TTtr rxTiTovT csTATfoifAW QATnr rvRFfifitt. - ottvtTav irrrYRVTvn sp.PTP!rnPTi ; iQ'Yi
jrxrjTLr-ijiv : - . . , - . .
-ii I
SALEM HAS IMPORT
ANT PART IN WORK
(Continued from page 1)
trlct in which Us work la most
needed- A study of the location of
the infant death in a city (as shown
on a spot map) will often determine
where the need Is g ratest. Conveni
ence for the mothers is a prime ne
ceeeity. .
Rooms for a health center mar
often be obtained in schoolhouses,
rent-free. These make excellent
quarters if the consultation hour
ran be arranged on Saturday or af
ter school hpurs. It may be estab
lished In a schoolhouse during the
summer months also. In smaller
communities ree quartet may
Bomet lines be secured In the city hall
or courthouse. In some cases it will
be necessary or advisable to rent
suitable rooms, '
Size
It Is desirable to have two 'rooms,
but If this Is not possible one room
or corner of rooms la used for a
waiting room for the mothers; here
the babies are undressed. In the
other room the babies are weighed
'srid the mother consulta with pbysl
cian and nurse. '
Equipment'
The essential equipment is very
simple, though it may be elaborated
If circumstances permit, it consists
of the following: . , r
Standard scales for weighing ba
bies. A platform scale, upon which
Is fastened a simple tray from which
a baby cannot fall ont. Is often used
with success. A very large scoop,
firmly fattened to the scales; may
also be used. Scales should be test
ed frequently for accuracy.
Two tables covered with oilcloth.
Pad for examining table, blanket,
snd sheet.
- Chairs; enough to accommodate
the doctor, nurse, and ; mother. -' '
One pall; running water. If pos
sible; If this Is not obtainable, bowl,
pitcher, and slop jar should be pro-
vlded. '
Wooden tongue depressors.
Paper napkins or paper towel; or,
what la less expensive, tissue paper,
'which may be bought by the ream
and cut Into needed sizes. A fresh
piece of paper should be placed in
the scales before each baby la
weighed and on the table pad before
each examination.
iRecord cards. No, standard record
. ' card for children's health center
has been ttevteed. Those in use by
agencies carrying on the work in
the larger cities may be studied be
fore printing cards for; local use.
- Tu.imdn. arm-
i . Fprmery many health centers dis
pensed milk, but at present far fewer
are doing so. Where : the general
milk supply is a safe one. It has been
found better to advise mothers to ob
tain milk from the regular milk com
panies and to confine -the work of
the center to supervision and advice.
When this method Is followed and
milk and ice, free or at reduced cost,
are necessary in special cases, - they
are obtained through the local char
ity organization society, to whom the
family Is referred.
The work of milk station will not
be taken up In this circular. j
Hours of Conference '
' Conferences should be held at
, least every week on the same- day
and at the same hour; If the" at
tendance Is grat, more frequent con
sultations will be necessary Much
of the success of the center .will de
pend upon setting the day and hour
of the conference at a time convent-
Mir fn Th A tnAlhAra
' Ccmt of establishing and Operating
The lnlttil cost of equipment need
not be great If 'the equipment is as
tfmple as that described. The scales
are the chief Item of expense.
Th cost of operation Includes the
following Items:
Balary of nurse, which is the chief
, expense. The salary of a good nurse
varies between 75 and 1125 per
month, i ' ' ;
Salaries of attending physicians.
, unless their services are given free.
Rent of rooms. If they are not ob
tained rent free.
Cleaning.
Supplies (tissue paper, tongue de
" pressors, record cards).
- - mwmmmrj ...... W , W7 IUVIUCI
are distributed at many children's
health centers. Many state and city
departments of : health and certain
fUlAMl ,AHld. Will I
,vnvica win luruuu excel'
lent literature for this purpose. A
list of these is given ttt Baby Week
Campaigns (revised edition), which
may be obtained upon application to
the Children's Bureau. K
Children's Health Centers in Small?
