The Century book for mothers; a practical guide in the rearing of healthy children

Front matter

S^^THE® 9

MOTHERS

1 "?-. •^• o O oo^ f :

Preface

IN preparing "The Century Book for Mothers" the authors have endeavored to keep in mind two queries : What ought an intelligent mother to know, and, beyond that, what would she Avish to know, regarding the care of her child ?

As regards the first, the writers have believed that she should understand matters of hygiene rather than the treatment of diseases ; that she should know the things which go to the establishing and preserving of healthful conditions; and that she should be aided in the recognition and avoidance of disease, rather than in its cure. In other words, their object has been to help the intelligent mother to become the alert and judicious guardian of the nursery, rather than to tempt her to play the physician and to dabble in dosing. In the first part of the book special emphasis has been laid on the caring for children, including the feeding, clothing, and housing. The subject of diseases, systematically even if somewhat briefly discussed in Part I, receives additional treatment in Part II.

As to the inquiry— What kind of information, beyond what she ought to possess, is the mother likely to seek? — the writers could think of no better way of giving such information than to follow the questions actually put by mothers to them as editors, for many years, of a magazine devoted to the care of children. The second part of the book is therefore almost entirely made up of a large number viii PREFACE

of questions concerning the many perplexities of daily nursery life, together with the answers furnished. The authors believe that in so doing they have more nearly approached the mother's point of view, and better met her needs, than by any systematic treatment of nursery matters they could have devised. Their aim has been to cover in this way the common ailments and troubles of early childhood, and they hope that, all in all, the volume may be found an instructive and safe guide for mothers in the care of children both in health and in illness.

Part I The General Care Of Children Page

I The Preparation for Motherhood 3

Diet — Dress — Exercise and Clothing — Discomforts — Care of the Breasts — The Monthly Nurse — Time of Confinement — The Outfit of the Lying-in Chamber — The Baby Basket

— Preparations for the Bath — Precautions for the Mother — The Value of a Cheerful Frame of Mind.

II The Nursery 18

Light and Air — Ventilation and Heating — The Proper Temperature — Lights — Nursery Furnishiugs.

III The New Baby 25

Baby's First Bath — Special Precautions — The Navel-String.

IV Nursery Routine so

Hours of Sleep — Disturbed Sleep — Suckling — Crying — Unsuccessful Suckling — The Mother's Diet — Bathing.

V Baby's Airing and Exercise 40

The Baby-Carriage — Exercise for Older Children.

VI Dress and Clothing 44

The Principal Eequirements in Dress— The Napkins — Socks

— Old-Fashioned Clothing— The ''Gertrude" Suit — Night Dress — Shoes — Fashion in Dress — Stocking Supporters and Drawers — Garments for Older Children.

VII Growth and Development 59

Gain in Weight— Gain in Height — Muscular Development— The Special Senses— Speech — The Teeth— Teething — Satisfactory Growth — Outgrowing Defects — Phimosis — Conditions of Proper Development, ix

X CONTENTS

PAGE

vm Food and Feeding 77

Breast Milk — Artificial Feeding — Cow's Milk — Purity of the Milk Supply— The Constituents of Milk — Modified Milk — Varying Proportions in Feeding — Bottles, Nipples, and Measures — The Separation of Cream — Various Mixtures — Feeding Conveniences — Sterilization — Gruels — Broths and Meat Juice — The Second Year — The Feeding of Older Children — Digestibility of Food— The Chewing Teeth — Meat and Eggs — Zwieback and Crackers — Gruels and Porridges —Fruits — Potatoes — The Five Meals — Feeding After the Second Year — General Rules for Diet — The Third Year and Thereafter— ^'Animal Foods"— The Value of Eggs — Various Meats — Fish as Food — Soups — Vegetables — Bread and Cereals — Macaroni — Desserts — Fruit — Water and Other Drinks — Objections to Sweets.

IX Disorders Associated with Improper Feeding 124

Symptoms of Rickets — Changes Due to Rickets — Causes and Cure of Rickets — Infantile Scurvy — Causes and Cure of Scurvy — Habitual Constipation — Hygienic Treatment of Constipation — Massage — Siippositories — Enemata and Laxative Medicines — Varieties of Diarrhoea — Rules for all Cases of Diarrhoea — Stomach Indigestion and Colic.

