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U. S. DEPARTMENT OF LABOR b fà. CHILDREN’S BUREAU I JULIA C. LATHROP. Chief BABY-SAVING CAMPAIGNS A PRELIMINARY REPORT ON WHAT AMERICAN CITIES ARE DOING TO PREVENT IN FAN T M O R T A L IT Y https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MORTALITY SERIES, No. I Bureau Publication No. 3 WASHINGTON GOVERNMENT PRINTING OFFICE 1913 L A W ESTABLISHIN G TH E CH ILD REN ’S BUREAU. AN ACT To establish in the Department o f Commerce and Labor a bureau to be known as the Children’s Bureau. [62d Cong., 2d session. S. 252. Public, No. 116.] Be it enacted by the Senate and House of Representatives of the Crated States of America in Congress assembled, That there shall be established in the Department o f Commerce and Labor a bureau to be known as the Children’s Bureau.1 # S e c . 2. That the said bureau shall be under the direction o f a chief, to be appointed by the President, by and with the advice and consent o f the Senate, and who shall receive an annual compensation o f five thousand dollars. The said bureau shall investigate and report to said department upon all matters pertaining to the welfare o f children and child life among all classes of our people, and shall especially investigate the questions o f infant mortality, the birth rate, orphanage, juvenile courts, desertion, dangerous occupations, accidents and diseases o f children, employment, legislation affecting children in the several States and Territories. But no official, or agent, or representative o f said bureau shall, over the objection o f the head o f the family, enter any house used exclusively as a family residence. The chief o f said bureau may from time to time publish the results o f these investigations in such manner and to such extent as may be prescribed by the Secretary o f Commerce and Labor. S ec . 3. That there shall be in said bureau, until otherwise pro vided for by law, an assistant chief, to be appointed by the Secretary o f Commerce and Labor, who shall receive an annual compensation o f two thousand four hundred dollars; one private secretary to the chief o f the bureau, who shall receive an annual compensation o f one thousand five hundred dollars; one statistical expert, at two.thou sand dollars; two clerks o f class four; two clerks o f class three; one clerk o f class two; one clerk o f class one; one clerk, at one thousand dollars; one copyist, at nine hundred dollars; one special agent, at one thousand four hundred dollars; one special agent, at one thou sand two hundred dollars, and one messenger at eight hundred and forty dollars. _ _ , T u S e c . 4. That the Secretary o f Commerce and Labor is hereby directed to furnish sufficient quarters for the work o f this bureau at an annual rental not to exceed two thousand dollars. S e c . 5. That this Act shall take effect and be in force from and after its passage. Approved, April 9, 1912. ________ _ 1 Transferred from Department o f Commerce and Labor to Department o f Labor, upon the creation o f the latter by act approved M arch 4, 1913. 2 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 3 6 s . 7 u ,s ~ g c . 3 - ^ CONTENTS. Letter of transmittal............ . . . . . . .............. ........................................................... Scope of the bulletin................................................................................................ City health officials’ work in reducing death rate............................................ Lack of adequate funds for carrying on work................................................. Cooperation of health boards with benevolent agencies........................................ Complete and prompt birth registration as a basis for effective work. . ___ Morbidity and mortality charts................................................................ . Inspection of milk su pply.. .................................................................................... Methods in different cities................................................................................ Recognized grades of milk................................................................................ Milk stations...............................................' ........ ..... .................................... Recent increase in number............................................................................... Not a means of encouraging bottle feeding.................................................... Instruction of mothers a necessary feature...................................................... Equipment and management.......................................................................... Baby clinics................ Operation in certain cities......................................................................... Little Mother Leagues.................... . , ...................... ............................... Visiting nurses................................ Value of service in prenatal and postnatal work............................................ Work in different cities................................................. Prenatal work..................................L.................................................. Effect of housing conditions on infant mortality......................................... Fight against flies, garbage accumulation, dust, etc.............................................. Stables and stable flies..................... Fresh-air camps and hospitals........................................................... Educational work through the distribution of circulars, pamphlets, etc............. Conclusion.............................................................................................. Appendix................................................................................................. How to Save the Babies (circular issued by the New York State Depart ment of Health)........................................................................ Ten Reasons Why a Mother Should Nurse Her Baby (leaflet issued by the New York City Department of Health)....................................................... Save the Babies (circular issued by the Pennsylvania Department of Health): English.......................... Italian........................ German...................................................................... Polish.................................................. Yiddish............................ „ Slovak............................|................. ... General Directions for Feeding Young Children (circular issued by the Providence, R . I., Health Department)...................................................... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 3 S v 'h ^ Page. 5 7 7 9 11 13 14 45 15 lg 20 20 22 22 23 24 26 3q 32 32 34 33 41 42 40 43 44 45 47 47 54 55 go «2 65 cn by i| 74 4 CONTENTS. Appendix—Continued. Pa&e* How to Take Care of Babies (published in French by the Providence, R . I., Health Department).......................- ................... - ....................................... 76 Summer Care of Babies (circular issued by the Bridgeport, Conn., Depart ment of Health) : English................................................. 79 Yiddish............................. - ..............- ........................................................ 81 Slavish..-................................................... 83 Hungarian................................................................................................... 85 Italian.................................................................................... - ................... 87 Advice to Those About to Become Mothers (leaflet issued by the Provi dence, R. I.j Health Department)............................................................... 90 To Expectant Mothers (leaflet issued by the Oregon State Department of Health).................... - .................................................................................... 