EXERCISES

Fig. 8.—A Fly with Germs (Greatly Magnified) on Its Legs.(U. S. Dept. Agri.)

Other diseases carried by insects are malaria and yellow fever, each by a special species of mosquito; typhus fever, by lice; and bubonic plague, by rat fleas. Various diseases less common in this country are carried by other insects. Even when mosquitoes are not carrying disease germs their bites may be harmful since they are often rubbed, especially by children, until the skin is broken, and various infections may enter through the wounds. Insects of every kind, rats, mice, and vermin should be excluded from houses.

Sewage.—Discharges from the bowels and bladder contain various germs, and constitute one of the most important routes by which germs of typhoid fever, cholera and certain other diseasestravel from person to person. Keeping sewage out of the water supply is consequently of great importance. Where a system of sewage disposal exists, the responsibility of making the system adequate and thus safeguarding public health rests upon the community as a whole. Communities ordinarily get just as much, or just as little typhoid fever as they are willing to endure.

—Discharges from the bowels and bladder contain various germs, and constitute one of the most important routes by which germs of typhoid fever, cholera and certain other diseasestravel from person to person. Keeping sewage out of the water supply is consequently of great importance. Where a system of sewage disposal exists, the responsibility of making the system adequate and thus safeguarding public health rests upon the community as a whole. Communities ordinarily get just as much, or just as little typhoid fever as they are willing to endure.

Illustration of ground water contamination via excrement from privy and barnyard.Fig. 9.—How a well may be polluted.(From "The Human Mechanism."Copyright by Theodore Hough and William T. Sedgwick. Ginn and Company, publishers. Used by permission.)

Fig. 9.—How a well may be polluted.(From "The Human Mechanism."Copyright by Theodore Hough and William T. Sedgwick. Ginn and Company, publishers. Used by permission.)

In places having no system of drainage privies must be used. They can be made harmless, as army camps prove, but they require scrupulouscare. Fecal matter must be prevented from draining into wells and other water supplies, and must be screened from flies. The privy should be located at a distance from the well. The minimum distance that is safe depends in each case upon the nature of the soil and the direction of the natural drainage. Even when the privy is situated below the well on sloping ground, drainage may still occur from the privy to the well; however, a well-made, properly located pit privy is safe unless it is near a limestone formation. The dry earth system is satisfactory in places having an efficient public scavenger system; in this system pails or cans are used to receive the discharges, which are then covered with sand, ashes, earth or, preferably, chloride of lime. The buckets are frequently emptied and the contents buried at least one foot below the surface of the ground. The objection to this method for more extended use is that proper care of the cans is a disagreeable duty of which most households soon tire.

Personal Cleanliness.—The main functions of the skin are three: to protect underlying tissues, to excrete waste matter, and to regulate bodily heat by checking or allowing the evaporation of perspiration. After perspiration has evaporated solid matter is left upon the skin, and oily matter also is deposited on it by the glands that keep theskin lubricated. Removing these and other materials at least once a day is desirable to improve the bodily tone and sense of well-being. Real cleanliness is impossible without frequent use of warm water and soap.

—The main functions of the skin are three: to protect underlying tissues, to excrete waste matter, and to regulate bodily heat by checking or allowing the evaporation of perspiration. After perspiration has evaporated solid matter is left upon the skin, and oily matter also is deposited on it by the glands that keep theskin lubricated. Removing these and other materials at least once a day is desirable to improve the bodily tone and sense of well-being. Real cleanliness is impossible without frequent use of warm water and soap.

Cold baths are stimulating, though not very efficacious for cleansing purposes. They are valuable tonics if properly used, but delicate or elderly persons should use them only by a physician's advice. Chilly feelings or depression following should be the signal for any person to discontinue cold bathing or swimming in cold water.

Warm baths are soothing in their effects, and are appropriate at bed time, particularly for persons inclined to sleeplessness. Very hot baths, especially if prolonged, may be harmful, and should not be taken often.

There is no clear connection between general cleanliness and disease. Frequent bathing does not protect a person from any particular disease, except in so far as bathing necessarily includes washing the hands. If typhoid germs for example have actually been swallowed, a clean bodily exterior is of no avail in preventing typhoid fever or in diminishing its severity. The same is true of other diseases.

But it is impossible to emphasize unduly theimportance of clean hands. Hands are prime offenders in distributing fresh bodily secretions, and germs both innocent and harmful. All health authorities agree on this point.

"Perhaps 90% of all infections are taken into the body through the mouth. They reach the mouth in water, food, fingers, dust, and upon the innumerable objects that are sometimes placed in the mouth. The fact that the great majority of infections are taken by way of the mouth gives scientific direction to personal hygiene. Sanitary habits demand that the hands should be washed after defecation and again before eating, and fingers should be kept away from the mouth and nose, and that no unnecessary objects should be mouthed. All food and drink should be clean or thoroughly cooked. These simple precautions alone would prevent many a case of infection."—(Rosenau: Preventive Medicine and Hygiene, p. 366.)