X The Evidences of Illness 136

General Behavior — The Head, Face, and Eyes — Signs About the Mouth — Throat Troubles — The Voice — The Ears- Breathing — Various Coughs — Vomiting — The Urine and Bowel Discharges — Fevers — Symptoms of Contagious Diseases — The Invasion Period — Characteristic Eruptions — Periods of Isolation.

XI Domestic Treatment of Illness 149

Precautionary Measures — The Warm Bath — Medicated Baths — How to Give Baths — Sponge-Baths — Vapor-Baths— Cold Compresses — Hot Applications — Poultices — How to Apply Poultices — Jackets for the Chest — Cathartics — Calomel — The Giving of an Enema.

XII Hints Regarding the Administration of Medicines . .162

Liquid Medicines — Ways of Giving Medicines — How to Prepare a Dose — Iron Preparations — Castor-Oil — Medicines in Solid Form — Swallowing Made Easy — Rules for the Sick- Room,

CONTENTS xi

PAGE

XIII Nursery Emergencies 169

Domestic Surgery — Ragged Wounds — The Cleansing of Punctured Wounds — Bruises and Bumps — Sprains — Burns and Scalds — Cautions as to Fire — Frost-Bite and Chilblains — Removal of Foreign Bodies — Nosebleed — Resuscitation in Drowning Accidents — Convulsions — Accidents Due to Poison.

XIV The Household Pharmacy 182

Conveniences — For Surgical Needs — Disinfectants — Medicines — Emetics — Carminatives — Remedies for Fever — . Bromides — Opium Preparations — Various Antidotes.

PART II QUESTIONS AND ANSWERS Minor Ailments and Troubles 193

The Causes and Treatment of Colic — Colic and Teething — Colic Accompanying Nursing — ''Three-Months' Colic" — Cure for Cold Hands — Cold Feet as a Consequence of Short Clothes — Perspiring Feet — Enlargement of Glands — Probable Cause of Mouth-Breathing — Enlarged Uvula — Patches on the Tongue — Coated Tongue — The Prevalence of " Sore Mouth " — The Causes of Sore Mouth — Swollen Tonsils — Roughness of the Voice — Bed- Wetting — Bed-Wetting in a Nervous Child — The Cause and Cure of Hiccough — Excessive Nosebleeding — Gritting the Teeth as a Symptom of Worms — The Signs of Worms — The Cause of Pin- Worms — Treatment for Pin-Worms — Persistent Itching of the Nose — What to do for an Attack of False Croup — The Treatment of Bumps — Drowsiness Following a Bump on the Head — , Fainting — Cracked Lips and Chapped Skin.

Freckles — A Mark on Baby's Face — The Removal of a Birth- Mark — Waits — The Beginning and Treatment of Stammering — Lisping — Want of Symmetry in the Formation of the Head — Umbilical Growth — Round Shoulders — Fear of Bow- Legs — Remedies for Bow-Legs — A Confirmed Habit of Stumbling — A Tongue-Tied Baby — Cleft Palate and Harelip — " Whopper- Jaw " — Deaf -Mutism.

xii CONTENTS

PAGE

III Colds and Catarrh 233

Fresh Air and Colds — Comprehensive Questions Concerning Coughs and Colds — Treatment of a " Hard Cold" — Causes and Treatment of Catarrh — The Communicability of Catarrh

— Care of a Sensitive Throat — Taking Cold Easily — Cold in the Head ; Application of Vaseline — '■ Starving a Cold."

IV Whooping-Cough 243

The First Symptoms of Whooping-Cough — Supposed Ignorance of Physicians Concerning Whooping-Cough — Contagion of Whooping-Cough — Severity of Whooping-Cough in Relation to Age.

V Difficulties of Walking and Disorders of the Limbs 247

The Possible Dangers from Early Walking — Possibly Overburdened Limbs — Turning-in of the Toes — Disinclination to Put the Foot Down — Weak Limbs — The Significance of a Limp — Pott's Disease — Knock-Knee — Weak Ankles.

