CHAPTER XX

Chapter 2712,082 wordsPublic domain

HOME NURSING AND FIRST AID IN THE NURSERY[34]

=General Principles.= Careful hygiene will reduce illness to a minimum. Study what to do in emergencies and illness before these appear, in order to be mentally and technically prepared to act promptly, with confidence and poise, when need arises. Teach children as early as possible how to spit, gargle, raise phlegm, inhale. Habits of obedience, self-control, and regularity will assist in recovery. Under any circumstances avoid excitement; keep calm and self-possessed. Use firmness, gentleness, patience, good cheer, and the spirit of play in care of illness. It is wiser to call the doctor at first, when symptoms of illness appear, than to incur severe sickness and greater cost by delay. A severely sick child needs a trained nurse. Children have less resistance than adults, and succumb more easily, therefore they need prompt, intelligent treatment.

Every woman who has the care of a little child should learn the following from the physician or nurse: use of clinical thermometer, bedpan, giving of enema, massage, dressing and bathing of bed patient, bandaging, first aid in serious cuts, fractures, broken limbs, drowning. There should always be at least one room in the house with washable walls, sunny exposure, and without carpets, heavy draperies or upholstered furniture, that can be used for an isolation sick room in emergency.

=Symptoms of Illness and Their Immediate Care.= When several symptoms are evident at once, the matter is more urgent. It is usually advisable to have the doctor call, rather than to expose the sick child to the change of temperature, dust, excitement of crowds, or danger of infecting others. In severe injury, secure any medical assistance in quickest way.

Discharge from nose C (?)[35] 1 Discharge from eyes with inflammation C (?) 1 Swollen lids, inflamed, yellow discharge C[36] 3 Sore throat C 2 Pain in or behind ears 1 Swollen glands in neck 1 Persistent cough C (?) 1 Persistent lassitude C (?) 1 Loss of appetite 1 Loss of weight 1 Severe or frequent earache 2 Headache with delirium 3 Stupor or dullness 2 Chills, with or without fever C (?) 2 Fever with languor, loss of appetite C (?) 2 Nausea with fever C (?) 2 Convulsions 3 Eruptions C (?) 2 Cramps and vomiting C (?) 3 may be poisoning Persistent pain in feet or legs 1 Swelling of feet and legs 2 Black, or bloody stools 2 Claylike stools 1 Constipation (48 hours, not yielding to home care) 1 Green stools, diarrhea 3 White vaginal discharge 2 Bleeding from mouth or rectum 2 Frequent bleeding from nose 1 Pain at urinating 1 Retention of urine (24 hours) 1 Injuries: Fall, especially of young child 3 Blow on head, severe 3 Deep cut, needing stitches 3 Deep burn 3 Excessive bleeding 3 Wound of rusty instrument 2 Bite of animal 2

1. Notify doctor. 2. Call doctor. 3. Get doctor immediately; urgent.

When a child shows even slight symptoms of illness, isolate and keep in bed for a day in a well-ventilated room. This avoids changes of temperature, requires less work of heart and nerves, removes pressure upon spinal nerves, and gives the body better opportunity to combat the lowered vital condition.

Communicable Diseases to which Children are Especially Susceptible

Communicable diseases may be conveyed by discharges, especially from nose and mouth, and in breath; also in vomitus, discharges from eyes and ears, feces, urine, and blood. May be contagious several days before serious symptoms appear in acute cases; and may be carried in throat and mouth many months and conveyed by persons showing no symptoms.

=To Prevent Contagion.= (1) Avoid exposing the child to any one who has a contagious disease. (2) Do not take young children (under seven, at least) into crowds, busy streets, city dust, or street cars. (3) Household employees, especially child’s nurse, cook, kitchen employee, or laundress, should be selected with regard to their health; a thorough health examination for the child’s caretaker, unless personally well known or professionally trained, is the only safeguard. (4) No one with a cold, sore throat or other symptoms of contagious disease should be with a young child or prepare its food. (5) Keep special handkerchiefs for each child and never use any one else’s for it. (6) Teach scrupulous individual use of cups, spoons, forks, wash cloths, towels, handkerchiefs, whistles, and not to use wash basin for brushing teeth. (7) Avoid pacifiers; wipe toys daily. (8) Clean the child’s finger nails daily, and always wash his hands before eating. (9) Attendant should always wash hands before preparing food, giving medicine, caring for eyes, nose, mouth, or wounds; and after care of diapers, toilet, wounds. (10) Milk and water supply should be carefully guarded; unless assured pure, milk must be pasteurized, water boiled. (11) Avoid cats or dogs for young children’s pets.

Disease germs can thrive in the mucus, in some tissues, or in the blood. They may enter (1) through the nose, (2) the mouth, (3) a break in the skin. The sick person may convey them (1) from the mouth, by coughing, by a kiss, or on cups, spoons, forks, napkins, towels; (2) in mucus from the nose, in sneezing, or on handkerchiefs; in discharges from eyes or ears; (3) in cases of intestinal infections, from intestinal discharges; (4) venereal disease, from break in skin, from open sore, from suppurating infected eyes; (5) from discharge of boils; (6) scales from skin probably only in smallpox or chicken-pox; (7) on fingers. (8) Germs of contagious diseases are sometimes carried in water, ice, milk, or dust. (9) Cats and dogs easily carry disease germs.

Contagious diseases are always dangerous, causing a large harvest of deaths and leaving lifelong defects in many survivors. It is not necessary that children should have any of them. Children should be carefully protected from exposure to any disease. Good hygiene raises vitality and increases the white blood corpuscles, which are the special protectors against disease germs.

If a child has been exposed to dust or crowds, or if contagious disease is prevalent, give a nasal douche and gargle with normal salt solution, 4% boric solution, or diluted listerine, before meals and at night. If exposed to disease, also disinfect face, neck, hands, clothes, shampoo the hair with tincture green soap, isolate, notify doctor; repeat after quarantine.

=Care of Illnesses Prevalent in Childhood.= _Anemia._ Pallor, languor, loss of weight, poor appetite. Give outdoor life, nutritious diet, cold baths, sun baths. Needs medical examination for cause.

_Boils._ Indicate low resistance. Applying hot fomentations wet in boric solution may prevent coming to head. If at head, apply hot fomentation five minutes; lance with sterilized needle. After removing contents, apply listerine, witch hazel or 25% alcohol, on sterile gauze; anoint with zinc ointment, and bandage to prevent re-infection. Poultices are unsanitary. Pus is infectious; prevent its touching skin, burn immediately, and sterilize needle.

_Chap._ Prevent by drying face and hands thoroughly after washing. Apply camphor ice or cold cream before taking outdoors, and at bedtime. Use corn meal or oatmeal in place of soap.

_Cold._ May be either a congestion or an infection. In any case isolate and treat first symptoms at once; give persistent care to cure quickly. Colds pave the way for more serious infections. Give oil laxative for one or two days. Apply few drops of glycerine, albolene, or liquid vaseline in nose every two hours and at bedtime. Use sterilized medicine dropper; warm oil slightly by heating in dropper over boiling water. For children over one year use nasal oil spray or nasal douche with physician’s prescription. Give hot leg bath or hot tub bath, wrapping well to produce slight perspiration; rub with 25% alcohol solution few hours later, or before rising, to close pores; keep well covered. Keep in bed while fever continues. If in head and eyes, apply cold cloth wet in weak boric or salt solution, over eyes and nose, changing every five minutes, in half-hour periods. Give all the water patient will take, at hourly intervals, or lemonade for children over eighteen months. For dry, parched mouth, rinse with weak salt water, give weak lemonade, or cracker to chew.

If accompanied by chills, keep in warm room, (68°) well ventilated. If without chills, and when fever has subsided, keep outdoors, well protected, but not dressed warm enough to perspire. If in chest, apply counter-irritant (adapted to age) to chest and back. If not recovered in a day or two, notify physician. For repeated colds, discover cause, improve hygiene; increase resistance by cold morning bath, at least to chest and back, and give cod-liver oil.

_Colic._ Give no food during the attack. Give a teaspoon of water (96° F.) with weak peppermint or soda mint dissolved in one ounce water; repeat every five minutes. Upright position, with patting on back, will relieve gas in stomach. For gas in intestine, massage gently, beginning at lower left side, and working backward along length of colon, always pressing and stroking toward end of colon. If constipated, or attack very severe, give warm enema (110° F.) with soap or normal salt solution. Apply hot fomentations, or hot stupe, made by thoroughly mixing twenty drops of turpentine in one pint water, to abdomen; or hot flannels or hot water bag, to abdomen, buttocks, and thighs. Keep feet warm. Change fomentation or stupe every ten minutes. When relieved, follow with cool hand rub (80°). Constipation in nursing mother will cause colic. Baby subject to colic should have two or three daily movements. Give less at feeding, with longer intervals, slower feeding.

_Constipation._ Prevent and treat by diet, exercise, and general hygiene. If these fail, have medical examination for possible anatomical defect or obstruction. For acute attack, give mineral oil, increase water, give abdominal exercises at intervals during day, gently knead abdomen, working along line of colon from right to left. The use of enemas and suppositories relaxes the intestinal wall, and induces a chronic condition. Salts, castor oil, cascara, and other drugs overstimulate intestinal secretions, irritate lining, and require continued, increasing use. Calomel may remain in system and cause serious illness; it should never be given to children. If necessary to use any special measures, adapt laxative from list (page 362). For chronic cases in older children, apply cold compress around abdomen at night until condition is improved.

