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are listed at the end of the text.

[Illustration: Eugenics Hath Its Own Reward]

The Eugenic Marriage

A Personal Guide to the
New Science of Better
Living and Better Babies

By W. GRANT HAGUE, M.D.

College of Physicians and Surgeons (Columbia University), New York; Member
of County Medical Society, and of the American Medical Association

In Four Volumes

VOLUME I

New York

THE REVIEW OF REVIEWS COMPANY

1916

Copyright, 1913, by W. GRANT HAGUE

Copyright, 1914, by W. GRANT HAGUE

       *       *       *       *       *


                                                                        [i]
INDEX OF THE FOUR VOLUMES

NOTE--The Roman numerals I, II, III and IV indicate the volume; the Arabic
figures 1, 2, 3, etc., indicate the page number.

Accidents and emergencies, IV, 629.

Accouchement Beds, how to prepare, I, 65.

Acne, IV, 576.

Adenoids, IV, 519; how to tell when child has, IV, 520; treatment of, IV,
521.

Adentitis, acute, IV, 558; causes of, IV, 558; symptoms of, IV, 558;
treatment of, IV, 558.

Advice to young wives, III, 357.

After-birth, expulsion of, I, 101.

After-pains, I, 103.

Age at which to marry, III, 331.

Albumen water, II, 245.

Alcohol, in patent medicines, III, 455.

Alcoholic drunkenness, I, 44; Dr. Branthwaite on, I, 45; Dr. Sullivan on,
I, 44.

Amenorrhea, causes, II, 192; absence of menstruation, II, 191; treatment
of, II, 192.

Anemia, severe, IV, 567; simple, IV, 565; treatment of various forms, IV,
567.

Anesthetics, new, IV, 654; use of in confinements, I, 112.

Angina, IV, 508.

Anti-meningitis, serum, IV, 656.

Aperient waters, abuse of in constipation, III, 326.

Appendicitis, IV, 546; treatment of, IV, 546.

Appetite, loss of, II, 287; poor, II, 286; treatment for loss of, II, 288.

Arrest of hemorrhage, IV, 635.

Artificial Food, II, 249; formulæ for, II, 253; mistakes in preparing, II,
267.

Aseptic surgery, IV, 653.

Baby, amusing the, II, 217; bathing the, II, 213; care of eyes, II, 215;
care of genital organs, II, 216; care of mouth and teeth, II, 215; care of
newly-born, II, 210; care of skin, II, 216; clothing of, II, 214;
constipation in bottle-fed, II, 309; food for first year, II, 261; fresh
air for, II, 232; how it gets nourishment in womb, II, 183; how long it
should sleep, II, 236; how to weigh, II, 220; hygiene and development of,
II, 209; intervals of feeding, II, 225; night-clothes of, II, 215;
overfeeding the, II, 224; proper way to lay in bed, II, 235; what to
prepare for the coming, II, 209; why it cries, II, 237.

Baby's comforter, II, 241.

Bacteria, what happens if we inhale, III, 410.

Barley gruel, II, 244.

Barley water, II, 244, 256.

                                                                       [ii]
Bath, bran, IV, 591; cold, for reducing fever, IV, 590; cold sponge or
shower, IV, 592; during pregnancy, I, 76; hot air or vapor, IV, 591; hot,
IV, 591; mustard, IV, 590; tepid, IV, 592; various kinds of, IV, 590.

Bathing, the baby, II, 213.

Bed, proper way to lay baby in, II, 235.

Bed-wetting, IV, 580.

Beef juice, II, 262.

Beef or meat pulp, II, 244.

Bichloride of mercury solution, IV, 627.

Binder, how to apply, I, 66.

Birth, management of, I, 99.

Birth-chamber, the, I, 61.

Birth marks, I, 128.

Bites, dog, IV, 638.

Blackheads, IV, 576.

Blood, children suffering from poor, IV, 566; poor, IV, 565.

Boils, IV, 559.

Boracic Acid, solution of, IV, 626.

Bottle-feeding, method of, II, 256; what a mother should know about, II,
264.

Bowels, daily movement necessary, II, 307; how to wash out, IV, 586;
importance of clean, II, 306.

Boy, building of, II, 139; chancre, the, II, 145; gonorrhea or "clap," II,
142; sex-hygiene for, II, 139; social evil, II, 141; sources of immorality,
II, 141; syphilis or "pox," II, 144.

Brain, complications of in syphilis, II, 146.

Bran, as a food, II, 292; bath, IV, 591; muffins, recipe for, II, 311.

Branthwaite, Dr., on alcoholic drunkenness, I, 45.

Bread, II, 273.

Breasts, care of when weaning, I, 125; colostrum in, I, 108; how long
should baby stay at, II, 225; putting baby to after labor, I, 108.

Bronchitis, IV, 511; chronic, IV, 515; diet for, IV, 513; drugs in, IV,
514; external applications for, IV, 514; inhalations for, IV, 513; in older
children, IV, 512; symptoms of in infants, IV, 512; treatment of IV, 512.

Broncho-Pneumonia, acute, IV, 516; symptoms of, IV, 516; how to tell when
child has, IV, 517; treatment of child with, IV, 517.

Bruise, or contusion, IV, 633.

Burbank, Luther, on education, I, 24.

Burning Clothing, how to extinguish, IV, 641.

Burns, and scalds, IV, 641.

Calomel, II, 297; how to take, II, 297.

Cancer, in women, III, 442; what every woman should know about, III, 442.

Carron oil, solution of, IV, 627.

Castor oil, II, 295; how to give dose of, II, 296.

Catarrh, acute nasal, IV, 500; symptoms of, IV, 500.

Catarrh powders, III, 458.

Cathartics, calomel, II, 295; castor oil, II, 295; citrate of magnesia, II,
298; how to give children, II, 295.

Cereals, II, 273.

Chancre, the, II, 145.

Change of life, conduct during, III, 446; the menopause, III, 443; symptoms
of, III, 444.

Cheerful wife and mother, III, 400.

Chicken broth, II, 244.

                                                                      [iii]
Chicken-pox, IV, 606; symptoms of, IV, 607.

Child, the delicate, II, 281; diet of sick, II, 279; most helpless living
thing, II, 279; rate of growth of, II, 221; sick, should be in bed, II,
277; washing mouth and eyes after birth, I, 102.

Child-Birth, I, 61; fear of, I, 111.

Children, acute intestinal diseases of, IV, 529; constipation in, II, 303;
hysterical, II, 293; rheumatism in, IV, 569; temperature in, II, 217; with
whom milk does not agree, IV, 535.

Cholera infantum, IV, 540.

Chlorosis, IV, 566; symptoms of, IV, 566.

Chronic Nasal catarrh, IV, 503; treatment of, IV, 504.

Circumcision, should it be advised, II, 169.

Citrate of magnesia, II, 295; how to take, II, 298.

Clap, or gonorrhea, II, 142.

Clothing, baby's, II, 214.

Coddled egg, II, 245.

Cold-pack, IV, 589.

Colds, catching, IV, 497.

Colic, IV, 544; symptoms of, IV, 545; treatment of, IV, 545.

Colitis, chronic, IV, 538.

Colon, irrigation of, IV, 587.

Colostrum, uses of, I, 108.

Condensed milk feeding, II, 227; objections to, II, 257.

Confinement, choice of physician, I, 69; convalescing after, I, 131;
domestic problem following first, I, 131; how to calculate date of, I, 66;
how to prepare bed for, I, 65; lacerations during, I, 116; how long woman
should stay in bed after, I, 114; position and arrangement of bed for, I,
64; preparations for, I, 61; selection of a nurse, I, 70; use of
anesthetics in, I, 112; what to provide for, I, 62.

Confinement chamber, presence of friends in, I, 113; presence of relatives
in, I, 113.

Constipation, II, 315; abuse of cathartics and aperient waters, II, 326;
always harmful, II, 321; chief cause of, II, 315; cost of, II, 317;
diseases of women and, II, 320; during pregnancy, I, 84; in bottle-fed
infants, II, 309; in breast-fed infants, II, 308; in girls between 16 and
20, II, 321; in children over two years old, II, 309; in infants and
children, II, 303; lack of bulk in food, II, 326; lack of exercise and, II,
325; lack of water, II, 325; negligence of, II, 324; pregnancy and, II,
321; significance of, II, 305; social exigencies and, II, 319; treatment
of, II, 323; treatment of obstinate, II, 311.

Consumption cure, III, 461.

Consumptives, information for and those living with, III, 421.

Contagious diseases, IV, 599; conduct and dress of nurse for, IV, 600;
convalescence after, IV, 603; rules to be observed in treatment, IV, 599;
what isolation means, IV, 600.

Contusion, or bruise, IV, 633.

Convulsions, IV, 577; treatment of child with, IV, 579.

Cord, cutting, the, I, 102; dressing the, II, 210.

Cough, treatment of, IV, 505; nervous or persistent, IV, 504.

                                                                       [iv]
Cream, for constipation in infants, II, 309.

Croup, false, IV, 506; treatment of false, IV, 507; spasmodic, IV, 507;
treatment of spasmodic, IV, 507.

Deaf and dumb, I, 37.

Detention, symptoms of, II, 219; treatment of, II, 219.

Desserts, II, 273.

Diarrhoea, inflammatory, IV, 535; summer, IV, 539; symptoms of summer, IV,
540; treatment of inflammatory, IV, 537; treatment of summer, IV, 541.

Diet, of nursing mother, I, 121; of the pregnant woman, I, 77; of sick
child, II, 279; for constipated child, II, 310; older children, II, 271.

Dinner, the first after labor, I, 109.

Diphtheria, IV, 610; symptoms of, IV, 611; treatment of, IV, 613.

Disease, how we catch, III, 409; tendency to, III, 416; vice and, I, 4; of
womb, ovaries or fallopian tubes, II, 199.

Disinfecting, Clothing and linen, IV, 601; mouth and nose, IV, 602; sick
chamber, IV, 604.

Dislocations, IV, 640.

Dog-bites, IV, 638.

Douche, how to give after labor, I, 108; the use of when pregnant, I, 76.

Draw-sheet, the, I, 65.

Dried bread, II, 245.

Dusting and cleaning, II, 391.

Dysentery, cause of, IV, 535; symptoms of, IV, 536.

Dysmenorrhea, II, 193.

Ear, foreign bodies in, IV, 631; inflammation of, IV, 556; method of
removing foreign bodies, IV, 632; treatment of inflammation, IV, 556.

Earache, IV, 555.

Ears, do not box, IV, 554; do not pick, IV, 554; let them alone, IV, 554.

Eczema, IV, 562; of the face, IV, 563; rubrum, IV, 563.

Education, and the educator, I, 29; eugenics and, I, 4; Dr. C. W. Saleeby
on, I, 22; Dr. Helen C. Putnam on, I, 27; Havelock Ellis on, I, 33; Herbert
Spencer on, I, 35; Luther Burbank on, I, 24; Wm. D. Lewis on, I, 25; true
province of, I, 35; what place sex hygiene will find in, II, 162; Ella
Wheeler Wilcox on, I, 22.

Educational systems, difficulty in devising, I, 27; inadequate, I, 22.

Efficiency, requisites of, III, 346.

Egg, coddled, II, 245; white of, II, 262.

Ellis, Havelock, on Education, I, 33.

Emergencies and accidents, IV, 629.

Enema, High, IV, 588; hot, 586.

Enteritis, cause of, IV, 535; symptoms of, IV, 536.

Entero-colitis, IV, 535.

Enuresis, IV, 580.

Environment, I, 3.

Eruptions of the skin, II, 145.

Establishing toilet habits, II, 240.

Eugenic clubs, mother's, I, 54.

Eugenic idea, the, I, 9.

Eugenic principle, I, 10.

Eugenics, I, 12; definition of, I, 12; education and, I, 21; and history,
I, 5; husband and, I, 19; marriage and, I, 11; motherhood and, I, 16;   [v]
parenthood and, I, 15; the unfit and, I, 37; what every mother should know
about, I, 47.

Exercise enough for husband, III, 347; lack of and constipation, III, 347.

Eye, foreign bodies in, IV, 630; method of removing foreign bodies from,
IV, 631.

Fake medical treatment, for venereal diseases, II, 167.

Father and the boy, II, 163.

Fault-finding, III, 350.

Feeble-minded, the, I, 37; Dr. John Punton on, I, 42; Dr. Max Schlapp on,
I, 39; segregation and treatment of, I, 42.

Feeding, artificial, II, 249; artificial from birth to twelfth month, II,
254; the delicate child condition which will justify artificial, II, 266;
during second year formulæ for artificial, II, 253; how to prepare milk
mixtures, II, 259; intervals of, II, 225; overfeeding, II, 223; regularity
of, II, 227; what a mother should know about, II, 264; why regularity is
important, II, 228.

Felon, run-around, or whitlow, IV, 640; treatment of, IV, 641.

Female, beginning of, disease, III, 434; chief cause of diseases, III, 436;
diseases are avoidable, III, 439; generative organs, II, 178; weakness
cures, III, 470; what woman with disease should do, III, 441.

Fermentation, of the stomach, II, 304.

Fertility, conditions which affect women, II, 196.

Fever, cold packs for, IV, 589; cold sponging for reducing, IV, 589; ice
cap for reducing, IV, 589; methods of reducing, IV, 589.

Finger, biting the nails, IV, 585.

Fit, the, only shall be born, I, 10.

Fits, IV, 577.

Fly, dangerous house, IV, 645; to kill, IV, 648.

Fomentations, hot, IV, 593.

Food, allowable during first year, II, 261; bran as a, II, 292; formulæ for
baby, II, 243.

Foodstuffs, IV, 647.

Foreign bodies, in nose, IV, 632; in throat, IV, 633.

Formative period, the, III, 339.

Fraudulent testimonials, III, 467.

Friends, choosing your, III, 367; your husband's, III, 363.

Fruits, II, 273.

Garbage, IV, 647.

Gastric indigestion, acute, IV, 527; treatment of, IV, 527.

Gastro duodenitis, IV, 547.

Generative organs, female, II, 178.

Genital organs, care of, II, 26.

Girl, what a mother should tell her little, II, 173.

Glands, swollen, IV, 558; treatment of swollen, IV, 558.

Gleet, II, 143

Gonorrhea, symptoms of in a man, II, 142; wife infected with, II, 147.

Good health, requirements of, II, 316.

Government investigation of patent medicines, IV, 486.

                                                                       [vi]
Habits, of delicate child, II, 285.

Hair, falls out in syphilis, II, 146.

Headache, IV, 585; during pregnancy, I, 83; remedies, III, 457; treatment
of, IV, 585.

Heartburn, during pregnancy, I, 84.

Hemorrhage, arrest of, IV, 635; nasal, IV, 522.

Heredity, I, 3; and eugenics, I, 16; function of education, I, 32.

Hiccough, IV, 523.

High School, system fallacious, I, 29.

Hives, IV, 559; cause of, IV, 559; treatment of, IV, 559.

Home, good housekeeper, III, 389; owning a, III, 400; the ideal, III, 393;
what makes the, III, 394.

Honeymoon, the, III, 335; marital relations during, III, 336.

Hot pack, IV, 589.

Housefly, dangerous, IV, 645.

Housekeeper, what constitutes an efficient, III, 390.

Husband, and home, III, 404; is he to blame, II, 151; the, and eugenics, I,
19.

Hysterics, and children, II, 293; treatment of, II, 294.

Ice-cap, for reducing fever, IV, 589.

Ileo-colitis, chronic, IV, 538; treatment of, IV, 539.

Imperial Granum, II, 245.

Incontinence, IV, 580.

Indigestion, acute gastric, IV, 527; acute intestinal, IV, 532; symptoms of
acute intestinal, IV, 532; treatment of acute gastric, IV, 527; treatment
of acute intestinal, IV, 533.

Infants, constipation in bottle-fed, II, 309; jaundice in, IV, 547;
mortality of, I, 2; records of, II, 222.

Infection, direct, IV, 499.

Infectious diseases, IV, 599.

Inflammatory diarrhea, IV, 535.

Influenza, IV, 608; symptoms of, IV, 608; treatment of, IV, 609.

Injections, oil, II, 312.

Insane, care of, I, 43.

Insomnia, during pregnancy, I, 86.

Interior organs, complications of in syphilis, II, 146.

Intermittent fever, IV, 571.

Intestinal diseases of children, IV, 529.

Intestinal Indigestion, acute, IV, 532; symptoms of acute, IV, 532;
treatment of, IV, 533.

Intestinal worms, IV, 548.

Jaundice, catarrhal, IV, 547; in infants, IV, 546; in older children, IV,
547.

Junket, II, 244.

Kelly pad, the, I, 65.

Knowledge, two ways of gaining, III, 377.

Labor, after-pains, I, 103; beginning of, I, 95; clothing during, I, 95;
conduct during second stage of, I, 96; conduct immediately following, I,
103; douching after, I, 107; first breakfast after, I, 105; first dinner
after, I, 109; first lunch after, I, 109; first stage of, I, 96; importance
of emptying bladder after, I, 106; the Lochia, or discharge after, I, 104;
management of, I, 93; putting baby to breast after, I, 108; second stage
of, I, 96.

Lacerations during confinement, I, 116.

                                                                      [vii]
La Grippe, IV, 608; treatment of, IV, 609.

Laryngitis, acute catarrhal, IV, 506; treatment of, IV, 507.

Leucorrhea, cause of sterility, II, 201; in girls, II, 190.

Lewis, Wm. D., on education, I, 25.

Life and insurance, III, 400.

Lithia water, III, 458.

Lochia, or discharge after labor, I, 104.

Lunch, the first after labor, I, 109.

Malaria, intermittent fever, IV, 571; serum for, IV, 656; treatment of, IV,
571.

Malformation, II, 201.

Man, building a, II, 151.

Marital relations, when they are painful, III, 337; when they should be
suspended, III, 337.

Marriage, and motherhood, I, 2; best age for, III, 331; certificate and
vice, I, 15; certificate, utility of, I, 13; evils of early, III, 333;
failures in, I, 2.

Mastitis, in infancy, IV, 553; in young girls, IV, 554.

Masturbation, or self-abuse, II, 157.

Meats, medical essentials of good, III, 393; preparation and selection of,
III, 390.

Measles, IV, 616; complications in, IV, 618; Koplik's spots in, IV, 617;
rules of department of health, IV, 619; symptoms of, IV, 616; treatment of,
IV, 618.

Medical, letter brokers, III, 482; reliable advice, III, 486.

Medicine chest, contents of family, IV, 629.

Medicine concern run by women, III, 475.

Menstruation, II, 187; irregular, II, 187; painful, II, 193; should not be
accompanied with pain, II, 189; symptoms of, II, 189; treatment for
painful, II, 194; why it occurs every 28 days, II, 180.

Milk, children with whom it does not agree, IV, 535; difference between
human and cows, II, 252; mixture, how to prepare, II, 259; peptonized, II,
262.

Mind, training the, III, 360.

Miscarriage, II, 202; after treatment of, II, 205; causes of, II, 203;
course and symptoms of, II, 204; what to do when threatened with, II, 204;
tendency to, II, 206; womb displacement in, II, 198.

Mosquitoes, regarding, IV, 572; rules of Department of Health, IV, 574.

Mother, the cheerful, III, 400; education of the, II, 277; existence of the
average, III, 437; what she should know about eugenics, I, 47; what she
should tell her little girl, II, 173; what she should tell her daughter,
II, 173.

Motherhood, eugenics and, I, 16; function of, I, 17; preparing for, II,
187.

Mothers, eugenic clubs, I, 54; girls must not become, II, 184.

Moths, IV, 648.

Mouth, how to disinfect, IV, 601; sore, IV, 523; treatment for ulcers in,
IV, 525; treatment of sore, IV, 524.

Mucous patches, and ulcers, II, 145.

Mumps, IV, 605; symptoms of, IV, 605.

Mustard bath, IV, 590.

Mustard paste, how to make, IV, 593.

                                                                     [viii]
Mustard pack, how to prepare and use, IV, 594.

Mutton Broth, II, 244.

Napkins, sanitary, I, 66.

Nasal discharge, chronic, IV, 502.

Nausea, during pregnancy, I, 80.

Nettle-rash, IV, 559; cause of, IV, 559; treatment of, IV, 559.

Night losses, or "wet dreams," II, 158.

Nightmare or night terrors, IV, 583; treatment of, IV, 581.

Nipples, care of, I, 121; cracked, I, 122; tender, I, 122; treatment of
cracked, I, 122; what mother should know about bottle and, II, 264.

Normal salt, solution of, IV, 627.

Nose, chronic discharge of, IV, 503; complications of in syphilis, II, 146;
foreign bodies in, IV, 632.

Nose-bleeds, IV, 522.

Nosophobia, or the dread of disease, III, 380.

Nursery maid, qualifications of, I, 129.

Nursing mothers, I, 121; diet of, I, 121; mastitis in, I, 122; nervous, I,
126.

Oatmeal water, for constipation in infants, II, 309.

Oat-water, II, 244.

Obstetrical outfits, ready to purchase, I, 63.

Oil injections, II, 312.

Oiled silk, IV, 594; what it is and why it is used, IV, 594.

Orange juice, II, 262; for constipation in infants, II, 309.

Organs, transplanting from dead to living, IV, 655.

Otitis, acute, IV, 556.

Ovaries, disease of, II, 199; function of, II, 179.

Overeating, II, 289; III, 327; symptoms of, II, 290.

Overfeeding the baby, II, 223.

Parents, and the Boy, II, 153; a word to, II, 161; eugenics and, I, 15.

Parotitis, epidemic, IV, 605.

Patent Medicines, and education, III, 493; and eugenics, III, 494; and the
newspaper, III, 484; conspiracy against freedom of press, III, 483; dangers
of, III, 489; fraudulent testimonials, III, 467; intoxicating effects of,
III, 453; government investigation of, III, 486; pure food and drug act,
III, 452, 490.

Patent Medicine Evil, III, 451, 489; and the duty of mothers III, 489; what
mothers should know about the, III, 451.

People, two kinds of, III, 363.

Peptonized milk, II, 262.

Physicians, what they are doing, IV, 649.

Pimples, IV, 576.

Pneumonia, IV, 516.

Poultices, IV, 593.

Pox, or syphilis, II, 144.

Precautions to be observed, IV, 647.

Pregnancy, avoidance of drugs during, I, 90; clothing during, I, 77;
constipation during, I, 84; headache during, I, 83; heartburn during, I,
84; hygiene of, I, 75; insomnia during, I, 86; minor ailments of, I, 76;
morning nausea, I, 80; sexual intercourse during, I, 76; social side of, I,
79; undue nervousness during, I, 82; vagaries of, I, 90; vaginal discharge,
I, 88; varicose veins, cramps and neuralgia during, I, 85.

                                                                       [ix]
Pregnant, few ailing women become, III, 435; conduct of woman, I, 75; diet
of woman, I, 77; mental state of woman, I, 78; when woman should first call
upon physician, I, 68.

Prickly Heat, IV, 560; treatment of, IV, 560.

Principle, differences of, III, 344.

Privy Vaults, IV, 647.

Procreative Function, abuse of, II, 153; III, 440.

Procreative Power, period of, II, 155.

Puberty, age of, II, 179; period of in the female, II, 178.

Pulse, rate in children and adults, II, 221.

Punton, Dr. John, on feeble-minded, I, 42.

Pure Food and Drug Act, III, 452, 490.

Putnam, Dr. Helen C., on education, I, 27.

Quacks, how they dispose of confidential letters, III, 481.

Quarrel, the first, III, 349.

Quinsy, IV, 523.

Race Culture, I, II.

Radium, IV, 652.

Rashes, of childhood, IV, 574; other, IV, 575; treatment of, IV, 576.

Records, Infant, II, 222.

Rectal Irrigations, to reduce fever, IV, 590.

Reproductive Organs, changes in, II, 178; function of the, II, 179.

Resolves, making, III, 371.

Rest and recreation, III, 398.

Rest and sleep, III, 347.

Rheumatism, in children, IV, 569; treatment of acute attack, IV, 570;
treatment of tendency to, IV, 570.

Rhinitis, chronic, IV, 503.

Rice water, II, 244.

Ringworm, of the scalp, IV, 561.

Rubbers, practice of wearing needs consideration, IV, 498.

Run-around, or felon, IV, 640; treatment of, IV, 641.

Rupture, IV, 551.

Saleeby, Dr. C.W., on education, I, 22.

Sanitary napkins, how to prepare, I, 66.

Santonin, for worms, IV, 549.

Scalds and burns, IV, 641.

Scalp, ringworm of, IV, 561; wounds of, IV, 640.

Scarlet Fever, IV, 620; complications in, IV, 621; eruptions, IV, 621;
measures to prevent spread of, IV, 621; treatment of, IV, 622.

Scarlatina, IV, 620.

Scientific Dressing, III, 427.

Schlapp, Dr. Max, on the feeble-minded, I, 39.

Self-abuse or Masturbation, II, 155.

Self-culture, young wife's incentive to, III, 379.

Serum, Anti-meningitis, IV, 656; for malaria, IV, 656.

Sexual excesses, II, 159; treatment of, II, 160.

Sexual intercourse, during pregnancy, I, 76.

Shock, the condition of, IV, 637.

Sitz bath, during pregnancy, I, 87.

"606," IV, 655.

Skin, care of, II, 216; care of in contagious diseases, IV, 602; eruptions
of, II, 145.

Sleeplessness, causes of, IV, 583; treatment of, IV, 583.

Social Evil, what parents should know about, II, 161.

Solutions, normal salt, IV, 627; various, IV, 626.

Soothing syrup, III, 458.

Sore Mouth, IV, 523; treatment of, IV, 524.

                                                                        [x]
Sore throat, IV, 508.

Sowing wild oats, II, 167.

Spasms, IV, 577.

Spencer, Herbert, on education, I, 35.

Spermatozoa, functions of the, II, 181; the male, or papa egg, II, 181.

Sprains, IV, 639.

Sprue, IV, 525; treatment of, IV, 525.

Stables, IV, 646.

Sterility, II, 195; causes of, in women, II, 198.

Sterilizing, food for day's feeding, II, 260.

Stomach, diseases of, IV, 527; fermentation of, II, 304; function of the,
II, 304.

Stomach bitters, alcohol in, III, 455.

Stomatitis, IV, 523.

Story, Dr. Thomas A., on education, I, 26.

Study habit, the, III, 374.

Sullivan, Dr., on alcoholic drunkenness, I, 44.

Success, attainment of, III, 345; formula of, III, 373.

Summer Diarrhea, IV, 539; symptoms of, IV, 540; treatment of, IV, 541.

Summer diseases of intestines, IV, 529.

Surgery, aseptic, IV, 653.

Syphilis, or the "pox," II, 144.

Tape worms, IV, 551.

Teeth, care of the, II, 219; how they come, II, 218.

Temperature, in children, II, 217.

Thiersch's solution, IV, 627.

Thought, bad habits of, III, 360; what is a, III, 359.

Thread worm, IV, 549.

Throat, foreign bodies in, IV, 633; sore, IV, 508.

Thrush, IV, 525; treatment of, IV, 525.

Thumb-sucking, IV, 585.

Tonsilitis: Angina, "sore throat," IV, 508; treatment of acute, IV, 510.

Transplanting organs of dead to living, IV, 655.

Tuberculosis, best treatment for, III, 418; facts about, III, 414.

Turpentine stupe, the, IV, 594.

Typhoid, how to keep from spreading, IV, 625; how to prevent getting, IV,
624; symptoms of, IV, 623; vaccine in, IV, 654.

Ulcers, in mouth, IV, 525; mucous patches and, II, 144.

Vacant lots, IV, 647.

Vaccination, method of, II, 299; symptoms of successful, II, 299; time for,
II, 299; treatment, II, 300.

Vaccine in typhoid fever, IV, 654.

Vapor bath, IV, 591.

Varicella, IV, 606.

Varicose veins, during pregnancy, I, 85.

Vegetables, II, 272.

Venereal Diseases, fake medical treatment for, II, 167; ten million victims
of, I, 11.

Vomiting, of children between feedings, II, 226; significance of after
feeding, II, 230.

Washing dishes, III, 391.

Water, drink plenty of, III, 429.

Weaning, I, 123; care of breasts when, I, 125; menstruation and, I, 124;
methods of, I, 123; rapid, when it is necessary, I, 124; when to start, I,
124.

Wedding night, its medical aspect, III, 334.

What to eat and wear in hot weather, III, 426.

When delays are dangerous, III, 423.

Whey, II, 244.

Whitlow, or felon, IV, 640.

                                                                       [xi]
Whooping Cough, IV, 613; symptoms of, IV, 614; treatment of, IV, 615.

Wife, her part, III, 353; the cheerful, III, 400; the indifferent, III,
401; what she owes to herself, III, 357.

Wifehood, first weeks and months of, III, 336.

Wilcox, Ella Wheeler, on education, I, 23.

Womb, function of, II, 180; how baby gets nourishment in, II, 183; how held
in place, II, 189.

Women, ailing, are inefficient, III, 434; diseases of, III, 433; who don't
want children, III, 439; medicine concern run by, III, 475; most popular,
III, 365; use of patent medicines in diseases, III, 473.

Work, must be interesting, III, 351.

Working for something, III, 395.

Worms, intestinal, IV, 548; round, IV, 548; symptoms of tape, IV, 551;
symptoms of thread, IV, 549; tape, IV, 551; thread, IV, 549; treatment of
round, IV, 549.

Worry, freedom from, III, 348.

Wound, cleaning a, IV, 637; closing and dressing a, IV, 637; removal of
foreign bodies from, IV, 636.

Wounds, IV, 634; of the scalp, IV, 640.

X-Ray, treatment and diagnosis, IV, 652.

       *       *       *       *       *


VOLUME I

       *       *       *       *       *


                                                                       [xv]
TABLE OF CONTENTS

EUGENICS. RACE CULTURE

CHAPTER I

CONDITIONS WHICH HAVE EVOLVED THE SCIENCE OF EUGENICS

Infant mortality--Marriage and
motherhood--Heredity--Environment--Education--Disease and
vice--History--Summary ... PAGE 1

CHAPTER II

THE EUGENIC IDEA

The value of human life--The eugenic principle--"The fit only shall
live"--Eugenics and marriage--The venereal diseases--The utility of
marriage certificates--The marriage certificates and vice--Eugenics and
parenthood--The principle of heredity--Eugenics and motherhood--Eugenics
and the husband ... PAGE 9

CHAPTER III

EUGENICS AND EDUCATION

The present educational system is inadequate--Opinions of Dr. C.W. Saleeby,
Ella Wheeler Wilcox, Luther Burbank, William D. Lewis, Elizabeth Atwood,
Dr. Thomas A. Story, William C. White, Dr. Helen C. Putnam--Difficulty in
devising a satisfactory educational system--Education an important
function--The function of the high school--The high school system
fallacious--The true function of education ... PAGE 21

CHAPTER IV

EUGENICS AND THE UNFIT

The deaf and dumb--The feeble-minded--A New York magistrate's
report--Report of the Children's Society--The segregation and treatment of
the feeble-minded--What the care of the insane costs--The
alcoholic--Drunkenness ... PAGE 37

CHAPTER V

WHAT EVERY MOTHER SHOULD KNOW ABOUT EUGENICS

PAGE 47

                                                                      [xvi]
CHILD-BIRTH

CHAPTER VI

PREPARATIONS FOR THE CONFINEMENT

The birth chamber--What to provide for a confinement--Ready to purchase
obstetrical outfits--Position and arrangement of the bed--How to properly
prepare the accouchement bed--The Kelly pad--The advantages of the Kelly
pad--Should a binder be used--Sanitary napkins--How to calculate the
probable date of the confinement--Obstetrical table--When should a pregnant
woman first call upon her physician--Regarding the choice of a
physician--How to know the right kind of a physician for a confinement--The
selection of a nurse--The difference between a trained and a maternity
nurse--Duties of a confinement nurse--The requisites of a good confinement
nurse--The personal rights of a confinement nurse--Criticizing and
gossiping about physicians ... PAGE 61

CHAPTER VII

THE HYGIENE OF PREGNANCY

Daily conduct of the pregnant woman--Instructions regarding household
work--Instructions regarding washing and sweeping--Instructions regarding
exercise--Instructions regarding passive exercise--Instructions regarding
toilet privileges--Instructions regarding bathing--Instructions regarding
sexual intercourse--Clothing during pregnancy--Diet of pregnant
women--Alcoholic drinks during pregnancy--The mental state of the pregnant
woman--The social side of pregnancy--Minor ailments of pregnancy--Morning
nausea, or sickness--Treatment of morning nausea, or sickness--Nausea
occurring at the end of pregnancy--Undue nervousness during pregnancy--The
100% baby--Headache--Acidity of the stomach, or
heartburn--Constipation--Varicose veins, cramps,
neuralgias--Insomnia--Treatment of insomnia--Ptyalism, or excessive flow of
saliva--Vaginal discharge, or leucorrhea--Importance of testing urine
during pregnancy--Attention to nipples and breasts--The vagaries of
pregnancy--Contact with infectious diseases--Avoidance of drugs--The danger
signals of pregnancy ... PAGE 75

CHAPTER VIII

THE MANAGEMENT OF LABOR

When to send for the physician in confinement cases--The preparation of the
patient--The beginning of labor--The first pains--The meaning of the term
"labor"--Length of the first stage of labor--What the first stage of [xvii]
labor means--What the second stage of labor means--Length of the second
stage--Duration of the first confinement--Duration of subsequent
confinements--Conduct of patient during second stage of labor--What a labor
pain means--How a willful woman can prolong labor--Management of actual
birth of child--Position of woman during birth of child--Duty of nurse
immediately following birth of child--Expulsion of after-birth--How to
expel after-birth--Cutting the cord--Washing the baby's eyes immediately
after birth--What to do with baby immediately after birth--Conduct
immediately after labor--After pains--Rest and quiet after labor--Position
of patient after labor--The Lochia--The events of the following day--The
first breakfast after confinement--The importance of emptying the bladder
after labor--How to effect a movement of the bowels after
labor--Instructing the nurse in details--Douching after labor--How to give
a douche--"Colostrum," its uses--Advantages of putting baby to breast early
after labor--The first lunch--The first dinner--Diet after third day ...
PAGE 93

CHAPTER IX

CONFINEMENT INCIDENTS

Regarding the dread and fear of childbirth--The woman who dreads
childbirth--Regarding the use of anesthetics in confinements--The presence
of friends and relatives in the confinement chamber--How long should a
woman stay in bed after confinement--Why do physicians permit women to get
out of bed before the womb is back in its proper place?--Lacerations, their
meaning, and their significance--The advantage of an examination six weeks
after the confinement--The physician who does not tell all of the truth ...
PAGE 111

CHAPTER X

NURSING MOTHERS

The diet of nursing mothers--Care of the nipples--Cracked nipples--Tender
nipples--Mastitis in nursing mothers--Inflammation of the breasts--When
should a child be weaned?--Method of weaning--Nursing while
menstruating--Care of breasts while weaning child--Nervous nursing
mothers--Birthmarks--Qualifications of a nursery maid ... PAGE 121

CHAPTER XI

CONVALESCING AFTER CONFINEMENT

The second critical period in the young wife's life--The domestic problem
following the first confinement ... PAGE 131

       *       *       *       *       *


                                                                      [xix]
INTRODUCTION

Despite the fact that much has been written during the past two or three
years with reference to Eugenics, it is quite evident to any one interested
in the subject that the average intelligent individual knows very little
about it so far as its scope and intent are concerned. This is not to be
wondered at, for the subject has not been presented to the ordinary reader
in a form that would tend to encourage inquiry or honest investigation. The
critic and the wit have deliberately misinterpreted its principles, and
have almost succeeded in masking its supreme function in the garb of folly.