VI Constipation 253

Constipation in both Mother and Child ; Laxative Diet ; The Action of Senna — Magnesia as a Laxative — Constipation in a '^ Bottle Baby" — Castile-Soap Suppositories; Candy Suppositories — Objections to Suppositories ; The Effect of Massage ; The Value of Regular Habits — The Effect of an Enema.

VII Various Digestive Disturbances 258

A Probable Case of '' Dyspepsia " — Habitually Coated Tongue

— Excessive Perspiration of the Head and Other Signs of Rickets — The Uses of Bicarbonate and Phosphate of Soda for Weak Digestion — ''Liver Troubles" — Domestic Treatment of Summer Complaint — Apparent Overfeeding — Indigestion; Dilution of Milk Called for — Paregoric for Green Movements — The Causes of Dirt-Eating.

VIII Eruptions 266

The Characteristics of Mild and of Serious Eruptions — '' Driving In" Eczema — Heat-Rash — Red-Gum — Psoriasis — Seborrhoea — Ringworm — Herpes and its Cure — * 'Black- Heads " — The Cause and Cure of Hives.

IX Common Diseases 277

Precautions in a Case of Diphtheria — General Experiences with Antitoxin — Antitoxin as a Preventive and Cure — Questions as to Diplitheria and Membranous Croup ; Popular Misconception of Medical Terms — Croup — Characteristics of

CONTENTS xiii

PAGE

Malarial Disorders — Remedies for Malarial Fever — The Causes and Treatment of Typhoid Fever — Symptoms of Typhoid Fever — The Usual Symptoms and Treatment of Scarlet Fever — Characteristics of Measles — German Measles or Rotheln — The Causes and Characteristics of Rheumatism

— The Contagiousness of Mumps — The Value of Gargling in Sore Throat ; Different Kinds of Sore Throat — St. Vitus's Dance — Signs of Heart Trouble — Alcoholic Stimulants in Fevers — The Value of Cod-Liver Oil in Cases of Scrofula — A Case of Tape- Worm in a Four-year-old Child— The Causes of Meningitis — Jaundice ; Biliousness — Hydrocephalus, or Water on the Brain — The Characteristics of Hernia — The Causes of Rupture — Treatment of Hernia — Treatment of a Protruding Navel — Falling of the Bowel.

X Harmful Habits 302

Thumb-Sucking — Objections to "Baby's Comforter " — Holding the Breath — Nail-Biting and Its Cure — The Che wing- Gum Habit in Children — Lip-Sucking.

XI Phases of Development 307

The Infant's Normal Weight — Measurements and Weights of Boys and Girls at Various Ages — When Children First Begin to See — Development of the Saliva and Tear-Glands — The Development of Speech — Imperfect Nutrition and its Causes

— Drooping Shoulders — Left-Handedness.

XII Weaning 3i3

Systematic Weaning — Dropping the Night Meal — Nursing During Pregnancy.

XIII Sleeping 3i6

The Hammock as a Sleep-Inducer — Putting a Baby to Sleep with the Rubber Nipple ; " Magic" Effects of Sugar-Rags — Experimenting with Anodynes — A Night-Light in the Nursery — The Value of the Pillow in Sleeping — The Most Comfortable Pillow — The Fir-Pillow — Objections to Having Children Sleep With Adults — Position for Sleep — Sleeping on the Stomach — The Causes of Night Terror — Worms as Possible Causes of Talking in Sleep.

XIV Bathing 324

A Bath at Night — The Effects of Cold and Wai-m Baths — Soap — Diminishing the Frequency of Baths — The Outing After a Bath.

XV Teething 328

Is Normal Teething Painless? — Late Teething — Drooling.

xiv CONTENTS

PAGE

XVI The Teeth 333

Strengthening the Teeth — Effect of Early Feeding Upon the Teeth ; the Use of the Tooth-Brush —Early Decay of Teeth — Discoloration of the Teeth — Peculiarity of Teeth — Removing Redundant or ''Extra" Teeth— The Filling of the First Teeth — Unusual Absence of Upper Incisors.

