But there is something fine and inspiring about the woman who firmly, cheerfully demands for herself and the child she is carrying the best that domestic conditions and environment afford. She becomes an heroic figure, fulfilling her highest duty to society, and demanding just toll. Men bow to this attitude when they flee hysterics and turn deaf ears to angry complaints. And no woman should disregard the importance of moral support and sympathy on the part of her husband.

To guard her own health and that of the child, the expectant mother must give careful attention to three things: diet, rest, exercise.

Upon the diet will depend largely the proper nourishment of two lives instead of one. Each woman is a law unto herself in diet, and should make an earnest study of her food-needs and the effect of foods upon her digestive and nervous system. No cut-and-dried diet can be prescribed for the pregnant woman, because what agrees with one woman may disagree with another.

Generally speaking, however, the diet should include a large proportion of liquids, fresh fruits and vegetables, with a small proportion of meats and practically no rich or highly spiced desserts. Excesses of any sort should be avoided.

Liquid food is important because it encourages the system to throw off impurities through the bowels, kidneys and skin. From two to three quarts of liquid should be drunk daily, particularly cool, pure water. An excellent plan is to drink one glass at rising, two between breakfast and dinner, two more between dinner and supper, and one before retiring—six in all. Water should not be drunk with meals. Milk, cocoa, chocolate, clear broths and buttermilk are excellent beverages, but both tea and coffee should be taken sparingly, and alcoholic drinks should be avoided. Nothing will be gained by forcing yourself to drink any of these liquids if they nauseate you or fail to digest easily. If milk, the most important of beverages to the expectant mother, is palatable but causes constipation, laxative foods can be used to correct this tendency.

Meat should be eaten once a day. Poultry and lamb are given the preference by dietitians. Beef is better than veal; pork is difficult to digest under any condition; and meat stewed until tender in a milk or cream sauce is more easily digested than fried meat. Smoked meat is not particularly nourishing to mother or child, but crisp ham and bacon are useful in whetting a failing appetite. Fish, oysters, and eggs may be used to vary the diet, but they do not replace meat.

Fruits and vegetables should be eaten freely. Fresh fruits, including apples, peaches, pears, oranges, grapes, shredded pineapple, grape-fruit, plums, strawberries, raspberries, and huckleberries, should be used regularly in season. When they are not to be had, stewed fruits—apples, prunes, rhubarb, peaches, figs, etc.—may be substituted. When dried fruits are used, they must be soaked well and cooked thoroughly.

The most desirable vegetables are young onions, asparagus, peas, potatoes, lima and string beans, carrots, spinach, celery, lettuce and romaine. Heavier vegetables such as cabbage, cauliflower, baked beans, beets, turnips and radishes are not so easily digested and should be eaten sparingly.

Salads made with olive oil dressing are an important item in the diet of the prospective mother. Many dietitians urge that fresh salad be eaten at least once a day.

Particular attention must be paid to the effect of cooked and prepared cereals on the digestion. Some women do not digest the heavier cereals, like oatmeal, cracked wheat, cornmeal, while patent foods of a lighter nature agree with them. In this case, the mother who “hates cereals” will do well to try some of the light patented foods, with cream and sugar or fruit, and train herself gradually to enjoy a cereal course with at least one meal a day. The coarser breads, such as whole wheat, graham, cornmeal and bran, are recommended for prospective mothers who suffer from constipation, indigestion or heartburn.

The woman who feels an inordinate craving for certain articles of diet, such as pickles, lemons, candy, etc., should exercise judgment and self-control. Like any other habit, extremes in diet will grow upon a woman until they really endanger her health. Their indulgence will in no way lighten the burdens of pregnancy. Considerable acid is supplied in salads and fruits; and a limited amount of sweet pickle, catsups and other modern condiments may be taken with meals.

Custards, gelatines, sponge cake, light desserts made with fruit, and ice-cream are desirable sweets.

Rest and normal sleep, alternating with healthful exercise which does not exhaust the system, are vitally important to both mother and child. Eight hours’ sleep each night is a good average, and to insure normal sleep the prospective mother should be made as comfortable as possible.

I have known mothers who, at this time, suffered torture if they shared a bed or even a room with other members of their family, and yet they denied themselves the important privilege of privacy. The expectant mother should sleep in the environment and atmosphere most conducive to perfect rest. Her bedding should be light but warm in cold weather. The room should be properly ventilated, with the window open top and bottom. No gas jet or lamp should burn in this room during the night. In cold weather a very simple way to insure comfort and prompt dropping off to sleep is to lay a hot water bag, covered with flannel, between the sheets. The pregnant woman should never suffer from chill or dampness.

The mental attitude of the expectant mother just before retiring is an important factor in insuring sleep. Family disputes, even discussions on impersonal problems, should be avoided. The woman engaged in a wordy argument on religion, politics, or any social question may go to bed so excited that she will go over and over the discussion when, for the sake of herself and her unborn child, she should be sleeping.

Neither should she go to bed hungry. A glass of milk, warm if it can be taken that way, cocoa, broth or gruel is a sleep coaxer, but no tea, coffee, or any other stimulant should be drunk just before bedtime.

In addition to regular sleep at night, the prospective mother should have at least one nap during the day, at a time which will least interfere with her household duties. A mother who has borne six children, who has had little domestic help, and who yet retains her youthful look and energy, has often told me that she thinks her present condition due to the fact that while carrying and nursing her babies she never permitted herself to reach that stage of exhaustion where her nerves twitched, her voice shrilled, and she became irritable. She made it a practice to drop her work when these symptoms appeared, and to seek the sanctuary of a quiet room apart from her family, if only for ten or fifteen minutes. And, most important, from the very start she trained her household to respect her right thus to draw apart.

Exercise for the pregnant woman should mean more than muscular activity. It should represent change of scene and thought, relaxation and recreation. The best form of exercise is walking for walking’s sake. This does not mean shopping or walking a few blocks to the home of a friend and then sitting down for a half hour or more of gossip. It means going out into God’s fresh air with one’s eyes open to the beauties of nature or the human drama through which the walk leads. On the other hand, the woman who has led a sedentary life should not walk too violently at first. Let her start with a half hour’s walk each day and increase it gradually until she spends at least two hours outdoors daily.

The woman who lives in a small city, a suburb, a country town, or on a farm, is singularly fortunate, as she will find light gardening the very best form of exercise.

In the side yard of a charming home where I often visit there is a flower-bed for each child born into the family circle. One year the mother laid out, planted and coaxed to bloom a border of lilies-of-the-valley; at another time she started her violet bed; a third child is represented by a wonderful circle of tulips and the fourth by an arbor of rambler roses. I often wonder whether the fine, flower-like natures of the girls in this family cannot be traced to the mother’s tranquil work in the garden.

Raising chickens, ducks, or pigeons will also take the expectant mother outdoors and provide pleasant recreation.

The woman who, through her girlhood, has been keen for athletic sports, such as tennis, golf, skating, and motoring, must curb these forms of recreation. Fully ninety per cent. of the physicians with whom I have discussed the question condemn constant motoring for the expectant mother. To employ the automobile as a transportation convenience is one thing; to take long, tiring rides or tours is positively dangerous for the pregnant woman, as it invites miscarriage.

Household duties exercise the muscles and are invaluable if performed in properly ventilated rooms. Unfortunately, however, many prospective mothers sacrifice their own health and that of their unborn children on the altar of domestic neatness. During pregnancy a woman should simplify her household management, even if this step involves packing away bric-à-brac and rolling up rugs.

This is no time for a woman to be self-sacrificing, and yet it often amounts to an obsession with her. I have seen such mothers performing heavy household duties, which other members of their family would gladly have assumed. I have seen them strain muscles and eyesight to embroider or trim raiment for the older children, and I have seen them carefully select the choicest bits of food at table for husband or growing child, when the mother should have, for her own health and that of her unborn child, the very best which the family purse can afford. This spirit of martyrdom may give a certain amount of mental satisfaction to the woman who practises it, but it is harmful to the unborn child and is really a symptom of mental disturbance not to be encouraged.