.. er Communities and Rural
, District j;
Many public health nurses doing
iniant welfare work In smaller com
munities and" rural districts have
, found thta central headquarters
wnere mothers can meet fw confer
ences have been verv anerMKfnl
Such centers have been established
n several county seats In connection
l V . . . f
wim rei rooms ior women, ant
conferences are held on the days on
j which it Is the custom of the women
, from the country to come to .town
, tor shopping. Nurses workinr In
rural counties find that, in m.AA.ttnn
to such a central headquarters, cen
ters at rural schools throughout the
country are needed. The state de
partment of health of one state Is
vwains a aeries of children's
neaun : centers in rr.r i.it...
e-ach center Is to be the headouar-
rur' puduc health nurse.
cu.ct sitendance is to be fur-
tli: J a Pc,t In Infant wel
fare and rhlMrn. a...
, m wiocsioOB Sri ill
5LJfv b-C at department of
Interval. r i 01 - at
nr,;.,, of tron "e to three
BABIES MUST HAVE
BEST OF CARE
(Continued from page 1)
efn m m,lk nature", food, but
even this form of nourishment can
bspoiled If the baby, la allured "
waenever he cries. Puttlnr
another meal into th- . .Jt .5
fore the previous one ii digested wil
Feed tne baby by the clock, and.
wake him regularly In the daytime
to take nourishment.
ffruitJulces should be given to
bottle fed babies once a day after
the third month, and may be given
to breast-fed children by the second
hair or the first year. At first, a
teaspoonful of. strained orange juice
(diluted with water) may be given
on an empty stomach, and .this grad
ually increased to the juice of half
an orange. The juice of other rip
fruits, such as peaches, may be sub
stituted for oranges, or the juice of
cooked fruit used. If no fresh fruit
is available.
lioiltd water ahould be offered to
every baby at least twice V day. Dur
ing hot weather; a baby may be al
lowed to take as much cool water as
desired from one to six ounces a
day, according to the age of the
baby.
Hath
A bath every day is necessary, at
least until the child is trained in
personal habits. Individual towels
and wash cloths should be used. The
room in which the bath is given
should have a temperature of from
70 to 75 degrees ; the bath water.
100 degrees, gradually decreasing to
90 degrees at six months. A cold
splash over the chest protects the
child from taking cold.
The bath can be taken at any
hour that suits the mother, but a
convenient time is usually before the
mid-morning feeding.
How to'DreMi the Baby
A simple, washable outfit should
be selected tor the newborn child.
Except in very warm weather, an
Infant should wear a light or medi
um weight band, shirt and stockings
of-part wool. The underwear and
the diaper are the essential articles
of clothing. A dress or nightgown
is usually added, and in cold weather
a flannel slip should be worn under
these. Dross, the baby lightly in-'
doors; additional garments 'may be
put on to suit the outer temperature,
when he la aired indoors, or is taken
out. Keep the baby clean and spot
lessly neat; frills will not male him
any sweeter. "
Play and Exercise
Nature provides plenty of exer
cise for the baby in crying, kicking
his legs, tossing his arms about, and
In learning to creep.
If these movements are not re
stricted by tight clothing, swaddling,
or pinning down in bed. no other
form of exercise Is needed In In
fancy. Every young baby should be
held once or twice every day, and
should not be allowed to stay a long
time in one position. Mothering is
good for a child, but It must be in
. telligent mothering, and not foolish
Indulgence which may lead to the
establishment of bad habits.
Daily Rootlne
A mother should plan a dally
schedule for her baby, considering
first what Is best for him. and next
what arrangement of hdurs fits in
with her other duties. It la not
necessary or wise for a whole house
hold to revolve around the baby.
The first decision to be made is whe
ther the baby shall be fed at a three
or four-hour interval, and how many
feedings shall be given in 24 hours;
next, at what hour the early morn
ing feeding shall be given.
PACIFIERS ARE
BAD FOR CHILD
(Continued from page 1)
tach no Importance to saving these
teeth, considering them merely as
"first teeth, for they give the
'shape' to the entire masticating
apparatus. Once lost, nature makes
an effort to close the space. The
result Is mal-formatlon and Improper
occlusion of the entire set of per
manent teeth.
Therefore it is of the utmost im
portance that the care of the teeth
be commenced even before the first
teeth appear. The gums should be
gently wiped with a solution of boric
acid (not borax) after each feeding
using a piece of soft lint or. clean
linen for this purpose. '
Then, from.; the time the first
tooth appears and regularly ever af
ter, so long as teeth and life last,
the teeth should be carefully brushed
with the only brush that thoroughly
cleans teeth the Prophy-lac-tiv. ,t-
AH particles of food should be re
moved from behind, and from all the
crevices and spaces between the
teeth, so that! no fermenting, food
debris be permitted to lodge between
them, breeding decay of tooth struc
ture, and eventually disease or even
death. ' j
Mothers fchould Temember that
bad teeih cause bad health, and bad
health handicaps the child for life.