XVII The Eyes 339

Squint— Test for Cross-Eyes — Needless Anxiety about Brilliant Eyes — Eye-Pupils of Different Sizes — Sties — Clipping the Eyelashes — A " Weeping" Eye — Eye-Strain as a Cause of Headache — Pink-Eye — Granular Eyelids — Astigmatism.

XVIII The Ears 346

Earache — Partial Deafness — Prominent Ears — Tampering with Large Ears — Hardening of Ear- Wax — Cause and Prevention of Ear Trouble — Significance of a Running Ear.

XIX The Hair and Scalp 351

strengthening Thin Hair — Washing the Scalp — The Use of Soap on the Head — Tampering with the Color of the Hair — Milk-Crust — The Belief that Long Hair is Weakening.

XX The Feet 355

Incipient Corns — Distorted Feet — Ingrowing Nails.

XXI Hygiene and Sanitation 359

The Objections to Vaccination ; Supposed Failure of Vaccination to Protect ; the Proper Age for Vaccination — The Disadvantage of Postponing Vaccination — The Desirability of Keeping Water on the Stove — Plants in the Bedroom — Proper and Improper Filters — Sulphur for Disinfection— Disinfectants — Ground Air from Excavations ; Quinine as a Preventive of Fever and Ague — Temperature of the Nursery and the Bedroom — The Gas-Stove in the Nursery — How Longdo Diphtheria Germs Linger f — Danger of Typhoid Fever to Babies from Impure Drinking- Water — Susceptibility to Second Attacks of Disease — Physical Exercise for Girls — Disinfecting Paper Money from a Sick-Room — Baby Powder — The Value of Water in Rheumatism — The Treatment of Nervous Children — The Hardening Theory — Hardening in Practice — Rational and Injurious School-Work; the School Lunch — Over-Study as a Cause of Chorea.

XXII Questions of Dress 376

The Knitted Band ; Getting Rid of the Piuning-Blanket — Seasonable Dress for a Five-Months-Old; Silk or Flannel? — Night Coverings — The Nightcap ; Stockings at Night — Sum-

CONTENTS XV

PAGE

mer Dress — Summer Night-Clothing — Clothing for Winter — The Value of Long Stockings — Stiff Soles for Babies — Garters and Stocking-Supporters — Proper Stockings and Shoes for a Depressed Toe — The Advisability of Going Barefoot.

XXIII Care of the Mother 385

Nervousness in the Mother as a Cause of Baby's Colic — A Sensitive Breast — Sore Nipples — The Diet of a Nursing Mother — The Best Method of Drying up the Mother's Milk — " Nursing Sore Mouth " — Excess of Abdominal Fat — Falling Out of the Hair after Confinement.

XXIV special Requirements and Perplexing Points in the

Crying and Sedatives — Hard Crying as a Cause of Rupture — Rocking the Baby — Age for Sitting up in the Chair — Baby in the Corner — Playing on the Floor — The Effects of " Jostling About " — Rapid Carriage-Driving for Very Young Children — Methods of Lifting the Baby — Objections to a Veil — Teaching the Use of the Nursery Chair — The Care of Finger-Nails — Supposed Advantages of Being the " Middle Child" — Unjustified Fear of Consumption — The Definition of Nervousness — Washing the Infant's Mouth — The Giving of an Enema — The Mustard-Plaster — Kissing by Force.

