Joseph H. Choate.

THE EDUCATION OF THE MOTHER

WHAT MOTHERS SHOULD KNOW ABOUT THE CARE OF CHILDREN DURING ILLNESS

Every child has a certain amount of vitality and resistance. When illness comes it should be our duty to maintain the vitality and resistance to the highest degree. We should, therefore, irrespective of the nature of the illness, surround the child with all the conditions that will minister to the preservation of whatever strength and vitality the child has. Experience has taught us that there are certain requirements that should be carried out in the general management of sick children.

A Sick Child Should be in Bed.—In the first place a sick child should be in bed. There is no exception to this rule. It is impossible to do justice to a child if you allow him to dissipate his strength and exhaust himself moving from place to place while he is sick. A mother should not forget that it is she who must exercise wisdom and decide what is best for her child. The judgment of a sick person is not to be relied upon, and it would be wrong to submit to the whims and fancies of an ailing child, if these are known to be medically disadvantageous to its best interests.

Quiet surroundings are essential in all acute illnesses. The nurse should be congenial to the child. If the patient demands the presence of the mother she should remain, but she should not try to entertain him or interfere with the nurse.

The clothing of the patient should be the ordinary night-dress which is worn in health. In no disease is any special kind, or quantity of clothing required.

The temperature of the room should be 68° F. Thermometers are cheap and an exact knowledge of the degree of heat in a sickroom is an essential requisite. Nothing drains the vitality during sickness quicker than varying degrees of heat and cold. It uses up nerve force and energy and renders the patient irritable and difficult to manage.

The strictest attention should be paid to the ventilation of the sickroom. We are learning more and more that fresh air is essential to the speedy cure of all diseases and to the general well-being of the patient. A direct, continuous communication between the sickroom and out-of-doors is imperative. It is a splendid measure to use two rooms for the patient and to change him twice daily, and to air thoroughly the unused room.

The sickroom itself should be large and in a quiet part of the house. In summer time the windows may be wide open, in winter months the degree of ventilation can be regulated by the thermometer.

Many mothers fail to appreciate that drinking water is an important requisite in all ailments of childhood, should be given freely, but it should be known to be absolutely pure. The same rule applies to sponging the patient. It must be done every day; sometimes it is necessary to do it more often, but if so it will be so directed by the attending physician.

The Diet of the Sick Child.—Prescribing the diet of the sick child is an important undertaking. It should be remembered that during sickness the digestive capacity is reduced; consequently the food must be lessened in quantity and in strength. If the patient is an infant at breast the best way to accomplish our purpose is to give before each feeding two ounces of boiled water, cooled to the temperature of the body. This dilutes the mother's milk and renders it more easy of digestion. If bottle-fed, it is accomplished by replacing one-half of the milk with water. In certain diseases milk is totally withdrawn, but these cases will be noted when discussing the treatment of the various diseases. With older children, we give milk diluted with water, or gruels, soups, or cereals, as conditions warrant.

Needless interference with the patient must not be indulged in. Sleep and quiet are essential features of nature's reparative process. It is seldom necessary to disturb a sick child for the giving of food or medicine oftener than every second or third hour. Medicine may always be given with food. Meddlesome interference, talkative attendants, or excessive noise may exhaust a child and may prolong and render dangerous or fatal a condition that would otherwise go on to recovery.

One satisfactory movement of the bowel daily is essential to the comfort and progress of a sick person. If this does not take place naturally, it should be obtained by an enema.

At the beginning of any illness in childhood it is a safe procedure to give a dose of a suitable cathartic as soon as it is discovered that the child is sick.

A Child is the Most Helpless Living Thing.—Nature endows the young of every species—except those of the human family—with certain instincts, which, when developed, govern and control their lives absolutely. The technical definition of an instinct is an exceedingly complicated word picture. It is only essential to an intelligent understanding of our subject that the reader should have a definite idea of the difference between an act that is the result of a process of reasoning and an act that is the result of an instinct. If a man finds his way out of his burning home he will stay out as long as there is any danger. The crudest kind of reasoning will teach this lesson. A horse, on the other hand—and incidentally it may be noted that a horse is regarded as an intelligent animal—if led out of a burning stable and let loose, will immediately reËnter and be burned to death. The horse is the victim of instinct; he obeys the unconquerable instinct to return to his stall—he cannot reason as the man can that a home that is burning is not a proper place to seek safety in. When an ostrich fears danger he buries his head in the sand, under the impression that if his head is out of sight he is safe from danger. This is his instinctive plan of procedure in the presence of danger, and it is the plan of every ostrich, everywhere, always. A little reasoning would show them how foolish the idea is—but they cannot reason. That is the province of man alone. If the first member of a flock of sheep jumps over a fence to get into the next field, every member of the flock will follow, each one jumping the fence, though there may be an open gate between the two fields a few yards away. Instinct dictates the plan to the sheep as they have received instructions from their ancestors always to "follow the lead." This is their hereditary legacy and they cannot disobey it.