As Dr. Chapin says:

"Probably the chief vehicle for the conveyance of nasal and oral secretion from one to another is the fingers. If one takes the trouble to watch for a short time his neighbors, or even himself, unless he has been particularly trained in such matters, he will be surprised to note the number of times that the fingers go to the mouth and the nose. Not only is the saliva made use of for a great variety of purposes, and numberless articles are for one reason or another placed in the mouth, but for no reason whatever, and all unconsciously, the fingers are with great frequency raised to the lips or the nose. Who candoubt that if the salivary glands secreted indigo the fingers would continually be stained a deep blue, and who can doubt that if the nasal and oral secretions contain the germs of disease these germs will be almost as constantly found upon the fingers? All successful commerce is reciprocal, and in this universal trade in human saliva the fingers not only bring foreign secretions to the mouth of their owner, but there exchanging them for his own, distribute the latter to everything that the hand touches. This happens not once, but scores and hundreds of times during the day's round of the individual. The cook spreads his saliva on the muffins and rolls, the waitress infects the glasses and spoons, the moistened fingers of the peddler arrange his fruit, the thumb of the milkman is in his measure, the reader moistens the pages of his book, the conductor his transfer tickets, the "lady" the fingers of her glove. Every one is busily engaged in this distribution of saliva, so that the end of each day finds this secretion freely distributed on the doors, window sills, furniture and playthings in the home, the straps of trolley cars, the rails and counter and desks of shops and public buildings, and indeed upon everything that the hands of man touch. What avails it if the pathogens do die quickly? A fresh supply is furnished each day."—(Chapin: The Sources and Modes of Infection, p. 188.)

Oral Hygiene.—Cleanliness and proper care of the mouth and teeth can hardly be over emphasized. Their bearing upon health is direct. Long ago it was recognized that persons with decayed or missing teeth frequently sufferedfrom dyspepsia, a natural result of inability to masticate properly, but only within recent years has it been realized that decayed teeth give rise to many other diseased conditions. Bacteria are constantly present in the mouth. If the mucus of the mouth is not removed, it forms a sticky coat upon the surfaces of the teeth and gums. In this bacteria collect, and pus or matter may also be formed, which, if carried by the blood to other parts of the body, may cause digestive troubles, rheumatism, and diseases of heart and kidneys. (See Dr. T. B. Hartzell, Health News, Oct., 1915, "The Importance of Mouth Hygiene and How to Practise it.")

—Cleanliness and proper care of the mouth and teeth can hardly be over emphasized. Their bearing upon health is direct. Long ago it was recognized that persons with decayed or missing teeth frequently sufferedfrom dyspepsia, a natural result of inability to masticate properly, but only within recent years has it been realized that decayed teeth give rise to many other diseased conditions. Bacteria are constantly present in the mouth. If the mucus of the mouth is not removed, it forms a sticky coat upon the surfaces of the teeth and gums. In this bacteria collect, and pus or matter may also be formed, which, if carried by the blood to other parts of the body, may cause digestive troubles, rheumatism, and diseases of heart and kidneys. (See Dr. T. B. Hartzell, Health News, Oct., 1915, "The Importance of Mouth Hygiene and How to Practise it.")

To keep the mouth and teeth healthy they must have:

1. Proper use.

2. Proper care.

3. Proper treatment.

1. Teeth, like other parts of the body, need exercise. Foods that require a considerable amount of chewing should be included in the diet. Such food is needed by children as soon as their first teeth have come, but care must be exercised to see that the food is actually chewed before it is swallowed.

2. A good brush should be provided. The stiffness of the bristles should be regulated accordingto the individual. The brush should be thoroughly rinsed after using, and discarded as soon as it is worn. Dental floss is generally needed to remove particles that have lodged between the teeth.

Brushing the teeth by passing the bristles across them is not efficacious. They should be brushed not across but with the cracks, as a good housewife sweeps a floor.

"In the light of recent investigation conducted by some of the leading students of mouth hygiene, the most effective way to use the toothbrush is to place the bristles of the brush firmly against the teeth, applying firm pressure, as though trying to force the bristles between the teeth, using a slight rotary or scrubbing motion.... After a little practice the user of this method will be surprised at the results obtained. Care should be used to go over all the surfaces of the teeth in this manner."—(See Dr. W. G. Ebersole. "The Importance of Mouth Hygiene and How to Practice it," Health News, Oct., 1915.)

After brushing the teeth, the mouth should be rinsed by forcing lukewarm water about the teeth, using all the force that can be brought to bear by the cheeks, lips, and tongue.

3.Treatment.—The teeth, including the first teeth of children, should be inspected by a competent dentist at least twice a year. Periodic cleansing by a dentist, and early attention tosmall cavities, may prevent serious ill health and impairment of the body, as well as the acute suffering generally accompanying treatment of advanced dental defects.

—The teeth, including the first teeth of children, should be inspected by a competent dentist at least twice a year. Periodic cleansing by a dentist, and early attention tosmall cavities, may prevent serious ill health and impairment of the body, as well as the acute suffering generally accompanying treatment of advanced dental defects.

