Handbook for wives and mothers in India

Preface

The subject of this book is principally the prevention of disease in mothers and their children during their sojourn in a tropical country, and it embodies the result of many years' experience in India.

I have ventured to write it, trusting that it may be of use not only to Wives and Mothers, but also to nurses and others, who in these countries are ofttimes left alone to face difficulties and responsibilities for which their training has not sufficed to prepare them.

Some compromise was necessary in consideration of these two classes of readers, but as far as possible, stress has been laid upon general practical methods of preventing and meeting disease, rather than upon the employment of drugs and medicaments.

Prevention is at all times better than cure, and the mother who first of all cherishes her own good gifts of health, and then carefully regulates her child's life from birth onwards, will have done much towards conquering the tendency to early collapse and death so striking among the foreign children in a tropical country.

PREFACE.

I have not attempted, within the circumscribed limits allowed me, to deal fully with the diseases of children ; there are several excellent books devoted entirely to that subject, which can be consulted if necessary.

Many other omissions there are, necessitated by the exigences of space.

It remains to acknowledge my indebtedness to those who have helped me in this labour, and to certain authors, Miiller, Goodhart, Eustace, Smith, and others, to the recent editions of whose books reference has been made from time to time.

My thanks are also due to others whose books and teaching have influenced my own mind and practice,, and who may therefore have been unconsciously reproduced in the pages of this book.

MILDRED E. STALE Y, M.B., L.M.

PART I. Page

('hap. I.— General Hygiene.— The Home and its

Surroundings — The Dwelling House ... 1—7

1 1. — Drinking-water. —Filters— Milk • — Conservancy ... ... ... ■ — 12

III. — Personal Hygiene. — General Considerations — Effect of Climate on the Bodily Organism — Diet — Exercise and Fresh Air — Clothing— Bathing— Sleep — Rest ... 12— TA

iv.— Some Common Indian Diseases.

Sunstroke — Chills — Malarial Fever — Dysentery — Enteric or Typhoid Fever ... 22 — 34.

v —Some ' Common Indian Diseases.

— Constipation — Congestion of the Liver

— Diarrhoea — Piles — Dyspepsia ... 35—43

, vi.— Management of the Sick and application Of Remedies.— The Sick-room — Baths — Fomentations — Enemas — Diet of the Sick — Food recipes for Invalids — Disinfection and Disinfectants ... 14— fil

Part II

< n.\ i'. i.— The Prevention of Women's Diseases. — Preliminary Observations — Structure and Use of Female Eeproductive Organs — Crowding o£ the Pelvis — Ovulation and Menstruation ... ... 02— G!>

VI

CONTENTS.

Chap. II.— Abnormal Menstruation.— Irregular Slensts — Profuse Menstruation — Ceasing of the Menses — Painful Menstruation — Climacteric or Menopause

„ HI. —Some Common Diseases of Women and their Treatment.— LeueorrhuM or " Tlie Whiles" — Congestion ami Inflammation of the Womb— Displacements of the Womb — Itching of the Vulva — Bladder Troubles

IV.— Nervous Exhaustion (Neurasthenia) and the Results of Pelvic

Disease. — General Surroundings— Mental Hygiene — Host — Clothing — Bowels — Exercise and Massage — Special Exercises 8s— lou

,, V.— Sterility : Its Cause* and Remedy ... lol — 10+

Part III

Chap. I.— Pregnancy and Parturition.— Preparation for Pregnancy — Ideal Pregnancy — Heredity and the Development of the Embryo ... ... ... If — 110

,, II.— Duration of Pregnancy.— Signs of

Pregnancy — Omission of Menstrual Periods — (iastric Disturbances — Changes in the Breasts— Enlargement of the Abdomen— Irritation of the Bladder ... 110— in;

„ II!.— Management of Pregnancy.— Diet- Clothing — Exercise and Massage — Bathing — The Bowels— The Breasts — Sleep and Best— Mental Hygiene ... ... lM— 130

„ IV.— Ailments of Pregnancy.— Excessive Vomiting — Acidity and Flatulence — Palpitation of the Heart— Fainting Fits — Constipation — Diarrhoea — Dysentery — Headache* — Neuralgia — Sleeplessness —

CONTENTS.

vii

Page.