Animals are born with instincts which need only circumstances to bring them out. Now a baby is not born with instincts of this character,—it has not even the instinct to help itself; it cannot find the breasts that were made for it; it is more helpless than the baby cat or dog or worm. Therefore a baby in whose brain the potential faculty of reason is slumbering must of necessity begin its career wholly dependent upon the supervision and love of its mother, until such time as it may be capable of reasoning for itself. Motherhood is therefore the supreme privilege of womanhood. It cannot be superseded, hence the fundamental factor in any system of race culture, or in any system of infant mortality, must tend to raise the quality and the intelligence of motherhood as a basic necessity. Motherhood at the present time, though the most important and sacred profession in the world, is almost exclusively carried on by unskilled labor. The maternal instinct is deeply rooted and universal; its absence must be regarded as an abnormality, or as a product of misdirected education. The requisites for the mothers of the future should be absolute physical health and love of children.

If nature endowed a baby with instincts there would be no need for reason or education. Education cannot teach a cat how to nurse or wash a kitten any better than it does,—its instinct is good enough. The mother of a human baby, however, is not born with the instinct which enables her to care for her baby equally as well as the cat cares for her kitten. She must be educated or taught to care for it. She can then care for it better than the cat cares for the kitten, and she can be taught to bake, to sew, to read; to play on the piano, which a cat cannot be taught. So while a baby may be the most helpless living thing at one stage of its career it has in it—in the faculty of reasoning—the ability to become the Lord of all the Earth and of all the animals therein. To limit the environment of a child by imposing instincts upon it, would be to limit its inherent freedom. To be obliged to obey a prescribed instinctive law would rob mankind of his creative or reasoning faculty, and that would be to lower him to the level of the brute creation. Reason is of no use if our acts are already determined for us. There are therefore good reasons why the human baby should be, at the moment of its birth, the most helpless living thing; and as a consequence it is imperative, if the eugenic ideal is worthy of attainment, that every baby should have the benefit of trained and efficient care and education.

THE DELICATE CHILD

There is a certain standard by which we measure the physical and mental development of children. This standard we regard as the evidence of normal development. Some children exceed these requirements; they are bigger and stronger at a given age than the average child at the same age. There are other children who cannot be called sick, but who are physically and mentally inferior to the average standard, whom we designate as "delicate." These children are not as big, or as strong, or as heavy, as other children of the same age. They are born with a reduced vitality, or through mismanagement in early infancy they have acquired a subnormal standard of development. Children born of parents who are not of standard vitality are predisposed to be delicate. If the parents are of average development, and the delicacy of the child is acquired by mismanagement, the proper dietetic and hygienic management will, as a rule, promptly result in a satisfactory restoration to normal health.

Treatment.—When a mother awakes to the knowledge that her child is delicate; when she understands that her child's vitality is not what it should be, and when she resolves to "do something" in the interest of her child, she is on the right road, and we hope to encourage her in the good intention. We would however tell her that her effort must be thorough, and that she must be patient and persevering. If she does not falter in well doing she will succeed beyond her expectation, and the satisfaction she will experience in noting the evidences of returning health and strength in the appearance and conduct of her child, should be ample recompense for the effort made and the time bestowed.

She must begin with a definite knowledge of just what she intends doing; she must know, however, what must be done and she must begin at the beginning and build from a sure foundation. It is therefore absolutely essential to ascertain if there is any actual disease underlying the reduced vitality which is responsible for the delicacy of the child; this necessitates a thorough examination by a competent physician. If you are assured there is no disease present, no tuberculosis, no syphilis, no malaria, and that debilitating conditions, such as adenoids, sexual abnormalities, the results of self-abuse, skin disease, do not exist, then certain fixed rules can be laid down, and definite principles followed in the daily management.

Weight, as a Standard of Development.—It has been stated elsewhere in this book that one of the safest guides to follow, as to whether a child is thriving, is its weight. This can be relied upon as a general rule. A child should therefore be weighed regularly every week. If it is not gaining an average of four ounces weekly it is not thriving up to standard. When the average is below four ounces there is something wrong with the quality or quantity of the food.

How to Feed the Delicate Child.—If the child is breast-fed and the weight standard, as evidenced by the weekly averages, is persistently below normal, we must find a substitute for the mother's milk. If the child is bottle-fed and it is demonstrated that it is impossible to maintain normal development on cow's milk, a wet-nurse should be obtained. After the child is weaned, or put upon a more liberal diet, milk should continue to be the chief article of diet. From the first to the third year a child should take one quart of milk daily in addition to the other food. There are some children, however, who seemingly cannot take milk without getting indigestion; they should be put on skimmed milk, to which may be added a small quantity of sugar to make up for the loss of fat. Mothers must be certain that too much milk is not given, or the desire for other necessary food will diminish.

