The Four Epochs of Woman's Life - Chapters XII-XIII



CHAPTER XII.
LYING-IN.
Management of the Lying-in; Lactation; Nursing.

"'Tis is ourselves that we are thus or thus. Our bodies are our gardens; 
to the which, our wills are gardeners."
-- Othello. 

Management of the Lying-in.-- Immediately after the delivery the first 
essential for the patient is absolute quiet and rest; the room must be 
kept quiet and darkened, and ordinarily the patient is allowed to fall 
into a light sleep. During the first few hours after labor the best 
position for the mother is flat on the back, with only a small pillow 
under the head. After the first twenty-four hours the patient may be 
allowed to turn on the side as she prefers. Since absolute rest is the 
first requisite for the patient, she must be left alone with the nurse, 
who must see that she does not fall into too deep a sleep. If the child's 
cries disturb the mother, it must be taken into another room. 

The lying-in room must be kept free from all odors, all soiled clothing 
must be at once removed from the room, and good ventilation must be 
insured, being careful to prevent any drafts. 

While the patient is asleep, and after the baby has been attended to, the 
nurse should place all blood-stained articles in cold water to soak. If in 
the city, the after-birth may be burned in the furnace or range; it should 
be well covered with coal. In the country the after-birth can be buried in 
a deep hole. 

During the first two or three days the vulvar dressings should be changed 
from every three to six hours, and at all times as often as they are 
soiled. Each time that the dressing is renewed the external genitals and 
their immediate surroundings are to be carefully cleansed with sterilized 
water, and finally washed with a solution of boric acid, in the proportion 
of one tablespoonful of boric acid to one quart of water. It is convenient 
to keep this solution mixed and on hand, as it takes some little time to 
prepare it; it should be kept in a strength double that which is desired, 
so that it may be diluted with warm water to give the desired temperature. 
This solution may be poured over the parts from a small pitcher, the 
douche-pan having been placed under the patient before the washing began. 
After labor the vulva is very sensitive, so that while the greatest care 
must be used to remove all clots of blood and the discharge, there must be 
no brisk rubbing of the parts. No blood-stained linen should be permitted 
to remain about the patient or the bed. 

Since the lying-in woman perspires freely, her skin ought to be frequently 
cleansed by sponging with a weak solution of alcohol in tepid water; this 
should be followed by friction with a towel until the skin is in a glow. 
Cleanliness of the bed is promoted by the use of a draw-sheet, which is a 
sheet folded to four thicknesses and placed beneath the patient's hips in 
such a way that the upper edge of the sheet shall come under the lower 
part of the pillows. Air and light must be freely admitted at all times in 
order that the room may be bright and cheerful. For the first few weeks 
the eyes of the new-born infant should be shielded from all strong light. 

Visitors.-- For the first week after the confinement the patient should 
see no visitors. Even the husband or mother should not remain in the room 
long at a time. Nothing of a disagreeable nature should be told to the 
patient; and whoever goes into the sick-room should always carry the most 
cheerful manner, as it is highly necessary that the patient should be kept 
mentally as well as physically quiet at this time. 

Diet.-- For the first twenty-four hours the diet must be restricted to 
liquids, and in most cases nothing is given until the patient has had a 
few hours' rest. The first thing that is given to the patient should be a 
cup of warm milk or tea. Milk is the best diet; this may be varied with 
beef-tea, bouillon, mutton or chicken broth; any of these broths may be 
made with rice or barley to vary the flavor, but these must not be given 
to the patient. The patient should have six ounces of the liquid every two 
hours during the day and every three hours during the night. 

On the second day bread well toasted through may be added to any of the 
liquids. On the third day stewed or baked apples should be added to the 
diet. On the fourth day, and from this on, the patient will have regular 
meals, but the diet must be a plain one. For breakfast, stale bread, a 
soft-boiled egg, fruit, and a cup of tea, not too strong. For dinner, 
which should always be given in the middle of the day, an oyster-stew or 
clam broth, a lamb chop, or a very small piece of beefsteak or chicken; 
but with these there must be no gravies or dressings; a potato baked in 
the skin; raw tomatoes, if in season; apple sauce or cranberry; celery; 
junket, plain corn-starch, lemon jelly, plain cup-custard. From this list 
the diet must be arranged so as to give as much variety as possible from 
day to day. Midway between breakfast and dinner, and again in the middle 
of the afternoon, the patient should have a glass of milk. The diet should 
be generous, but simple. 