91 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis LETTER OF TRANSMITTAL. U. S. D e p a r t m e n t of L abor , C h il d r e n ’ s B u r e a u , Washington, D. C., June 16, 1913. S i r : As a preliminary to more careful study o f the work now car ried on in various cities for the prevention o f infant mortality, the following letter was sent to the mayors o f the 109 cities o f the United States having a population o f 50,000 or more each: D eab Si b : We are much interested in ascertaining the prospects o f baby saving campaigns for the summer o f 1913 in the principal cities o f the country. May we ask you to give us information as to the organization o f your depart ment of health as especially related to the care of infants in summer? We should like especially to have any recent reports that you have made as to this service, and to know whether there is to be any enlargement o f the service over last year; also what special features o f your system you would recom mend for general adoption. In making this inquiry it was only anticipated that it would secure needed information for the office o f this Bureau. The replies have shown that work o f the utmost significance is going on in certain cities, while little or nothing is being done in others. In various instances city officials have shown much interest in such work and have made inquiries as to the best methods o f initiating it. In view o f the interest shown and o f the practical value of many o f the replies received, the Bureau has summed up the information contained in them in the following statement as to the summer care o f babies in oertain American cities. The effort has been not to pre sent in any respect an exhaustive report, but to show what is being done in various localities and the ways to go about such work. The appendix contains examples o f circulars in various languages avail able for reproduction. It is intended to follow this preliminary statement by fuller bulletins, issued from time to time, showing the most advanced methods employed by various communities to safe guard the health o f children, with especial reference to the growing work o f rural health officers and rural nursing. Special acknowledgment is made o f the services o f Mr. Ethelbert Stewart, statistical expert o f this Bureau, in the preparation of the present pamphlet. Very respectfully, J u l ia C. L a t h r o p , Hon, W il l ia m B. W https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Chief. il so n , Secretary of Labor. 5 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVING CAMPAIGNS. SCOPE OF T H E BU LLETIN . What the American cities are doing and can do toward preventing infant mortality and xthe too common high death rate o f children under 5 years o f age is to be the subject o f an annual bulletin by the Children’s Bureau. The present issue does not claim to be com plete either as to the cities which are giving attention to such work or to the scope o f their activities ; it is merely a preliminary outline, introductory o f ‘what the Bureau hopes to accomplish in the way of acquainting cities with one another, when all cities have come habit ually to report all such activities or lack o f them to this Bureau. Summer campaigns for babies’ lives have been waged with such marvelously good effect in some cities, both in this and foreign countries, that it seems important to enlist the energies o f as many cities in this work as possible. T o this end it is most important that each city should know, in somewhat of detail, just what the other cities are doing. Information which represents a large expenditure o f labor and which is invaluable as demonstrating comparative methods in different cities is tied up in reports o f local health officials which have little or no circulation. To present, for the information and perhaps encouragement o f all, the results o f inves tigation as to the little or much that is being done by the various cities, whether directly or through municipal activity in conjunc tion or cooperation with private philanthropies, will be the purpose o f this annual bulletin on summer campaigns for babies to be issued hereafter by this Bureau. CITY H E A LT H O FFICIALS’ W O R K IN REDUCING D EATH RATE. The Special Public Health Commission o f the State o f New York, which was appointed by Gov. William Sulzer to collect facts, receive suggestions, and make recommendations as to changes in the public health laws and their administration, in its report to the governor, under date o f February 19, 1913, makes clear the influence o f city health officers in reducing the general death rate o f cities within the last 10 years. It shows the mortality rate per'100,000 in cities of https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 7 8 BABY-SAYING CAMPAIGNS. the State, including villages o f over 8,000 inhabitants, and the corre sponding rate in rural districts and villages o f fewer than 8,000 inhabitants. “ It will be noted,” says the report in discussing a chart in which the conditions are graphically shown, “ that the urban death rate, beginning at 1,771 in 1902, falls to 1,466 in 1912. The rural and village death rate, beginning at 1,404 in 1902, has slowly risen, beginning to exceed the urban death rate in 1909, and since that date the divergence between the two in favor of the urban death rate has steadily increased.” While, as Prof. Walter F. Willcox, o f Cornell University, states, the somewhat more “ complete registration o f rural deaths in later years and the preponderance o f population o f the middle ages in cities, owing to immigration ” may account for some o f the sharpness o f the contrast, nevertheless these consider ations leave practically unaffected the general fact indicated by the figures, that the urban death rate is falling more rapidly than the rural and village death rate. That the- attention given to such mat ters by local health officers, by private charitable societies, and by both in cooperation, has reduced the general death rate o f cities below that o f rural districts and villages is certainly a tribute to such efforts. It indicates clearly what can be done even with faulty organization and meager cooperation and emphasizes the importance o f more extended and better organized means and method. Discussing the reduction o f death rates, the report referred to, after detailing the work against tuberculosis, says: 1 Next largest in the groups o f deaths which are to a large extent preventable by known and practical methods, is infant mortality. The number o f deaths from diarrhea and enteritis among those under 2 years o f age in 1912 was 7,024. Measures are being taken in a number o f cities fo r reducing infant mortality. The first step in a comprehensive plan for the State as a whole is an adequate birth registration law, efficiently and uniformly enforced throughout the State. The enactment of such a law and the initial steps in its enforcement rest upon the State. With knowledge o f the number o f infants bom and the localities and the causes o f deaths, each village and city o f considerable size should, when necessary, secure through its health department (a ) the instruction of mothers during the prenatal period, ( 6) competent attendance at childbirth, (c ) the encouragement o f breast feeding, ( d) medical supervision o f the child at stated intervals, whether breast or bottle fed, and (e) pure, clean milk for infants for whom maternal nursing is impossible. Each city with a population in excess of 10,000 and having an industrial population should have one infant-welfare station and larger cities with an industrial population should have one such station for approximately each 20,000 inhabitants. There is no doubt that through effective action by the State in securing birth registration and in encouraging localities to undertake and effectively to prose cute such infant-welfare work, the number o f deaths o f children under 2 years could be enormously reduced in the immediate future. 1 Gov. Sulzer’ s Message on Public Health w ith Report o f Special Health Commission, transm itted to the legislature Feb. 19, 1913. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVING CAMPAIGNS. 