The care of the baby: a manual for mothers and nurses, containing practical directions for the management of infancy and childhood in health and in disease

Front matter

I '

THE

A MANUAL FOR MOTHERS AND NURSES

Preface To The Second Edition

The very gratifying success which the first edition has met has made the author desirous of bringing the present one thoroughly up to the demands of the times. He has therefore submitted it to a complete revision, enlarging it considerably and adding several new illustrations. He would again emphasize the statement made repeatedly throughout the volume, that the chapter on ''The Sick Baby" is not intended to supplant the physician. This he considers impossible. It is designed especially for mothers in eineii'Liicv. where medical aid cannot be obtained.

Preface

The author has endeavored in the following pages to furnish a reliable guide for mothers anxious to infonn themselves with regard to the best way of caring for their children in sickness and in health.

The first chapter of the book discusses the hygiene of pregnancy, the method of calculating the date of confinement, and similar data. The characteristics of a healthy baby are considered in the second chapter, and the growth of its mind and body in the succeeding one. The chapters which follow relate to the methods of bathing, dressing, and feeding children of different 'ages, to the hours for sleeping, to physical and mental exercise and training, and to the proper qualities of the children's various nurses and rooms. A special effort has been made to emphasize details and to make them clear, complete, and thoroughly up to date.

The chapter upon the baby's diseases has been written particularly for those mothers who, through various circumstances, are unable to have a physician constantly within a moment's call. It contains a description of the symptoms by which we may know that disease is present; a consideration of the nursing of sick children;

a concise resume of the commonest diseases of infancy

12 PREFACE.

and childhood; and directions for the management of various accidents, including, among others, drowning and the swallowing of poisons.

Such illustrations have been inserted as, it is thought, will make more plain the meaning of the text. To avoid repetition throughout the book, various recipes for food or medicine, as well as remarks on the employment of baths of various sorts in sickness, of poultices, disinfectants, massage, and the like, have been placed in the Appendix. Here also are tables showing the proper proportionate doses at different ages, the doses of many of the remedies most commonly given to children, the contents of the emergency medicine closet, etc. The numbered references scattered throughout the text of the book refer to corresponding paragraphs in the Appendix.

The author has endeavored to make his statements plain and easily tmderstood, yet scientifically accurate, in the hope that the volume may be of service not only to mothers and nurses, but also to medical students and to those practitioners whose opportunities for obser\ang children have been limited. With what his own experience with children has led him to believe w^ould be most helpful, he has combined those teachings in other books of like nature which have seemed to him of most value; and he takes this opportunity to acknowledge his indebtedness to previous writers, not forgetting the contributors to the files of that excellent magazine for mothers, ' ' Babyhood. ' ' He would also

PREFACE. 13

express his grateful thanks to his colleagues at the University of Pennsylvania and at the Philadelphia Polyclinic and School for Graduates in Medicine, Professors Hirst, Roberts, Randall, Van Harlingen, and Risley, who have revised for him, with many valuable suggestions, the pages bearing respectively upon the hygiene of pregnancy and of the nursing mother, surgical affections, diseases of the ear, diseases of the skin, and diseases of the eye.

Introduction

It seems often to be taken for granted that the young mother will understand by a sort of intuition the care which her baby requires, as though it needed no more than a newborn animal of some lower order of life. The fact is that such a little animal, slight though its needs are when compared with those of a baby, has a parent which by instinct is far better able to care for it than is the human mother for her child.

That she knows nothing is both the mother's safeguard and her danger. Ready and anxious as she is to fit herself for her new duties, she is even by this anxiety rendered too ready to accept as gospel all that is told her about the care of her infant by those who assume to know, but who "darken counsel by words without knowledge." She thus becomes the prey of " old wives' fables" and of all sorts of gratuitous advice, the injuriousness of which is shown too late in the condition of the unfortunate child.