Salivation — Hysteria— Pruritis— Varicose Veins — Inflammation in the Breasts — Bladder Troubles— Chronic Uterine Disease and Leucorrhoea (Whites) ... 131 — 1411 Chai>. v.— Evil Consequences.— Haemorrhage —

., VI. — Labour. — Preparation for ... ... 150—163

,. VII Labour.— Signs and Progress of ... 161-168

, VIII.— Labour.— The Management of ... 168— 178

ix.— Emergencies 1 of Labour.— Delayed Labour — Rupture of the Perineum — Misplacements of the Child — Convulsions — Retained After Birth — Flooding — Death of Foetus— Still-Births ... 178—188

, X.— Lying-in Period.— Its Complications— The Discharge — The Bowels — Piles — White Leg ... ... ... 18!)— 197

„ XI. — Nursing. — Care of the Breasts and Hints on Nursing — Regularity in Feeding — Refusal of the Breast— Deficiency of Milk — Sore Nipples — Inflammation of the Breasts — Abscess of the Breasts— Procedure in case of Child's Death ... ... ... 198—205

Part IV

Chap. I.— The Newborn Infant.— Premature Infants—The Bath— Baby's Toilette— Wardrobe— Stools— The Urine— The Skin ... 207— 219

„ II.— The Feeding of Infants.— Breast-feeding — Wetnursing — Weaning ... ... 220 — 226

,. III.— Artificial Feeding.— How to administer the Feed — Cream — Whole Milk — Peptonized Milk— Condensed Milk— Egg Diets... 227—237

„ iv.— The Development of Infants. —Position when sleeping— The Abdomen — Weight and Size of Child— The Head— The Brain — Teething — Speech — Routine ... 237 — 252 viii

CONTENTS.

Chap, v.— Ailments of Infancy.— Drugsing— Early Signs of Disease— Bleeding from the Navel — Convulsions — Ophthalmia— Jaundice— Thrush— Skin Rashes ... _ 252— 268

vi. — Ailments of Infancy. — Digestive

Disorders — Flatulence and Colic — Vomiting — Constipation — Green Diarrhoea — Acute Diarrhoea — Chronic Diarrhoea .„ 268 — 281

vii. — The Hygiene of Childhood.— Nursery

Routine — Diet — Drinks— Sleep and Rest — Fresh Air and Light — Exercise — Clothing —The Bowels— The Bladder— The Permanent Teeth — School Hygiene — Meals —Sleep— Mental Training ... ... 281—301

viii. — Diseases of Childhood. — Rickets and

Scurvy — Constipation — Vomiting — Diarrhoea and Dysentery — Worms — Protrusion of the Bowel — Prominent Abdomen — Rupture — Respiratory Diseases ... ... 302 — S24

HANDBOOK FOR WIVES AND MOTHERS IN INDIA.

CHAPTER I. The Home and its Surroundings — The Dwelling-house

In India, occupying as it does part of the tropical zone from the Equator to the north parallels 23° 28' 40", the conditions of life are necessarily very different from those found in Europe. Great variations of climate and temperature are found in this vast country. It is only by a careful study of these conditions, from the health point of view, that the inexperienced housekeeper can maintain her household in health and comfort, and prevent serious disease from entering the home.

THE DWELLING-HOUSE.

One can see in every native town and village a striking object lesson in what constitutes an insanitary habitation. There, large populations are crammed into dark closely packed ill-contrived dwellings, built around evil smelling courtyards, in which a privy and a refuse heap figure largely. The narrow dark streets admit little air to the house, and what does reach them is badly J polluted tby the open drains stopped up with refuse, or by earthenware receptacles sunk in the plinth of the house to catch and retain house-slops and refuse.

There the malarial mosquito breeds and flourishes with impunity, the germs causing dysentery, cholera, and enteric find a ready home, and the resistant power of the inhabitant is fatally lowered.

The European will, therefore, do well to choose a house situated as far as possible away from any native bazaar or huts. The house should stand on sloping ground and as high as possible ; on masonry arches if the soil is a wet one, or at least well above the level of the canal, or river course, for irrigation. There should be no stagnant pools of water, or tanks, near the house.