After the first year it is a very good plan to give one teaspoonful of scraped beef daily. If this is well borne, two may be given and later three. It can be given immediately before the regular feeding of cereal and milk. From the twelfth to the sixteenth month eggs may be given: at first one-half, and later a whole egg mixed with bread crumbs. Various vegetables should also be given cooked in the form of a purÉe. If at any time the child should refuse the food, or act as if it had no appetite, leave the milk out of the diet; this may then restore the appetite and it will take the other food freely; the milk can be resumed later.

As the child grows older, the distaste for milk may grow, or he may be one of those children with whom milk really does not agree; in either event, do not hesitate to leave it out of the child's dietary. These children should be encouraged to eat plenty of good butter on their bread and crackers. Butter will not only agree with them, but it will supply any fat deficiency in the general diet. The diet may now consist of milk (unless it disagrees), cereals cooked three hours, raw or rare meat, poultry, eggs, vegetables, purÉes, cooked and raw fruit, bread, crackers.

How to Bathe the Delicate Child.—Regular daily baths are particularly of benefit to the delicate child, despite the prevailing fear that they may catch cold. The salt bath is advised and the time to take it is just before retiring. The room should be warm and the temperature of the water should be 90° F.: it should not last longer than five minutes, and the water should be cooled down to 70° F., before the child is removed from the bath. While the cold water is running in, the surface of the body should be briskly rubbed with the mother's hands and after removal the child should be dried with a fairly coarse bath towel to ensure a good reaction. Very delicate children need not have the temperature of the water reduced; others may stand water of 80° F., but no lower. In the poorly nourished it is frequently advantageous to rub the body, after drying, with olive oil or goose oil. This aids nutrition and because of the massage it aids circulation. In some older children a daily cold spinal douche seems to act particularly well. If the child does not promptly react from the effect of the cold water it is best to discontinue it.

Airing the Delicate Child.—Delicate children should, above all things, be assured of the maximum amount of fresh air and sunlight. Many mothers entertain the idea that these children are disposed to take cold easily, if in the open air,—which is not the case. All children need an abundance of fresh air and the delicate need it particularly. The season of the year and the character of the weather will, of course, dictate just how much open-air exercise they may take.

If the weather is very cold and the air damp, or if there is a very cold high wind, it is best to remain indoors; otherwise the child should remain out for four or five hours. Indoor airing is obtained by dressing the child to go out-doors, putting him in his carriage, and leaving him before an open window in a room of good size with all the doors closed so as not to create a draught.

Habits of the Delicate Child.—The amount of sleep necessary for a delicate child is the same as for a normal child of the same age. The room should always be well aired, night and day, and should be devoted to the exclusive use of the child.

These children should never be allowed to sit on the floor. It is always a difficult matter to avoid this, but it must be religiously guarded against; otherwise a cold is the inevitable result.

A change of air is sometimes advisable and essential, especially during the hot, humid weather of July and August. Much better results will be obtained by sending these children to the mountains than to the seashore.

Delicate children should always be clothed warmly, but not too warmly. The feet and legs must always be kept comfortable. Moderate exercise, short of fatigue, is necessary. A midday nap after the noon meal should be taken every day. The child should be undressed and put to bed for two hours and left there, whether it sleeps or not. This applies to delicate children of all ages.

The education of delicate children should be postponed until the health is restored. They should, however, be made to obey and they should be taught good habits. When school work begins it should be made light and easy. They should not go to school before the eighth year, and then not unless physically fit. They should not play at rough games or with rough companions, though it is not wise to shield them too much. Their habits and peculiarities should be studied and every possible effort made to direct them kindly and wisely so that they may contribute to their own upbuilding.

A systematic observance of these suggestions will save many lives and will aid very considerably in producing stronger men and women. Infinite patience, tact and self-sacrifice is necessary, but the results in every case justify the measures adopted.

Indiscriminate Feeding: Poor Appetite.—In considering many of the diseases of childhood the term "indiscriminate feeding" is used. An explanation of just what is meant by this will be of decided advantage. There are two fundamental essentials in the successful feeding of infants and children: regularity and suitable food.

A child whose feeding intervals are not regular and whose food is unsuitable is a victim of indiscriminate feeding.

The lack of observance of the regularity rule always leads to loss of appetite and indigestion.

Loss of appetite is a serious condition in a growing child and may give infinite trouble. Indigestion in a growing child is unnecessary, unfortunate, and frequently is the one factor that spoils an entire life. It is unnecessary, because it means and is caused by neglect on the part of the mother; it is unfortunate, because it always paves the way for any serious ailment that is epidemic or "in the air"; and it is important, because it very frequently weakens the stomach and renders it unfit for normal digestion for a long period, if not for life.