9 Among the specific recommendations made by the commission and approved by the governor in his message to the legislature are: Each city, county, village, and town should be given specific authority to employ one or more trained nurses to act as infant-welfare nurses, school nurses, tuberculosis nurses, and generally at the request o f physicians or health officers, to visit the sick who are unable otherwise to secure adequate care and to instruct other members o f the households in the care o f the sick. The State Public Health Council should establish qualifications of eligibility and condi tions of appointment for such public-health nurses. In larger communities, when several nurses are employed, some would doubtless be assigned to one or the other o f these duties, but in smaller localities all o f them may be performed by one trained nurse. The advent of trained nursing marks not only a new era in the treatment o f the sick, but a new era in public-health administration. In the city o f New York there are in the service o f the department o f health over 300 trained nurses in addition to those employed in hospitals for con tagious diseases. Trained nurses are also employed by health authorities in some -of the other cities of the State. Three counties and a considerable num ber o f cities, villages, and voluntary committees employ tuberculosis nurses. An exceptionally interesting account was given to this commission o f the work of district visiting nurses in the rural communities and villages o f north ern Westchester County. These nurses are in the employ o f a benevolent cor poration and are supported by private contributions, but in our judgment such nurses might equally well be employed elsewhere by local authorities. We strongly urge, therefore, that specific authority be given to each city, county, village, and town to employ one or more trained nurses for all the publichealth purposes for which trained nursing has now been found to be practi cable. LACK OF ADEQUATE FUNDS FOR CARRYING ON WORK. The principal impediment to efficient work in the health depart ment o f most cities is the lack o f adequate funds either to pay a suit able salary to the health officer or to provide means for carrying on preventive measures intelligently. The New York commission rec ommended minimum salaries to health officers o f towns and villages, equivalent to at least 15 cents per inhabitant o f the village or town. This in addition to expense o f carrying on the work. As a general rule the most effective health service is not accom plished when the annual resources o f the department, including salary o f health officer, falls much below $1 per capita o f population. In cities o f over 100,000, or when a great deal o f work is done and the expense met by benevolent societies working in cooperation with the health department, this per capita is sometimes reduced without crip pling the efficiency o f the office. That it is worth while to make some effort to arouse such an inter est in saving infant lives as shall force appropriations in some degree commensurate with the work to be done is made evident by the fol lowing illustrations o f the situation in two States, New York and Illinois—States in which certainly the poverty o f the taxing bodies can not be pleaded in excuse for parsimony. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 10 BABY-SAYING CAMPAIGNS. Dr. George Thomas Palmer, o f Springfield, 111., has collected reports from Illinois cities which show that in 44 cities and towns in Illinois having a population of 3,000 or over, and averaging about 16,500 for all, the average salary paid to health officers is $300. Twelve cities, including one with a population o f 30,000, another o f 22,000, and one o f 21,500, pay nothing. Twenty-one o f the 44 cities and towns make no appropriation for expense beyond that covering the nominal salary o f the health officer, i f any. His report is contained in a paper written by him, entitled “ The Shortcomings o f Municipal Public Health Administration,” pub lished in the American City for August, 1911. Some o f the strongest paragraphs o f the report are as follow s: * * * -I have ascertained the facts in 44 Illinois cities o f 3,000 population or over. * * * Of the 44 Illinois cities, we find that 6 have medical com missioners personally responsible for the work o f their departments, and 15 have boards of health with medical officers. That is, 21 o f the 44 cities have forms o f health organization which may reasonably be presumed to afford effi cient service. Of the others, 4 have headless boards o f physicians in which no one is especially responsible; 1 has a board o f physicians with layman health officer; 7 have boards of physicians and laymen with no health officer; 1 has a mixed board with layman health officer; 6 have boards o f laymen with no medical guidance; and 3 intrust their health affairs to lay health officers with out boards o f any kind. One city o f 26,000 employs merely a layman health officer, while a city of 22,000 has a board of laymen, the police matron acting as health officer when she is not otherwise engaged. While 15 of these cities exceed 20,000 in population and 3 are over 50,000, not one pays sufficient salary to warrant a competent man in devoting all o f his time to the health department. One city o f 59,000 pays $1,500 per year, the highest salary paid to any munici pal health officer in Illinois outside Chicago; a city o f 70,000 pays $1,200, and one of 51,000 pays $1,000. Three o f the 44 cities pay $900 per annum, 1 pays $800 per annum, 5 pay $600, 2 pay $400, 2 pay $300, 7 pay $200, 1 pays $150, 1 pays $100, 1 pays $75, 4 pay $50, 2 pay $25, and 12 pay nothing at all for publichealth supervision. The average population of the 44 cities is about 16,500; the average salary paid to health officers is $300. The 12 cities paying nothing, including one of 30,000, one o f 22,000, and one o f 21,500, should expect nothing in the way o f protection o f the lives and health o f their people. A city o f 30,000 which pays $400 per year for its health officer could not expect to receive the services o f a competent man for more than one-sixth of his time, while a city of 25,000 paying $200 per year could not ask a well-qualified officer to de vote a full hour a day to its public-health affairs. I make this estimate on the assumption that a competent health officer could be secured to devote all his time to the office for $2,400 per year, and it was this assumption I had in mind when I stated that, in my opinion, every growing city o f 20,000 or over should employ a competent man constantly in its protective and constructive publichealth work. * * * It may be noted that 36 o f the 44 Illinois cities pay less than un skilled workman’s wages to their health officers. Applying our third standard o f preparedness and efficiency— specific appropriation for public-health pur poses—we find that 21 o f the 44 Illinois cities have no appropriation, or only that for the payment of the nominal salaries of board members and health https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVH?G CAMPAIGNS. 