Mother and baby; helpful suggestions concerning motherhood and the care of children

Preface

The excuse — if one is needed — for adding one more book on this subject to the great number already in the market is that it contains a few simple and easily understood suggestions for mothers on the care of children, more stress being laid on the every-day, commonplace requirements than is usually the case. This little book makes no pretensions, nor is it an exhaustive treatise ; its one aim is to attract attention to these things, and to give the reason for doing them.

In spite of the fact that books and magazine articles are constantly appearing, each conveying advice and theories, there is no need to fear that the subject will be exhausted, and it is impossible to crowd everything into one book. Living is becoming so complex that the ideas of two decades ago — if not antiquated — no longer answer the requirements. To many, much

VI PREFACE

that is here said may have been heretofore considered unnecessary, and to others, possibly, the ideas have never occurred.

Although this is written by a physician, it is not intended in any way to take the place of a doctor's advice. On the other hand, it is hoped that the necessity for selecting a physician and following his advice before the child is born is made apparent. The author feels quite sure that the suggestions here offered will not prove contrary to the advice or judgment of any regular physician, for what is here put forth for mothers and the care of their babies consists of simply the ordinary regulations for hygienic living. The suggestions for the requirements of the nurse, and for the care of older children are the result of years of experience.

Believing firmly that preventive medicine is a higher art than curative medicine, more attention is given in these chapters to the keeping the baby well than to the treatment of the sick baby. Only the simplest rules for treating the sick child, and descriptions of the commoner ills which are met with are here given.

PREFACE Vll

Nothing is said about tuberculosis, meningitis, and many other diseases for the simple reason that nothing can be told to the laity which will be of any reasonable service, excepting the suggestions and rules which hold good for the nursing in any illness.

Anne B. Newton, M. D.

May, 1912.

Contents

CHAPTER PAGE

Preface ix

I Counsel to Mothers 1

Chapter I Counsel To Mothers

Perhaps the author may be pardoned for beginning this chapter of advice to mothers by including in the first few sentences the fathers also. In all the books on this subject the father's responsibility is entirely ignored. One might imagine his role perfectly insignificant, and that attention to the financial side was all that could be expected of him.

Much has been said, though, about the necessity for cheerfulness and hopefulness, etc., on the mother's part; in other words it is assumed that her mental attitude has a marked influence on the disposition of the child. This is undoubtedly true, but the father has great obligations, too, and his mental attitude also makes a great dif- 1

I MOTHER AND BABY

ference to both mother and child. The highest degree of perfection for children is only reached by having both parents hold high standards for themselves — moral as well as physical. Of course, people generally appreciate that a man afflicted with tuberculosis or any chronic malady of a grave nature is apt to have children physically below normal, but the majority apparently forget that many other failings not quite so pronounced as the above mentioned are transmitted to the children by the fathers, and that not only the child's physical condition, but his mental and moral structure depends largely upon his paternal inheritance.

This line of thought could be carried out indefinitely, but as this book is primarily intended for the mother, one instance only will be cited, because it is of a great deal of importance and so rarely noticed.

A woman is naturally greatly influenced by her husband. It adds much to her comfort during a very uncomfortable period if he exercises self-control and forbearance, giving up when necessary and putting up with many inconveniences for the good of

COUNSEL TO MOTHERS o

the prospective mother, and for that of the offspring.

The prospective mother is rarely able to do just as before, so that certain pleasures or apparent obligations under other conditions have to be given up or set aside for the time being. These changes may be only matters of inconvenience, or they may be of a nature to cause considerable selfsacrifice; but certain obligations are inevitable, and the grace with which they are assumed by both parents makes the greatest possible difference to the entire household, and no one is more materially affected than the child himself.

Taking for instance, anything so apparently simple as fresh air — few people realize the amount of fresh air which should be taken into the system, nor how much difference is made in the well-being of both mother and child by the amount of fresh air which is taken into the systems of both. During the long months before the baby is born, the mother is breathing for two separate individuals, and requires much more than the ordinary amount of oxygen. Difficulty of respiration is one of the unpleasant experiences women in pregnancy pass through, and as far more air is needed all the time than under ordinary conditions, it is very apparent that it should be pure and not in any way vitiated. One of the most frequent causes of impure air is tobacco smoke. This is always injurious to pregnant women, and to some it is absolutely nauseating, for the smoke itself contains nicotine, which is a deadly poison. For this reason, also, no young baby with his delicate respiratory apparatus should inhale this poison.