If for some reason a child's appetite becomes poor and it is not properly managed until the appetite is restored to normal, indiscriminate feeding is always the result.

The reason for the poor appetite may be because the child is kept indoors too long, or because it is being fed on unsuitable food, or is living in unsanitary surroundings, or many other reasons, sometimes trifling reasons, may cause it. When a child will not eat at meal time, the mother feels that it should eat sometime, so she encourages it to eat between meals, and because of a mistaken kindness she breaks the law of regularity,—a law that can never be broken without serious results following. A child in this condition becomes a disturber of the peace; the parents can do nothing with him; he insists on eating just what he likes and when he likes; and he chooses, as a rule, candy, cake, pastries, ice cream, tea, coffee. Indigestion follows, the child loses weight, is languid and listless and constipated.

When finally the physician is called in he finds it necessary to go back to first principles. He lays down the law in a definite, stern way, and the mother and the child must obey. Most parents know and admit they are doing wrong to give in to a whimsical child, and if they would only make up their minds to conquer when conquering is easy they would save themselves many heartaches, many regrets, and the child much suffering and much possible permanent injury as a consequence. Usually one parent is willing to be master but the other lacks the mental equipment to meet the issue, and argues, as he or she imagines, in favor of the child. The parent whose instinct is correct, whose judgment is true, whose interpretation of the situation is just, should not be dissuaded, or argued away from his or her duty. If it is the first real problem in your domestic experience in which a decided stand must be made, make it without fear and without hesitation, and carry it through to the bitter end. Results will justify and vindicate you.

The general treatment of these children will be found outlined in the following paragraph on Loss of Appetite.

Loss of Appetite.—If a child complains of not being hungry, and will not take enough food, and if this condition continues for some time, we must regard the matter as being abnormal and find the cause. This is necessary because a child must eat in order to maintain a certain standard of growth and vitality. These children are not sick; they are active and continue to play as usual and they sleep soundly, but they have no appetite. One of the most frequent causes of this condition is too frequent feedings. Some children are naturally small eaters. They thrive and maintain a satisfactory weight; their system seems not to demand large quantities or even ordinary quantities of food. Parents observe this habit of little eating and begin to coax and bribe the child to eat more at meal time, and to eat between meals. In this way the child really overeats, the appetite becomes capricious, and the stomach rebels. In a very short time the condition of "loss of appetite" is established as a consequence. Another cause is the drinking of too much milk, and yet another and very common cause is indiscriminate eating of candy, cakes crackers, and fruit between meals. Children who are fed at the table with adults eat things they should not eat, and spoil their digestive organs and loss of appetite is the result. The Scotch custom of compelling children to eat at a separate table is an excellent one. They are not tempted to ask for things they cannot have. Lack of fresh air and exercise frequently results in impaired appetite.

Treatment.—The very first thing to do with these children is to stop any habit that may be responsible for the loss of appetite. If the child has been eating between meals, stop it absolutely. If too much milk has been taken, stop milk entirely. If the child has not been getting enough fresh air, or if it has been sleeping in a badly ventilated room, or if baths have been too infrequent, rectify the fault. If eating at the family table and fed indiscriminately, change the programme; feed him before the family sits down to meals. Now regulate the time of feeding to suit the age of the child and adhere to strict regularity. It is a pernicious and absolutely wrong custom to force children to eat, or to coax them to eat when they do not want to eat. Loss of appetite will never be cured by forced feeding, or by reducing the interval between feedings, or by giving the child stronger or more concentrated food under the mistaken idea that in this way the loss of appetite can be "made up." The interval of feeding should rather be lengthened than otherwise in order to give the digestive organs an opportunity to regain the normal desire for food. Pay strict attention to the bowels. Be certain the child has a daily satisfactory movement and that he drinks frequently between meals.

If the child does not promptly respond to the proper hygienic and dietary treatment as outlined above there are two things that can be done:

1st: Send the child away. A change of scene and climate will sometimes work like a charm in these cases, and will, after a reasonable length of time, establish a permanently good appetite.

2nd: If this is not possible, as sometimes it may not be with poor patients, then we can give the child suitable tonics.

Overeating.—The large majority of individuals eat too much. Most of us would enjoy better health, better spirits, and greater efficiency if we consumed from one-third to one-half less food than we habitually do.

Every living organism requires a certain amount of nourishment according to the work performed and to replenish wear and tear; when food is supplied in excess, the system cannot utilize it, but it is compelled to rid itself of the excess in some way. The work involved in this eliminating process is exceedingly detrimental to the various organs and to the individual. To overeat is to overwork, and to overwork a machine or an animal is not only poor economy but bad judgment. If the digestive apparatus is required to work overtime, it is a self-evident assumption that the various organs will not digest efficiently the food necessary for ordinary existence. If the necessary nourishment is not adequately digested, the general health will suffer as a consequence. If the general health is below standard the individual will not be competent to carry on the requirements of a normal, healthy life.