XXV Feeding Problems 408

The Selection of a Wet-Nurse — Can the Nurse's or Mother's Milk be Poisonous ? — The Flow of Milk the First Days after Delivery — Goat's Milk and Ass's Milk — Testing the Quality of Breast Milk — Objections to Giving Breast Milk by Spoon — Bottle versus Spoon — *' Sucking Wind" — Combined Nursing and Bottle-Feeding at One Meal — The Signs of Insufficient Breast Milk — Nursing Another Baby in Addition to One's Own — The Supply of Breast Milk as Compared with the Allowance of Bottle-Fed Babies — Evils of Early Mixed Feeding ; Effect of the Mother's Diet Upon the Child's Teething — Feeding at Night after Weaning — The Tests of Rich Milk — Scum on Boiled Milk — A Warning against Sour Milk — Dangers from Impure Milk ; When Sterilization is Necessary — Keeping Sterilized Milk in Summer — Does Sterilized Milk Constipate ? — Injurious Quality of Lime-Water — Food versus Sleep — The Preparation of Barley-Water ; Advisability of Sterilization ; Quantity of Milk and Barley-Water for a One- Year-Old — The Value of Barley and Oatmeal Gruel — Harmfulness of New Bread and Cookies — The Relative Merits of Graham and White Bread — Balls from Graham Flour —

CONTENTS

Graham, Oatmeal, and the Various Prepared Cereals — Honey and Molasses — Pop-Corn — Oatmeal Gruel as a Laxative — Is Oatmeal ' * Heating " ? — Incompatibility of Fruit and Milk — Strawberries at Four Years — Smuggling Milk into the Bill of Fare — Bananas, Apples, and Oranges — The Uses of Sage- Tea— The Abuse of Sugar — Breaking the "Bottle Habit"— Teaching Baby to Eat ; the Need of Water to Quench Thirst — Pure versus Diluted Milk at Two and a Half Years — Buttermilk as Food for Children — Ice-Cream — Inordinate Fondness for Salt — Why Frozen Cream is Unsuitable Food — Uses of Fat in Foods — Variety in Food — The Effect of Tea on Children — Cocoa — Feeding a Premature Child — Butter and Eggs for a Child of Delicate Digestion — Proper Dilution of Condensed Milk — A '' Hard-Reared " Baby — Probable Over- Feeding ; Frequent Changes of Food ; Excessive Vomiting — Suggestions for Improving the Dietary in a Case of Slow Teething — Loss of Appetite; Imperfect Nutrition — Distaste for Meat.

PART I THE GENERAL CARE OF CHILDREN

IN one sense, the care of a child begins with its conception. But the ante-natal care cannot be given directly to the unborn ; it must be bestowed upon the mother. Whatever she would do for its welfare must be performed through judicious care of her own health. Let it be understood at once that there is no special or patent regimen to be followed during pregnancy. Success attends the careful and common-sense application of the ordinary rules of health to the changed conditions that come with pregnancy. Just in proportion as the mother has previously led a hygienic life will the task be an easy one. If she has lived in neglect or defiance of hygiene, then she must ' ' cease to do evil, learn to do well."

DIET

The diet of pregnancy should be simple and nutritious, but should not, unless by reason of some special disorder, be different from the wholesome diet of a non-pregnant woman. The special restricted dietaries vaunted to insure easy delivery have no such effect, and if the results claimed were really attained they would be merely a saving of some pain on the part of the mother at the expense of her infant's development. As there is a tendency to nausea, flatulence, and acidity with resulting heartburn, the diet should be not only nutritious but easily digestible. While the derangements just mentioned are most likely of nervous origin, there is no doubt that the digestive power is usually to some degree impaired. The use, therefore, of foods, such as sweets, pastry, and rich articles generally, which are particularly likely to produce fermentation in any state of health, must tend to aggravate these unpleasant symptoms.

There is a tendency during pregnancy to constipation, chiefly from mechanical pressure of the growing womb, or to the exaggeration of such a tendency if it already exists. To some degree this may be combated by the use of foods of a laxative tendency— fruits, coarse cereals, and all the usual articles employed Avith this intent. In the latter part of pregnancy, when the pressure of the womb upon the other abdominal organs becomes considerable, it is usually wise to moderate the amount of flesh diet, if it has been considerable, and to supply its place with milk and eggs, in order that the tax upon the kidneys may be lessened. The free use of liquids— that is to say, of water or thin nutrimentis valuable, both as further helping the work of the kidneys and as favoring the proper action of the bowels.