A well-informed monthly nurse can be of great assistance to a new mother beginning the care of her baby. Unfortunately, not all nurses are of this class, and some are full of absurd and harmful practices and teachings, while even those who are intelligent and well trained often err greatly in many points. Of all this the mother is, of course, unable to judge, unless she herself

2 17 knows what is right. The baby's grandmother is naturally rather rusty in matters relating to the care of children, although she may not be ready to admit it. Moreover, it is most true, in the words of the old song,

that

" Times have changed since then, And life is a different thing,"

and many methods which were considered entirely correct years ago have since been greatly improved or even found to have been actually wrong. The mother there-, fore finds herself, after the departure of her nurse and physician, ignorant and without reliable resources upon which to draw. Such being the case, we may profitably consider, as briefly as possible with due regard to completeness, some of the matters connected with babyhood from birth, and even before it, up to the time when childhood ceases.

Baby is, indeed, a very indefinite term, often applied by mothers to children who have far outgrown their right to the name as strictly used. But "baby" the child still is to its mother, unless a second comer has. added dignity to the first-born's position, so "baby" it shall be to us in our present study of its wants ; for we must not forget that a child even of several years demands just as great care, although of a different sort, as it did when still in arms.

From a strictly medical standpoint babyhood and childhood are very commonly divided into three jDeriods, concerning the exact limits of which physicians are not altogether agreed. Most conveniently we may speak of, first, mfancy^ which extends from birth to the age of tw^o years; second, early childhood^ from the age of two to that of six years; and, third, later childhood^ from the age of six years to that of puberty — that is, thirteen to fifteen years. We shall repeatedly have occasion during our study of the subject to use these terms as thus defined.

No observations made in the following pages concerning the baby when ill are intended to do away with the j physician any more than they are meant to make a ! mother entirely dependent upon him. Their object is ' only to help her understand what she can do without I medical advice, and how she shall do it; when she shall call a physician to her aid, and what she shall do before he comes.

Chapter I. Before The Baby Comes

It is a fact which ought never to be forgotten that the proper care of the baby begins long before it is born, for to produce healthy offspring the parents must themselves be healthy. Although the manner of living always healthily is a subject far beyond the province of this volume, at least some attention must be given here to the way in which a woman should live after she has discovered that she is to be a mother. How she shall order her life should certainly be her first consideration, for, whether or not the coming of the baby is a welcome thought, her responsibility for the future welfare of the child that is to be remains the same. She has no right to act in any way that may injure another human life.

Signs of Pregnancy. — Whether she is really pregnant is naturally the first question, and one concerning which a woman does not ordinarily consult her physician. There are a large number of presumptive signs of pregnancy, many of which she is capable of observing her-

II self. It is proper to remark that none of these indicate anything further than the probable existence of pregnancy. There are only a i^^ positive signs, and these can be detected by the physician alone.

The most striking and valuable of the presumptive j signs is, of course, the cessation of the monthly periods; 1 yet even this is not entirely reliable, for various other • causes may account for it. It sometimes happens that ' menstruation is absent for several months in early mar- j ried life, and yet that conception has not taken place; \ while, on the other hand, the monthly periods occasion- ; ally come on regularly during a part or, rarely, all of j pregnancy, although in this case they are usually scanty ' and of short duration. Finally, a woman may conceive while still nursing and before menstruation has been re-established. As a rule, however, the cessation of j menstruation in a married woman previously regular "j indicates pregnancy. i

Enlargement of the abdomen is another important ' sign, although usually not detected before the fourth j month of pregnancy. A valuable indication is enlarge- j nient of the breasts with tenderness of the nipples and a I decided widening and browning of the pink ring, or areola^ around them. Sometimes a small amount of a watery fluid is secreted later. The enlargement of the | breasts begins in some instances in the second month of ' pregnancy, and becomes quite noticeable in the fourth and fifth months. The alteration of the areola commences to be visible by the end of the second month.

' ' Morning sickness " is a symptom present in many women. It usually consists in the occurrence of nausea, and perhaps vomiting, in the early morning, but it sometimes lasts all day. It appears generally in the second month, occurs every day or less frequently, and lasts only through the third month ; but in bad cases it may continue through the whole period, and become dangerous from the difficulty the patient experiences in retaining food.