In the nursery, the school, and in
the business world, the value of
tooth care is Incalculable. - The man
or woman whose dental education
began as an Infant who In child
hood first became acquainted with
a toothbrush has a profound reason
to be grateful.
BEST FORMS OF
FOOD FOR BABY
(Continued from page 1)
at a single feeding and the total
number of feedings in 24 hours.
Take the amount of whole cows milk
suited to the weight and digestive
capacity of the Infant, dilute the
milk with sufficient boiled water or
cereal water to bring It up to the
deaired amonnt for the total num
ber ot feedings. One-half to one
ounce of augar (for cane sugar. '3
to '6 level teaspoonfuls) should be
dissolved in the boiled water or cer
eal water before adding It to the
milk. Mix well and divide It Into
the deired number of feedings.
- Cereal water Instead of boiled wa
ter may be used after the first
month for diluting the milk. Dur
ing the early months. It should be
made by using only one-half a level
teaspoonful of . flour (barley or
wheat) to a plat of water. This
may be gradually increased to two
level tables poonfuls at six months
and three level tables poonfuls at 9
month. . -
In making cereal water, mix the
flour in a little cold water until It
1 a smoth paste and then stir this
Into a pint of boiling water. Let the
mixture cook over a flame until it
thickens and then cook slowly in a
double boiler for at least one hour.
Do not salt for young Infants.
Example: A well baby six months
of age. weighing 14 pounds, has a
stomach capacity or six ounces;
therefore, if six meals a day are giv
en, the total amount to be. given
would be 36 ounces; If five meals a
day are given, the Infant could safe
ly be given seven ounces at a feed
ing, making the total amount 35
ounces; allowing 1 ounces of milk
to the pound weight gives the total
of 21 ounces.
Feeding Formula
Milk (whole) 21 ounce
Water 14 ounce
Sugar . . . 1 ounce
Total 3 ounces
Regularity in feeding Is the first
habit a child must acquire.
Well Chosen Diet Given
for the Child's Daily Meals
A little child who Is carefully fed
In accordance with his bodily needs
receives every day at least one food
from each of the following groups:
1. Milk and dishes made chiefly of
milk (most important of the group
as regards children's diet); meat,
fish, poultry, eggs and meat substi
tutes. 2. .Rread and other cereal foods.
3. Butter and other wholesome
fats.
4. Vegetables and fruits.
5. Simple sweets.
The following bills of fare are sim.
pie. easy to prepare, sufficiently var
ied, and. If well prepared, should
taste good.
Breakfast.
These breakfasts might well be en-.
larged by the addition of aoft-boiled
r coddled eggs.
Orange (juice only for the youngest
children).
Farina with milk.
Bread and butter.
Apple sauce.
Oatmeal.
Toast and butter.
Baked apples (pulp only for the
youngest children).
Milk toast.
Cocoa
Stewed prunes (pulp only
for the
youngest children).
Cornmeal mush and. milk.
Toast anT butter.
Grape fruit (Juice only for the young
est children).
Milk toast with grated yolk of hard-
boiled egg.
Apple (scraped for very little chil
dren).
Toast.
Hot milk.
Dinner.
Meat soup.
Egg on toast.
String beans.
Rice pudding.
Roast beef.
Baked potatoes.
Asparagus.
Bread and jelly. .
Lamb stew with carrots and potatoes.
Twice-baked bread.
Tapioca custard.
Creamed potatoes.
Green peaa. '
Stewed plums with thin cerepl-milk
pudding.
Baked halibut.
Boiled potatoes.
Stewed celery.
boiled rice with honey or sirup.
Broiled meat cakes.
Grits.
Creamed carrots.
Bread, butter and sugar sandwiches
Sapper.
Baked potatoes, served with cream
and salt, or with milk gravy. Cook
ies. Bread and milk.
Ac pHe sauce. I
Cookies.
Potato milk soup.
Twice baked bread.
Marmalade sandwiches.
Graham crackers and milk.
Baked custard.
Milk toast.
Stewed peaches.
Cup cake.
Celery-milk aoup.
Toast.
Floating Island.
In each case enough milk should
be given to make up the required
daily amount.' which is about a
quart.