11 officer. In some o f the appropriations given the cost o f garbage disposal is included, making the showing, so far as public-health purposes are concerned, far too high. We note, however, that two cities o f over 20,000 propose to give adequate public-health protection at a cost o f $300 per year, while one city has no appropriation. * * * Of the 44 cities, 29 employ no inspectors ; among these one o f over 20,000' pays nothing for its health officer, and another o f 10,000 pays its health officer $25 per annum. The New York situation is described by the Special Health Com mission thus r1 There is the widest diversity as to the compensation of town and village health officers, except that in nearly every case it is inadequate and in many cases ridiculous. In some cases there is a salary, in other cases fees, in some cases both, and in a few cases no compensation at all. The average annual com pensation including fees and salaries o f health officers of the 771 towns and vil lages represented by the 652 health officers replying to our letter o f inquiry (652 o f a total o f 1,032) was $60.84. The amounts received range from $3 to $1,400. Their average annual compensation (some serving more than one town or village) is $71.96. There is no reason to believe that New York and Illinois are different from other States in this regard. A letter from the clerk o f the board o f health in a city o f 687,029 population to this Bureau, dated February 20, 1913, says : “ I have to advise that the health depart ment has no funds available for organizing a division for the care of infants. Another health officer o f a city o f over 168,000, replving to the Bureau s letter asking what plans were being considered for a summer campaign against infant mortality, said: “ We have been unable to get an appropriation from the city council for carrying on a campaign o f this kind.” When the truth o f the motto o f the New York City Health Depart ment “ Public health is purchasable; within natural limitations a community can determine its own death rate ”—is generally recog nized, it is certain that civic appropriations will become adequate. COOPERATION OF H E A LT H BOARDS W IT H P R IV A T E BEN EV O LEN T AGENCIES. In view o f this wide-spread, if not general, lack o f appropriation to enable health boards to deal with the situation, direct cooperation with private benevolent societies has suggested itself and has been acted upon with excellent results in many places. Dr. Selskar M. Gunn, when health officer o f Orange, N. J., said: The campaigns against infant mortality in the past have been conducted for the most part in large cities, and this is quite natural, as in the large city the necessity for work in this direction is more evident than in the smaller com munity, but I venture to state that in some o f our smaller cities the eondi1 Gov. Sulzer’s Message on Public Health, w ith R eport o f Special Public Health Commission, transm itted to the legislature Feb. 19, 1913. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 12 BABY-SAVING CAMPAIGNS. tions are almost as serious as in the larger places. * * * The methods o f approaching and attacking these problems are varied and many. One o f the first things to be done is for the board o f health to establish, if it has neglected to do so, good relationships with the various civic organizations that are present in the community. I refer particularly to the bureau o f associated charities, day nurseries, diet kitchens, visiting nursing settlements, and organizations of similar character that are working for the good of the community. This is very essential in small cities where the board o f health does not receive adequate financial support from the city fathers, a condition usually to be met. These societies can be o f very material help in supplying the necessary weapons for the attack. Such cooperation will be found particularly useful in all branches of public-health work. * * * Many o f these organizations are not doing the effective work they are capable o f because they are not in a position to discover the cases which they really should be assisting. They have oftentimes to take the cases as they come, irrespective o f the real need, and so many who most need help are never reached. All of this emphasizes the important fact that in small cities the health department should cooperate in every way possible with all the private social agencies that are at work in the city. These agencies are not infrequently doing work which probably should be done by the health department, but which, through the parsimony or false economy o f the city fathers, can not be undertaken at the present time. * * * Milk depots are examples o f this.1 When, as is sometimes the case, no private agencies exist with which to cooperate, the health officer often resorts to agitation to bring them into existence. This is done by using the local press to call attention to the infant mortality o f the place, emphasizing the number o f pre ventable deaths each week from causes so largely social in their nature that the individual parents can not be considered wholly to blame. In thus showing the need o f private philanthropies, directed toward the causes of preventable infant mortality, the health officer has recourse to his wall charts. In Utica, N. Y., a fusillade o f news paper paragraphs calling attention to the fact that the infant death rate o f that city exceeded that o f any other city o f its size in the State except two, one o f which was exceptional because of its hospital population, finally brought into existence the Utica Babies’ Pure Milk and Health Station Association, which most effectively entered the campaign against preventable infant mortality in 1912. The health officer can, more effectively than anyone else, call public attention to the fact that: “ The reduction of infant mortality is a public-health problem. The basis o f responsibility lies with the public which must voice its decision through its mouthpiece, the gov ernment.” 2 In the event o f local government neglecting or refus ing, private philanthropies must step in. When cooperation is offered with a view to directing and thus minimizing wasted effort, it is usually accepted in good spirit. The 1 Dr. Selskar M. Gunn, M odem M ethods o f Health Boards In Small Cities, Journal o f American Public Health Association, May, 1911. 3 “ The Principles o f the Reduction o f Infant M ortality,” by Josephine B akei, M. D., New York M edical Journal o f Nov. 25, 1911. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVING CAMPAIGNS. 13 excellent work being done in Atlanta, Ga., with the exception o f milk inspection, is private work with municipal cooperation; this is also true in Baltimore, M d.; Columbus, Ohio; Erie, Pa.; Indianap olis, In d .; Jacksonville, Fla.; Newark, N. J .; Washington, D. C .; and many other cities. Probably the most conspicuous examples of successful cooperation are those o f the New York City Health De partment with the New York Milk Committee and Cleveland, Ohio, with the Babies’ Dispensary and Hospital. In the report o f the latter institution for the year ending September 13, 1912, Dr. H. J. Gerstenberger writes: The success In the reduction o f infant mortality in any community depends principally upon the following factors: First, the full recognition o f the various causes of infant mortality and their relative importance; second, the knowledge o f the means to remedy these causes and, better still, to prevent them, and the application o f these means; third, the education of the future parents, physi cians, and nurses; and fourth, the degree o f unity in plans for action existing among the various private philanthropies and departments o f the municipality and State that are more or less directly interested in this subject. The outcome o f successful private work through the cooperation o f city health officers is usually to cause the city councils to appro priate sufficient funds to allow the municipality to take over this work, ,gradually sometimes, but eventually completely. This has been the experience, for instance, in Bridgeport, Conn., where a pri vate visiting nurses’ association established a milk station, demon strating its value to the city, which established two in 1912, providing a nurse in connection with them. The Milwaukee division o f child welfare in the Municipal Health Department is an outgrowth o f a child-welfare campaign conducted by a commission. This extension o f municipal control o f preventive work through cooperation with private associations is being experienced in Reading, P a; Holyoke, Mass.; Indianapolis, Ind.; Philadelphia, Pa.; Boston, Mass.; Rich mond, Va.; Jacksonville, Fla.; and many other places. The health officer o f Jacksonville, Fla., writes: We have organized an Infant Welfare Association and are at the present time preparing to employ a nurse who shall devote her whole time to that work. She will be under the direction o f the welfare association and in con stant touch with