Urination.-- The feeble condition of the bladder in the first few hours 
after delivery frequently leads to the retention of urine. Owing to the 
copious secretion of urine which is so common at this time, painful and 
injurious distention of the bladder may result. The patient should 
therefore endeavor to pass her urine in at least six hours after labor, 
whether she feels any inclination to do so or not; the sound of running 
water or warm fomentations over the bladder, warm water in the douche-pan, 
and moderate pressure applied by the hand over the suprapubic region, are 
often effective in accomplishing the desired result. If all these means 
fail, the catheter must be used as the last resort. During the entire 
lying-in the bladder should be emptied every six hours. 

Evacuation of the Bowels.-- There should be an evacuation of the bowels in 
from twenty-four to thirty-six hours after the labor. For this purpose a 
seidlitz powder may be given, or the liquid citrate of magnesia. If this 
does not suffice, an enema of warm water, to which a little soap or two 
teaspoonfuls of glycerin have been added, may be given. Two pints of water 
should be prepared; the patient will retain as much as she comfortably 
can, and as long as she can. The bowels should be opened daily after the 
first day. 

After-pains are caused by the same physiologic process that causes labor 
pains-- namely, by the contractions of the uterus. After the first 
confinement the after-pains are, as a rule, not severe; attention to the 
regular emptying of the bladder and bowels also lessens the severity of 
the after-pains; these pains seldom last after the second day. 

The Lochia.-- The discharges of the mother continue for about two weeks, 
and are called lochia. For the first twenty-four hours they are pure 
blood; the second and the third day they are of the character of bloody 
water; from the fourth to the sixth day they have a, greenish-yellow 
color, and from the tenth to the twelfth day they become pure white. 
Soiled napkins and dressings should never be allowed to remain in the 
patient's room. 

Duration of the Lying-in.-- This lasts for six weeks. During this time the 
organs of generation are returning to their normal size and condition. In 
order that the woman may be in the best condition possible at the end of 
this time, it is essential that for the first two weeks she should remain 
in bed; and so long as there is any blood in the discharge the woman 
should not be allowed to sit up. The first sitting up should be in bed, 
the patient being supported by a bed-rest. During the second two weeks the 
patient may be allowed to divide her time between the bed and the couch; 
in the latter part of this time she may be allowed to go around her room a 
very little; and for two weeks more she should remain on the same floor. 
The first sitting up should not last more than half an hour. Getting up 
and going around too soon after the confinement, "being too smart," is one 
of the most prolific sources of falling of the womb, and all manner of 
uterine trouble, by which the general health of the woman is greatly 
impaired. 

Lactation.-- If it is at all possible, every mother should nurse her own 
child; in the interests of both the mother and the child. So far as the 
mother is concerned, the process of lactation is beneficial because it 
hastens the return of the uterus to its normal size. Wet-nurses are known 
tyrants, and if the quality of the milk has anything to do with the 
disposition of the child, as is believed to be the case, the idea is 
distasteful of having a woman who belongs to the lower classes provide 
nourishment for your child; and artificial feeding is one unmitigated 
trouble. 

A deficiency of the quantity or the quality of the mother's milk can 
generally be remedied by the diet and attention to the health of the 
mother; if the deficiency in quantity persists, the mother's milk can be 
supplemented by artificial feeding. 

There may exist certain conditions of the mother in which nursing her own 
infant would be inadvisable or even impossible. Syphilis contracted late 
in the pregnancy, and tuberculosis, are contraindications, owing to the 
danger of the mother infecting the child. Inversion of the nipples, their 
excoriation, or persistent sensitiveness may make it impossible. In marked 
general debility of the mother from any cause whatever, it would be 
injurious to the mother and the child. 

After the mother and the new-born infant have had some hours of rest and 
sleep, it is advisable to apply the child to the breast, to receive by 
this first effort the small quantity of milk which is an especial 
provision to act as a natural purge and to start the bowels of the child 
into a healthy activity; this also excites the milk glands to secretion. 
The mother's milk in full supply may be expected in from forty to sixty 
hours after delivery. 

Nursing.-- When the mother's nipples are of the normal size and well 
formed, the healthy infant instinctively suckles at once when placed at 
the breast, but sometimes it has to be taught; by squeezing out a few 
drops of milk to wet the nipple, the child will usually take hold, or a 
little sugar and water may be put on the nipple; a little patience and 
tact are all that is necessary to insure success. But the infant must be 
taught to nurse at once before the breasts become engorged with milk. 

Under ordinary circumstances the child is to be kept at the breast for one 
year. But if within this time the menstrual period should recur and be 
profuse, or should the woman again become pregnant, the quality of the 
milk becomes poor, and necessitates the immediate weaning of the child; 
the character of the milk is also altered, and even its secretion may be 
checked. Nervous agitation may so alter the quality of the milk as to make 
it poisonous. A fretful temper, fits of anger, grief, and sudden terror 
not only lessen the quantity of the milk, but render it thin and 
unhealthful, inducing disturbances of the child's bowels, diarrhea, and so 
forth. 