*' Quickening" is a sign of much value, but, like the others, only presumptive. By this term is meant the detection by the mother of the movements of the child within her. It was once thought that the child received life at this time, but this was, of course, erroneous. The child is just as much alive before quickening as afterward, but its early movements are too feeble to be perceived until four or four and a half months after conception. The movements at first give the sensation of a feeble fluttering, but soon become much more evident, and then feel like sudden, sharp strokes or kicks, and are often the cause of considerable or even great discomfort.

There are a number of other less important presumptive signs, such as variations in appetite, with abnormal hunger, or "longings," for unusual kinds of food. Again, the whole disposition may be changed completely for the time, and she who was formerly vivacious, cheerful, and good-natured may become dull and melancholic, full of the gloomiest forebodings, or excessively irritable. Sometimes, but, unfortunately, less frequently, just the reverse of this takes place, and the disposition is at the best during pregnancy.

The exact time at which the baby may be expected is a matter of great importance, since so many preparations must be made for its arrival. Confinement occurs 272 to 275 days from the date of conception; but, as this date can rarely be determined exactly, it is customar}^ to reckon that pregnancy lasts 10 menstrual months of 28 days each — that is, 280 days — from the first day of the last menstrual period. This equals 40 weeks, or a little over 9 calendar months. A ready rule for determining the date on which confinement may be expected is to count three months backward from the first day of the last menstruation and to add seven days to the date obtained. Thus, if the last period began on February 3, three months backward would bring it to November 3, and seven days added would make November lo the probable date. Since, however, the months are not of equal length, various tables have been constructed for a more accurate and convenient method of computing the date. The one upon the opposite page is a form very commonly in use.

This method of reckoning is, of course, only approximate even when the exact date is known on which it is supposed that conception occurred. It is therefore only safe to consider the calculated date of confinement as the middle of a period of two weeks, on any day of which labor may naturally take place. Where it is impossible ■ to reckon from the last menstrual period, it is customary to count from the date of quickening. Four and a half months from this date, or five months in the case of a woman pregnant not for the first time, will give the " approximate date of confinement, although this is not " very accurate.

Management of Pregnancy. — The prospective mother has, then, forty weeks during which she shall conduct herself in the way that will exert the most powerful influence for good upon the health of the coming little j. one. Bathing in tepid water may be enjoyed daily, but i very hot or very cold baths, sea-bathing, and foot-baths \ are dangerous. Moderate exercise in the open air is im- ^ portant, while the constant occupancy of close, heated rooms is distinctly harm^ful. All the pure air possible should be obtained. Walking is beneficial, as is driving \

BEFORE THE BABY COMES.

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z< over smooth roads or riding in street cars; but horseback riding, bicycling, dancing, driving over rough roads, lifting, straining of any kind, the use of the sewing-machine, and all other violent or long-continued forms of exercise ought sedulously to be avoided. Particular care must be observed at the times at which the menstrual period would naturally occur if pregnancy did not exist. Sea-voyages are dangerous, on account of the liability to sea-sickness and the straining which accompanies it. There is a very injurious custom among some women — that of refusing to go out of the house from the time when the alteration of figure becomes marked. Even were concealment of the figure impossible, health rather than appearance should be the first consideration.

Amusement is, of course, necessary. There is no reason why pleasures should be abandoned, provided they are made entirely secondary to health. So, too, the frequenting of the theatre and of similar places of amusement is often harmless, especially if it is found to exert no unduly exciting influence upon the emotions. In many women, however, the emotional nature is unusually susceptible during pregnancy, and crowded places and exciting reading must be avoided. No amusements should be allowed to interfere with the obtaining of the large amount of sleep which is always required at this time.

This brings us naturally to the consideration of the management of the mental condition. The unusually impressionable state characteristic of pregnancy renders a woman very prone to become the subject of great despondency. This she can relieve to a certain extent by the recollection that it is only a symptom shared by a great many others, and that there is no reason for the conviction that she will never survive the birth of her child.