this department, from which she will probably receive the largest portion of her calls. COMPLETE AND PROMPT BIRTH REGISTRATION AS A BASIS FOR EFFECTIVE WORK. The plan adopted in some cities toward a summer campaign is to arrange for a complete and quick registration o f births; to get the baby under observation as quickly as possible.1 Even where State https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 14 BABY-SAVING CAMPAIGNS. laws permit much longer time in which to report births* some city health officers have made arrangements with physicians and mid wives to give immediate notification o f births during the summer months. Lists o f all physicians and midwives are presumably kept complete at all times, and calling these groups together— separately o f course— and having frequent conferences with them is suggested as a great aid in securing speedy notification o f births. Sending each mother immediately a card or letter stating that the health office has been apprised o f the birth o f her child, as is done in Kansas City and other places,1 "has been found to be an effectual means o f securing the interest o f the mother and o f spreading sentiment in favor o f complete registration. Upon receipt o f a card or letter the mother will comment upon it to other mothers. The mother who has not re ceived such a letter will at once want to know of her physician or midwife why her baby was not registered and why she did not get a notice o f it. Inclosed with this card or letter to the mother many cities send a folder containing advice to mothers on the care o f babies. The health bureau thus gets in with its advice ahead o f the neighbors. The folders carry, o f course, a strong appeal for breast feeding and give instructions for the care o f the breasts and for feeding in case breast feeding is impossible. M ORBIDITY AND MORTALITY CHARTS. The health officer should be the guiding hand in these private activ ities; he has but to call attention to his morbidity and mortality charts upon which, with various colored pins, he shows exactly where the high death rate is coming from and the causes producing it. These wall charts are city ward maps upon which blocks and, if pos sible, lots and buildings are indicated. A colored pin is stuck into the map at the proper place for each reported death and for each reportable disease return. By means o f these pins of various colors the relative health conditions o f the different localities can be shown and the health officer can point out the high death-rate districts, and can show the causes which have produced this death rate. As Mr. Sherman C. Kingsley, when superintendent o f the United Charities of Chicago, said: “ Where the white hearse goes most often there you will find the weakest place in your municipal housekeeping.” The health officer, from the pins upon his wall chart, can follow the route of the bad-milk man and can prophesy very accurately where 1 The work in Detroit, M ich., is thus described by the health officer: “ As to some spe cial features in connection w ith this w ork would say that we are looking after the mid wives, boarding out o f babies, m aternity homes, w atching the birth certificates very closely, seeing about getting proper registration o f births, keeping close w atch o f the death rates, making maps showing where the babies die, in order to d irect our w ork to these locations this coming summer.” https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVING CAMPAIGNS. 15 the white hearse will go. Summer diarrhea and enteritis in children under 2 years is, wherever possible, made a reportable disease during the hot months, and reported morbidity from this cause is indicated on the wall map. A separate map is frequently used for children’s diseases. Better results in locating bad-milk routes are obtained from studying these morbidity returns than from merely following mortality returns. Cooperation with private benevolent societies makes itself most felt and is most effective when such societies have immediate notification o f births and o f morbidity returns. The best results have been ob tained where there is no waiting for the official formalities; when birth notifications, reports o f sick babies, and infant death returns are immediately telephoned to the private society. INSPECTION OF M ILK SUPPLY. A rigid inspection of the milk supply is strictly the province o f the municipality, and usually the summer campaign against infant mor tality begins, as in Atlanta, Ga., with a “ more rigid inspection o f the milk and dairies during the summer.” Lists o f every milk producer furnishing milk to the city and every dealer in the city, whether from wagon or from store, usually kept complete at all times, is made subject to vigorous revision, even where license is not necessary, and frequent samples from all dealers are thoroughly tested, not only for fat but for dirt and bacteria. A num ber o f cities that get no further in the way of summer baby saving make a complete inspection o f dairies and the milk supply during the hot months. The importance o f milk control in summer months can not be overestimated. Health officers are practically as one in the opinion that unclean milk, or the improper preparation and care o f milk in the home, is responsible for a large share o f the increase in infant death rate that comes with the heated season. It is the city’s duty to see that the people can buy clean m ilk; it is the parent’s duty to see that the milk is kept clean. The wall charts above referred to enable the health officer to locate the bad districts—to get a geog raphy, as it were, o f the death rate. METHODS IN DIFFERENT CITIES. That the example of Atlanta, Ga., in beginning the summer with more rigid inspection o f the milk and dairies is followed by many cities, the following extracts from letters to this Bureau will attest: New Haven, Conn.— We give more close attention to dairy and farm inspec tions and make a larger number of examinations o f milk. Salt Lake City, Utah.—We have a very good milk ordinance which is rigidly enforced and has a tendency to reduce infant mortality. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 16 BABY-SAVING CAMPAIGNS. Springfield, 111— The Department o f Health has done nothing toward the prevention of infant mortality, except very careful inspection and reinspection o f dairies for an area oif 15 miles about the city. Seattle, Wash.—In all our milk work we have endeavored to raise the standard o f milk production along lines somewhat original. We have first sought to make the business profitable by . endeavoring, so far as possible, to educate the dairyman how to produce the best stock, how to feed the same, and in general make the occupation of dairying profitable. We have done this primarily so that we might have steady shippers. There is no branch of milk production comparable with this in my judgment. A city must strive to maintain a shipment o f milk from dairymen who are well acquainted with the laws and ordinances, who on account of experience can produce milk under the terms of our ordinances. I f a city has a number of dairymen changing from one vocation to another, such a milk supply can never be first class. Schenectady, N. Y.