John Ball Pays For
Healthy, Happy Babies
John Bull believes that healthy
babies make strong men. and is will
ing to pay tor them, according to re
ports recently received by the Chil
dren's Bureau o f the United States
department of labor. In 1918 grants
made by the national government In
support, of infant welfare work In
England and Wale amounted to
about $1,150,000. which represents
one-halt of approved expenditure for
welfare centers, "health visitors."
maternity care and similar work for
mothers and children.
The number of health centers In
creased from 850 in 1917. to 1550
In June. 1919. over one-half of them
supported entirely by public fund.
Attendance at the centers has also
shown a phenomenal Increase. One
center In Glonchester. which. In 1918
received 2S3 expectant mothers, had
932 on Its rolls In 1919.
As a result, it Is thought, of public
protection of maternity and infancy,
the Infant mortality rate for Eng
land and Wtales for 1918 Is 94.
Thers was no increase over 1917
under the adverse conditions of .war
and influenza.
The 1918 Infant mortality rate for
the U. S. birth registration area, just
published. Is 101. 7 points higher
than the rate for the preceding year.
Children's bureau investigations
have shown that Uncle Sam's babies
die because they and their mothers
do not have skilled care. Until such
rare is made available, as la Eng
land for all women la all parts or
the country, regardless of economic
standing, no great decline In the in
fant mortality rate may. be expected.
CHILDREN NEED
LARGE AMOUNT
RESTFUL SLEEP
Much of Growth Takes Place
While Sleeping Young Ba
by Should be Watched
REGULARITY ESSENTIAL
Temperature Important Fac
tor Cool Room Consid
ered Best
The infant brain Increases in size
two and one-half times In the first
rear, a greater growth than takes
place during all the remaining years
of life. At the same time this enor
mous brain development Is taking
place the other organs of the little
body are growing rapidly. During
sleep the body tissues are recreated
and the energy and materials needed
for the activity of the waking hours
are stored up. It Is manifest, there
fore, that the baby must have a
correspondingly large allowance of
sleep. He should be provided with
the best possible sleeping accommo
, dations. so that the hours of sleep
may be of the greatest value to him.
He should always slee pta a bed by
himself, and whenever possible la a
room by himself, where he need not
be disturbed by the presence of oth
er persons, and where light, warmth.
and ventilation may be adjusted to
his particular needs. Not a few
young babies are smothered while
lying in the bed with on older per
son, some part of whose body la
thrown over the baby's lace durlifg
heavy sleep.
: Amonnt
'A young baby sleeps 18 to 20
tours out 'of 24. At siv months of
age -a baby sleeps about 16 hours,
at one year about 14 hours, and at
two years at least 12 hours. Day
time naps should be continued as
long as possible.
IlegmUrity
A baby should be trained from the
beginning to have the longest peri
od of unbroken sleep at night. Some
babies get a wrong start In this re
spect and make great trouble by
turning night Into day. A strong
argument In favor of the three-hour
nursing Interval is that It does away
largely with the need for waking the
baby to nurse. Nature Intends that
the baby shall waken when hungry,
and this normally occurs about once
In three hours In a healthy baby, so
that with a little care the regular
.feeding interval can be made to co
incide with the normal periods of
waking. It the baby la still sound
asleep when the three-hour period
has eome aroand. he ahould be
gently, ronsed and put to breast.
This will involve little shock to his
nerves. . because he will be about
ready to waken In any event.
For the first three months the
baby will probably sleep both morn
ing and afternoon. As he grows
older these naps will be merged into
one. and an effort should be made
to have the longest waking interval
in the afternoon, gradually tratnlng .
the baby to stay awake long enough
at that time to be quite ready to
drop oft to sleep for the night as
soon as he has had his supper. A
mother who must prepare and serve
the evening meal of the family will
find It a. great comfort to give the
baby his supper' at half past S and
have him in his crib at C. For the
first few months he will be fed
again about 10 o'clock, but after
that he should not be taken up. He
must be made comfortable in every
way, the light ahould be put out. the
window opened, his covers adapted
to the temperature, but after the
mother has assured herself that ev
erything essential to his comfort has
been attended to, she should not go
to him when he cries. If he Is a per
fectly healthy baby.- A few nights
of this training will result In entire
comfort tor the baby and the fam
ily, while the opposite conditions
will make the baby a tyrant who
ruthlessly spoils the comfort of the
entire household.