Position of the Mother When Nursing.-- When in bed in the recumbent 
position, the mother should lie on that side from which the infant is 
going to nurse; when up, the mother should sit erect. 

Care of the Nipples.-- Immediately after each nursing the nipples should 
be washed off in a saturated solution of boric acid in cold water, and 
dried with a soft cloth. If they are disposed to crack, anoint them with 
cocoa-butter immediately after each cleansing. If the skin of the nipple 
is very sensitive, a nipple-shield should be used for the first few days; 
or should the nipple become sore at any time, the shield can be resorted 
to. The nipple-shield must fit tightly; the best ones are made of glass 
with a rubber tip. In the intervals of nursing the nipple-shield should be 
kept in cold water after it has been thoroughly cleansed by being brushed 
on both sides. 

The breasts are sometimes distended from an over-secretion of milk; this 
is relieved by saline cathartics, by abstinence from liquids, and by the 
use of a compression breast bandage. This is made of a straight piece of 
muslin, with a shallow notch cut in one edge for the neck, and, a deep one 
for each arm; the bandage is closely applied over the breasts, and the 
ends pinned in front; it is also pinned over the shoulders. 

In debilitated women the supply of milk may be insufficient; the most 
reliable evidence of this is the fact that the infant ceases to gain in 
weight. 



CHAPTER XIII.
THE NEW-BORN INFANT. 
The Infant's Toilet; the Crib; Feeding of Infants; Artificial Feeding; the 
Wet-nurse; Characteristics of Healthy Infants; the Stools; Constipation; 
Urination; Dentition.

"O thou child of many prayers, 
 Life hath quicksands; life hath snares." 
-- LONGFELLOW. 

The Infant's Toilet.-- So soon as the mother has been made comfortable, 
the toilet of the infant is attended to. This should be made near the 
register or stove; and the lap of the nurse should be covered with a small 
flannel blanket. The baby's body will be found to be covered over with a 
white, greasy, somewhat cheesy substance; some sort of grease is needed 
for its removal; rendered lard, sweet oil, and lanolin are the best; 
vaselin is less effective. All of this cheesy substance must be at once 
removed; the most difficult parts will be in the folds and creases. The 
nurse should grease the palms of her hands, then take the head of the 
child between them, and thoroughly grease it; particular attention must be 
given to the ears; then come the neck, shoulders, arms, chest and back, 
groins, external genital organs, and lower extremities. After the child 
has been thoroughly gone over, the grease should be rubbed off with a soft 
towel. 

A rectal injection of one tablespoonful of warm water is given at once to 
unload the bowels of the meconium; this generally acts before the baby's 
toilet is completed. The meconium is the first discharge from the infant's 
bowels after birth, and that which had collected in the intestines during 
the pregnancy. 

The Baby's Bath.-- The baby's bath-tub is filled about one-third full of 
water at a temperature of 100 degrees F., tested by the thermometer. The 
baby is then gradually immersed in the water, with the exception of the 
head; this is supported on the left wrist of the nurse, which passes under 
the infant's neck, while her hand grasps the left shoulder; with the right 
hand the nurse quickly rubs over the child's head and body; the entire 
bath should not occupy over five minutes. The infant is then lifted out 
into the lap of the nurse, on which is spread a soft, warm towel, with 
which it is carefully dried. One of the important points in giving the 
infant its bath is to be sure that the groins, arm-pits, and genitals are 
thoroughly well dried; otherwise excoriation at these parts is sure to 
occur. 

After this a daily tub-bath is given in the same way; soap is rarely 
needed; when it is, castile soap should be used; its constant use is not 
necessary and would only irritate the skin. These daily baths strengthen 
the nervous system and prevent coughs and colds. The bath should be given 
during the morning, one hour after feeding, and should not last more than 
five minutes. The mother herself, just as soon as she is able to go 
around, should superintend the bath; in this way she is assured that if 
properly given, and will also recognize any incipient affection of the 
child. These daily baths should be continued till the child is four years 
old. Powder is not essential; but if it is desired, a plain talcum powder 
may be used. 

The Dressing of the Cord.-- After the bath the ligature which was tied 
around the cord at the birth of the child will be found slightly loosened; 
this should first be made tight, and then the cord, doubled back on 
itself, should be tied by the ends of the same ligature. A square of soft 
sterilized linen or gauze is slit up to its center; the cord is allowed to 
pass through this slit, which looks toward the child's right; the stump of 
cord is laid on the left and the ends of gauze are folded over this; the 
whole is kept in place by the abdominal bandage. As there is some 
exudation from the cord, it is necessary to change these dressings twice a 
day; as this exudation is of a somewhat gluey nature, it will be found 
that the dressings stick to the cord. In removing the gauze great care 
must be used not to make any traction on the cord; when the infant is 
placed in the bath, the water loosens the dressing and it falls off in the 
water; at other times it must be removed with the greatest care. There 
should never be any odor about the cord; it usually drops off about the 
fifth day. 