When building a house, a rainproof course should be laid in the middle of the plinth to prevent damp from rising to the floors. Beyond the walls, a layer of bricks or beaten kunkar should be laid on the ground around the basement of the house, with a slope down to an open drain or water-course. This should run into the main drains of the road, to carry off the rain water from the roof and house and so prevent it from sinking into the foundations.

Any undergrowth or jungle near the house should be cleared away, and gravel or short grass laid down. There should be high verandahs running round three sides of the house — east, south and west, with holes in their roofs to allow of ventilation.

Bath and house water must never be allowed to run out of a hole in the wall and sink into the soil outside the bath-room. It should be drained off with the roof water, or else carefully removed in buckets

THE DWELLING-HOUSE.

•directly from the bath-room, and carried to a distant part of the garden before being thrown on the soil.

The drainage from the house, kitchen and garden, etc., should all be carried by cement drains into the main road drains. If this is impossible, a deep well , or pit should be dug at a distance from the house, and filled up with pieces of rock and stone for 12 feet. The house and garden drains can lead into this well, and these can do no harm, since the fluids will sink into the deepest layers of the soil.

Now let us turn to the house itself.

First of all, it is well that the young wife should realize from the beginning that the making of a happy healthful home in India means heavier responsibilities and more anxious cares than would ever have been hers in England. She will need as skilled a judgment and as great a courage and self-control as any required from her husband in his professional work, though directed to different ends. Indeed, most men in India are so ■over-burdened with work and anxieties, that many home matters not usually considered in the province of the wife will have to be decided and arranged by her, if she would take her share n the building up of the Empire and of the Race.

The Rooms in the house should be light, airy and well-ventilated. If a dark house is the only one obtainable, more light and air can be ensured by having a few swing windows (roshanddns) let into the walls above the line of the verandahs. This can be done at small cost, and enables the hot vitiated air to escape from the rooms as it never could do otherwise. These upper windows should never be closed altogether even in the hot weather on the plains.

HANDBOOK FOR WIVES AND MOTHERS.

The practice of sealing up the whole house from the outside air from early morning is an evil one. The air in the rooms soon gets- vitiated, and encourages the drowsiness, languor and ansemia so common among those whose work does not take them much out of doors. Hot air does not injwe the system as much as impure air does.

If likely to remain for some time in a house, it is well worth while to have glazed Italian tiles laid down round each room for a distance of 2 — 3 feet from the walls ; these are now manufactured in India and are not expensive. The piece of matting or oil-cloth in the centre of the room can then be frequently rolled up and removed, and the tiles should daily be wiped over with a damp cloth.

The new fashion of papering the walls is a pernicious one. Papers even in England are found to absorb and preserve infectious germs for years, and in India where germ diseases are so common they should be altogether eschewed. If white-wash is objected to, ' ' Distemper ' ' in all art shades is now available and can be quite easily applied. If put on to cemented walls, these can be wiped over with a damp cloth, and this should be done regularly once a month. When white-wash or colour-washes are used, the old layer should be scraped off the walls every year before the new one is applied, and this should also be done after any infectious disease has occurred in the house.

During the hot weather all superfluous rugs, hangings and curtains should be removed from the room. The sweeper should never be allowed to sweep the mattings, durries or rugs in a room. All floor rugs should be carried out and shaken in the open air, and china

THE DWELLING-HOUSE.

mattings wiped over with a damp cloth. All furniture should be merely wiped over with slightly damp duster to remove the dust. The flicking with a dry duster as native servants like to do, only distributes the dust and germs, but does not remove them from the room.

The Bath-rooms attached to each of the bed-rooms should have stone or good cement floors, with merely oilcloth or a washing mat laid upon them — not matting.

There should be free ventilation by windows from the outside, and a bottle of phenyle should be kept in each bath-room to keep the commodes and floor sweet and clean.

In place of earthenware pans to store cold water in, «very bath-room should be provided with iron or white ■enamelled buckets with lids for this purpose. Earthenware vessels should never be used for drinking or bathing water, since being porous, they rapidly absorb the vegetable matters from the water, which putrefy in their pores ; they can therefore never be kept clean.