Temperature of Sleeping Room
For Very young babies the tem
perature of the sleeping room ahould
' be kept at about 5 degrees. After
the baby Is three months old the
temperature may be permitted to fail
to 55 degrees, and during the second
year to 45. Strong and healthy ba
bies are quickly accustomed to cool
and even cold sleeping rooms and
usually sleep more soundly and keep
themselves covered better than when
sleeping in warm rooms. In the
severe northern winter, where the
temperature drops many degrees be
low freezing before morning, the
baby must wear a flannel nightgown
over the cotton one. The sleeves
ahould be pinned together over the
ends of the fingers so that the hands
will be covered. A very aoft flan
nel nightcap may be needed, and
heated articles, such as hot water
bottles or bags of san dor sale may
be placed in the bed. great care be
ing taken that they are covered In
such a way that they baby cannot
be burned. The baby should also
take his daytime naps In a cold
room.
Comfortable sleep during the
heated portion of the year Is more
difficult to secure. The most airy
room should be chosen, and all the
baby's clothing removed, save the
diaper and a very thin cotton gown
with loose sleeves. It la better. If
possible, to keep the baby ont of
doors during late afternoon and
evening until the rooms have cooled.
A baby should never be put down
to sleep in all his clothes. His
shoes, especially, ahould be re
moved, and unless the weather Is
very cold, it la better to remove the
stocking also. Rut the baby's feet
must always be kept warm.
IHstarbcd Bleep
If the baby sleeps lightly, wakens
often, and seems uncomfortable. It
: may be that something Is disturbing
him which esn be remedied. He
may be nervous from having been
tickled, played with, or tossed about
in the latter part of the day. Over
stimulation la to be avoided at all
times, no matter what the cause nor
what the age of the baby.
He may be too warm, too cold, or
wet; there may be something
scratching him. or there may be
wrinkles in the bed clothing: he
may be Lying In a cramped position,
or the band or diaper may be too
tight. Or more likely, he haa been
overfed, or has had something un
suitable to eat. or Is hungry or
thirsty.
The room may be too, hot. or too
cold, too light, too noisy, or not suf
ficiently aired. The conditions
which make sleep a delight to older
persons affect the baby in the same
way. namely, plenty of fresh air
passing in a current through the
room, quiet, a clean body, and clean,
comfortable clothing, a good bed,
and suitable coverings.
A cool bath, or a warm one. ac
cording to the temperature, will help
to Induce quiet sleep. In the sum
mer, when the baby Is fretful and
sleeps restlessly, a tub bath at bed
time will help to relieve him. A.
little baby should be turned over
once or twice in the course of a
long nap.
Medicines
Never give a baby any sort of
medicines to induce sleep. All
soothing syrups or other similar
preparations contain drugs that are
bad for the baby, and many of them
are exceedingly dangerous. Many
babies die every year from beta;
given such medicines. The abjr
should never be allowed to g'o to
deep with any kind of pacifier In Its
mouth.
SPECIALIST PLEADS
FOR OLD METHOD
(Continued from page 1)
additional means must be employed
to Increase the flow of milk.
Four methods of Increasing breast
milk have been nsed: drugs, diet,
massage, and expression. Practical
ly every drug In the pharmacopeia
has been nsed for the purpose, each
In turn having been discarded. The
latest ones are the glandular prod
ucts with pitultria leading. Careful
physiological experiments show thst
pltultrn acts upon the smooth mus
cle fibres, causing them to contract
and forcing the' milk more rapidly
from the breast. The amount of
milk excreted In a given time Is in
creased, but again, we are disap
pointed because ' the total seereter
tor 24 hours la unchanged. Morse
and Talbot sum up the evidence by
saying. There are no drugs which,
whether taken Internally or applied
externally, can Increase, the flow of
milk to any appreciable extent.
The Influence of diet on breast
milk has long been a mooted ques
tion. Of course the mother must
have additional food to make up for
the 750 calories lost with the milk
and enough water to replace the
quart secreted. . Hoobler, In careful
led experiments, haa shown that 1(
the mother has & glass ot milk per
day, one egg or its equivalent In
meat, the protein content ot her
breast milk will be normal. Except
among the very poor, therefore, a
mother's diet is usually adequate.
Probably the most common mistake
In practice Is to overfeed a nursing
woman especially with a milk diet.
The Idea prevails extensively smong
the laity that cow's milk poured In
to the stomach appears again In
the mammary gland. Instead it usu
ally fattens the mother and If the
breasts have begun to dry up they
continue In that course.