This is not intended as a dissertation on the evils of smoking, but only to call attention to the almost universal custom, which in the case of some men at least, would be stopped at once if smoking in the house could be proved harmful. If smoking has to be indulged in, there should be some place for it besides the bedrooms and living-rooms of the family.

In one of our large cities a much-longedfor, and eagerly anticipated baby came to the delight of her parents' hearts ; although she was breast-fed and seemed to have a fine start, after a short time she showed symptons which alarmed the family. The doctor could not find that anything was the matter, but the baby was not thriving, so a change of air was suggested, and tried with satisfactory results.

After returning home, the same symptoms appeared again, and the doctor began to think that moving into the country was necessary, for the child was steadily losing ground. This was practically impossible, owing to peculiar circumstances, and while the question was being agitated as to what could be done, the baby became decidedly miserable, so that the doctor ordered her kept in one room and had her treated as a sick baby. This involved the abolition of smoking in her room with the result that in a short time, having better air, she began to improve.

It was only after a number of setbacks, and much anxiety on the part of both parents and the physician, that the idea of poisoning from tobacco smoke occurred to them.

The father was an inveterate smoker, so that the air of the home was never pure. Every time he stopped the baby began at once to improve, but as regularly as he resumed and the house was again filled with smoke, she invariably drooped. The lesson was finally learned, but nearly at the cost of the baby's life.

This incident is not an exception, but a condition often met with, though frequently perhaps not recognized, or at least not mentioned.

Besides pure air, much exercise is indispensable for good health, and every human being in order to keep in good trim ought to be in the open air a great deal. Fresh-air treatment is becoming more and more popular; there never has been a time when it was more extensively advocated than at the present. It is one of the best panaceas for sleeplessness, and nervousness of all kinds. This and sunshine are the chief agents which are beneficial in tuberculosis, and all forms of anaemia, and they are plentiful for all who wish it.

All pregnant women, or women who are nursing their babies should be exceedingly careful to form the fresh-air habit. The best way to accomplish it is not to leave it until a convenient time, but to spend a part of every day in the open air, or go out at a regular time each day.

For women who can do so, taking care of flowers, digging in the dirt, superintending the garden, or having any daily occupation which keeps them much out of doors is beneficial beyond words. It probably seems quite unnecessary to lay so much stress on the necessity for fresh air when so much is being said on the subject by physicians and writers, but, like many of the most commonplace facts in life, it is too often overlooked by the many who know better than they practise.

A certain foreign physician, anxious to prove some scientific question, engaged a few peasant women to submit to certain rules of living during a period of pregnancy. These women were of the poorest of a very poor class, and many of the babies that had previously come into these homes had died because they were too poorly developed to live. The living children were feeble specimens, but the babies that were born after the mothers conformed to the hygienic rules prescribed by the physician were entirely satisfactory, physically.

These women were required to be out in sunshine and fresh air daily, and to take a regular, simple diet and plenty of sleep. The results were just the reverse of their former experiences, showing that children from the same stock can be physically satisfactory or otherwise, depending largely upon whether conditions are healthful or unhealthful.

Added to the necessity for physical exercise is that for mental exercise also. There is nothing like keeping the mind occupied with some wholesome pursuit as a preventive for unnecessary nervous discomforts, or morbid fears. It is an excellent plan for women, as far as practicable, to take up some course of reading or study.

It is said of one of the American novelists, whose books were quite extensively read some years ago, that she did her best work when pregnant; always making a practice of working systematically and hard at this time.

She was convinced that the results attained, and her freedom from nervousness more than repaid her for the force of will and determination used.

If women could be made to appreciate how much of the formation and moulding of the character of their children rests upon them, some would surely try harder than they do to secure the best results.

The mental, moral, and physical well-being of children is so largely in the hands of the parents, and so much depends upon the attitude they take, that we may venture to say that it is practically impossible for women who will not exercise or keep their minds occupied in a normal, legitimate manner to have healthy or satisfactory children.

Very many of the human wrecks which are evident on all sides owe their poor physical condition and their moral failures to the utter indifference of the fathers and mothers. There are many people who finally wake up to this, but the scars are always to be seen, no matter how sincere the desire to make amends. Prophylaxis — that is to say, a realization of the evils that may come unless the proper precautions are taken here, as everywhere in medicine — is by far the wiser course.