_Convulsions._ Give leg or tub bath at 98° F. for ten minutes; mustard may be added. Be very careful that water is not too hot. Child may be put in with clothing on. Put cold cloth around neck and on head. Give prompt laxative and an emetic. Keep child in bed till recovered from shock.

_Cramp in Intestines._ Treat as colic.

_Croup._ Apply hot fomentation to chest for ten minutes, followed by cold compress. Give salt water emetic to cause vomiting and remove phlegm, if breathing is still difficult. If necessary, in severe case, give half teaspoon of syrup of ipecac to produce vomiting; apply counter-irritant to chest and back. Keep child well wrapped. If severe, prepare kettle of boiling water so child can inhale steam. Add two tablespoonfuls of compound tincture of benzoin, creosote or oil eucalyptus, or teaspoon of vinegar or ammonia. Use light blanket to cover kettle and head of child. See that kettle is not near enough to burn face. Be careful that child does not choke, and that clothing is not dampened. Wrap a piece of rubber sheeting or woolen blanket about shoulders, and remove when through steaming. For mild cases, or when child is relieved, place saucer with tincture of benzoin near child’s head, where fumes will be inhaled. Treat as for cold, on following day, with counter-irritants, and use menthol, oil nasal spray, or tincture of benzoin for inhaling. For children subject to repeated attacks, provide a special croup kettle.

_Cough._ Ascertain cause from physician and treat by his prescription. Avoid cough syrups, which are dangerous for children. Plain honey, figs, fig juice, are soothing. Use menthol inhaler. Apply salve of menthol and vaseline in nose at night, and a cold compress or mild counter-irritant on throat.

_Diarrhea._ Stop regular food. Give infants barley water, older children only special dietary. Give prompt laxative. Keep in bed. Call doctor promptly and save stools for his inspection.

_Earache._ Symptoms in infant include crying, and turning head from side to side. Apply counter-irritant behind and below ears. Place few drops of lukewarm phenol and olive oil mixture in ear, on sterilized cotton. Apply hot flannel, hot-water bag, or other dry heat.

_Eczema._ Apply salve or lotion, according to doctor’s direction. Avoid water or vaseline on affected places, as these are irritating. Keep clean with olive oil or cold cream. Give dietary treatment.

_Eyes Inflamed._ Bathe hourly with 2% boric solution or weak salt water. For cold in eyes, also apply vaseline at night and in morning to lids, avoiding eyes.

_Headache._ Frequently due to constipation, indigestion, eyestrain, excitement, fatigue, overheating. Ascertain and treat cause. Apply cold cloths, changing every five minutes, or hot cloths, changing every ten minutes, or alternate hot and cold, according to wishes of patient, to forehead and back of neck. Apply menthol pencil to forehead and base of brain. Massage back of neck, with strong pressure downward and toward sides. Inhale menthol, mild camphor, ammonia, or smelling salts.

_Hiccough._ Due to indigestion or overeating. Hold breath. Sip water slowly while holding breath. Give small lump of sugar. If severe and continued, induce sneezing or give emetic to remove cause.

_Nausea._ Give soda mint tablet in glass of hot water. If not relieved, give emetic. After vomiting, give glass of hot or cold water hourly, mildly salted or with soda mint, for several hours.

_Poisoning._ Keep poisons out of children’s reach. Nick cork of bottles containing poison, and tie red ribbon around neck. Keep list of common poisons and antidotes posted on door of medicine cabinet for ready reference.

_Prickly Heat._ Due to overheating from too much clothing or from weather. Reduce quantity of clothing. Avoid wool next the skin. Bathe several times a day with water 70°-80° F., adding one teaspoon baking soda to a quart of water. Powder affected places lightly with starch or baby powder (page 47).

_Rheumatism._ Found in all its forms in childhood. If chronic, may permanently injure heart. Give mild laxative. Keep in bed. Apply dry heat as directed to affected parts. Rub with alcohol (25% solution), witch hazel, or arnica. Improve diet, reducing purins and increasing alkali-forming foods. Electric treatments may be beneficial.

_Sunburn._ Prevent by use of canopy, sunshade, or hat, and by applying cold cream before taking out in sun or wind. To treat, apply cloths wet in sweet cream, cold cream, almond lotion. Avoid use of water on affected parts.

_Fever._ Keep in bed. Fever is not a disease but a symptom of poison in system. Reduce temperature gradually. Give cool sponge (75°-80° F.) with plain water, weak salt solution, or 25% alcohol solution, for ten or fifteen minutes every hour. Keep cool collar of wet cloth around neck, or on head, changing every five minutes. In severe cases, also keep icebag at head, hot-water bag at feet. Give abundance of cold water, cold fruit juice with little or no sugar, or small quantity of ice cream. Keep room cool (60°-65° F.). There is no danger of patient taking cold while temperature is high, but special precautions must be taken, as fever diminishes, to prevent chilling.

_Sore Throat._ Dissolve chlorate of potash tablet in half pint of water, and give spoonful every half hour, holding in mouth as long as possible. Gargle and rinse mouth with normal salt solution, boric acid, or listerine, without swallowing. For mild cases, apply cold compress to throat. For severe attack, use counter-irritant.

_Stomach._ Sour stomach or heartburn. Use soda mint tablet or saltspoon of baking soda in glass of hot water. For stomach-ache give same treatment, and massage by deep breathing and voluntary pulling in and pushing out abdominal wall by muscular effort; use mild trunk-bending and twisting exercises. If constipated, give prompt laxative.

_Toothache._ Apply listerine or oil of cloves or wintergreen on cotton to the cavity, and dry heat or counter-irritant outside, until dentist can be seen.

_Worms._ Indicated by disturbed sleep, grating teeth in sleep, picking at nose, poor or ravenous appetite, irritation at rectum. May sometimes be visible as fine white threads in stools. Can be accurately diagnosed only by microscopic examination. Avoid giving medicine except on doctor’s prescription. Reduce candy and meat in diet.

=Injuries.= Practice first aid until prepared to act promptly in any ordinary emergency. Call physician in all but mildest cases, to ascertain extent of injury, overcome shock, and prevent poisoning. Disinfect hands before treating any wounds.

_Bruise, Bump, or Sprain._ Apply very cold or very hot water, changing at proper intervals. Continue until swelling is reduced.

_Burns._ Never use flour or cotton on burns. Exclude air and prevent infection from dirt or water. Burns are easily infected or cause shock. For burns by dry heat, apply vaseline, baking soda, carron oil, or olive oil, and wrap in sterilized gauze to exclude air. For scalds, apply wet cloths of cool water (sterilized if possible), with baking soda or boric acid. Exclude air and be careful not to break blister. Treat blisters as burns.

If clothing is afire, smother by rolling on floor or wrapping in heavy coverings. Prevent fumes and smoke from entering lungs. If clothing is burned to skin, cut around it and soak off with olive oil. For fire in room, close windows and doors, and attempt to smother before using water. To go through smoke, put wet cloth over mouth and nose.

_Cuts and Scratches._ Hold under running cool water to thoroughly rinse out dirt. Wash with disinfectant. Take special care with wounds from rusty instruments. Scratches may then be painted with collodion, cuts covered with court plaster (do not moisten in mouth) or surgeon’s plaster.

_Fall or Shock._ Lay flat. Apply cold water to head, hot-water bag at heart and to feet. Cover warmly. Rub arms and legs toward heart, without uncovering. Apply mild smelling salts, ammonia, or camphor at nose. Never give alcohol without doctor’s order. Hot milk, tea, or coffee are safe stimulants.

_Foreign Body in Ear._ Do not attempt to remove by poking. Put in few drops of sweet oil, lay head down on that side, till doctor comes.

_Foreign Body in Nose._ Do not attempt to remove by poking. Let child blow nose, closing opposite nostril. Call doctor.

_Foreign Body in Throat._ If not easily removed with finger, hold child by ankles, head downward, and slap on back. If swallowed, give soft bread at once but do not give laxative. Remove fishbone with fingers.

_Foreign Body in Eye._ Do not rub. Encourage crying. Blow nose. If visible, remove with corner of clean handkerchief. If not visible, pull upper lid over lower, and move gently. Wash eyes with boric or salt solution. For injury, apply cold cloths wet in boric or salt solution.

_Slivers._ Remove with a sterilized needle, wash with antiseptic and bandage with zinc ointment or paint with collodion. Never use a pin. If very difficult to remove, apply hot fomentations.

=Use of Water, Heat, and Light.= Heat, cold, water and light are effective because of their action upon the distribution of circulation, rate of metabolism, the local and reflex nerves, the heart action, the chemical condition of the blood. Their therapeutic use has only in recent years become a science. Extensive study and experience is necessary for their efficient application. A few fundamental principles will guide in their ordinary use, but only a physician trained in hydrotherapy and thermotherapy can give directions meeting every factor in an individual case.

Applications affect not only the local part but also the parts with which it is reflexly connected. The volume of blood can be withdrawn from any part or to any part. The first effect of hot applications is stimulating; continued for more than ten or fifteen minutes (after the surface is reddened) is depressing. Cold is first depressing; continued slightly is stimulating, and long continued becomes depressing. Alternate heat and cold for three to ten minutes is the most stimulating.