The writer has yet to meet a conscientious mother who fails to evince a
reasonable degree of enthusiastic interest in eugenics when properly
informed of its fundamental principles.

The eugenic ideal is a worthy race--a race of men and women physically and
mentally capable of self-support. The eugenist, therefore, demands that
every child born shall be a worthy child--a child born of healthy, selected
parents.

No one can successfully assail the ethics of this appeal. It is morally a
just contention to strive for a healthy race. It is also an economic
necessity as we shall see.

The history of the world informs us that there have been many civilizations
which, in some respects, equalled our own. These races of people have all
achieved a certain success, and have then passed entirely out of existence.
Why? _And are we destined to extinction in the same way?_ We know that the
cause of the decline and ultimate extinction of all past civilizations was
due primarily to the moral decadence of their people. Disease and vice
gradually sapped their vitality, and their continuance was impossible. [xx]
It would seem to be the destiny of a race to achieve material prosperity at
the expense of its morality. When conditions render possible the fulfilment
of every human desire, the race exhausts its vitality in a surfeitment of
caprice. The animal instincts predominate, and the potential vigor of the
people is exhausted in contributing to its own amusement. Each succeeding
civilization has reached this epochal period, and has fallen, victim of the
rapacity of stronger and younger invading antagonists, _themselves to
succumb to the same insidious process_.

The present civilization has reached this epochal--this transition--period.
In one hundred years from now we shall either have accomplished what no
previous civilization accomplished, or we shall have ceased to exist as a
race. Our success depends on the response of the people to the eugenic
appeal. Few appreciate the responsibility involved.

It is not necessary, however, to combat or deplore the evils of the past.
Civilization has failed in the task of race-maintenance; it failed,
however, in ignorance. We cannot plead the same excuse. We are face to face
with conditions that we must solve quickly or our destiny will be decreed
before we apply the remedy.

A function of the eugenist is to gather and attest statistics, and to
establish conclusions based on these statistics. It has been conclusively
demonstrated that, if the race continues to progress as it exists now--that
is, if conditions remain the same, and our standard of enlightenment, so
far as racial evolution is concerned, does not prompt us to adopt new
constructive measures--_every second child born in this country, in fifty
years, will be unfit; and, in one hundred years, the American race will
have ceased to exist_. We mean by this that every second child born will be
born to die in infancy, or, if it lives, will be incapable of self-support
during its life, because either of mental degeneracy or physical
inefficiency. This appalling situation immediately becomes a problem of
civilization. No state can exist under these conditions. If these
statistics are reliable--and we know they are true and capable of
verification by any individual who will go to the trouble of          [xxi]
investigating them--it is self-evident that a radical change must
immediately be instituted to obviate the logical consequences that must
follow as a sequence. The eugenic demand, that "every child born shall be a
worthy child," is, therefore, the solution of the problem.

This does not imply, however, that the eugenist must solve the elementary
problem of how the state will ensure its own salvation by guaranteeing
worthy children. Worthy children can come only from fit and worthy (clean
and healthy) parents. It becomes the imperative function of the state--the
function on which the very life of the state depends--to see that every
applicant for marriage is possessed of the qualities that will ensure
healthy, worthy children. We must, therefore, sooner or later devise a
system of scientific regulation of marriage, and it is at this point we
stumble against the problem that has prompted the ebullitions of the wit
and the sarcasm of the critic. A casual reference to the science
immediately suggests to the layman an impossible or quixotic system of
marriage by force. Even the word "eugenics" is associated in the minds of
many otherwise estimable old ladies, and others who should know better,
with a species of malodorous free love, and their hands go up in holy
horror at the intimation of a scientific regulation of this ancient
function.

Unfortunately, the popular mind has received the impression that this
incident constitutes the sum total of the eugenic idea, while the truth is
that the eugenist is only slightly concerned with its modus operandi. This
feature has been so magnified by widely published disingenuous discussion
that it has assumed the aspect of a test problem, a judgment on which shall
decide the utility of the science itself. Should this decision be
unfavorable, it would seem, according to its exponents, that it would not
be worth while promulgating the doctrines of the science beyond this point.
It is as though we were asked to deny ourselves the inspiration and
pleasure of a trip abroad because the morning of the day on which the ship
sailed happened to be cloudy.

It is certainly no part of the function of the eugenist to uproot    [xxii]
instinct, or to trample into the dust age-long rights, though the instinct
is simply the product of an established habit, based on an erroneous
hypothesis, and the so-called rights simply acquired privileges, because
the intelligence that would have builded differently was not awakened.
Eugenic necessity will render imperative the state's solution of this
fundamental problem, for the reason that civilization will be driven to
demand its just inheritance--the right to exist. The eugenist will not be
compelled to open the door; it will be opened for him. We can afford,
therefore, to wait with supreme confidence, because the good sense of the
people will not always submit to the tactics of the jester when it needs a
saviour.

The eugenist does not seek to interfere with the liberties of the rising
generation: a boy may choose whom he will; the girl may select the one who
appeals to her most, and they may enjoy all the vested rights and romance
that custom has decreed the lover; but, when they resolve to marry, _the
state must decide their qualifications for parenthood_. This must be the
crucial test of the future. The life of the state depends on it. The
continuance of the race must be the supreme object of all future
constructive legislation. We must recognize that "life is the only wealth,"
and that every other criterion of an advanced civilization must measure its
success according to its wealth in worthy parenthood.

The eugenist does not even dictate what the test for parenthood shall be.
Common sense, however, suggests that it will assume some form that will
eliminate those physically or mentally diseased. He believes that, when the
people are sufficiently educated to appreciate the object in view, they
will devise a system that will meet with universal approval.

Eugenics concerns itself with problems on which the destiny of the race
depends. It must not, therefore, be limited to questions relative to mating
and breeding. Every factor that contributes to the well-being and uplifting
of the race, every subject that bespeaks physical or mental regeneration,
that aids moral and social righteousness and salvation, and promises a
greater social happiness and contentment, has a eugenic             [xxiii]
significance. So long as there exists an unsupported mother or a suffering
child; so long as we rely on hospitals and prisons, penitentiaries and the
police, to minister to the correction and regeneration of the unfit and
degenerate; so long as we tolerate grafting politicians and deprive the
poor of breathing spaces, sanitary appliances, and a hygienic environment;
so long as war and pestilence deprive posterity of the best of the race for
parenthood; so long as we emphasize rescue rather than prevention, so long
must the eugenist strive unceasingly to preach his propaganda of race
regeneration.

The scope of eugenics is too far-reaching in its beneficent purpose to be
fettered by the querulous triflings of the ancient or intellectual prude;
nor should it be belittled by the superficial insight of the habitual
scoffer. It is not a fantasy nor an idle dream. It is not even an
inspiration. The destiny of the race has brought us face to face with
conditions unparalleled in the history of this civilization, and the very
existence of the race itself may be wholly dependent on the foresight of
the minds that have made the science of eugenics possible.

A brief consideration of the conditions that actually exist, with which we
are face to face, and which certainly justify the existence of a science
whose function it should be to demand serious investigation of methods of
race regeneration, may help the reader to an intelligent and practical
understanding of the tremendous importance of the subject.

It has been already remarked that, at the present rate of decrease, the
birth-rate will be reduced to zero within a century. If the birth-rates in
England, Germany, and France should continue to decrease as they have since
1880, there would be no children born, one hundred years hence, in these
countries. While we do not assert, and probably none of us believes that
either or all of these nations will actually be out of existence in a
hundred years--unquestionably because we feel, at least we hope, that our
methods will be so changed in that time that the necessary modification
will ensure a continuance of the race, nevertheless, the fact remains that
_the inevitable result of continuing along present lines will be     [xxiv]
that, within the period of one hundred years, these peoples will cease to
perpetuate themselves_.

It is not necessary to enquire closely into the various causes for this
unparalleled situation. The falling birth-rate in itself is not the prime
cause. Even admitting that there are enough babies born, too many of them
are born only to die in infancy. We need no further proof of the urgent
need for conscientious inquiry, call it by what name you please. The
science of common sense is all-sufficient. The seemingly intelligent
individual who can only find material for ribaldry in this connection is a
more serious buffoon than he imagines. It is apparent that our methods are
wrong. Any constructive effort to correct them is commendable. When it is
stated that 20 per cent. of the American women are unable to bear children,
and that 25 per cent. of all the others are unwilling to assume the burden
and responsibility of motherhood, we partly realize the gravity of the
case.

On the other hand, statistics show that the majority of men have acquired
disease before they marry, and that a very large percentage of these men
convey contagion to their wives. This condition, to a very large extent,
accounts for the inefficiency of women as mothers. It is responsible for at
least 75 per cent. of the sterility that exists. The effect of this
deplorable condition is directly responsible, also, for the ill health that
afflicts women and that renders necessary the daily operations of a serious
nature that are conducted in every hospital in every city in the civilized
world. As a result of the dissemination of this poison, children are born
blind, or are born to die, or, if they live, they are compelled to carry
all through their helpless lives the stigma of disease and degeneration. It
would surely seem that the individual to whom God has given intelligence
and a conscience cannot think of these, the saddest facts in human
experience, without resentment and humility. _Surely the time has arrived
when every boy should know, from his earliest youth, that there is here on
earth an actual punishment for vicious living as frightful as any that the
mind of man can conceive._ [Page xxv]

When we inquire into the cause of this trend toward race degeneracy, we
find that poverty and the inability of the workingman to support large
families, luxurious living, and the life of ease and amusement on the part
of the women of wealth; the fact that an increasingly large number of women
have entered professions that prevent motherhood, and that the number of
apartment-houses where children are not wanted are on the increase, all
play their part. In this age of intense living, it is not to be wondered at
that many shrink from the responsibility of rearing children, and the same
conditions that contribute to this decadent ideal intensifies sex-hunger,
and it is this dominating passion that tolerates and makes possible the
most frightful crime of the age--infanticide. Greece and Rome paved the way
for their ultimate annihilation when their beautiful women ceased to bear
children and their men sought the companionship of courtesans.

Baby contests have demonstrated that only one child in ten was found to be
good enough to justify a second examination. In a test examination in the
public schools, only eight in five thousand were competent to qualify in
all the tests. One of these eight was a Chinese boy and another an
American-born son of a native Greek. Of the twenty million school-children
in the United States, not less than 75 per cent. need immediate attention
for physical defects.

While man has been assiduously improving everything else, he has neglected
to better his own condition. Every animal that man has taken from its
native haunts and domesticated, he has efficiently improved. He has even
produced more marvelous results by the application of the same principles
to the vegetable kingdom. In his haste to civilize himself, however, he has
failed to apply the principles that are essential to self-preservation. It
is regrettable, also, to know that, while the government has spent many
thousands of dollars in sending out literature to the farmers, instructing
them how to raise profitable crops and to breed prize horses and pigs,
absolutely none of the public money has been used in instructing American
mothers how to raise healthy children. [Page xxvi]

A distinguished insurance expert has proved that there was an increase of
nearly 100 per cent. in the mortality from degenerative diseases in the
United States between 1880 and 1909. The growing prevalence of these
diseases indicates a falling-off in the vitality of the race. It means that
the diseases of old age are invading the younger ranks.

The Life Extension Institute, of New York City, in its recent report,
states that "forty of every hundred men and women employed in the Wall
Street district require medical attention; twenty of the forty need it
immediately, and ten of the forty must have it to avert serious results."

There are from one-quarter to three-quarters of a million of preventable
deaths every years in this country. That number of individuals could have
been saved with proper care and attention to health in the early stages of
disease, or before it gained a start. Practically all the diseases that
carry business men off prematurely are curable in the early stages.

Of the percentage of Wall Street men who need medical attention
immediately, most have kidney or heart disease. The others are victims of
typical unhygienic habits, such as fast, gluttonous eating, neglect of
exercise, too much tobacco and liquor, and bad posturing in the office. The
business man considers these trifles, but they count heavily.

Business efficiency is greatly increased, first, by selecting men
physically fit for work, and, second, by keeping them in that condition.
There is a tremendous waste from inefficiency constantly going on, due to
impaired health. Wall Street has an astonishing corps of neurasthenics.

We need a broader interpretation of the term Eugenics, so that we may gain
a more sympathetic and tolerant audience. The remedy does not lie in an
academic discussion of these problems; to continue the debate behind closed
doors will not lead anywhere: the public must be educated to a just
appreciation of existing conditions and the remedy must be the product of
effort on its part.

Any condition that fundamentally means race deterioration must be   [xxvii]
rendered intolerable. The prevalant dancing craze is an anti-eugenic
institution, as is the popularity of the delicatessen store. No sane person
can regard with complacency the vicious environment in which the future
mothers of the race "tango" their time, their morals, and their vitality
away. We do not assume to pass judgment on the merits of the dance; we do,
however, emphatically condemn the surroundings.

The moving-picture shows, vaudeville entertainments, dancing carnivals, the
ease of travel, the laxity of laws, the opportunities for promiscuous
interviews, all tend to give youth a false impression of the reality of
life and to make the path of the degenerate easy and attractive.

The history of civilization is, curiously enough, the story of masculine
brutality, self-indulgence, and vice. The history of the world also proves
that woman's sphere has been to submit patiently and silently to injustice
and imposition. _Practical eugenics is the first worthy effort in the
history of all time to hold men and women responsible for their mode of
living._ It is a mighty problem. There is no greater nor more difficult one
to be solved. It has taken eons to bring men to the point of questioning
their right to do as they please; it will take time to compel them to
realize their disgrace and acknowledge their duty. When we consider that
there are eighty thousand women condemned to professional moral degradation
in the City of London, and that every so-called civilized city on the globe
contributes its pro rata share to this army of potential mothers, we begin
to appreciate the vastness of the task.

Eugenics has already accomplished what no other movement has ever
accomplished: it has created the spirit that gave birth to the thought of
men's responsibility, and it has taught us that the female of the race has
rights. We can now speak without fear; the light is no longer hidden.

Women must realize, however, that they have contributed, and continue to
contribute, to race degeneracy. We hear and read much about the double
standard of morals. As long as woman are willing to marry their daughters
to reformed rakes, providing they have money and social position,  [xxviii]
so long shall we have a double standard. So long as young society women go
into hysterics over pedigreed dogs and horses and then marry men reeking in
filthy unfitness for parenthood, mothers cannot expect any other standard
of morals. So long as one marriage in twelve ends in divorce, the ethics of
the female need enlightenment. We shall not get another standard of morals
until women themselves demand it and insist on it. If they lend themselves
to breaking down the conspiracy of silence, the women may solve the
marriage problem by refusing to marry rakes.

We need a more liberal construction of the intent of eugenics in order to
clarify the obtuse minds so that its propaganda of education may be easily
and justly comprehended.

There is no field for speculation in the analysis of right living. It
conforms to the law of cause and effect. It is positively concrete in
substance. A recital of the life history of Jonathan Edwards, in comparison
with that of the celebrated "Jukes" family, emphasises this assumption with
a degree of positiveness that is tragic in its significance.

Jonathan Edwards was born in England in Queen Elizabeth's time. He was a
clergyman and he lived an upright life. So did his wife. His son came to
the United States, to Hartford, Connecticut, and became an honorable
merchant. His son, in turn, also became a merchant, upright and honored.
His son, again, became a minister, and so honored was he that Harvard
University conferred two degrees on him on the same day; one in the morning
and one in the afternoon. This learned man again had a son, and he became a
minister. Jonathan Edwards was his name.

Now let us see, in 1900, what this one family, started by a man in England
who lived an upright life and gave that heritage to his children, produced:
1,394 descendants of this man have been traced and identified; 295 were
college graduates; 13 were college presidents; 65 were professors; 60 were
physicians; 108 were clergymen; 101 were lawyers; 30 were judges; 1 was
Vice-President of the United States; 75 were Army and Navy officers; [xxix]
60 were prominent authors; 16 were railroad and steamship presidents; and
in the entire record not one has been convicted of a crime.

Twelve hundred descendants have been traced from the one man who founded
the "Jukes" family. This record covers a period of seventy-five years; out
of these, 310 were professional paupers, who spent an aggregate of two
thousand three hundred years in poorhouses; 50 were evil women; 7 were
murderers; 60 were habitual thieves; and 130 were common criminals.

It has been estimated that this one family was an economic loss to the
state, measured in terms of potential usefulness wasted; costs of
prosecution; expenses of maintenance in jails, hospitals and asylums; and
of private loss through thefts, and robberies, of $1,300,000 in
seventy-five years, or more than $1,000 for each member of the family.

_It would seem to be worth while to be well born, after all._

In order to succeed in the regeneration of the race, we must believe that
race regeneration is possible, and, that it is worth while. We must preach
its principles as we would a religion. The power of knowledge is a mighty
lever. We are living in a period of transition, but we are nearer the
future than the past.

We are told by the average individual that it will be impossible to arouse
the public to an intelligent appreciation of the scope of race
regeneration. When the writer conceived the happy phrase, "Better Babies,"
a few years ago, he builded better than he knew. It has become the slogan
of splendid achievement already, and there are a multitude of signs and
tokens that the propaganda is established on a sure foundation.

If the annihilation of all past civilizations was due to the refusal of its
members to breed for posterity, may we not reasonably assume that we have,
according to our statistics, reached the same crisis? If this is logical
reasoning, and every factor warrants this conclusion, have we not reached
the time when the perpetuation of the race is the most serious question of
our times? Is it not a problem for the enthusiastic and immediate     [xxx]
support of every statesman, politician, teacher, and preacher alike? Can
any question be of more importance? What will our marvelous material
splendor avail if the race is destined to immediate extinction?

We need the assistance of every intelligent citizen, we need most, the
awakening impulse of the mothers of the race. We who are alive are
responsible for environment and nurture, and we must believe that the
purpose to be achieved is of supreme importance. Every mother, through the
power of knowledge, may become a practical eugenist. It is to aid her in an
intelligent appreciation of the practical intent of the science that this
work is presented.

  W. GRANT HAGUE, M.D.

  New York City.

       *       *       *       *       *


                                                                        [1]
THE EUGENIC MARRIAGE

CHAPTER I

    "Nations are gathered out of nurseries."

    CHARLES KINGSLEY.

    "To be a good animal is the first requisite to success in life, and to
    be a nation of good animals is the first condition of national
    prosperity."

    HERBERT SPENCER.

CONDITIONS WHICH HAVE EVOLVED THE SCIENCE OF EUGENICS

    INFANT MORTALITY--MARRIAGE AND
    MOTHERHOOD--HEREDITY--ENVIRONMENT--EDUCATION--DISEASE AND
    VICE--HISTORY--SUMMARY.

There has been evinced during recent years a desire to know something more
definite about the science of eugenics.

Eugenics, simply defined, means "better babies." It is the art of being
well born. It implies consideration of everything that has to do with the
well-being of the race: motherhood, marriage, heredity, environment,
disease, hygiene, sanitation, vice, education, culture,--in short,
everything upon which the health of the people depends. If we contribute
the maximum of health to those living, it is reasonable to assume that the
future generation will profit thereby, and "better babies" will be a direct
consequence.

We are frequently told that we must take the world as we find it. This has
been aptly termed, "the motto of the impotent and cowardly." "Life is what
we make it," is the more satisfying assertion of the optimist, and most [2]
of us seem to be trying to make existence more tolerable and more happy. It
is encouraging to know that intelligent men and women to-day seek an
opportunity to devote serious consideration to the betterment of the race,
while yet the pursuit of wealth and pleasure are enticing and strenuous
occupations.

It would be superfluous in a book of this character to enter into any
lengthy explanation as to how the science of eugenics proposes to work out
its problems. We hope only to excite the interest of mothers in the
subject, and to instruct them in its rudiments and principles.

It will be of distinct advantage, however, first to briefly consider the
conditions,--which are known to all of us,--which have led up to the
present status of the subject.

INFANT MORTALITY.--No elaborate argument is necessary to prove that the
present infant mortality, in every civilized country, is too high. It is
conceded by every authority interested in the subject, no matter what
explanation he offers, or what system he advances as a solution of the
problem.

MARRIAGE AND MOTHERHOOD.--Every intelligent person knows that most young
girls enter into the marriage relationship without a real understanding of
its true meaning, or even a serious thought regarding its duties or its
responsibilities. We know that their home training in domestic science is
generally not adequate, and that their educational equipment is
inefficient. We also know that economic necessity has deprived them of the
tutelage essential to social progress and physical health, and has endowed
them with temperamental characteristics undesirable in the mothers of the
race. Maternity is thrust upon these physically and mentally immature young
wives, and they assume the principal rôle in a relationship that is onerous
and exacting. We know that the duties of wife and mother require an
intelligence which is rendered efficient only by maturity and experience.
We know that many, if not most, young wives acquire habits which undermine
their health and their morals unwittingly, and we also know that the
product of this inefficiency results in the decadence and the           [3]
degeneration of the race.

HEREDITY.--Much remains inexplicable at the present time regarding this
intensely interesting department of science. We do know, however, that its
truths are being investigated and tabulated. Our present knowledge of its
principles has demonstrated the existence of laws from which we can
ethically deduce explanations of conditions which were, in the past, not
amenable to any classification. These relate to individual and racial
characteristics. We are beginning to learn that we can modify these
characteristics by proper selection, by environment, and by education. This
process will, to an eminent degree, redound to the permanent advantage of
mankind. We may reasonably aspire to a system of race-culture which will
eliminate the undesirable or unfit, and conserve all effort in the
propagation of the desirable or fit. This is a consummation to be desired,
and if by any system of eugenics the promise of the future is realized it
is deserving of the intelligent interest and the active coöperation of
every aspiring mother.

ENVIRONMENT.--By environment we mean the provision of suitable surroundings
in its largest sense. A child to be fit and efficient must be born of
selected parentage, the home surroundings must be desirable, the
educational possibilities must be advantageous, the sanitary and hygienic
conditions must be suitable, opportunities for physical and spiritual
culture must be provided, and the State must ensure justice and the right
to achieve success. We know that--generally speaking--these conditions do
not exist. We know that the dregs of the human species--the blind, the
deaf-mute, the degenerate, the imbecile, the epileptic, the criminal
even,--are better protected by organized charity and by the State than are
the deserving fit and healthy. We know that in the slums thousands of
desirable children waste their vitality in the battle for existence, and we
know that, though philanthropy and governmental supervision and protection
are afforded the deaf, the dumb, the blind and degenerate child, no helping
hand is held out to save the healthy and efficient child, who must pay in
disease and inefficiency the price of his normality in degrading toil,  [4]
in factory and pit, where child labor is tolerated. We need the awakening
which is the promise of the eugenist, that these wrongs will be righted,
not by the statesmanship which believes that empires are founded and
maintained by the power of material might, but by a process which will
ennoble selected motherhood and give to every child born its due and its
right.

EDUCATION.--The present system of education is one of the great reflections
on the intelligence of the human race. One of the greatest of contemporary
writers has characterized it as "a curse to modern childhood and a menace
to the future." Even the humblest of us--who would willingly believe the
system efficient, who have no desire to invite criticism as to our
opinion--are forced to acknowledge that there is something wrong with the
educational system now in vogue. The writer is disposed to believe,
however, that the fault is not wholly one of art. The conditions with which
education has to contend are essentially hypothetical. It may be that the
laws of heredity and psychology, when fixed, will evolve, at least, a more
rational and a more ethical hypothesis. So far as eugenics is concerned
with education, its limitation is defined and fixed. If the innate ability
is not possessed by the child, no system of instruction, and no art of
pedagogy, will ever draw it out. When the proper material is supplied by an
adequate system of race culture, science may probably supply the requisite
complementary data which will ensure an educational system that will really
educate.

DISEASE AND VICE.--The eugenic idea is more directly concerned with disease
which tends to deteriorate the racial type. The average parent has no means
of adequately estimating the significance of this type of disease. It has
been estimated that one-half of the total effort of one-third of the race
is expended in combating conditions against which no successful effort is
possible. Think what this means. The struggle of life is a real struggle,
even with success as an incentive and as a possible reward. It becomes a
tragedy when we think of the wasted years, the hopeless prayers and the
anguish of those who fight the battle which is predestined to end in    [5]
apparent failure. We are disposed to doubt the justice of the Omnipotent
Mind who created us and left us seemingly alone--derelicts in the eddies of
eternity.

This is but a finite fault, however. The truth is that the scheme of the
universe is unalterable, we are but part of the whole and must share in the
evolution of the process. An apparent failure is not necessarily a
discreditable one. Most lives are failures, if appraised by human estimate.
Take for example the life of a young wife who marries a man with disease in
his blood. She begins her wedded life with certain commendable ideals. She
is young, enthusiastic, ambitious, strong, and she inherently possesses the
right to aspire to become an efficient home-maker and a good mother. She
gives birth to a child, conceived in love, and during her travail she
beseeches her Creator to help her and to help her baby, as all women do at
such a time. Her baby is born blind and it is a weak and puny mite. The
mother recovers slowly, but she is never the same vigorous and ambitious
woman. Later her strength fades away, her enthusiasm falters, the home is
blighted and seems a desecrated spot. The baby is a constant worry, it is
always sick, it needs expensive care and it exhausts the physical remnant
of its mother's health. It finally dies and is laid away, not forgotten,
but a sad, sad memory. The ailing and dispirited mother is informed that
she must submit to an operation if she desires to regain her health, if not
to save her life. She returns from the hospital--not a woman--a blighted
thing, an unsexed substitute for what once was a happy, sunny, healthy,
innocent girl.

This is not an overdrawn tale,--it is a true story, a common, every-day
story. Who was to blame? Why were her prayers not heard? Why, indeed? One
might as well ask why seemingly splendid civilizations decayed into
forgotten dust, or why empires rotted away. The answer is the same.

HISTORY.--From the eugenists' standpoint history is prolific only in
negation. A correct interpretation of its pages teaches us that it has not
taught the lesson of the "survival of the fittest," but rather the survival
of the strongest. That the strongest is not always the "fittest" needs  [6]
no commentary. That the fit should survive is the genetic law of nature,
and it has been strictly obeyed by biology and humanity when these sciences
have adhered to, and have been under the jurisdiction of the natural law.

When religious schisms swayed the world, the stronger party, in material
strength or in actual numbers, massacred the weaker, which was frequently
the fitter from the standpoint of desirability as progenitors of the race.
Thus posterity was deprived of what probably was the representative,
potential strength of generations.

At a later date religious schism changed her _modus operandi_ but
accomplished the same pernicious purpose, as the following shows:

"Whenever a man or woman was possessed of a gentle nature that fitted him
or her to deeds of charity, to meditation, to literature or to art, the
social condition of the time was such that they had no refuge elsewhere
than in the bosom of the Church. But the Church chose to preach and exact
celibacy, and the consequence was that these gentle natures had no
continuance, and thus, by a policy, was brutalized the breed of our
forefathers."

When religion was not the dominating power, mankind was ruled by militant
tyrants. The non-elect were slaves,--uneducated, uncivilized, debased and
diseased. The elect were licentious and indolent. Neither class practised
any domestic virtues, or respected the institution of motherhood. The
process of the selection of the fittest for survival for the purpose of
parentage, and for the consummation of the evolutionary gradation, through
which the human race is apparently destined to pass, was again in abeyance
for a series of generations.

In our own times, the fate of nations and the destiny of their people would
seem to depend upon the size of the fighting force and the efficiency of
the ships we build; our ability to dicker and barter, to gain a
questionable commercial supremacy, and the loquaciousness of our
politicians. This, at least, is the criterion upon which the modern
statesman estimates the quality of present-day civilization. He is not  [7]
apparently interested in the story of the ages. The progress of God's
supernal scheme through æons of bigotry and darkness neither suggests nor
inspires in him a loftier constructive analysis. He is content to leave the
destiny of nations to tons of material, tons of men and tons of talk.

Nowhere do we find any reference to the quality of the blood-stream of the
people. Nor does it seem to have been discovered by those who wield
authority, that the glory of a nation depends upon its brains, not its
bulk; nor do they apprehend that the greatness of a people is not in its
past history, but in its ever-existing motherhood; and that its battles, in
the future, must be fought, not on battlefields, but in its nurseries. When
we judge our national worth and wealth by the quality of our maternal
material, and estimate our greatness and our glory by the record of our
infant mortality, we will have carved an enduring niche in the celestial
scheme that will be unchangeable and for all time.

There are in Britain to-day over a million and a quarter females of
marriageable age in excess of the number of marriageable males. A war
between Britain and Germany would unquestionably be the bloodiest war in
all history, and it probably would be the last one, because it would only
end in the dominance of one power over all the others. If we concern
ourselves only with Britain--from the eugenic standpoint--who would dare
compute the ratio of marriageable females over the males after the war was
over? The consequence of such a war on posterity would be tragic. It would
mean the annihilation of the fittest for fatherhood for generations. Only
the unfit would be left from which to begin a new breed.

The multitude of females who would necessarily be left unable to
participate in the highest function of womanhood would have to be
self-supporting. The economic problem would, therefore, have a far-reaching
influence and even if solved adequately as an economic problem, it could
never be solved satisfactorily as a sociological, or as a problem in
eugenics.

Infant mortality is too high. Apart from the statistical proof which    [8]
shows it, we may rightly construe as further proof of it, the widespread
effort being made in every civilized country in the world to ameliorate the
condition.

The laws and ethics of marriage are inadequate. Its true purpose is
frustrated and racial and individual injustice and imperfection are the
products of existing conditions.

Motherhood, in its every aspect is not, and has not in the past, been
elevated to the plane which a true estimate of its supreme importance to
the race justifies.

Heredity as a scientific principle is undeveloped, and because of
maladministration in past generations, the present generation is
endeavoring to do the work, the fruits of which it should be enjoying.

Environment in its highest sense is impossible because of inadequate laws,
imperfect hygienic and sanitary knowledge, incomplete education, vice and
disease.

If there was not some supremely important, cardinal error somewhere, it is
reasonable to suppose that in one or other of the departments of human
effort we would have reached the summit of idealism. The State, as an
institution, would have evolved a perfection which would enable it to exist
as an independent mechanism, complete and ideal in all its ramifications.
We have had no such state, however. The highest type of empire has been
ludicrously dependent upon the minor exigencies of individual human
existence.

Science would have evolved the superman, but history, as we have seen, has
persistently deprived science of the material wherewith to contribute him.

The institution of marriage would have been a fixed and an inviolable
guarantee of the happiness of the home, but human wisdom has erred and the
solution is as yet apparently undiscovered.

Investigation into every field of human effort shows that the ultimate aim
in view, if any, was something other than the welfare of the race, as a
race or as individuals.

       *       *       *       *       *


                                                                        [9]
CHAPTER II

    "The public health is the foundation on which reposes the happiness of
    the people and the power of a country. The care of the public health is
    the first duty of a statesman."