DRESS

The dress of the pregnant woman must be entirely free from constriction. Very early in gestation the corset would better be abandoned, or, if worn at all, so loopely laced as to make no pressure. All of the organs, lungs, heart, stomach, bowels, not to mention the womb itself, demand the greatest freedom. There is a new and increased demand for oxygen: the lungs must take in more air, the heart and blood-vessels must convey a more unrestricted supply of the better oxygenated blood. All other sources of constriction, such as tight garments and bands, must be avoided. The garter deserves special mention, as in pregnancy there is a tendency to swelling of the veins of the lower extremities, and this is aggravated by a tight garter. Some other form of stocking support is preferable when the hose must be kept trimly in position.

EXERCISE AND CLOTHING

Am and exercise conduce to well-being in pregnancy as at other times. The amount of exercise that can be taken will vary very much with cases. The woman who does her own housework or any considerable part of it will not need exercise, for instance, but will need open air. A woman troubled badly with "morning sickness" may be unable for the time being to take outdoor exercise at all, but to her, as to all, air and sunshine will be beneficial, and it should be had if possible, even if it be no more than what can be got in the invalid's bedroom. Assuming that the woman is able to take exercise, how much shall she take? It must stop short of serious fatigue, and it must never be violent, lest, especially in those with a tendency in that direction, it favor or excite miscarriage. In a general way, exercise which gives a feeling of well-being and of only gentle weariness is beneficial and aids sleep.

The customary use of the bath need not ordinarily be interrupted. It aids the functions of the skin, and is still another mode of assisting the kidneys in their functions. The action of the skin may be further assisted by sufficiently warm, but not burdensome, clothing, and the lower limbs especially need protection from chilling when the protuberant abdomen prevents the usual clinging of the garments about the person. Then the warmth of the garments next the skin should be increased. Many women dislike warm under-drawers, but their use at this time, if the weather be cold, is very desirable.

DISCOMFORTS

It is not easy to say at just what point the disturbances of functions usual in pregnancy cease to be normal and become disorders to be dealt with. Thus, a certain amount of ''morning sickness" is so common as to be considered normal, but this symptom may become so severe as to be dangerous. Whenever any of the ordinary functional disorders of pregnancy become really troublesome they are the proper care of the physician. Short of this point, it is desirable that the expectant mother should keep up a certain observation of her own symptoms, without allowing herself to become at all hypochondriacal concerning them. Too much self -consideration is always harmful ; too little may occasionally be disadvantageous. In this spirit we may consider what may be done by domestic practice for some of the commonest ailments of pregnancy.

Nausea and vomiting, popularly called ''morning sickness," because of their usual occurrence at that time of day, are, as has just been said, almost always present at some time of pregnancy, especially in the earlier months. Sometimes salivation is associated with them or takes their place. Ordinarily their severity is not so great as to demand the interference of the physician, although they may sometimes tax his resources to the utmost. In the simpler cases the discomforts can be mitigated until the symptoms disappear, as they commonly do after the first three months, by attention to all the details of hygiene already suggested, and especially those of feeding and rest. Thus, food should be given in small quantities at a time and proportionately often; easily digested forms of food, such as milk with lime-water or with effervescing waters, nutritious soups or meat extracts, and the like, being chosen if the nausea is severe or persistent. Many patients, if they can remain absolutely quiet in bed until the middle of the forenoon, are able to pass the remainder of the day in comfort at their usual occupations. If the symptoms are more severe it may be necessary to keep the bed continuously for some time.

Another symptom referred to the stomach is heart-burn, generally due to acidity. This is more persistent than nausea usually is, and is perhaps more severe in the later months.

It is best met by antacids— that is to say, alkalis. Those most used are the familiar cubes of magnesium carbonate or other magnesia preparations, lime-water, sodium bicarbonate, or the aromatic spirits of ammonia, both of the latter being dissolved in water when administered.

The flatulence of pregnancy is best met by insuring regularity of the bowels and by correcting disordered conditions of the stomach.

Constipation is to be combated by the same means as in the non-pregnant condition— namely, by mild laxatives, suppositories, or enemata, in addition to the dietetic helps already alluded to.