Pain, inflammation or increased secretion in any part usually indicates local congestion of blood which needs to be withdrawn. Congestion in the head, indicated by headache or cold; or in the chest, indicated by chest cold; or in the abdomen or pelvic organs, can be reduced either by a general distribution of blood to the surface or by withdrawing the supply to the legs and feet. A hot bath or pack draws the supply to the surface; a hot leg bath or pack draws it to these extremities. The cool sponge following the hot water keeps the blood in these parts, besides reducing the temperature of the superheated surface and toning up the skin. Hot fomentations draw the circulation to the surface, away from the congested internal parts directly beneath or reflexly connected. Thus, heat applied to the forehead and base of brain reduces head congestion; or as fever is usually present, cold (50° F.) will have the same effect and at the same time reduce the temperature, while a hot-water bag at the feet will maintain the temperature if the fever is mild or absent. Congestion in the abdomen or pelvic organs is relieved by local applications of heat to these parts and to their reflex areas—the buttocks, thighs, feet and hands.

In using heat or cold, the application must be changed whenever its temperature approaches that of the body. Local hot applications may be continued until the surface is reddened—from five to twenty minutes. The surface is then sponged quickly with water, or 25% alcohol, at 70°-80° F., to prevent superheating of tissues. Cold general sponging in fever may be continued ten or fifteen minutes, one part sponged and dried at a time, patient covered with a light blanket; and repeated every hour. Local cold, as icebags or cold cloths, may be continued half an hour, and repeated at half hourly intervals. A cold compress is a mild counter-irritant. Water reaches tissues below the surface, and for deep-seated disorders is therefore more effective than dry applications, when practicable. Care must be taken to protect hair, clothing and bedding from dampness, by use of rubber cloth or oiled silk. For young children, temperatures must be less severe and changes more gradual than with adults. The nurse should test the heat of applications by applying to her own face.

_Hot Tub Bath._ For chills, convulsions, incipient cold, general depression without fever. If patient is constipated or had no movement in preceding twelve hours, precede by enema, as hot water increases absorption from intestinal tract. Give in warm room (70° F.), at 100° F., or higher for children over four years. One tablespoon mustard (in cheesecloth bag) per gallon of water increases effect. Wrap cold cloth around neck, and protect hair. Continue five to ten minutes, until skin is red, adding hot water carefully to slightly raise temperature. Give quick hand rub with water at 80° F. unless sweating is desired. Dry quickly, wrap and cover warmly. Giving water to drink will increase perspiration. After perspiring, rub with 25% alcohol.

_Hot Leg Bath._ For intestinal pain, headache, incipient cold, cold feet, convulsions. Conditions and temperatures as for tub bath. Keep patient well covered. Can be given with patient lying in bed, water in bucket on chair at side of bed. Rinse with lukewarm water, put on stockings, and keep hot-water bag at feet.

_Hot Fomentations._ To relieve local pain and congestion. Apply one or two thicknesses of flannel to place; lay on this a double flannel wrung out of boiling water, and cover with dry flannel and waterproof. Be careful that it is not too hot at first. In changing, prevent air striking part. Change every three minutes, and continue twelve minutes. Sponge quickly with water 70°-80° F.

_Warm Tub Bath_ (90°-93° F.). For nervousness and irritability. May continue, maintaining temperature, for half an hour.

_Dry Heat._ For chills, neuralgia, rheumatic pain, earache. Use thermophore, hot-water bottle, hot flannel, salt, bran, hops, soapstone, flatiron wrapped in flannel, or Japanese handstove. In using hot-water bag, be careful it is not too hot; wrap in flannel, and watch for leakage. Water should be below boiling or rubber will be damaged. Press out air before putting in stopper. Remove when cool. If electric pad is used, turn off current when hot. Continue dry heat for half hour periods; sponge quickly with water 80° F.; repeat at half hour intervals if necessary.

_Light._ Light rays penetrate about two inches below the surface, and therefore continue the therapeutic effects of heat to the deeper tissues. Systematic sun baths may be given. Carbon electric light gives the same effect; it cannot be used to advantage, however, with children under four or five years. For pain in chest, sore throat, abdominal pain, may be used instead of hot water or dry heat. Concentrate the light and protect the skin from contact with bulb by a cone made of white paper. For earache, use the smallest size bulb. Apply for fifteen or twenty minutes, until redness is induced, then give quick cool sponge. May be repeated several times during day.

_Cold Bath, Tub or Sponge._ For fever. Cool as patient can react from, beginning at 85° and working lower. Give several times during day, continuing ten to fifteen minutes. Add 25% alcohol for severe cases.

_Cold Compress._ Useful as counter-irritant and stimulant in sore throat, cough, croup, cold in chest, constipation. Wring cloth out of cold water (50°); wrap on part; cover with flannel and with oiled silk or rubber sheeting. Leave on overnight. For greater effect, may be preceded by hot fomentation. For throat, apply from ear to ear, bring up behind ears and hold in place by tapes over head.

_Cold Cloths for Local Congestion in Head or Back._ Apply to temples, throat, base of brain, and to spine. Change every ten minutes, or sooner if warm. For severe congestion and pain, alternate hot and cold cloths, changing as soon as warm.

=Feeding in Illness.= The food is a great factor in recovery from illness, and should be regulated with much care. Do not urge eating. Sick animals refrain from eating, or seek grass or special herbs. Less food is needed when patient is in bed, except in wasting diseases. In any illness give simple, easily digested food, requiring minimum of chewing, providing much nourishment with minimum of effort for patient. In disease, provide anti-toxic diet, highly alkaline, with little or no purins, laxative (except in intestinal disorders), dainty, small servings, served hot, with variety from day to day. Note all symptoms and fit dietary to all conditions present. It is an error to stuff a cold, but rather it should be starved. Beef tea and meat broths contain very little nourishment, but harmful extractives; their stimulation is in part from extractives, in part from the salt and heat. Hot milk, toast-water with butter, clear vegetable broths, provide the stimulation, with a higher percentage of nourishment and minerals, and with none of the disadvantages of meat broths.

_Colds._ Reduce food almost entirely for one or two days. Follow general diet for illness, or as for constipation.

_Constipation._ (See page 171.) Increase oils, fruits, and fruit juice, especially on rising and at bedtime. Oatmeal is laxative to some children, constipating to others. Figs, prunes, and seedless dates may be cooked together or made into a paste. Pecan nuts, ground for children under five, may be used for sandwiches or with fig paste. Use olive oil and lemon juice for salad. Serve eggs raw. Avoid foods prescribed for diarrhea.

_Diarrhea._ Flour browned in oven lightly, then made into gruel, cooking twenty minutes; season with salt. Milk boiled, bread toasted; cornstarch pudding, blackberry juice, gelatine, buttermilk made with yogurt tablets; especially avoid purins, cellulose, raw milk, raw eggs, as well as laxative foods.

_Fever._ Moot question whether diet should be limited or increased. Reduce proteins, omit purins; provide salads, highly alkaline foods, as celery, spinach, baked potato, cantaloupe; allow gelatine, fruit juices, strained vegetable purées, pure ice cream, sherbets, yogurt buttermilk, whey, toast-water.

_Sore Throat._ Infection or from operation. Soft, soothing, healing food. Gelatine, honey, dipped or milk toast, fig paste, date butter, jellies, raw beaten egg, egg and milk, blanc mange, pure ice cream. Avoid hard, strongly acid foods, or those requiring any chewing.

_Wasting Diseases._ Increase diet to patient’s capacity, especially milk, eggs, spinach, salads, fruits, butter, olive oil.

=The Sick Room.= Furnishing, care, and cleaning should be as for nursery. For a contagious disease, disinfect room before and after patient uses. Attendant should wear cotton dress. Street clothes should not be allowed in sick room. Discretion should be used regarding visitors; no one should enter in case of contagion. Use separate bed linen and clothing for night and day. Turn pillows frequently and change position of patient. Use ring of cotton cloth to lift head and prevent bedsores. Reduce room temperature by hanging up wet sheets. Open dishes of chloride of lime will absorb dampness. Charcoal, occasionally changed, will absorb odors. Keep all medicines, glasses, and food covered, room orderly and well ventilated. In contagious diseases, attendant should disinfect hands, gargle and rinse mouth with antiseptic before eating; and before leaving the room, wash face and hands with weak bichloride solution and remove dress, cap, and shoes; a cap should cover the hair.

=Bathing and Dressing.= The sick child should usually have a bath twice a day, temperature and method depending upon his condition. This removal of waste will add to his comfort and hasten recovery. A sponge bath is less fatiguing than the tub. A salt bath (one third cup per gallon of water) is a tonic. It should not be used if the skin is irritated. Bran, starch, or soda baths relieve chafing, inflamed skin, prickly heat, irritation in eruptive diseases. To one gallon water use half a cup of clean bran, tied in cheesecloth and previously soaked; or a cup of ordinary raw laundry starch, or a tablespoon of baking soda. Alcohol bath, using one fourth alcohol, is cooling and hardening. Pure alcohol reduces heat too rapidly. Oil rub with cocoa butter, or olive oil may be used for cleansing in cold weather, for emaciation, or after bath in eruptive diseases.