Again, the pregnant woman besides being careful about fresh air, exercise, and keeping her mind occupied, should observe some other essential rules. A great deal of sleep is as indispensable as the other necessities, and early regular hours should be an unalterable rule. In addition to early retiring, the woman needs to sleep in the daytime, and an hour's nap either before or after the midday meal ought to be taken religiously each day. The woman who observes these simple rules will be well repaid, and after trying it once will see for herself that it makes just the difference between being very comfortable, and only slightly inconvenienced, or having more or less discomfort all the time; and the difference will also be very apparent in the child.

It hardly seems necessary in this enlightened age after so much has been said and written about tight lacing to bring it up here. Comparatively few women are quite so foolish as to indulge in this hurtful practice now. Very loose corsets or corset "waists which support the clothes are not necessarily harmful; the point is to have plenty of room to develop, and some support for the abdominal muscles. Of course, the skirts should be light in weight, and everything made to allow for free respiration.

Large shoes with straight heels should always be worn ; tight shoes or high heels, never. Eubber heels are very comfortable for the majority of women, especially those who come down with considerable force on the heel instead of the ball of the foot. Occasionally a woman finds them too heavy for comfort, but as a rule, if they are properly fitted, they not only facilitate walking, but save much unnecessary fatigue. Unless the best grade of heels is used they will catch and tear the skirts, which is very undesirable.

Often one of the really trying conditions attending pregnancy is the tendency of the teeth to decay. A woman should be very careful to have them put in good condition as early as possible, and very much of the trouble can be averted by carefully brushing them after each meal. On this point it is surprising how indifferent many people are. One of the great causes of the decay of the teeth is simply that no extra care is taken of them where the digestion is somewhat overtaxed; this is the time of all others to be particularly careful. It is a very wise precaution not only to brush them after each meal, but to rinse the mouth three or four times a day with some good antiseptic solution. It is better perhaps to vary this solution occasionally. Bicarbonate of soda (baking soda) — about a quarter of a teaspoonful to a glass of water — makes an excellent mouth wash.

Sieler's tablets — one tablet to a glass of water — have been used with satisfaction for many years. Thoughtfulness in this matter may save much pain and annoyance. It might be added that these precautions will never come amiss, and ought to be taken by every one.

Closely allied to the care of the teeth is the question of diet, which is of prime importance, and ought to receive more careful attention than it does in both pregnant and nursing women. The necessity of eating food which is wholesome and easily digested should be apparent to every one, but in this matter, as in many others, it is perfectly evident that errors of judgment are the rule rather than the exception. Before the baby comes — at first, at least — loss of appetite is very common; this, however, will adjust itself if the woman will carefully follow the suggestions that follow.

Generally speaking, it is not wise to eat from a sense of duty, for nature will assert herself, and the appetite will come back. Sometimes the craving for food is excessive, and a desire to eat all the time is quite overpowering. A cup of hot water or a glass of lemonade will usually serve to stop the craving, and will be far better for the woman, and eating between meals should be carefully avoided, as it produces indigestion. Very much can be accomplished by a firm will and determination not to be disturbed by these unusual feelings.

Meat should be indulged in sparingly from the very beginning; it is too rich in albumin, which may, and often does, affect the kidneys. Two or three times a week is sufficient, gradually diminishing this amount until the last three or four months, when none should be eaten. It is often wise to give it up entirely, as it is not a necessary article of diet for the pregnant woman.

Coffee and tea play an important role and are injurious unless very weak. Eich foods, pastry, and much sweets will only clog up the bowels and make the patient generally miserable. Alcohol, of course, should never be touched.

Apples, pears, peaches, grapes, oranges, grape fruit, plums, in fact all ripe fruit can be eaten with great freedom, and perhaps it is not too much to say that no one can eat too much fruit if it is taken as food, and eaten at meal-time.

Bananas are rarely ripe when eaten, consequently are often indigestible. They should be kept until the green ends have turned entirely, and the skin somewhat black. The inside should be soft and smooth. If they are eaten in this state most people would not find them hurtful in the least. In common with all other fruits, they ward off constipation. Green fruit of any kind is indigestible. If there is any question about the ripeness of it, of course it should be cooked, and for some people this is the better way always. The plea here is for a free fruit diet; the way of serving it, however, depends upon the individual. One word here about the necessity for washing thoroughly all fruits and vegetables before eating, especially if they are purchased in any public place. There is a possibility of infection from vegetables and fruits which come from markets, farms, and private gardens. The rule for every one should be to eat nothing of this kind until made clean, for there is no question but that many diseases are carried into the system through the mouth. The mysterious origin of many cases of typhoid fever, for instance, could be cleared up if it were possible to detect the bacillus by the naked eye, instead of the complicated laboratory methods.