    LORD BEACONSFIELD.

THE EUGENIC IDEA

    THE VALUE OF HUMAN LIFE--THE EUGENIC PRINCIPLE--"THE FIT ONLY SHALL
    LIVE"--EUGENICS AND MARRIAGE--THE VENEREAL DISEASES--THE UTILITY OF
    MARRIAGE CERTIFICATES--THE MARRIAGE CERTIFICATES AND VICE--EUGENICS AND
    PARENTHOOD--THE PRINCIPLE OF HEREDITY--EUGENICS AND
    MOTHERHOOD--EUGENICS AND THE HUSBAND.

The eugenist believes the cardinal error of the past has been a failure to
recognize the worth or value of human life. In the past human lives have
counted for absolutely nothing. As we have seen, each generation has
practically deprived posterity of the best of its breed, and we shall see,
when we consider the facts which affect the present vitality of the race,
that the same preposterous conditions still exist.

It is not necessary to waste the reader's time in an effort to prove,
simply from an argumentative standpoint, the logic of the eugenic idea.
There is no existing economic problem that has established itself so firmly
in the hearts of the people who understand it, as has the study of race
culture. It is not the subject, but its scope of application, that is new.
Biologically, we see the manifestations of eugenics on every side. In the
flower garden we breed for beauty, in the orchard for quality. In the
poultry yard and on the stock farm the same process weeds out the unfit and
cultivates the desirable. The value of the eugenic idea is most strikingly
illustrated in the cultivation, or breeding, of the horse from a primitive
creature into the splendid animals which represent the various types of
equine present-day perfection. It has taken generations of the most    [10]
painstaking intelligence to understand the traits which had to be evolved
in scientific mating to reach the present standard. If the same rules, or
lack of rules, applied to the mating of horses as applied to ourselves,
there would be few, if any, "thoroughbreds" among them. The principle which
we must recognize is that "Life is the only wealth."

Progress and efficiency will be ensured and of an enduring character, when
all human effort is consecrated to this fundamental principle as a basic
law, and not till then.

To cultivate the human race on prescribed scientific principles will be the
supreme science of all the future, the object and the final goal of all
honest governmental jurisprudence, and the ultimate judge of all true
constructive legislation.

THE EUGENIC PRINCIPLE

The eugenic principle is, that "the fit only shall live." This does not
mean that the unfit must die, but that only the fit shall be born.
Occasionally, as a product of bad environment, or faulty training, or
eccentricity, a horse gives evidence of vicious traits, but the scientific
breeder never mates him. He is allowed to die out. If he were permitted to
father a race, his progeny would develop murderous characteristics that
would retard the type for generations.

THE FIT ONLY SHALL BE BORN.--This implies the exclusion of those, as
parents, who are incapable of creating fit children. Fit children are
children who are physically and mentally healthy. Parents who are unfit to
create physically and mentally healthy children are those diseased in body
or mind, especially if the disease is of the type which science has proved
to be transmissible, or which directly affects the vitality of the child.
In such a category we place those who are deaf, dumb, blind, epileptic,
feeble-minded, insane, criminal, consumptive, cancerous, haemophilic,
syphilitic, or drunkards, and those known to be victims of disease of  [11]
any other special type.

It must not be inferred that the above classification is made arbitrarily.
There are many arguments which may be advanced limiting the eugenic
applicability of certain of these diseased conditions. These, however, do
not directly come within the province of the mother. They may be safely
left to special state regulation. We simply make the assertion that no
mother would willingly, or designedly, ally her offspring with any member
of society afflicted with any of the diseases enumerated.

EUGENICS AND MARRIAGE.--The eugenic idea, practically applied to the
institution of marriage, means that no unfit person will be allowed to
marry. It will be necessary for each applicant to pass a medical
examination as to his, or her, physical and mental fitness. This is
eminently a just decree. It will not only be a competent safeguard against
marriage with those obviously diseased and incompetent, but it will render
impossible marriage with those afflicted with undetected or secret disease.
Inasmuch as the latter type of disease is the foundation for most of the
failures in marriage, and for most of the ills and tragedies in the lives
of women, it is essential to devote special consideration to it in the
interest of the mothers of the race.

It is estimated that there are more than ten million victims of venereal
disease in the United States to-day. In New York City alone there are two
million men and women--not including boys and girls from six to twelve
years of age--actively suffering from gonorrhea and syphilis. Eight out of
every ten young men, between seventeen and thirty years of age, are
suffering directly or indirectly from the effects of these diseases, and a
very large percentage of these cases will be conveyed to wife and children
and will wreck their lives. No one but a physician can have the faintest
conception of the far-reaching consequences of infection of this character.
The great White Plague is merely an incident compared to it. These diseases
are largely responsible for our blind children, for the feeble-minded, for
the degenerate and criminal, the incompetent and the insane. No other  [12]
disease can approximate syphilis in its hideous influence upon parenthood
and the future. The women of the race, and particularly the mothers, should
fully appreciate the real significance of the situation as it applies to
them individually. That they do not appreciate it is well known to every
physician and surgeon.

It is first necessary to state certain medical facts regarding these
diseases. They exist for years after all symptoms have disappeared; no
evidences exist even to suggest to the patient that he, or she, is not
entirely cured. After the germs have been in the patient for some time they
lose a certain degree of their virility, and a condition of immunity is
established. In other words the tissue ceases to be a favorable medium for
the development, or activity, of the germs. If these germs, however, are
conveyed to another person, who has never had the disease, or whose tissue
is not immune, they will immediately resume their full activity and
virulence, and will establish the disease, frequently in its most violent
form, in the person so infected. The startling deduction which we must draw
from these facts is, that a man may infect his wife, and may thereby be the
direct cause of wrecking her entire life, and may, in addition, as a
consequence of the infection, cause a child to be born blind, without even
remotely suspecting that he is in any way responsible for it. In the light
of this knowledge, what is the percentage risk a young girl takes when she
selects a husband, remembering that eight out of every ten husbands bring
these germs to the marriage bed? Reread the true story of the young woman
on page five, accept my assurance that there are thousands and thousands of
such cases, and ask yourself, who is to blame? We may certainly assure
ourselves that no man living would wilfully desecrate his bride. He did not
know,--did not even suspect that the disease he had years ago was still in
his system. Society is to blame--you and I--the laxity of the law is the
culprit. Had he been compelled to pass a physical examination before
marriage he would have been told the truth.

It is a notorious fact, that in every civilized city in the world, the
number of operations that are daily performed on women, is increasing  [13]
appallingly. Every surgeon knows that nine-tenths of these operations are
caused, directly or indirectly, by these diseases, and in almost every case
in married women, they are obtained innocently from their own husbands. It
is rare to find a married woman who is not suffering from some ovarian or
uterine trouble, or some obscure nervous condition, which is not amenable
to the ordinary remedies, and a very large percentage of these cases are
primarily caused by infection obtained in the same way.

When a girl marries she does not know what fate has in store for her, nor
is there any possible way of knowing under the present marriage system. If
she begets a sickly, puny child,--assuming she herself has providentially
escaped immediate disease,--she devotes all her mother love and devotion to
it, but she is fighting a hopeless fight, as I previously explained when I
stated that one-half of the total effort of one-third of the race is
expended in combating conditions against which no successful effort is
possible. Even her prayers are futile, because the wrong is implanted in
the constitution of the child, and the remedy is elsewhere. These are the
tragedies of life, which no words can adequately describe, and compared to
which the incidental troubles of the world are as nothing.

So long as these conditions exist need we not tremble for the future of the
race? Is not this future welfare a personal issue, or can we trust the
future of our daughters to the same indiscriminate fate that has written
the pages of history in the past?

This problem has been debated from every possible angle without our
reaching any seemingly practical solution. The promise of emancipation,
however, came with the dawn of eugenics. It is the only solution that gives
promise of immediate and reasonable success. For that reason alone it
should receive the active support of every good mother in all lands.

THE UTILITY OF MARRIAGE CERTIFICATES.--There would seem to be no question
as to the utility of marriage certificates. We must remember, however, that
there is a distinction between marriage and parenthood, and that       [14]
eugenics is concerned only with parenthood. It is interested in the
institution of marriage to the extent only that it may, by some system of
regulation, be a positive and fixed factor in the production of exclusively
healthy children. The eugenist demands fit children. If society can ensure
fit children, as a consequence of any marriage system which may or may not
include medical certification, the eugenic aim is fully met. At the present
time the giving of a marriage certificate, which is really a permit to
marry, would seem to be the most practical way promptly to accomplish the
eugenic purpose. We should promptly question the honor of any prospective
husband disposed to evade the examination simply because he was not
compelled to obey by a legislative enactment.

We believe that when the public is educated to the truth and intent of
eugenics, there need be no compulsory examination. Men and women will, of
their own accord, desire to know if their marriage will jeopardize the
race. There will be questions of heredity to elucidate, questions of
inherited insanity, poison taints, of blindness and deafness, or it may be
of drunkenness.

Further, marriage certificates, or permits, must be considered in regard to
the future conduct of those to whom we refuse permits to marry. A refusal
of the permission to marry will not change the desire to marry. Many, of
course, to whom a permit is refused, will accept the situation, will be
thankful to be possessed of the knowledge of their incompetency in order
that they may seek medical aid. These individuals will remain under medical
supervision until their ailments are cured and their competency
established. In this way the eugenic aim is materially furthered. Others
may not abide by the decree which forbids marriage. It would wholly defeat
the eugenic idea if the unfit children were to continue to be born
illegitimately. These individuals will comprise the few--probably the
present unfit members of society--and the final solution of the matter must
remain a question of education and evolution. When public opinion is
educated to the degree necessary to establish a system of eugenic
self-protection, we shall be provided with a race of children whose    [15]
culture will achieve the ideal of parenthood by a process of education
rather than legislation.

THE MARRIAGE CERTIFICATE AND VICE.--If a prenuptial examination were made
compulsory there is no doubt of the very prompt and salutory effect it
would have on present-day vice. It has often been said that "You cannot
legislate virtue or sobriety into a people." We are familiar too with the
maxim that "You can lead a horse to the well, but you cannot make him
drink." You can lead a horse to the well, however, and lo! he drinks. If
you lead him at the right time he will always drink. If we legislate at the
psychological moment we can legislate virtue and sobriety into a people.

A very large percentage of existing vice is the immediate product of
ignorance, and the larger percentage of the remainder is the result of
propinquity and the idea that it will never be found out. Very little of it
is the outcome of innate degeneracy. It is an acquired degeneracy we must
guard against, and that is the special educational motive of eugenics.
Young men will be taught the truth about vice, and if they have been
victims in the past, they will willingly submit themselves to a _competent_
investigation of their fitness for marriage. If they are still pure, the
desire to remain so, in order to be eligible for parenthood, will guard
them against the risk of contamination. This will not only result in a
distinct improvement of the moral tone, but the potential possibilities to
posterity will be incalculable. Legislation might therefore be the vehicle
through which eugenic education could enlighten and evolve a fit race.

EUGENICS AND PARENTHOOD

If the supreme end is a better race we must recognize that the great need
for society to-day is to educate for parenthood. History teaches that a
civilization that dissipates its virility in profligacy or spends its
energy in political and commercial trickery, and gives no thought to the
character of the men and women it produces, is destined to total failure.
Parenthood and birth--in these we have the eugenic instruments of the  [16]
future. The only permanent way to cure the ills of the world is to prevent
the multiplication of people below a certain standard. The elevation and
the actual preservation of the race depends upon rendering it impossible
for the unfit coming into existence at all. In other words the unfit or
unworthy must be rejected, not necessarily as individuals, but as parents.

Eugenics is allied to the principle of heredity,--the principle that
enables us to modify conditions so as to ensure the right children being
born. The propaganda against infant mortality is directed only toward the
provision of a good environment,--so that children, when born, may survive
and attain the maximum of their hereditary promise. The two campaigns are
essentially complementary. The one applies only before birth, the other
after birth. The statistics of infant mortality unfortunately show that it
is not a process that extinguishes the unfit only. The healthy succumb to
unfavorable environment and it was to amend this condition that the
campaign against infant mortality was undertaken. The two campaigns appeal
to the same creed: that parenthood is the supreme function of the race,
that it must not be indifferently undertaken; that it demands the most
careful preparation; that it is a duty which can only be carried out
eugenically by the highest attainable health of body and mind and emotions.

EUGENICS AND MOTHERHOOD.--Any plan or scheme which has for its object race
regeneration must concern itself with the health, the education, and the
psychology of woman; the environment which shall surround her period of
motherhood, and her selection of the fathers of the future. Society must
safeguard her in all her relations. The race to-morrow are the babies of
to-day. The wealth of a nation therefore is the type of baby that will
constitute its civilization from generation to generation, and absolutely
nothing else counts. We hear much about race suicide, but is it not
monstrous to cry for more babies when we do not know how to keep alive
those we have? It is a fact that everywhere the birth rate of the Caucasian
people is on the decline. Our birth rate as a whole, however, is ample;[17]
it is the death rate that is significant and appalling. When we remember
that one-third of all the babies born die before they reach the age of five
years; and that the deaths of babies under one year of age comprise about
one-fourth of the total death-roll; and that fully one-half of all these
deaths are needless and unnecessary, wherein is the wisdom of working for a
higher birth rate if it is merely that more may die?

The majority of babies are born physically healthy, but because of our
destructive process, we proceed to annihilate hundreds of thousands of them
yearly, and because of defective environment and education we render
thousands of others, including the fit and unfit, inefficient and
incompetent as propagating factors. It is to remove this disastrous stigma
on our intelligence that we have been forced to study the conditions which
the eugenic idea represents. When these principles are understood and
believed, and when they are acted upon, infant mortality will cease to
exist.

It was the design of the Creator that human motherhood should be an exalted
occupation. He placed in her care to nurture and to love, the most helpless
living thing. Few have regarded a baby from this viewpoint and fewer still
understand its supreme significance. That it is the most utterly helpless
thing possessing life is a self-evident fact, and that it should be
destined to be King of all mammalian tribes as well as Lord of all the
earth is a superlative paradox. Because of its utter inability to care for
itself it is more in need of care than any other representative of the
animal world. It is not only in need of immediate care, but it demands care
longer than the young of any other species.

It stands to reason, therefore, that the function of motherhood must be
reckoned with in any scheme of race regeneration; that it must be provided
with the most favorable environment; and that it must be relieved of any
condition which would materially retard the meeting of the obligation to
its fullest possible extent. In an ideal eugenic sense the state must
ensure sustenance to those deprived of ample food and raiment, and     [18]
science must continue to solve the problem of a fitter sanitary and
hygienic environment for the congested and densely populated zones of
habitation. Philanthropy must not continue to be wholly misdirected, it
must extend its aid to the deserving healthy and fit, as well as to be
exclusively the protecting agency of the diseased and unfit. If life is the
only wealth, and the preservation of childhood the highest duty of society
and the state,--which it would seem to be, since the continuance and
preservation of the race is obviously essential to the continuance of the
state itself,--the life of every child must be considered an economic as
well as a moral trust. If, therefore, every child is sacred, every mother
is equally sacred. If every child is to be cared for, every mother must be
cared for. If the state cannot afford to provide for what is imperatively
essential to its own continuance, it might as well go out of existence, as
it inevitably will in the end on any other basis, and as all preceding
states have done.

Mothers must not be dependent upon their children's labor for their
maintenance, because if children are compelled to work, they will not be
able to work in the future,--and adult efficiency is necessary to the
well-being of the individual, the race, and the state.

No mother should work, because in the care of her children she is already
doing the supreme work. The proper care of children is so continuous and
exacting a task, and of such importance to posterity, that it must be
regarded as the highest and foremost work--and adequate in itself--and its
efficiency must not be hampered by mothers having to do anything else.

Motherhood must not be financially insecure, because this would defeat its
eugenic purpose. Society, therefore, as a matter of self-preservation, must
ensure to woman her mental and economic security. Civilization's margin is
large enough to provide this. We spend large amounts on luxuries and evils
which are contrary to the genesis of self-preservation, while motherhood is
its basic necessity. When public opinion is educated in the essentials of
eugenics much of this can be, and will be diverted to a nobler purpose. The
total cost necessary to ensure the adequate care of dependent          [19]
motherhood would be a mere fraction of the national expenditure, and not a
tithe of what we spend in pension allowances yearly. The latter is regarded
as an honorable debt and is at best the direct product of a decadent ideal,
while motherhood constitutes the very germ of the only altruistic idealism
for all the future.

We concede, therefore, that the children and the mothers must be provided
for, not only as a product of the true construction of the ethics of
sociology, but in obedience to the fundamental law of a moral system of
eugenics. We must go further and assert that children must be cared for
through the mother. It has been the practice to divorce the improvident
mother from her dependent children. This has been demonstrated to be not
only an altruistic fallacy. It has proved to be an economic blunder.

There is another type of evil which largely menaces the eugenic ideal of
motherhood. It is those cases where married women who have children are
compelled to be the bread winners of the family as well as its mothers. No
woman can earn support for herself and children outside of her home and
competently assume the responsibilities of motherhood at the same time.
Whatever aid a mother renders to the state, as a result of effort in
factory or shop, is of infinitely less value, from an economic standpoint,
than her contribution as mother in caring for her own children in her own
home. A careful study of infant mortality, and the conditions of child
life, so far as survival value is concerned, condemns in the strongest and
most vital sense this whole practice. The preservation of the race is the
essential requisite, and it is the vital industry of any people. Any
seeming economic necessity which destroys that industry is one that will
contribute largely to the downfall of the people as a race.

EUGENICS AND THE HUSBAND.--The question of the husband's moral and parental
obligation, as dictated by the marriage institution and constitution, may
be left out of this discussion. We may assert, however, that we do not
believe the eugenic principle intends, in devising ways and means for  [20]
the adequate protection, in its completest sense, of motherhood, to relieve
the father of any of his moral or parental obligations. These obligations
will be justly defined, and as previously stated, will be the subject of
special state legislation. No legislation of an economic character can
detract from the performance of a moral obligation, and by no process of
sophistication can modern statesmanship accomplish the dethronement of
motherhood. The duty of the father is to support his children and the
mother of his children, and the duty of the state is to see that this is
done. The fundamental law of the eugenist must be to recognize that
fatherhood is a deliberate and responsible act, for which a fixed
accountability must be maintained. Whatever legislation is undertaken in
this connection must be with the object in view of strengthening the
efforts of the right kind of father and husband, and of rendering more
difficult the path of the irresponsible father and husband. If the supreme
duty of a state is the maintenance of justice, its whole effort in the
future will be to legislate in harmony with the eugenic principle.

       *       *       *       *       *


                                                                       [21]
CHAPTER III

    "I hope to live to see the time when the increased efficiency in the
    public health service--Federal, State and municipal--will show itself
    in a greatly reduced death rate. The Federal Government can give a
    powerful impulse to this end by creating a model public health
    service."

    EX-PRESIDENT TAFT.

EUGENICS AND EDUCATION

    THE PRESENT EDUCATIONAL SYSTEM IS INADEQUATE--OPINIONS OF DR. C. W.
    SALEEBY, ELLA WHEELER WILCOX, LUTHER BURBANK, WILLIAM D. LEWIS,
    ELIZABETH ATWOOD, DR. THOMAS A. STORY, WILLIAM C. WHITE, DR. HELEN C.
    PUTNAM--DIFFICULTY IN DEVISING A SATISFACTORY EDUCATIONAL
    SYSTEM--EDUCATION AN IMPORTANT FUNCTION--THE FUNCTION OF THE HIGH
    SCHOOL--THE HIGH SCHOOL SYSTEM FALLACIOUS--THE TRUE FUNCTION OF
    EDUCATION.

The fundamental law of eugenics demands that all education be exerted for
parenthood. We have proved that the child is not only essential to the life
of the state, but is the state. Consequently any function other than
parenthood is a non-essential so far as organic existence is dependent upon
it. Education can, therefore, have no higher or more righteous motive than
as a contributory agency in the perpetuation of the function upon which all
existence depends. If the only function of education is to make one a
worthy citizen, or to make him, or her, self-supporting, or able to bear
arms in defense of his country, rather than a perfect link in the complete
chain of enduring life, its purpose is being perverted. It is not
sufficient to provide a girl, for instance, with an exclusive environment
which regards her simply as a muscular entity, as is the tendency in some
of the "best" girls' schools to-day; nor to fit her as a domestic or
society ornament; nor must she be regarded simply as an intellectual
machine, as is done under the system styled "the higher education of
women." Any one of these is an example of misdirected excess and is    [22]
only part of the whole. None of these systems strives to develop the
emotional side of the complex female character, and any educational system
which ignores the emotions is not only inadequate but reprehensible in the
highest degree. The ideal which will strive for education for ultimate
parenthood will more completely solve the question of complete (eugenic)
living.

THE PRESENT EDUCATIONAL SYSTEM IS INADEQUATE.--There is no question that
education, as conducted at the present time, is one of the most disastrous
institutional fallacies of modern civilization. In support of this
contention, we are prompted to quote at length from various authorities
bearing on this subject.

Dr. C. W. Saleeby, an international authority on education, writes as
follows:

"A simple analogy will show the disastrous character of the present
process, which may be briefly described as 'education' by cram and emetic.
It is as if you filled a child's stomach to repletion with marbles, pieces
of coal and similar material incapable of digestion--the more worthless the
material the more accurate the analogy--then applied an emetic and
estimated your success by the completeness with which everything was
returned, more especially if it was returned 'unchanged,' as the doctors
say. Just so do we cram the child's mental stomach, its memory, with a
selection of dead facts of history and the like (at least when they are not
fictions) and then apply a violent emetic called an examination (which like
most other emetics causes much depression) and estimate our success by the
number of statements which the child vomits onto the examination paper--if
the reader will excuse me. Further, if we are what we usually are, we
prefer that the statements shall come back 'unchanged'--showing no sign of
mental digestion. We call this 'training the memory.' The present type of
education is a curse to modern childhood and a menace to the future. The
teacher who cannot tell whether a child is doing well without formally
examining it, should be heaving bricks, but such a teacher does not exist.
In Berlin they are now learning that the depression caused by these    [23]
emetics (examinations) often lead to child suicide--a steadily increasing
phenomenon mainly due to educational overpressure and worry about
examinations.

"Short of such appalling disasters, however, we have to reckon with the
existence of this enormous amount of stupidity, which those who fortunately
escaped such education in childhood have to drag along with them in the
long struggle towards the stars. This dead weight of inertia lamentably
retards progress.

"If you have been treated with marbles and emetics long enough, you may
begin to question whether there is such a thing as nourishing food; if you
have been crammed with dead facts, and then compelled to disgorge them, you
may well question whether there are such things as nourishing facts or
ideas."

The gifted writer, Ella Wheeler Wilcox, in an editorial in the _New York
American_, expressed herself recently in the following terms:

"A wave of dissatisfaction is sweeping over the country regarding our
school system. And eventually this will cause a change to be made. The
larger understanding of mothers regarding education will result in the
personal element entering into the training of children.

"When women have a voice in the affairs of the nation there will be more
teachers, larger salaries, fewer pupils in each department, and more
attention will be given to the temperaments and varying dispositions of
children by their instructors.

"Instead of regarding the little ones who enter public schools as machines
which must be taught to go according to one rule, each child will be
studied as a threefold being, and his mind, body and spirit will be cared
for and developed according to his own peculiar needs. All this will come
slowly, but it will come.

"Before children enter the public schools there should be a great sifting
process under the direction of a national board of scientific men. The
brain equipment of each child, the tendencies given it at birth, should be
tested; then the nervous, hysterical and erratic minds ought to be     [24]
placed in a school by themselves, under the care of men and women who know
the law of mental suggestion.

"Quiet, loving, wholesome rules, followed day after day and month after
month, would bring these children out into the light of self-control and
concentration. The hurried, crowding, exciting methods of the public
schools are disastrous to fully half of the unformed minds sent into the
intellectual maelstrom which America provides under the name of Public
Schools.

"For the well-born, normal-minded, healthy-bodied child, who has wise and
careful guardians or parents to assist in his mental guidance, the public
school forms a good basis on which to build an education. For the average
American child of excitable nerves and precocious tendencies, it is like
deep surf swimming for the inexperienced and adventurous bather.

"The great foundation of education--character--is not taught in the public
schools. There is no systematized process of developing a child's power of
concentration; there is not time for this in the cramming process now in
vogue and with the enormous pressure placed on teachers. No teacher can do
justice to more than fifteen children through the school hours. In many of
our public schools there are fifty and sixty children under one instructor.
This is fatal to the nervous system of the teacher and deprives the pupils
of that personal sympathy which is of such vital importance."

Luther Burbank, the famous California horticulturist, declares that the
great object and aim of his life is to apply to the training of children
those scientific ideas which he has so successfully employed in working
transformation in plant life.

In an editorial, entitled, "Teaching Health," the _New York Globe_ states,
"Anatomy and physiology are reasonably exact sciences, and nine-tenths of
the hygienic abuses against which the doctors are preaching would be
prevented if the laity had an elementary knowledge of physiology. Such an
educational reform could be carried out without causing any clash whatever
between the warring medical sects." [Page 25]

William D. Lewis, Principal of the William Penn School, Philadelphia, in an
article entitled: "The High School and the Girl," in a recent issue of the
_Saturday Evening Post_, wrote in part as follows:

... "The first thing that society wants of our girl is good health. This is
the first essential for her efficient service and personal happiness in
shop, office, store, school or home. The future of the race so far as she
represents it, depends upon her health. What is the high school doing to
improve the girl's health? In the overwhelming majority of cases absolutely
nothing. On the other hand, it is subjecting her to a regimen planned for
boys, without the slightest consideration of the physical and functional
differences between the sexes.

"It pays no attention to the curvature of the spine developed by the
exclusively sit-at-a-desk-and-study-a-book type of education bequeathed to
the girlhood of the nation by the medieval monastery: It ignores the
chorea, otherwise known as St. Vitus' dance developed by overstudy and
underexercise; it disregards the malnutrition of hasty breakfasts, and
lunches of pickles, fudge, cream-puffs and other kickshaws, not to mention
the catch penny trash too often provided by the janitor or concessionaire
of the school luncheon, who isn't doing business for his health or for
anybody else's; it neglects eye-strain, unhygienic dress, uncleanly habits,
anemia, periodic headaches, nervousness, adenoids, and wrong habits of
posture and movements.... If you believe that the high school is a social
institution with a mission of public service, regardless of the relation of
that service to Latin or Algebra, then you must agree that it should look
after what everyone recognizes as the foremost need of the adolescent girl.

"One fact that every educator in both camps knows is that the home is not
attending to the health of the adolescent girl. This problem is pressing
upon us now largely because of the revolutions in living conditions that
has come within the last quarter of a century."

In a report of a recent Conference on the Conservation of School       [26]
Children held at Lehigh University by the American Academy of Medicine, the
following items appear.

Four great reasons why medical inspection in schools is needed were brought
out by Dr. Thomas A. Story of New York, who spoke from the educator's
standpoint:

"The first reason is concerned with communicable diseases, and the second
with remediable incapacitating physical defects. It was reported in 1906
that over twenty per cent. of the children in the schools of New York City
had defective vision, and over fifty per cent. had defective teeth. These
defective conditions are amenable to treatment whereby the functional
efficiency of the pupil is improved. He is capable of better work and the
school efficiency is advanced.

"The third reason is concerned with irremediable physical defects. The
cripples, the deformed and the delinquents whose incapacitating defects are
permanent should be found and classified. This enables special instruction
and opens up educational possibilities otherwise unattainable, besides
removing retarding factors in the progress of the normal pupil.

"The fourth reason is concerned with the development of hygienic habits in
the school child, and through the child, of the community. Medical
inspection which influences the health habits of the masses is a matter of
supreme importance. The teacher will have pupils of cleaner habits and
healthier, with fewer interruptions and disturbances from absences.

"To make medical inspection successful physical examinations should uncover
the anatomic, physiologic, and hygienic conditions. Every piece of advice
given to a pupil that can be followed up should be followed up and the
result recorded. No system of medical inspection in schools can be complete
and permanently successful which does not eventually educate the parent and
child to a sympathetic and coöperative relationship with the system.
Medical inspection is a force working for a better general education in
personal hygiene and should coördinate with the class room instruction.
Hence it must be a system in sympathetic relationship with the general [27]
management of the school, and should be under the same responsible control.
Since it is an educational influence and so directly related to the success
of the school, it ought to be a part of the school organization."

A paper was read by Dr. Helen C. Putnam of Providence, R. I., on "The
Teaching of Hygiene for Better Parentage." She said:

"Life is a trust from fathers and mothers beginning before history; to be
guarded and bettered in one's turn, and passed along to children's
children. A definite conception of this trust is essential to right living.
Educators are finding that well directed correlation of human life, with
phenomena of growing things in school gardens and nature studies, develops
a wholesome mental attitude. Since tens of millions of our population have
only fractions of primary schooling, there is where the teaching must
begin. These primary years are the time to lay foundations before a wrong
bias is established.

"Education for parenthood cannot be completed at this early age. The
strategic years for making it most effective are from sixteen to
twenty-four, when home-making instincts are waking and strongest. We have
15,000,000 young people of these ages in no schools, and eligible for such
instruction. All state boards of education were recently petitioned by the
American Association for Study and Prevention of Infant Mortality to urge
the appointment of commissions on continuation schools of home-making, to
investigate conditions and needs in their respective states and to report
plans for meeting them effectively through such continuation schools or
classes."

DIFFICULTY IN DEVISING A SATISFACTORY EDUCATIONAL SYSTEM.--It will be
observed that each of these authoritative writers criticises the system of
education now in vogue. The criticism is not, nor could it justly be,
specialized. It is simply an expression, from different viewpoints, of the
feeling that we are not doing ourselves justice as yet, we are groping
after something better. It may be, as I have previously stated, that no[28]
satisfactory system of education will be evolved until the laws of kindred
sciences, which have organic relationship to what we understand as
education, are fixed and better understood. We are just beginning to
appreciate the true meaning of environment. We know little about heredity,
but enough to appreciate its vital importance. Psychology is a realm of
much hope, but we have only tasted of its surface promise and know little
of the mysteries it may unfold. Eugenics, the infant giant of science,
promises to establish the race on an enduring foundation. These sciences
have laws which we do not yet understand; they relate to that part of human
evolution which mind dominates. The quality of the mind's dominion depends
upon the mind's education and environment, and since the laws of these
sciences, upon which a perfect system of education depends, have not been
revealed, it is quite evident that all past systems of education have been
more or less deficient. It is further evident that evolution has suffered
as a result of the mind's imperfect education,--a condition that is
manifest all around us.

It must be appreciated, however, that we are discussing a large subject. If
we understood all there is to know about environment; if we knew the laws
of heredity, and psychology, and eugenics, and then could apply them, and
educate the product of this combination of forces, we would be very near to
the super-man. One must have a sober mental horizon to evolve the picture
which would be the product of the above solution and then to estimate its
meaning on human happiness and progress. We are approaching the ethics of
right living,--of justice and truth,--the divine in man. At no time in the
history of man has civilization been so near a solution of life's supreme
problem as at the present moment.

Education is an important function in life's scheme, and while we may
regret that it is not possible to formulate a system that would be perfect
and capable of immediate application, we can continue to work patiently and
hopefully, with assurance that in the near future the problem will be
satisfactorily solved. When heredity, psychology, and eugenics combine [29]
to dictate the system, we shall doubtless find, that, in the beginning, it
will be a system of individualization. In the interest of health and of
justice, and consequently of efficiency, this would seem to be the natural
and the logical lead.

So long as human nature is as it is, we must meet conditions as they exist.
We know as parents, and some of us know as physicians, that a task easily
performed by one individual, without any apparent harmful results, will tax
the capacity of another individual to the very utmost. Any educational
system which does not recognize this law, is vicious. Yet such is the
system in vogue to-day in America. We must adapt the burden to the
endurance of the pupil. The administration of an educational machinery must
solve this problem from the individual standpoint.

In the departmental work in our public schools there seems to be no system.
Each teacher prescribes home work without any knowledge of what others of
the same grade do, and without any apparent consideration in favor of the
individual pupil. The result is that the total amount for each night is
absurdly in excess of the capacity of the ordinary, or for that matter the
extraordinary, pupil. This engenders nervousness and irritability, and is
contrary to the ethics of education,--the fundamental law of which should
be the preservation of good health. We must have regard for the physical
and mental health of each pupil, and as the capacity of each pupil is
different, the system is committing an egregious wrong by sacrificing the
weaker instead of adapting the burden according to the strength and
endurance of the bearer.

THE HIGH SCHOOL SYSTEM FALLACIOUS.--Even the high schools do not seem to be
wisely availing themselves of their opportunity from the eugenic or
economic standpoint. According to the report of the Commissioner of
Education of the United States the percentage of pupils studying some of
the more important subjects in the year 1909-1910 is stated as follows:[30]

Latin, French and German         83 per cent.
Algebra and Geometry             88  "    "
English Literature               57  "    "
Rhetoric                         57  "    "
History                          55  "    "
Domestic Economy,--including
  sewing, cooking and household
  economies                       4  "    "
If only barely four per cent. of the girls in our high schools are studying
subjects which directly contribute to their efficiency as home-makers, what
are the prospects for worthy parenthood in the light of the fact that
seventy-five per cent. of all women between the ages of twenty and
twenty-four are married?