Clothing.—Clothing was originally used for purposes of ornament. Desire for protection from cold and dampness came later. The amount of clothing required varies greatly according to individual needs and habits, but it is increasingly recognized that light clothing is best, provided that the wearer is really protected from cold. Clothing should be porous in order to allow ventilation of the body, supported so far as possible from the shoulders, and clean and well aired. Dampness favors the growth of germs which may cause irritation of the skin.

—Clothing was originally used for purposes of ornament. Desire for protection from cold and dampness came later. The amount of clothing required varies greatly according to individual needs and habits, but it is increasingly recognized that light clothing is best, provided that the wearer is really protected from cold. Clothing should be porous in order to allow ventilation of the body, supported so far as possible from the shoulders, and clean and well aired. Dampness favors the growth of germs which may cause irritation of the skin.

Clothing should not constrict the body or hamper its movements. Perhaps the worst health menace for which clothing is to blame comes from the high heeled shoes on which many women prefer to limp through life. From the health standpoint shoes are of great importance. Bad shoes are responsible for many cases of flat feet, whose muscles have degenerated through non-use, and for much so-called "rheumatism," which is merely the protest of abused muscles. Bad shoes also, by distorting the feet, prevent comfortable walking, which is the only out-of-door exercise readilyavailable for the vast majority of people; and still worse, the resulting unnatural position of the body sometimes has serious consequences by bringing injurious strains on other muscles and organs.

Food.—Two distinct problems are encountered here: the problem of nutrition, and the problem of preventing sickness. Nutrition, or proper feeding, is a subject beyond the scope of this book; it is nevertheless one of the most important, if not the most important, factor in maintaining health. Food preparation and care of children, the two most important functions of the home, are unfortunately relegated to the least intelligent and least interested members of most households in which servants are employed.

—Two distinct problems are encountered here: the problem of nutrition, and the problem of preventing sickness. Nutrition, or proper feeding, is a subject beyond the scope of this book; it is nevertheless one of the most important, if not the most important, factor in maintaining health. Food preparation and care of children, the two most important functions of the home, are unfortunately relegated to the least intelligent and least interested members of most households in which servants are employed.

Most American families eat too much protein food, such as meat and eggs. Excess of protein probably leads to degeneration of tissues, and plays a part in causing the degenerative diseases already mentioned. Habit is important here as in other ways of living, but cereals and vegetables should in large measure make up the diet of sedentary persons and indeed of everyone in warm weather.

The amount of food required in 24 hours depends on many factors: age, height, weight, occupation, season, and habit. Underweight andoverweight are both abnormal conditions; probably the latter is the more easily remedied. Both require the advice of a physician. Rapid reduction of weight involves certain dangers, especially for persons with weak hearts.

Food may cause sickness either because it is in itself harmful, or because it carries disease germs. Meat from diseased animals should be destroyed before it reaches the market, but bacterial activities in food originally wholesome may form in it poisonous substances.

The chief diseases known to be carried by food, water, or milk are typhoid fever, paratyphoid, dysentery and other diarrhœal diseases, scarlet fever, diphtheria, septic sore throat, and tuberculosis. The sole problem here is to keep human and animal excretions out of food, water, and milk. Since thorough cooking kills disease germs, danger arises chiefly from raw foods. All fruits and vegetables eaten raw should first be thoroughly washed.

Water is essential to health. At least three pints should be taken daily, the amount varying somewhat according to diet, exercise, temperature, and so forth. Most persons drink too little water.

Cities and towns should of course have public supplies of pure water. Contamination of water,when it occurs, is caused chiefly by sewage from cesspools, privies, and drains. All well or spring water must be constantly watched and Boards of Health are always ready to examine samples of water and to report whether it is safe to drink. At the present time a porcelain filter is the only satisfactory kind for a household, but many domestic filters are so badly cared for that in actual practice they are worse than none. Danger from a filter containing an accumulation of impurities is greater than the danger from most ordinary water supplies. Boiling water for ten minutes kills all pathogenic germs, but this method is inconvenient on a large scale and is not practical for continued family use.

Every effort should be made to insure a regular supply of pure water in every house. It is not satisfactory to have two kinds, one for drinking and one for other purposes, since mistakes are sure to be made, especially by children. Some families who use only bottled or filtered water for drinking purposes habitually run the risk involved in using impure water from the tap for cleaning the teeth.

Freezing destroys most germs, but ice is not necessarily free from bacterial life, and should be used in drinking water only when known to be free from impurities. Neither does freezing milkor cream necessarily kill germs that may be contained in it.

Raw milk plays so important a part in the spread of disease that its fitness for human consumption is open to serious question. Certified milk, where obtainable, is safe but expensive. Boiled milk is safe, but changed in taste and to some extent in quality. If milk is heated to 142°-145° F. and kept at that temperature for 30 minutes all disease germs in it are killed. This process, called pasteurization, renders milk safe. The objection is sometimes made that continued use of pasteurized milk for infants causes scurvy, but in New York City where over 90 per cent. of the milk is pasteurized no increase in scurvy has been noticed, while a large diminution in deaths of infants from diarrhœal diseases has resulted, as in all cities where pasteurization is required.