The process of ulceration by which the cord falls off leaves an open 
surface on the child's body which offers an avenue for septic infection. 
Great care must therefore be taken that the nurse's hands or anything 
which comes in contact with this surface should be perfectly clean. The 
dressings used must be thoroughly antiseptic. 

Care should be used not to fasten the abdominal bandage too tightly; the 
bath is given on an empty stomach, and allowance should be made for this; 
the binder should be loose enough to allow two or three fingers to easily 
slip under it. 

The Meconium.-- The First discharge that comes from the bowels is of a 
dark, greenish color, and should come away during the first twenty-four 
hours; if it does not, the baby may suffer a good deal of pain, and an 
enema of warm water must be given. As this substance is very difficult to 
be washed out of napkins, the first ones used should be old and afterward 
be burned. 

Cleansing.-- Every time the napkin needs to be changed, even if it is only 
wet, the baby should be washed with warm water. A napkin should never be 
used twice without washing; it chafes the child, and it is an unsafe as 
well as a filthy practice; the napkin must always be removed as soon as it 
is wet. 

The Infant's Toilet.-- After the application of the binder and napkin, 
comes the undervest; the fingers of the nurse are passed up through the 
sleeve to seize the infant's hand and pull it through; as soon as it gets 
a little older the child will grasp a finger laid in its palm, which 
greatly facilitates this part of the toilet. The stockings are next put on 
and pinned with safety-pins to the napkin; then comes the petticoat, the 
band of which is also loosely fastened with safety-pins, and with the slip 
the toilet is complete. All the clothing should be changed night and 
morning. 

The eyes and mouth should be washed out with separate pieces of gauze or 
old linen. For the mouth, a small piece of cloth wet in warm water is 
wrapped around the little finger of the right hand, going into the left 
angle of the baby's mouth and coming out at the right, going between the 
gums and cheeks as well as over the tongue. This procedure should be gone 
through with every time preceding and following the nursing, and in this 
way the milk is prevented from souring in the mouth, and the digestion is 
kept in good condition. A sore mouth in a baby indicates carelessness on 
the part of the nurse. 

A soft hair-brush may be used, but the scalp is too tender to permit the 
use of a comb. 

After the toilet has been completed, the baby is laid in its crib, on the 
right side of the body, and warmly covered. The weaker the baby, the more 
attention must be paid to the external warmth. It may be necessary to 
place a warm-water bottle in the crib, but this must never touch the 
infant. 

The Crib.-- The infant must have its own crib, without rockers, and it 
must on no account be put to sleep in the same bed with its mother. In its 
early life it should never be taken out of its crib except to be fed, to 
have its clothing changed, or to be bathed. There should be no holding on 
the lap, no dangling, no carrying or fussing over the new-born infant; and 
the more the baby is let alone, the better and healthier it will be. If 
baby cries, look at once to see if it needs a fresh napkin; if not, if any 
pins are sticking into it, if the clothing is possibly too tight; if none 
of these things are wrong, give it a sup of water and turn it over on the 
other side. The baby often becomes restless by sleeping for several hours 
in the same position. But on no account take the infant up out of its crib 
simply because it cries. 

Cheerfulness and good nature on the part of the infant are dependent on 
its general good health. A healthy infant should not have colic, but if 
such is the case, there is a peculiar look of distress on the face, which 
indicates that the child is in pain; what is needed is warmth or 
medication according to the severity of the case, but never floor walking. 
Begin the latter procedure, and you may hope to keep it up for several 
years. 

Ventilation.-- The air is sometimes vitiated for children's uses in 
various ways; their nervous susceptibilities are greater than those of 
older people. A very little odor of tobacco may cause nausea and 
discomfort to an infant in arms. The atmosphere of the room should be 
sweet and pure and unscented. All scents and perfumes affect the nervous 
system, and by constant excitation do it damage. A bouquet of flowers 
renders the air of a closed room too heavy. 

Feeding of Infants.-- During the day the infant should be put to the 
breast once every two hours, and once every three hours during the night. 
This interval of time between the feeding is necessary in order that there 
may be sufficient time given for digestion to take place. Regurgitation of 
milk soon after feeding is a sign that the stomach has been overfilled. As 
the infant usually falls asleep after nursing, it is necessary to waken it 
up at the time for the next nursing, as good digestion depends upon 
regularity of feeding. 