The function of the high school, so far as girls are concerned, is to
conserve health, to train for domestic efficiency and motherhood, and if
necessary for economic independence. It must also furnish the stimulus for
mental culture and direct a proper aspiration for social enlightenment. The
curriculum should include biology, hygiene, psychology, home beautifying,
the story-telling side of literature, music and a few other studies tending
to make woman more like woman than she is to-day. When we have this,
teaching for mothercraft will be more nearly realized.

From the eugenic standpoint the present system of education is not
satisfactory. To attain our end it is essential to devise other means of
education. It must be remembered, however, that no system of education
alone can ever enable us to achieve our end, no matter how perfect the
system may be. Education can only draw out what is in the child; it cannot
draw out what is not there. What the child is, depends upon its heredity.
The pedagogic ability of the school-master will never make a genius.

A child's mind may be likened to a block puzzle, each block representing a
part of a picture, which can only be completed when they are all arranged
in their correct places. Each block is an ancestral legacy,--the child's
heritage--and to find its proper place in order to complete the        [31]
character picture--to solve the riddle of the jumbled blocks,--is the duty
of the educator. He can only manipulate what is there, and the test of his
system will depend upon his ability to solve the puzzle of the ancestral
blocks. We must divorce ourselves from the idea that a child's mind, at the
beginning, is an empty space, to be filled in with knowledge according to
the ability of the teacher; or that it is like a sheet of paper, to be
written upon. Education, and the educator, is absolutely limited to
"drawing out" what heredity put there. Education frequently is given credit
which rightly belongs to nature. A child cannot do certain things until
nature intends that it should. A baby cannot possibly walk until the
nervous mechanism which controls the function of walking is developed. Many
children walk at the first attempt, simply because they did not make the
first attempt until after nature had perfected the mechanism and the innate
ability to walk was already there. Suppose we tried to teach that baby to
walk a month before nature was ready; each day we patiently coax it to
"step out," we guide it from support to support, and we protect it from
stumbling. Some day it walks, and we congratulate ourselves on the victory,
when as a matter of fact, we not only had nothing to do with it but were
impertinent meddlers, not instructors. Nature was the teacher and she was
quite capable of completing the task without our aid. It is reasonable also
to assume that any effort to force a natural function is quite likely to do
much harm. We have found this to be so in various departments of education
when the system was wrongly conceived. In physical culture this principle
has been demonstrated over and over again.

If our ancestral legacy is a good one, our picture blocks will be numerous
and it will be possible for the proper system of education, aided by a
suitable environment, to arrange them into many designs. If, on the other
hand, our heredity did not endow us abundantly the number of our picture
blocks may be limited to three or four, and they will be easily arranged so
as to form a simple picture. The one represents a child whom heredity has
richly endowed, the other one whom it has meagerly supplied with innate[32]
possibilities. Heredity therefore dictates the function of education; and
the school-master can only fashion the picture put there. If the ancestral
blocks are not there with which to make an elaborate picture he must
content himself with what is there,--he or his art cannot create others.
When he congratulates himself on achieving a wonderful result in graduating
a particularly brilliant student, he is taking to himself unmerited honors.
If his individual ability is responsible in one instance, why not apply the
same system to all pupils? If this system is responsible for the brilliancy
of one pupil, why does not the same system make all brilliant? The reader
knows the answer,--because heredity did not endow them equally. Men are not
born equal, despite the Declaration of Independence.

The school-master is not responsible for the apt and the inapt pupil. He is
responsible for his system which dictates how he will differentiate between
the apt and the inapt pupil, in order to achieve the best results without
injustice to either.

The inefficient teacher is a dangerous equation in the school system. I
mean by inefficiency, the quality of being temperamentally unsuited to the
profession. There are a large number of anemic, hysterical young women
teaching in the public schools of our cities who should not be there. They
should not be there in justice to themselves, nor should they be there in
justice to their pupils. A strict, yearly medical examination should be
made of the teachers to decide their physical and psychical fitness to fill
their positions adequately. One teacher, physically or psychically
inefficient, can do an inconceivable amount of harm in one school term. We
cannot afford to experiment along this line. It means too much, and even at
the price of one unhappy child it is too much to pay. The teacher who feels
that she is not suited to the work; who has constantly to hold herself and
her temper under control; whose nerves are such that she cannot do justice
to herself, whose sense of justice is capable of perversion on purely
sentimental grounds; or who has lost--or never possessed--the gift of
maintaining discipline, should promptly find another position. She is  [33]
earning her salary under false pretenses, and that alone condemns her. I
believe, that a large percentage of the inefficiency of the New York
Schools is due, not to the academic or scholastic inability of the average
teacher, but to the average female teacher's physical, and especially her
psychical unfitness to teach. We must concede, however, that in many
instances the teacher's unfitness is a direct product of the pernicious
system itself.

[Illustration: _From "The Village of a Thousand Souls," Gesell, American
Magazine_

Evidence of a Feeble Mind

A dirty shack in a mud hole in the country is merely another reflection of
the same condition that causes the slums of the city. In our glowing spirit
of humanity we cry out to raise up "the submerged tenth." Rather, should we
not stamp them out of existence--treat them as a menace, and not as a thing
of pity?

Men, in general, rise; their minds are subjectively or objectively educated
to their mental limit. They cannot go beyond it. "The submerged tenth"
exists because its mental limit is low--often close to the upper margins of
feeble-mindedness--and because it is mentally incapable of rising to
anything else.]

[Illustration: _From "The Village of a Thousand Souls," Gesell, American
Magazine_

Evidence of a Vigorous Mind

The family that is vigorous, healthy in mind and body, "up and coming,"
reflects itself in a hundred different ways. Small matter whether or not it
is "an old family," has wealth, social position, a college education. A
daughter's or a son's happiness, the real, deep-down-inside happiness that
is worth while, may be more certainly insured by marrying with an eye to
mentality and stock than by a marriage into a so-called "first family."

Eugenics hath its reward.]

Under an ideal system of education the child would be left absolutely free
until the age of seven. We do not believe that the physical apparatus of
the mind is prepared for educational interference before that age, and we
know that the growth of the brain, physiologically and anatomically, is not
complete until after the seventh year.

The greater portion of a child's education necessarily depends upon its
environment. Heredity and environment, therefore, are the two factors which
determine the characters of any living thing. Heredity gives to the child
its potential greatness,--its promise of greatness. Whether these potential
qualities ever become real depends upon environment. A child may have the
hereditary (innate) ability to become a Shakespeare, but if his environment
is not suitable to the development of this potential greatness, he will
never realize his hereditary promise. In other words, the innate qualities
which he has, and which will make of him a Shakespeare are never "drawn
out" or educated. Hence he can never become great until environment
furnishes the means to him.

Environment, including education, does not add to the potential qualities
of inheritance. Education can only educate what heredity gives; it can give
or add nothing itself; it simply educates what is there already. There is
plenty of material, but it is not the right material. What educators want
is the right kind of material--the material which the eugenists will
eventually supply. Or as Mr. Havelock Ellis has expressed it:

"Education has been put at the beginning, when it ought to have been put at
the end. It matters comparatively little what sort of education we give[34]
children; the primary matter is what sort of children we have to educate.
That is the most fundamental of questions. It lies deeper even than the
great question of Socialism versus Individualism, and indeed touches a
foundation that is common to both. The best organized social system is only
a house of cards if it cannot be constructed with sound individuals; and no
individualism worth the name is possible unless a sound social organization
permits the breeding of individuals who count. On this plane Socialism and
Individualism move in the same circle."

Education, then, as an exclusive factor, cannot achieve our ideal of
race-culture. In order that education may achieve a large measure of
success, it must have the proper material, and the right material can only
come as a result of the working out of the eugenic principle. Then--in the
aftertime--our educational efforts will not be wasted and misdirected, as
they are almost wholly to-day.

If we could transmit our acquired characteristics, education would have a
relatively smaller, and a much more fixed function in the "general scheme,"
but we cannot. We can only transmit what was inherent in us when created.
This simply means that, at the moment of conception, the child is
created,--it is a completed whole,--what it is to be is fixed at that
moment, its inherent capacities are formed. Nothing can affect it, in this
sense, after that moment. No act of either parent can have any influence on
it. Whatever ability the father or mother possessed of an innate character
is transmitted to the child at the instant of conception and that innate
legacy constitutes the working instrument of the child for all time. It
cannot be added to by education, or by environment, but both of these may
have a large influence in deciding whether it will be developed to its
highest possible limit of attainment.

Education, mental, moral and physical, is limited by this inability to
transmit acquired character to the persons educated. Each generation must,
therefore, begin, not where their parents left off, but at the point   [35]
where they began. The same difficulties and the same problems must be met
at the beginning of each generation.

THE TRUE PROVINCE OF EDUCATION.--Education may justly be the instrument,
however, which will educate public opinion to a true appreciation of the
function of race culture. In this way the cause of the eugenist will
greatly prosper, and the race will profit through the effort which will
further the conservation of the best and most fit specimens for parenthood.
So also may education, through the molding of public opinion, create sound
opinion,--when each individual will be a center of eugenic enthusiasm.
Especially does this responsibility fall upon parents and those who are in
charge of childhood. The young must be taught the supreme sanctity of
parenthood. They must be instructed in eugenic principles in a way that
will impart to them the definite knowledge that it is the highest and
holiest science. The eugenic education of children is the real beginning at
the beginning, the indispensable necessity, if race culture is to assume
its transcendent role in modern civilization. It is urgently necessary for
both sexes but more especially for girls. "Urgently necessary," because,
though Herbert Spencer wrote the following criticism nearly fifty years
ago, the conditions are much the same to-day:--

... "But though some care is taken to fit youth of both sexes for society
and citizenship, no care whatever is taken to fit them for the position of
parents. While it is seen that, for the purpose of gaining a livelihood, an
elaborate preparation is needed, it appears to be thought that for the
bringing up of children, no preparation whatever is needed. While many
years are spent by a boy in gaining knowledge of which the chief value is
that it constitutes 'the education of a gentleman'; and while many years
are spent by a girl in those decorative acquirements which fit her for
evening parties; not an hour is spent by either in preparation for that
gravest of all responsibilities--the management of a family. Is it that
this responsibility is but a remote contingency? On the contrary, it is
sure to develop on nine out of ten. Is it that the discharge of it is easy?
Certainly not. Of all functions which the adult has to fulfill, this is the
most difficult. Is it that each may be trusted by self-instruction to  [36]
fit himself, or herself, for the office of parent? No; not only is the need
for such self-instruction unrecognized, but the complexity of the subject
renders it the one of all others in which self-instruction is least likely
to succeed."

It must be our highest educational aim to cultivate or create the eugenic
sense. In this way, and in this way only, may we feel satisfied that the
foundation, upon which shall be erected the generations that are yet to
come, will be of an enduring character.

       *       *       *       *       *


                                                                       [37]
CHAPTER IV

    "It is only because we are accustomed to this waste of life and are
    prone to think it is one of the dispensations of Providence that we go
    on about our business, little thinking of the preventive measures that
    are possible."

    CHARLES E. HUGHES.

EUGENICS AND THE UNFIT

    THE DEAF AND DUMB--THE FEEBLE-MINDED--A NEW YORK MAGISTRATE'S
    REPORT--REPORT OF THE CHILDREN'S SOCIETY--THE SEGREGATION AND TREATMENT
    OF THE FEEBLE-MINDED--WHAT THE CARE OF THE INSANE COSTS--THE
    ALCOHOLIC--DRUNKENNESS.

In order to achieve success in eugenics we must strive to encourage the
parenthood of the worthy or fit, and to discourage the parenthood of the
unworthy or unfit. The unfit are those, as previously explained, who,
because of mental or physical disability, are unable to create fit or
healthy children.

THE DEAF AND DUMB.--The condition known as deaf-mutism is due to innate
defect in about half of all cases. Deaf children have one or two deaf
parents or grandparents. There may be two or three such children in a
family. That the deaf should not marry is generally conceded by those who
work amongst them. It should be our aim to discourage the intimate
association of the adolescent deaf and dumb in institutions. It has been
found that such intimate association frequently results in marriage. They
should be educated and instructed in the knowledge that they cannot marry.
When they understand the eugenic principle upon which this social law is
constructed they will be amenable to reason. No process of suasion will be
necessary, however, if their intimate association is prevented.

THE FEEBLE-MINDED.--This includes the criminal, the imbecile, the insane,
and the epileptic. The feeble-minded, technically speaking, belong to the
degenerate class. They enter life mentally deficient, not necessarily  [38]
diseased. They should, therefore, be regarded as fit subjects for
educational modification rather than for penal correction or punishment. It
is conservatively estimated that there are five million feeble-minded
people in the United States to-day and not one-eighth of them are receiving
adequate treatment or education. Recent statistics, from various countries,
show that the percentage of deficient or feeble-minded children is
decidedly on the increase. According to a bulletin issued by the United
States Bureau of Education (August, 1912) there are 15,000,000 school
children suffering from physical defects which need immediate attention and
which are prejudicial to health. It would seem as though the time had
passed for anything other than radical measures in the interest of the
race.

Apart from the eugenic fact that these feeble-minded children are not fit
subjects for parenthood, they are a constantly contaminating influence on
society morally, and are a detriment and a hindrance to social and economic
advancement. One illustration of this contaminating process, which is of
serious eugenic import, is the presence of these deficient children in our
public schools. By reason of their lack of attention and concentration,
their mental or psychic insufficiency, their moral delinquency, and
uncontrollable instincts and impulses, they are a menace to the well-being
and to the progress of the normal or fit pupils; they retard and undermine
the discipline of the schoolroom, and they affect the efficiency of the
teachers. They are allowed to stay in school because of the indifference of
the authorities, or because of the influence and social standing, or
political "pull" of the parents, despite the recognition of the injustice
done. Many of the parents of these children seek medical advice but,
because of absurdly inadequate civic or state provision for such cases, the
physician is practically helpless. Most of these irresponsible children are
allowed to wander through the years unrestrained and unprotected. They
easily become the victims of vice and crime, and eventually they become
degenerates and end their lives in insane institutions. Because of the
stigma of degeneration these feeble-minded individuals fall into the   [39]
hands of the law and are thereby robbed of the medical assistance which
society should afford them in the early years when improvement is yet
possible.

The following report which recently appeared in one of the daily papers is
interesting and suggestive in this connection. One of the New York City
Magistrates, in his annual report, said: "There is growing up in this city
a menacing army of boys and young men who are the most troublesome element
we have to deal with.... From the ranks of these rowdies that are organized
in bands, or bound up with chums or pals, come most of the crop of
burglars, truck thieves, holdup men, gun-bearers, so-called 'bad men' and
other criminals and dangerous characters. Without reverence for anything,
subject to no parental control, cynical, viciously wise beyond their years,
utterly regardless of the rights of others, firmly determined not to work
for a living, terrorizing the occupants of public vehicles and disturbing
the peace of the neighborhoods, they have no regard for common decency."

But it is to the records of the Children's Society that one must go for
reliable statistics of the potential criminal, as there the only systematic
study of their conditions is made and recorded by one of the greatest
neurologists in the country, Dr. Max Schlapp, of New York. As a specialist
in nervous diseases he has been connected with the Children's Society and
the Children's Court, where he has had wide opportunities for observing the
relation between delinquence and mental defectiveness. In cases of
viciousness or feeble-mindedness exhaustive studies have been made by Dr.
Schlapp. And the extent to which society is daily at the mercy of
uncontrolled potential criminality is alarming.

"Feeble-minded children and feeble-minded men," says Dr. Schlapp, "are
roaming about the streets of New York to-day as free agents. Parents are
not compelled by law to put a feeble-minded child in custody. Yet that
feeble-minded child unsuspected as such, amiable and care-free as he
usually is, is potentially a criminal, and at any moment may commit a
crime. That child is permitted to grow up without restraint, except    [40]
such as the parents exercise, and this has no effect whatever in these
cases. The child is allowed to marry and bring forth children of his own
kind, more feeble-minded and more dangerous. There is no system designed to
pick out from the community persons so afflicted, and no law whatever to
prevent their untrammelled movements.

"The city street is a recruiting ground for the gangster because it is full
of defective children, mental and moral, who are potential criminals. This
question has never been seriously considered. When brought under corrective
restraint it has hitherto long been the custom to herd all the cases
together while serving time. But in 1894 the German Government woke up to
the fact that 3 to 7 per cent. of city children and those of isolated rural
communities contain the 'moron,' or intellectually defective type, together
with the moral imbecile."

Investigation showed recently that in a reformatory near Berlin 63 per
cent. of the inmates were abnormal, while over 50 per cent. were seriously
defective or menaces to society. This has since been shown to exist in all
the leading nations--England, France, Italy, where, by the way, the
Camorrist type is the equivalent for our New York gangster. In the Elmira
Reformatory 38 per cent. are, as a rule, feeble-minded and consist of types
that repeat their offense against society or commit some other crime.

There is only one way to prevent these types from becoming a menace.
Restrain them while they are still developing; keep them from becoming free
agents in the community they menace. Types continually come up in the
Children's Society and the Children's Court. They are carefully studied.
From the actions of the child, from his parents and family history, from
the frequency with which he repeats some offense particularly pleasing to
him, and by virtue of psychological tests and careful medical examinations
the examiners are able to pick out children who should receive scientific
care and treatment.

"The characteristics of the feeble-minded are usually deceiving. One
expects to find them with low brows and furtive looks and more or less
vicious in appearance after they develop criminal tendencies. One would[41]
expect them to show stupidity at a glance. On the contrary, they are
sometimes bright on the surface, amiable, good-tempered under trying
conditions, and almost likeable for their external social side. This is
particularly true of the high grade defectives. The lower order may be
taciturn, gloomy and retiring, and these traits may be noticed almost from
infancy. But as they grow up their social nature may be developed, and they
too may give the appearance of amiableness. One notable thing about them is
their pose of frank innocence. In this they are engaging, and almost
convincing.

"The street type that makes a gangster is practically the same if cruder in
development. These children usually exhibit absolutely no sign of affection
for their parents, no sympathy, and are notably cruel toward animals. One
boy we had in the Children's Society persistently killed all the dogs and
cats his family kept. Finally, when they ceased keeping the animals he got
at the canary cage and killed the bird by pulling the feathers out singly.
He had no compunction about lying, and looked you right in the eye when he
lied. Otherwise he was charming and natural."

While moral insanity is hereditary, yet it can be produced in one
generation. An alcoholic man with clean antecedents may leave tainted
descendants. The only way to combat these conditions in the city is to have
strict registration of all feeble-minded and insane. The state should
discover them, examine them through public officials, and segregate them.
Not only physicians, but school teachers and officials in public
institutions should detect them. There should be in each state an
institution for feeble-minded delinquents.

The history of the average "gangster" shows a taint of alcoholism. This is
further aggravated by living under immoral surroundings, where petty crimes
like stealing and lying are considered "smart." This is the starting point
of the New York "gangster." He is handicapped, and under ancestral
disabilities and the disadvantages of environment that is pernicious, he
cannot get very far. A boy usually qualifies with a gang on his own    [42]
personality and tastes. He will often wander from one gang to another until
he has found his particular atmosphere. The best will never find any one
gang congenial enough to hold him, and he finally emerges a decent citizen.
It is all a process of finding himself. The aim of the police should be to
discount as much as possible any swaggering and false hero worship.

The time has come when this great nation should take national cognizance of
this problem. There should be a national institution on some isolated
island. Civilization is coming to recognize such a necessity. With a close
eye on the tide of immigration and a careful segregation of these defective
types, we should soon rid ourselves of what is now growing to be a serious
menace to the home and the nation.

THE SEGREGATION AND TREATMENT OF THE FEEBLE-MINDED.--Dr. John Punton, of
Kansas City, Mo., in an able and exhaustive article on "The Segregation and
Treatment of the Feeble-Minded," writes as follows:

"Your attention is directed to a recent report issued by Wentworth E.
Griffin, Chief of Police of Kansas City, Mo., in which he claims that
recently within six months' time no less than 2,480 juveniles were arrested
charged with crimes ranging from vagrancy to murder and that the majority
of these boys and girls were not normal children, but degenerates who
required medical rather than penal treatment. 'Boys and girls,' says he,
'should not receive correction in the city jails, the work house or
reformatories. These should be the last resort. To correct a boy you must
have an idea of his mental processes. It is natural that the parents
understand something of the child and use that knowledge to make a good boy
out of him. Certainly it cannot be done in the reformatories, for although
the authorities there are competent, they are hardly medical psychologists.
In my opinion, if any progress is to be made it is the parent and the
doctor that must do the work, not the police and the courts.'

"That our Chief of Police deserves credit for not only publishing this
report, but also for the advanced position he takes in recognizing the
appropriate care and treatment of the juvenile offender, is certain,   [43]
for he understands the fact that the parents are often the chief culprits
in the child's delinquency and that medical rather than penal treatment is
more often indicated than is at present allowed or practiced.

"When we come to inquire into the cause of feeble-mindedness, alcoholic
heredity, syphilitic heredity, and consanguineous marriages are found to be
the chief etiological factors. Bourneville claims that 48 per cent. of the
idiots and imbeciles are the offspring of alcoholic parents.... Acute and
chronic diseases in the parents, fright, shock, injuries, parental neglect,
faulty education, poverty, malnutrition, social dissipation and lack of
proper control are all well-known factors in the production of
feeble-mindedness.

"Segregation of the feeble-minded is advocated by medical authority the
world over, and when this is done they can be made under appropriate
medico-pedagogic treatment to become largely self-supporting.

"As an economical as well as a humane measure, the various States can well
afford to make such provision, more especially for the large body of
feeble-minded who are now without any medical care whatever. Moreover,
where it is possible, laws prohibiting the marriage of such as well as all
other defectives should be passed and enforced."

WHAT THE CARE OF THE INSANE COSTS.--The total cost of the care of the
insane, in this country, has been estimated to be $165,000,000 a year. In
estimating the cost of the insane we must take into account the value or
worth of each adult to the State. This value has been computed to be $700 a
year. If, upon this basis, we count the adult membership of the insane
class between the ages of eighteen and forty-five, we find that their worth
is roughly about $132,000,000.

The cost of maintenance in the various insane institutions is about
thirty-three millions of dollars a year. It would be quite possible to
justly increase this total by estimating the worth of the help whose whole
time is devoted to the care of the insane. If these individuals worked at
some other trade or profession, their time would. be of value to the   [44]
state in general--not to a class who should be non-existent. The cost to
the state of the potential criminal is not included in this estimate.

From the above figures it may be observed that it costs more to simply
maintain the insane each year than it costs to work the Panama Canal; or to
pay for the total cost of the Executive, Legislative and Judicial
departments of our government. The total cost is more than the entire value
of the wheat, corn, tobacco, and dairy and beef products exported each year
from this country.

ALCOHOLIC DRUNKENNESS.--Alcoholism is a sign and a symptom of degeneracy
and is a distinct indication of unfitness for parenthood. The only cure for
alcoholism is to prohibit parenthood. It has been proved that alcohol taken
into the stomach can be demonstrated in the testicle or ovary within a few
minutes, and, like any other poison, may injure the sperm or the germ
element therein contained. As a result of this intoxication of the primary
elements, children may be conceived and born who become idiots, epileptics
or feeble-minded. It is asserted that 48 per cent. of all the idiots and
imbeciles are the offspring of alcoholic parents.

Recent experiments show that parental alcoholism alone can determine
degeneration. Mr. Galton quoted the case of a man who, "after begetting
several normal children became a drunkard and had imbecile offspring"; and
another case has been recorded of a healthy woman who, when married to a
drunkard, had five sickly children, dying in infancy, but in a later union
with a healthy man bore normal and vigorous children.

Dr. Sullivan found on inquiry that:

.... "Of 600 children born of 120 drunken mothers 335 died in infancy or
were still-born, and that several of the survivors were mentally defective,
and as many as 4.1 per cent. were epileptic. Many of these women had female
relatives, sisters or daughters, of sober habits and married to sober
husbands. On comparing the death rate amongst the children of the sober
mothers with that amongst the children of the drunken women of the same
stock, the former was found to be 23.9 per cent., the latter 55.2 per
cent., or nearly two and a half times as much. It was further observed [45]
that in the drunken families there was a progressive rise in the death rate
from the earlier to the later born children."

Dr. Sullivan cites as a typical alcoholic family one in which the first
three children were healthy, the fourth was of defective intelligence, the
fifth was an epileptic idiot, the sixth was dead born, and finally the
productive career ended with an abortion.

The nervous systems of many children of alcoholic parents are wrecked for
life; many die in convulsions as infants. Many, however, who do not die,
live as epileptics. This action of alcohol on the health and vitality of
the race is the most serious of the evils that intemperance brings on the
community. The tendency of all children of alcoholics is toward nervous
disorders of a grave type.

Statistics show a very high rate of still-births and abortions among the
children of drunken mothers, show that drunken women must not be permitted
to become mothers.

Dr. Branthwaite in a lecture stated: "In my judgment, habitual drunkenness,
so far as women are concerned, has materially increased, during the last
twenty-five years, which I have spent entirely amongst drunkards and
drunkenness. These people are not in the least affected by orthodox
temperance efforts; they continue to propagate drunkenness, and thereby
nullify the good results of temperance energy. Their children, born of
defective parents, and educated by their surroundings grow up without a
chance of decent life, and constitute the reserve from which the strength
of our present army of habitual drunkards is maintained. Truly we have
neglected in the past, and are still neglecting, the main source of
drunkard supply--the drunkard himself; crippled that and we should soon see
some good results from our work."

Dr. Fleck, another authority, says: "It is my strong conviction that a
large percentage of our mentally defective children, including idiots,
imbeciles and epileptics, are the descendants of drunkards."

Therefore the chronic inebriate must not become a parent.

       *       *       *       *       *


                                                                       [47]
CHAPTER V

    "The real undermining of health is not seen. It is done in an insidious
    way. It has to be carefully ferreted out."

    DR. HARVEY W. WILEY.

WHAT EVERY MOTHER SHOULD KNOW ABOUT EUGENICS

In the preceding pages we have written about eugenics as a science; it is
our intention now to point out briefly in just what way eugenics directly
concerns the mothers of to-day. In the first place let us try to appreciate
what it will mean to the race if "the fit only are born." "Fit" children,
it will be recalled, means children born healthy of healthy, selected
parents, parents with a good ancestral history, conveying to their
offspring a reasonably adequate legacy. If the "fit only are born" we start
with a healthy stock. What a significant and tremendous advantage this is.
At once we rid the world of the potential inefficients--the feeble-minded,
the insane, the criminal, the deaf-mute, the drunkard. If we are correct in
assuming that the reason why all former civilizations have failed and
passed away, was because they bred a race of people physically and mentally
unfit to survive, the demand of the eugenist that only "fit children shall
be born" will strike at the very root of this evil. If we uproot the cause
of racial degeneration we begin the building of a race that should not
degenerate. If we establish a race that will not degenerate, it must gain
strength and virility with each generation.

This assumption is logically correct, but we must do more than breed "fit"
children. We must take care of them after they are born. We must furnish
them with a good environment (see page 3). Heredity without favorable
environment counts for very little,--we must never forget that. Heredity
and environment are the two important determining factors in the life of
every child born. If eugenics furnishes the heredity by ensuring the   [48]
birth of the "fit" only, it depends upon the mothers of the race to provide
the environment. Every mother must know how to take the best care of
herself and of her child. This book is devoted to instructing her in the
details of this duty.

We cannot hope, however, to reach this high altruistic plane by simply
taking the first step in the right direction. We who are alive to-day must
begin the work, and leave it to posterity to carry forward. We must do our
part. Every mother must become an enthusiastic eugenist. If she begins to
teach, and preach, and practise its principles now, she will contribute to
the heredity of unborn generations. To those of us who are alive to-day,
environment is the vastly more important consideration, for our heredity is
fixed and beyond the power of control. The question of eugenics for the
present generation, therefore, is a question of environment.

All our efforts must be directly in developing what heredity gives our
children. We are wholly responsible for that. We must feed and clothe them
properly; we must provide air spaces and playgrounds for exercise; we must
educate them, and protect them from disease; and we must safeguard the
birth of future generations by keeping our race stream pure. This is no
small task, and the only way it will ever be satisfactorily accomplished is
for each mother to realize her individual trust. The average individual
does not realize the actual conditions that prevail. When recently the
question of the public health was investigated by competent authorities,
and the report furnished to the United States Senate, it caused a
tremendous sensation. If that is possible in a body composed of men who are
supposed to be intelligent and wide-awake to existing conditions, how much
more significant and appalling it should be to the average mother whose
interest is centered in her own home.

According to the statistics and statements given in that document the
annual financial loss from needless deaths and accidents alone amounted to
$3,000,000,000. [Page 49]

Acute diseases are held responsible for a large part of the loss. Chronic
diseases are responsible for the greatest part of the waste of life, and
they are believed to be increasing in their ravages. Minor ailments,
believed to be nine-tenths preventable, are now costing the nation many
dollars through incapacitation of persons and through leading to serious
illness. Industrial accidents, largely preventable, are also exacting a
heavy toll annually.

That this great waste of life and health and the national economic loss
that results can be modified by national action is asserted. Here are to be
found the reasons advanced for a great national department of health. The
work of this department would be varied. It would include direct work in
promoting health on the part of the government, such as administering the
food and drug act; aiding the healing and educational agencies, both city
and State; obtaining information concerning the cause and prevention of
diseases, and disseminating scientifically proved information on all health
subjects.

It is maintained that the movement for the conservation of health is the
most momentous of the conservation movements in this country, and that of
all the national wastes which are to be condemned, this waste of health is
the gravest.

Many startling statements are set forth in the document. Dr. Charles
Wardell Stiles, of the United States Public Health and Marine Hospital
Services, declares that "The United States is seven times dirtier than
Germany and ten times as unclean as Switzerland." He declares that: "Lack
of interest in preventive measures against diseases is slaughtering the
human race." He takes the position that the real trouble is not so much
race suicide as race slaughter, and that it is rather that too many
children are allowed to die than that not enough children are born.

It is estimated that tuberculosis, a preventable disease, costs the nations
$1,000,000,000 annually. Typhoid fever is estimated by Dr. George M. Kober,
dean of the medical department of Georgetown University, to cost over
$300,000,000 annually. [Page 50]

In connection with acute diseases this statement is made: "The loss from
tuberculosis has been reduced to half of what it was thirty years ago.
Nevertheless, of the 90,000,000 people now living in the United States at
least 5,000,000 will be lost through this disease because adequate effort
is not made to prevent it. Besides the economic waste through deaths from
any disease, the waste through sickness from the same disease is also
colossal."

Great as are the reductions in the rates of infant mortality by improved
milk and water supplies and by educational campaigns, the present rate is
still enormous.

"If some witch or wizard could conjure up the unnecessary babies' funerals
annually occurring in this country it would be found that the little
hearses would reach from New York to Chicago. If we should add the mourning
mothers and friends, it would make a cortége extending across the
continent."

While the death rates from acute diseases have been greatly reduced, the
rates from chronic diseases have been steadily increasing. Cancer is one of
the chronic diseases apparently on the increase.

That the annual death toll and the 3,000,000 constant sick beds could be
reduced from one-fourth to one-half by proper measures is asserted. In
other words, there might be saved every day, as many lives as perished on
the _Titanic_, with the consequent enormous economic saving.

These are surely impressive statements. It would seem as though it should
be a simple task to pass a Public Health Bill, establishing a bureau in
Washington, with a representative in the cabinet, whose sole duty it would
be to preserve the public health. It has proved rather the reverse,
however. We have been able to inaugurate various species of
conservation,--of lands, of forests, of water,--but the conservation of
human life is not important enough. Even though states and empires depend
upon their people for their very existence, our statesmen feel that human
life is too cheap, too common, to take immediate steps in this direction.

If women--especially mothers--would devote themselves to the eugenic   [51]
end of legislation, men would soon obey. The application of eugenics to the
human species, coming, almost in the spirit of an inspiration, at the time
when women are about to be enfranchised, is significant. It may be that
destiny has decreed that the one shall be the complement of the other; it
is certainly beyond contradiction that in eugenics the women of the earth
have a divine weapon with which to wage a righteous and an awaking
propaganda of truth.

A mother should be interested in every phase of the subject. Her daughter's
success in marriage should intimately concern her. Her health and her
happiness in that sphere should elicit her deepest maternal consideration.
She may rightly hope to be proud of her daughter's offspring, and to find
pleasure in the society of her grandchildren. She should, therefore, devote
all her efforts to ascertain the truth, with reference to the physical and
mental equipment of her future son-in-law; his ability adequately to
support a family; his sobriety, his disposition, associates, etc., should
all be carefully considered and pondered over. This is not going far
enough, however; we must know positively that he is not diseased,--that he
is not a victim of gonorrhoea or syphilis.