The actual physical comfort of the mother means much to the child. If there is any time when a woman has the right to allow herself time to care for her body, money to purchase easy clothes and small personal luxuries, it is when she is carrying a child. Bathing is a luxury which many overworked home-makers deny themselves. The expectant mother should make time to take a daily bath. If there is a stationary tub in the house, this bath may be of the sort which is most comforting to her: a tepid bath before retiring or a cool bath on rising. When there are no bath and plumbing in the house, the mother should have a portable tub in her room, in which she can sponge off quickly with tepid water, followed by brisk rubbing with a Turkish towel. A warm bath with soap should be taken twice a week, but very hot or very cold baths must be avoided. Bathing is important because it keeps the pores of the skin open. It is estimated that at least a pint of waste matter is thrown off each twenty-four hours through open pores. There is danger for mother and child if this waste matter is permitted to clog the former’s system.

The mission of maternity clothing is to make the mother comfortable. For that reason experts are beginning to design raiment that is both comforting to the body and pleasing to the eye. The woman who has never worn flannels should not don them during pregnancy. They merely produce irritation which she should be spared. Union undergarments, with or without sleeves, come in cotton as well as wool, and are much better than the separate garments with bands. Particularly comforting are the maternity corsets, made largely of elastic. These have the side garters; no round leg garters should be worn. One-piece dresses with a drop skirt save the expectant mother another set of bands. All the clothing should be loose and easy, and it is well for the expectant mother to buy stockings, shoes and even gloves in a size larger than she ordinarily wears. Pressure on any part of the body affects the circulation and heart action of the pregnant woman. Patterns for maternity garments can be purchased at the agencies for all reliable pattern firms, and they deserve the consideration of the expectant mother who will suffer if she attempts to wear the clothing made for her use under ordinary conditions.

The teeth should be especially guarded during pregnancy. They should be examined at regular intervals by the family dentist, and small cavities promptly filled. Both physicians and dentists claim that the teeth are extremely susceptible to decay during pregnancy for two reasons: first, because the mother’s system is drained of the lime salts which go to build up the bones of the child; second, because, as pregnancy progresses, acids are often retained in the system, and these, together with slight indigestion, affect the teeth.

The breasts should be carefully watched, especially toward the end of pregnancy. The family physician should make an examination and see whether they require any special treatment. The nipples may be toughened by bathing them at bedtime and then covering them with lanolin and old linen or gauze. This prenatal care of the breasts and nipples may prevent great suffering immediately after the birth of the child.

“All this is very well,” exclaims a busy home-maker, “but to follow this régime I must rearrange our entire scheme of living.”

If this is true, then, indeed, motherhood will bring to that home a double blessing, for the life outlined in this chapter is a normal one, as good for the childless wife as for the expectant mother. And here is a case in point:

Among the prize-winning children at a Better Babies Contest on the Pacific Coast was a little boy, born of the type of woman commonly known as “delicate.” Throughout her girlhood she had been a semi-invalid. Her husband’s friends shook their heads when the engagement was announced. The first year of their married life was marked by frequent illnesses for the wife. When she learned that she was to become a mother, she was suddenly alarmed for the future of her child. She made an earnest study of how to reform her own life so that her child might be spared the ailments from which she suffered. She chose a normal, nourishing diet, and persisted in it. She gradually learned to take and enjoy outdoor exercise. She had a small porch converted into an outdoor sleeping-room. As a result—her labor was easy and natural, her child healthy, normal and good-tempered. Her own health was rehabilitated. She has never reverted to her former state of semi-invalidism.

CHAPTER II
BABY’S BIRTHDAY

CHOOSING THE NURSE AND DOCTOR—SANITARY BEDROOM AND ITS EQUIPMENT—THE BABY’S LAYETTE—PREVENTION OF BLINDNESS IN NEW-BORN BABIES—THE BABY’S FIRST BATH

The ushering of a new life into the world is an event so momentous and fraught with such wonderful possibilities for both mother and child that it should be planned with every possible precaution. No item of preparation, however trifling, should be left to the last moment. The mother should be able to find relief in the thought that all things are in readiness for the safety and comfort of herself and her child.

The doctor who will be in attendance should be chosen early in the period of pregnancy and consulted whenever the expectant mother feels any anxiety about herself. In this matter the wishes of the woman should be supreme, for her dread of confinement will be greatly lessened if she feels confidence in her physician. I have known women to become extremely nervous because, for reasons of expediency, they were forced to accept the services of a physician desired by husband or family. No one has a right to dictate in this matter to her who must pass through the ordeal of labor. If the woman prefers the family physician to the obstetrician recommended to her husband by friends, relatives, or neighbors, her wishes should be respected. Or if, on the other hand, she decides in favor of the obstetrician instead of the family doctor, there should be no interference. The faith which casts out fear, that indefinable sense of security which she feels in her chosen physician, supports her through the hours of confinement.

During the months of pregnancy the physician thus consulted will follow the changes in his patient and study particularly her nervous condition.

The nurse chosen should also be congenial to the expectant mother, who will depend upon her for assistance and comfort in the last trying hours before actual confinement. The engagement with the nurse should be so made as to insure her freedom to answer the call at least a week in advance. It is poor economy to let a nurse work on another case up to the last moment. Better to pay for a week of idleness and be in command of her services. To prevent misunderstanding, the date on which her pay is to begin, irrespective of the actual date of confinement, should be named definitely.

A few weeks before the date on which the confinement is expected the nurse should come to the house and make herself thoroughly familiar with the plan of the rooms, the water supply, closets, etc. There is nothing more trying for the expectant mother than to have a nurse arrive at the last moment, asking questions and locating needed articles, when she should be rendering service.

When the woman is confined in her own home, the nurse is engaged to remain at least two weeks after the baby is born, and three or four weeks, if the family purse will permit.

In cities the custom of going to a hospital for confinement is growing steadily. It is recognized that the hospital is cheaper, safer and more convenient. The sanitation is perfect, danger from infection is practically nil, and there are expert nurses and house physicians at hand should an emergency arise. It is cheaper because the hospital equipment is at the command of all patients; while, in the home, individual equipment must be bought outright. Moreover, if labor is normal, a special nurse is not required at the hospital, but the patient is cared for by the ward or corridor nurse.

There are women, however, for whom the hospital holds a terror which doctor, husband and friends cannot eradicate. Other women have a deep sentiment or home instinct. They do not want to be taken from the familiar environment of their family. When the question has been placed before the woman in every possible light, and she elects to remain at home, undue pressure should not be brought to bear upon her. The result to her nervous and mental condition may be quite serious.

The room in which the mother will be confined at home should be the most comfortable, cheerful, and the best ventilated room in the house. If there is any room which has an open fireplace, this should be selected, as it improves the ventilation and makes the room cheerful. Two sets of shades, light and dark, should be provided; but heavy hangings, upholstered furniture and dusty carpets should be removed. Small, clean rugs on the floor, and simple, light furniture, which can be easily moved about, are preferable.

A strong single or three-quarter bed is better than the double size, and it should be so placed that it can be reached from all sides by the nurse and doctor. If it is possible to rent a high iron bed, such as is used in hospitals, the work of the doctor and nurse will be lightened. If this cannot be done, a bed of ordinary height can be raised on four strong blocks of wood.

There should be an ample supply of old soft night-dresses, either open all the way down the front or, better still, open in the back and tied at the neck with tapes. For the mother’s convalescence there should be, especially in cold weather, dainty short negligées or dressing-sacques in softly tinted silk and wool, albatross, or outing flannel.

For the home confinement the following equipment should be purchased under the direction of doctor or nurse:

One and one-half yards of rubber sheeting, 36 inches wide, or more—or ordinary white table oilcloth—to stretch over the mattress.

One 2-quart fountain syringe.

Two agateware basins, 11 inches and 16 inches in diameter, respectively.

Two agateware pitchers, holding one quart or more.

One slop-jar or covered enameled bucket.

One douche pan.

One nailbrush.

One medicine glass.

One medicine dropper.

Several cakes of castile or pure white soap.

One jar of vaseline.

Fifty bichloride of mercury tablets, clearly marked, for disinfectant purposes.

One ounce fluid extract of ergot, bought one week before confinement.

Pint bottle of chloroform.

Small bottle of brandy.

Quart bottle of alcohol for rubbing purposes.

Two dozen large safety-pins.

Two yards stout muslin for abdominal binders.

Two old sheets.