Rinse mouth and clean teeth after each feeding, using boric solution, weak soda water, mild listerine or 1% menthol solution. Disinfect brush in 70% alcohol after using. In contagious diseases, or great weakness, use a mouth swab, and clean teeth with antiseptic gauze on toothpick, instead of with brush.

=Maternal Nursing and Hygiene.= _Constipation._ Purgatives are never to be used, and enemas employed only as a last resort. If diet and exercise fail, cascara sagrada or compound licorice powder may be used.

_Heartburn._ (Acidity of the stomach.) Sometimes develops. It may be prevented by avoiding nervousness, by taking less fat at meals, and drinking a glass of rich milk half an hour before mealtime; if it develops after a meal, a soda mint tablet or a quarter of a teaspoonful of soda bicarbonate will relieve it. The nausea sometimes present in the first four months is probably due to auto-intoxication from lack of elimination of toxins. Preventive measures include careful attention to diet, daily baths, and exercise. If it occurs, a cup of hot water slightly salted, or a piece of dry, hard toast taken before rising, will usually overcome it. Peppermint, acid from grape fruit, salty food, whole cloves held in the mouth, or a cold cloth laid over the abdomen, are relief measures. It is rarely present in the last four months.

_Varicose Veins._ May be prevented by avoiding fatigue, long standing, and by lying down several times a day, especially after meals, for a quarter hour, with feet elevated higher than hips. Tight bandaging or elastic stockings must be used, if veins become varicose; in severe cases, rest in bed is necessary.

_Hemorrhoids._ May be prevented by avoiding constipation, heavy exercise, overfatigue, and by lying down a few minutes after a movement. May be corrected by local applications, either of cold or hot cloths.

_Pruritus._ Local applications of lukewarm bran water several times a day, followed by dusting powder made by combining one teaspoon salicylic acid with one cup cornstarch, will relieve itching.

_Hemorrhage._ Patient should be put to bed, hips and legs elevated, with local applications of cold cloths or styptic cotton. Doctor should be called immediately.

_Urine._ Decrease in quantity (less than one quart a day), high color, odor, or sediment, should be reported at once to physician.

_Abdomen._ After fourth month anoint daily with cocoa butter or vaseline to give elasticity to skin.

_Breasts._ During last two months wash morning and evening with soap and warm water, drying thoroughly. Anoint at night with cocoa butter, gently draw out nipple. In the morning apply 25% alcohol.

_Teeth._ Rinse mouth after each meal and at bedtime with milk of magnesia or weak sodium bicarbonate solution, to neutralize acids.

_Childbirth._ Primitive women have only slight discomfort, because of natural outdoor living and unrestricting clothing. Minimum of pain requires well-developed pelvis, normal position of organs, strong abdominal muscles, previous good hygiene, moderate-sized baby, with normal presentation. Narrow, ill-shaped pelvis may be caused by rickets, tight binders or diapers in infancy, or to indoor life, long sitting, and tight clothing in girlhood, especially from twelve to sixteen years. Abnormal position of organs or of infant may be caused by tight clothing, heavy clothing supported from the waist, incorrect posture, long hours of standing during girlhood or womanhood. Weak abdominal muscles are due to corsets and lack of exercise. Hygiene includes regularity and rest at periods, freedom from excitation of the pelvic organs during pregnancy and lactation, an interval of two or three years between births, and a condition of reserve vitality at the beginning of maternity. An overweight baby is produced by overfeeding and lack of exercise during pregnancy. Abnormal presentation may be corrected by skilful medical care during pregnancy. Osteopathic treatment during pregnancy, by a skilful practitioner, may improve muscle tone.

The physician should be selected with special care, either a specialist or a general practitioner with an extensive successful obstetrical practice; and the nurse likewise. The physician should be consulted and the urine examined once a month until the last two months, then fortnightly. This is necessary to prevent toxemias, correct any abnormal position, and prepare for any possible complications. Absolute surgical cleanliness by physician and attendants is of the greatest importance at birth and during confinement. Silver nitrate solution for the baby’s eyes should not be neglected. If there are no probabilities of complications, if the local physician is competent and can be readily reached, and if the home can provide sterile conditions, strong artificial light and quiet, the home is preferable for confinement; otherwise the hospital is better. Midwives, unless from accredited foreign training schools, with local licenses, and of scrupulous cleanliness, are a dangerous investment; a competent physician is preferable. With prenatal medical care, an experienced physician, _and aseptic care_ during confinement, it is a very safe experience. Thoroughly satisfactory anesthetics have not yet been discovered. With attention to hygiene from infancy, natural means will minimize pain.

Diet should be light during the first few days. Overfeeding may cause constipation and poor milk. Rest in bed for two weeks, and quiet life, with only light exercise, and chiefly out-of-doors, for the succeeding month, is necessary for complete recovery of the pelvic organs. A few weeks’ care and quiet at this time, even though the mother feels strong, may prevent months or years of invalidism. The physician should make examinations of both mother and baby four weeks and six weeks after birth.

_Nursing._ The baby should be put to the breast six to twelve hours after birth, when the mother has rested, and every six hours for two days; thereafter, according to schedule. This should be persisted in for ten days, at least, the milk sometimes not coming for a week. This is as important for the recovery of the pelvic organs of the mother as for the nourishment of the baby. The baby should be given water between the feedings, but no food, unless on the doctor’s order.

If the baby is unable to take the breast, through weakness or some malformation of the mouth, the milk should be drawn out with disinfected fingers or breast pump into a sterilized glass, and fed through a sterilized medicine dropper, or after two months, with a spoon.

If the nipples become sore or cracked, a glass breast shield with rubber nipple should be used. This is to be boiled for five minutes after using, and kept in saturated boric solution until needed. If the breasts are heavy, congested, or tender, a knitted breast binder should be worn, the breasts massaged from base toward the center for ten minutes between nursings. If they become caked, hot fomentations should also be applied for fifteen minutes before massaging or nursing.

=Administering Medicine.= Use as little medicine as possible. When prescribed, give exactly according to directions. Wipe mouth of bottle and examine label carefully, before and after pouring. Use clean spoon and disinfect after using. Remove cork with fingers, not with teeth. Avoid getting irritating substances into eyes or on tender, broken skin. Make a game of administering medicine and keep the child amiable, if possible. When necessary, hold nose, and put spoon back on base of tongue, to administer.

=The Nursery Apothecary Chest.= A few essentials should be kept at hand in a cabinet, protected from dust.

2-ounce bottle each: liquid vaseline liquid albolene glycerine carron oil turpentine camphor oil eucalyptus oil Wintergreen castor oil tincture green soap carbolic 5% listerine

1-ounce bottle each: peppermint olive oil with 3% phenol syrup ipecac soda mint tablets chlorate potash tablets collodion

Tube or box: zinc ointment analgesic balm vaseline cocoa butter

½-pound each: mustard sodium bicarbonate boracic acid

½-pint bottle each: grain alcohol olive oil compound tincture benzoin witch hazel

milk of magnesia mineral oil

_Apparatus_:

medicine dropper, sterilized, kept in sterilized jar clinical thermometer menthol inhaler nasal spray; nasal douche thermophore or hot-water bag bulb syringe court plaster; surgeon’s plaster, small size; antiseptic gauze, small size antiseptic cotton; styptic cotton sterilized bandages; 18-inch flannel squares; oiled silk, paper napkins safety pins, needles, tooth picks, handbrush, scissors

In case of infectious disease, lysol, creolin, or _fresh_ chloride of lime will be needed.

_Emetics._ _Mild_: lukewarm water with teaspoon salt. _Stronger_: tablespoon salt or teaspoon mustard in glass lukewarm water. _Severe_: 10 to 20 drops syrup ipecac (fresh).

_Laxatives._ _Mild_: mineral oil, milk of magnesia, olive oil; one teaspoon for babies, tablespoon at six years. For emergency, castor oil, preferably in capsule, or between layers of orange or grape juice. For immediate action, citrate of magnesia. For older children or adults, compound licorice powder may be used. Laxative oils should be given between meals; nutritive oils shortly after meals.

_Antiseptics._ These hinder development of germs. For internal use and on eyes, normal salt solution (1 teaspoon salt to 1 pint water), 2% boric solution (1 teaspoon to quart water), listerine 50%. For external use, saturated boric solution (1 teaspoon to pint water) listerine, 70% alcohol, witch hazel. Peroxide is uncertain. Use tincture of green soap in warm water for washing infected tissues. Use boiled or distilled water in making solutions. Put in sterilized bottles.

_Disinfecting._ Hands: scrub with hot water and tincture of green soap or lysol, clean and trim finger nails; for surgical cleanliness, scrub through several waters, soak one minute in 70% alcohol, and dry on sterilized towel. Linen from infectious patient: soak in solution of ½ ounce creolin to two gallons water for twelve hours before removing to laundry; boil at once. Dishes from infectious patient: burn food; put into covered kettle with soap powder; immediately boil twenty minutes; or keep in patient’s room; or use papier-maché and burn. Excreta from infectious patient (urine, stools, vomitus): put with equal volume of a solution made of equal parts saturated solution of chloride of lime and 2% solution acetic acid or vinegar; let stand quarter hour before disposing. Use tissue napkins, squares of cheesecloth or old linen for nose and mouth discharges. Put these and soiled dressings into paper bag and burn at once. Room: formaldehyde gas. Hot water and soap suds, strong sunlight, and fresh air are disinfectants.