Servants' Quarters. — The servants usually live in the ' compound ' or enclosure round the house. Their quarters should be as far off from the house as possible and should be properly lighted and ventilated. The careful housewife will make a daily visit to these when on her round of inspection, to see that they are kept clean and that there are no cases of illness concealed in them. Visitors and outsiders should never be allowed to sleep in servants' houses at night without her permission.

Kitchen. — This should be near the house, connected by some kind of covered passage with it. The careful wife and mother will never fail to visit it daily. It should be a light, well- ventilated room with a stone

HANDBOOK FOR WIVES AND MOTHERS.

or brick floor, and should be scrupulously clean at all times. The sweeper should never enter it, but the water-carrier (hheestie) must flush it down with plenty of fresh water once or twice a day. After meal times, no food should ever be kept in the kitchen, which can easily be kept locked up when meals are not being prepared. If this is not done, the kitchen is apt to be a loafing place for the servants and their friends.

All cooking pots need looking into daily. The best and cleanest are the aluminium saucepans, which are easily cleansed with soft soap. Iron buckets must beprovided for fresh water in the kitchen, which should be taken and filled directly at the tap or well of drinking-water. If care be not taken, the bheestie will fill them from his dirty leather waterskin, the lining of which is often found swarming with germs of infectious diseases. The washing up of pots and pans must all be done outside the kitchen, and a cemented drain provided to carry the water off quickly, as it is apt to putrefy rapidly in the heat.

The Store-room. — A well-ventilated store-room is a necessity in an Indian house. There all food is kept between meals in gauze covered safes. A special safe for the milk and butter is advisable which can be kept always locked by the mistress.

In Indian houses, the custom of keeping one bedroom for all the women of the household to sleep in is very unhealthy. Again, stores of food and vessels containing milk are kept in the sleeping room, in which too often the sick and well of a household are crowded together, and the atmosphere is poisonous.

The food should have its own place where it cannot absorb foul germs given off from the living body. A gauze safe in the verandah, and one or two almirahs with shelves for solid food and grains will suffice for most Indian families.

DEINKING-WATEK.

The cook should never be permitted to buy milk or cream for puddings, ices, etc., as he will probably bring it from the bazaar where it has been standing for hours over the foul drains, absorbing the germs of enteric and other such diseases.

CHAPTEE II.

Drinking-water — Filters — M ilk — Conservancy. DRINKING-WATER.

The supply of pure drinking-water for a household is of the first importance.

Such are the customs of the lower class natives, that, even with a public supply from water-works, there is no security against pollution.

Hence, all waters in India require boiling for ten minutes, and filtration is also needed in most cases.

Boiling not only destroys existing germs, but also removes the chalk, iron and vegetable organic matter, which render water harmful to the organism in various ways. After boiling, water must be stored in clean enamel or china jugs, never in earthenware or clay soraiet and covered with a damp cloth to keep out the dust.

Where the only water-supply is from a tank or well in the grounds, this should be fenced round and covered with mosquito gauze-netting. The water-carrier must be provided with clean iron buckets for fetching the water in, hife waterskin (mushak) meanwhile being left behind at the house where it can be seen.

A pure water shows a faint blue or greyish colour, and has often a sparkle and lustre in it, but foul waters may also be lustrous. It should be clear, without sediment on Standing, and without appreciable odour or taste. .On the other hand, an impure water may be of a yellow or brown colour, with an unpleasant taste and smell. If on warming a specimen of water, its steam gives off a foetid disagreeable smell, it should on no account be drunk. If the only drinking-water procurable should be muddy, a preliminary rough filtering should be done before anything else.

This can be carried out as follows : — To four gallons of the water, add one teaspoonful of Condy's fluid, or fifteen grains of permanganate of potash. Wait 5 minutes, and if the colour of the water is still brown or yellow instead of pale pink, add another half teaspoonful of the Condy, and wait for the sediment to settle. Continue doing this until a pale pink tinge only is apparent in the water.

After allowing the water to stand for six hours, add 24 grains of alum and let it stand if possible for 12 hours. When poured off from the resultant sediment the water is ready for boiling, but it needs to be filtered alBO before being drunk.