- The effect ot massage on the flow
of breast milk has long been rec
ognized. Its most ardent advocate
and the one who nsed It most Suc
cessfully Is E. Trulby King of Lon
don. He used electrical and manual
maaaage. hot and cold applications
followed by suction with a breast
pump. He says that when the moth
er la occupied in thla way the psy
chotherapeutic effect also Is ot great
value.
The fourth method Is expression
by hand. Soranua of Ephesus A.D.
100 said that emptying the breasts
Increased their activity. Why manu
al dexterity In this art has been so
long neglected Is one of the myster
ies of medicine. Pfsundler and
Schlossman. as late as 1912. gave
a method as follows: "Manipula
tion with the hand consists In grasp
ing the part' ot breast covered by
the areola only. Draw the whole
breast downward and forward, cease
momentarily, then repeat this man
euver." Then "they proceed to con
demn their own method, by stating
that the complete emptying ot the
milk glands, possible by hand with
the cow. is possible with the human
breast by no other means thsn the
nursing infant.
De Lee's Obstetrics gives the fol
lowing method: "Steady the breast
with one hand while four fingers of
the other wipe the milk towsrd the
nipple." This laborious method re
quires both hands and is too alow
to be practicable.
Sedgwick has given us the first
really practical technic: "The breast
Is grasped about one or two cm.
back of the colored areola and a
milking motion Is carried out toward
the nipple. I have to thank Dr.
Sedgwick for teaching me this meth
od and for giving me interest and
Inspiration 4n the subjeojt. W3th
Sedgwick's method I have had some
very gratifying results, due to the
fact that some mothers and nurses
were able to acquire the tricks ot
the milking motion themselves.
When I tried to teach manual ex
pression to French and Italian doc
tors and nurses, 1 found I needed to
make a more careful analysis of the
necessary motions Involved In the
milking process and hence evolved
the following formula: First: Place
the balls ot the thumb and of the
forefinger on opposite sides ot the
nipple just outside the areola, press
ing on opposite sides of the nipple
just outside the areola, pressing
them firmly against the gland Itself.
Second: Maintaining this pressure,
bring the thumb and forefinger to
gether bsck ot the base ot the nip
ple. This presses the milk out ot
the sinus lactiferous or ampulla.'
which forms -the beginning of each
external milk duct- Third: Give a
slight forward pull to empty these
external ducts. Stripping or even
touching the ntyple Itself la usually
unnecessary. With inverted nipples
the ampulla is often two cm. dorsal
to the external openings of the milk
ducts. To compress It the tips of
the thumb and finger must be
pressed deep Into the areolar pft.
As Sedgwick at the University ot
Minnesota haa pioneered In the
movement for universal breast feed
ing; and., as my only claim to orig
inality Ir the method of Increasing
the amotint of breast milk Is an
analysis pf the milking motions, I
feel that simple justice demands
that thls be called the Minnesota
method of manual expression.
The method Is so simple thst It
can be taught to the most Ignorant
mother or nursemaid. In iMflan.
Italy, at the time of the opening of
our Red Cross refugee home of 90
beds, our only nurse was an llllter
ste Italian without hospital training.
We receive two babies that had been
born during "the great retreat."
Both had been weaned, one for
eight, and the other for 11 weeks.
We pnt both back on the breast and
had eaeh mother nurse her baby
every four hours. The nurse then
expressed all the remaining milk. .
Following the nursing, the baby
received the milk expressed st the
previous nursing snd la addition a
complimentary feeding from the bot
tle. The amount given from the bot
tle varied Inversely as the amount
procured from the "breast. Aa the
babies grew stronger they emptied
the breasts more completely, thus
stimulating further production, so
thst In few weeks the babies were
nursing normally to the great sur
prise of our Italian colleagues.
In Paris, at our BIcetre dli pes
sary, twe taught the fundamental
law that every mother can nurse her
baby. The rule wss established that
every baby coming to the clinic, who
had been weaned aix weeks or leas,
was put back on the breast and aa
attemot made to reestablish the flow
of milk.
Abnormal breast feeding cases
were classified aa follows:
I. Establishment.
IL Re-Establishment.
HI. Development, I
. 1. Spastic nipple muscles
(hard milkers).
. 2. Temporary redaction or
lots of milk.