The following is a simple method for pasteurizing a quart bottle of milk. If the directions are exactly followed the milk will be pasteurized at the end of the process; no thermometer need be used. To prevent the bottle from breaking, it is first warmed by placing it for a few minutes in a pail of warm water.

"From the results of the experiments it was concluded that any housewife can pasteurize a one quart bottle of milk by:1. Boiling 2½ quarts of water in a large agate saucepan; or better2. Boiling 2 quarts of water in a 10 pound tin lard pail, placing the slightly warmed bottle from the ice chest in it, covering with a cloth and setting in a warm place. At the end of one hour the bottle of milk should be removed and chilled promptly. The water must be boiled in the container in which the pasteurization is to be done."—(Ruth Vories, in "Health News," Sept., 1916.)

"From the results of the experiments it was concluded that any housewife can pasteurize a one quart bottle of milk by:

1. Boiling 2½ quarts of water in a large agate saucepan; or better

2. Boiling 2 quarts of water in a 10 pound tin lard pail, placing the slightly warmed bottle from the ice chest in it, covering with a cloth and setting in a warm place. At the end of one hour the bottle of milk should be removed and chilled promptly. The water must be boiled in the container in which the pasteurization is to be done."—(Ruth Vories, in "Health News," Sept., 1916.)

Elimination.—Careful attention should be paid to elimination through the bowels and kidneys. Constipation is responsible for many common ailments; among them are headache, disinclination to work, irritable temper, and lowered resistance. If long continued, constipation becomes serious both from congestion and displacement of pelvic organs, and from absorption over a considerable time of even small amounts of the poisonous substances resulting from decomposition of food in the large intestine. The bowels can best be regulated by diet, water, exercise, and habit. The habitual use of cathartic and laxative drugs is most unwise, because they tend to aggravate the trouble. Moreover the habitual and continued use of injections and "internal baths" is harmful, and would not be considered necessary if bran and coarse flour and vegetables were substituted for concentrated foods. Greed, laziness, and lack ofintelligence lead most persons suffering with constipation to prefer pills to the restraints demanded by hygienic living. The habit of evacuating the bowels at a regular time, if established in early childhood and rigidly adhered to, will prevent constipation among most healthy people. Any person who thinks drugs necessary should consult a physician, and be prepared to follow the régime he advises over a considerable period of time and at the cost of some self-denial.

—Careful attention should be paid to elimination through the bowels and kidneys. Constipation is responsible for many common ailments; among them are headache, disinclination to work, irritable temper, and lowered resistance. If long continued, constipation becomes serious both from congestion and displacement of pelvic organs, and from absorption over a considerable time of even small amounts of the poisonous substances resulting from decomposition of food in the large intestine. The bowels can best be regulated by diet, water, exercise, and habit. The habitual use of cathartic and laxative drugs is most unwise, because they tend to aggravate the trouble. Moreover the habitual and continued use of injections and "internal baths" is harmful, and would not be considered necessary if bran and coarse flour and vegetables were substituted for concentrated foods. Greed, laziness, and lack ofintelligence lead most persons suffering with constipation to prefer pills to the restraints demanded by hygienic living. The habit of evacuating the bowels at a regular time, if established in early childhood and rigidly adhered to, will prevent constipation among most healthy people. Any person who thinks drugs necessary should consult a physician, and be prepared to follow the régime he advises over a considerable period of time and at the cost of some self-denial.

For healthy people, voiding urine presents no difficulty if a sufficient amount of water is taken; but some persons reduce the amount of liquid taken in order to escape the inconvenience of urination. This practice is harmful, and may involve insufficient cleansing of the entire system. If frequent urination disturbs sleep, liquids may be withheld during the evening; but the total amount of water taken in 24 hours should not be diminished.

Rest and Fatigue.—A fatigued person is a poisoned person. Muscular exertion burns the fuel constituents of the body, as we recognize by the greater heat generated within us during muscular exertion. Waste products, resulting from this burning process, accumulate if not removed, and clog the body in somewhat the same way that ashes and cinders clog a furnace. The fatiguedperson remains fatigued, consequently, until the accumulations of waste matter are removed by the normal action of the lungs, skin, and kidneys.

—A fatigued person is a poisoned person. Muscular exertion burns the fuel constituents of the body, as we recognize by the greater heat generated within us during muscular exertion. Waste products, resulting from this burning process, accumulate if not removed, and clog the body in somewhat the same way that ashes and cinders clog a furnace. The fatiguedperson remains fatigued, consequently, until the accumulations of waste matter are removed by the normal action of the lungs, skin, and kidneys.

Fatigue is caused by both mental and physical work, and when excessive, affects the nervous system most disastrously. The body can and should respond to occasional extra drafts on strength and endurance; its flexibility and power of adjusting to varying conditions may even be stimulated thereby. But even slight fatigue, if continued and especially if associated with anxiety or worry, has caused many nervous and mental breakdowns.