We must, however, give some thought to the effect which the excess of food exerts upon the human machine.

Nature provides and maintains a standard relationship between the capacity of the individual and his needs. A child has a digestive capacity to digest and assimilate a quantity of food sufficient for his growth and proper nourishment; an adult maintains the same standard according to his requirements. All the other organs are adjusted to harmonize with this scheme. If we overeat, the immediate result is to disorganize this relationship between the various organs; hence we have a multitude of effects which manifest themselves in various ways as a direct result of overeating. The combined general effect expresses itself in the form of what is regarded as poor health and a low standard of efficiency. When a larger quantity of food is taken into the stomach than it can properly digest within a reasonable time, two conditions immediately follow. The stomach itself is dilated and the food is not thoroughly digested. If the habit is persisted in, indigestion, and later chronic gastritis ensues. The direct symptoms of these conditions are given in detail in another part of this book. Very few individuals, however, appreciate the indirect consequences of overeating and of indiscriminate eating on the general health. It is impossible to tabulate in so many words the effect which this habit has on efficiency and temperament. We read and hear a great deal to-day about efficiency. Now, an individual's efficiency is an expression of that individual's health standard or capacity. To be 100 per cent. efficient one must enjoy good health. It would be absurd to expect a high standard of efficiency from an individual with a low standard of health. Poor health means poor vitality. Vitality is the mark of the master. Without vitality one can never dominate. All the great achievements of the race have been consummated by those who conserved their vitality. No single factor contributes a larger percentage of inefficients and failures than overeating. The man or woman who, from habit or experience, has learned the lesson of right eating and living need not be lacking in efficiency, nor need they despair of the attainment of success.

Symptoms of Overeating.—Efficiency depends not only upon one's capacity to perform, but upon the character of the performance. The spirit must be willing to perform. The overeater is heavy, phlegmatic, indifferent, lacking in energy, tact and initiative. She is constantly subjecting her system to needless overwork; she is depressed, nervous, imaginative and she is not ambitious. She is a victim of self-poisoning, of constipation, indigestion, headaches, flatulency, neuralgia, vertigo, and melancholia. An overeater never enjoys good health, never is efficient, and cannot possibly be successful.

To enjoy good health one should know how to select food and how to combine and proportion it. It has been said that the American people are a race of dyspeptics, and it must be admitted that the assertion is more or less true. There are millions of people who suffer from indigestion in some degree, and it may justly be said that indigestion has its beginning in overeating, in some form. It may not be overeating in actual bulk, but it is overeating some article or articles that do not agree with the individual, and the fact that certain articles do not agree is unquestionably dependent upon the nervous temperament of the American people—and the temperament of a people is a product of the kind of existence the people subject themselves to. We are, therefore, unwittingly, victims of our environment.

Correct eating means simple eating—only a few things at a time. Food should be selected according to one's age and occupation, and according to the season of the year. To eat habitually large quantities and at the same time a large variety is suicide pure and simple. If one dared to make the experiment of cutting down one's diet one-half, it is absolutely certain the effect would be immediate benefit. The benefit would not only be manifest in the physical betterment, but the efficiency and general well-being would be greatly enhanced. It is not the kind of food that makes a dyspeptic, but the quantity. A well person need not consider whether a certain kind of food will or will not agree, providing she does not eat too freely of that food, or combine it with other food. The combination of which may in itself form too much of one kind at a time.

Some people imagine, for example, that oatmeal porridge does not agree with them. When the matter is inquired into, however, it is found that they habitually eat bread, eggs, and other articles, with coffee at the the same meal with the porridge. From this combination they experience distress and blame the porridge. If these would take a plate of oatmeal porridge with cream and salt, and some stewed fruit for breakfast they would not experience any trouble, and this would be an ample meal for the ordinary individual. It is not the porridge, but the unsuitable combination, that is at fault. The same may be said of milk. Many people state that they cannot take milk and they deprive themselves of one of the very best articles of diet because of this idea. There are very few people in the world who cannot take milk in some way. It is not the milk that is at fault; it is the combination of it with other less nutritious articles that is the cause of the distress. Even candy is responsible for thousands of cases of indigestion. Anyone may safely take a reasonable quantity of good candy, but if it is taken at a wrong time, or combined with other articles, it may readily produce indigestion.

Indiscriminate eating and overeating are prolific causes of rheumatism, kidney disease, heart disease, liver troubles, obesity, arteriosclerosis, and apoplexy. These diseases are notoriously on the increase and must be construed as a direct consequence of the tendency of the American people to overeat and to eat indiscriminately.

Bran as a Food.—In the chapter on constipation there may be found a formula for making bran muffins. These muffins are invaluable to children in health, and to the victim of indigestion or constipation, whether child or adult. One muffin with each meal will solve the problem of constipation in growing children without the use of drugs or other aid. They will regulate the bowels of adults in many instances without resorting to drugs.