FILTERS.

A great many filters are a source of danger rather than of security, and one of the worst is the familiar three earthenware vessels one above the other, so often seen in Indian verandahs. Even if the ghurras are constantly cleaned and renewed, the sand in the uppermost vessel needs thoroughly bofling every two or three days, while the charcoal in the middle one should also be taken out, heated to redness, and then boiled for one hour in water containing permanganate of potash and some sulphuric acid. Of

MILK.

course this process and the daily emptying and refilling of the ghurras must be supervised by the mistress.

In one case where the only child of the house died of a mysterious attack of blood-poisoning, a dead putrid rat was found in the lowermost ghurra which had not been cleaned for weeks.

The only safe filters are those of the Pasteur-Chamberland type, of which various modifications can be obtained. Some can be attached to any supply pipe in the house ; others with a siphon arrangement are for use when travelling. They are efficient filters, easily taken to pieces, and cleaned, but this should be done by the mistress herself. Muddy waters must first be cleared by the ' ' Condy-alum ' ' process ; then passed through the Pasteur filter, and lastly boiled for fifteen minutes.

If rain water only can be obtained, this should be collected in masonry or iron tanks, not wood. These must be covered with mosquito gauze-netting, and thoroughly cleaned out before rain is expected. Rain water should be filtered, and then boiled to remove all impurities with which it may accidentally have been contaminated.

MILK.

The purity of the milk supply for the household is one of the most important questions, since it may be the source of many mortal diseases, consumption, enteric fever, dysentery and cholera. The prevalence of disease among the cattle is very widespread, owing to the filthy surroundings in which they are kept, and bad feeding ; while the milk is too often stored in dirty brass or earthenware vessels, in a foul atmosphere, or adulterated with dirty unboiled water.

It is not enough to receive the pure milk directly into clean vessels which have been scalded out with boiling water, but the udders of the cows should be first washed over with warm soap suds, and dried with a clean soft towel. The milk must be then brought thoroughly to the boil, and kept there for 3 to & minutes. It should be now stored in clean enamel or china jugs or bowls, covered over with several thicknesses of a damp cloth to exclude dust (or better in sterilized glass bottles with glass stoppers), and stored in a room where the atmosphere is as pure as possible.

Boiling the milk kills disease germs in it, and prevents decomposition ; but even so, it will again rapidly absorb foul gases and germs, if stored near a bad drain or other source of contamination.

Milk is a perfect food, that is, it alone can support life in health. Invalids and children can live and thrive for a time upon it when modified to suit the special circumstances, age, or disease.

CONSERVANCY.

Lastly, conservancy matters and the proper disposal of the refuse of the household, needs constant care and supervision. Except in a few large towns of India where there are drains, all sewage has to be removed daily from the premises in carts. If there is a servants' latrine in the compound, it should be remote from the dwelling-house and servants' quarters ; and will need regular inspection to see that it is kept clean. The floor should be paved with concrete or stone, and the sweeper must be provided with several large earthenware pans (ghurras) of clean water, and plenty of phenyle to wash it down with.

CONSERVANCY.

The sides of the latrine should be of corrugated iron, tarred inside and out for some feet up from the ground. Near by will stand two large iron receptacles, one of which is emptied daily, and the contents removed by the public cart. The other one not in use should be carefully dried in the sun after cleaning, and tarred over, ready for use in its turn. Both receptacles must have well-fitting lids.

The sweepers must also mix some dry earth (not sand) with the excreta when emptying the commodes into the iron pans ; and there should always be a little clean phenyle standing in the commode in the bathroom. If these unsavoury matters are not attended to by the mistress, the household will surely suffer ; for the sweeper much prefers to save himself trouble by emptying out the refuse into a corner of the compound, where it remains a source of danger to the residents.

In one case where the household suffered from constantly recurring attacks of dysentery without apparent reason, a strict watch was set upon the sweeper. It was then discovered that the commodes were being regularly emptied into a shallow pit close behind the house, a mere handful of sand being then thrown upon the dangerous mass. When this improvised cesspool

In an Indian household, the privy should be built far away from the living rooms, and all the refuse should then be received in well, tarred iron pans, which can be easily removed twice a day. Dry earth should be thrown on the dejecta every time the privy is used. The privy should be the cleanest place in the dwelling and may be swilled down with phenyle twice a day. Two or three kerosine tins should be kept for the other house refuse, remains of food, etc.