When parents weigh in the balance the possibility of a wrecked life, of
destroying the right to have children, or of bringing them into the world
blind or diseased; of permanently destroying the hope of happiness, peace,
and success, no combination of advantages in a son-in-law is deserving of
the slightest consideration. We are treating of the sacred things of
life--of life itself. If parents combine to crucify and betray their
daughters--to sell them body and soul into bondage for social or other
advantages; if they preserve silence when they should speak and thereby
take all the sunshine, for all eternity, out of one existence; then, if on
their death-beds these daughters should accuse them, the guilty knowledge
that they were responsible will be the sting that will blast their hope of
peace and forgiveness here and in the worlds to come.

When mothers realize that, every day, in every large hospital in every city
in the civilized world some woman (a daughter of some mother) is being [52]
unsexed because of these unjustly obtained diseases, surely their voices
shall speak in no uncertain way.

Another eugenic suggestion that should deeply concern every good mother is,
that the mother's milk is the private property of the babe, and whoever
deprives the babe of this, the sole right it possesses, is not only a thief
but a scoundrel. A curious and significant fact was discovered by
investigators when studying the question of infant mortality a few years
ago. It was found from a mass of statistics that there were two recent
instances when the death rate of infants decreased suddenly and quite
decidedly. The first instance was when the Civil War in this country caused
a cotton famine in England. As a result of the famine the factories of
Lancashire were all closed and the employees being then without work
remained at home. As a large percentage of the workers were married women
with children they had the time and the opportunity to nurse their children
regularly. Despite the fact that these women were starved and badly clad
and deprived of the comforts of home, the death rate of the infants dropped
steadily to an unprecedently low mark.

A number of years later, when the German army surrounded Paris during the
Franco-Prussian War the besieged inhabitants of the capital suffered from
hunger and disease. The death rate of the adult population increased
enormously while the death rate of the infants dropped markedly.

The explanation of this curious phenomenon was simply that while times were
normal the women labored outside of their homes and as a consequence the
babies were not fed regularly and when fed were not fed mothers' milk. It
demonstrated a truth that we are apt to lose sight of, that mothers' milk,
even the milk from badly-nourished, poverty-stricken mothers is infinitely
better than an abundant supply of artificial food combined with neglect. In
view of the fact that there is a distinct tendency to evade this maternal
duty these facts should be suggestive and important. It is the duty of the
mother with any eugenic sense to preach and to practise this gospel.   [53]
Paris learned the lesson of the siege because though she has the smallest
birth-rate to-day, she nevertheless has the smallest infant death-rate of
any large city in Europe.

The writer believes that in eugenics the women of the race have the
instrument wherewith to save the world. He is assured that it is the
supreme potential agency for the betterment of the race, and that mankind
will never be inspired with a holier cause. He believes that through all
the ages the human race has been growing better, coming nearer the truth,
and that as a result of this patient progress, there has been evolved the
eugenic idea that is to solve the problems of the human family. If the "fit
only are born" think of the possibilities of education and of environment.
Each child is born with a great potential promise, and endowed with a
reasonably good heredity, the whole effort of that child will be toward a
higher moral attainment. If the effort of the individuals of the race is to
achieve a high moral success, the quality of the civilization of future
generations will be far superior to the type with which we are familiar.

Eugenics gives to women the supreme civilizing instrument of the future. It
places the burden of the morality of the home and of the race on their
shoulders. If we deny the writing on the wall it does not render the
warning negative. The signs of the times are epochal. The great political
parties are realizing, for the first time in history, that new and
important issues concerning the family, the home, and the children, in
other words the nation's manhood and womanhood, must be considered and
included in their platforms. They know that the time has gone when
statesmen will exclusively decide what shall be done with the sons and
daughters which women bring into the world. They know that the mothers of
the race must have a voice in deciding for peace or war since they create
every soldier that will lie dead when war is over. Women will help decide
the question of taxation by government and by trusts, because they know
that it comes out of their incomes and they need it all for their children.
Women know that their cause is the cause of freedom, and freedom is the[54]
cause of the eugenist. They know that the function of government should be
justice and no code of justice can have higher ethics than the ethics of
eugenism.

MOTHERS' EUGENIC CLUBS.--There should be established in every community a
mothers' eugenic club. The object of the club should be to further the
eugenic idea. Papers should be prepared, read, and discussed on subjects
having a eugenic interest.

One of the main aims of these clubs should be to interest the local
Congressman and the member of the State Legislature in eugenics. In all
probability they will know nothing specific about race-culture--unless they
are exceptional men--in which case it will be the duty of the members of
the club to educate them. The object of such education of course would be
to ensure that they will act intelligently when any legislative proposal is
made having a eugenic interest. Find out what they know about the public
health as contained in the report on page 48, and if they will vote in
favor of a Public Health Bureau. You should know how your representatives
stand on the Pure Food and Drugs Act; if they really appreciate the
significance of the measure; if they would be in favor of pensioning
mothers and widows who have children depending upon them; what their views
are regarding compulsory marriage licenses; the reporting of venereal
diseases to the local health authorities; if they would favor the
segregation of the feeble-minded and their maintenance and treatment by the
state; if they endorse the eugenic principle that "the fit only shall be
born," and if they really understand just what that means.

If the mothers in every community would take this step, they could control
the legislation affecting such subjects in a comparatively short time. If
the various States concede to women the right to vote--as they will sooner
or later--such mothers' clubs would have a large and intelligent share in
educating the women's votes on questions which directly concern their own
immediate and remote welfare.

The question of education would concern these clubs and much could be done
by mothers to direct the authorities as to just what is needed to educate
for [Page 55] parenthood, along the lines suggested elsewhere in this book.

A mothers' eugenic club would rightly become an instrument for good in all
local sociological interests. It could maintain a trained nurse to care for
the sick and helpless, to teach the people how to live, and how to care for
their homes and their children. The members themselves could visit the
poor, the needy, and the sick.

There are so many people in the world who are near the brink of
failure,--so many who need a little hope infused into their lives,--and so
many who are really deserving of help and sympathy and inspiration. The
women who do this work for the work's sake are amply repaid by the good
they find to do. The doing of such work is a consecration and an education.
Life means more, and the whole temperament reflects a truer sympathy and a
stronger purpose.

There are many mothers, for example, who are willing to do what is
essential in the interest of their children, but they do not know what
should be done. These people cannot afford a physician or a nurse to teach
them, nor do they even know that their methods are wrong or that they need
any instruction. We must carry the information and the explanation to them.
We must show them the need for a change of methods. This is the work for
those charitably disposed women who desire some worthy purpose in life, who
really wish to do some genuine good. All the equipment they need is good
common sense. They will explain why it is essential to pasteurize the milk
before feeding it to the baby because most of the milk used by the poor is
unfit for use as a baby food. They will show how to keep the nipples and
the bottles clean, and they will give them lessons on how to prepare the
food to the best advantage. They will instruct them how to dress the baby
in hot weather, and they will explain why it is necessary to provide the
baby with all the fresh air possible. They will gain the confidence of
these mothers and they will tell them all they know, in tactful and
diplomatic and common-sense language so that they may appreciate the
eugenic reasons for everything they do regarding the care and well-being of
the baby. In every city in the country this work is needed and is      [56]
waiting for the missionaries who will volunteer. To teach mothers the need
for boiled water as a necessary drink for baby and older children is alone
a worthy avocation. To impress upon one of these willing but ignorant
mothers the absolute necessity for washing her hands before preparing
baby's food, that she must keep a covered vessel in which the soiled
napkins are placed until washed, that she should frequently sponge her baby
in hot weather,--and explain thoroughly why these are important
details,--is a work of true religious charity. They should be taught to rid
their houses of flies, and especially to keep them from the baby and from
its food, bottles, and nipples. They should be instructed to discontinue
milk at the first sign of intestinal trouble, to give a suitable dose of
castor oil, and to put the child on barley water as a food until the danger
is passed. They should be taught to know the serious significance of a
green watery stool, that it is the one danger signal in the summer time
that no mother can ignore without wilfully risking the life of her baby.
They should be shown how to prepare special articles of diet when they are
needed. If every mother were educated to the extent as indicated in the
above outline the appalling infant mortality would fall into
insignificance. It is not a difficult task, nor would it take a long time
to carry out; it is the work for willing women who have time and who
perhaps spend that time in less desirable but more dramatic ways. It is
education that is needed, and it is education that is willingly received,
as all mothers are ready to devote their time in the acquirement of
knowledge that will help them save their offspring. This is the eugenic
opportunity and it is an opportunity that should devolve upon the women of
the race.

Such a mothers' club would receive the willing financial support of the men
of the community. It should be placed upon a sound financial basis because,
to be successful, it would have to bestow much material aid. I know of
clubs that are self-supporting, however. Each club needs a leader to begin
it; will the reader be that one in her Community?

A Mothers' Eugenic Club would of course discuss the practical side of  [57]
the eugenic question: the proper feeding and clothing of children; hygiene,
sanitation, housekeeping and homemaking, and the efficiency and health of
each member of the home, and all other topics of interest to every wife and
mother. The writer believes that in the very near future we shall have a
Mothers' Eugenic Club in every community in the United States; that these
clubs will be guided by, and be an instrument of, a National Eugenic
Bureau, composed of women, that will coöperate and harmonize the work as a
whole, so that the conservation of human life will be effected to its
maximum extent; that the excessive infant mortality will be overcome,
because ignorant and incompetent mothers--the greatest cause of infant
mortality--will be educated and instructed in the rudiments of eugenics and
will consequently, to a large extent, cease to be ignorant and incompetent;
that the desecration of young wives will stop, and stop forever, because
vice and disease will be branded and exposed; that the feeble-minded, the
deaf-mute, the imbecile, and the insane, will no longer be allowed to
propagate their kind, to the permanent detriment of the race.

When such clubs are established, and when all mothers do their individual
duty in the interest of the race, we shall begin to see the dawn of a
promise that will achieve its supreme success in the generations that will
people the earth in the eugenic aftertime.

       *       *       *       *       *


                                                                       [61]
CHILD-BIRTH

CHAPTER VI

    "Solicitude for children is one of the signs of a growing civilization.
    To cure is the voice of the past; to prevent, the divine whisper of
    to-day."

    KATE DOUGLAS WIGGIN.

PREPARATIONS FOR THE CONFINEMENT

    THE BIRTH CHAMBER--WHAT TO PROVIDE FOR A CONFINEMENT--READY TO PURCHASE
    OBSTETRICAL OUTFITS--POSITION AND ARRANGEMENT OF THE BED--HOW TO
    PROPERLY PREPARE THE ACCOUCHMENT BED--THE KELLY PAD--THE ADVANTAGES OF
    THE KELLY PAD--SHOULD A BINDER BE USED?--SANITARY NAPKINS--HOW TO
    CALCULATE THE PROBABLE DATE OF THE CONFINEMENT--OBSTETRICAL TABLE--WHEN
    SHOULD A PREGNANT WOMAN FIRST CALL UPON HER PHYSICIAN--REGARDING THE
    CHOICE OF A PHYSICIAN--HOW TO KNOW THE RIGHT KIND OF A PHYSICIAN FOR A
    CONFINEMENT--THE SELECTION OF A NURSE--THE DIFFERENCE BETWEEN A TRAINED
    AND A MATERNITY NURSE--DUTIES OF A CONFINEMENT NURSE--THE REQUISITES OF
    A GOOD CONFINEMENT NURSE--THE PERSONAL RIGHTS OF A CONFINEMENT
    NURSE--CRITICIZING AND GOSSIPING ABOUT PHYSICIANS.

THE BIRTH CHAMBER

The room in which the confinement is to take place should be selected with
care. In many cases there will be no choice for the reason that there will
be only one suitable bedroom available. Where practicable however a room
having the following accessories, or as many of them as is possible, should
be given the preference.

    1.--Good light, and a southern exposure.

    2.--Capable of being well ventilated and well heated if necessary.

    3.--Running water if plumbing is modern.

    4.--Fairly large size (not a hallroom).

    5.--A quiet room, free from street noises.

If the house is a private one the room should be on the second floor. If
the home is in an apartment house the confinement chamber should be as [62]
far removed from the living-room as circumstances will permit,--especially
if there are other children who will make more or less continuous noise.

All unnecessary furniture, pictures and draperies should be taken out of
the room a few days before the confinement is due; the room itself, and
everything left in it, should be thoroughly cleaned and aired. A small
table for holding instruments, sterilizing basins, etc., should be provided
and in readiness.

WHAT TO PROVIDE FOR A CONFINEMENT.--The following articles should be in
readiness at all confinements:--

    1.--Douche pan.

    2.--Bed pan.

    3.--Douche bag (fountain syringe) with glass douche tube.

    4.--One rubber sheet 1½ yards square.

    5.--Two bed pads, one yard square, made of absorbent cotton or old
    clean cloths, covered with washed cheese cloth and stitched here and
    there to hold in place.

    6.--One dozen clean towels.

    7.--One-half dozen clean sheets.

    8.--A hot water bottle.

    9.--One pound absorbent cotton (good quality).

    10.--Five yards sterile gauze.

    11.--Four quarts of hot, and as much cold water, that has been boiled.

    12.--One-half dozen papers assorted safety pins.

    13.--One box sanitary pads.

    14.--Four pieces of unbleached cotton or muslin, one and one-quarter
    yards long.

    15.--Four ounces powdered boracic acid.

    16.--Four ounces of brandy or whisky.

    17.--One jar of white vaseline (unopened).

    18.--One cake of castile soap.

    19.--Two or three agate or china hand basins.

    20.--One slop jar.

    21.--One pan under bed for after birth.

The physician will direct that certain additional articles be provided
according to his individual taste and custom. These will include an    [63]
antiseptic and ergot; any other requisite found necessary can be sent for,
or the physician can supply it, as he invariably has in his bag whatever
may be required in complicated cases or in an emergency. All the items
enumerated in the above list are absolutely essential, they may not all be
used but it would not be safe to undertake a confinement without providing
the essential requisites. Many maternity outfits are prepared ready for use
and can be obtained at the larger drug stores, costing from $10 to $25. The
articles in the above list can be bought for about $6, not including those
articles which the patient is assumed to have. The following are samples of
the ready-to-purchase outfits:

READY-TO-PURCHASE OBSTETRICAL OUTFITS

          OUTFIT NO. 1
  1 Sterilized Bed Pad (30 inches square).
  2 dozen Sterilized Vulva Pads.
  2 Sterilized Mull Binders (18 inches wide).
  5 yards Sterilized Gauze.
  1 pound Sterilized Absorbent Cotton (½ pound).
  Rubber Sheet, 1½ yards by 2 yards, Sterilized.
  Douche Pan, Sterilized.
  1 Tube K-Y Lubricating Jelly.
  Sterilized Nail Brush.
  Boric Acid, Powdered.
  Tinct. Green Soap.
  Bichloride Tablets.
  Lysol.
  Tube Sterilized Tape.
          PRICE $10.00.

          OUTFIT NO. 2.
  2 Sterilized Bed Pads (30 inches square).
  2 dozen Sterilized Vulva Pads.
  2 Sterilized Mull Binders (18 inches wide).
  6 Sterilized Towels.
  10 yards Sterilized Gauze.
  [Page 64]
  1 pound Sterilized Absorbent Cotton (½ pound).
  Rubber Sheet, 1 yard by 1½ yards, Sterilized.
  Rubber Sheet, 1½ yards by 2 yards, Sterilized.
  4 quart Sterilized Douche Bag with glass nozzle.
  Douche Pan, Sterilized.
  Sterilized Nail Brush.
  2 Agate Basins, Sterilized.
  Safety Pins.
  2 Tubes Sterilized Petrolatum.
  1 Tube K-Y Lubricating Jelly.
  Boric Acid, Powdered.
  100 grms. Chloroform (Squibb's).
  Fl. Ext. Ergot.
  Tinct. Green Soap.
  Bichloride Tablets.
  Lysol.
  Tube Sterilized Tape.
  Sterilized Soft Rubber Catheter.
  Sterilized Glass Catheter.
  Stocking Drawers, Sterilized.
  Talcum Powder.
  Bath Thermometer.
          PRICE $19.50.

These materials, being cleansed and sterilized, are ready for use at any
time.

These complete outfits are packed in neat boxes, thus enabling the contents
to be kept intact until needed.

THE POSITION AND ARRANGEMENT OF THE BED.--The bed should be a substantial
single bed. If a double one is used, prepare the side for the confinement
which will permit the physician to use his right hand,--that will be the
right side of the patient as she lies in bed. One objection to a double bed
is its tendency to sag. This tendency can be obviated however by placing an
ironing board under the spring from side to side, or by using shelves from
a book case. This expedient will support the mattress, thereby rendering
the bed firm and free from any sagging tendency. The position of the bed in
the room should be such that the patient will not directly face the window
light, nor be in a direct draught between the window and the door. It  [65]
should be so arranged that the nurse can get easily to either side,
consequently it must not be pushed against the wall.

HOW TO PREPARE THE ACCOUCHMENT BED.--Over the mattress place the rubber
sheet so that its center will be exactly under the hips of the patient. Pin
with large safety pins each corner of the rubber sheet to the mattress; now
put the sheet on exactly as you do when making an ordinary bed. On top of
the sheet, and in the middle of the bed (again where the patient's hips
will rest), place a draw sheet. A draw sheet is a sheet folded once, placed
across the bed, and pinned tightly with large safety pins to the mattress
at each side. The advantage of this sheet is, that it can be removed when
necessary, leaving the original clean sheet on the bed, without disturbing
the patient. Be particular not to have the top of the draw sheet higher
than the middle of the patient's back. Place the pad,--previously prepared
for the purpose,--on the draw sheet and level with the top of the draw
sheet.

Most physicians carry with them to all confinements a _Kelly pad_. A Kelly
pad is a rubber pad with inflated sides, which is put under the patient's
hips, and which retains all the discharges incident to a confinement so
that when it is removed the bed is clean and fresh. The advantage of the
Kelly pad is twofold; first, it ensures a clean, compact, systematic
confinement; second, its use subjects the patient to the least necessary
movement at a time when movement is distressing, painful, and frequently
dangerous. If a Kelly pad is not used, it is desirable to place under the
pad (between the pad and the draw sheet) a piece of oil cloth or rubber
sheeting, or a number of newspapers will do. This will prevent, to a
considerable degree, the discharges from soaking through the pad on to the
draw sheet and sheet and mattress below.

After the confinement is over and the patient is clean, remove the Kelly
pad, and the pad below if necessary, or the pad and newspapers if these are
used,--place a clean pad under the patient and you are ready to place the
binder on if a binder is to be used. [Page 66]

SHOULD A BINDER BE USED?--Medically a binder is not necessary, neither is
it objectionable from a medical standpoint. It is supposed to hold the
flaccid, empty womb in place. This it does not do and we are of the
opinion, that it, in many instances, according to how it is put on,
compresses the womb out of place. The binder is certainly appreciated by
most patients because of its snug, comfortable feeling; and in cases when
the abdominal wall is fat and the muscles soft, it holds them together in a
way that is impossible by the use of any other device. To claim that the
binder prevents hemorrhages is absurd. Our personal rule is to put one on
if the patient wants one, or if she has previously had one. To be
effective, in any sense, the binder should extend from the waist line down
to halfway between the hips and knees and should be snugly, but not too
tightly pinned.

SANITARY NAPKINS.--These can be purchased already prepared in most drug
stores, or they can be made in the following manner: Take an ordinary grade
of cheese cloth, wash it, and when dry, cut it into half yard squares. In
the center of each square place a strip, six or eight inches long, of
absorbent cotton and fold the gauze lengthwise over it so as to make a pad.
These can be used as napkins, and after they are soiled can be burned. It
is absolutely wrong to use rags or any old cloths for napkins, as the
patient can be infected and made seriously sick by this procedure.

HOW TO CALCULATE THE PROBABLE DATE OF THE CONFINEMENT.--The duration of
pregnancy extends for 280 days from the end of the last menstruation. Add
seven days to the date of the last menstruation, and from that date count
ahead nine months, or backward three months and you may have the probable
date of the confinement. Should you pass this time you will probably go on
for two additional weeks. The reason for this is that the most susceptible
time for conception to occur is either during the week following
menstruation or a few days before menstruation. If, therefore, you pass the
above probable date which was calculated from the end of the last
menstruation, it shows that conception did not take place during the   [67]
week following that menstruation; and the assumption will be that it took
place a few days before the next menstruation, which will be about two
weeks later than the date as calculated above.

If, for example, a pregnant woman was last sick from January 1st to 5th we
add seven days to the 5th, which is the 12th, to which we add nine months,
which will give us, as the probable date of confinement, October 12th.
Should she go a few days over the 12th, the probability is that the
confinement will take place on October 26th.

  TABLE FOR CALCULATING THE DATE OF CONFINEMENT
  -----------------------------------------------------------------
  JAN.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
  OCT.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
  -----------------------------------------------------------------
  JAN.  21 22 23 24 25 26 27 28 29 30 31
  OCT.  28 29 30 31  1  2  3  4  5  6  7   NOV.
  -----------------------------------------------------------------
  FEB.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
  NOV.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
  -----------------------------------------------------------------
  FEB.  21 22 23 24 25 26 27 28
  NOV.  28 29 30  1  2  3  4  5            DEC.
  -----------------------------------------------------------------
  MAR.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
  DEC.   6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
  -----------------------------------------------------------------
  MAR.  21 22 23 24 25 26 27 28 29 30 31
  DEC.  26 27 28 29 30 31  1  2  3  4  5   JAN.
  -----------------------------------------------------------------
  APR.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
  JAN.   6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
  -----------------------------------------------------------------
  APR.  21 22 23 24 25 26 27 28 29 30
  JAN.  26 27 28 29 30 31  1  2  3  4      FEB.
  -----------------------------------------------------------------
  MAY.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
  FEB.   5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
  -----------------------------------------------------------------
  MAY.  21 22 23 24 25 26 27 28 29 30 31
  FEB.  25 26 27 28  1  2  3  4  5  6  7   MAR.
  -----------------------------------------------------------------
  JUNE   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
  MAR.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
  -----------------------------------------------------------------
  JUNE  21 22 23 24 25 26 27 28 29 30
  MAR.  28 29 30 31  1  2  3  4  5  6      APR.
  -----------------------------------------------------------------
  JULY   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
  APR.   7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
  -----------------------------------------------------------------
  JULY  21 22 23 24 25 26 27 28 29 30 31
  APR.  27 28 29 30  1  2  3  4  5  6  7   MAY
  -----------------------------------------------------------------
  AUG.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
  MAY    8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
  -----------------------------------------------------------------
  AUG.  21 22 23 24 25 26 27 28 29 30 31
  MAY   28 29 30 31  1  2  3  4  5  6  7   JUNE
  -----------------------------------------------------------------
  SEPT.  1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
  JUNE   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
  -----------------------------------------------------------------
  SEPT. 21 22 23 24 25 26 27 28 29 30
  JUNE  28 29 30  1  2  3  4  5  6  7      JULY
  -----------------------------------------------------------------
  OCT.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
  JULY   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
  -----------------------------------------------------------------
  OCT.  21 22 23 24 25 26 27 28 29 30 31
  JULY  28 29 30 31  1  2  3  4  5  6  7   AUG.
  -----------------------------------------------------------------
  NOV.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
  AUG.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
  -----------------------------------------------------------------
  NOV.  21 22 23 24 25 26 27 28 29 30
  AUG.  28 29 30 31  1  2  3  4  5  6     SEPT.
  -----------------------------------------------------------------
  DEC.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
  SEPT.  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
  -----------------------------------------------------------------
  DEC.  21 22 23 24 25 26 27 28 29 30 31
  SEPT. 27 28 29 30  1  2  3  4  5  6  7   OCT.
  -----------------------------------------------------------------

                                                                       [68]
The foregoing table affords us a handy means of finding the probable date
of confinement at a glance.

Find the date of the last day of the last menstrual period in the upper
row; the date immediately below it is the probable date of confinement.

For example if the last menstrual period was from Jan. 1st to 5th, we find
January 5th and below it we note October 12th as the probable date of
confinement.

WHEN SHOULD A PREGNANT WOMAN FIRST CALL UPON HER PHYSICIAN?--The earliest
indication of pregnancy is the interruption of menstruation. When
menstruation fails to appear at its regular time in a young married woman
whose past menstrual history is good,--i.e., she has been sick every month
regularly and without pain since she began menstruating as a girl,--the
assumption would naturally be that she was pregnant. Menstruation may
however "miss" one month for other reasons than pregnancy just at this
time, as is explained elsewhere, so it is wise to defer a positive
assumption on such an important matter. When the second menstruation does
not appear, and there are no specific reasons for its failure to appear, it
may be safely assumed that pregnancy has taken place. A visit to the family
physician one week after the second menstruation should have appeared, or
at least long enough to feel absolutely certain that the sickness is not
coming around, is not only necessary, but is the essential and correct step
to take for a number of very good reasons. If a woman for example has not
had a baby, how does she know she can have one? It is quite possible to
become pregnant and yet it may be wholly impossible to give birth to a
child. It is necessary to be constructed normally, or as near what is
regarded as normal as is possible, in order safely to assume the
responsibility of carrying a pregnancy to a successful completion. No one
but a physician, who is skilled and familiar in the knowledge of what
constitutes the proper size, and shape, and quality, and relations, one
with another, of your bones, and ligaments, and muscles, can tell      [69]
whether you can safely be permitted to carry a pregnancy to term or not. If
the anatomical conditions are not just right; if circumstances from a
medical standpoint are not favorable; if your personal risk is too
hazardous; if, in other words, medical science should decide that you are
one of the very few women who cannot have a baby, is it not of very great
importance that you should know this as soon as possible? Does not that
fact alone render your early call upon your physician imperative? A
physician can bring out facts, relating to the personal and family history,
and habits, of the prospective mother, which will enable him to formulate
advice which will prove of the highest value from the very beginning of
pregnancy. Instructions carried into effect at this early date, as to
personal conduct, exercise, diet, etc., will have a distinctly beneficial
influence, not only on the patient's health and the character of her
confinement, but on the physical vitality of the coming baby.

REGARDING THE CHOICE OF A PHYSICIAN.--This is a matter that should receive
the most careful consideration. While it is just to admit that every
physician is capable of successfully conducting maternity cases, there are
certain characteristics in the individual temperament that would seem to
indicate that some physicians are better adapted to this special work.

Trustworthiness is an imperative essential in a physician who assumes the
responsibility of confinement engagements. He must be clean in his personal
habits as well as morally. He should possess the virtue of patience and be
tactful, and above all he should be made to feel that he has your implicit
confidence. If you will analyze these qualifications you will understand
just what they imply. The physician who has the reputation of having the
largest practice is not necessarily the man you want, nor does it imply
that he is the best fitted to conduct your case to your satisfaction. The
fact that he is a very busy man may be distinctly detrimental to your best
interests. If the physician has the reputation of being an excellent
doctor, but, "You can't always depend on him,--he may be out of town, or he
may send his assistant, or substitute," you don't want him; it is too  [70]
important an event to you to take a chance with. Rely rather upon the man
who, though his charge may be a little higher, is known to be trustworthy;
who will take a personal interest in you, and is known to be patient and
capable.

THE SELECTION OF A NURSE.--A choice must be made between having a trained
nurse and what is known as a maternity, or monthly, nurse. The choice may
be dictated by the financial means of the patient. A trained nurse is paid
from $25 to $30 per week, while a maternity nurse usually gets $15 per
week.

A trained nurse is a graduate from a hospital where she has successfully
completed a course of training. She is to be preferred, if she can be
afforded, for the reason that she has been trained to obey absolutely the
orders of a physician, and because she has the requisite knowledge to
detect emergencies, and the necessary skill and experience to enable her to
act intelligently of her own initiative in any emergency.

The maternity nurse, on the other hand, has not had an adequate training
and is absolutely helpless, so far as medical knowledge is concerned, in a
real emergency. Her experience is limited to what she has picked up in the
various cases she has had. She, as a rule, has chosen this means of
obtaining a living as a result of some domestic financial affliction. She
does not understand the laws of sterilization and has not been trained to
obey, without question, the instructions of a physician. The maternity
nurse follows a routine which she is incapable of modifying to suit the
particular case. She has old-fashioned ideas and notions which she carries
out as a matter of course, and she overestimates the great importance of
her experience to the extent of wholly disregarding the advice of the
physician. She assumes the care of the patient and baby, and regards this
as her right, and as a result she is frequently responsible for much injury
to the mother and child. Despite these objections we have worked with many
of these nurses who were to be preferred to trained nurses. It is the
individual after all that counts, and if a maternity nurse, though
technically untrained, is adaptable, tactful, and will consent to be   [71]
instructed to the extent of obeying without argument, she can become
invaluable, and her skill and experience will carry her creditably over
many trying incidents. The objection of the medical profession to an
untrained nurse is based, not so much on her lack of ability, as upon her
propensity to indiscriminate and indiscreet talk,--they have not been
trained to know the value of professional silence, nor have they had the
necessary education which would have enabled them to acquire through their
experience the knowledge that "silence is golden" at all times. A trained
nurse possesses the requisite knowledge, but may have an objectionable
individuality. An untrained nurse may have sufficient knowledge, and what
she lacks she may make up for in being congenial and adaptable. While the
trained nurse strictly attends exclusively to the mother and the baby, a
maternity nurse as a rule attends to the household duties in addition. She
cooks the meals of the entire family, and dresses and cares for the other
children if there is no one else to do it. The duties of a maternity nurse
can be specified and agreed upon, and the terms arranged when she is
engaged. The duties of a trained nurse are fixed by nursing laws and
medical rules and cannot be changed or modified by private agreement. These
laws and rules, however, are not sufficiently arbitrary to make it
impossible for the nurse to be obliging, courteous, and
sincere,--qualifications which every patient has a right to expect, and a
right to insist upon from every graduate nurse.

The selection of a nurse should receive careful consideration. She should
be known to be honest, honorable, competent, healthy, and personally clean
in habits and dress, and she should be tactful, obliging, and she should
attend to her own affairs strictly. She should not be a gossip; she should
not shirk her work or pry into family affairs that do not concern her; and
she should not drag into the conversation her own personal or family
secrets.

The nurse has certain rights which the patient should willingly recognize.
She is entitled to a comfortable bed, sufficient sleep, good food, and
exercise in the open air every day. These are essential in order that  [72]
she maintain her own health, as well as keep at the highest point of
efficiency.

When you select your physician consult with him regarding your nurse. If
you know personally a capable nurse, there is no objection to selecting
her, and no physician will oppose this procedure if you assume the
responsibility of her capability.

There are many advantages, however, in permitting the physician to provide
a nurse. He assumes the responsibility of the nurse's capability, and it is
safe to assume he will not recommend one whom he knows to be personally
objectionable, or professionally incapable. Every physician acquires
certain individual methods in the conduct of maternity cases, which
experience has taught him to be successful. A competent knowledge of these
methods by the nurse greatly facilitates the details and ensures a
harmonious conduct of the entire case,--facts which accrue to the comfort
and the well-being of the patient.

It is not out of place here to warn a young wife against being advised by a
neighbor or a busybody, as to whom she should select as physician or nurse.
You must not depend upon the gossip of the neighborhood. The physician or
nurse whom you are told by one of these irresponsible individuals not to
take, may be the one above all others whom you should take. When you hear a
gossiping woman decry a physician, depend upon it, she owes him
something,--most often it is a bill, but it may only be a grudge. There is
no class of men in any community who are maligned and abused so much as are
physicians. They seem to be the choice victims of the enmity and spite of
every malicious feminine tongue. A woman should think twice before she
utters a criticism regarding the work of a physician. She would, if she but
knew how quickly she brands and advertises herself as irresponsible and
lacking in ordinary courtesy and good breeding, as she is not qualified to
criticise the professional capability of a physician, nor is she qualified
to estimate the extent of the wrong she perpetrates. There is no class of
men who do more conscientious work, day after day, than do physicians, [73]
and there is no class of men who are more deserving of the commendation of
the entire community than the thousands of self-sacrificing, underpaid
members of the medical profession. Be suspicious therefore when you hear a
criticism, and be very, very sure before you utter one,--rather give him
the benefit of the doubt and you will do no wrong, and it may be at some
future date you will be thankful you did not criticise.

       *       *       *       *       *


                                                                       [75]
CHAPTER VII

THE HYGIENE OF PREGNANCY.

    DAILY CONDUCT OF THE PREGNANT WOMAN--INSTRUCTIONS REGARDING HOUSEHOLD
    WORK--INSTRUCTIONS REGARDING WASHING AND SWEEPING--INSTRUCTIONS
    REGARDING EXERCISE--INSTRUCTIONS REGARDING PASSIVE
    EXERCISE--INSTRUCTIONS REGARDING TOILET PRIVILEGES---INSTRUCTIONS
    REGARDING BATHING--INSTRUCTIONS REGARDING SEXUAL INTERCOURSE--CLOTHING
    DURING PREGNANCY--DIET OF PREGNANT WOMEN--ALCOHOLIC DRINKS DURING
    PREGNANCY--THE MENTAL STATE OF THE PREGNANT WOMAN--THE SOCIAL SIDE OF
    PREGNANCY--MINOR AILMENTS OF PREGNANCY--MORNING NAUSEA, OR
    SICKNESS--TREATMENT OF MORNING NAUSEA, OR SICKNESS--NAUSEA OCCURRING AT
    THE END OF PREGNANCY--UNDUE NERVOUSNESS DURING PREGNANCY--THE 100 PER
    CENT. BABY--HEADACHE--ACIDITY OF THE STOMACH, OR
    HEARTBURN--CONSTIPATION--VARICOSE VEINS, CRAMPS,
    NEURALGIAS--INSOMNIA--TREATMENT OF INSOMNIA--PTYALISM, OR EXCESSIVE
    FLOW OF SALIVA--VAGINAL DISCHARGE, OR LEUCORRHEA--IMPORTANCE OF TESTING
    URINE DURING PREGNANCY--ATTENTION TO NIPPLES AND BREASTS--THE VAGARIES
    OF PREGNANCY--CONTACT WITH INFECTIOUS DISEASES--AVOIDANCE OF DRUGS--THE
    DANGER SIGNALS OF PREGNANCY.