_Sterilizing._ Needle: dip in 70% alcohol, or hold in match flame until red. Water: boil twenty minutes. Dishes: boil twenty minutes; keep in water with vessel covered, or in boric solution, until needed. Gauze, bandages: boil twenty minutes in saturated boric solution or 2% carbolic. Let cool slightly in water, wring out with disinfected hands or in sterilized towel. Or suspend in cheesecloth hammock tied to handles of wash boiler. Cover tightly and steam, with water boiling, thirty minutes. Press in sterile towel with hot iron, leave wrapped, and keep in covered receptacle until needed. Small squares for nursery use: cut and tack in bundles of five before sterilizing, store in a sterile, covered jar, and remove only as needed.

_Counter-irritants._ These draw the circulation to the surface, relieving internal congestion; they have not the chemical or metabolic effect of water and light. Mild: analgesic balm, mentholated vaseline, cold compress. Mustard plaster is more severe. Mix one part mustard and two parts flour, then bind together with white of egg or _lukewarm_ water. Rub lard or vaseline into skin before applying. Leave on five to ten minutes. If necessary, repeat in six hours, using four parts flour. Kerosene, capsicum vaseline, red pepper, are too severe for children. Dry mustard may be rubbed behind ears for earache. Blistering has no value.

Patent medicines are expensive and dangerous. Avoid them, especially soothing syrups, cough or worm medicines, cold or headache cures, tonics. Many of these contain forms of opium or of coal tar products that affect the heart, and high per cent. of alcohol, and are positively dangerous. Hygienic measures are safe and more certain.

Choose a physician who favors hygienic treatment, and who knows how to use physiological measures—diet, hydrotherapy, massage, open-air treatment—with a minimum of drugs.

APPENDIX

VALUE OF 100-CALORIE PORTIONS OF COMMON FOODS

EDIBLE PORTION, UNCOOKED

(Note: Calo. = Calories; Gr. = Grams) ==============+============+===============+=======+=======+======= FOOD MATERIAL | WEIGHT[40] | COMMON | PROT. | FAT | CBHY. | | MEASURES[41] | [41] | [41] | [41] ——————————————+——————+—————+———————————————+———————+———————+——————— |_Oz._ |_Gr._| |_Calo._|_Calo._|_Calo._ Almonds | .54| 15.5|8-12 | 13 | 77 | 10 Apples | 5.61|159. |1 large | 3 | 7 | 90 Apricots | 1.27| 36. |4 large | 7 | 3 | 90 (dried) | | | | | | Bacon | .56| 16. |2 thin slices | 7 | 93 | 0 Bananas | 3.58|101.4|1 large | 5 | 5 | 90 Barley flour | 1. | 28. |2 T.[44] | 10 | 3 | 87 Beans (dried),| 1.01| 28.6|1½ T. | 21 | 4 | 75 Lima | | | | | | Beans, string | 8.5 |241. |1 qt. | 15 | 48 | 37 Beef, round, | 2.26| 64. |½ × 2 × 2 in. | 55 | 45 | 0 lean | | | | | | Beets | 7.66|217.1|2 med. | 2 | 23 | 75 Bread, white | 1.38| 39.0|1 thick slice | 13 | 6 | 81 Bread, whole | 1.44| 40.7|1 thick slice | 15 | 5 | 80 wheat | | | | | | Butter | .46| 13. |1 T. scant | .5 | 99.5 | 0 Chicken | 3.27| 92.6|½ × 3 × 3 in. | 90 | 10 | 0 Carrots | 7.80|221.2|2 med. | 10 | 8 | 82 Celery | 19.07|540.6|2 heads | 24 | 5 | 71 Cheese, | .8 | 22.8|1½ cub. in. | 25 | 73 | 2 American | | | | | | Cheese, | 3.21| 91.1|3½ T. | 76 | 8 | 16 cottage | | | | | | Chestnuts | 1.46| 41.3|9 | 10 | 20 | 70 Cocoa | .71| 20.1|3 T. | 17 | 52 | 31 Corn, green | 3.49| 99. |3 T. | 13 | 10 | 77 Crackers, | .85| 24.2|2½ | 9 | 20 | 71 soda | | | | | | Crackers, | .81| 23. |3 | 15 | 20 | 65 wheatsworth | | | | | | Crackers, | .81| 23. |2 | 11 | 24 | 65 oatmeal | | | | | | Crackers, | .82| 23. |2 | 9 | 20 | 71 graham | | | | | | Corn meal, | .99| 28.1|3 T. | 10 | 5 | 85 granular | | | | | | Corn meal, | .92| |3 T. | 9 | | unbolted[42]| | | | | | Cream, | 1.49| 40. |2 T. | 5 | 86 | 9 20 per cent | | | | | | Dates | 1.02| 28.8|4-6 | 2 | 7 | 91 Eggs | 2.38| 67.5|1¼ | 32 | 68 | 0 Egg white | 6.92|196.1|7-8 | 100 | 0 | 0 Egg yolk | .97| 27.6|2 | 17 | 83 | 0 Figs | 1.12| 31.6|1 large | 5 | 0 | 95 Fish, cod | 3.1 | 88. |1 c.[45] | 97 | 3 | 0 (salt) | | | not packed | | | Fish, haddock | 4.94|139.9|1 slice | 96 | 4 | 0 (fresh) | | | 1×2×3 in. | | | Fish, halibut | 2.93| 82.5|1 slice | 61 | 39 | 0 (fresh) | | | ½×2×3 in. | | | Grape juice | 3.53|100. |7 T. | 0 | 0 | 100 Honey | 1.03| 30.6|4 t.[46] | 1 | 0 | 99 Lady finger | .96| 27. |1 | 10 | 12 | 78 Lentils | .01| 28.7|2 T. | 21 | 7 | 72 Lettuce | 18.47|523.6|1 large head | 25 | 14 | 61 Macaroni | .99| 28. |16 sticks | 15 | 0 | 85 Maple syrup | 1.2| 35. |4 t. | 0 | 0 | 100 Milk, whole | 5.1|144.5|⅔ c. | 19 | 52 | 29 Milk, skimmed | 9.61|272.5|1⅓ c. | 37 | 7 | 56 Molasses | 1.23| 34.9|1½ T. | .5 | 0 | 95.5 Molasses | .95| 27. |1 | 6 | 23 | 71 cookie | | | | | | Oatmeal | .88| 25.1|4 T. | 18 | 7 | 75 Olives (ripe) | 1.3 | 38. |7 | 2 | 91 | 7 Onions | 7.24|205.4|2½ large | 13 | 5 | 82 Orange juice | 8.17|231.5|1 large | 0 | 0 | 100 Peaches | 8.53|242.1|2 large | 7 | 2 | 91 (fresh) | | | | | | Peanuts | .62| 18. |13 double | 20 | 63 | 17 Peanut butter | .58| 16. |1 T. | 19 | 64 | 17 Pears (fresh) | 5.57|158. |1 large | 4 | 7 | 89 Peas, dried | .99| 28.1|2 T. | 28 | 2 | 70 Peas, green | 3.52| 99.9|4 T. | 28 | 4 | 68 Pecans | .46| 13. |8 | 6 | 87 | 7 Pineapple | 8.18|232. |½ c. scant | 4 | 6 | 90 (fresh) | | | | | | Plums | 4.18|118.5|3-4 large | 4 | 6 | 90 Potatoes | 4.23|120. |1 med. | 11 | 1 | 88 Potatoes, | 2.86| 81.2|1 small | 6 | 5 | 89 sweet | | | | | | Prunes (dried)| 1.17| 33.2|4-6 (30’s-40’s)| 3 | 0 | 97 Raisins | 1.02| 29. |20 | 3 | 9 | 88 Rhubarb | 15.27|433. |8 stalks | 10 | 27 | 63 Rice | 1.01| 28.5| 2 T. | 9 | 1 | 90 (polished)[43]| | | | | | Rye flour | 1.01| 28.5|3½ T. | 8 | 0 | 92 Spinach | 14.76|418.4|scant qt. | 36 | 10 | 54 Squash | 7.4 |210. |9 T. | 12 | 10 | 78 Sugar | .86| 25. |5 t. | 0 | 0 | 100 Tomatoes | 15.47|438.6|2-4 med. | 15 | 16 | 69 fresh | | | | | | Tapioca | .99| 28.2|2 T. | 0 | 0 | 100 Walnuts, | .48| 14. |6 | 10 | 83 | 7 Calif. | | | | | | Wheat flour | .98| 27.8|3½ T. | 15 | 5 | 80 entire | | | | | | Wheat flour, | 1. | 28.3|3½ T. | 12 | 3 | 85 wht., process| | | | | | Wheat, | .94| 27. |1 | 13 | 4 | 83 shredded | | | | | | ==============+============+===============+=======+=======+=======