Swollen veins in the loAver limbs are common. If not very severe they can be held in check by regulating the bowels and the wearing of some kind of elastic stocking if necessary. The avoiding of unnecessary standing when the patient is not walking is useful, as is also the raising of the limbs whenever practicable. Similar care is advantageous to relieve effects of pressure elsewhere, as, for instance, upon the bladder, as evidenced by frequent calls to pass water.

CARE OF THE BREASTS

As pregnancy proceeds, progressive changes occur in the breasts and nipples. In many, perhaps most, cases no care is needed beyond the avoidance of pressure upon the parts, which is insured by ampleness of the garments covering them. Occasionally the nipples are so diminutive as to make it probable that the infant will have difficulty in seizing them. In such cases it seems advantageous that the mother should gently draw or coax out the nipples with the fingers morning and evening during the later months of pregnancy. When the surface of the nipples is very tender and shows a tendency to crack or to become excoriated, it may usually be hardened by a daily application of some astringent. Among those commonly used are tannin and glycerin, twenty grains of the former to an ounce of the latter; alcohol and water, equal parts, with a little alum added; tincture of myrrh and the familiar preparations of witch-hazel. They should be applied with the finger or a soft camel's hair pencil. The nipples should be cleansed carefully with a bland soap, such as Castile, and warm water, and care should be taken to dry them very thoroughly before each application.

THE MONTHLY NURSE

One of the duties of the expectant mother, unless some friend relieves her of the task, is the selecting of a monthly nurse. The choice may be, in small places, a very limited one, and the selection practically forced. But in most large towns at the present time, since nursing has become a recognized profession, quite a number of nurses are usually available. Two elements have to be considered in the nurse —her professional capability and her acceptability. Perhaps more often than not, the physician is not consulted as to the selection. The opinion of female friends as to the nurse's acceptability determines the question. And if the nurse selected is one Avho has graduated from a good training-school, this method of selection is probably as good as any for ordinary cases. The physician might err upon the other side by considering only the nurse's skill. The Avriter, Avhen he is asked concerning a nurse, usually considers the circumstances of the household as well as the medical aspects of the case, and submits the names of several nurses likely to be suitable. The patient can then select that one most attractive to herself. The physician can generally learn pretty accurately the professional qualifications of the nurse. The elements that go to make up acceptability, which the physician may be acquainted with or which the patient or her friends may be able to learn about, are her diligence, her disposition and adaptability. Thus, a nurse may be entirely competent, but lazy, in which case details may not be properly attended to. On the other hand— although this is a lesser evil— she may be something of a martinet, and attend

THE PEEPARATION FOR MOTHERHOOD 9

to her duties Avith a strictness which is tiresome and perhaps unnecessary. Her disposition tells in the ease with which she puts up with the necessary annoyances— and they are many— of the confinement chamber, and the tact with which she gets on with the servants, so that they cheerfully do the extra work put upon them. In the same way her general adaptability counts. Some nurses are excellent when all the resources of a wealthy family are at command; but are useless in cramped quarters. The tactful nurse fits in anywhere, in the luxurious mansion or the narrow apartment, and gives satisfaction above stairs and below stairs alike; and if she departs with the cook's good-will she may be accounted to have earned her blue ribbon. The greatest tax upon her tact will be the excluding, without giving offense, of obtrusive visitors, whose presence and conversation in the lying-in chamber are often harmful to the patient and increase the anxiety of both nurse and physician.

TIME OF CONFINEMENT

The nurse having been selected, her first inquiry is likely to be, ' ' From what date do you wish to engage me ? " This opens the question of the duration of pregnancy. The variations of its duration, like those of every natural process, are well known to medical men. Nevertheless, it is equally well known that when the facts relating to the probable beginning of pregnancy are accurately given, this variation is in the great majority of cases within pretty narrow limits. It is indeed surprising how frequently really intelligent women are unable to give the physician even the date of the last period. This is sometimes due to mere carelessness, sometimes to the substitution of a theory for a fact. Practically there is but one method of reckoning— from the last menstrual period, the first day being used as the most certain. When reckoning is made from this first day, the average time to delivery is forty weeks, or two hundred and eighty days, which is Just ten ordinary menstrual intervals.