Raw fruit in season, or stewed fruit, or a baked apple, with a light boiled egg and one bran muffin, is an ample and a nourishing breakfast for a child at school.

For lunch the same child should have a plate of thoroughly done vegetable soup, a bran muffin, and more fruit. After school, a glass of milk with two or three Graham wafers may be given.

For dinner the child at school may have a mixed meal. This meal should not be later than six-thirty o'clock and the child should retire at eight-thirty at the latest. A bran muffin should be taken with this meal unless the child's bowels are too loose.

Mothers should insist on their children eating these muffins. If a child eats only what it likes it will not eat what is good for it. If the mother insists in the right way she will win; if she does not the child will win. If the child wins, the mother is the wrong kind of mother. I do not know of any other single article of diet that is of such value to growing children as these bran muffins. Children who eat them regularly will have less sickness than other children; they will be strong, healthy and full of energy. The bran in itself is not responsible for this list of excellent acquirements, but the regular eating of the bran is. Most ailments of children are of gastro-intestinal origin; bran keeps the entire length of the gastro-intestinal tract sweet and clean; if the child eats a bran muffin with each meal it will not have much desire or much room for any other form of bread or pastry. If white bread or pastry is abstained from the child will not have indigestion, or constipation, and hence it will not be constantly poisoning itself as most children do whose diet is not restricted and whose bowels are more or less constipated.

These muffins should be made of the ordinary unsifted bran. If this is not procurable the sifted bran (Johnstone's) may be employed. This bran may be bought in any good grocery.

Modern milling methods, modern cookery, and modern methods of forced farming, have each contributed their share of rendering food inert and frequently deleterious. The miller has extracted the coarse cellulose from the various flours in the effort to manufacture a product suitable to the super-civilized public demand. This cellulose is absolutely essential to gastric and intestinal digestion, and if children are deprived of it constipation and indigestion are the natural result. Forced farming accomplishes the same effect—the fiber of the vegetable is deficient. Bran is rich in mineral salts, iron, protein, and phosphates, and gives to growing children the ingredients which ordinary food is deficient in. Bran prevents intestinal fermentation and children who eat it are free from intestinal gas and putrefaction. It harmonizes chemically with all other foods. Children should be made to take it every day as a matter of self-preservation and of duty.

Hysterical Children.—Hysteria is not a disease of infancy or of young children. It is seen as a rule after the eight year. Male as well as female children may be the victims to an equal degree. It is much more frequently seen in the offspring of parents who are themselves nervous, or alcoholic, or who suffer from insanity, or have insanity in the family history. If these children in addition to the hereditary influence suffer from stomach or intestinal disease, or general poor health and are overworked at school, they are very apt to become hysterical.

They are capricious, indifferent, and excitable. Their disposition is irritable; they frequently exhibit fits of great excitability of temper and passion. They cry or weep without cause. They often have hallucinations and while asleep have attacks resembling night terrors. They complain of pains in the joints, and are frequently treated for disease that does not exist. Such condition as hysterical cough, spasm of the muscles of the face, mouth, eyes, and of the neck exist and are difficult to diagnose from real disease. These children complain of painful sensations and sensitive areas and exaggerate all symptoms unnecessarily.

The possibility of curing these patients is good, providing the treatment is faithfully carried out. It is less favorable when marked hereditary influences are strong.

Treatment.—In all children of distinctly nervous type and especially those of nervous parents, the first essential duty is to develop their muscular system. Try in every way to make healthy animals of them. Attention and treatment should not be directed toward the nervous system. If the child is made strong by out-door life, good plain, digestible food, early hours, regular sleep in thoroughly aired rooms, regular bathing, and if the school work is conducted with moderation and judgment, the nerves and the nervous temperament will participate in the healthy growth which will follow as a result. Tea and coffee should be forbidden. Exciting books and questionable entertainment as given in picture shows and theaters must not be allowed. If older members of the family, or parents, are excitable and nervous the children should be sent away to the country from them.

They should be put in charge of a person who will exercise firm control over them. It may be necessary to take these patients away from other children, and isolate them under proper control until they are able to control themselves. They should be interested in exercise that compels them to work; they should live and if convenient sleep out of doors; and they should take iron or cod liver oil, or any other indicated tonic. If they complain of pain they should receive cold-water douches, or the cold pack, or the shower bath; and they should be put to bed and treated firmly but kindly. Attention to the bowels is always essential, because these children are as a rule the victims of chronic constipation.

What a Mother Should Know About Cathartics and How to Give a Child a Dose of Castor Oil.—Broadly speaking there are three kinds of cathartics. I will, in a simple way, explain their action so that a mother may know which one to select under certain circumstances. Frequently a mother is told by her physician to "keep the bowels of her child open." Few mothers know how to keep the bowels open, and as this is an important matter, every mother should know the reason why "any" laxative or cathartic is not always suitable.