—During the past year we have made radical changes in our milk-inspection work. July 1, 1912, we adopted a new set o f rules govern ing the production, sale, and care of milk in the city of Schenectady, after having studied the milk question thoroughly. At present we are contemplat ing several further changes, and we hope to get an ordinance which will pro hibit milk being dipped on the streets and o f enforcing the sale of bottled milk only. In fact, we are trying to get our milk-inspection system as near the ideal as possible. When all is said, perhaps the most important factor of a baby saving campaign is pure milk. To trace the cases o f intestinal diseases from the cow or the dairy farm to the nursing bottle o f the infected child, just as was done in the case o f diphtheria in the towns o f Dorchester, Milton, and Hyde Park, Mass., is a very effective and conclusive method o f securing ordinances which permit either the establishment of municipal milk supply or complete control o f private sources.1 Cartoons descriptive o f well-known local conditions are always good to emphasize local needs. The Chicago Health Department very effectively illustrates the superiority o f breast feeding by a cartoon which it calls “ The Long and Short Haul,” which is repro duced on the opposite page. Local illustrations along similar lines have been made very effective elsewhere. The larger cities, such as New York, Chicago, Boston, Philadel phia, and particularly Washington, D. C., have made every effort to control the milk supply from its source. The following quotation from “ The Milk Question,” by M. J. Rosenau, gives some idea o f the problem involved in a survey o f the milk supply for large cities: The extent to which this separation o f consumer and producer has taken place in the milk industry is patent when we recall that Boston gets most o f its milk supply outside o f a 50-mile circle, and some milk starts 243 miles from the city. New York receives practically no milk within 50 miles, and 1 See M onthly Bulletin o f the State B oard o f Health, Mass., May, 1907, V ol. II, No. 5, p. 1 1 7 ; also Bulletin 56 o f the H ygienic Laboratory, U. S. Public Health Service, entitled *• M ilk and its Relation to the Public Health,” p. 36. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVING CAMPAIGNS. 17 4 ||| The Long The Short Haul I. _ ^ v s . 7 0 percent of city babies get the» food through a tube 6 0 miles long. It takes about 3 6 hours— often 4 2 hours— for the milk to run from the cow end of the tube to the baby end of the tube. This tube is open m many places and baby s food is frequently pol luted. It is often wrongly kept in overheated places. Then there may b e a diseased cow at the country end of the tube. IM ILK T O W N l 1- And Y et Some People W onder W hy So Many Babies D ie! O n the other hand the motherfed baby gets its milk fresh, pure and healthful— no germs can get into it Eri a ittltK % ” t5StPo?KC9k / ' ■ I ¡a rs\ T o Lessen Baby Deaths Let Us Have More Mother-Fed Babies. Y ou can’t improve on G od ’s plan, For T our Baby’s Sake— Nurse I t! m AsU Chicago Health Department Educational Poster No. 72, Designed by Dr, C. St. Clair Drake. 94219°—13-----2 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 18 BABY-SAYING CAMPAIGNS. some of its supply comes from points as far away as 400 miles. New York City uses about 1,600,000 quarts o f milk a day, derived from 40,000 dairy farms. Most o f the milk supply o f Chicago is produced within 60 miles o f the city. A 100-mile circle about the city would include nearly all the dairies producing its supply. In times of exceptional scarcity in summer sweet cream is shipped 200 miles. The production o f Chicago’s milk within such a short distance o f the city is in marked contrast with conditions in Boston and New York. Chicago uses about 1,000,000 quarts o f milk a day. The health commissioner estimates that, in 1910, 120,000 milch cows were necessary to furnish the city supply, making an average production of 6.3 quarts per day per cow. The District o f Columbia consumes about 76,000 quarts of milk a day, or about 0.4 of a pint per capita. This milk is produced on 1,091 dairy farms from 17,688 cows. About one-third is brought in by wagons and two-thirds by steam and electric railroads. The cream is largely received from Philadelphia and New York. Smaller cities or cities situated in the center o f rural districts do not, o f course, have a problem so serious as this. Nevertheless, the survey and control o f the milk supply is not the province o f private philanthropies and should not be expected of them.1 RECOGNIZED GRADES OF MILK. Beyond milk inspection and survey o f the milk supply, the next step is the establishment of milk depots to furnish pure milk for babies who for any reason can not be breast fed. The health depart ment usually examines and certifies the character o f the milk. The milk is usually graded in three classes: (1) Certified milk, (2) in spected milk, and (3) pasteurized milk, and these classifications are embodied in the laws or the regulations and enforced by public-health authorities. The following definitions or specifications for the grades o f milk named are taken from a paper on “ The Classification o f Market Milk,” by Dr. A. D. Melvin, chief o f the Bureau of Animal Industry, United States Department o f Agriculture, published in Hygienic 1 There are, o f course, numerous private publications on methods o f dairy and milk inspection. Health officers will, however, find most concise and helpful “ Tw enty Dairy Suggestions w ith Special R eference to Sanitation,” a stable placard obtainable from the Bureau o f Animal Industry, United States Departm ent o f Agriculture. In “ M unicipal Ordinances, Rules, and Regulations Pertaining to Public Hygiene,” reprint from Public H ealth Reports, No. 70, o f the U. S. Public Health Service, W ashington, 1912, w ill be found ordinances and regulations from a large number o f cities (pp. 7 0 -1 5 0 ), from w hich a satisfactory ordinance could be selected or drafted to suit any locality. The city ordi nance o f Berkeley, Cal., contains a score card used in grading dairies. Other reports pub lished by the U. S. Public Health Service w hich health officers w ill find extrem ely useful are “ Milk and Its R elation to Public Health,” issued as H ygienic Laboratory Bulletin No. 56, second edition, 1912, and “ Methods and Standards fo r the Production and D istri bution o f ‘ Certified M ilk,’ ” reprint from Public H ealth Reports, No. 85, 1912. The Bureau o f Anim al Industry is sometimes able to help raise the standard o f local condi tions, by sending, upon request o f a city or State health officer, an expert to assist in pinking a survey o f the milk and milk supply. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAYING CAMPAIGNS. 19 Laboratory Bull. No. 56, second edition, 1912, entitled “ Milk and Its Relation to the Public Health,” pp. 608-610 : Class i : Certified milk.— The use o f this term should be limited to milk produced at dairies subjected to periodic inspection and the products o f which are subjected to frequent analyses. The cows producing such milk must be properly fed and watered, free from tuberculosis, as shown by the tuberculin test and physical examination by a qualified veterinarian, and free from all other communicable diseases, and from all diseases and conditions whatsoever likely to deteriorate the milk. They must be housed in clean and properly ventilated stables o f sanitary construction and must be kept clean. All persons who come in contact with the milk must exercise scrupulous cleanliness and must not harbor the germs o f typhoid fever, tuberculosis, diphtheria, or other infections liable to be conveyed by the milk. Milk must be drawn under all pre cautions necessary to avoid infection and be immediately strained ahd cooled, packed in sterilized bottles, and kept at a temperature not exceeding 50° F. until delivered to the consumer. Pure water, as determined by chemical and bacteriological examination, is,to be provided fo r use throughout the dairy farm and dairy. Certified milk should not contain more than 10,000 bacteria per cubic centimeter, and should not be more than 12 ’hours old when delivered. Such milk should be certified by public health officers or by some other prop erly constituted authority. Class 2: Inspected milk.— This term should be limited to clean raw milk from healthy cows, as determined by the tuberculin test and physical examina tion by a qualified veterinarian. The cows are to be fed, watered, housed, and milked under good conditions, but not necessarily equal to the conditions pre scribed for class 1. All persons who come in contact with the milk must exer cise scrupulous cleanliness and must not harbor the germs o f typhoid fever, tuberculosis, diphtheria, or other infections liable to be conveyed by the milk. This milk is to be delivered in sterilized containers and is to be kept at a temperature not exceeding 50° F. until it reaches the consumer. It should con tain not more than 100,000 bacteria per cubic centimeter. Class 3: Pasteurized milk.