Work carried beyond the point of normal fatigue requires a proportionately longer time for recovery. For example, if the point of fatigue has been reached by a certain finger muscle after 15 contractions, and if half an hour is required to rest it completely, one might suppose that one hour would rest it after 30 contractions. This is not so, however; after 30 contractions 2 hours are required, or 4 times as much rest for twice the amount of work, if continued beyond the point of fatigue. Laboratory experiments and experience alike show that this principle holds true in other forms of fatigue. Thus the output of factories has been shown in many instances to be greater, other things being equal, when operatives work 8 hours a day thanwhen they work longer. Excessive hours in any kind of work are the poorest economy.

Fatigue is increased in direct proportion not only to muscular exertion but also to the amount of speed, complexity, responsibility, monotony, noise, and confusion involved in an occupation. Ability to bear fatigue differs greatly with different people, as ability varies to bear other kinds of strain. Rest at night and on Sunday, and the annual vacation should be enough to keep a person in good condition. If not, there is probably something wrong with the worker's health, the nature of his work, or his adaptation to his particular kind of work. This statement is not only true of persons regularly employed, but of those living at home, including children in school, women in "society," and especially mothers of families.

Sleep.—A sufficient amount of sleep is essential to health, but individual requirements vary widely. Each person should know and regard his own need, and children and young people should be obliged to go to bed early. Ability to sleep is largely habit; good habits should be formed and continued. Sleep-producing drugs should never be taken, except by a doctor's prescription.

—A sufficient amount of sleep is essential to health, but individual requirements vary widely. Each person should know and regard his own need, and children and young people should be obliged to go to bed early. Ability to sleep is largely habit; good habits should be formed and continued. Sleep-producing drugs should never be taken, except by a doctor's prescription.

Recreation.—Owing to the speed, complexity, and worry of modern life among all classes, and to the monotony of work in industry, recreation hasbecome a matter of vital importance for everyone. Some muscular activity, preferably in the open air, is needed by every healthy person. Recreation should be as unlike the regular occupation as possible: going to the theatre, for example, is not the best exercise for sedentary workers employed all day in artificially lighted offices. The element of pleasure is essential. Hoisting dumb-bells purely from conscientious motives is seldom beneficial, and is generally soon abandoned.

—Owing to the speed, complexity, and worry of modern life among all classes, and to the monotony of work in industry, recreation hasbecome a matter of vital importance for everyone. Some muscular activity, preferably in the open air, is needed by every healthy person. Recreation should be as unlike the regular occupation as possible: going to the theatre, for example, is not the best exercise for sedentary workers employed all day in artificially lighted offices. The element of pleasure is essential. Hoisting dumb-bells purely from conscientious motives is seldom beneficial, and is generally soon abandoned.

The part played by habit in matters of health is often overlooked. Although the body adjusts itself to widely varying conditions and even to unfavorable ones, the importance of forming desirable habits cannot be overemphasized. Sudden or radical changes in living, however, particularly among people no longer young, may play havoc. New and violent systems of exercise, weight reduction, and food fads forced on families by enthusiastic discoverers involve considerable risk.

Many elements enter into health; in no single one is found hygienic salvation. Temptation always exists to emphasize one element at the expense of others. For instance, people who insist upon overventilating rooms regardless of others' comfort may themselves be utterly careless in regard to necessary sleep, and more than one fastidiouslyclean person has disregarded the highly unclean condition of constipation. To maintain sound health only a rational program will suffice: properly balanced work and play, sleep and food and all other elements must be included in due proportion. And over-anxious health seekers might well remember that health is not so much an end in itself, as a means to a happy and productive life; even in concern over health, it is possible for him that saveth his life to lose it.

The principles of hygiene are fundamentally the same for young and old. The applications, however, differ at different ages. From the time when physical growth and development are complete until changes due to old age appear, an individual commonly has greater resistance than at other ages, and is able in consequence to endure unfavorable conditions of life with more success.

Babies, on the other hand, are exceedingly sensitive to their environment. Surroundings that are even slightly unfavorable are likely to make babies sick. In order to remain healthy, they must have exactly the right kind of food, in the right quantities and at the right times; their sleep, exercise, and clothing must be carefully regulated; they must be protected from careless handling, from nervous strain, and above all, from the many kinds of infection to which they are peculiarly susceptible. The life of a baby fortunately can be controlled almost completely;when properly regulated it offers, therefore, an unequalled opportunity to see how hygienic principles work out in actual practice.

The primitive mother's instinct to nourish and protect and succor her helpless child was the original form of nursing. Instinct alone, unfortunately, has never accomplished much in preserving health. The human race has now had an experience in the care of infants that extends over thousands of years. Yet today we are still, on the whole, less successful in keeping babies alive than we are in raising domestic animals; we still allow society to continue, like a modern Herod, in its ruthless career of slaughtering the innocents.

About 14 babies out of every 100 born in the registration area[1]of the United States die before reaching the age of one year, while in some of our industrial cities as many as 25 out of every 100 born die before they are a year old. Most of these deaths are preventable. Thus, in a few American cities, the death rates have been so reduced that fewer than 10 babies out of every 100 die before completing the first year; while in Dunedin, New Zealand, as a result of the work of the Society for the Health of Women andChildren, the infant death rate has been so reduced that in 1912 only about 4 out of every 100 babies died before they were a year old.