3. Weak baby.
2. Premature,
b. Immature,
e. Acutely 111, e.g. eor
yaa. 4Quotlng from my reports of June
to September 1918: "We had only
one case (Lntz) on which to attempt
the establishment of a flow ot breast
milk. The mother had three chil
dren, none of whom were breast fed.
She brought her baby la at 42 days
of age, vomiting, and In a bad con
dition. We taught the mother our
method of manual expression and
had a nurse call on her as often aa
our limited forces permitted. To
make matters worse the baby stead-
fastly refused to take the nipple.
After two months' effort, however,
the mother states he Is getting
"beaucoup de lait.' aa some nurs
ings: the vomiting Is cured, and hla
general condition la good. -
"We have had tour reeetabliah
ment cases. One Ot these, Gilbert,
Is typical. The baby was weaned at
three weeks because the mother had
to. work. Ten days later they came
to our clinic, where the baby was
put back on the breast and the moth
er was assured of some financial as
sistance. After two weeks' work on
the part of the nurse and the moth
er, .the baby was breast fed ex
clusively. At three and a half
months it weighed C280 grams, hav
ing gained 2130 grama In 10 weeks.
"Among the development eases
were six hard milkers that Is,
mothers with circular nipple, mus
cles of abnormal strength. An In
teresting restore with the hard milk
ers Is that as the amount ot milk In
the breast Increased the spasticity
of the nipple muscles decreased and
the milk came with greater ease.
'There were eight premature ba
bies babies whose strength was
naturally txlow par and who. there
fore, needed assistance In their at
tempt to get milk from the breast.
Among these babies Duplot Illus
trated nicely the, rule that babies
who are underweight at blrth gradu
ally catch up with those who are of
normal weight, If properly fed. The
baby weighed 1900 grams at birth
and during the first six weeks
gslned 1985 grams, thus more than
doubling the birth weight In this
short time.
"We had 11 cases of temporary
reduction or loss ot milk. These,
when untreated, ar the most com
mon causes of weaning. The Leavy
baby is an Interesting case as show
ing one cause of temporary loss of
milk. At birth the baby weighed
3000 grams. It came to use when
five and one-halt weeka old weigh
ing 303S grams and was la the
third degree ( Marfan ( of emacia
tion. It had been fed on the bottle
for a week. The mother's breasts
were found to be of .good size, with
lsrge blue veins snd normal nip
ples. The n.other clsimed thst from
the eleventh dsy the baby had been
cross and peevish, had failed to gain
in weight, and finally had begun to
vomit her milk. Investigation
showed thst the active catharsis,
which was given the mother for
three dsys preceding her departure
from the hospital, had caused; a
marked reduction In the amount ot
milk, and this In turn produced an
Infant too weak to stimulate, again,
a normal flow.
("We prescribed our manual post
nursing expression snd complemen
tary feeding. The baby gained 718
grams In three weeks and the moth
er changed from a tearful, fretful,
nervous woman to a happy, smiling
one."
The French showed sincere appre
ciation of the result In our Parts
clinic, the .mayor bestowing upon ns
the very high compliment ot send
ing to our clinic his dsughter with
her three weeks old Infant.
On mv arrival In London. Dr. E.
Truby King, who had visited my
clinic in Paris, asked me to explain
and demonstrate our manual meth
od before a meeting of Interested
doctors, nurses and laymen. Their
enthusiastic Interest assured me of
their success In this Important work.
A recent letter from Dr. King stated
that he was soon to carry the Idea
to South Africa. India and Austra
lia. .
To show Ihat the method works
la Portland as well aa In Europe I
wish to present two cases. Ont Il
lustrates the development type A
ine omer. reesiauiisnnieat. The
first also shows to what dietetic ex
tremes mothers will go i their en
desvor to increase the flow of breast
.milk. This mother came with th -statement
that her milk was arris r
up. that It made the bnby ?oajl
and that a physician had tcl4 il7
that her milk was poor la aaJiT
Tbe mother gave her Ll2j tLau
consisting of three ' regaUr keau
and In addition. IS pints et mils ci.
or more cups of tea, besides brou.
coups and a bottle of beer. , Tar.
thermore, nhe said fast she did a
like milk and that It made her cov
st I paled. The baby was her seconl
child, normal dell r cry. with a birtt
weight of H nounds (hospiui
scales). It had beea fed at ta
breast every three hours and for
eight dsys had received In additios
after each nursing three ounces of
a milk mixture containing three
fifths whole milk. It wss brourtt
to me when 18 dsys old and it thea
weighed two ounces less thsn at'
birth.