— Milk from dairies which do not comply with the requirements specified for classes 1 and 2 should be pasteurized before being sold, and should be sold under the designation “ pasteurized milk.” Milk for pasteurization should be kept at all times at a temperature not exceeding 60° F. while in transit from the dairy farm to the pasteurizing plant, and milk after pasteurization should be placed in sterilized containers and delivered to the consumer at a temperature not exceeding 50° F. All milk o f unknown origin should be placed in class 3 and subjected to clarification and pasteurization. No cow in any way unfit for the production of milk for use by man, as determined upon physical examination by an author ized veterinarian, and no cow suffering from a communicable disease should be permitted to remain on any dairy farm on which milk o f class 3 is pro duced, except that cows which upon physical examination do not show physical signs o f tuberculosis may be included in dairy herds supplying milk of this class. This milk is to be clarified and pasteurized at central pasteurizing plants, which should be under the personal supervision o f an officer or officers o f the health department. These pasteurizing plants may be provided either by private enterprise or by the municipality, and should be located within the city. By the term “ pasteurization,” as used herein, is meant the heating of milk to a temperature of 150° F. or 65° C. for 20 minutes, or 160° F. or 70° C. for 10 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 20 BABY-SAVING CAMPAIGNS. minutes, as soon as practicable after milking, in inclosed vessels preferably the final containers, and after such heating immediate cooling to a temperature not exceeding 50° F. or 10° C. Other c o n d itio n s.— No milk should be regarded as pure and wholesome which, after standing for two hours or less, reveals a visible sediment at the bottom of the bottle. No dairy farm should be permitted to supply milk o f a higher class than that for which its permit has been issued, and each dairy farm supplying milk o f a specified class should be separate and distinct from any dairy farm of a differ ent class. The same owner, however, may supply different classes o f milk, pro viding the dairy farms are separate and distinct. The term “ m ilk” .as herein used includes cream. The New York City Board o f Health adopted the following reso lutions in regard to the sale o f “ loose” or “ dipped” milk, on September 17, 1912, effective on June 1,1913: Whereas the interest of the public health requires that milk should be protected from contamination by human agencies and by dust, dirt, and flies; and, Whereas many o f the premises in the city o f New York where milk is sold by dipping from cans are grocery stores in which foods and food products and other commodities not in sealed packages are sold in a manner which causes much dust; and, Whereas the facilities for proper icing, the proper cleansing o f utensils, and the proper protection from flies are often inadequate in such stores, many of which are so arranged that the living rooms open directly into the store: Therefore be it Resolved, That after June 1, 1913, the sale o f milk dipped from cans will be permitted only in milk stores approved by this department, and for which a permit has been issued, or in places in which foodstuffs, other than milk prod ucts, are sold in original packages only. M ILK STATIONS. RECENT INCREASE IN NUMBER. A constantly increasing number of cities of all sizes are establish ing milk stations and dispensing milk, whether pure whole milk, certified, modified, pasteurized, or sterilized milk, to mothers of babies that must be bottle fed. The U. S. Public Health Service, published a compilation1 from schedules received by that Service from certain cities in which such work is being carried on. The re port covers 43 institutions located in 30 cities of over 50,000. These cities are Albany, Baltimore, Boston, Buffalo, Chicago, Dayton, De troit, Hartford, Honolulu, Indianapolis, Kansas City, Mo., Lawrence, Louisville, Lowell, Milwaukee, Newark, New Bedford, New Haven, New York City, Peoria, Pittsburgh, Providence, Rochester, St. Louis, Springfield, Ohio, Washington, D. C., Waterbury, Wilkes-Barre, Worcester, Yonkers. 1 “ Data Regarding the Operation o f the Infants’ Milk Depots in the United States.” R eprints from Public Health Reports No. 64, U. S. P ublic Health Service. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAYING CAMPAIGNS. 21 Twenty-nine of the institutions are maintained by private benevo lence; 11 did not report on this point; while one was reported as maintained partly by private means and partly by public appro priation. Forty-three o f the institutions mentioned distribute milk, 23 of them to infants only, and 20 to both infants and adults. At some depots the milk supplied is for expectant or nursing mothers, thus contributing indirectly to the welfare o f the children. O f the 36 institutions furnishing information as to the average age o f the children fed, in the majority the children are under 1 year o f age, and in practically all they are under 3 years. At 30 o f the institutions reporting, literature on infant hygiene is distributed with the milk; one o f the circulars is issued in seven languages. Twelve institutions distribute no literature, and one insti tution distributes practically none. Every institution which reported except one takes special measures for the education o f mothers in infant hygiene. These instructions are given by physicians and nurses or by means o f literature or by both. In 2 cases the educational work was carried on in the homes ; in 2 only at central stations; in 38 both in the homes and at central consultations. The letters received by the Children’s Bureau indicate a number of cities of the class named having milk stations in 1912, or intending to establish them in 1913, not in this tabulation. Salem, Mass., for instance, has conducted a certified milk station for four summers and continues it for 1913. During the 60 days o f 1912 in which it was operated, 35,863 feedings were dispensed to an average o f 66 cases per day. O f course, a large number o f cities under 50,000, and many, like Montclair, N. J., under the 25,000 class, have excellent milk sta tions and are doing splendid work along many child-saving lines. It is the intention o f this Bureau to obtain, so far as possible} complete returns from all cities and towns having more than 15,000 inhabitants and to present the result o f the investigation in tabular form in next year’s bulletin. The magnitude o f the movement in New York City is shown in the report on “ Milk Stations ” issued by the Clean Milk Association. In nothing is the importance o f cooperation between the municipal health office and private philanthropies and civic associations so ap parent as in this matter o f summer milk supply. Where municipal milk stations and municipal milk supply are impossible it is never theless usually possible to organize a local charity that will supply the needed funds for a sufficient number o f pure-milk stations. The experience o f Utica, N. Y., previously referred to in this report, could no doubt be duplicated in scores of cities from which reports have not yet been received. The frequent and persistent publication o f the https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 22 BABY-SAYING CAMPAIGNS. local infant death rate and its relation to the nature of the milk supply will sooner or later arouse sufficient public interest in any locality to insure to the health office sufficient funds and cooperation to apply the remedy. NOT A MEANS OF ENCOURAGING BOTTLE FEEDING. Usually the first step taken toward a summer campaign for saving babies’ lives, whether by a municipal health department or by private benevolence, is to establish a pure-milk station. Since the largest part o f the