Castor Oil.—This is one of the oldest and one of the best cathartics we possess for children. It is a mechanical cathartic; it acts in exactly the same way as a street-cleaning machine. It cleans the street by sweeping or pushing everything before it.

Calomel—This is a chemical cathartic. It acts through the blood. When it is absorbed by the blood its chemical ingredients act on certain nerves as irritants. These nerves excite the liver and bowel to action and an evacuation is the result.

Citrate of Magnesia.—This is a saline laxative. It acts by drawing out of the bowel wall enough liquid from the blood to sweep the contents out. It may be likened to the street cleaner who flushes and cleans the street by means of a hose pipe attached to the water hydrant.

Under what condition should a mother use these remedies? Castor oil is ordinarily the best cathartic in childhood; it is not, however, always the best. Most ailments of children are of gastro-intestinal origin—they have either overeaten or they have eaten the wrong kind of food. The stomach and bowel are overloaded: they must be cleaned out. We want a mechanical cathartic, one that will push everything ahead of it, so we use castor oil. When a child needs a cleaning out, use castor oil. By a "cleaning out" we mean, when we know he has eaten too much of a questionable variety of food, as pastries, cakes, fruit, ice cream, etc., as children do at parties; or when he has eaten unripe fruit, as green apples, etc.; or when for some reason he is constipated and complains of not feeling well, use castor oil.

If you decide to use castor oil, use enough. A large dose will act promptly and with less pain and with more certain results than a small dose.

It is always safe and it is always best to decide upon castor oil as the proper remedy, if the child has no fever. If he has a fever he will most likely vomit castor oil when another kind of cathartic would stay on the stomach.

Castor oil works more effectively, more thoroughly, and is less likely to be vomited if given on an empty stomach, so we give it two hours after eating and we give no food for two hours after it is taken.

Castor oil is distinctly of advantage in many chronic diseases of the intestines because of its healing properties. In chronic colitis, for example, when the child is suffering with malnutrition, irregular bowel action with an odor, and mucous or bloody stools, a combination of castor oil and salol, in emulsion, in small doses,—to which a small quantity of opium may be added or withheld according to the frequency of the movements,—with an occasional colon irrigation, is sometimes invaluable.

Mothers must remember that castor oil is not good in the treatment of constipation, because its after effect is to constipate, consequently we would not use it "to keep the bowels open,"—it is only of use to clean the bowel out thoroughly when that is indicated.

How to Give a Dose of Castor Oil—The best way to give a child castor oil is as follows: Place the bottle containing the oil on its side on a piece of ice in the ice box; chill it thoroughly. Take a tablespoon and smear it with butter; pour the ice cold oil into the spoon; it will stick together like a piece of chewing gum and it will slide out of the buttered spoon in one lump. In this way it will not spread over the mouth and teeth and throat, leaving a bad taste, but will go straight and surely into the stomach. The child cannot swallow some and retain enough in the mouth to sputter it all over itself and only get half a dose; it will not nauseate it, because it practically is tasteless if given cold, and the stomach will tolerate the cold oil much better than when given in the ordinary way.

A baby can be given oil in the same way, but in smaller doses. When the teaspoon is put into the mouth of a baby it should be immediately turned on its side so that it will keep the mouth open. If the nose is held closed and the mouth wide open for a few seconds the baby cannot spit the oil out—it must swallow, and if the oil sticks together as cold oil will, it gets the whole dose. It usually takes two persons to give a baby a dose of oil—one to open the mouth and give the medicine, the other to hold the nose and arms.

Calomel.—The general indication for calomel is fever. When a child develops a disease it immediately gets a temperature, and very frequently the fever is quite high because the slightest ailment gives a child fever. When fever begins, digestion practically stops, it is therefore imperative to clean the whole gastro-intestinal canal; otherwise the undigested material will putrefy and poison the entire system and render the disease more serious than it need be.

Now we select in such conditions calomel for two reasons:

First, because the presence of fever indicates that infection of the blood is taking place; this may come either from the intestinal canal itself, or from the germs of the disease with which the child is suffering. Since calomel acts chemically through the blood it is the cathartic indicated.

Second, because a cathartic like castor oil does not act through the blood and it would most likely be vomited by a fevered stomach.

Certain conditions indicate calomel; biliousness and jaundice, for example, because it has a specific action on the liver and if the liver is at fault calomel is the proper remedy.

Calomel is best given in small divided doses, 1-10 of a grain every half hour, for ten doses. It is best given combined with soda; every drug store carries tablets of calomel and soda for this reason.

Calomel should never be given in the treatment of constipation, nor should it be used indiscriminately by mothers, as much harm may result. It has its specific use as indicated above, but it should never be used under any other circumstances.