One dozen old soft towels.

One yard of bobbin, or very narrow tape, or braided silk, for tying the cord.

Twenty-five yards of sterile gauze.

Four rolls of cotton-batting.

Three pounds of absorbent cotton.

The ergot and chloroform need not be provided by the city mother, with the drugstore close at hand, but for the suburban or country mother their presence in the house, if the doctor is summoned hastily and there is no drugstore near by, may save confusion and perhaps futile errand running. Neither drug is to be used without the permission of the doctor, for, if chloroform is administered too soon, it may hinder the progress of labor. If given in too large a quantity it increases the possibilities of hemorrhage.

The gauze, cotton-batting and absorbent cotton are used for dressings for the bed. These may be made by the mother or the nurse. They must then be sterilized and put in an air-tight box or drawer until needed. With great care they may be sterilized by dry heat in the oven, but as there is danger from scorching, steam is more satisfactory. The most convenient way is to utilize a washboiler, one-fourth full of water. The dressings are laid, first in loose cheese-cloth bags, then in a hammock-shaped strip of muslin attached by either end to the handles of the boiler. The hammock should be swung high enough in the boiler so that it does not actually touch the water. The lid is fastened on tight and the steaming goes on for an hour. The dressings are then dried in the sun or in the oven. In the latter case great care must be taken or they will be scorched.

In preparing an outfit for the baby, it should be borne in mind that this is an age of simplicity in dressing children; also that a baby outgrows its first clothes very quickly. The essentials for the new-born baby are:

Four abdominal bands of soft flannel, unhemmed, six to eight inches wide, twenty inches long.

Four shirts of wool and silk mixed, or wool and cotton, in size 2.

Four flannel skirts, hung from the shoulder, not made with bands to pin around the abdomen.

Four nightgowns or wrappers of outing flannel, which button in the front.

Three knitted bands of wool and cotton mixed, with shoulder straps.

Six white slips, made very simply.

Four dozen diapers, made of cheese-cloth or a material known as stork diapering, which is much like Turkish toweling.

Three pairs of socks, if it is a summer baby.

Three pairs of long white merino stockings, if it is a winter baby.

One simple cloak, made of soft material.

One cap lined with silk.

Mittens for the winter baby.

One bath blanket, made from an old summer weight blanket.

Several crocheted, knitted, or flannel blankets.

Soft material should be used for making the baby’s garments and neither lace nor embroidery should be employed around the necks and sleeves of the little slips, as they may chafe the tender skin and cause eczema. Cleanliness is the one demand for the baby until it has passed safely through the first month of its life, when the mother may give more attention to its raiment.

In this day when cotton materials are highly mercerized and bleached, it is safest to wash the little garments made from them before they are worn by the new-born baby with its delicate skin. Diapers in particular should be washed, and dried, but not ironed. The necks of dresses or slips should be loose and tied with tape; buttons or fancy pins may cause discomfort to the baby.

Every woman knows that efficiency in all branches of home-making depends largely on having the proper tools. This is true in the nursery as well as in the kitchen. There is no more delightful occupation for the last two months before confinement than fitting up a nursery for the little guest. A modern nursery equipped with all the up-to-date appliances is not within the purse or even the house limitations of many mothers, but there is no reason why the new baby should not have its own corner in the house whether this be an entire room or just one end of “mother’s room.”

The expectant mother with a modern house, plenty of rooms, electric light, and running water, at her command, has half of the problem solved for her. She will choose for the nursery a room opening off her own, and convenient to the bathroom. This need not be large, but it should be well ventilated, and, if possible, have a southern exposure in order that it may be flooded with air and sunshine. The walls should be painted, not papered, and the floor should be of hard wood or stained pine, never carpeted. A few rugs that can be washed or cleaned will be sufficient floor covering. It is better not to have a stationary washstand in this room, because, unless the plumbing is above suspicion, the pipes may breed germs.

There are two ways of providing against draughts: one of these is the use of a screen that can be placed around the baby’s bed; the other is a wooden board, about five or six inches high, and long enough to fit the window when the lower sash is raised. The upper sash can then be dropped to let the impure air out, and the clean, pure air will enter the room between the upper and lower sashes.

The windows should have both light and dark shades. Babies stare at the light, and, especially during the first few weeks after birth, the nursery should be kept dark, or at least with only a dim light. The custom of hanging an old shawl or dark curtain over the window is not sanitary. At no time should the young baby’s eyes be exposed to a strong light, either artificial light or sunlight. The crib should be so placed that the baby looks away from the light, not toward it. Protecting the baby’s eyes from glare may mean guarding it from defective vision.

Except for very cold weather an open fireplace is the best possible method of heating the room. When there is no fireplace, hot water heating is best for the nursery; as it is for the entire house. When steam or hot air is used, a pan of water, changed daily, should always be kept in the room to relieve dryness in the atmosphere. Air-tight coal stoves, gas or oil stoves should never be used in the nursery.

For the first week or so after the baby’s birth the nursery should be kept at a temperature of 70° F. by day and 64° F. by night. As the child grows older, the temperature may gradually be reduced at night.

Electric lighting is the best for the nursery. If this is not a part of the equipment of the house, neither gas nor an oil lamp should be allowed to burn in the room at night; a candle or wax night light should be at hand. These can be bought at any house-furnishing store.

It is very important that the nursery should be fitted with screens to keep out flies and mosquitoes. Mosquitoes carry malaria, and the foot of a fly brings germs from the street, garbage and trash piles far beyond the limits of the most sanitary nursery. The nursery should furnish the baby’s first protection from contagious diseases. It must be a veritable haven of safety. Therefore, no household work of any kind should be done in the room, such as washing or drying the baby’s clothes. The floors and the furniture should be wiped daily with damp cloths. A dry cloth or feather duster should never be used to scatter dust around the room.

Very important are the bath equipment, fully described in Chapter [VIII], “Cleanliness and Health,” and the baby’s toilet basket. The latter is most sanitary when made of wicker, plain or enameled, and fitted with celluloid or ivorine boxes. Swiss lining, with lace-trimmed pockets and bows, soon soils and catches dust and germs.

The equipment of the nursery should include a crib of enameled iron, a low table, a screen, a closet or chest for the baby’s clothing and supplies, a small clothes-rack, a pair of scales, and a low chair—a rocker without arms if the mother prefers it. If these are all painted white, they give the room a very sanitary appearance.

The crib should be supplied with springs, mattress—preferably of hair—a piece of India-rubber sheeting, and several cotton pads which can be washed, half a dozen cotton sheets, a pair of light woolen blankets—woven especially for cribs, or made from old blankets on hand, carefully washed and bound, or wide flannel by the yard finished with binding ribbon. The quilt should be of eider-down or a light-weight cotton-batting, covered with silk or silkaline. If the bed clothing is heavy, the baby will perspire and take cold more easily. A small hair pillow is better than feathers, and the pillow-slip should not be embroidered. It is far better to start the baby early in life sleeping without any pillow at all. A hot-water bottle or bag, covered with flannel, should always be at hand for warming the baby’s cold feet.

Many mothers cannot provide either a separate room or the modern equipment described; but a resourceful woman will supply admirable substitutes. If she can do no better, she will arrange one corner of her own bedroom for the baby. To make this sanitary she will follow the general plan of a bare floor, painted walls, and even sacrifice her ruffled curtains to the health of her baby. The baby’s corner can be separated from the rest of the room by screens. A screen may be made from an ordinary clothes-horse, enameled white, and covered with heavy dotted Swiss or silkaline, which can be taken off and washed.

If the white enameled crib is beyond the family purse, there are several substitutes which can be placed on an ordinary table with the legs cut off a few inches. One woman whom I met at a contest had found an old kitchen table in the attic. Her husband first cut off the legs evenly and then inserted casters, painting the whole white. On this she placed an ordinary marketing basket, with the handle sawed off. This, too, was painted with white enamel. In it she laid a hair pillow, cut down to the size of the basket, and then added the usual protecting piece of rubber cloth, sheets, and bedding. This basket was closely woven, and when the paint filled all the cracks, it made a snug little bed. If an open-work basket or an ordinary laundry basket is used, it may be draped on the outside with plain muslin, fastened with thumb tacks so that it can easily be removed and washed. Decorating the basket with frills of dotted Swiss over paper-muslin or silesia may give very attractive results, but it is not sanitary.