Not many years ago a young woman was in a hot climate for the first time. In spite of the warnings of companions and old residents, she persisted in eating fruit, uncooked and unwashed; as a consequence, she contracted a fatal bowel trouble and died, alone, and far from her family and relations. This was a perfectly unnecessary sacrifice of life, and all because she would not take what seemed to her a useless precaution.

Cereals are most wholesome, wheat, hominy, rice, etc. It is safe to say that vegetables, simple dessert, and milk can be taken in great abundance. Too much stress can not be laid upon the necessity for drinking much milk, although there are women who object to this, because they say it disagrees with them. It rarely disagrees with a pregnant or nursing woman, and if given with some care, can practically always be taken and well digested. Nature demands it, and in these cases, as in all others, it is the part of wisdom to obey nature 's dictates. Many more women could nurse their children if they would be careful to drink milk freely all the months before the baby comes. Sweets in moderation are allowable, especially chocolate, unless owing to some personal idiosyncrasy it gives trouble, a concession to personality, however, which applies to all articles of diet.

It is imperative that a large amount of water should be taken into the system every day. There is nothing which will do more to guard against constipation than drinking plenty of good, pure water. If this has not been a habit before, it should be most assiduously cultivated during pregnancy.

This should be taken before breakfast, the last thing before going to bed, and also several times between meals. Vichy is agreeable to many, and perfectly allowable, the chief objection to it being that it may cause eructations, which are rather more easily acquired at this time, and decidedly unpleasant. An unnatural desire or craving for some unusual article of food is sometimes met with. The woman who steadily refuses to indulge herself inordinately in any way has gained a victory which tells in more ways than one. Great moderation in everything and no excesses of any kind should be the rule, and the woman who adheres to this will save herself much unnecessary trouble.

Pregnant women have unlimited opportunities to exercise self-control, although it may be hard for a woman who has never practised this to make a beginning now. But if she wishes to get the best out of life for herself or her child, it is absolutely essential.

No fine character develops without self-control as one of its bases. Godliness, truthfulness, and cleanliness complete the figure, and on this structure the power for good that may be reached is really unlimited.

A teacher was relating some of the woes of her experience to a wise woman, the mother of a large family of boys and girls who were famous for their good minds and good manners. Finally she said, "But you do not understand any of this, for your mother trained you before you were born, and you have trained every one of your children before he was born, consequently one-half of life's battles were won for them before they started out themselves."

Of all the factors which go to make up the complex existence which we call life, there is not one which does so much toward building up the general well-being of humanity as a methodical emptying of the bowels at regular intervals. It makes so much difference in the mental attitude as well as the physical that it is positively astounding with what indifference the matter is treated by so many intelligent people. It is the first question asked by a physician, and a great many times the answer is that in order to have any movements a cathartic has to be taken; and many people say that it is nothing uncommon not to have the bowels move for two, three or more days at a time. The effect of this carelessness is more far-reaching than the laity can possibly realize.

It is a common factor in many nervous disorders, extreme or otherwise. Insane patients almost to a unit are constipated. It is a well-known fact that the great majority of sufferers from appendicitis have been constipated, perhaps for years. In many of the large department stores anti-appendicitis medicine is sold to the credulous public. Those who buy it suppose that it contains some magic charm to ward off that much-dreaded disease, when in reality it is largely composed of simple and well-known remedies added to some cathartic which simply causes the bowels to move.

Constipation not only renders individuals particularly liable to appendicitis, and in fact to all diseased conditions, but unless the alimentary tract is kept cleared it makes them a far easier prey to typhoid fever, dysentery, and all kindred diseases. In fact, there is no abnormal condition that is not made materially worse by having the bowels clogged. Of late there has been a good deal of talk about auto-infection as an exciting cause in those obscure cases of headache and neurasthenia, which are the bugbear of every physician and often so hard to treat successfully. This simply means lack of properly keeping the system cleared of the effete matters which act as a poison. The lungs, the skin, the kidneys and the bowels are required to do active work to keep the machinery going. If any one of these agents is not up to the work the others have added work to do. It is decidedly the part of wisdom if one would have good health to take care that each organ does its best so far as the individual can control it.