==============+======+=====+===== FOOD MATERIAL | LIME |PHOS.| IRON | [40] |[40] |[40] ——————————————+——————+—————+————— |_Gr._ |_Gr._|_Gr._ Almonds | .046 |.132 |.0003 Apples | .022 |.05 |.0005 Apricots | .031 |.1 | (dried) | | | Bacon | .001 |.04 |.0002 Bananas | .01 |.055 |.0006 Barley flour | |.083 |.00028 Beans (dried),| .028 |.219 |.00195 Lima | | | Beans, string | .177 |.284 |.0038 Beef, round, | .01 |.313 |.002 lean | | | Beets | .06 |.19 |.0013 Bread, white | .011 |.075 |.0003 Bread, whole | .016 |.16 |.0006 wheat | | | Butter | .003 |.004 | Chicken | .007 |.25 | Carrots | .168 |.22 |.0016 Celery | .54 |.54 |.0027 Cheese, | .25 |.329 | American | | | Cheese, | .3 |.4 | cottage | | | Chestnuts | .017 |.08 |.0004 Cocoa | .027 |.22 |.0005 Corn, green | .008 |.21 |.00075 Crackers, | .006 |.054 |.00035 soda | | | Crackers, | .016 |.243 |.0014 wheatsworth | | | Crackers, | .03 |.216 |.0009 oatmeal | | | Crackers, | .016 |.243 |.0014 graham | | | Corn meal, | .004 |.08 |.0003 granular | | | Corn meal, | | | unbolted[42]| | | Cream, | .07 | .10 |.0001 20 per cent | | | Dates | .03 | .03 |.001 Eggs | .06 | .24 |.0019 Egg white | .028 | .05 |.0002 Egg yolk | .05 | .27 |.0023 Figs | .089 | .099|.001 Fish, cod | .036 | .601|.001 (salt) | | | Fish, haddock | .04 | .5 | (fresh) | | | Fish, halibut | .01 | .3 |.0002 (fresh) | | | Grape juice | .021 | .04 | Honey | .001 | .01 |.0003 Lady finger | .01 | .05 |.0003 Lentils | .03 | .18 |.0024 Lettuce | .26 | .47 |.005 Macaroni | | | Maple syrup | .06 | .02 |.0009 Milk, whole | .239 | .303|.00034 Milk, skimmed | .478 | .606|.00068 Molasses | .3 | .1 | Molasses | .01 | .05 |.0003 cookie | | | Oatmeal | .03 | .216|.0009 Olives (ripe) | .06 | .01 |.0009 Onions | .12 | .24 |.0011 Orange juice | .12 | .07 | Peaches | .02 | .113|.0007 (fresh) | | | Peanuts | .018 | .160|.00035 Peanut butter | .018 | .160|.00035 Pears (fresh) | .032 | .09 |.0005 Peas, dried | .04 | .25 |.0015 Peas, green | .032 | .24 |.0016 Pecans | .016 | .104|.00035 Pineapple | .04 | .14 |.0011 (fresh) | | | Plums | .029 | .064|.0006 Potatoes | .019 | .166|.0015 Potatoes, | .02 | .08 |.0004 sweet | | | Prunes (dried)| .02 | .08 |.0009 Raisins | .02 | .08 |.001 Rhubarb | .26 | .3 | Rice | .003 | .057|.0003 (polished)[43]| | | Rye flour | .005 | .22 | Spinach | .37 | .54 |.0133 Squash | .054 | .17 |.0017 Sugar | 0 | 0 | Tomatoes | .087 | .257|.0017 fresh | | | Tapioca | 0 | 0 | Walnuts, | .01 | .108|.0003 Calif. | | | Wheat flour | .01 | .12 |.0006 entire | | | Wheat flour, | .007 | .05 |.0004 wht., process| | | Wheat, | .016 | .243|.0014 shredded | | | ==============+======+=====+=====

COMPOSITION OF COMMON MEASURE PORTIONS OF FOOD[41]

EDIBLE PORTION, UNCOOKED

(Note: Calo. = Calories) ===============+=====+=====+=====+=======+=======+======= | OZ. |GRAMS|TOTAL| PROT. | FAT | CBHY. | | |CAL. | | | ———————————————+—————+—————+—————+———————+———————+——————— | | | |_Calo._|_Calo._|_Calo._ Egg, whole | 1.8 | 57 | 74 | 24 | 50 | 0 Egg, white | 1.2 | 33 | 14 | 14 | 0 | 0 Egg, yolk | .6 | 17 | 60 | 10 | 50 | 0 Wheat flour, | .28| 9.7| 28 | 4 | 1 | 23 entire, 1 T. | | | | | | Wheat flour, | 4.48|155.6|448 | 67 | 12 | 359 entire, 1 cup| | | | | | Wheat flour, | .3 | 8 | 28 | 3 | 1 | 24 white, 1 T. | | | | | | Wheat flour, | 5. |142 |500 | 60 | 15 | 425 white, 1 cup | | | | | | Milk, whole, | .7 | 20 | 14 | 3 | 7 | 4 1 T. | | | | | | Milk, whole, |17.2 |487 |337 | 64 | 175 | 98 1 pt. | | | | | | Milk, whole, |34.4 |975 |675 | 128 | 350 | 196 1 qt. | | | | | | Milk, skimmed, | .7 | 20 | 7 | 2.5 | .5 | 4 1 T. | | | | | | Milk, skimmed, |17.2 |487 |179 | 66 | 13 | 100 1 pt. | | | | | | Sugar, gran., | .2 | 5 | 20 | | | 20 1 t. | | | | | | Sugar. gran., | .7 | 15 | 60 | | | 60 1 T. | | | | | | Sugar, gran., | 7.5 |210 |840 | | | 840 1 cup | | | | | | ===============+=====+=====+=====+=======+=======+=======

===============+=======+=======+======= | LIME | PHOS. |IRON | | | ———————————————+———————+———————+——————— |_Grams_|_Grams_|_Grams_ Egg, whole | .044 | .175 |.0014 Egg, white | .004 | .01 |.00003 Egg, yolk | .03 | .16 |.0014 Wheat flour, | .017 | .227 |.0015 entire, 1 T. | | | Wheat flour, | .268 | 4.076 |.027 entire, 1 cup| | | Wheat flour, | .002 | .014 |.0001 white, 1 T. | | | Wheat flour, | .035 | .25 |.002 white, 1 cup | | | Milk, whole, | .033 | .042 |.00005 1 T. | | | Milk, whole, | .805 | 1.021 |.0011 1 pt. | | | Milk, whole, | 1.61 | 2.042 |.0023 1 qt. | | | Milk, skimmed, | .035 | .044 |.00005 1 T. | | | Milk, skimmed, | .85 | .108 |.0012 1 pt. | | | Sugar, gran., | | | 1 t. | | | Sugar. gran., | | | 1 T. | | | Sugar, gran., | | | 1 cup | | | ===============+=======+=======+=======

FOODS WITH ACID BALANCE[47]

Figures are per 100-Calorie portion

FOODS WITH POTENTIAL ALKALINITY[47]

Figures are per 100-Calorie portion

Principles of Growth

Height and weight are only one index of physical condition. They must be interpreted in connection with other factors, as organic and muscular conditions, appetite, energy.

Growth is not constant and regular but by spurts. Increase in height and in weight usually do not proceed together but alternate.

Two types of individuals are distinguished:

_a._ Rapid growth in height and weight until 9 to 12 years

Slower growth 12 to 16 years

Early maturity (12 to 14 years, girls; 13 to 15 years, boys);

_b._ Slow growth in height and weight until 12 to 12 years

Rapid growth after acceleration begins

Late maturity (14 to 16 years, girls; 15 to 18 years, boys).

Growth is influenced by various factors.

=I. Heredity.=

1. Race. Americans average heavier than Europeans, and taller than Europeans except Swedish, Danish, and Dutch. Children of Irish parentage average taller than children of German parentage. Children of American-born parents are in this country taller and heavier than children of foreign-born parents.

2. Family. Children tend to approximate height and build of family; good hygiene slightly increases average above immediate ancestors.

3. Sex. See pages 372-375.

=II. Environment and Hygiene.=

1. Hygiene. Good hygiene promotes growth in height and weight. Breastfed babies are usually found to increase more rapidly than those artificially fed, and this growth impulse continues through life. See page 100.

A comparative study recently made of (_a_) 278 children in well-nourished families, (_b_) 1,000 orphan asylum inmates, (_c_) 69,000 public school children, revealed a difference of six (6) inches average height and twenty (20) pounds average weight, at twelve years of age, in favor of the first group, living under good conditions of nourishment, exercise, and hygiene, above the public-school group, the asylum group being intermediate.[49]

Illness retards growth, especially weight; adenoids retard growth in height and weight.

2. Urban or rural environment. Country children average taller, heavier, and greater lung capacity than city children.

3. Season. In the North Temperate Zone, increase in height is greatest from December to July, least from June to January; growth in weight is the reverse.

=Maturity.= Various factors influence the age of physiological maturity.

1. Sex. Girls mature at from 12 to 16 years, two years earlier than boys,—from 14 to 18 years. The period of adjustment is longer, slower, and with less stress and upheaval with boys than with girls.

2. Growth. Children above the average in height and weight at 12 years mature earlier than those at or below average height and weight.

3. Climate. Maturity is earlier in warm climates, and later in cold climates.

4. Urban or rural environment. Maturity is earlier with city children, later with country children.

5. Stimulation. Stimulating physical or psychical influences, as a stimulating diet, use of alcohol, early social dissipation, reading and plays that stimulate sex interest, tend to cause earlier maturity.

Children mentally defective, retarded, or laggards in school, are usually shorter and lighter weight and smaller lung capacity than the median for normal children.