Another substitute for a crib is an ordinary packing box, which can be bought from any grocer or shoe dealer, scrubbed, dried and then painted white inside and out, and covered with muslin attached with thumb tacks.

If a feather pillow, instead of hair, must be used, it should be completely covered with rubber cloth or ordinary table oilcloth, because the feathers are heating and should be separated from the baby by the rubber.

If a good-sized basket or box is chosen, the baby can sleep in this until it is several months old.

On the day of baby’s birth, his clothes-rack and toilet basket, a low chair, and a table with basin should be placed near the fireplace, stove, or radiator. On the clothes-rack hang the first garments he will wear. On the chair hang an outing flannel or soft woolen apron for the nurse, and the soft shawl or blanket in which the little newcomer will be wrapped directly after birth. The toilet basket should contain the following supplies:

Four dozen safety-pins in assorted sizes.

A roll of old soft towels.

Soft wash-cloths and squares of sterile gauze to be thrown away after using.

Talcum powder.

Castile or Ivory soap.

Very soft hair-brush.

Small bottle of olive oil.

Two-ounce bottle of boric acid.

Every item mentioned in these preparations for the baby’s birth is important, as it bears directly upon sanitation, the comfort of the mother, and the safety of the child. This is no hour in which to take chances through false economy or procrastination.

Directly after the child is born and the navel cord has been tied, either the nurse or doctor should give attention to the baby’s eyes. Science has proved that a large proportion of blindness is preventable, if prompt care is given to the eyes of new-born children. Hundreds of children are blind from birth through infection which might have been prevented.

The eyes of the new-born baby are generally closed and covered with mucus. This should be washed off very gently with absorbent cotton dipped in boracic acid solution, starting at the nose and wiping outward, without opening the lids. To remove any chance of infection which leads to blindness, or ophthalmia neonatorum, as it is known to the medical profession, the nurse then applies a few drops of antiseptic solution, provided by the physician. For this purpose she uses a medicine dropper. So successful has been this treatment in reducing the percentage of blindness at birth, that many health boards, notably in New York, demand such precautions of physicians and midwives.

If for any reason the treatment is not given, the mother will do well to watch the baby’s eyes for such symptoms as redness, swollen lids, and a slight discharge oozing from under the lids. If these symptoms appear, the parents should insist upon summoning a physician, for at this time prompt treatment may save the child’s sight. Neglect may result in total blindness or, at best, permanently impaired vision.

The baby’s eyes should be washed daily with boracic acid solution, the cotton or gauze used for this purpose being destroyed and never used a second time.

Next, the baby’s skin should receive the nurse’s attention. Before it is bathed, the entire surface of the body should be covered with olive oil or vaseline; after this process, the baby may be wrapped warmly in a blanket and tucked into a safe corner, while the nurse turns her attention to the mother. The baby need not be bathed until the mother has been made comfortable.

By this time the olive oil or vaseline has softened the cheese-like substance which encrusts the skin of the new-born baby. The nurse fills the basin or tub with water, which registers 100 degrees F., if a bath thermometer is used, or which will feel comfortably warm when she thrusts her bare elbow into the water. Making a soft suds with Castile or Ivory soap, the nurse then lathers the entire body, taking great care not to get soap in the baby’s eyes. The soap is rinsed off with gauze or old linen and clear water, and the flesh is patted dry with old soft towels which have been warmed. The tender skin must never be rubbed. Talcum powder is then applied, and the baby is ready to be dressed in flannel binder, shirt, soft diaper, flannel skirt and outing flannel wrapper.

As the little body is indescribably tender and sensitive at this time, the nurse must handle it with exquisite care, always supporting the head and back and protecting it from draughts; she must be very careful not to let a strong light strike the eyes. If the baby is normally healthy and has been made comfortable, it now falls sound asleep. This is nature’s way of permitting the mother to recuperate before nursing the baby for the first time. When the baby wakens, the mother will have regained her strength in that amazing way which is appreciated only by those who have watched her pass from the ordeal of labor into the joys of maternity as through a miracle. The baby should be given the breast when it awakens from its first sleep, and if there is any flow of milk whatever, no artificial food should be supplied. Thus does the baby start aright its splendid progress toward a normal, healthy childhood.

CHAPTER III
THE NURSING BABY

THE NURSING BABY—WHY THREE HUNDRED THOUSAND BABIES ARE SACRIFICED EVERY YEAR TO IGNORANCE—INFLUENCE OF THE MOTHER’S DIET ON THE BABY’S HEALTH—WHEN THE NEW-BORN BABY MUST BE BOTTLE-FED—A WELL-BALANCED DIET FOR THE NURSING MOTHER—CARE OF THE BREASTS AND NIPPLES—IMPORTANCE OF REGULARITY IN NURSING

Correct feeding is the foundation on which the baby’s good health rests. A dirty baby, properly fed, will thrive. A baby deprived of fresh air, but wisely fed, will survive and even develop into a strong man or woman. But the baby raised according to the latest and most approved rules of sanitation and hygiene, if improperly fed, will languish and die.

If every mother who reads this book will grasp this vital fact and live up to the doctrine for which it stands, she will not only reduce the family doctor bills, but will protect herself from untold hours of trouble, sleeplessness, anxiety and, perhaps, grief. Correct feeding and good digestion for the baby spell health-insurance. The well-nourished body of a properly fed child does not furnish an abiding-place for disease-germs.

Through watching the conferences between mothers and physicians at Better Babies Contests, I have come to realize that, while 75 per cent. of the ailments from which babies suffer can be traced to some form of stomach or bowel trouble, comparatively few women recognize symptoms of malnutrition or overfeeding for the menace which they really are. Many mothers seem to consider that a slight digestive trouble is almost as casual a feature of baby’s career as teething.

At times I felt as if the doctors at the contests were introducing mothers to their babies, for hundreds of intelligent, affectionate, well-intentioned mothers did not really know their babies. Oh, yes, they knew Baby’s name, the color of his hair and his eyes, the exact point where his cheek or his chin broke into a delightful dimple, the side of his family from which Babykins inherited his many good points and his few bad ones, the day when he first sat up or toddled across the floor; these and many other things the mothers knew, but still they did not know what was going on inside of Baby, in the digestive apparatus on which so much of his health and happiness depend.

At one contest, I saw a physician penalize an attractive eighteen-months baby because of a rash. The mother protested.

“Why,” she cried, “Baby has always had that rash. It’s a sort of birthmark.”

“No,” answered the physician; “it’s a symptom of rich food. You are either overfeeding this baby or giving him food that is too heavy, milk that is too rich for him to digest.”

That mother learned how to modify milk.

Another mother presented a doll-like baby girl for examination, perfectly proportioned but under-weight, and under-height for its age. With silky curls and rose-petal cheeks, Baby leaned wearily against her mother, watching the doctors languidly from eyes around which there were blue circles. Think of that! Blue circles round the eyes of a baby that had not yet celebrated its first birthday!

It did not take the doctors long to analyze this baby’s trouble and to introduce Mother to her child’s true condition.

“Mrs. S——,” said the doctor, “you are starving your baby.”

The mother was shocked and hurt.

“I nurse her every three hours,” she protested.

“No doubt,” answered the doctor; “but your milk is not nourishing her. Perhaps you are not strong enough. Perhaps your baby should have both the breast and modified milk. We will find out.”

They did. That mother learned that her baby was drifting toward the dangerous rock of anemia. Her lesson was how to alternate the breast milk with a bottle feeding of modified milk.

A third baby was what you would call a “fat boy.” He was covered with the most “pattable” creases, and his complexion was blooming, but he had an ugly scowl on his round face and he shoved everything and everybody away from him as if the entire world were distasteful. Mother said he had never been a really good-natured baby, and she didn’t know why. But the doctors found out. The plump stomach of which his mother was so proud was not an indication of health but of undigested, unassimilated food, overfeeding.

At sixteen months, a baby’s head, chest and abdomen should measure just the same, 18½ inches. This poor little laddie had an eighteen-inch head, a seventeen-inch chest and an abdomen measuring twenty inches. And just by exploring with his finger, the doctor found an ugly little mass of undigested food down in one corner of that bulging abdomen. Of course, Baby wanted to shove people away. So do grown-ups when they have a sick headache or a bilious attack.