While ignorant mothers, who may or may not be uneducated women, and contaminated milk, are as a matter of fact, chiefly responsible for our high infant death rates, yet as we have already seen, every factor in the environment has its effect upon a baby. This fact has led Sir Arthur Newsholme, an eminent English authority, to say:

"Infant Mortality is the most sensitive index we possess of social welfare. If babies were well born and well cared for, their mortality would be negligible. The infant death rate measures the intelligence, health, and right living of fathers and mothers, the standards of morals and sanitation of communities and governments, the efficiency of physicians, nurses, health officers, and educators."

Care of the child should begin at the earliest possible moment: that is, nearly nine months before he is born. Care before birth, for want of a better name, is called prenatal care of the mother. Every woman who thinks that she is pregnant should put herself at once under the care of a competent physician, so that he can make the necessary examinations as early as possible. If she follows his advice in regard to hygiene and proper regulation of her life, she may be free from anxiety,and may justly expect that her delivery will be a safe and normal process.

A demonstration of the value of prenatal care was recently made by the Boston District Nursing Association. During the year 1915 prenatal care was given to 751 expectant mothers in 5 wards of the city; each woman attended a pregnancy clinic, where she was under the care of an experienced obstetrician, and was visited at intervals by a nurse who kept careful watch of her general condition and gave necessary advice and encouragement. In consequence the death rate among the babies whose mothers had prenatal care was only half as great, through the whole first year of life, as the death rate of babies in the same wards whose mothers had not had prenatal care. Moreover, the rate of still-births was only half as great as the rate among the general population of Boston. If prenatal care can save so many lives, surely it ought to be available for every pregnant woman in the land, including even that generally neglected class of people who are neither very rich nor very poor.

Each baby's birth should be recorded by the registrar of births, and parents should make sure that registration has been attended to in the city or town where they live. In some states birth registration is already obligatory, but in any caseit is required by the child's own interest. For instance, in later life it may be necessary for him to prove the date and place of birth in order to establish, among other things, his right to vote and to inherit property, and to settle the question of his liability to military service. Moreover, complete and accurate birth registration is needed by every community because it is essential to such reforms as reducing infant mortality and abolishing child labor.

Statements in regard to growth and development are based on observations of many children. It should be remembered that the following figures represent averages only, and that healthy children may vary from them considerably without giving cause for alarm.

Average Size.—The average weight of a baby at birth is from 7 to 7½ lbs. and the average length is about 20 inches, but it is not unusual for a child to weigh anywhere from 5 to 10 pounds at birth and to measure from 16 to 22 inches in length. During the first week of life a baby loses slightly in weight. After the first week a healthy baby should gain from 4 to 8 ounces a week until he is six months old; after that time the weekly gain is less. The weight at birth will usually double during the first fivemonths, and treble during the first year. Consequently, a baby weighing 7 pounds at birth may be expected to weigh 14 pounds when five months old, and 21 pounds when a year old. Weight is one of the most important indications of a baby's condition. He should be weighed every week during the first 6 months, once in two weeks during the second 6 months, and once a month throughout the 2nd year.

—The average weight of a baby at birth is from 7 to 7½ lbs. and the average length is about 20 inches, but it is not unusual for a child to weigh anywhere from 5 to 10 pounds at birth and to measure from 16 to 22 inches in length. During the first week of life a baby loses slightly in weight. After the first week a healthy baby should gain from 4 to 8 ounces a week until he is six months old; after that time the weekly gain is less. The weight at birth will usually double during the first fivemonths, and treble during the first year. Consequently, a baby weighing 7 pounds at birth may be expected to weigh 14 pounds when five months old, and 21 pounds when a year old. Weight is one of the most important indications of a baby's condition. He should be weighed every week during the first 6 months, once in two weeks during the second 6 months, and once a month throughout the 2nd year.

Muscular Development.—A baby at birth is helpless, and during the first few months he has little muscular control. During the third month he ordinarily begins to lift his head, and he can usually hold it up without support by the time he is 3 months old; when 7 to 8 months old he sits erect and begins to play with toys. From this time a baby makes rapid progress; he attempts to stand on his feet, begins to creep, and by the time he is 14 months old he is usually able to stand alone, or even to walk a few steps. He is usually running about without difficulty when fifteen or sixteen months old.

—A baby at birth is helpless, and during the first few months he has little muscular control. During the third month he ordinarily begins to lift his head, and he can usually hold it up without support by the time he is 3 months old; when 7 to 8 months old he sits erect and begins to play with toys. From this time a baby makes rapid progress; he attempts to stand on his feet, begins to creep, and by the time he is 14 months old he is usually able to stand alone, or even to walk a few steps. He is usually running about without difficulty when fifteen or sixteen months old.