Children above the median in height, weight, and lung capacity (the three are usually found together) are usually above the average in school grades of other children the same chronological age. Such children may be from 1 to 5 years older physiologically and mentally than children of the same chronological age who are below the median in height and weight.

=Proportions.=

During the entire growth period the proportions of different parts are constantly changing because of their uneven rate of growth. The awkwardness, easy fatigue, and weakness during childhood and adolescence are in no small measure due to these changing proportions and their inadequacy as compared with their adjustment in maturity.

The following variations from the average are indices of weakness, and measures should be taken for bringing them to normal.[50]

1. Over average weight with under average height.[50]

2. Under average weight with over average height.[50]

3. Chest circumference less than head circumference after two years, or less by more than one-fourth inch under two years; or chest circumference less than the following proportions of the body length: first year, 60%; 1 to 6 years, 56%; 6 to 9 years, 52%.[51]

4. Circumference of abdomen more than chest.

The Tables for the first five years are a composite of the figures by Holt (compiled from several hundred hospital and private practice cases in New York City), the American Medical Association (compiled from several thousand cases in 23 States), the Life Extension Institute, and the Better Babies’ Bureau of the Woman’s Home Companion. In the main, the minimum figures are those of Dr. Holt, the maximum those of the Woman’s Home Companion. The figures of Dr. Freeman from 278 children in private practice (see page of Charts) are from 5 to 10 per cent higher than the maximum given in the Tables, for height and weight.

All measurements are without clothing.

Height—Boys[52]

======+===============+=======++======+===========+======== AGE | RANGE | GAIN || AGE | RANGE | GAIN | INCHES |INCHES || | INCHES | INCHES ——————+———————————————+———————++——————+———————————+———————— Birth | 19½-20½ | || 2 yr | 31-33¾ | 3-4 3 mo | 21-23½ | 3½ || 3 yr | 34-37 | 3-3½ 6 mo | 25-26½ | 3¼ || 4 yr | 36-39½ | 1-3 1 yr | 29-29½ | 9-10 || 5 yr | 39-42½ | 1-3 ======+===============+=======++======+===========+========

Until acceleration period, annual gain 1-2 inches. During acceleration, annual gain 2-3 inches.

Acceleration period: girls, 11 to 14 years; boys, 13 to 15.

Slight gains after acceleration period.

After three years, height varies during day, being greatest on rising, shortest at night.

Weight—Boys[53]

========+===============+=============+============================== AGE | RANGE | GAIN | | POUNDS | POUNDS | ————————+———————————————+—————————————+—————————————————————————————— Birth | 6½-7½ | | Weight doubled: 5 months 3 mo | 12½- | | Weight trebled: 1 year 6 mo | 16-17½ | | Weight quadrupled: 2½ years 9 mo | 17½-20 | | Weight fivefold: 4 years 1 yr | 20½-22 | 12-15 | Loss of weight first 3 days 2 yr | 26½-27½ | 5½-6 | Regained by 7th to 10th day 3 yr | 31½-33½ | 4½-6 | Weekly gain: 4 yr | 35-38 | 3½-4½ | 1st 5 months, 6 to 8 ounces 5 yr | 41-43 | 5-6 | To 1 year, 4 to 6 ounces ========+===============+=============+==============================

Acceleration period: girls, 11 to 16 years; boys, 13 to 18.

Weight varies during day, being greatest after supper, lowest before breakfast.

Girls nearly cease growing at about 17 years, boys at about 23 years.

Lung capacity is greater in boys than girls, all ages.

Relative Weight and Height Table—Boys[54]

The figures represent weight in pounds

=========+======+======+======+======+======+=======+=======+======= HEIGHT IN|5 YRS.|6 YRS.|7 YRS.|8 YRS.|9 YRS.|10 YRS.|11 YRS.|12 YRS. INCHES | | | | | | | | =========+======+======+======+======+======+=======+=======+======= 39 | 35 | | | | | | | 40 | 38 | 36 | | | | | | 41 | 39 | 39 | | | | | | 42 | 41 | 41 | | | | | | 43 | 42 | 42 | 42 | | | | | 44 | 46 | 44 | 43 | | | | | 45 | | 46 | 46 | 45 | | | | 46 | | 48 | 48 | 48 | | | | 47 | | | 49 | 50 | 50 | | | 48 | | | 54 | 53 | 53 | 53 | | 49 | | | | 54 | 55 | 55 | | 50 | | | | 57 | 58 | 58 | | 51 | | | | 59 | 60 | 60 | 61 | 52 | | | | | 62 | 62 | 61 | 63 53 | | | | | 62 | 65 | 65 | 67 54 | | | | | 65 | 68 | 68 | 70 55 | | | | | | 69 | 71 | 75 56 | | | | | | 71 | 77 | 76 57 | | | | | | | 77 | 79 58 | | | | | | | 78 | 84 59 | | | | | | | | 84 60 | | | | | | | | 85 61 | | | | | | | | 62 | | | | | | | | 63 | | | | | | | | 64 | | | | | | | | 65 | | | | | | | | 66 | | | | | | | | 67 | | | | | | | | 68 | | | | | | | | 69 | | | | | | | | 70 | | | | | | | | 71 | | | | | | | | 72 | | | | | | | | 73 | | | | | | | | =========+======+======+======+======+======+=======+=======+=======

=========+=======+=======+=======+=======+=======+=======+=======+===== HEIGHT IN|13 YRS.|14 YRS.|15 YRS.|16 YRS.|17 YRS.|18 YRS.|19 YRS.|20 INCHES | | | | | | | |YRS. =========+=======+=======+=======+=======+=======+=======+=======+===== 39 | | | | | | | | 40 | | | | | | | | 41 | | | | | | | | 42 | | | | | | | | 43 | | | | | | | | 44 | | | | | | | | 45 | | | | | | | | 46 | | | | | | | | 47 | | | | | | | | 48 | | | | | | | | 49 | | | | | | | | 50 | | | | | | | | 51 | | | | | | | | 52 | | | | | | | | 53 | 67 | 67 | | | | | | 54 | 71 | 71 | | | | | | 55 | 75 | 76 | | | | | | 56 | 78 | 79 | 79 | | | | | 57 | 80 | 82 | 82 | | | | | 58 | 85 | 86 | 87 | | | | | 59 | 86 | 90 | 91 | | | | | 60 | 91 | 94 | 95 | 90 | | | | 61 | 98 | 97 | 99 | 96 | | | | 62 | 99 | 103 | 106 | 104 | 104 | | | 63 | 100 | 107 | 112 | 112 | 110 | 118 | | 64 | | 114 | 118 | 120 | 117 | 120 | 120 | 65 | | 122 | 119 | 122 | 122 | 120 | 126 | 125 66 | | | 121 | 125 | 125 | 126 | 129 | 130 67 | | | 128 | 129 | 128 | 131 | 134 | 132 68 | | | 133 | 133 | 130 | 136 | 136 | 136 69 | | | | 134 | 136 | 139 | 139 | 139 70 | | | | 136 | 140 | 143 | 144 | 145 71 | | | | | 140 | 146 | 146 | 146 72 | | | | | | | 149 | 154 73 | | | | | | | | 165 =========+=======+=======+=======+=======+=======+=======+=======+=====

Relative Weight and Height Table—Girls[54]

The figures represent weight in pounds

=========+======+======+======+======+======+=======+=======+======= HEIGHT IN|5 YRS.|6 YRS.|7 YRS.|8 YRS.|9 YRS.|10 YRS.|11 YRS.|12 YRS. INCHES | | | | | | | | =========+======+======+======+======+======+=======+=======+======= 39 | 34 | | | | | | | 40 | 37 | 35 | | | | | | 41 | 38 | 37 | | | | | | 42 | 41 | 39 | 39 | | | | | 43 | 41 | 41 | 42 | | | | | 44 | 45 | 43 | 44 | 42 | | | | 45 | | 45 | 45 | 45 | | | | 46 | | 48 | 47 | 47 | | | | 47 | | | 50 | 49 | 49 | | | 48 | | | | 51 | 51 | | | 49 | | | | 53 | 53 | 54 | | 50 | | | | 56 | 56 | 57 | | 51 | | | | | 59 | 58 | 60 | 52 | | | | | 63 | 62 | 62 | 63 53 | | | | | | 64 | 63 | 66 54 | | | | | | 69 | 68 | 69 55 | | | | | | | 70 | 71 56 | | | | | | | 75 | 75 57 | | | | | | | | 78 58 | | | | | | | | 83 59 | | | | | | | | 88 60 | | | | | | | | 94 61 | | | | | | | | 62 | | | | | | | | 63 | | | | | | | | 64 | | | | | | | | 65 | | | | | | | | =========+======+======+======+======+======+=======+=======+=======