Here was a baby being overfed with milk, just milk, but milk not properly prepared.

And there you have it, rash, malnutrition, and indigestion, all because three mothers did not know what was going on inside of Baby’s stomach. Mothers often think that so long as Baby has milk and nothing else he is safe; but milk, even mother’s milk, needs watching.

Nature provides signs when milk does not agree with the baby. Of course, if the baby could talk, mother would know exactly how he feels, because he could explain where the ache is located. But when one’s means of communication is limited to wriggling, and rolling up the eyes, and emitting disturbed yaps, mother must look for signs or symptoms to take the place of worded complaints.

It is estimated that 300,000 infants under one year of age die in the United States each year. Of this frightful number, it is also estimated that fully 50 per cent. could be saved by proper care. Men and women who specialize in the care and feeding of infants affirm that practically all of these unnecessary, preventable deaths can be charged to improper feeding. Is it not vitally important, therefore, that every mother should make an earnest, unremitting study of infant feeding as health-insurance for her family circle?

The nourishment of the child begins before it is born. Ailments in digestion accompany it into the world. For this reason, in Chapter [I], special stress was laid on diet for the pregnant mother. But it is not enough to bring the baby into the world blessed with a sound digestion. The mother must study the science of keeping her child’s digestion sound.

Half her battle for baby’s good health will be won if she nurses it. The natural, the almost unfailingly safe food for the new-born babe is mother’s milk. The Creator, who made woman the mother of the human race, provided also the first means of nourishing the children brought into the world. The average woman has the strength to nourish her child in the natural way; and only a real physical inability, admitted by the family physician, should lead her to deprive the child of its rightful nourishment.

It is often said that the lack of maternal instinct in the modern woman is responsible for the large proportion of bottle-fed babies. I think that this charge against my sex is undeserved. Women are far more apt to stop nursing their babies as the result of ailments in themselves which they do not know how to cure or control, or because they accept the word of those who are not in a position to give medical advice or even offer common-sense suggestions.

Sometimes, directly after the baby’s birth, when the mother is extremely weak, well-meaning but interfering relatives or neighbors urge her to wean the baby at once. So another baby’s life is endangered and another mother is induced to undertake the grave responsibility of artificial feeding, when, with a little patience at the time of the baby’s birth, the supply of mother’s milk could be increased and strengthened.

The mother who suffers or has suffered from tuberculosis, epilepsy, persistent anemia, kidney disease, or any grave mental disturbance should not attempt to nurse her baby. If a fever, such as scarlet fever, typhoid, etc., develops shortly after the birth of the child, it must be weaned promptly. An operation which will greatly weaken the mother is another cause for discontinuing breast-milk. The reappearance of menstruation does not necessitate weaning the child; but pregnancy makes it desirable. Thus it will be seen that only the gravest conditions in the mother justify her in placing the new-born baby on the bottle until she is convinced by symptoms in the child itself that breast milk does not nourish.

The mother of her first-born, beset by a thousand fears, is very apt to regard the first flow of milk from her breast with suspicion. For two or three days it is a thin, colorless, watery fluid. The frightened young mother decides that it cannot possibly satisfy her baby. The very thought of the precious little creature being hungry terrifies her, and she accepts the advice of an untrained nurse or a fussy neighbor to give him sweetened water, or diluted and sweetened cow’s milk. So the new baby starts life all wrong on artificial food, when the thin, watery fluid provided by nature is precisely what he needs at this time. Naturally, if he is fed artificially, he will not draw on the breast, for he is not hungry, and so the flow of milk is discouraged. The new-born baby should be given the breast every four hours, whether he seems hungry or not, whether the flow of milk is established or not.

It is most important that at this time the mother should not worry. Nervousness and hysteria of themselves react on the baby’s digestion.

As the mother gains strength and begins to move about, she should guard her health carefully, because upon this depend the quantity and quality of the milk she furnishes her baby. At this time she requires plenty of sleep; and while her rest is broken at night to nurse the baby, she should have regular naps during the day. Eight hours’ sleep at night and a short nap in the middle of the afternoon form a good rule.

As far as possible, she should lead what, to her, is a normal life, free from excesses or any wide deviation from her habits before the birth of the baby. Unhappiness and discontent unsettle the nerves of the mother and injure the quality of the milk. The woman who is accustomed to much outdoor exercise should not shut herself up in the house, nor should the woman of sedative habits plunge into violent outdoor exercise. The latter needs fresh air as a mother, precisely as she should have had it as a girl, but she should form the habit gradually, not start with exhausting walks. Moreover, the woman who is fond of society and accustomed to going out, should not deprive herself of all social pleasures because she has become a mother. Within reason, she should enjoy them. The moment motherhood becomes a hateful burden, an altar on which the woman sacrifices all personal preferences and pleasures, the drastic changes entailed affect the health of the mother and react on the child.

The same is true of diet for the nursing mother. Deprivation and excess alike are undesirable. A well-balanced diet, made up from a variety of foods which the mother craves under normal conditions, will nourish both the mother and the child.

In this connection, the young mother should be warned against what might be termed superstitions in diet, “old women’s tales.” While attending Better Babies Contests, I have often been shocked at the superstition and ignorance which interfere with the nourishment, comfort, and contentment of the nursing mother. One young mother said that she was drinking malt to make her milk more nourishing for the baby. And how she did hate that malt! It nauseated her every time she drank it.

When the doctors told her that anything which nauseated her would affect the baby in the same way, she was actually relieved. Yet she had been forcing herself to drink the malt, because an elderly neighbor told her what wonders it had done for other women. Doctors, not neighbors, should be consulted on these problems.

Another woman told me that she did not see why her baby could not retain her milk. It curdled on his stomach. And she assured me quite solemnly that she never ate anything acid. She did love pickles, salads and lemonade, but her nurse had told her she must not eat sour things while she nursed the baby. I heard the sensible doctor in charge of that contest tell her to go straight home and make herself a good fresh salad.

Her digestion craved acid, and her child actually suffered because her system was denied it. Excessive indulgence in acids, as in anything else, would not be good for the mother or the baby; but, well balanced with other foods, sweet pickles, properly sweetened lemonade, and salad dressing prepared with plenty of good olive oil, would not hurt this mother.

The same judgment must be shown in the matter of drinking. The woman of German parentage and customs should not give up the moderate use of beer to which she has been accustomed; but, on the other hand, the woman who is not accustomed to drinking beer, and does not care for it, will not improve the quality of milk for her child by forcing herself to drink beer. The Italian mother, habituated to the use of light wine with her meals, would miss it sorely if deprived of it while nursing her child; but the average American would find it stimulating only. The woman who drinks coffee and tea in moderation may increase the supply of milk by drinking to excess; but the milk will not gain in quality, and her nerves will suffer from overstimulation. Milk, cocoa, and chocolate in moderation increase the quantity of milk and improve the quality, except in the rare cases where the mother cannot digest them. The woman who can sip gruel, plain or with cream, will find the supply of breast milk gaining in both quantity and quality; but when the gruel is disliked, when it actually nauseates the mother, it does not have a good effect on the milk.

In fact, sanity, good judgment, ordinary common sense, should govern the planning of diet for the nursing mother. It should include cereals, soups, meat at least once a day, fish, eggs, macaroni or spaghetti, fresh vegetables, salads, fruits, and light, wholesome desserts. The fresh vegetables and salads prepared with olive oil are particularly good, as they prevent constipation. Stewed fruit is better than fresh, especially when the fruits are highly acid. No dessert like pies, pastries, or puddings made from heavy dough, which are apt to lie undigested on the stomach, should be eaten; but custards and all desserts with fruit for a foundation are desirable. Nuts are highly recommended by vegetarians, but they must be well chewed.

The nursing mother must bear in mind that she is eating for two. If she depends upon the three daily meals served to the balance of her family, she is apt to become very hungry and to overeat at the table. It is better for her to eat wisely between meals, in the mid-morning and mid-afternoon. These lunches should consist of milk, cocoa, a cup of soup or gruel, or a little stewed fruit, with zwieback or toast. Crackers do not make more or better milk. The nursing mother who must prepare breakfast for her family should eat a little fruit, or a slice of bread, or drink milk, before taking up her task, and she should also have a nourishing drink just before retiring.