Babies should never be urged to walk or to bear their weight on their feet. If healthy they are generally eager to go about unaided, and like to investigate their surroundings without assistance. If walking is unusually delayed, a physician should be consulted.

Development of Special Senses.—A new-born baby is unable to distinguish objects, but the eyes are sensitive to light and need careful protection. Hearing, although undeveloped at birth, soon becomes acute; consequently the child should stay in a quiet room. When six or eight weeks old he notices objects, and at three months old he welcomes his mother when he is hungry. A month or two later he begins to distinguish between familiar and unfamiliar faces, and to show approval or disapproval.

—A new-born baby is unable to distinguish objects, but the eyes are sensitive to light and need careful protection. Hearing, although undeveloped at birth, soon becomes acute; consequently the child should stay in a quiet room. When six or eight weeks old he notices objects, and at three months old he welcomes his mother when he is hungry. A month or two later he begins to distinguish between familiar and unfamiliar faces, and to show approval or disapproval.

Development of Speech.—A baby six or seven months old begins consciously to utter sounds, and usually can say a few unconnected words by the time he is a year old. The average child, however, does not begin to form sentences of more than two or three words until he is about two years old.

—A baby six or seven months old begins consciously to utter sounds, and usually can say a few unconnected words by the time he is a year old. The average child, however, does not begin to form sentences of more than two or three words until he is about two years old.

Development of Teeth.—The so-called milk teeth are twenty in number; they are followed by thirty-two permanent teeth. The two lower front teeth (central incisors) generally appear when a child is from five to nine months old, and in from one to three months later the four upper front teeth (upper incisors) appear. All the first or milk teeth should have come through by the time a child is two and a half years old, but wide variations occur both in the time and order ofappearance and should occasion no uneasiness if the child seems well. Unusual conditions of any sort should be referred to the physician; it is a great mistake to attribute all illness at this time to teething.

—The so-called milk teeth are twenty in number; they are followed by thirty-two permanent teeth. The two lower front teeth (central incisors) generally appear when a child is from five to nine months old, and in from one to three months later the four upper front teeth (upper incisors) appear. All the first or milk teeth should have come through by the time a child is two and a half years old, but wide variations occur both in the time and order ofappearance and should occasion no uneasiness if the child seems well. Unusual conditions of any sort should be referred to the physician; it is a great mistake to attribute all illness at this time to teething.

The first of the permanent teeth appear when a child is about six years old. Mothers sometimes mistake the first permanent molars for temporary teeth, a mistake that frequently leads to neglect and even extraction of highly important teeth. All but the last four molars, sometimes called wisdom teeth, should be through by the time a child is fifteen. The wisdom teeth may not appear before the 20th or even the 25th year.

Normal Excretions.—A new-born baby should have one or two bowel movements during the first twenty-four hours; the first bowel movements are sticky and almost black in color. After the baby begins to nurse, three to four movements a day are not unusual, and throughout infancy and childhood as well as adult life there should be one or two evacuations of the bowels daily. The character of the stools is more important than the number. While the baby is taking milk only, the movements should be soft, yellow in color, and nearly odorless. Change in frequency of the movements, or appearance of undigested food or curds of milk in the stool, should be carefully notedand if continued, reported to a physician; they may be the first signs of serious digestive trouble.

—A new-born baby should have one or two bowel movements during the first twenty-four hours; the first bowel movements are sticky and almost black in color. After the baby begins to nurse, three to four movements a day are not unusual, and throughout infancy and childhood as well as adult life there should be one or two evacuations of the bowels daily. The character of the stools is more important than the number. While the baby is taking milk only, the movements should be soft, yellow in color, and nearly odorless. Change in frequency of the movements, or appearance of undigested food or curds of milk in the stool, should be carefully notedand if continued, reported to a physician; they may be the first signs of serious digestive trouble.

The urine of an infant should be odorless and colorless. It should be voided at least once during the first twenty-four hours, and much more frequently after the baby begins to nurse. Marked diminution in the amount of urine should be reported to a doctor.

Efforts should be made early to develop habits of regularity in the evacuation of the bladder and bowels. If taken up regularly most children learn to use a chamber for bowel movements by the time they are three months old. Normal children, if properly trained, usually have no bladder discharge during the night after they are 18 months old, and they learn even earlier to indicate a desire to urinate during the day time.

Clothing.—The amount and weight of a baby's clothing should depend upon the season; but garments worn next to the skin, except the diaper, should be wholly or partly of wool, the lightest weight in summer and heavier weight in winter. During the first few weeks a baby's abdomen should be supported by a flannel binder about six inches wide, applied snugly but not tightly enough to restrict either the abdomen or chest walls. It may be replaced later by a loosely fitting knitted band worn for warmth only. Sucha band is especially necessary if there is tendency to diarrhœa, but in no case should it be discarded before the 18th month. All garments except the diaper and first flannel binder should hang from the shoulders, and should fit loosely but well.