For the first nursing the infant may be put to the breast in from two to 
six hours after the labor if the mother is sufficiently rested; from ten 
to twenty minutes is long enough for each nursing. Before each nursing the 
nipples should be carefully washed off with a solution of boric acid. The 
first secretion of the breasts is laxative; that is, it acts on the 
bowels, and makes is unnecessary to give the infant anything to take for 
this purpose. The breasts should be used alternately in feeding the 
infant, as this allows a longer time for the accumulation of the milk. For 
the first few days the infant needs very little food, and the mother's 
milk is generally sufficient. 

The infant should be given a teaspoonful of cool water to drink two or 
three times a day, as the milk does not quench the thirst. The water 
should be sterilized by boiling, and be kept in an air-tight flask. 

At the end of the third month the intervals of nursing for the daytime 
should be three hours, and the last nursing at night should be at eleven 
o'clock, and the first nursing in the morning at five o'clock; thus 
allowing the mother an interval of six hours of unbroken sleep. 

The best evidence of the proper nutrition of the child is a progressive 
gain in weight. The child should be weighed every week. A loss of a few 
ounces usually takes place during the first few days after birth, so that 
the child does well if at the end of the first week it weighs as much as 
it did at birth. After the first week the weekly gain should not fall 
below five ounces. 

The Wet-nurse.-- When the mother for any reason whatever is not able to 
nurse her child, the best substitute is a wet-nurse. Before she is 
employed the wet-nurse should always be carefully examined by a physician 
to insure her freedom from disease. The best age is between twenty and 
thirty years, and the age of the child of the nurse should be at least 
within a month of that of the child to be nursed. The best sign of the 
good health of the nurse and of the condition of her milk is furnished by 
the health of her own child. The breasts should be well formed and the 
nipple of good shape. It is well, if possible, to get a woman who has 
borne several children, as she will understand the care of the child 
better. No woman who is not perfectly healthy is fit to be a wet-nurse; 
and even after she has been engaged her health and her habits must be 
watched over. 

Artificia1 Feeding.-- The first requisite in artificial feeding is that 
the milk shall be made to correspond as nearly as possible to that of the 
mother. For this purpose the following formula, prepared by Rotch, of 
modified cow's milk is considered the best: 

Milk   2 ounces 
Cream   3 ounces 
Water   10 drams 
Milk-sugar   6 3/4 drams 
Lime-water   1 ounce 

To make one pint of the mixture for use in the twenty-four hours, take the 
milk and cream as soon as it comes in the morning, and mix as above 
directed. 

No less important than the correct proportions of the ingredients, is 
freedom from disease germs and bacteria of putrefaction. Complete 
sterilization is possible by prolonged boiling; but experience has proved 
that under prolonged exposure to a temperature near the boiling-point 
certain changes take place in the albuminoids of the milk which greatly 
impair its digestibility. Full sterilization of milk for infant feeding 
has therefore practically been abandoned. It has been found that milk 
heated to 167 degrees F. for twenty minutes, and promptly chilled by 
placing on ice, remains practically sterile for twenty-four hours, and it 
is spared the injurious changes which take place at a higher temperature. 
This process is known as Pasteurization. The Arnold steam sterilizer 
affords a convenient method of sterilizing; if used with the cover 
removed, the steam chamber being open, the temperature of the steam 
chamber does not exceed 170 degrees F. 

It is claimed that in the Arnold steam sterilizer, with the use of a 
suitable gas stove, the water begins to boil at the end of two minutes 
after the gas is lighted. A four-ounce bottle of milk at an initial 
temperature of 70 degrees F. in the open steam chamber attains a 
temperature of 170 degrees in just one hour. An exposure of about one hour 
and twenty minutes in the steam chamber is therefore necessary for the 
Pasteurization. 

The rules for sterilizing are as follows: 

First, clean the bottles thoroughly; then place them in cold water, which 
is allowed to come to boil and boiled for ten minutes. 

Second, fill each with the milk you wish to use; put in the rubber cork 
without the glass plug; this leaves a small opening in the rubber cork; 
set the bottle in the basket, then in the boiler. 

Third, set in the refrigerator until needed for use. 

Fourth, when wanted for use, place a bottle of the milk so prepared in the 
tin mug which accompanies the sterilizer; fill the mug with hot water to 
the height of the milk in the bottle, heat the milk to the temperature of 
99 degrees F., remove the rubber cork and put on the nipple, when it is 
ready for use. 

Fifth, cleanse the bottle immediately after using; throw away any milk 
that has not been used. 