The busy house-mother who is nursing her baby is particularly warned against nursing the child when greatly exhausted. It is far better to keep the baby waiting a few minutes, while the mother sits down and rests or sips a glass of milk. Nursing a baby when overtired or overheated, or extremely nervous and angry, is positively injurious and unjust to the child.

Of the utmost importance in regulating the condition of the baby’s health through breast milk is the condition of the mother’s bowels. These should move once daily and, if possible, the movement should be natural. Drastic cathartics disturb both mother and child. If constipation in the mother does not yield to careful diet, including fresh vegetables and fruit, she should consult her physician and not dose herself. If the mother’s bowels are in good condition and the baby’s are not, the physician should be consulted about the baby.

The care of the breast and nipples is extremely important, for many ills, notably the very painful abscess of the breast, may spring from lack of cleanliness. The tugging of the baby’s mouth on the nipple makes it soft and tender, often laying it open in tiny cracks which are easily infected. The nipple, therefore, should never be handled by mother or nurse unless the hands have first been scrubbed with soap and a nailbrush.

Not only for cleanliness but for hardening them, the nipples should be washed after each nursing with a solution of boracic acid and very hot water, in the proportion of one teaspoon of the acid to one pint of water. When thoroughly dried with soft old linen or gauze kept for the purpose, they should be covered with a piece of sterilized gauze to prevent any possible infection from clothing. If, in spite of all these precautions, the nipple shows cracks or fissures, and nursing becomes torture, the baby must not be permitted to suck at the nipple, but a nipple shield should be used. There are various kinds, the best being of glass with a rubber nipple on the end. When the nipple is as sore as this, boracic acid in solution will not effect a cure. Zinc ointment must be used instead; but only when the nipple shield is used, never when the baby’s mouth touches the breast.

Another aid to baby’s digestion is regularity in feeding. Directly after birth, the feedings should be regulated by the doctor and the nurse, who are better able to determine the strength and needs of the baby. If it is a normal, healthy child, for the first few days it will spend most of its time in sleep, but it should be given the breast at least once in four hours. A small, weak baby should nurse once in two hours, between 6 A.M. and 10 P.M., with one nursing in the middle of the night between 1:30 and 2:30.

After the first week, a strong baby may be nursed every three hours, between 6 A.M. and 9 P.M., with one night feeding. At three months, a healthy baby is nursed every three hours, and at four months the night feeding is dropped. That is, he is not nursed between 9 P.M. and 6 A.M.

Feeding a baby every time he cries is bad for both mother and child. It ties the nursing mother to her baby’s side. It injures the baby’s digestion. It is the first misstep in molding the baby’s character.

If, in spite of the care here outlined for mother and baby, the child does not thrive on breast milk, the cause must be ascertained and artificial feeding must be considered.

CHAPTER IV
ARTIFICIAL FEEDING

WHEN ARTIFICIAL FEEDING IS NECESSARY—WEIGHT THE TEST OF PROPER NOURISHMENT—COW’S MILK, CAREFULLY MODIFIED, IS THE BEST SUBSTITUTE FOR MOTHER’S MILK—SOURCE OF SUPPLY AND CARE—CARE OF THE BOTTLES AND NIPPLES

Successful artificial feeding of infants is one of the big problems which the medical profession strives unceasingly to solve. It has never found a perfect substitute for mother’s milk, but it has greatly reduced the rate of infant mortality, due to artificial feeding, by working out formulas that combine the food properties provided by breast milk. And not the least valuable result of its investigations has been the agitation for pure milk supply, the sanitary care of milk and dairies.

Any mother who has followed the reports of pure milk commissions, and heard the talks and lectures given by specialists in infant feeding, must realize the tremendous chance she takes in weaning her baby. Therefore, she will not take the step unless convinced that her milk positively disagrees with her child.

The most important test is the child’s development or lack of development, gain or loss in weight. This cannot be determined during the first week, for the average normal child loses from four to eight ounces during the first six or seven days of its life. Thereafter it should gain at the rate of from four to eight ounces a week, until it is six months old. After that the gain per week runs from two to four ounces, until the child is a year old, when the first danger-period of feeding is past.

During this time—and, in fact, throughout its childhood—an accurate record of its weight and measurements should be kept by the mother. For this purpose, the well-equipped nursery should contain a good pair of scales and a measuring board. The scales should record at least forty pounds. They are of the platform, not the spring, variety, with a basket for holding the baby while it is small and helpless. Later, when the child is able to sit up, the basket is replaced by a pad.

The measuring board used at the Better Babies Contests is a great convenience and can be made by any carpenter. It consists of a smoothly planed board forty inches long and eleven inches wide, with a firm, upright headpiece, and a sliding footboard which runs on grooves on the outer edges of the board. On one of these edges is tacked a steel tape, in the inch-scale. The baby, up to eighteen months of age, is laid on the board with the back of the body touching the board all along, from head to foot. The nurse makes sure that the little head is placed firmly against the headpiece. Then, while the mother or some other assistant holds the baby’s knees firmly in place, the nurse adjusts the sliding board until it touches the flat soles of the baby’s feet. The child is then lifted up, without moving the footboard, and the measurement is read from the tape where the footboard stops.

After the child is eighteen months old it is measured standing. For this purpose the board is reversed. The firm headpiece is placed on the floor for the child to stand on, and the sliding footboard is brought down to touch the top of the child’s head.

After its third year, the child may be measured according to good old nursery tradition, by a pencil mark against the woodwork.

Measuring a baby with a tape-line is not accurate. While the height is not so important a factor as the weight in determining the development and especially the nutrition of the baby, it should be watched; and this measuring board, which represents an investment of only a dollar or so, will be found very useful.

The baby that is thriving on mother’s milk should show a gain of at least two pounds at the end of thirty days. The baby which weighed seven pounds at birth should weigh nine pounds when one month old; ten and one-half pounds at two months; twelve pounds at three months. When the gain is less than these figures, the baby’s diet needs attention. The following symptoms point to the fact that the mother’s milk does not agree with the child:

(1) Excessive vomiting, with loss of weight or no increase of weight for two weeks or more.

(2) A persistent diarrhea, with loss of weight or no increase of weight for two weeks or more. If there is a progressive gain in weight, however, loose bowels are not a danger signal.

(3) Steady loss of weight extending over a period of three weeks or more, in spite of the fact that otherwise the child seems normal.

Sometimes the trouble can be corrected by a change in the mother’s diet; and this must be discussed with the family physician. Sometimes the mother is too much exhausted by household duties to provide the amount and quality of milk needed to nourish the child. If it is possible to lighten the mother’s burdens, and thereby strengthen the breast milk, this is better economy than investing in bottles and artificial food.

If, in spite of the doctor’s efforts to build up the mother’s strength and improve the quality of the breast milk, the baby does not thrive, then mother and doctor together must work out the problem of artificial feeding.

The scientific and successful raising of a baby on the bottle depends upon two distinct lines of care and caution: the selection of the food to be supplied, and the care of the bottles. The best of food in an unsanitary bottle or drawn through an unclean nipple becomes dangerous to baby’s health.

In choosing artificial food for your baby, remember that even physicians differ on this question. Most American specialists for children insist that fresh cow’s milk, properly modified, is the only substitute for mother’s milk. European authorities recommend goat’s milk. And there are other recognized authorities on baby-health who have found it advisable to prescribe for delicate bottle-fed babies a combination of milk and patent food. Not only must the mother consult her family physician on this question, but, with the physician, she must watch the effect of the chosen food on the baby.

Vomiting, restlessness, sleeplessness, and the condition of the bowels, all tell the tale of food that is not being assimilated.

In this connection the inexperienced mother must understand that there are two forms of vomiting in the young baby; or, more properly speaking, there is a difference between vomiting and regurgitation—slight, to be sure, but worth watching. Regurgitation is merely the overflow of milk when the baby has taken too much. It follows almost immediately upon having the breast or bottle taken away, and the milk is in practically the same condition as when it entered the stomach. But when the baby vomits habitually after feeding, and the milk is curdled or tough or sour, there is something wrong with the bottle diet.