—The amount and weight of a baby's clothing should depend upon the season; but garments worn next to the skin, except the diaper, should be wholly or partly of wool, the lightest weight in summer and heavier weight in winter. During the first few weeks a baby's abdomen should be supported by a flannel binder about six inches wide, applied snugly but not tightly enough to restrict either the abdomen or chest walls. It may be replaced later by a loosely fitting knitted band worn for warmth only. Sucha band is especially necessary if there is tendency to diarrhœa, but in no case should it be discarded before the 18th month. All garments except the diaper and first flannel binder should hang from the shoulders, and should fit loosely but well.

Clothing for babies should be of soft materials and should be simply made. Even the first clothes should not be very long. The weight of very long clothing is an unnecessary burden, and prevents free movements of the legs. At night an entire change of clothing should be made, and a nightgown of warmer material substituted for the petticoat and slip. Most children are dressed too warmly indoors, but in low temperatures they need to be well protected.

Diapers should be soft and absorbent. It may be necessary to wash new diapers several times before using in order to make them soft enough. Care should be taken not to apply them too tightly, or in such a way as to cause pressure on the genitals. They should be changed during the day whenever wet or soiled, and at night when the baby is taken up to be fed. Proper care of diapers is highly important, however laborious. They should be well washed, boiled, and thoroughly dried before they are used a second time. Diapers that have been wet but not soiled should not be dried and used again before beingwashed. Much work can be saved if pads of loosely woven absorbent material are used inside the diaper to receive discharges. The pads can be burned, but even if washed the labor is less than washing full sized diapers. Like all other infant's garments, diapers should be washed with pure white soap and without starch. Waterproof material used to cover the diaper is almost sure to irritate the baby's skin, and is consequently harmful.

Sleep.—During his first few weeks a normal baby sleeps about nine-tenths of the time, and should be left undisturbed except for necessary care. He should sleep in a crib, bassinet or basket protected from light and drafts; in no circumstances should a baby sleep in the bed with his mother or any other person. Pillows are unnecessary for babies, and indeed for older children, but if used they should be thin and firm.

—During his first few weeks a normal baby sleeps about nine-tenths of the time, and should be left undisturbed except for necessary care. He should sleep in a crib, bassinet or basket protected from light and drafts; in no circumstances should a baby sleep in the bed with his mother or any other person. Pillows are unnecessary for babies, and indeed for older children, but if used they should be thin and firm.

The amount of sleep necessary gradually diminishes, but during all the years of growth a child needs more sleep than an adult. The amount of sleep required daily is approximately as follows:

After this time a child should sleep at least ten hours out of the twenty-four. During the first year a nap in the middle of the forenoon and another in the afternoon are desirable. A child who is inclined to sleep so long that his nap interferes with his night's sleep, should be waked from his nap, but at the same hour every day. When a child is a year old, one nap during the day is often sufficient, if he is doing well, but the habit of taking a nap at some time during the day should be continued through the fifth year if possible, or even later.

Babies should not be rocked or otherwise coaxed to go to sleep; they should be made comfortable and then left alone. They learn to go to sleep by themselves as soon as they are convinced that sleep is expected of them, and that no unfounded objections on their part will be regarded. Continued inability to sleep normally usually indicates discomfort or poor general condition, and should be taken up with the doctor. Pacifiers and thumb-sucking should not be allowed, since they lead to changes in the shape of the jaw with resulting imperfect adjustment of the teeth. Soothing syrup and like medicines should never be given to a baby; death or permanent injury has resulted from their use. It is impossible to emphasize too strongly the danger of giving them even a single time.

Fresh Air.—All that has been said about the importance of fresh air for adults applies with even greater force to infants and children. During his first month especially a baby is susceptible to draughts; nevertheless, the room should be well ventilated and its temperature kept between 68° and 70° F. during the day, and at about 65° F. at night. Even in cold weather the room should be well aired two or three times a day; the baby should be removed to another room while the windows are open. After the baby is three or four months old the windows may be left open at night provided the outside temperature does not fall below freezing. A healthy baby two or three weeks old may be taken out-of-doors for a short time in mild weather; when he is three months old he may be taken out-of-doors even in winter on bright sunny days. The time spent out-of-doors should be gradually increased until the baby stays out the greater part of the day; but he should not be exposed to storms, wind, flying dust, dampness, extremes of temperature, or insects. The eyes should not be covered by veils, but they should be shielded from the direct rays of the sun at all times.

—All that has been said about the importance of fresh air for adults applies with even greater force to infants and children. During his first month especially a baby is susceptible to draughts; nevertheless, the room should be well ventilated and its temperature kept between 68° and 70° F. during the day, and at about 65° F. at night. Even in cold weather the room should be well aired two or three times a day; the baby should be removed to another room while the windows are open. After the baby is three or four months old the windows may be left open at night provided the outside temperature does not fall below freezing. A healthy baby two or three weeks old may be taken out-of-doors for a short time in mild weather; when he is three months old he may be taken out-of-doors even in winter on bright sunny days. The time spent out-of-doors should be gradually increased until the baby stays out the greater part of the day; but he should not be exposed to storms, wind, flying dust, dampness, extremes of temperature, or insects. The eyes should not be covered by veils, but they should be shielded from the direct rays of the sun at all times.

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