Sixth, if the steaming process is preferred, place the basket without the 
bottles in the boiler, fill the water up to, but not above, the bottom of 
the basket, place the bottles in the basket, and proceed as before. 

It is important that the milk should be sterilized or Pasteurized as soon 
as it is served in the morning. Each bottle must be thoroughly washed as 
soon as it is emptied. Milk sterilized in this way will keep for days 
without spoiling, as it is hermetically sealed and all the unhealthy germs 
have been removed. 

The most exact method for the artificial feeding of infants, and that 
which most nearly approaches the mother's milk, is that used by the 
"Walker-Gordon Laboratory," branches of which are to be found in many of 
the large cities. 

Not only is the greatest care taken that the milk used shall be pure and 
sterilized ready for use, but these laboratories are equipped by special 
machinery which separates the important elements of the milk-- namely, the 
fat, the milk-sugar, and the proteids. So that the physician can modify 
the proportions of these various ingredients of the milk to meet the 
necessity of the age and requirements of the infant. 

When the milk contains too little sugar, the infant does not gain as 
rapidly in weight as it would otherwise do. Too much sugar in the milk is 
indicated by colic, thin, green, or acid stools, or eructations of gas 
from the stomach. 

An excess of fat in the milk is indicated by vomiting; too little fat 
causes constipation with dry hard stools. Proteids in excess are a 
prolific cause of colic and also of diarrhea. 

Prescription blanks are furnished the physician, who fills out the 
percentages of fat, milk-sugar, proteids, and alkalinity, to suit the age, 
weight, and general condition of the child. He orders also the amount to 
be given at each feeding, and the number of feedings to be given in the 
twenty-four hours. Each bottle contains just the amount to be given at one 
feeding. All that the mother needs to do is to place the bottle in a 
receptacle containing warm water, until the milk has attained a 
temperature of 99 degrees F., remove the cotton stopper, and put on the 
nipple, when it is ready for use. 

The Nursing Bottle.-- This should be of clear glass, with a rounded 
bottom, and of such a shape as is easy to clean; so that no particles will 
cling around a corner which cannot be reached. The graduated bottle is the 
most convenient, as it enables the quantities of each of the materials 
used in the preparation of the feeding to be mixed in the bottle, doing 
away with the trouble of measuring before putting into the bottle. 

Rubber Nipples.-- Two nipples should be kept for alternate use, and no 
nipple should be used longer than two weeks. A soft rubber of conical 
shape is best, with an opening at the top which is not too large, so that 
the milk will not flow through, as it is desirable that the child should 
obtain the milk by suction. So soon as the feeding is over, the nipple 
should be removed from the bottle, and brushed on both sides with a stiff 
brush. It should then be put in cold water, where it is kept until it is 
again wanted. 

The baby should be fed slowly, from ten to twenty minutes being taken for 
each feeding. Sucking from an empty bottle or with a nipple in the mouth 
should never be permitted, as in this way the baby draws air into its 
stomach, which will result in colic. Each flask should contain only enough 
for one feeding. 

In lieu of the regular sterilizing apparatus, milk may be similarly 
prepared by placing the milk in an ordinary glass fruit-jar with a screw 
lid. This is placed in a colander over a pot of boiling water; the milk 
should be allowed to boil in the open jar for two minutes; the jar-lid is 
then screwed on, and it should steam for twenty minutes longer. 

The capacity of the infant stomach at birth is about one ounce, which is 
the average quantity of food that should be taken at one meal. The average 
rate of increase in the amount of food is one and a half drams a week for 
the first six months; subsequently somewhat less. The intervals of feeding 
should be two hours at birth, and increased to three hours at the end of 
the third month. The food should be given at a temperature of 99 degrees 
F. and fed directly from the sterilizing bottle. 

Fresh Air.-- In warm weather the baby is taken out-of-doors in from three 
to four weeks after birth; in cold weather not before two to three months. 
In the latter case it is prepared for the change by being first dressed as 
for the street, with wrap and cap; the windows of the room are then 
opened, and the infant is carried about here. In the winter months when 
the baby is first taken out, it is better to carry it in the arms, as it 
will be kept warmer in this way, and if it does become chilled it will be 
more quickly noticed. 

Characteristics of the Healthy Infant.-- The average weight of an infant 
at birth is about seven pounds, and its length is about twenty inches; the 
extremes are four pounds or a little less up to eleven pounds. The head 
and trunk of the child are developed out of proportion to the limbs. 

The skin of the new-born infant varies from pinkish to red; about the 
fourth day the color becomes somewhat yellowish; this tinge should 
disappear about the end of the second week, and at the same time the skin 
begins to peel off.This process lasts about two weeks longer, when the 
baby's skin takes on its normal color. 