The bowels are a sure indication of the way in which the bottle diet agrees or disagrees with the baby. When the passage is hard and bullet-like, when it shows curds or white lumps like cheese, or when mucus is present or there is diarrhea, the mother may be sure that the food does not agree with her baby, and the doctor should be consulted immediately.

No medicine should be given in such cases without consulting a doctor. What the baby needs is not dosing, but the right sort of food, the food its stomach will digest.

At one contest in the midwest the mother of a little prize winner told me that, at eleven months, she almost lost her baby. She had changed diet time and time again, varying from certified cow’s milk to a well-known patent food. The baby was reduced to a skeleton when the physician decided to try not milk, but cream, diluted with barley water. The change in baby’s condition was immediate, and it continued to thrive without further change of diet. On the other hand, some babies fed on this modified cream would not thrive.

Frankly, feeding a baby deprived of breast milk often resolves itself into an experiment; but an experiment which must be conducted in an intelligent manner, with the advice of a physician. Do not consult your neighbor, no matter how many babies she has raised successfully. The bottle food which was nourishment to her babies may be poison to yours. There are no hard and fast rules for bottle foods. Each baby is a case unto itself and requires the most delicate attention and unrelenting vigilance. Even two babies in one family may require different forms of artificial nourishment, or at least different modifications of cow’s milk.

Perhaps there is no phrase familiar to the maternal ear which is so generally misunderstood and abused as “modified milk.” It is confused with sterilized, pasteurized, and condensed milk, and with patent foods. In reality the phrase means any milk, other than mother’s milk, so modified by the addition of elements like water and sugar as to bring it as near as possible to the quality of breast milk.

The substitute for mother’s milk most generally approved by American pediatrists or specialists in the care of children is cow’s milk, carefully modified.

The safety of the child that is to be fed on modified cow’s milk depends largely upon the source of milk supply. The mother should acquaint herself with this source of supply and the conditions under which the cows are housed and milked. If you had to hire a wet nurse, you would not choose a tubercular or personally unclean woman. Why permit your baby to drink milk that comes from a tubercular cow, or one which is milked in a filthy stable?

If you live in a city, write to your department of health or your health officer for information regarding properly inspected dairies. If no such information can be furnished you, then it is high time that you started a campaign for dairy inspection in your town. If you live in the country, find a dairyman or a neighbor whose cows will stand the test and whose stables are clean. Do not buy baby’s milk at a grocery-store or dairy whose source of supply you cannot trace.

Cow’s milk which comes from a herd of healthy cows, or at least several cows, is preferred to that which comes from a single animal, as it varies less in quality and elemental proportions. It is not necessary to order rich milk from highly bred Jersey and Alderney cows. In fact, physicians agree that the milk produced by ordinary grade cows in the herd is better suited to the needs of the child. You should be quite sure, however, as to the age of the milk. In cold weather it must not be fed to the child after it is forty-eight hours old. In summer it should never be more than twenty-four hours old.

In nearly all large cities are now found agencies of dairies which specialize on milk for infants. This is sometimes known as certified or guaranteed milk. The cows from which it is drawn are carefully inspected, the stables and milkers are clean, all the utensils, pails, cans, etc., are sterilized before use, and the milk is cooled immediately after it is drawn from the cows and kept at or near a temperature of 50° F. until delivered to the purchaser. Milk produced in this way saves the mother anxiety and trouble. It costs only a few cents more a quart than milk which is not certified.

When certified milk is received in the home, the stoppered bottles should be placed immediately in the refrigerator or set in a pail of ice-water to remain until it is modified for use during the next twenty-four hours.

The city mother, with her stationary refrigerator and convenient ice supply, has no possible excuse for not keeping the baby’s milk in perfect condition. Some of the new refrigerators have separate compartments. One of these should be used for the baby’s milk. In many well regulated homes you will find special nursery refrigerators which can be bought at any department or house-furnishing store. These have their own supply of ice and nothing but the baby’s milk is stored in them.

The small town or country mother, whose ice supply is irregular and who depends upon an old-fashioned ice-chest or perhaps a spring or cool well for chilling the baby’s milk, faces a more difficult problem. It is especially important that she keep the milk bottle tightly stoppered. If she uses the old-fashioned ice-chest, where food and ice are not separated and where germs lodge easily, she had best pack the stoppered bottles in a covered pail and set them next to the ice. If she has no refrigerator at all, she should induce her men-folk to provide a substitute, if it is only one strong wooden pail set within another, the sawdust and ice packed between. Then she can thrust her stoppered bottles into the inner pail, cover all with heavy felting or burlap, and feel tolerably safe.

At one of the contests a mother told me how sad experience had taught her the importance of having such a safeguard in her home. With her first baby she kept the milk in a tin pail, hung in the cool water of an old well. The milk absorbed germs and the doctor traced the baby’s death from acute bowel trouble to these germs.

Next in importance to the supply and storing of milk comes the care of the utensils for modifying it and feeding it to the child. These should be kept in a sanitary condition that is absolutely above suspicion. If the mother herself does not take charge of this task, she must delegate another member of the family or a servant upon whose faithfulness she can depend. The supply of milk for the ensuing day should be cared for at a certain hour each morning, soon after the milk is delivered. The utensils should be used for this purpose alone, and should not be kept in a cupboard with ordinary cooking equipment.

For the ordinary modifying of milk the following utensils are needed:

A strong measuring glass, holding sixteen ounces, divided into ounces, which can be bought at any hospital supply house and in many department and drug stores; a two-quart pitcher with a wide neck; a glass funnel, which fits easily into the neck of the nursing bottle; an enameled tablespoon; an enameled saucepan for boiling the water or gruel; a quart glass jar, with an air-tight cover, in which the boiled water or gruel is set away until it is cool; a wire rack, which will hold eight or ten nursing bottles; eight or ten plain, round, cylindrical bottles with a narrow neck; a half dozen plain nipples of a size to fit around the neck of the bottles; a long-handled brush for washing the bottles; soap, washing-powder and borax for cleaning purposes.

The shape of the bottles is extremely important, for a round bottle offers no corners in which germs can lodge; square bottles have this disadvantage. The number of the bottles is governed by the number of feedings in twenty-four hours, one for each feeding. The wire bottle-rack protects the bottles from breakage and is an economical investment. The nipple changes in size with the age of the baby; for the small baby care should be taken that the nipple is not long enough to choke the baby and make it vomit.

The size of the hole in the nipple also is important. If it is too small the baby has to work too hard for its nourishment. If the hole is too large the baby will gulp the feeding, which may cause colic, indigestion, or vomiting. Test the nipples by holding the filled bottle in a horizontal position and watch how the milk drops from the nipple: the drops should be an inch or more apart.

New bottles and nipples should be put into a cheese-cloth bag and then into boiling water to be sterilized before using. After the baby has been fed, the bottle should be washed out with the long-handled brush with soap or washing-powder. When the soap has been rinsed out with hot water, a teaspoonful of borax and a little warm water are turned into the bottle and shaken vigorously. When the borax is dissolved, the bottle is filled to the brim with water and permitted to stand in this way until needed the following morning. When the borax solution has been thrown away, and the bottles rinsed with clear water, they are ready for use. It is not necessary to boil bottles cared for in this way; and borax will be found a more satisfactory antiseptic than the bicarbonate of soda which the average mother uses in cleansing her bottles.

The nipples must be cleansed with equal care. After the feeding, a pinch of borax should be dropped into the nipple, then a little water added and the nipple gently rubbed between the thumb and fingers. It is then rinsed out and laid on a clean saucer, with a clean glass turned over it, to protect it from dust.

It is a time saver to prepare the boiled water or gruel several hours before it is to be used for modifying the milk—even the night before. It can then be placed in the quart jar, tightly covered, and set in the ice-chest.

Now comes the important hour for mixing the food. The bottles are emptied of the borax water and turned upside-down in the wire rack to drain. Next they are filled with hot water for rinsing out the borax, emptied and again turned upside-down in the rack to drain. By the time the food is mixed the bottles are cool enough to fill.