Citrate of Magnesia.—This is a mild laxative. After the bowels have been thoroughly opened with castor oil or calomel, small doses of citrate of magnesia may be given for a few days, "to keep the bowels open." There is no danger or harm in its use if used for this purpose. It must not be used, however, in the treatment of constipation of children for the simple reason that you cannot cure constipation by the use of drugs of any kind. Laxatives of this type have become a national curse. Adults, especially women, use them constantly. All these advertised saline laxative waters work by weakening the blood—when a dose is taken the chemicals in it draw through the bowel wall blood serum, and produce, because of the excess of this watery fluid, large, and frequently many, liquid movements.

If this practice is continued, as it often is every day, the quality of the blood will suffer seriously, and many individuals are the victims of neuralgic pains, headaches, nervousness, insomnia, anemia, and general broken health as a direct consequence of this pernicious habit.

Mothers will try to remember, therefore, that drugs and saline waters have no place in the treatment of constipation in children or themselves. Constipation must be treated by diet, exercise regular living and by the observance of hygienic and sanitary common-sense rules.

VACCINATION

Time for Vaccination.—The best time to vaccinate a child is during the first three months if he is healthy. The reason for selecting so early a period is because the constitutional disturbances are much less at this time than in later childhood. It should not be done during active dentition. If the child is delicate if his nutrition is bad it should be deferred until a later time. Children suffering from eczema or from any skin disease or those syphilitic should not be vaccinated until it is compulsory, or until exposed to small-pox.

Methods of Vaccinating.—It is customary in America to vaccinate at one point rather than to make a number of inoculations as is the custom in some other countries. The leg or the arm is the usual location selected. In infants the sore can be protected better on the leg; in children of the run-about age, the arm is the better location because it can be kept at rest easier.

Before vaccinating the skin should be rendered surgically clean; this can be done by washing with soap and water, drying and then rubbing with alcohol. The wound should be left uncovered for about twenty minutes to dry, it may then be covered with a bandage, or with a vaccine shield. The part should not be washed for twenty-four hours.

The Symptoms of Successful Vaccination.—Nothing is noticed until the third or fourth day, when a red papule appears. In the course of the following day a vesicle appears; this vesicle enlarges until it reaches its full development on the ninth day. The size of the vesicle is about one-half inch in diameter; it is surrounded with a reddish inflammatory area for about two inches. The vesicle begins to dry and is shortly a dark crust which remains from one to three weeks and then falls off. It leaves a bluish scar which soon turns white and the part is roughened and honeycombed. During the period when the vaccination is at its height the child suffers from fever and irritability and loss of appetite.

If vaccination does not "take" in an infant it should be done two or three times and if then unsuccessful it should be repeated every year until it takes. The fact that vaccination does not take does not imply that the child would not take small-pox but rather that the vaccine used is not suitable. There are some children, however, who seem to be immune to vaccination.

Sometimes the symptoms are more severe than those enumerated; this seems to depend upon the susceptibility of the child. The vesicle may be much larger and the area of inflammation much more dense and angry. The fever may be higher and may last longer; there may be a general rash and the degree of depression more profound. Vesicles may be produced on other parts of the body as a result of scratching. Mothers must always remember that vaccination is a surgical wound to begin with and that it is capable of infection in the same way as are other wounds, and that any result coming from such an infection is not due to the vaccine or to the process of vaccination, but to the infection. Many people get unjust ideas about vaccination from just such cases. If the mother is not cleanly or neglects the vaccinated area and permits it to become infected she must not and others should not decry vaccination as a consequence. Anyone who doubts the virtue of vaccination is condemning himself; he is simply ignorant of the accumulation of evidence in favor of it and assumes a position without any possible justification. The mortality of vaccination is stated by Voigt from statistics to be 35 in 2,275,000 cases. In fact, all the deaths are from causes which are preventable and no doubt the result of direct carelessness on the part of the operator or the mother.

Treatment.—The mother must understand in what way she may contribute to the successful termination of a case of vaccination. She should see that the part upon which the child is to be vaccinated is absolutely clean so far as she can make it with soap and water. She should see that the part is allowed to dry thoroughly after vaccination. She should not wash the part for at least twenty-four hours. If a vaccine shield is put on she should not disturb it. If the mother is prepared to do her part faithfully a vaccine shield is not necessary from a medical standpoint and in some cases it is objectionable. A simple, clean bandage is all that is necessary. It is very important that the child be kept from scratching the part; most of the troubles of vaccination come from this habit. It is desirable that the limb should be kept at rest during the stage when the process is at its height. If the vesicle discharges it is necessary that the area should be kept clean and dusted with boracic acid. If the wound becomes infected it must be treated by a physician. The mother must not resort to home remedies in such cases unless she is prepared to take the consequences, which may be serious.