The shape of the head varies greatly, much being due to the amount of 
pressure during labor; but this disappears in a few days. As a rule, the 
large bones of the head are felt to be separated by membranous ridges 
called sutures; there is one on the median line on the top of the head, 
and at either end of the suture is a large open space, called a fontanel. 
The largest one is at the front of the head, and is called the anterior 
fontanel; it is about large enough to be covered by the tips of two 
fingers, and is of a lozenge shape; this opening does not close till the 
child is about eighteen months old. In a healthy baby this fontanel should 
be on a level with the bones of the head; a slight pulsation may be 
noticed in it, due to the pulsations of the vessels of the brain. There is 
a much smaller three-cornered fontanel at the back of the suture, and one 
behind either ear; these soon close up with bone. 

A new-born baby cannot probably do any more than distinguish light from 
darkness. Up to the sixth week there is an inability at coordination of 
the ocular muscles; after this time the eyes begin to move in an orderly 
manner, and they will follow a bright object moved slowly in front of 
them. At about the end of the second month rapid movements are perceived, 
as is evinced by the child's closing its eyes quickly on an object 
suddenly approaching it. At three months the child begins to recognize 
colors; the first recognized are yellow, red, pure white, gray, and black. 
But the faculty of distinguishing between colors is not perfected till the 
third year. The mother is recognized about the third month. Hearing and a 
sense of smell develop rapidly after birth; loud noises in its vicinity 
will cause a child to start during the first day after birth. By the time 
the child has reached three months of age it shows signs of having a mind 
of its own, and is capable of exercising thought. It grasps for objects, 
and indicates its likes and dislikes. At from eight to ten months it can 
utter several syllables, and at the age of one year should be able to say 
mama and papa; at two years it should be able to frame short sentences. 

Weight of the Baby.-- By the end of the sixth month the child's weight 
should be double what it was at birth; that is, about fourteen pounds; at 
the end of the twelfth month be three times as much as at birth, or about 
twenty pounds. 

Muscular Action.-- Muscular action in the new-born infant is entirely 
involuntary, there being no voluntary acts until about the end of the 
third month. Sucking and licking are largely instinctive. The movements of 
the arms and legs are impulsive acts, and occur during sleep, just as they 
did in the intra-uterine life. The act of raising the head, which is 
attempted about the fourth month in healthy children, is volitional, 
requiring not so much added strength of muscle as power of coordination. 
As volition develops the power of coordination gradually increases, and 
the child learns to perform voluntary or purposeful acts. Voluntary 
grasping is done after the fourth month. As the child learns to balance 
its head, it attempts to sit up. This act is not successfully accomplished 
until about the fortieth week; the child sits firmly alone when ten or 
eleven months old. Before this time it is necessary to support the head 
and spine of the child with the hand. By the third or fourth month the 
infant should be able to grasp things. The child begins to creep about the 
ninth month. The clothing should be so arranged as to allow entire freedom 
of motion. 

It should be able to stand up by a chair by the tenth month, and be able 
to walk alone at the end of the first year. It is important that parents 
should know this, since not knowing what a normal baby ought to be able to 
do, cases of birth palsy, or even an attack of paralysis due to teething, 
are not infrequently overlooked, not only by the mother, but even by the 
doctor, who attributes the inability of the child to do what other 
children can do at this age simply to weakness, which the child will 
outgrow; and thus the time passes in which the most could be done to cure 
the child and to prevent the subsequent deformity. 

A baby should not be forced to stand or walk; a very stout baby, on 
account of its weight, will stand up and walk much later than a slight 
one, the two being equally healthy. Or if a baby has been sick, it will 
feel no inclination to stand up. Naturally, a child creeps before it 
walks, and this develops the muscles of the lower limbs, so that they will 
support the weight of the child in standing. By prematurely forcing a 
child to stand up and walk, there is danger of causing bow-legs, as the 
bones of the legs are still weak; the child should be discouraged from 
standing up too much rather than encouraged to stand up more. 

Sleep.-- A large proportion of the time of early infancy is spent in 
sleep; for the first few weeks the infant only wakens up to be fed. During 
sleep the eyelids should be tightly closed; a partial opening of the lids, 
showing the whites of the eyes, is an indication of ill health. Up to the 
age of six, children require twelve hours of sleep at night, besides an 
hour or more in the middle of the day; the child should be permitted to 
sleep as long in the morning as it will. 

Respiration.-- The healthy infant breathes on an average forty-four times 
a minute; the only time the respirations can be satisfactorily counted is 
during sleep. When the child is awake, the respirations are hurried by 
slight movements of the body, crying, and so forth. The average pulse of a 
newborn baby is one hundred and forty; this is hurried by the same causes 
that hastens respirations; the pulse is most easily counted at the 
anterior fontanel. The average temperature of the infant is 99 degrees F. 
When the tip of the nose and the extremities are cold, it indicates a 
lowered vitality. 