=========+=======+=======+=======+=======+=======+=======+=======+===== HEIGHT IN|13 YRS.|14 YRS.|15 YRS.|16 YRS.|17 YRS.|18 YRS.|19 YRS.|20 INCHES | | | | | | | |YRS. =========+=======+=======+=======+=======+=======+=======+=======+===== 39 | | | | | | | | 40 | | | | | | | | 41 | | | | | | | | 42 | | | | | | | | 43 | | | | | | | | 44 | | | | | | | | 45 | | | | | | | | 46 | | | | | | | | 47 | | | | | | | | 48 | | | | | | | | 49 | | | | | | | | 50 | | | | | | | | 51 | | | | | | | | 52 | | | | | | | | 53 | 65 | | | | | | | 54 | 68 | | | | | | | 55 | 73 | | | | | | | 56 | 76 | 78 | | | | | | 57 | 80 | 83 | | | | | | 58 | 86 | 88 | 89 | | | | | 59 | 89 | 93 | 97 | 100 | | | | 60 | 94 | 96 | 100 | 104 | 109 | 103 | 99 | 99 61 | 99 | 100 | 102 | 109 | 109 | 106 | 105 | 111 62 | 104 | 104 | 106 | 111 | 110 | 107 | 111 | 114 63 | | 107 | 109 | 116 | 110 | 112 | 113 | 114 64 | | 112 | 118 | 116 | 117 | 114 | 119 | 115 65 | | 114 | 118 | 121 | 125 | 120 | 123 | 125 =========+=======+=======+=======+=======+=======+=======+=======+=====

Pulse[55]

===========+============== AGE | PER MINUTE ———————————+—————————————— Birth | 130 6-12 mo. | 105-115 2-6 yr. | 90-105 7-10 yr. | 80-90 11-14 yr. | 75-85 ===========+==============

Respiration[56]

(During sleep)

==========+============= AGE | PER MINUTE ——————————+————————————— Birth | 35 1 yr. | 27 2 yr. | 25 6 yr. | 22 12 yr. | 20 Adult | 16-18 ==========+=============

Pulse and respiration in infants may be normally irregular and the rate greatly modified by apparently slight causes. In very young infants regular rhythmic breathing is seen only in sleep, and rhythm is not fully established before two years.

Temperature in young children is normally 98°-99.5°F., taken by rectum; it occasionally rises to 100.5 in apparently perfect health. It is normally higher in late afternoon.[57]

The rate of circulation (time required from leaving the heart till return to the heart) is in the newly born 12 seconds, at 3 years 15 seconds, in the adult 22 seconds.[57]

Infant Mortality

The infant mortality rate is the number of deaths of babies which occur for every 1,000 live births. Figures in the United States are available only for that part of the country known as the registration area, where the reporting of births and deaths is legally required. It is important that the birth of every child should be registered, and that laws requiring registration should be enforced in every State.

Deaths of Infants Under One Year of Age Per 1,000 Live Births in Foreign Countries[58]

==================+======+====== COUNTRY | YEAR | RATE ——————————————————+——————+—————— Russia | 1909 | 248 Ceylon | 1912 | 215 German Empire | 1911 | 192 Austria | 1912 | 180 Italy | 1911 | 153 Switzerland | 1911 | 123 England and Wales | 1912 | 95 Ireland | 1912 | 86 France | 1912 | 78 Australia | 1912 | 72 Norway | 1911 | 65 New Zealand | 1912 | 51 ==================+======+======

The New York Milk Committee states that an infant mortality rate above 50 per 1,000 is preventable by sanitation, hygiene, prenatal care, and the instruction of mothers; and that a rate beyond this is unfair to the babies, and a disgrace to the community for its negligence.

Principal Causes of Death During Growth

Registration Area, United States, including about 65 per cent. of population. For the year 1913.

==================+=======+=====+=====+=====+=====+=====+====== CAUSE OF DEATH | UNDER | 1-2 | 2-3 | 3-4 | 4-5 | 5-9 | 10-20 | 1 YR. | YRS.| YRS.| YRS.| YRS.| YRS.| YRS. ——————————————————+———————+—————+—————+—————+—————+—————+—————— 1. Congenital | | | | | | | debility | 60,551| | | | | | 2. Premature | | | | | | | birth | 27,359| | | | | | 3. Injuries at | | | | | | | birth | 5,131| | | | | | 4. Digestive | 43,243|9,942|2,653|1,124| 697|1,968|2,939 5. Respiratory | | | | | | | (except | | | | | | | tuberculosis,| | | | | | | chiefly | | | | | | | pneumonia) | 25,274|9,272|3,567|1,724|1,055|2,296|2,502 Tuberculosis | 2,491|1,879|1,053| 693| 507|1,702|8,350 6. Whooping | | | | | | | cough | 3,442|1,516| 596| 301| 152| 246| 40 7. Measles | 2,011|2,562|1,117 | 584| 302| 660| 346 8. Diphtheria | | | | | | | and croup | 913|1,857|1,781|1,498|1,293|3,171| 918 9. Scarlet fever | 255| 618| 798| 684| 603|1,563| 621 10. Influenza | 608| 171| 105| 47| 42| 126| 202 11. Smallpox[59] | 27| 4| 4| 3| | 5| 8 ==================+=======+=====+=====+=====+=====+=====+======

The death rate is higher during the first five years than at any other five-year period; higher during the first year than any other year; highest during the first month; and its maximum is during the first week of life.

It is estimated that about fifty per cent. of all children die before they are born. Life is conferred at conception, and miscarriage is really death before birth. The registration of stillbirths, with causes, should be required by law, as it now is in some foreign countries.

Diarrhea and other digestive disorders are prevalent causes in summer; pneumonia and colds in winter.

Of the deaths from summer diarrhea, about 90 per cent. are babies artificially fed, compared with 10 per cent. naturally fed.

Mortality in Pregnancy

United States Registration Area, 1913

============================================================== Puerperal septicemia (blood poisoning, due to lack of surgical cleanliness in care) 4,542 Albuminaria and convulsions (usually preventable by regular examination of urine) 2,397 Accidents (frequently preventable by prenatal hygiene and skilful medical supervision) 2,703 Other causes 368 —————— 10,010 ==============================================================

Most of these deaths were due to preventable causes.

Even with these preventable deaths, the chances of death in childbirth were only 1 in about 200 births.

In every community where instruction has been provided in prenatal hygiene and the care of infants, a marked reduction has resulted, both in prenatal deaths, in mortality in pregnancy, in infant mortality and in the inability of mothers to nurse their babies.

FOOTNOTES:

[34] See Preface, page xiii.

[35] C (?) = Possibly contagious; isolate.

[36] C = Contagious; child should be isolated.

[37] Diagnosis of a specific disease in a given case can only be made by an experienced physician. The Table is of value particularly as indicating the mild symptoms with which these begin. Incubation is the period from exposure to first symptoms. Isolation dates from first symptoms.

[38] G. = Onset gradual.

[39] S. = Onset sudden.

[40] Quoted from Rose’s “Laboratory Manual in Dietetics”, and Sherman’s “Food Products”, by permission.

[41] In part, quoted from Fisher’s “Graphic Method in Dietetics”, by permission; in part, calculated by the author, from data in Rose’s “Manual.”

[42] Exact figures not yet available; mineral about 3 times that in bolted.

[43] Exact figures for unpolished not yet available; mineral about 3 times that in polished.

[44] T = tablespoon.

[45] c = cup.

[46] t = teaspoon. Level measures.

[47] From “Food Products”, H. C. Sherman, by permission of the publishers (The Macmillan Company). Complete tables there itemized.

[48] Blatherwick.

[49] Amer. Jour. Diseases of Children, November, 1914. Doctor Roland G. Freeman.

[50] For normal relativity see tables, pages 374, 375.

[51] _Daten und Tabellen_, _Vierordt_.

[52] Girls average ½ inch shorter until 2 to 4 years, then 1 to 2 inches shorter until 11 to 14 years; ½ to 2 inches taller 11 to 14 years; then shorter.

[53] Girls average ½ pound lighter than boys during first year; then 1 to 2 pounds lighter until 12 years; 2 to 3 pounds heavier until 14 years, then lighter.

[54] From the Ninth Yearbook of the National Society for the Study of Education, by courtesy of the author, Doctor Thomas D. Wood. (Data are based upon examinations, during fourteen years, of pupils in Horace Mann School, New York City.)

[55] Holt.

[56] _Uffelmann_, quoted by Holt.

[57] _Vierordt_, quoted by Holt.

[58] In the United States the rate in the registration area, according to the Census of 1910, was 124 per 1,000, a total of 159,435, from which the Census Bureau estimates the total deaths for the entire country as 300,000 under 1 year of age.

[59] Before vaccine was generally used, was as prevalent as tuberculosis.

BIBLIOGRAPHY

The following annotated list has been carefully selected, the purpose being to include the most valuable and indispensable books, those that readers will find positively and constructively helpful, and that amplify or illustrate the principles taught in this volume. Many helpful books are necessarily omitted for lack of space.

It is usually impossible to say that any one book is the best on its subject. One book will be better than another for individual readers, according to their individual experience, training, environment, and problems. In the main, the publications listed are of approximately the same caliber as the present Manual. In the list of periodicals, note is made of those that are official publications of organizations. By including in the description of each book the year of publication, number of pages, price, and whether illustrated, the reader has some further clue to its character. Books including a bibliography are usually more systematic and scientific than those without such a list. The dates given are those of latest edition or translations, to 1916. Prices quoted are net, and do not include transportation.

I. Books. I. _b._ Pamphlets and Bulletins. II. Periodicals. III. Organizations and Institutions. † Titles especially recommended for libraries, class use, and private ownership. _a_ Books of a more elementary character. _c_ Books of a more technical character. ° Also useful for pictures.