A special sweeper kept for each household, instead of depending on occasional visits of the road sweepers, would save much money spent on doctors and medicines for illness.

HANDBOOK FOR WIVES AND MOTHERS.

was done away with and the surrounding earth dug up and removed, the dysentery ceased at once.

Chapter III

General considerations — Effect of climate on the bodily organism — Diet — Exercise and fresh air — Clothing — Bathing — Sleep — Rest.

PERSONAL HYGIENE.

From all that has gone before, it can be seen what minute care is needed for the healthful regulation of the household in India. To be a successful 'home maker ' the same care is needed in matters of personal hygiene.

It is only by the exercsie of thought and determination that the wife and mother will preserve her health and energies, and hand on an unimpaired constitution to her children.

It is well for her to realize first of all what special dangers are to be feared from the action of the climate and surroundings upon the bodily frame.

To begin with, the effect of high temperatures througli prolonged periods is to overstimulate the nervous system, which becomes highly susceptible and, in the end, overstrained and depressed. The heart and circulation participate in this depression, digestion is slower than in cold countries, the appetite less keen, and the liver overburdened with work.

As a result of all this, the proper nutrition of the body is not carried out and the blood becomes poor and thin ; while the body in consequence loses its power of resisting disease, and all the muscles become relax and weakened. Lastly, the heat over stimulates the skin, rendering it more liable to chills.

DIET.

In chill, the blood is suddenly sent from the skin to the deeper organs of the body ; hence the 'congestion' of the liver and disorders of the bowels so often following upon a 'chill.'

Other questions which will have to be faced are : " What points in my daily habits will need modification if I am to adapt myself to these new conditions ? ' '

"How much rest and sleep do I need to recuperate my nerve energies, and ensure a serene temper being preserved under all circumstances ? ' '

' ' What shall I deny myself in order to make the best of my time and reconcile my home duties with the claims of society so often insistent in India ? ' '

Lastly, "How can I guard against the climatic diseases of India ? ' '

DIET.

The result of living in a hot atmosphere is that less work is demanded of the lungs, but more work falls upon the liver in getting rid of the waste products of the body. Consequently lighter meals and more easily digested food are necessary. Still, plenty of food and that of the best quality obtainable must be eaten, for, as before explained, the climate itself tends to lower the nutrition of the body.

The early breakfast on rising of tea or cocoa, toast and fruit, makes a good beginning of the day. The second meal is taken at about 11, and should consist of light meat, eggs or fish, porridge and stewed fruit. Between these two meals an active woman if she rises early to see to her household, will certainly need a cup of milk or other light refreshment, without which she may feel exhausted after her exertions.

Tea at 3 or 4 o'clock, and dinner at eight, at which red meat may be eaten, complete the meals of the day. Altogether, less of animal food, and more of milk, cereals, vegetables and fruit are needed than in a temperate climate.

Tinned provisions should be altogether eschewed by the wise housekeeper. She should inspect the meat daily, and see that it is firm, red, and acid to litmus paper, (turning this red in colour) and free from all unpleasant smell.

Good fish is not easily to be obtained far from the sea ; the gills should show a pink colour ; and the mistress must take knowledge as to how it has been caught in the case of river fish. Too often, a native will pick dead or poisoned fish out of a backwater, and take it round to sell !

Raw salads often contain germs of infectious diseases, absorbed from foul soil, or the ova of worms, so must be cleansed with boiled water and Condy's fluid repeatedly, before being eaten.

Meat is most nourishing when roasted, stewed or hashed. Baking spoils it, and twice cooked meat should never be eaten in India.

Aerated waters should be obtained only from some reliable English firm and never bought (when travelling) from natives or at small stations. Ice should not be put into water or other fluids for drinking, as freezing does not destroy germs in it.

Plenty of fluid in the diet is a necessity especially in the hot weather. A tumbler of icy cold water half an hour before all meals will often stimulate a jaded appetite, and will prevent constipation.