CONDUCT OF THE PREGNANT WOMAN

The young wife will arrange her daily routine according to the physician's
instructions, which, by the way, she should faithfully carry out. If you
are one of the fortunate many who enjoy reasonably good health, you have
doubtless been told to follow a plan very similar to the one we shall now
briefly outline.

For the first six months she can safely continue to do her household work.
It is to her advantage to do so for many reasons, but especially because it
helps to keep her physically in good condition, and because it keeps her
mind engaged, thus avoiding a tendency to nervous worry. After the sixth
month it is desirable to give up the heavier part of the work. Washing and
sweeping should be absolutely prohibited. Moving furniture or heavy trunks
must not be done by the prospective mother, but all light work can and [76]
should be indulged in to the very end. Find time to spend at least one hour
and a half in the open air every day. Unless there is a medical reason
against active exercise there is nothing so beneficial to the pregnant
woman as walking, nor is there any substitute for it. A drive or motor ride
into the country, or a car ride around town, is an excellent device against
ennui and is highly desirable during this time, but not as a substitute for
the daily long walk. A pregnant woman must keep her muscles strong and in
good tone if she hopes to do her share toward having a short and easy
confinement. She must keep active to ensure perfect action of all her
organs--the stomach must digest; the bowels and kidneys must act perfectly;
the heart, and lungs, and nerves must be supplied with good blood and fresh
air; the appetite must be keen, and the sleep sound. Walking in the open
air will do all this and nothing else can, to the same satisfactory degree.

Light passive exercise at home is desirable to those very few who cannot
walk in the open air, but at best it is a poor substitute. It is necessary
to avoid any exercise or any labor of the following character from the very
beginning of pregnancy: stretching, lifting, jarring, jumping, the use of
the sewing machine, bicycling, riding, and dancing.

She should continue to employ the same toilet privileges she has been
accustomed to except the use of the vaginal douche, which must be stopped
from the date of the first missed menstrual period. This is the only safe
rule to follow and no exception should be made to it except upon the advice
of a physician.

Bathing during the entire course of pregnancy is a highly necessary duty.
It is particularly advantageous during the later months because it relieves
the kidneys at a time when they are called upon to perform an excess of
work. The temperature of the bath should be warm and rapidly cooled at the
finish. Brisk rubbing with a course towel will ensure the proper reaction.

Sexual intercourse must be restricted during pregnancy; and it should be
wholly abstained from during what would have been the regular menstrual
periods, if pregnancy had not occurred, for the reason that abortion is[77]
apt to take place. It is most harmful during the early and late months of
pregnancy. Sexual intercourse is distasteful to most and harmful to every
pregnant woman.

CLOTHING DURING PREGNANCY.--The clothing should be so constructed as to
relieve any undue pressure on the breasts or abdomen. For this reason it
should be suspended from the shoulder. When it is appreciated that clothing
supported by the waist crowds the growing womb, and exerts pressure upon
the kidneys, and is responsible for many of the kidney complications that
occur during pregnancy, no further reason need be given for discarding all
clothing, except very light garments, that are not held by some device
whose support is from the shoulders. A specially constructed linen waist is
made and sold for this purpose. It is fashioned so that all the lower
garments and the garters can be fastened to, and supported by it. Corsets
should be absolutely discarded from the very first day of pregnancy.

In a large woman with a lax abdomen, a properly made abdominal support will
not only be a great comfort but of real advantage. It should exert a
support upward by lifting the abdomen, not by constricting it. It should
therefore be obtained from a reliable dealer and be made and applied to
effect the above object,--otherwise it may do more harm than good.

DIET OF PREGNANT WOMEN.--Some degree of digestive disturbance and loss of
appetite is the rule early in pregnancy. By the fourth month these
conditions invariably cease, and the appetite and the ability to digest
will greatly improve. The diet from the very beginning of pregnancy should
be plain and easily digested. It is not possible to formulate an absolute
table of what or what not to eat, as the same foods do not agree equally
well with all patients. The individual taste should be catered to within,
reason, and the meals should be taken at regular intervals. Articles of
diet that experience shows do not agree with the patient should be rigidly
excluded from the menu. A varied diet of nutritious character is essential
during pregnancy in order to ensure good blood, health, and strength. A
monotonous diet, or a diet composed largely of stale tea, coffee, and  [78]
cake, is not permissible, and may do untold harm. Pastries and desserts of
all kinds should be excluded. In the later weeks of pregnancy, because of
the large size of the womb, the diet should be cut down as the stomach is
interfered with in the process of digestion. Should the patient at any time
during pregnancy experience a loss of appetite, or an actual disgust for
food as sometimes occurs, it is preferable to suggest a change of scene and
surroundings rather than the use of medicine. A short vacation, a change of
table, new scenery, will promptly effect a cure. This condition is mental
rather than physical; the patient allows herself to become introspective;
the daily routine becomes monotonous and stale; hence a change of a few
days will be all that is necessary. If it is not possible for the patient
to obtain a change of scene, a complete change of diet for a few days will
often tide over the difficulty. We have known patients to take kindly to an
exclusive diet of kumyss, or matzoon, or predigested foods, with stale
toast or zwieback, to which can be added stewed fruits. Alcoholic drinks
should be left out entirely.

THE MENTAL STATE OF THE PREGNANT WOMAN.--The coming baby should be the text
of many interesting, spontaneous talks between the young couple from the
time when it is first known that a new member of the family is on its way.
The husband should feel that he is a party to the successful consummation
of the little one's journey. He can contribute enormously to this end. It
should be his duty, born of a sincere affection and love, to formulate the
programme of events which has for its main object the wife's entire mental
environment. He should encourage her to live up to the physician's
instructions, and arrange details so that she will obtain the proper
exercise daily. He should read to her in the evening, and arrange his own
business affairs so that he will be with her as much as is possible. In
many little ways he can impress upon her the fact that they both owe
something to the unborn babe and that each must sacrifice self in its
behalf. His principal aim, of course, will be that she will not worry or
have cause to worry. He will so direct her mental attitude that she will
dwell only upon the bright side of the picture; she will thus strive to[79]
realize the hope that the baby will be strong and healthy, and she will,
prompted by his encouragement and devotion, try to do her duty faithfully.
Working together in this way, much can be done that means far more than we
know of, and in the end the little one comes into the world a welcome baby,
created in love and born into the joy of a happy, harmonious, contented
home.

THE SOCIAL SIDE OF PREGNANCY.--The social side of the question should not
be overlooked or neglected at this time. Here again the imperative
necessity arises to warn the young wife against certain individuals who
seem to have a predilection toward recounting all the terrible experiences
they have heard regarding confinements. It is astonishing to learn how
diversified a knowledge some women burden themselves with in this
connection. They can recount case after case, with the harrowing details of
a well-told tale, and seem to delight in so doing. Every physician has met
these women. The young wife must not permit or encourage any reference to
her condition. Simply refusing to discuss the question is the only sure
method of preventing its discussion. She will find among her friends a few
who have her best interests at heart, and these few will strive sincerely
to be of real usefulness to her. If she will keep in mind that the most
important element in the success of the whole period, and consequently the
degree of her own health, happiness, and comfort, as well as that of her
unborn baby, is the character of her own thoughts from day to day, and
month to month, she will be complete master of the situation. By constantly
dwelling on happy thoughts, reading encouraging and inspiring books,
admiring and studying good pictures, working with cheerful colors in sunny
rooms, exercising, dieting, and sleeping in a well-aired room, she will
have no cause to regret her share in the task before her, or the kind of
baby she will bring into the world.

MINOR AILMENTS OF PREGNANCY.--There are certain minor ailments which it
would be well to be familiar with lest a little worry should creep into the
picture.

Maternity is not only a natural physiological function, but it is a    [80]
desirable experience for every woman to go through. The parts which
participate in this duty have been for years preparing themselves for it.
Each month a train of congestive symptoms have taxed their working
strength; pregnancy is therefore a period of rest and recuperation,--a
physiological episode in the life history of these parts. If any ailment
arises during pregnancy it is a consequence of neglect, or injury, for
which the woman herself is responsible,--it is not a natural accompaniment
of, or a physiological sequence to pregnancy. Find out, therefore, wherein
you are at fault, rectify it, and it will promptly disappear.

MORNING NAUSEA OR SICKNESS.--So-called morning nausea or sickness is very
frequently an annoying symptom. It is present as a rule during the first
two or three months of pregnancy. How is it produced and how can it be
remedied?

It is produced most frequently by errors in diet. It may be caused by an
unnatural position of the womb or uterus, by nervousness, constipation, or
by too much exercise or too little exercise. The physician should be
consulted as soon as it is observed to be a regular occurrence. He will
eliminate by examination any anatomical condition which might cause it; or
will successfully correct any defect found. When the cause is defined his
instructions will help you to avoid any error of diet, constipation, or
exercise. Many cases will respond to a simple remedy,--a cup of coffee,
without milk, taken in bed as soon as awake will often cure the nausea. The
coffee must be taken while still lying down,--before you sit up in bed. If
coffee is not agreeable any hot liquid, tea, beef tea, clam bouillon, or
chicken broth, or hot water may answer the purpose, though black coffee,
made fresh, seems to be the most successful. Ten drops of adrenalin three
times daily is a very certain remedy in some cases, though this should be
taken with your physician's permission only. If the nausea occurs during
the day and is accompanied with a feeling of faintness, take twenty drops
of aromatic spirits of ammonia in a half glass of plain water or Vichy
water. Sometimes the nausea is caused by the gradual increase of the   [81]
womb itself. This is not usually of a persistent character and disappears
as soon as the womb rises in the abdominal cavity at the end of the second
month.

Nausea frequently does not occur until toward the end of pregnancy. In
these cases the cause is quite different. Because of the size of the womb
at this time the element of compression becomes an important consideration.
The function of the kidneys, bowels, bladder, and respiration may be more
or less interfered with, and it may be desirable to use a properly
constructed abdominal support, or maternity corset. These devices support
and distribute the weight, and prevent the womb from resting on or
compressing, and hence interfering with, the function of any one organ. If
the womb sags to one side, thereby retarding the return circulation of the
blood in the veins from the leg, it may cause cramps in the leg, especially
at night, or it may cause varicose veins, or a temporary dropsy. The
correct support will prevent these troublesome annoyances; a properly
constructed maternity corset is often quite effective. The diet should
receive some special attention when these conditions exist. Any article of
diet which favors fermentation (collection of gas) in the stomach or bowel
should be excluded. These articles are the sugars, starches, and fats. It
can readily be understood that if the bowels should be more or less filled
with gas, or if they should be constipated, it will cause, not only great
distress, but actual pain. Regulation of the diet, therefore, and exercise
(walking best of all) will contribute greatly to the avoidance of these
unnecessary sequelae.

It must be kept in mind that the entire apparatus of the body is
accommodating a changed condition, and though that condition is a natural
one, it requires perfect health for its successful accomplishment. This
means a perfect physical and mental condition,--a condition that is
dependent upon good digestion, good muscles, healthy nerves, clean bowels,
and so on. The slightest deviation from absolute health tends to change the
character of the body excretions, the quality of the blood, etc. If the
excretions are not properly eliminated, the blood becomes impure, and so we
sometimes get itching of the body surfaces, especially of the abdomen  [82]
and genitals; neuralgias, especially of the exposed nerves of the face and
head; insomnia and nervousness. These are all amenable to cure, which again
means, as a rule, correct diet and proper exercise as the principal
remedial agencies.

UNDUE NERVOUSNESS DURING PREGNANCY.--This is very largely a matter of will
power. Some women simply will not exert any effort in their own behalf.
They are perverse, obstinate, and unreasonable. The measures which
ordinarily effect a cure, they refuse to employ. It is useless to argue
with them; drugs should never be employed; censure and affection are
apparently wasted on them; they cannot even be shamed into obedience. The
maternal duty they owe to the unborn child does not seem to appeal to them.
We do not know of any way to handle these women and to our mind they are
wholly unfit to bring children into the world. Fortunately these women are
few in number. The maternal instinct will, and does, guide most women into
making sincere efforts to restrain any undue nervous tendency, and to be
obedient and willing to follow instructions. There is nothing so beneficial
in these cases as an absolutely regulated, congenial, daily routine, so
diversified as to occupy their whole time and thought to the exclusion of
any introspective possibility. Frequent short changes to the country or
seashore to break the monotony, give good results in most of these cases.
The domestic atmosphere must also be congenial and the husband should
appreciate his responsibility in this respect.

Women of this type should have their attention drawn to the following facts
in this connection: While the most recent investigations of heredity prove
that a woman cannot affect the potential possibilities of her child, she
can seriously affect its physical vitality. The following illustration may
render our meaning clear: suppose your child had the inborn qualities
necessary to attain a 100 per cent. record of achievement in the struggle
of life; anything you may or may not do cannot affect these qualities--the
child will still have the ability to achieve 100 per cent. Inasmuch,
however, as a mother can affect the health or physical qualities of her[83]
child she is directly responsible, through her conduct, as to whether her
child will ever attain the 100 per cent. record, or if it does, she is
responsible for the character of its comfort, its health, its enjoyment,
all through its life's struggle toward the 100 per cent. achievement
record. She may so compromise its physical efficiency that it will succumb
to disease as a consequence of the ill health with which its mother
unjustly endowed it, even though it possess the ability to attain the 100
per cent. if it lived.

We often see brilliant children who are nervous and physically unfit, and
we see others of more ordinary mental achievement who are healthy and
robust animals. The one is the offspring of parents possessing unusual
mental qualities but who are physically unable or unwilling to render
justice to their progeny; the other parents may be less gifted mentally,
but they are healthy and they are willing to give their best in conduct and
in blood to their babies. Many of these brilliant children never achieve
their potential greatness because they fall by the wayside owing to
physical inability, while the healthy little animals achieve a greater
degree of success because of the physical vitality which carries them
through. To achieve a moderate success and enjoy good health is a better
eugenic ideal than the promise of a possible genius never attained because
of continuous physical inefficiency.

The nervous and willful mother should therefore consider how much depends
upon her conduct. It cannot be too frequently reiterated and emphasized
that every mother should do her utmost to guard and retain her good health.
Good health means blood of the best quality and this is essential to the
nourishment of the child. To keep in good health does not mean to obey in
one respect and fail in other essentials. It means that you must obey every
rule laid down by your physician, willingly and freely in your own interest
and in the interest of your unborn babe. In no other way may you hope to
creditably carry out the eugenic ideal that "the fit only shall be born."

HEADACHE.--This is a symptom of great importance. If it occurs         [84]
frequently, without apparent cause, the physician should be consulted at
once, as it may indicate a diseased condition of the kidneys, and
necessitate immediate treatment. Headaches may, of course, be caused in
many ways and most frequently they do not have any serious significance,
but they must always be brought to the attention of the physician. As a
rule they are caused by errors of diet,--too much sugar, candy, for
instance, late and indigestible suppers, indiscriminate eating of rich
edibles, etc.,--or they may be products of nervous excitement (too little
rest), as shopping expeditions, strenuous social engagements, late hours,
etc.

ACIDITY OF THE STOMACH, AND SO-CALLED HEARTBURN.--These are sometimes in
the early months of pregnancy annoying troubles. The following simple means
will relieve temporarily: A half-teaspoonful of bicarbonate of soda or
baking soda in a glass of water or Vichy water; or a half teaspoonful of
aromatic spirits of ammonia in Vichy, or plain water; or a tablespoonful of
pure glycerine. The best remedy is one tablespoonful of Philip's Milk of
Magnesia taken every night for some time just before retiring.

Heartburn is the result of eating improper food, or a failure to digest the
food taken. Starchy foods should be avoided. Meats and fats should be taken
sparingly. Avoid also the et ceteras of the table, as pickles, sauces,
relishes, gravies, mustard, vinegar, etc. Good results follow dry
meals,--meals taken without liquids of any kind. Live on a simple, easily
digested, properly cooked diet. Chew the food thoroughly, take plenty of
time and be cheerful.

CONSTIPATION DURING PREGNANCY.--Most women are as a rule more or less
constipated during pregnancy. It is caused by failure to take the proper
amount of outdoor exercise, to take enough water daily, to live on the
proper diet, to live hygienically, or because of wrong methods of dress. It
is most important that the bowels should move thoroughly every day.
Pregnancy no doubt aggravates constipation by diminishing intestinal
activity. Consequently there is a greater need for activity on the part of
the woman, and open air exercise is the best way to accomplish this.   [85]
She should eat fruits, fresh vegetables, brown or Graham bread, or bran
muffins, figs, stewed prunes, and any article of diet which she knows from
experience works upon her bowel. She should drink water freely; a glass of
hot water sipped slowly on arising every morning or one-half hour before
meals, is good. Mineral waters, Pluto, Apenta, Hunyadi, or one teaspoonful
of sodium phosphate, or the same quantity of imported Carlsbad salts in a
glass of hot water one-half hour before breakfast, answers admirably. If
the salts cannot be taken a three- or five-grain, chocolate-coated, cascara
sagrada tablet, may be taken before retiring, but other cathartics should
not be taken unless the physician prescribes them. Rectal injections should
be avoided as a cure of constipation during pregnancy. They are very apt to
irritate the womb and if taken at a time when the child is active, they may
annoy it enough to cause violent movement on its part, and these movements
may cause a miscarriage. See article on "Constipation in Women."

VARICOSE VEINS, CRAMPS, AND NEURALGIA OF THE LIMBS.--When cramps or painful
neuralgia occur repeatedly in one or both legs, some remedial measures
should be tried. Inasmuch as the cause of this condition is a mechanical
one, it would suggest a mechanical remedy. The baby habitually seeks for
the most comfortable position, and having found it stays there until
conditions render it uncomfortable. He does not consult you in the matter,
but he may be subjecting you to untold misery and pain. The child may rest
on the mother's nerves or blood-vessels as they enter her body from her
lower limbs. If the pressure is sufficient, it can interfere quite
seriously with the return blood supply, because veins which carry back to
the heart the venous or used blood, are vessels with thin, soft,
compressible walls, while arteries which carry blood away from the heart
cannot be compressed easily, because their walls are hard and tense. The
condition therefore is that more blood is being sent into the limb than is
being allowed to return; in this way are produced varicose veins. If these
varicose veins burst or rupture we have ulcers, which may quickly heal,[86]
or they may refuse to heal, and become chronic. A dropsical condition of
the leg may follow, and because of interference with the circulation of the
blood we get cramps and neuralgias. How can we remedy this painful
condition?

Sometimes we don't succeed, but at least we can try. So long as the cause
exists, it is self-evident that rubbing the limb with any external
application, will not give any permanent relief, though it is well to try.
When rubbing, to relieve cramps at night, always rub upward. It is not a
condition that calls for medicine of any kind, while hot baths and hot
applications will only make the trouble worse. The remedy that promises the
quickest and longest relief is for the patient to assume the knee-chest
position for fifteen minutes, three times a day, till relief is permanently
established. The patient rests on her knees in bed, and bends forward until
her chest rests on the bed also. The incline of the body in this position
is reversed; hips are highest, the head lowest. The baby will seek a more
comfortable position and this new position may relieve the pressure and
cure the condition. Doing this three times daily for fifteen minutes gives
relief to the leg by reestablishing a normal blood circulation, and very
soon the baby finds a new position that does not interfere with its
mother's blood supply, and the cramps, and neuralgia and dropsy, and maybe
the varicose veins will soon show improvement. Wearing the proper kind of
abdominal support may help, as explained on page 77. If the varicose veins
are bad, it is desirable to wear silk rubber stockings or to bandage the
limbs.

INSOMNIA DURING PREGNANCY.--Insomnia or sleeplessness is sometimes a
vexatious complication during pregnancy. It seldom if ever becomes of
sufficient importance or seriousness to interfere with the pregnancy or the
health of the patient. Nevertheless, a period of sleeplessness lasting for
two or three weeks is not a pleasant experience to a pregnant woman. It is
most often met with during the latter half of pregnancy.

There can be no question that every case of insomnia has definite cause,
and can be relieved if we can find the cause. The only way to find it  [87]
is to systematically take up the consideration of each case, and this is
best done by the physician. He must have patience and tact; you must answer
each question truthfully and fully. Your diet, personal conduct, exercise,
condition of bowels, mental environment, domestic atmosphere, everything,
in fact, which has any relation to you or your nerves, must be inspected
with a magnifying glass. Some little circumstance, easily overlooked, of
seemingly no importance, may be the cause of the trouble. You may need more
outdoor exercise, or you may need less outdoor exercise. You may need more
diversion, more variety, or you may need less. You may need a sincere,
honest, tactful, patient confidant and friend, or you may need to be saved
from your friends. You may be exhausting your vitality and fraying your
nerves by social exigencies,--those empty occupations which fill the lives
of so many fussy, loquacious females,--echoless, wasted, babbling moments,
of supreme important to the social bubbles who ceaselessly chase them but
of no more interest to humanity than the wasted evening zephyrs that play
tag with the sand eddies on the surface of the dead and silent desert. You
may have wandered from the narrow limitations of the diet allowable in
pregnancy, or you may be the victim of an objectionably sincere relation
who pesters you with solicitous inquiries of a needless character. Whatever
it is, rectify it. A good plan to follow on general principles is to take a
brisk evening walk with your husband just before bedtime, and at least two
hours after the evening meal. Follow this with a sitz bath as soon as you
return from the walk.

A sitz bath is a bath taken in the sitting position with the water reaching
to the waist line. It should last about fifteen minutes and the water
should be comfortably hot. It is sometimes found that this form of bath
creates too much activity on the part of the child and defeats the purpose
in view. This is apt to be the case in very thin women when the abdomen is
not covered by a sufficient layer of fatty tissue. These women will find it
advisable to take, in place of the sitz bath, a sponge bath in a warm room,
using the water rather cool than hot but in a warm room. Rub your skin [88]
briskly but waste no time in getting into bed. A glass of hot milk, before
going to bed, or when wakeful during the night, may serve as a preventive.
When these measures fail the physician should be called upon to advise and
prescribe.

PTYALISM, OR AN EXCESSIVE FLOW OF SALIVA.--This is a common condition in
pregnancy, but cannot be prevented. It is of no importance other than that
it is a temporary annoyance.

Itching of the abdomen can usually be allayed by a warm alcohol rub,
followed by gently kneading the surface of the abdomen with warm melted
cocoa butter, just before retiring.

A VAGINAL DISCHARGE.--Soon after pregnancy has taken place the woman may
notice a discharge. It may be very slight or it may be quite profuse. In
some cases it does not exist at all during the entire period. As a rule the
discharge is more frequent and more profuse toward the end of pregnancy.

If the discharge exists at any time,--and it is no cause for worry or alarm
if it does exist,--inform your physician. He will advise you what to do,
because it is not wise for you to begin taking vaginal douches or
injections without his knowledge, and at a time when they may do you
serious harm. Should itching occur as a result of any vaginal discharge the
following remedial measures may be employed:

A solution of one teaspoonful of baking soda to a douche bag of tepid water
may be allowed to flow over the parts, or cloths saturated with this
mixture may be laid on the itching part. A solution of carbolic acid in hot
water (one teaspoonful to one pint of hot water), is also useful, or a wash
followed by smearing carbolic vaseline over the itching parts. If your
physician should suggest a mild douche for itching of the vagina as the
result of a discharge, it may be promptly relieved by using Borolyptol in
the water. Buy a bottle and follow directions on the label.

TESTING URINE IN PREGNANCY--IMPORTANCE OF.--One of the most important
duties, if not the most important, of both the physician and the patient is
to have the urine of the pregnant woman examined every month during the[89]
first seven months and every two weeks during the last two months. The
urine examined during the first seven months should be the first urine
passed on the day it is sent for examination. During the last two months of
pregnancy the patient should pass all her water into a chamber for an
entire day, and take about three ounces of this mixed water for
examination. She should measure the total quantity passed during these days
and mark it with her name on the label of the bottle. The physician will
thus have an absolute record and guide of just how the kidneys are acting,
and as they are the most important organs to watch carefully during every
pregnancy, the greatest care should be taken to see that failure to note
the first symptom of trouble does not take place.

ATTENTION TO NIPPLES AND BREAST.--The physician should inspect the breasts
and nipples of every pregnant woman when she first visits his office.
Frequently the nipples are found to have been neglected, probably subjected
to pressure by badly fitting corsets or too tight clothing. Instructions
gently to pull depressed nipples out once daily, if begun early, will
result in marked improvement by the end of pregnancy. During the latter
part of pregnancy the breasts should be carefully and thoroughly bathed
daily in addition to the daily bath. This special bath should be with a
solution of boric acid (one teaspoonful to one pint of water). After the
bath apply a thin coating of white vaseline to the nipples. It may be
necessary to resort to the following mixture to harden the nipples and to
make them stand out so that the child can get them in its mouth: Alcohol
and water, equal parts into which put a pinch of powdered alum; this
mixture should be put in a saucer and the nipples gently massaged with it
twice daily. A depressed nipple may also be drawn out by means of a breast
pump. If the nipples are not pulled out the child will be unable to nurse.
It may then be necessary to put the child on the bottle and when the
nipples are ready he may not take them after being used to the rubber
nipple. The breasts may become caked and as a caked breast is a very
painful and serious ailment it is wise to attend to this matter in     [90]
time.

THE VAGARIES OF PREGNANCY.--Certain foolish, old-fashioned ideas, have
crept into the minds of impressionable people regarding pregnancy, which
are aptly termed vagaries. It is believed by some that if the pregnant
woman is the victim of fright, or is badly scared, or witnesses a
terrifying or tragic sight, her child will be, in some way, affected by it.
If the incident is not of sufficient gravity to cause an abortion or a
miscarriage it will not, in any way mark, or affect the shape of the child
in the womb.

It is believed by some that a child can be marked by reason of some event
occurring to the mother while carrying it. This is not so; a child cannot
be marked by any experience or mental impression of the mother. Some
believe that the actual character of a child can be changed by influences
surrounding the mother while carrying it. The character of a child cannot
be changed one particle after conception takes place, no matter how the
mother spends her time in the interim.

It should be carefully understood that the character of the baby is
entirely different from the physical characteristics of the baby. Were this
not so it would be futile on the part of the mother to discipline or
sacrifice herself in the interest of her baby. The baby's character will
reflect the qualities of the combined union of mother and father. The
baby's physical characteristics will largely depend upon the treatment
accorded it by the mother during its intro-uterine life. Hence we lay down
rules of conduct, diet and exercise in order to produce a good, sturdy
animal, while the character or mind of the animal is a part of the
fundamental species already created. In other words, no matter how much
care you bestow upon a rose bush, its flower will still be a rose,--it may
be a better rose, a stronger, sturdier rose, a better smelling and a more
beautiful rose, but it is still a rose.

CONTACT WITH INFECTIOUS DISEASES.--The pregnant woman should be warned
against the danger of coming in contact with any person suffering from any
infectious or contagious diseases. To become the victim of one of these[91]
diseases near the time of labor would be a dangerous complication not only
to the mother, but to the child. A woman is more liable to catch one of
these diseases during the last month of pregnancy than at any other time.
The most dangerous diseases at this period are Scarlet Fever, Diphtheria,
Erysipelas, and all diseased conditions where pus is present.

AVOIDANCE OF DRUGS.--It is a safe rule during pregnancy to avoid absolutely
the taking of all medicines unless prescribed by a physician.

THE DANGER SIGNALS OF PREGNANCY.--The following conditions may be of very
great importance and may be the danger signals of serious coming trouble.
They must not therefore be neglected or lightly considered. When any of
them make their appearance send for the physician who has charge of your
case, at once, and follow his advice whatever it may be.

    1. Any escape of blood from the vagina, whether in the form of a sudden
    hemorrhage or a constant leaking, like a menstrual period.

    2. Headache, constant and severe.

    3. Severe pain in the stomach.

    4. Vertigo or dizziness.

    5. Severe sudden nausea and vomiting.

    6. A fever, with or without a chill.

       *       *       *       *       *


                                                                       [93]
CHAPTER VIII

THE MANAGEMENT OF LABOR

    WHEN TO SEND FOR THE PHYSICIAN IN CONFINEMENT CASES--THE PREPARATION OF
    THE PATIENT--THE BEGINNING OF LABOR--THE FIRST PAINS--THE MEANING OF
    THE TERM "LABOR"--LENGTH OF THE FIRST STAGE OF LABOR--WHAT THE FIRST
    STAGE OF LABOR MEANS--WHAT THE SECOND STAGE OF LABOR MEANS--LENGTH OF
    THE SECOND STAGE--DURATION OF THE FIRST CONFINEMENT--DURATION OF
    SUBSEQUENT CONFINEMENTS--CONDUCT OF PATIENT DURING SECOND STAGE OF
    LABOR--WHAT A LABOR PAIN MEANS--HOW A WILLFUL WOMAN CAN PROLONG
    LABOR--MANAGEMENT OF ACTUAL BIRTH OF CHILD--POSITION OF WOMAN DURING
    BIRTH OF CHILD--DUTY OF NURSE IMMEDIATELY FOLLOWING BIRTH OF
    CHILD--EXPULSION OF AFTER-BIRTH--HOW TO EXPEL AFTER-BIRTH--CUTTING THE
    CORD--WASHING THE BABY'S EYES IMMEDIATELY AFTER BIRTH--WHAT TO DO WITH
    BABY IMMEDIATELY AFTER BIRTH--CONDUCT IMMEDIATELY AFTER LABOR--AFTER
    PAINS--REST AND QUIET AFTER LABOR--POSITION OF PATIENT AFTER LABOR--THE
    LOCHIA--THE EVENTS OF THE FOLLOWING DAY--THE FIRST BREAKFAST AFTER
    CONFINEMENT--THE IMPORTANCE OF EMPTYING THE BLADDER AFTER LABOR--HOW TO
    EFFECT A MOVEMENT OF THE BOWELS AFTER LABOR--INSTRUCTING THE NURSE IN
    DETAILS--DOUCHING AFTER LABOR--HOW TO GIVE A DOUCHE--"COLOSTRUM," ITS
    USES--ADVANTAGES OF PUTTING BABY TO BREAST EARLY AFTER LABOR--THE FIRST
    LUNCH--THE FIRST DINNER--DIET AFTER THIRD DAY.

WHEN TO SEND FOR THE PHYSICIAN IN CONFINEMENT CASES.--The physician should
be notified just as soon as it is known that labor has begun. The adoption
of this course is necessary for a number of reasons. It is only just that
he should have an opportunity to arrange his work so that he may be at
liberty to give his whole time to your case when he is wanted. He may not
be at home at the moment, but can be notified, and can arrange to be on
hand when your case progresses far enough to need his personal attention.
It will relieve your mind to be assured that he will be with you in plenty
of time. [Page 94]

Don't worry unnecessarily if he does not come immediately when you notify
him, provided you notify him at the beginning of labor. There is plenty of
time. You have a lot of work to do before he can be of any help. Many women
entertain the idea that a physician can immediately perform some kind of
miracle to relieve them of all pains at any stage in labor. This is a
mistaken idea. No physician can hasten, or would if he could, a natural
confinement. He waits until nature accomplishes her work, and he simply
watches to see that nature is not being interfered with. If something goes
wrong, as it does now and again; or if the pains become too weak, or if the
proper progress is not being made, he may help nature or take the case out
of her hands and complete the confinement. If it is thought best to do
this, there will be plenty of time.

THE PREPARATION OF THE PATIENT AND THE CONDUCT OF ACTUAL LABOR.--It is
assumed that the patient has adhered to the instructions of the physician
given during the early days of her pregnancy. These instructions included
directions as to exercise, diet, bathing, etc.

Having calculated the probable date of the confinement, it is the better
wisdom to curtail all out-of-door visiting, shopping, social engagements,
etc.,--everything in fact out-of-doors except actual exercise, for two
weeks previous to the confinement date. The usual walk in the open air
should be continued up to the actual confinement day. The daily bath may be
taken, and it is desirable that it should be taken, up to and on the
confinement day.