It is, of course, much easier to give this advice than to follow it. Consequently it is important that she avoid adding to her fears by listening to detailed accounts of the trials of other women under similar conditions, or by reading depressing novels or witnessing distressing sights. The experiencing of frights, the seeing of deformed persons or animals, the hearing of bad news, and so on — maternal impressions^ as the doctors call them — are very commonly supposed to exert a powerful influence in producing some deformity or defect in the child; while the looking at beautiful objects, the listening to delightful music, and the reading of elevating books are also claimed to affect favorably the body or mind of the baby. As there is a possibility that such influences exist, every pregnant woman should avoid the one sort and cultivate the other. At the same time, there is certainly far more fable than truth in all this, and the action of such things is so infinitesimal and so uncommon that no woman need conclude that her child will surely be '^ marked " because she has been frightened or impressed in some way. The chances are hundreds of thousands to one that no such thing will happen. The various instances of maternal impression of which we so often hear are simply imaginary. On the other hand, there does exist the very certain influence of inheritance. If a mother wishes her child to be healthy of body and beautiful of mind, she must previously have cultivated her own mind and body through years of training.

The diet during pregnancy should be generous yet easily digestible. There is no reason why the usual diet should be altered at all, if it has been healthful and well assimilated, except that it is sometimes better to have the evening meal light. It is also wiser to eat meat only once a day, in order to throw less work upon the kidneys.

There is no truth in the fancy that certain articles of food eaten can exert any special influence upon the development of the child.

The dress is very important. The skin should be well protected against change of temperature by wearing woollen clothing both in summer and in winter. All garments must be loose enough not to interfere in the slightest with the progressive enlargement of the abdomen and breasts. No woman with the slightest regard for the health of her child or for her own safety will resort to tight lacing in the endeavor to conceal her state as long as possible. From the very beginning of pregnancy she should abandon the corset altogether or use one especially adapted to prevent pressure, and should avoid circular garters and suspend the clothing from the shoulders as far as possible. There are now various dress-reform systems on the market which answer the purpose very well, and which are certainly to be commended during pregnancy, even though a woman cannot persuade herself to wear them always. High-heeled shoes ought not to be

worn, as they put a strain on the back and the pelvis and may do serious damage. With the exhibition of proper taste and skill the dress can be so fashioned that no woman need have cause Fig. i.-Abdomi„al b^ *« "^egaM herself as unfit to

appear in public.

The abdomen may grow very large, especially in women who have previously borne children, and may demand some support. A binder will give relief, or, better still, one of the abdominal supporters which are especially made for this purpose (Fig. i). A week or two before confinement the abdomen usually seems to grow a little smaller, the result of the settling of the womb lower into the pelvis.

The care of the breasts must be commenced early, since upon this the ability to nurse the baby may largely depend. The entire removal of the pressure of the clothing allows the breasts full opportunity to grow properly. They should, however, be covered warmly, and be well supported if their increasing size renders their weight uncomfortable. Particular attention must be given to the nipples, in order both to render them of a shape which the child can readily grasp and to make them secure later against the development of painful fissures. Sometimes there is a tendency to the formation on the nipples of a large amount of scaling skin. These scales must be washed away frequently if they show a disposition to adhere. If, as the breast grows, the nipple is found not to stand out well, a nipple-protector of some sort may be worn constantly as an additional safeguard and aid to development. This should not be done except by medical advice. In cases of flat nipples it is frequently of advantage to endeavor every day to pull them very gently with the fingers out from the breast. Another excellent plan for accomplishing this end is the use of a breast-pump. The form shown in the illustration (Fig. 2) is one of the best, as some pumps are too powerful and are apt to do injur}^ Traction by the fingers or by the pump should not be used in a way to do the slightest harm,

^ ^ Fig. 2. — Breast-pump.

and no treatment of this sort

should be begun until the last four weeks of pregnancy, lest a miscarriage be produced in women liable to it. With the beginning of the last month a hardening process for the nipples ought to be instituted, in order to prevent the formation of fissures later. A useful plan is that of applying, morning and night, a tannin solution (Appendix, 73) to the nipples with a piece of absorbent cotton.

The question often arises whether there is any way of determining the sex of the coming child, or any course which the mother can pursue to influence it. The very fact that so many different methods are heard of is excellent proof that none of them are good for much. The truth is that there is absolutely no reliable means known to medical science for discovering in advance whether the child will be a boy or a girl, and not the slightest power of doing anything that will have an iota of influence in producing a child of the desired sex.