In mixing the food the process is the same whatever the proportion. The bottle of milk is turned into the pitcher so that the cream will be mixed in well. It is then poured into the glass measure and, when the right amount has been secured, it is poured back into the emptied pitcher. Next is measured the boiled water or gruel, and this is then turned into the pitcher. The sugar must be measured very carefully with a tablespoon. If a level spoonful is ordered, it must be leveled off carefully with a knife. A heaping spoonful means all that the spoon will hold. Stir the mixture together—milk, gruel or water, and sugar—until the last is dissolved. Now, using the funnel to avoid waste, pour into each bottle the exact amount of this modified milk which has been prescribed for a single feeding. Cork the bottles with rolls of clean absorbent cotton, set the bottles in the wire rack, and place it in the ice-chest.

As the hour for each feeding approaches, one of these bottles is taken from the ice-chest, placed in a pan of hot water, or in any patent bottle heater, to be warmed for the baby’s use.

It will be seen that by following this process the milk is never touched by any hand, and if the utensils are kept immaculately clean, there can be no danger from germs or contagion. And right here a word of caution: After keeping the nipple in borax water, do not test the heat of the milk by tasting it through the nipple. Never put the baby’s nipple in your own mouth or allow any one else to do so. The food should be what is known as body temperature, and it can be tested by letting a little drop upon the bare forearm. Remember that a baby’s mouth is very tender and easily burned. Never give the baby the bottle without testing the temperature of the food.

It should take about twenty minutes for the baby to drink the prescribed amount of either breast milk or artificial food. In cold weather it is a good idea to cover the bottle with a little flannel or crocheted bag, to keep it warm until the last drop is drained. Food which becomes chilled may cause colic.

CHAPTER V
FORMULAS FOR ARTIFICIAL FOODS

FORMULAS FOR MODIFYING MILK—MILK SUGAR, CANE SUGAR, OR MALT SUGAR—HOW TO TELL WHEN THE BABY IS PROPERLY NOURISHED—LIME WATER IN THE MILK—CONDENSED MILK—PATENT FOODS

Formulas for the preparation of artificial food for infants will some day form a vital feature in the practical education of girls for motherhood. Chemistry, physiology and dietetics, all subjects which are taught to young women in high schools and colleges, will contribute to a better understanding of this very important subject.

The mother who is able to nurse her child has no conception of the difficulties which confront her sister or neighbor who must raise a baby on the bottle. She should be profoundly grateful that she is spared the study and working out of food formulas by the gracious dispensation of Providence which supplies her child with the natural form of nourishment. Certainly no woman who reads the chapters of this book, devoted to the sanitary and scientific care required to carry a baby through the period of bottle feeding, will wean her baby unless such a step is absolutely necessary.

The mother whose family physician has specialized in diseases of children and infant feeding has half the battle fought for her. The physician who has made a study of artificial feeding knows exactly the proportions necessary for producing a nourishing modified milk, and the quantity to be given at each feeding. But there still remain all over the country a large number of busy and successful general practitioners who have given little or no study to formulas for infant feeding, a condition fortunately due to the fact that the majority of the mothers whom they attend nurse their babies.

Again many mothers are so situated, geographically and economically, that they cannot place the baby to be artificially fed under the constant supervision of a physician. It is for such mothers that this chapter has been written, and the material which it contains represents the best ideas of men who have long specialized on the feeding of infants.

These physicians have decided that the simple formula which includes plain cow’s milk, with the cream stirred in, water and sugar, is the best substitute for mother’s milk until the baby has passed its sixth or seventh month. Then barley or oatmeal gruel may be used instead of the water. Cream, top milk, whey, lime water and patent foods should not be used except with the approval of a physician. The mother who finds herself forced to work out alone the problem of artificial feeding, should give the simple formula a thorough trial before trying more elaborate experiments, and, above all things, before taking the advice of her neighbors.

Mother’s milk is composed of thirteen parts solids and eighty-seven parts water. The solids are fat, sugar, proteids and salts. The fat is represented by cream; the sugar by lactose or milk sugar; the proteids by the milk-curd. The fat encourages bone growth and fat in the baby’s body; it produces heat and is good for the nerves. The sugar also produces fat and heat and has a laxative effect on the bowels. The proteids go to make body cells in the blood, the muscles and the various organs. The salts are needed for bone-making. The water serves two purposes: it keeps the solids in solution so that the food can be easily digested; it forms the medium through which the body throws off its waste material.

Formulas for artificial food should follow the proportions found in mother’s milk by expert analysis. Plain cow’s milk unmodified is too rich in solids to be given to an infant. On the other hand, the nursing baby, or the baby fed on properly modified milk, does not require much plain water, as it receives an ample supply of water in its feedings to quench thirst and keep the body in good condition.

For the baby which is to be artificially fed at one month or less, plain cow’s milk, boiled water, and malt sugar form the best possible combination.

Milk sugar, once very popular with dietitians, has been condemned by specialists in infant feeding. Cane sugar is preferred to milk sugar, and pediatrists recommend most highly the Dextri-Maltose, or malt sugar, manufactured by Mead, Johnson & Company, Jersey City, New Jersey.

Having decided on these ingredients, the next problem is their proper combination in correct proportions. These are governed by the baby’s weight. In twenty-four hours a baby should be fed twice as much plain cow’s milk in ounces as he weighs in pounds; this means that a baby weighing twelve pounds should be fed twenty-four ounces of plain cow’s milk in twenty-four hours.

In preparing this quantity of cow’s milk for the baby’s consumption, it must be borne in mind that this milk contains only half as much sugar as mother’s milk, while it holds three times as much proteids and salts, and both the proteids and the fat are less digestible than those found in breast milk. This explains why water must be used to dilute the heavier cow’s milk. For the new-born baby the following proportions are recommended when what is known as plain milk is to be used:

Four ounces of milk.

One ounce, or two rounded tablespoonfuls, of Dextri-Maltose.

Sixteen ounces of boiled water.

In two or three days this formula may be changed to:

Five ounces of milk.

One ounce, or two rounded tablespoonfuls, of Dextri-Maltose.

Fifteen ounces of boiled water.

If the baby is digesting this food without trouble, about the tenth day, increase the milk by one ounce and decrease the water by one ounce.

A normal child, with whom modified milk agrees, is able at the end of a month to digest its food in the following proportions:

Eight ounces of plain milk.

One ounce, or two tablespoonfuls, of Dextri-Maltose.

Twelve ounces of boiled water.

At seven months the baby is ready to have gruel combined with the water and the milk in the following proportions:

Nine ounces of plain milk.

One and one-half ounces (3 tablespoonfuls) Dextri-Maltose.

Five ounces of water.

Six ounces of gruel—made as follows:
Two tablespoonfuls of prepared barley, wheat, or oat flour; smooth with cold water; have ready one pint of water boiling hard; add a pinch of salt; stir in the smoothed flour; cook for thirty minutes in a double-boiler, and strain through a hair sieve. Add enough boiling water to make a pint, and set it away to cool.

At ten months the child is taking modified milk in these proportions:

Thirteen ounces of plain milk.

One heaping tablespoonful of Dextri-Maltose.

Six ounces of thin gruel; no water.

Milk thus modified can be given to the child until it is one year old.

Between the first and the seventh month the increase in the amount of cow’s milk and the decrease in the amount of boiled water will depend entirely upon the condition of the child’s digestion. After the first month the increase in cow’s milk should be made quite gradually, and several days should be permitted to elapse after each change, to watch the effect upon the digestion.

The child himself furnishes a pretty fair indication of when the strength of the food should be increased. If he drains the bottle rapidly and cries when it is taken from him, or if he begins to fret anywhere from an hour to half an hour before his feeding time, and if he constantly sucks his fingers in hungry fashion, either the quantity of the food or its strength must be increased.

If the food is already too rich for the child, this is shown by indigestion, vomiting, diarrhea, or constipation. The increase in the strength of the formulas should be at the rate of half an ounce or less in three days or more for about a month after artificial feeding begins; then a greater amount of time should be permitted to elapse.

The increase in quantity should be at the rate of a quarter of an ounce at each feeding, made at intervals of four to seven days, according to the growth and appetite of the child. It will be noticed that there is a more rapid increase during the first month of the child’s life than at any other time. This is because exquisite care must be taken to start the child on the most delicate form of artificial food. Then, if modified milk does agree with the infant, it thrives and demands artificial food of increasing strength, precisely as the mother’s milk gains in strength as she gains in health and energy after her confinement.