THE MEANING OF THE TERM "LABOR."--By labor is meant, the task or work
involved in the progress by means of which a woman expels from her womb the
matured ovum or child. After the child has been carried in the womb for a
certain time (estimated to be 280 days) it is ripe, or fully matured, and
is ready to be born. The womb itself becomes irritable because it has
reached the limit of its growth and is becoming overstretched. Any slight
jar, or physical effort on the part of the patient, or the taking of a
cathartic, is apt to set up, or begin the contractions which nature has
devised as the process of "labor" by which the womb empties itself.    [95]

THE BEGINNING OF LABOR.--When the first so-called pains of actual labor
begin they are not always recognized as such. The explanation of this
seeming paradox is that the "pains" are not always painful. A woman will
experience certain undefined sensations in her abdomen; to some, the
feeling is as if gas were rumbling around in their bowels; to others, the
feeling is as if they were having an attack of not very painful abdominal
colic; while others complain of actual pain. The fact that these sensations
continue, and that they grow a little worse; and that the day of the
confinement is due, or actually here, impresses them that something unusual
is taking place; then, and not till then, does the knowledge that labor is
really approaching dawn upon them.

In due time one of these new sensations, which constitute the first stage
of labor, will be more emphatic; there will be a little actual pain so that
she will feel like standing still, holding her breath and bearing down.
That is the first real labor pain and marks the beginning of the second
stage of labor, and may be the first absolute sign that will leave no doubt
in her mind that labor has begun.

The nurse will now inquire into the condition of the patient's bowels. If
they have not already moved freely that day, she will give the patient a
rectal injection of one pint of warm soap suds into which one teaspoonful
of turpentine is put. After the bowels have been thoroughly cleansed, the
patient will be made ready for the confinement. The clothing necessary
consists of dressing gown, night gown, stockings and slippers. These are
worn as long as the patient is out of bed, when all but the night gown will
be discarded. The entire body of the patient, from the waist line to the
knees, should be thoroughly cleansed, paying particular attention to the
private parts; first with warm water and castile soap, and then rendered
aseptic by washing with four quarts warm boiled water into which has been
put one teaspoonful of Pearson's Creolin. A soft napkin is then wrung out
of water that has been boiled and cooled to a suitable temperature, and
laid over the genital region, and held in place by a dry clean napkin, [96]
and allowed to remain there until the physician takes personal charge of
the case.

LENGTH OF THE FIRST STAGE OF LABOR.--There is no definite or even
approximate length of time for the first stage of labor,--that, you may
recall, was the more or less painless stage, or as it has been termed, the
"getting-ready" stage. Inasmuch as it is an unimportant and practically
painless stage, most patients do not mind it. They continue to be up and
around and work as usual.

The first stage of labor is utilized by nature in opening the mouth of the
womb.

The second stage of labor is utilized by nature in expelling the child into
the outer world.

LENGTH OF THE SECOND STAGE OF LABOR.--After the second stage has begun, the
length of time necessary to end the labor, assuming everything is normal,
depends upon the strength and frequency of the pains. The stronger and more
frequent the pains, the quicker it will be over. First confinements
necessarily take longer, because the parts take more time to open up, or
dilate, to a degree sufficient to allow the child to be born. In subsequent
confinements, these parts having once been dilated yield much easier, thus
shortening the time and the pains of this, the most painful, stage of
labor. The average duration of labor is eighteen hours in the case of the
first child, and about twelve hours with women who have already borne
children. The time, however, is subject to considerable variation, in
individual cases, as has been pointed out.

CONDUCT OF THE PATIENT DURING THE SECOND STAGE OF LABOR.--She should remain
up, out of bed, as long as she possibly can. The object of this is because
experience shows that the labor pains are stronger, and more frequent, when
in the upright position. Even though this procedure would seem to invite
more constant suffering, it must be remember that labor is a physiological,
natural process, that there is nothing to fear or dread; and if the patient
is in good health, it is to her advantage to have it over soon, rather than
to encourage a long drawn out, exhausting labor. When the pains come   [97]
she should be told to hold on to something, to hold her breath as long as
possible, and to bear down. A good plan is to roll up a sheet lengthwise,
and throw it over the top of an open door and let her grasp both ends
tightly and bear down; or she can put her arms over the shoulders of the
nurse and bear down. Instruct her to hold her breath as long as she can,
bearing down all the time, and when she can't hold it any longer, tell her
to let up, and then take a quick deep breath and bear down again, repeating
this programme until the pain ceases. Tell her specifically to be sure to
keep bearing down till the end of the pain, because the most important
time, and the few seconds during which each pain does most of its work
during the second stage of labor, is at the very end of each pain. When a
woman understands that these instructions are for her good, and that they
are given with the one purpose of saving her pain, and shortening the
length of labor, she will try to obey. Each pain is intended by nature to
do a certain amount of work, and each pain will accomplish that work if the
woman does not prevent it; and if she does prevent it, she is only fooling
herself, because the next pain will have to do what she would not allow the
former to do, and so on according to how she acts.

THE CARRIERS OF HERITAGE

[Illustration: Here is the actual bridge from this generation to the next.

Into these two little bodies--the larger not over one-twenty-fifth of an
inch in diameter--is condensed the multitude of characteristics transmitted
from one generation to another.

The vital part of the _Ovum_ is the _Nucleus_, which contains the actual
bodies that carry heritage--the little grains that are the mother's
characteristics--_Chromosomes_. This nucleus is nourished by oils, salts
and other inclusions, known as _Cytoplasm_. Floating in the cytoplasm may
be found a tiny body known as the _Centrosome_, which acts as a magnet in
certain phases of cell development. Around this whole mass is a _Cell
Wall_, more or less resisting and protective.

The _Spermatozoan_ is structurally much different from the ovum, but it
also has its nucleus and chromosomes, which carry to the child the
transmittable characteristics of the father.

The ovum is usually comparatively large and stationary, and whatever motion
is therefore necessary to bring it into contact with the male cell devolves
upon the latter, which possesses what is known as a _locomotor tail_. In
addition there are usually many sperms to one ovum, so that the chances are
that at least one male cell will reach the egg and effect fertilization,
and the beginning of a new life.

The diagrams on the opposite page show the actual steps by which the
spermatozoan unites with the ovum. It is the very first stage of the
process of cell multiplication that results in the offspring.]

THE FORMATION OF A NEW LIFE

[Illustration: _Reproduced by permission from "Genetics," Walters, The
Macmillan Co._]

HOW A WILLFUL WOMAN CAN PROLONG LABOR.--For a certain time, during the
second stage of labor, a willful, unreasonable woman, can work against
nature and save herself a little pain by prolonging the issue; but there
will come a time when, the head having reached a certain position, the
expulsive pains will be so great that she won't be able to control them and
nature then seems to take her revenge. So if a woman holds back, and begins
to cry, and scream, when she feels a pain coming, she renders the pain to a
large degree negative, she prolongs her labor, adds to the total number of
pains, exhausts herself, and endangers the life of her child. It must,
however, be remembered in all justice that this is a time when it is much
easier to preach than to practice.

Every confinement is a new experience; no matter how many a physician may
have seen, there are no two alike. It is one of the interesting        [98]
psychological problems in medicine to observe the conduct of women during
their first confinement.

Some are calm, exhibiting a degree of self-control that is admirable. They
are willing to be instructed, and they recognize that the advice is given
for their benefit. They conscientiously try to obey suggestions, and they
make praiseworthy efforts to keep themselves under control. They are
stoics.

Others collapse at once; they go to pieces under the slightest excuse, and
frequently without as much as an excuse. As soon as the pain begins, they
willfully ignore all the instructions given and desperately and foolishly
try to escape what they cannot escape. In this unreasonable selfishness
they resent advice, and at the same time they implore you to "do something"
for them. There is absolutely no excuse for this kind of conduct; and any
prospective mother who, because of a willful trait in her disposition,
refuses to profit by the kindly professional advice of her physician or
nurse, should at least have some consideration for her unborn babe. It may
seem unkind to criticise the conduct of any woman at such a time. It is not
prompted by a lack of patience or justice however. These women permit, in
spite of every assurance to the contrary, an unreasonable fear to overwhelm
them; and because of this fear they refuse to be guided into a path of
conduct that will save them suffering and shorten the pains which they
complain of. It is our conviction that if a woman would try to follow the
advice of the physician at this time, at least half of all the seeming
suffering would be avoided. We are glad to be able to truthfully state that
this type of woman is vastly in the minority.

When the second stage has advanced far enough, the patient will decide to
go to bed. It may be necessary to put her in bed earlier, if her pains are
very strong, as there is always a possibility of suddenly expelling the
child under the influence of a strong pain. She will, as previously stated,
discard all clothing, except her night gown, which can be folded up to her
waist line and let down as far as necessary after the confinement is over.
The obvious advantage of this arrangement is that the gown remains     [99]
unsoiled, and saves what would be needless trouble if it proved necessary
to change the night gown at a time when the tired-out patient needs rest.
Much aid may be afforded the woman at this stage by twisting an ordinary
bed sheet and putting it around one of the posts or bars of the foot of the
bed. The patient may then pull on the ends during the pain; she may also
find much comfort and aid by bracing her feet on the foot of the bed while
pulling. It is desirable to instruct the nurse to press on the small of the
back during these pains. Some women appreciate a hot water bottle in this
region. If the pains are hard the patient may perspire freely; it is always
refreshing occasionally to wipe the face and brow off with a cloth wrung
out of cold water. Cramps of the limbs may be relieved by forcibly
stretching the leg and pulling the foot up toward the knee. From this time
until the child and after-birth are born the physician will take active
charge of the case.

THE MANAGEMENT OF THE ACTUAL BIRTH OF THE CHILD.--Near the end of the
second stage of labor it will be observed that the pains have grown strong,
expulsive, and more frequent. Very soon the advancing head will begin to
push outward the space between the front and back passage; the rectum is
pushed outward and the lips of the vagina open. If an anesthetic is to be
used these are the pains that call for it. A few drops may be dropped
singly on a small clean handkerchief held up by the middle over the nose,
its ends falling over the face. A few drops will just take the edge off the
pains, and render them quite bearable. As soon as the pain is over the
patient should rest, relax completely, and not fret and exhaust herself
worrying about the pains to come. It is astonishing how much actual rest a
woman can get between pains if she will only try; and it is astonishing how
much concentrated mischief a willful, unreasonable woman can do in the same
time. She will not try to rest, but cries and moans and pleads for
chloroform, until she succeeds in giving everyone except the physician and
nurse the impression that she is suffering unnecessarily. Her husband or
her mother, whichever is present, gets nervous; they begin to wonder  [100]
if the physician is really trying to help; assume a long, sad, serious
face! forget their promise to look cheerful, and mayhap offer sympathy to
the woman. It is a trying moment and needs infinite patience and tact. The
physician attends strictly to his duty, which will now be to guard the
woman against exerting too great a force during the last few pains. About
this time, or before it in many instances, the "waters will break." This
means simply that the bag or membrane in the contents of which the child
floated burst because of the pressure of a pain. This is a perfectly
natural procedure and should not cause any worry: simply ignore it as if it
had no bearing on the labor in any way. As soon as the oncoming head has
dilated the passage sufficiently, so that the edges of the entrance to the
vagina will slip over the head without tearing, the physician allows the
head to be born. It takes some time to do this, and he must hold the head
back until just the right moment. It is best not to let the head slip
through at the height of a pain, or rupture is sure to occur. Wait till it
will slip through as a pain is dying out, and if you have waited long
enough and handled the head skillfully, the conditions will be just right
at a certain moment to permit this without tearing the parts. There are
some cases where a tear, and a good tear, is impossible to guard against.
It is not a question of patience, or tact, or skill; it is a combination of
conditions which patience, tact, and skill are powerless against.

POSITION OF WOMAN DURING BIRTH OF CHILD.--The position of the woman is a
matter of choice and is not contributory to the results at all. She can lie
on her back, which is the ordinary way, or on her side, as the physician or
the patient prefer. As soon as the head is born the physician should see
that the cord is not round the child's neck; if it is, release it. The
shoulders will most likely be born with the next or succeeding pain. The
physician will permit the lower shoulder to slip over the soft parts first;
this is done by retarding the upper shoulder by pushing it gently behind
the pubic bone of the mother. When the shoulders are through, the rest[101]
of the body of the child slips out without effort.

DUTY OF NURSE IMMEDIATELY FOLLOWING BIRTH OF CHILD.--As soon as the child
is born the nurse should sit by the side of the mother and hold the womb
until the after-birth is expelled. The womb can be easily felt in the lower
part of the woman's abdomen as a hard mass. It feels about the size of an
extra large orange. The object of holding it is to prevent the possibility
of an internal hemorrhage. It can be readily appreciated that the interior
of a womb, immediately after a child is born, is simply a large bleeding
wound. So long as the womb remains firmly contracted there is very little
chance for an extensive bleeding to take place. As a rule the womb remains
sufficiently contracted to preclude a hemorrhage until the after-birth is
out. After the after-birth is expelled, the womb usually closes down firmly
and the liability to bleed is very much reduced. Because there is a
distinct chance or tendency for the womb to bleed freely during the time
the after-birth remains in, it is customary, as stated above, to watch it
closely and to hold it securely. It is best held with the right hand. The
fingers should surround the top of the womb and exert a slight downward
pressure. Should it show any tendency to dilate or fill with blood, get it
between the fingers and the thumb and squeeze it, pushing downward at the
same time.

EXPULSION OF AFTER-BIRTH.--The after-birth is usually expelled in about
twenty minutes after the child is born. Great care should be experienced in
its expulsion. It should not be pulled at any stage of its expulsion. If it
does not come easily give it a longer time,--it takes time for the womb to
detach itself from the after-birth; and some after-births are very firmly
attached. Eventually it will come out with a little encouragement in the
way of frictional massage of the womb through the abdominal walls. If the
membranes remain in the womb after the body of the after-birth is out, do
not pull on them. Take the after-birth up in the palm of your hand and turn
or twist it around, and keep turning it around gently, thereby loosening
the membranes from the womb instead of pulling them, which would surely
break them, leaving the broken ends in the womb, and, as a result, the[102]
chance of developing serious trouble.

The patient should now be given one teaspoonful of the fluid extract of
ergot, which should be repeated in an hour. Should there be an excessive
flow of blood after this period it may be again repeated at the third hour.

CUTTING THE CORD.--As soon as the child is born, and of course long before
the after-birth is expelled, the physician will tie the cord. This is best
done at two places, one about two inches from the child, and the other two
or three inches nearer the mother. Cut the cord about one-half inch beyond
the first ligature, which will be between the two ligatures. The cord
should be tied with sterile tape made for the purpose, or heavy twisted
ligature silk, or a narrow, ordinary, strong tape, previously boiled. It
should be tied firmly and inspected a number of times within one hour of
its birth. It is possible for a baby to lose enough blood from a cord badly
tied to cause its death. A very good way to ensure against such an accident
is to cut the cord one inch from the ligature nearest the baby, then turn
this inch backward and retie with the same ligature, thus making a double
tie at the same spot. Cut the cord with scissors that have been boiled and
reserved for this purpose.

WASHING BABY'S EYES AND MOUTH IMMEDIATELY AFTER BIRTH.--As soon after birth
as is practicable, wash the baby's eyes with a saturated solution of
boracic acid.

Immediately after the eyes have been washed the physician will drop into
them a solution of silver nitrate, three drops of a two per cent. solution
in each eye, or argyrol, three drops 20 per cent. solution. This precaution
is taken against possible infection during labor and, as explained
elsewhere, it is a preventive against certain diseased conditions which, if
present, would result in blindness.

The physician should then wind a little sterile cotton round his moistened
little finger, dip it in the boracic solution, and holding the baby up by
the feet head down, insert this finger into the throat, thus clearing it of
mucus. The tongue and mouth may be gently washed with the same        [103]
solution.

After the baby has cried lustily as an evidence of life and strength, he
should be wrapped up in a warm blanket quickly, and immediately put in a
cozy basket in a warm place, and left there undisturbed, with his eyes
shaded from the light until the nurse is ready to attend to him. The baby
should be laid on his right side.

CONDUCT IMMEDIATELY FOLLOWING LABOR.--As soon as the physician is satisfied
that the patient is well enough to be left in care of the nurse or
attendant, every effort should be made to favor a long, refreshing sleep.
Nothing will contribute to the patient's well-being so much as a quiet,
restful sleep after labor. The nurse will therefore take the baby into
another room, fix the mother comfortably, and give her a glass of warm
milk,--draw the shades or lower the light and tell the tired-out mother to
go to sleep. As a rule she will sleep easily, as she is sore and exhausted.

AFTER-PAINS.--In women who have had children the womb does not as a rule
contract down as firmly as after the first confinement. This condition
permits of slight relaxation of the muscular wall, at which times there is
a slight oozing of blood. This blood collects and forms clots in the
uterine cavity which acts as irritants, exciting contractions in the effort
to expel them. These contractions cause what are commonly known as
"after-pains." These pains last until the womb is free from blood-clots.
They may be severe the first twenty-four hours and then gradually die out
during the following two or three days. Ordinarily in uncomplicated
confinements they rarely annoy the patient longer than a few hours. It is a
rare exception to observe them after the first confinement.

REST AND QUIET AFTER LABOR.--Sometimes the birth chamber is the rendezvous
for all the inquisitive ladies in the neighborhood. No one should be
permitted in the lying-in chamber until the patient is sitting up, except
the husband and the mother. This should be made an absolute rule in every
confinement. This is a period that demands the maximum of uninterrupted
rest and repose. The world and all its concerns should remain a blank to a
woman during the whole period of her confinement. This is the only
successful means of obtaining mental rest. The husband and mother     [104]
should be instructed to present themselves just often enough to demonstrate
their interest in the welfare of the patient and the baby.

POSITION OF THE PATIENT AFTER LABOR.--After delivery a woman should be
instructed to lie on her back, without a pillow, for the first night. On
the following morning she may have a pillow, but she must remain on her
back for the first week. Sometimes an exception may be made to this rule by
letting the patient move around on the side, with a pillow supporting the
back, on the fourth day. These exceptional cases are those whose womb has
contracted firmly, as shown by the quick change in the amount and color of
the lochia. Women should be told why they must remain on their backs as
explained in the chapter: "How long should a woman remain in bed?"

THE LOCHIA.--The discharge which occurs after every labor is called the
lochia. Its color is red for the first four or five days; for the
succeeding two or three days it is yellow; for the remainder of its
existence it is of a whitish color. It lasts from ten days to three weeks.

The odor of the lochia is at first that of fresh blood; later it has the
odor peculiar to these parts. If at any time the odor should become foul or
putrid it is a danger signal to which the nurse should immediately draw the
physician's attention.

If the amount of the lochia should be excessive it should be investigated.

THE EVENTS OF THE DAY FOLLOWING LABOR.--We will assume that the patient
enjoyed a long sleep and wakes up refreshed, and with a thankful feeling
that all is over and that baby is safely here. She will want to see and
caress baby, of course. Lay the baby down in bed beside her and let her
love and mother it. Tell her not to lift it, for the strain might injure
her, then quietly steal away for ten or fifteen minutes, for these are
precious, sacred moments. Motherhood--that angel spirit, whose influence
every human heart has felt--that guards and guides the world in its
sheltering arms--is born in its divine sense, into the heart of every woman
for the first time, as she gazes in ecstasy and wonder at her         [105]
first-born. She feels that she has begotten a trust,--a trust direct from
her Creator, and she makes a silent resolve, as she gently and timidly
feels the softness of baby's cheek, that she will watch over it, and guide
it, and do all a mother can for it, with God's help. It is good for the
race that mothers do feel this way: and it is good for all concerned that
they be given the opportunity to be so inspired.

Just as gently take the baby away at the expiration of the allotted time.
Take it with a cheerful, smiling word, and do not comment upon mother's
happy, thoughtful face, she will quickly collect herself and enter into the
spirit of quiet congratulation that should now permeate the home.

THE FIRST BREAKFAST AFTER LABOR.--If the patient has passed a comfortable
night, feels well, and is free from temperature, and has a normal pulse,
breakfast will consist of a cup of warm milk, or a cup of cocoa made with
milk, a piece of toasted bread, and a light boiled egg; or if preferred a
cereal with milk and toasted bread. This will be the breakfast for the two
following days also. The milk, or the cocoa (whichever is taken), must be
sipped, while the attendant supports the patient's head. The cereal, or the
egg (whichever is taken), must be fed to the patient out of a spoon. The
patient must not make any physical effort to help herself; she must remain
relaxed. Even when she sips her milk, or cocoa, she must not make any
effort to raise her head; the nurse must support its entire weight. This
will be the absolute routine of every meal until the physician gives
permission to change the procedure. It is a waste of time to formulate
rules only to disobey them.

Shortly after breakfast the patient's toilet should be attended to. She
should have her hair combed, and her face and hands washed. The hair on the
right half of her head should be combed while the head rests on the left
side, and vice versa. The water used for washing the hands and face should
be slightly warmed. It is best to keep the hair braided and to consult the
wishes of the patient as to the frequency of combing it. [Page 106]

THE IMPORTANCE OF EMPTYING THE BLADDER AFTER LABOR.--An effort should be
made now to have the patient urinate. This is very important at this time,
as it is not an uncommon experience to find that the abdominal muscles are
so worn out and overstrained with the fatigue of labor that they refuse to
act when an effort is made to urinate. As a consequence the bladder becomes
distended and may have to be emptied by other means. This condition is a
temporary and a painless one, and will rectify itself in a day or two;
meantime, if this accident has occurred, it is essential that the bladder
should be emptied from time to time until the patient can do it herself. To
test this function place the patient on the bed pan into which a pint of
hot water has been put, and give her a reasonable time to make the effort
to pass her water. Should she fail, take an ordinary small bath towel and
wring it out of very hot water, just as hot as she can tolerate, and spread
it over the region of the bladder and genitals: if there is running water
in the room, turn it on full and let it run while the towel is in position
as above. If the bladder is full, there is a peculiar, irresistible desire
to urinate when one hears running water. If this effort fails, report the
fact to the physician when he makes his daily call; he will draw the urine
and it will be part of his daily duty to give specific instructions
regarding this function until nature reëstablishes it.

No particular attention need be paid to the bowels for the first two days.
On the morning of the third day, if they have not acted of their own
accord, the physician will give the necessary instructions to move them.
The means necessary to accomplish the first movement after a confinement is
a matter of choice. The old-time idea was to use castor oil, and while
other remedies are now more or less fashionable, castor oil is still an
excellent agent. Enemas are frequently used, but their use is questionable
in this instance, inasmuch as a movement has not taken place for three
days, the object is to clean out the whole length of the intestinal tract,
and an enema is limited to part of the large intestine only,--according to
how it is given. If the small intestines are not thoroughly emptied,  [107]
particles of food may remain there, and if so, they will putrify and the
patient runs the risk of developing gas,--sometimes to an enormous extent.
This affliction is painful, and dangerous, and nearly always unnecessary.
It is always, therefore, more safe, and more desirable, to use some agent
by the mouth, and we know of no better one than castor oil; and as castor
oil can be so masked as to be practically tasteless at any drug-store soda
fountain there can be small objection to it. My custom is to send the nurse
or husband with an empty glass to the drug store to have the mixture made
there and brought back ready for use. We have frequently obtained it in
this way and given it to the patient without her knowing what it was. The
best time to give castor oil is two hours after a meal, and two hours
before the next meal--i.e., on an empty stomach. It works quicker and does
not nauseate when the stomach is empty.

INSTRUCTING THE NURSE IN DETAILS.--The nurse will attend to the patient's
discharges by changing the napkins frequently. The bruised parts should be
washed twice daily, for the first three or four days. If the nurse is a
trained graduate nurse a few directions will suffice. If she is not a
trained nurse the physician should be explicit in his instructions. It
would be better if he actually showed her just how he wanted this work
done. The best way to cleanse the vulvæ or privates is to take an ordinary
douche bag at the proper height (about three feet) and allow the solution
(1 to 2,000 bichlorid) to run over the parts into the douche pan, but do
not touch any part of the patient with the nozzle of the douche bag. While
she is directing the water with the left hand she should have a piece of
sterile cotton in the right hand with which she will gently mop the parts.
This method ensures disengaging any clotted blood and is aseptic. Dry the
parts afterwards with a soft sterile piece of gauze and apply a clean
sterile napkin.

DOUCHING AFTER LABOR.--A nurse should never give a vaginal douche without
instructions from the physician. Douches are not necessary in the
convalescence of ordinary uncomplicated confinement cases. When it is [108]
necessary to give vaginal douches after a confinement, there are good
reasons why they should be given, and it is therefore absolutely essential
that they should be given properly, and with the highest degree of aseptic
precautions. If these rules are not observed, the danger of causing serious
trouble is very great, and as the physician is directly responsible for the
conduct of the case, he should in justice to himself and his patient, do
the douching himself.

HOW TO GIVE A DOUCHE.--The proper way to give a vaginal douche after a
confinement, when the parts are bruised and lacerated, and when, as a
consequence, the possibility of infection is very great, is as follows:

Instruct the nurse to boil and cool about two quarts of water and have
another kettle of water boiling. Boil the douche bag and its rubber tubing
and the glass douche tube (do not use the hard rubber nozzle that comes
with the ordinary douche bag). Drain off the water after it has boiled for
ten minutes, but instruct the nurse not to touch the bag or tube, to leave
them in the pan, covered, till the physician uses them. When the physician
calls, place the patient on a clean warm douche pan while he is sterilizing
his hands and making the solution ready. While he is douching the patient
the nurse will hold the bag. The bag should not be held higher than two
feet above the level of the patient.

ADVANTAGES OF PUTTING BABY TO THE BREAST EARLY AFTER BIRTH.--The patient
can now take, and will likely be ready for, an hour's nap. After the rest
it is desirable to put the baby to the nipple, first carefully cleaning the
nipple with a soft piece of sterile gauze dipped in a saturated solution of
boracic acid. The reasons for this are as follows:

1st. There is in the breasts of every woman after confinement a secretion
known as "colostrum" which has the property of acting as a laxative to the
child, in addition to being a food.

2nd. It is advisable that the child's bowels should move during the first
twenty-four hours and the colostrum was put there partly for that purpose.

3rd. The act of suckling has a well-known influence on the womb, in   [109]
that it distinctly aids in contracting it, and thereby expelling
blood-clots and small shreds of the after-birth which might cause trouble
if left in.

4th. By nursing the colostrum out of the breasts, it will favor and hasten
the secretion of milk.

5th. It is frequently easier for the baby to get the nipple before the
breast is full of milk, and having once had the nipple it will be easier to
induce him to take it again when it is more difficult to get.

THE FIRST LUNCH AFTER LABOR.--Lunch will be next in order, and that should
consist of a clear soup,--chicken broth, mutton broth, beef broth with a
few Graham wafers or biscuits, and a cup of custard or rice pudding. This
will be the lunch for the two following days also. The same precautions are
to be observed in giving this as were observed with breakfast and as will
be observed with all other meals as clearly stated before, and repeated
again, so that no mistake may be made. In the middle of the afternoon the
patient can take a cup of beef tea or a cup of warm milk.

THE FIRST DINNER AFTER LABOR.--Dinner will consist of more broth, or a
plate of clear consomme with a dropped egg, or a cereal, a little boiled
rice with milk, and stewed prunes, or a baked apple.

After the bowels have moved, on the third day, and provided the temperature
and pulse have been normal since the confinement, the patient can be put on
an ordinary mixed diet, particulars regarding which are given on page 121
under the heading "Diet for the nursing mother."

       *       *       *       *       *


                                                                      [111]
CHAPTER IX

CONFINEMENT INCIDENTS

    REGARDING THE DREAD AND FEAR OF CHILDBIRTH--THE WOMAN WHO DREADS
    CHILDBIRTH--REGARDING THE USE OF ANESTHETICS IN CONFINEMENTS--THE
    PRESENCE OF FRIENDS AND RELATIVES IN THE CONFINEMENT CHAMBER--HOW LONG
    SHOULD A WOMAN STAY IN BED AFTER A CONFINEMENT?--WHY DO PHYSICIANS
    PERMIT WOMEN TO GET OUT OF BED BEFORE THE WOMB IS BACK IN ITS PROPER
    PLACE?--LACERATIONS, THEIR MEANING AND THEIR SIGNIFICANCE--THE
    ADVANTAGE OF AN EXAMINATION SIX WEEKS AFTER THE CONFINEMENT--THE
    PHYSICIAN WHO DOES NOT TELL ALL OF THE TRUTH

REGARDING THE MORE OR LESS PREVALENT DREAD OR FEAR OF CHILDBIRTH.--Much has
been written, and much more could be written upon this subject. Inasmuch as
this book is largely intended for prospective mothers to read and profit
thereby, and is not for physicians and nurses whose actual acquaintance
with confinement work would render such comments superfluous, it will not
be out of place to consider this phase of the subject briefly, from a
medical standpoint. When one considers that "a child is born every minute"
as the saying goes, and which is approximately true, and at the same time
remembers that statistics prove, as near as can be estimated, that there is
only one death of a mother in twenty thousand confinements, it would really
seem as though we were "looking for trouble" to even regard the subject as
worthy of the smallest consideration. It is much more dangerous to ride
five miles on a railroad, or on a street car, or even take a two-mile
walk,--the percentage possibility of accident is decidedly in your favor to
stay at home and have a baby. Almost any disease you can mention has a
higher, a much higher fatality percentage than the risks run by a     [112]
pregnant woman. The real justification for actual fear of serious trouble
is so small that it barely exists. These are facts that cannot be argued
away by any specious if or and. Why, therefore, should there be any real
fear?

Did you ever hear of the remarks made by a famous philosopher who was given
a dinner by his friends in celebration of his 85th birthday? In replying to
the eulogisms of his friends he said in part:

"As I look back into those blessed years that have faded away, I can recall
a lot of troubles and many worries as well as much happiness and pleasure,
and thinking of it all this evening I can truthfully say my worst troubles
and worries never happened."

So it is with the woman who for weeks or months has made her own life
wretched, and possibly the life of her husband and friends, the same in
imagining all kinds of dreadful things that never take place. It is
undoubtedly an exhibition of weakness, an evidence of failure in the
development of self-control. Childbirth is a natural process,--there is
nothing mysterious about it. If you do your part you have no cause to
fear,--the very fact, however, that you entertain a dread of it, shows that
you are not doing your part. One of the saddest parts of life, one of the
real tragedies of living, is the fact that most of us have to live so long
before we really begin to profit by our experiences. Could we only be
taught to learn the lesson of experience earlier, when life is younger and
hope stronger, we would have so much more to live for and so many more
satisfied moments to profit by. One of the most valuable lessons experience
can teach any human being is not to worry and fret about the future. You
can plant ahead of yourself a path of roses and be cheerful, or you can
plant a bed of thorns and reap a thorny reward. Cultivate the spirit of
contentment, devote all your energy to making the actual present
comfortable. Don't fret about what is going to bother you next week,
because, as the philosopher said, most of the troubles we anticipate and
worry about never occur, but the worry kills.

REGARDING THE USE OF ANESTHETICS IN CONFINEMENTS.--Anesthetics are as a
rule given in all confinements that are not normal. To make this      [113]
statement more plain it may be said, that, when it is necessary to use
instruments, or to perform any operation of a painful character, it is the
invariable rule to give anesthetics. As to the wisdom of giving an
anesthetic when labor is progressing in a normal and satisfactory manner,
there is a difference of opinion. Much depends upon the disposition of the
patient and the viewpoint of the physician in charge of the case. It is a
fact that a large number of confinements are easy and are admitted to be
so, by the patients themselves, and in which it would be medically wrong to
give an anesthetic. In a normal confinement, however, when the pains are
particularly severe and the progress slow, there is no medical reason why
an anesthetic could not be given to ease the pain. In these cases it is not
necessary to render the patient completely unconscious. Sufficient
anesthetic to dull each pain is all that is necessary, and as this can be
accomplished with absolute safety by the use of an anesthetic mixture of
alcohol, ether and chloroform, there can be no possible objection to it.
The use of an anesthetic, however, is a matter that must be left entirely
to the judgment of the physician as there are frequently good reasons why
it should not be given under any circumstances.

THE PRESENCE OF FRIENDS AND RELATIVES IN THE CONFINEMENT CHAMBER.--It is a
safe rule to exclude every one from the confinement room during the later
stages of labor. Sometimes it is desirable to make an exception to this
rule in the interest of the patient, by permitting the mother or husband to
remain. If this exception is made, however, they must be told to conduct
themselves in a way that will tend to keep the patient in cheerful spirits.
They must not sympathize, or go around with solemn, gloomy faces.
Cheerfulness and an encouraging word will tide over a trying moment when
the reverse might prove disastrous.

Practically the same rule applies to the entire period of convalescence
during which time the patient is confined to bed. This is a very important
episode in a woman's life and the consequences may be serious if it is
misused in any way. Friends and relatives do not appreciate the       [114]
absolute necessity of guarding the patient from small talk and gossip, and
an unwitting remark may cause grave mental distress, which may retard the
patient's convalescence and disastrously affect the quality and quantity of
her milk, thereby injuring the child.