We assared the mother that her
cilk was normal la quality and al
lowed her to si op drinking milk, ssd
to eat a normal, balanced diet. Tk
baby was put to the breast every
four hours, being weighed before
and after tsch nursing. The moth
er was taught the manual method ot
expressing the breast milk and was
Instructed to do so after each nsrv
tn. .
On weighing the baby before sad
after feeding It was found to u
getting only 7V ounces from ta
breast In 21 hours. That the baby
was fretful and lost weight and -that
those In charge considered the milk
to be of a poor quality was. there
fore, to be expected. 'The baby be
ing small and weak did not take a
sufficient amount for Its needs as 4
It left In the breasts a residuum of
10 U ounces. This the mother ex
pressed by hand and used In coxa
plcmentary feedings.
Thirty-four days later the baby
had Increased S per cent In weigit
aad the amount ot milk whkh he
obtained from the breast had la
creased 288 per cent. The mother
began giving a pint of breast mCk
to charity cases aad bemoaned the
fact that she did not hare twins.
. The re-establlshmeat case is a "
doctor's second child.. Their tint
taby. waa breast fed only1 IS min
utes or so: they dldat expect the
mother would be able to nurse this
one. After two weeks ot sasac
eessful effort they put the baby oa
goat's milk. It weighed six 'pounds
12 ounces at birth aad only six
pounds seven ounces at five weeks -when
I first saw IL Besides loslsg
weight ft was vomiting freqaeatly
and erled day and night.
I explained to them the necessity
ot hsvlng breast milk for the baby
would do her part, the milk woali
return . even though the baby had
beea weaned for three weeka.
In three months ume'the breast
secretion Increased from nothing to
almostN quart a day. The father
T that f hla Katnr la f m-r 4.rJ
and more intelligent than the Cnt
baby was at the same sge. while it
physical condition la better beye&l
comparison. .
Seminary
1. Lack ot breast milk In Infancy
causes many ot the Imperfections ot
adult lite and la manifest la ta
bony, muscular, and nervous tissues.
2. Breast milk Is the only Infaat
food which stands both chemical
and biologic testa..
3. When breast milk Is thought
to disagree the trouble Is a matter
ot .quantity, not quality. ,
4. Attempts at Increasing the Cow '
of breast milk have beea made by '
using trtgx, diets, massage, aad
manual expression. The last Is giv
ing success,
S. A careful analysis ot the tech
nic of manual expression shows tt
to consist ot three dlstlact yet sim
ple movements.
8. A classification ot cases with
insufficient flow of breast milk Is
given.
7. That this method of erpressixr
breast milk gives satisfactory re
sults and thta every mother caa
nurse her baby Is shown by experi
ence in France. Italy. England, and
rortland. Ore.
It is Important Thai Your ;
Child's Birth be Recorded
It la Important that It should be
To prove his age and citizenship
To prove his right to go to school.
To prove his right to work.
To prove his right to an Inheri
tance, To prove his right to marry.
To prove his right to hold offlcev.
To prove his right to secure past
ports for foreign travel.
To prove his mother's right ta
a widow's pension.
The War ajsd Birth Registration
The drafting of thousand of mea
for military service haa emphasized
the need for more complete birth
registration. Young men have beea
confronted with the necessity of fur
nishing proof of ag or citizenship,
and have found proof lscking oa ac
count or faulty laws or imperfect
enforcement of the law.
The Birth Regis ratio Era
The birth registration era com
prises 20 stales and the District of
Columbia, and Includes over halt
the population of the United States.
in iurw sLaies vu per cent oi
births are recorded. They are:
Connecticut. District ot Columbia.
Indiana. Kansas. Kentucky. Mains.
Maryland. Massachusetts, allchigaa.
Minnesota. New Hampshire, New
York. North Carolina. Ohio. Penn
sylvania. Rhode Island. Utah. Ver
mont, Washington, and Wisconsin.
Provisions of Birth IXegUtratlow
Laws
The law requires that the baby's
birth be reported by the physician,
the nurse or midwife la attendance,
to the health officer or town clerk,
who reports It to the state board ef
health.. It you are not sure that
this has beea done for your baby,
write to the state hoard of health,
and If they have no record they will
send yon a blank oa which you may
record the child's birth yourself. It
Is not too late at any time, and may
be. very Important tor him la the
years to come.
Register your child's birth bow.
1