The cases of constipation (unless due to malformation) which cannot be cured by patience and perseverance on the part of the victim are few and far between. The trouble is that people will not persistently try. If the dainty and fastidious would only stop to consider that the breath and perspiration of people whose bowels do not move with great regularity are always more or less offensive, this might act as an additional spur. Acne (blackheads) and various skin eruptions are caused by digestive disturbances, all of which can be greatly benefited by care and attention to the diet and the proper condition of the bowels.

The above remarks are applicable to all mankind, but they apply with double force to the pregnant woman. There is more danger of auto-infection in her case, than under ordinary conditions; therefore, no pregnant woman should allow one single day to pass without a free defecation. The rule should never be violated. According to the suggestions already given, fresh air, with an abundance of water and the proper diet ivill invariably do the work. Cathartics are harmful and should never be used, except by the physicians' orders.

It has been said that one of the waste channels is through the skin. This is a complex structure composed of various layers, the external one made up of old dead scales of skin which are constantly peeling off to make room for other scales. This process of scaling or desquamating is going on all the time, otherwise the skin would become leathery and hard, as is seen in old people who do not bathe enough. It is plentifully provided with two kinds of glands, sweat or sudoriferous, and sebaceous or oil glands. The sweat glands are many, and all over the body, being particularly plentiful in the palms of the hands and the soles of the feet. The sebaceous glands are closely related to the hair, each separate hair having two or more little glands around it. Their function is to keep the skin soft and supple by supplying the necessary oil, and to give the hair nourishment and lustre. These glands are particularly large around the nose, and on the cheeks. Besides the oily or sebaceous substance which comes from the oil glands, normal sweat contains an oil also, and with these secretions is freely mixed effete matter from the system. The process of discharging these mixed substances is going on more or less completely all the time, depending upon a number of conditions. When the other avenues of elimination are doing their part, and only the normal amount of work is put upon the skin, conditions are generally satisfactory, but just as soon as an extra amount of work is expected, unless care is taken there is apt to be trouble. There are cases where the glands are abnormally active. If these are the sebaceous, the skin looks oily and greasy unless great care is taken. If the sweat glands are easily excited, profuse perspiration is the result, which is only too apparent to every one. The two essentials for having a fine skin are first, a good digestion, and second, bathing freely.

The Spanish lady of high rank who boasted that she had never had an ordinary bath with soap and water in her life, but that she was occasionally rubbed down with, a towel soaked in oil undoubtedly preferred this method.

No mention is made, however, of her appearance or the odor which emanated from her person, but perhaps it is better to pass these over in silence. To keep the skin in good order, and to have it do its share of the work toward good health, a person should take a bath from head to foot once a day the three hundred and sixty-five days in the year.

There are people who look clean on much less than this number, but the great majority can not keep so on much less than one bath a day. A proof of this may be found by taking a Turkish bath, which includes a vigorous steaming and scrubbing. From many people small rolls of skin and dirt are removed, and this means a lack of sufficient bathing and rubbing to keep the surface of the skin freed from the dead particles combined with dirt and perspiration. If a person exercises a good deal, and perspires freely, nothing but bathing once a day at least makes him agreeable to his friends and comrades.

The question as to the wisdom of taking a bath every day has been discussed by many, some for and others against the scheme. There may be peculiar circumstances which make it unwise for an occasional person to bathe often, but this is the exception not the rule. For a normal, healthy person who eats, exercises, and sleeps as he should, a cold bath in the morning is one of the best tonics that can possibly be taken. So far, these notes apply to the pregnant woman as to all healthy women.

The question may be legitimately raised as to the advisability of her taking a cold plunge every morning, but a sponge bath cannot hurt any one, and it will help get the circulation and respiration into good order as nothing else. It is essential to remove these scales from the skin, which frequently adhere, especially if the oil glands are active so that a hard rubbing with a flesh brush or coarse towel is needed to keep the surface smooth. Cold baths alone are hardly equal to removing all this outer layer, particularly if the water is hard, so that they had better be supplemerited during the week by one or two warm ones. There is very little danger of a well-occupied individual bathing too much — the great majority do not begin to bathe enough.