HOW LONG SHOULD A WOMAN STAY IN BED AFTER A CONFINEMENT?--To answer this
question by stating a specific number of days would be wrong, because, few
women understand the need for staying in bed after they feel well enough to
get up. If any answer was given, it should be at least fourteen days, and
it would be nearer the truth medically to double that time. Let us consider
what is going on at this period. The natural size of the unimpregnated womb
is three by one and three-quarter inches, and its weight is one to two
ounces. The average size of the pregnant womb just previous to labor is
twenty by fourteen inches, and its weight about sixteen ounces. We have,
therefore, an increase of about 600% to be got rid of before it assumes
again its normal condition. This decrease cannot be accomplished quickly by
any known medical miracle. Nature takes time and she will not be hurried:
she will do it in an orderly, perfect manner if she is allowed to. The womb
will again find its proper location and will resume its work, in a
painless, natural way, in due time, if all goes well. The uterus or womb is
held in its place by two bands or ligaments, one on either side, and is
supported in front and back by the structures next to it. These bands keep
the womb in place in much the same way as a clothes pin sits on a clothes
line, and it will retain its proper place provided everything is just
right. After labor, it is large and top heavy. If you put a weight on the
top of a clothes pin as it sits on a clothes line, what will take place? It
will tilt one way or the other, and if the weight is heavy, it will turn
completely over. So long as the woman lies in bed the womb will gradually
shrink back to its proper size and place; if she sits up or gets out of bed
too soon, the weight of the womb, being top heavy, will cause it to tilt
and sag out of its true position. As soon as it does this the weight of the
bowels and other structures above will push and crowd it further out  [115]
of place. This crowding and tilting interferes with the circulation in the
womb and its proper contraction is interfered with, and thus is laid the
foundation for the multitude of womb troubles that exist.

It is a mechanical as well as a medical problem. Being partly mechanical,
it is subject to the rules that govern mechanical problems. The importance
of this dual process will be appreciated by considering the following fact.
Many medical conditions tend to cure or rectify themselves because nature
is always working in our behalf if we give her a chance. Take for example
an ordinary cold. You can have a very severe cold and you can neglect it,
and in spite of your neglect you will get well. It is not wise to neglect
colds, nevertheless, it is true that nature will cure, unaided, a great
many diseased conditions, if she has half a chance. This, to a very large
extent, is the secret of Christian Science, yet the principle is known to
everyone. A mechanical condition, on the other hand, has absolutely no
tendency to get well of its own accord, or without mechanical aid. This is
why Christian Science cannot cure a broken leg. It is this principle that
makes diseases of the womb so persistent, and so stubborn of cure. When a
womb once becomes slightly displaced, the tendency always is for it to grow
worse and never to cure itself. The longer it lasts the worse it gets. Its
cure depends upon mechanically putting it back in place and holding it long
enough there to permit nature to reëstablish its circulation, and by toning
and strengthening it so that when the mechanical support is taken away it
will retain its position. There is no other possible way of doing it. Now
since it has been proved that nature takes many days to contract a pregnant
womb, a woman is taking a risk, and inviting trouble by getting out of bed
before that time.

WHY DO PHYSICIANS PERMIT WOMEN TO GET UP BEFORE THE WOMB IS BACK IN ITS
PROPER PLACE?--Without offering the excuse that a woman will not stay in
bed as long as a physician knows she should, there is, however, a large
degree of truth in this excuse. And we are of the opinion that, if a
physician made it a rule to keep all his confinement cases in bed for one
month, [Page 116] he would very soon find himself without these patients.

Experience has taught us, however, that it is safe, under proper
restrictions, and in uncomplicated confinements, to allow patients to sit
up in bed on the 12th and in certain cases on the 10th day, and to get out
of bed on the 12th or 14th day. When the patient is allowed to sit up, out
of bed, it should not be for longer than one or two hours, and during that
time she should sit in a comfortable rocking or Morris chair, which should
be placed by the side of the bed. Each day the time can be lengthened, and
the distance of the chair from the bed increased. This procedure gives her
the opportunity to walk a little further each day, thereby to test her
strength and ability to use her limbs. On the fourth day, if all has gone
well, she may stay up all day and she may walk more freely about the room.
She should be just to herself, however. As soon as she is fatigued she
should not make any effort to try to "work it off." When a feeling of
fatigue appears she should rest completely. If she has any pain or distress
she should acquaint the physician with it at once. She should not try to
hide anything on the mistaken idea that "it isn't much." She does not know,
and she is not supposed to know what the pain may mean; it may be
exceedingly significant. Many women have saved themselves needless
suffering, and their husbands unnecessary expenditure of money, by calling
the physician's attention to conditions, which in time would have been
serious, and would have necessitated long, expensive treatment.

LACERATIONS DURING CONFINEMENT, THEIR MEANING AND THEIR SIGNIFICANCE.--The
only interest a laceration or a tear has to a physician, is whether the
laceration or tear is of sufficient importance to need surgical
interference. The laceration can take place at the mouth of the womb, or on
the outside, between the vagina and rectum.

Those of the mouth of the womb always take place, in every confinement, to
some degree. They are never given any attention at the time of the
confinement, unless under extraordinary circumstances, such as a more or
less complete rupture of the womb, and this is such a rare accident   [117]
that most physicians practice a lifetime and never see or hear of one
single case. Those on the outside are always attended to immediately after
labor, or should be, unless they are very extensive and the patient is not
in condition to permit of any immediate operative work. In such a case it
is best to leave it alone until the patient is in condition to have it
operated on at a later date.

It is distinctly preferable to have it attended to immediately after labor
when it is possible, and it is possible in a very large percentage of the
cases. The explanation of this is because it is practically painless then,
owing to the parts having been so stretched and bruised that they have
little or no feeling. If it is left for a day or two and then repaired, it
will be more painful, because the parts will have regained their
sensitiveness. Another good reason in favor of immediate repair is that a
much better and quicker union will take place than if postponed.

When a patient is torn, but not to the degree necessary to stitch, it is to
her advantage to be told to lie on her back and keep her knees together for
twelve hours, thus keeping the torn edges together and at rest, thereby
favoring quick and healthy repair of the tear. Some physicians go as far as
to bind the patient's knees together so she cannot separate them during
sleep.

It is the custom of every conscientious physician to request every woman he
confines to report at his office six or eight weeks after labor. The reason
for this is to find out by examination the character and extent of the
lacerations of the mouth of the womb. No physician can tell at the time of
labor just how much damage has been done, because the mouth of the womb, at
the time of labor, is so stretched and thinned out, that it is impossible
to tell. After the womb has contracted to about its normal size, it is a
very simple matter for any physician to tell exactly the character and
extent of the lacerations. Most of these tears need absolutely no
attention; there are a few however that do. This is a very important matter
for two very good reasons.

1st. Every woman should know, and is entitled to know, just what      [118]
condition she is in, because if she has been torn to an extent that needs
attention, and is left in ignorance of it, her physical health may be
slowly and seriously undermined and the cause of it may not be understood
or even guessed at. A woman who becomes nervous and irritable, loses vim
and vitality, has headaches, backaches and anemia, and no symptoms, or few,
that point to disease of the womb, will suffer a long time before she seeks
relief of the right kind, and will be astonished and outraged when she is
told that it all results from a bad tear of her womb that she knew nothing
about.

2nd. A physician should in justice to himself insist on this late
examination, because if a woman is told, at some subsequent time, by
another physician that she is badly torn, and she was not told of it by the
physician who confined her, she is very apt to form an unjust opinion of
his work and to entertain an unfriendly feeling toward him as a man.

Some physicians also, to their discredit, are not slow in permitting an
unjust opinion of a colleague to be spread around, by preserving a silence,
when an explanation would result in an entirely different opinion by the
patient. They permit it to be inferred that the physician was responsible
for the tear, when such is not the case. No physician on earth can prevent
a tear of the mouth of the womb and this should be explained to the
patient. Where the physician is at fault is in the failure to examine his
patients when it is possible to tell that a tear of any consequence exists.
If such an examination is made, he is in a position to state that a tear
exists of sufficient extent to justify careful attention. Immediate
operation is seldom necessary, and if the patient is comparatively young,
it may not be wise to operate, because if pregnancy takes place within a
reasonable time the womb will again tear. She should be told, however, that
should she not become pregnant during the next three years she should be
examined from time to time, and if the condition of her womb, or her health
suggest it, she should have the tear attended to. If after this explanation
she neglects herself she must blame herself, she will at least have no[119]
cause to harbor any resentment against her physician who has done all any
physician is called upon to do under the circumstances. Another important
reason for finding out the character of the laceration is because these
lacerations of the mouth of the womb frequently cause sterility.

       *       *       *       *       *


                                                                      [121]
CHAPTER X

NURSING MOTHERS

    THE DIET OF NURSING MOTHERS--CARE OF THE NIPPLES--CRACKED
    NIPPLES--TENDER NIPPLES--MASTITIS IN NURSING MOTHERS--INFLAMMATION OF
    THE BREASTS--WHEN SHOULD A CHILD BE WEANED?--METHOD OF WEANING--NURSING
    WHILE MENSTRUATING--CARE OF BREASTS WHILE WEANING CHILD--NERVOUS
    NURSING MOTHERS--BIRTH MARKS--QUALIFICATIONS OF A NURSERY MAID.

THE DIET OF NURSING MOTHERS.--A nursing mother should eat exactly the same
diet as she has always been accustomed to before she became pregnant. If
any article of diet disagrees with her she should give up that particular
article. She should not experiment; simply adhere to what she knows agreed
with her in the past. More, rather than less, should be taken, especially
more liquids as they favor milk-making. It is sometimes advisable to drink
an extra glass of milk in the mid-afternoon and before retiring. If milk
disagrees, or is not liked, she may take clear soup or beef tea in place of
it. In a general way milk in quantities not over one quart daily, eggs,
meat, fish, poultry, cereals, green vegetables, and stewed fruit constitute
a varied and ample dietary to select from.

Every nursing mother should have one daily movement of the bowels; she
should get three or four hours' exercise in the open air every day; and she
should nurse her child regularly.

The diet of the nursing mother during the period immediately after
confinement is given elsewhere.

Alcohol, of all kinds, should be absolutely avoided during the entire
period of nursing.

Drugs of every variety, or for any purpose, should never be taken unless by
special permission of her physician.

CARE OF THE NIPPLES.--As soon as the mother has had a good sleep after the
confinement the nipples should be washed with a saturated solution of [122]
boracic acid, and the child allowed to nurse. The milk does not come into
the breast for two or three days, but the child should nurse every four
hours during that time. There is secreted at this time a substance called
colostrum. This is a laxative agent which nature intends the child should
have as it tends to move the bowels and at the same time it appeases the
hunger of the infant. It also accustoms the child to nursing and gradually
prepares the nipples for the work ahead of them.

After each nursing the nipples should be carefully washed with the same
solution and thoroughly dried.

CRACKED NIPPLES.--Cracked nipples often result from lack of care and
cleanliness. If they are not cared for as described above they are very apt
during the first few days to crack. They should never be left moist. They
should be washed and dried after every feeding. If the breasts are full
enough to leak they should be covered with a pad of sterile absorbent
gauze.

Nursing mothers should guard against cracked nipples, as they are
exceedingly painful; frequently necessitating a discontinuance of nursing;
and may produce abscess of the breast.

TREATMENT OF CRACKED NIPPLES.--In addition to washing the nipples, drying
them thoroughly, and placing a pad of dry gauze over them after each
feeding, they should be painted with an 8 per cent. solution of nitrate of
silver twice daily. Before the next feeding, after the silver has been
used, they should be washed with cooled boiled water. If the cracks are
very bad it may be necessary to use a nipple-shield over them while nursing
for a few days.

TENDER NIPPLES.--Many women complain of the pain caused by the baby when it
is first put to the breast. These nipples are not cracked, they are simple
hypersensitive. They should be thoroughly cleansed and dried as above and
painted with the compound tincture of benzoin. They should be washed off
with the boracic acid solution before each feeding. After a few days under
this treatment the tenderness will leave them.

MASTITIS IN NURSING MOTHERS.--When inflammation of the breast takes   [123]
place in a nursing mother it is the result of exposure to cold, or it may
result from injury. If infection occurs and an abscess develops, it results
from the entrance, through the nipples, or cracks, or fissures in the
nipple, of bacteria into the breast. There is fever, with chills and
prostration, and very soon it is impossible to nurse the child because of
the pain. Nursing should be immediately discontinued, the breast supported
by a bandage and the milk drawn, with a breast pump, at the regular nursing
intervals. An ice-bag should be constantly applied to the painful area and
the bowels kept freely open with a saline laxative. When the fever and the
pain subside nursing may be resumed.

If the gland suppurates in spite of treatment it must be freely opened and
freely drained.

WEANING

WHEN TO WEAN THE BABY.--Medically there is no exact time at which the baby
should be weaned. Certain conditions indicate when it should be undertaken.
It is desirable to wean the baby between the tenth and twelfth months. A
month or two one way or another will not make much difference if the mother
and child are in good condition. It should be weaned between the periods of
dentition rather than when it is actively teething. The time of year is
important. It would be better to wean it before the hot weather if it is
strong and has been accustomed to taking other food than the breast milk.
On the other hand it would be decidedly better to defer the weaning until
the fall, rather than risk weaning at the tenth or twelfth months if these
fall during the height of the hot weather.

METHODS OF WEANING.--The best way to wean is to do it gradually. It is not
desirable to take the mother's milk away suddenly unless there is a very
good reason for it. The child should be fed small portions of suitable
other food at the beginning of the tenth month. By the end of the tenth
month he should be taking a feeding two or three times a day of food other
than the breast milk. This feeding may be given in a bottle. In some  [124]
cases the mother may be able to feed the child with a spoon instead of the
bottle. The substitute feedings allowable at this age are given in another
chapter.

TIMES WHEN RAPID WEANING IS NECESSARY.--There are times when the child must
be weaned suddenly, as, for example, at the death of the mother, serious
sickness of the mother, or in cases where for any cause the mother suddenly
loses her milk. In these cases it is best to wean at once. If an infant
refuses to take the bottle under such circumstances, the best plan to
adopt, and the wisest one in the long run, is to starve the child into
submission. If he gets absolutely nothing but the bottle he will shortly
take it without protest. If a meddling individual attempts to feed the
child some other food and tries to coax it to take the bottle in the
meantime, much harm may result; it is safe only to fight it out for a day
or two and win than to half starve the child and lose in the end.

The child should be weaned if it is not gaining in weight. This may
indicate a deficient quality of the mother's milk, or it may indicate a
lack of proportion between the child and mother. If a robust child is
depending upon the nourishment furnished by a mother who is not in good
physical condition the milk may not be adequate in quality and quantity.
The child will not therefore develop normally and it may be necessary to
wean it.

If the mother becomes pregnant it will be necessary to wean, because
pregnancy invariably affects the quality of the milk. It is a very good
habit to accustom the child to take its daily supply of water from a bottle
from a very early age. This procedure will make it easier to wean at any
time.

Menstruation is not an indication for weaning as has been explained. If,
however, the return of menstruation affects the milk so that it disagrees
with, or fails to satisfactorily nourish the child, it may be necessary to
wean, but not unless.

The best reason for weaning a child at the twelfth month is that a mother's
milk after that time is not adequate in quality for a child of that age. A
child at one year of age has grown beyond the capability of its mother[125]
to nurse it: nature demands a stronger and a more substantial food than any
mother can supply. A mother who nurses her child beyond that period is not
only injuring herself, but she is cheating her child. The exception to this
rule is, as has been explained, the second summer.

The child will evidence its dissatisfaction with the breast supply if it is
not enough; it will not gain in weight, it will be irritable and fretful,
it will tug long and tenaciously at the nipple, it will be unwilling to
cease nursing after it should have finished, and it will drop the nipple
frequently with a dissatisfied cry. These are all signs of insufficient
nourishment, and to the observant mother they will at once indicate that
the child must be weaned and fed upon a mixed diet.

CARE OF BREASTS WHILE WEANING CHILD.--The process of weaning should cause
little or no discomfort. If the weaning is gradual it is necessary to press
out enough milk to relieve the tension from time to time. It usually takes
three or four days.

If it is necessary to wean abruptly, as it is occasionally, there may be
considerable distress. In these cases it is necessary to massage the
breasts completely,--until all the milk is out, or as much as it is
possible to get out,--then rub the breasts with warm camphorated oil, and
bind them firmly. When the breasts are massaged for any reason, the rubbing
should be toward the nipple and it should be done gently. If there are any
hard lumps, or caked milk, in the breasts, they must be massaged until
soft, and the binding renewed. It may be necessary to repeat this process
for a number of days. In binding the breasts use a large wad of absorbent
cotton at the sides, under the arms, to support the breasts, and another
wad between the breasts. This renders the binding more effective; permits
the binder to be put on tighter; and prevents it from cutting into the
skin. When weaning has to be done quickly the patient should absolutely
abstain from all liquids. A large dose of any saline, Pluto, Apenta, or
Hunyadi Water, or Rochelle salts, or Magnesium Citrate, should be given
every morning for four or five days. [Page 126]

If the weaning is gradually undertaken the child should be allowed to nurse
less frequently. One less nursing every second day until two nursings daily
are given. Keep the two daily nursings up for one week and then discontinue
them, after which the above measures may be adopted. To dry the milk up,
the breasts may be anointed with the following mixture: Ext. Belladonna, 2
drams; Glycerine, 2 ounces; Oil of Wintergreen, 10 drops.

NERVOUS NURSING MOTHERS.--Nervousness, considered not as the product of a
diseased condition, but as a temperamental quality, is an unfortunate
affliction in some nursing mothers. Let us illustrate just how this
characteristic is detrimental to the helpless baby. A mother was instructed
to give her baby a half teaspoonful of medicine one-half hour after each
feeding. She was told how to give it, and how to hold the baby when giving
it. She was also told that the baby would not like it, and would try to
eject it from its mouth rather than swallow it, and that when it did
swallow it, it would make a little choking noise in its throat, but not to
mind these, to go ahead and give it, as the baby could not strangle or
choke. It was essential to give the baby this medicine, and hence the
physician explicitly instructed her in these details. What was the result?
On the following day when the physician called, and found the baby much
worse, the mother said: "Oh, doctor! I couldn't give the medicine, the baby
wouldn't take it, she nearly strangled to death when I tried to give it."
The physician asked for the medicine and placing the baby over his knee,
gave it without the slightest trouble, much to the mother's amazement. The
servant girl who was a hard-headed, cool, Scotch girl, was instructed and
shown how to give the medicine, which she did successfully. The mother was
temperamentally nervous, was easily excited and became helpless the moment
the baby objected, though she was a strong, robust, healthy woman.

Another mother was carefully instructed to drop into the eye of her baby
two drops of medicine every four hours. She was told and apparently
appreciated the urgent necessity of the medication as her baby's eye  [127]
was badly infected. She was further told that if she did exactly as shown,
the eye would be better in two or three days, and if she did not, the other
eye would become infected, and blindness might result. She undertook to
carry out the directions faithfully. She absolutely failed, however, to
carry out the instructions. Her husband informed the physician on the
following day that she became so nervous and excited that she utterly
failed to treat the eye once, and when he and a sister offered their
assistance she became so unreasonable in her fear that "they might hurt the
baby" that it was impossible to do anything with her. Her sister was
finally shown how to do it and carried the case through quite successfully.

Inasmuch as this book is intended to convey helpful instruction to every
mother, the author would suggest to those of this type the necessity of
resisting this tendency. It is a matter of will power, just make up your
mind not to be silly and if you find that you cannot trust yourself to
follow instructions, let someone else do it. When the physician tells you a
certain thing must be done, and that no harm can result, do it, and don't
imagine all kinds of impossible happenings.

So much anguish and annoyance is caused in this world by imagining and
anticipating trouble, that half the pleasure of life is denied us. You
cannot do your whole duty by a helpless baby if you do not reason and act
upon sound judgment. Many babies are lost by mothers being afraid to do
what should be done, and what they know should be done. It is not what the
doctor does that brings a baby through a dangerous sickness; it is the
faithfulness of the nurse in carrying out his instructions that is
responsible for the outcome. A timid, halting, doubting nurse can quickly
undo all a physician hopes to accomplish; while a prompt, faithful nurse,
with initiative, and good judgment, can save a little life in a crisis,
even in the absence of the physician. Follow instructions implicitly, even
though the carrying out of the instructions seem to cause the baby pain and
suffering,--it is for the baby's best interest.

                                                                      [128]
BIRTH MARKS.--Much has been written on this subject which a later study of
biology and eugenics have shown to be utterly false. Let us consider the
actual facts. The baby is already a baby, floating in a fluid of its own
manufacture. It has absolutely no connection with its mother except by
means of its umbilical cord,--which is composed of blood vessels. The blood
in these vessels is the child's blood and never at any time does it even
mix with the blood of the mother. It is sent along these vessels into the
placenta, or after-birth, in which it circulates in small thin vessels, so
close to the mother's blood that their contents can be interchanged. Yet
the two streams never actually mix. The carbonic acid and waste products,
in the child's blood, are taken up by the mother's blood, and given in
exchange oxygen and food, which is returned to nourish the child. There is
absolutely no nervous connection between the mother and the child. How then
is it possible for the mother to affect her child in any way except insofar
as the quality of its nourishment is concerned? Nor can a mother affect her
child in any other sense. If the intermingling of blood could affect a
child's education we would frequently resort to surgery. In the article on
Eugenics, under the heading, "Education and Eugenics," it is explained that
the child is "created" at the moment of conception; that absolutely nothing
can affect it after it is created; that no influence of the mother or
father can in any way affect it for better or worse. A mother cannot create
in her child any quality which she may desire no matter how she conducts
herself. It was formerly thought that a mother could for example create a
musical genius by devoting all her time to the study of music while she
carried the unborn child; or that she could make a historian of it if she
studied history; or an artist if she studied paintings. We now know this to
be wholly wrong and for very excellent reasons.

The mother must realize that the only aid she can bestow upon her unborn
child is to give it the best possible nourishment. She must provide good
blood because the quality of the maternal blood stream bespeaks a healthy
or unhealthy, a fit or unfit, child. Whatever the child is to be is   [129]
already fixed, its innate characteristics art part of itself. Whether it
will have the vitality to develop its inherent possibilities depends, to a
great degree, upon its intra-uterine environment,--and its intra-uterine
environment depends upon the health of its mother and the quality of the
blood she is feeding it upon. After birth its health, its success, its
efficiency, depends upon the care it gets and the quality of its mother's
milk. A mother therefore must be in good physical and mental health if she
hopes to do her full duty as a mother.

QUALIFICATIONS OF A NURSERY MAID.--When a helper, or maid, is employed to
aid in caring for the baby, much precaution should be exercised in
selecting her. The association of the nursery maid and the child, is
necessarity an intimate one, and she should be willing to submit to a
medical examination to prove her physical fitness. Her lungs should be
examined thoroughly, so also should the condition of her mouth, throat and
nose be known. An observant and tactful mother will also find out if there
are any other objectionable conditions existing, which would render her
unfit for the position. A nursery maid should be naturally fond of
children, she should be industrious, and sensible; of quiet tastes and good
disposition. Her work should be a pleasure not a task.

       *       *       *       *       *


                                                                      [131]
CHAPTER XI

CONVALESCING AFTER CONFINEMENT

    THE SECOND CRITICAL PERIOD IN THE YOUNG WIFE'S LIFE--THE DOMESTIC
    PROBLEM FOLLOWING THE FIRST CONFINEMENT.

The first three or four months following the first confinement is the
second important period in the young wife's life. In one sense it is the
most critical period. The first important period you will remember we
stated to be the first few months after marriage. During these months the
young wife passed through the period of adaptation. She found out that
matrimony was not all sunshine and happiness. She learned that her husband
was not the paragon she had idealized. She discovered his human side. She
met daily trials and annoyances incident to domestic life. She found her
level, and, in finding it, she discovered herself. She is not very safely
anchored yet but she is trying to succeed and the future promises well.
Some day she awakes to the knowledge that she is pregnant and a multitude
of new speculations enter into the situation. She finds she must go on
striving and hoping and praying that she may have the strength and courage
to do her part. Time passes, and if she is an ordinary woman she scarcely
does justice to herself. Her duties are exacting, and her physical
condition is not given the study and care which she ought to give it. She
does not understand the importance of the hygiene of pregnancy, and the day
of the confinement finds her more or less exhausted, and worn out. She
passes through the crisis of maternity, however, and spends the customary
ten days in bed. At the end of that period the nurse and physician leave
her to face the most important problem of life alone. She is a mother, and
has in her exclusive charge a human life.

Let us exactly understand what the real situation is. It would not further
the object of this book or help in the solution of the problem the author
has in mind to depict a false situation. We must concede the following[132]
facts to be true, if we understand the subject:

1. That the mothers of the human race are, in the vast majority, the poor.

2. That they are uneducated in the sense that they are not versed in the
science of hygiene and sanitation, and consequently health preservation.

3. That even the fairly well educated are innocently ignorant of the
science of heredity, environment, hygiene, sanitation and health
preservation.

4. That to benefit the majority we must depict conditions as they exist
among the poor, and reason from that standard.

Such books as have been written on this subject have based their facts upon
too high a plane. Their remedies are beyond the means and the understanding
of the average poor mother. Their analogies are based upon conditions that
exist among the better class. The average poor housewife gets no practical
assistance or help from their deductions, because her environment precludes
any utilization of the data furnished; the data is not practical in her
particular case.

Our young mother is in all probability a physically and mentally immature
girl. She most likely entered the marriage relationship without a real
understanding of its true meaning, or even a serious thought regarding its
duties or its responsibilities. She was not taught the true meaning of
motherhood before actual maternity was thrust upon her. She has probably
innocently acquired habits which are detrimental to her health and her
morals; and she has no conception of the fundamental duties of a homemaker.
Yet into the keeping of this woman a human life has been given.

Her home surroundings are not such as to inspire confidence or from which
to elicit encouragement. It has been a struggle to make ends meet; to keep
the peace; to be hopeful and cheerful. If she has succeeded in keeping her
home neat and clean and comfortable, it has been at the expense of her not
too robust constitution. If she has made efforts to observe the amenities
of life, to be true as wife, companion and confidant, it has taxed her[133]
nerves, her courage and her vitality. She has frequently been at the
breaking point but she has kept up because she felt it was her duty, and
because there was nothing else to do.

As she rests from her weary labor during the first long days after getting
out of bed, the loneliness of it all crushes her. She is weak, nervous, and
discouraged, and her white, wan face, with its tired, appealing eyes,
bespeaks her anemic and hopeless condition. She is only a child herself,
yet fate has crowned her with the holy diadem of motherhood. There are
thousands of such mothers and yet posterity need not despair. This is just
the beginning, and from such beginnings have sprung the heroes of the race.
If the reader has carefully read the chapter on Heredity she will
understand that the temporary condition of this mother is not important so
far as the destiny of the child is concerned. The really important question
is, How will this mother develop? The environment of the child depends upon
the conditions with which its mother surrounds it. If she is a failure, the
child's environmental influences will be unfavorable; if she proves worthy
of her trust, if she progresses and masters her difficulties; if she is a
good mother and a good homemaker the child's surroundings and influences
will be favorable to the full development of its hereditary endowment. But
it must be remembered that even an unfavorable environment need not prevent
the hereditary promise from dominating the life of the individual.

To return to our girl mother, upon whose slender shoulders the weight of a
great responsibility rests,--we wish to concede that her burden is great.
Her home duties are rendered more onerous because of her physical weakness
and disability. The strain of nursing her fretful child is taxing her
vitality and her nerves to the limit. Her disposition is imposed upon by
the exactions of an uncomprehending husband. She is inclined to fretfulness
and melancholia by the seeming uncharitableness of fate and fortune. Her
moments of introspection are almost bitter. It is a critical period,--she
has reached the breaking point. [Page 134]

Such moments are apt to be epochal. The turning of the wheel of fortune
will decide the destiny of a human soul.

It may be a friend who will supply the needed inspiration that will
revitalize hope, and courage, and the determination to succeed. Or it may
be a prayer, breathed in the silence of despair that will inspire the
courage to fight on, and change the complexion of life.

Once again we would advise such a young wife to calmly think matters over;
to find out "what she is working for"; to assemble her ideals and to "know
what she wants." There is nothing organically wrong. It is a condition, not
a disease. She is discouraged, despondent, nervous and weak. The
discouragement, despondency, and nervousness is a result of reduced
physical vitality and lack of system. She is not efficient because she is
not a trained worker. She is easily discouraged because anemia or
bloodlessness fails to supply the oxygen necessary to a fight. There is no
period in a woman's life when she is more apt to fall into a rut than at
this time. Every element, spiritual and physical, which is necessary to
stagnation and indifference is present, and it will take a bold and brave
effort to resist the temptation to failure which has encompassed her.

How can we suggest a remedy? She must first regain her health. She has
simply a condition to combat, not a disease, and a definite system, a well
laid out plan strictly adhered to will effect the result. She must regain
her health, because, without health, she cannot hope to be efficient in
work or agreeable in disposition, and she owes both to herself, to her
husband and to her child. She must get out of doors. She must walk in the
open air. There is absolutely nothing in life that will effect so
miraculous a transformation in a discouraged, tired, weary and sick woman,
as systematic daily walks in the open air. She must walk briskly, however,
and she must desire to get well. We cannot get well if we do not wish to
get well. One who walks with a purpose will walk erect, firmly and briskly;
she will hold her chest up, and will breathe deeply, and she will drink in
hope, and health, and happiness. It takes time to regain strength     [135]
after the strain of pregnancy and labor. Many women complain that they feel
weak and do not regain strength quickly, but they make no effort. They must
make a beginning. Sitting around waiting for it to come will not bring it.
If they cannot walk a mile, they must walk half that distance to begin
with; the five mile walk will follow in time. Many young mothers get into
the habit of taking baby out in his carriage for an airing, and regard this
as exercise for themselves. They join the baby brigade and parade up and
down the block, or select a sunny spot where there are others on a like
quest, and sit around exchanging confidences. These outings usually
degenerate into gossiping parties and are a dangerous and questionable
practice. They are no doubt good for the baby, but they are morally and
physically bad for the young mother. This daily habit is called exercise,
but it is in no sense physical exercise. The young mother should select a
certain time each day, immediately after a nursing when baby is likely to
sleep, and devote this period to walking. One hour each day will accomplish
much in regaining and establishing health and strength, and appetite for
the mother. No indoor work can take the place of a walk out of doors. It is
a duty on the part of the nursing mother to do this. It will enable her to
supply better milk; it will banish her tendency to nervousness; it will
ensure a good appetite, good spirits, and sound sleep. It will make her a
better mother and a better wife. Many young wives sow the first seeds of
discontent, and ultimate failure during the natural depression that follows
maternity.

She must adopt system in the performance of her household duties. A good
plan is to set aside a certain definite time for meals, when to begin
cooking and when to end washing the dishes. Then arrange regarding the
general household duties. Make a schedule for a week devoting each day to a
certain task so that at the end of the week all the essential work will
have been completed. By systematizing work in this way a great deal of
ground can be covered and as time passes it will become easier, as many
helpful ways will suggest themselves whereby time will be economized. [136]

Adopt a system with the baby. Many mothers are worn-out, nervous wrecks for
no other reason than a lack of system in the management of the daily life
of their offspring. If system is not adopted in feeding and caring for an
infant it becomes irritable. To a sick, tired, weary mother an irritable
child is an unspeakable torture. Begin right. Give it adequate, but no
unnecessary attention. Nurse it every two hours, and at no other time. Wake
it to nurse at its regular time. It will in a few days acquire the habit of
feeding regularly and will sleep between feedings. Do not overfeed it.
Remember babies never die from starvation, but many do by overkindness, and
overfeeding is the most prolific cause of infant mortality known. Read the
article on "How long should a baby nurse?" Keep the baby clean, comfortable
and happy and you will not have a fretful child, but one that will be a
constant inspiration and incentive to you.

Find time to rest, take a mid-day nap. Get off occasionally to the country
or the sea shore for a day or two. Keep up your interest in your personal
appearance, be neat and clean, and invite the attention of your husband
during the evening hour. Don't let him grow away from you. Be cheerful,
encourage him to tell of his hopes and plans, and show an interest in his
health and in his work. Do not forget the dominating influence on your
efficiency, and on your happiness which the study habit possesses. Interest
yourself in some art, cultivate your mind, and soon, sooner than you think,
you will have forgotten your troubles and you will have regained your
health.

There is no other way to do it. There is no royal way in which it can be
done which is not open to the poorest mother.

An ocean voyage, a trip to Europe, a society Doctor, a professional
masseur, beauty experts and miracle workers cannot accomplish more than you
can in your poor apartment, if you "go about it in the right way and in the
right spirit." Keep in mind always, that: "failure exists only in
acknowledging it." Every task that is worth while is won by self-sacrifice,
by self-abnegation, by patient, persistent, enthusiastic effort, and in no
other way. The joy of consummation is reward enough for all human
sacrifice.

       *       *       *       *       *


Corrections made to printed original.

Index: Constipation, in breast-fed infants: 'in-infants' (line-break) in
original

Ibid.: Gleet; Mucous patches; Pox; Vol II: Vol I. in original

Ibid.: Sanitary napkins; I, 66: I, 63 in original

Ibid.: Sexual intercourse; I, 76: I, 78 in original

Page 23: whether there is such a thing: 'think' (hand-corrected) in
original

Page 40: recruiting ground for the gangster: 'ganster' in original

Page 65: incident to a confinement: 'confiement' in original

Ibid.: The advantage of the Kelly pad: 'paid' in original

Page 89: the patient should pass: 'pateint' in original

Page 93: Advantages of Putting Baby to Breast: 'Adantages' in original

Page 127: anguish and annoyance: 'anoyance' in original