Disorders of Pregnancy. — There are many discomforts of pregnancy for which the sufferer herself may be able to do much. If simple means do not avail, she should not neglect to consult her physician, for there is surely no need of enduring any inconvenience that can be avoided. Constipation is exceedingly common at this time. The use of some laxative food, such as oatmeal porridge, green vegetables, figs, oranges, or stewed fruit, especially prunes, is often sufficiently effective. If not, mild drugs may be used without danger, as, for example, Seidlitz powders, or such mineral waters, in small doses before breakfast, as Hunyadi, Rubinat, Friedrichshall, and the like, or some gentle laxative pill prescribed by the attending physician. All strong purgatives and patent medicines are to be shunned. Enemata of tepid water may be used safely. Suppositories of glycerine or of gluten, or very small glycerine enemata are also of service.

Irritability of the bladder is very common. It is relieved to some extent by the recumbent position, which takes away the pressure of the heavy womb. If the urine is high-colored and causes smarting, a physician's advice should be had. Hemorrhoids, or piles, not infrequently develop in the later months of pregnancy. Ver)^ hot fomentations or sponging with very cold water, done frequently and followed by boric-acid-and-zinc ointment (Appendix, 71) often affords great relief. Rest in the recumbent position is also of value. If the bowels are kept regular and all straining is avoided, hemorrhoids will not be so liable to form. Varicose veins or a painful swelling of the legs and lower parts of the body is often very annoying as pregnancy advances. Rest lying down is one of the best means of relief, as is rubbing of the legs in an upward direction. It is often necessary to apply a soft flannel roller bandage from the toes nearly to the hips. This should be done before getting out of bed in the morning. If varicose veins grow at all large, a physician should be consulted, as there is danger of their bursting. Should the face swell, as well as the legs, it is probable that the kidneys are affected. As this is a dangerous complication, no time should be lost in obtaining medical advice. Indeed, a specimen of the urine should be sent to the physician from time to time during pregnancy, to make sure that no disorder of the kidneys is insidiously developing. A profuse flow of saliva sometimes occurs. It is occasionally relieved by a mouth-wash of tincture of myrrh in water. Toothache is not infrequent. If neuralgic only, it is often relieved by the use of a hot- water bag; but, unfortunately, it is not always of this nature. Decay of the teeth is very apt to occur during pregnancy, and it is best to consult a dentist occasionally, even though there be no toothache. No painful dental operation should be undergone if it possibly can be avoided.

It sometimes happens that the hair falls out badly during pregnancy. This, like the toothache, may be only a temporary matter; but as it may be permanent, it is well to receive treatment for it.

There is no reason whatever why a woman should suffer from morning sickness without at least making an effort to have it relieved. A plan frequently effectual is to take a cup of coffee, tea, broth, or hot milk early in the morning, without sitting up in bed, and then to rest or to sleep again for a short time before rising. If the vomiting persists during the day, food ought to be taken in very small amounts at frequent intervals. Of course, too, the food ought to be digestible and the bowels kept regular. Should the vomiting be severe and not be relieved in the way mentioned, medicines ordered by the physician will often control it.

Heartburn and other evidences of indigestion, which are quite common in pregnancy, are often promptly relieved by soda-mint, and, if not, they should be prescribed for by the attending physician. Leucorrhoea is sometimes decidedly troublesome and even very irritating. Injections should not be used unless ordered by a physician, and then only with a very gentle stream from a fountain syringe (Fig. 3). The bag of the syringe must never be elevated more than a foot or two above the hips. Externally, a solution of boric acid in water (Appendix, 75) may be used for bathing if there is any soreness, followed by the application of an ointment of oxide of zinc or of a pow^der of talc.

Fig. x. — Fountain s^Tinge. _ . . ^ ^ ^.

^ ^ ^ Preparations for Confine-

ment. — Finally, we must consider briefly some of the varioiis preparations to be made for the confinement itself. The following list comprises the articles for the mother's use that should be provided in advance:

Hand-towels.

Ether, one-half pound.

Brandy, two ounces.

Vinegar, four ounces.

Antiseptic tablets (corrosive sublimate), one bottle.

A large, coarse new sponge.