The nature of the child's cry indicates, variously, hunger, temper, or 
pain; the mother will soon learn to distinguish these varieties. If the 
child cries because it is hungry, the cry ceases so soon as it is fed. But 
a child is never to be fed simply because it cries; it must be fed on the 
hour by the clock. If this rule is not strictly adhered to, it will suffer 
all the forms of indigestion and colic that babies are heir to. If it 
cries because of colic, there is a drawn look on the face, and at the same 
time the legs are sharply flexed on the thighs and the thighs on the 
abdomen. If the cries are due to earache, the head will be rolled about 
from one side to the other. In either case nothing will stop the cries 
until the pain is relieved. A baby does not shed tears until the third 
month. 

The Stools.-- The stools of a very young baby fed on breast-milk should be 
of a yellow or orange color. There should be three or four evacuations 
daily; they should contain no curds. Stools of bottle-fed babies are 
lighter in color and more offensive. 

Constipation.-- Constipation is not uncommon in infancy; it may be 
overcome by the use of a soap suppository, or by an injection of warm soap-
suds into the bowel, or by an injection of oil and water, or by gentle 
friction over the bowel, following the course of the large intestine. 

To make the soap suppository, take a piece of castile soap about an inch 
long, give it the shape of a cone not any larger than the end of the 
little finger, and make it perfectly smooth. This is inserted to about 
half of its length into the rectum and held there until it causes the 
bowels to move. 

The bowel injection is best given by means of the single-bulb syringe, 
known as the eye and ear syringe; the bulb holds about two tablespoonfuls 
of liquid. This may be warm cotton-seed oil, sweet oil, or glycerin one 
teaspoonful to warm water two tablespoonfuls. The nozle should be small, 
smooth, and well oiled. It should be very carefully introduced into the 
bowel, being directed a little to the left side, and the bulb gently 
squeezed to force the contents into the bowel. The injection is more 
effective if it is retained for a little while; this is accomplished by 
making slight pressure on the anus with a towel. 

Rubbing the abdomen for about ten minutes in the direction of the large 
bowel is sometimes very effective in overcoming constipation; begin in the 
right groin and rub up as far as the border of the ribs, then across to 
the left, then down on the left side. 

Vomiting.-- Vomiting means often only that the stomach has been 
overfilled, and may be relieved by withholding all food for a few hours. 

Urination.-- The frequency of urination in a newborn baby will vary 
greatly with the weather and other conditions; in cool weather it is not 
unusual for the napkin to need changing almost every hour. Healthy urine 
should not stain the napkin. The new-born infant secretes very little 
urine until it begins to take nourishment freely. The bladder is usually 
emptied during birth, and very often the bowels also, so that if the child 
seems well and there is no malformation of the parts, the family may be 
assured that the apparent retention of urine is only temporary. 

The use of hot fomentations over the kidneys and bladder will often hasten 
the evacuation of urine if it has been unduly delayed. If the secretion 
seems highly concentrated, a drop of sweet spirits of niter in a 
teaspoonful of water may be given every two hours. 

Teething.-- The first tooth generally appears about the end of the fourth 
month; in delicate children they come later. As a rule, the lower front 
teeth come first, coming in pairs, one tooth coming on each side of the 
mouth; followed in about a month by the corresponding teeth in the upper 
jaw. Preceding their appearance the gums become swollen, hot, and painful, 
and the saliva forms in excess and runs from the mouth. The child is 
irritable, flushed and restless; and there usually occurs some disturbance 
of the bowels, commonly diarrhea. This all indicates a nervous 
derangement, and calls for a judicious diet and general careful oversight. 
The symptoms subside when the teeth are through. During teething the child 
manifests a desire to bite on something, and a soft rubber ring will give 
it great comfort. 

The first set of teeth are twenty in number, and are usually cut in 
groups, starting about the fourth month and continuing until between the 
twentieth and thirtieth month, when the first dentition should be 
complete. As a rule there is an interval of rest between the eruption of 
the various groups. During dentition children are generally more peevish 
and fretful than usual, but there should be no general constitutional 
disturbance. During dentition it is of especial importance to keep the 
bowels well opened; it is better to have them too loose than costive; 
constipation at this time greatly increases the tendency to convulsions. 

Bottle-fed babies are apt to cut their teeth later than those nursed at 
the breast. The lack of appearance of any teeth before the end of the 
first year indicates that the nutrition of the child is below par, or, in 
other words, that the child has rickets. The permanent teeth begin to 
appear about the sixth or seventh year.