summer infant mortality comes from bottle-fed babies and is traceable to dirty milk, the pure-milk station suggests itself as the most obvious and direct remedy. From a number of sources, how ever, comes a warning that the pure-milk station as a separate institu tion must not be too much accentuated. The danger comes from the fact that it deals only with bottle-fed babies. Since a bottle-fed baby has only one-tenth the chance to live that a breast-fed baby has, it is perfectly natural that preventive efforts should first be directed to ward the most potent causes o f high death rate, but there may be and in some places there have been certain attending dangers where the furnishing o f milk has been the only thing attempted. On this ac count in many, i f not most, milk stations positive proof is required that the mother either can not or ought not to nurse her baby be fore she can get the pure milk, and this precaution has been found necessary in order to prevent an increase in bottle feeding in the com munity as a result of the feeling o f greater safety which the puremilk station gives to mothers who, while perfectly able to nurse their children, would prefer, for insufficient reasons, not to do so. It is never intended that there should be less insistence upon the duty o f breast feeding because o f the milk station, for while the death rate among the bottle fed is reduced by pure milk, the death rate among the bottle fed from the purest milk possible is still much higher than the death rate among the breast fed, and i f there is any perceptible in crease in bottle feeding as against breast feeding because o f the milk station the latter might thus become an agency to increase rather than decrease infant mortality. INSTRUCTION OF MOTHERS A NECESSARY FEATURE. It has been the experience o f practically all milk dispensaries that it is useless to send pure, clean milk into a dirty home to be handled by an ignorant, dirty mother or older child. It is necessary to reach the mothers, and not only to teach them how to care for the baby’s milk, but to convince them o f the necessity o f cleanliness where the baby’s food is concerned— convince them o f the deadliness o f dirt, especially o f dirty milk. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVING CAMPAIGNS. 23 In many cities it is believed that the principal good to be derived from milk stations consists in the opportunity given for those in charge to» come in contact with the mothers and with the home sur roundings o f the babies in the high death-rate districts. The nurse and the physician in consultation with the mother thus become a necessary adjunct o f the milk station. No milk, however pure or clean, agrees at all times with all babies, and the distribution of modified milk become necessary almost immediately in a number of cases. To modify the milk to serve the needs of a given child that child’s case must be studied; hence the child clinic, which almost at once grows out o f the necessities o f the milk station. EQUIPMENT AND MANAGEMENT. A milk station is simply a room from which pure milk is given out for the use of babies that can not be breast fed. The best location is in or as near as possible to the congested part o f the city. It is only necessary that the room shall be sufficiently large to accommodate the patrons and the equipment and that it be light and clean. In the case o f Utica, N. Y., for instance, the first milk station was opened in a schoolhouse, and it would seem that schoolrooms, thoroughly scrubbed and cleaned, might more generally be turned into this use during the summer vacation. The equipment is simple: A good ice box, large, and kept clean, a desk, some chairs, and a table. The walls and wood work are usually painted white, and the floor is covered with linoleum, which makes easier the task o f keeping it clean. Signs in large letters and in all needed languages are usually put up, stating that pure milk is furnished at the lowest possible price . (sometimes free to the poor), for the use o f babies only. Most cities find it better to sell the milk at practically the ordinary price at whicli milk is sold in the city. This avoids conflict with the dairy interests, and allays the suspicions o f the ignorant, that the puremilk station is but a scheme to get higher prices. The following from the report for 1910 of the Babies’ Milk Fund Association, o f Louisville, Ky., is illustrative o f the practices and experiences of a ll: At each of the seven stations certified milk was sold below cost for the chil dren o f the poor. The regular retail price o f certified milk, 12J cents a quart, being prohibitive in our station neighborhoods, we made our price at first 8 cents a quart, meeting exactly the price o f the ordinary market milk our pa trons had been accustomed to buy, and raising our price to 9 cents later, when market milk was advanced to that price by the retail dealers throughout the city. W e paid 10 cents a quart for this certified milk, and so we lost at first 2 cents, later 1 cent, on every quart sold. The modified milk, which costs the association about 17 cents a day for each baby, was sold for 10 cents a day. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 24 BABY-SAVING CAMPAIGNS. While payment o f our low charges was exacted o f all families able to pay, the milk was furnished entirely free o f cost to those unable to pay, and to some others at half price, when the applicants were recommended after careful in vestigation by the Associated Charities or the Federation o f Jewish Charities. BABY CLINICS. It has been found generally advisable to put the milk station in charge o f a competent nurse, who is on duty at the station during stated hours o f the day to distribute the milk. In many cases she finds it imperative to give mothers instructions in the care o f the milk in the home— for pure milk will not stay pure in a dirty home if it is exposed— and as well to teach them how to take care o f their babies. Thus, the milk station unavoidably and inevitably becomes a “ consultation,” like the French institution o f the same type. A consulting nurse is the first feature ; later, in most cases, “ modified milk ” is added to the pure milk supply ; with modified milk comes the frequent necessity o f bringing certain babies to the station to be examined by a physician for the purpose o f determining just how the milk should be modified to meet the case. And thus begins the “ baby clinic,” all as the inevitable outgrowth of the milk station. At first, milk modifications proceed along the line o f a few formulae, and graded by numbers this milk is furnished according to the age or apparent condition o f the child. The tendency here, o f course, is to diagnose the child to fit the milk, as Dr. Newmayer says: “ Modified-milk stations with set formulae Nos. 1, 2, 3, try to make the baby fit the milk modifications instead o f the milk to fit the baby.” But this does not usually last long and seldom becomes serious. The baby clinic soon becomes a recognized necessity o f the modified-milk dispensary, and out o f this grows the visiting-nurse system, since the nurse must go to the mother’s house and teach her how to modify the milk for her particular baby according to the pre scription given by the physician at the clinic. Although the methods employed in the conduct o f infants’ milk depots have varied somewhat both in this country and abroad, their objects have been the same. It is recognized that all milk dispensed should be produced and transported under conditions insuring a product o f the highest purity, that it should be prepared and modi fied in the depot under medical supervision, and that strict bac teriological precautions should be taken in every step o f the process. In addition to the care exercised in the depot, the milk is packed in a manner to guard against contamination in the home. Each bottle contains but one feeding, and is so designed that it will not stand on end, and therefore can not be left standing open. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVING CAMPAIGNS. 25 The milk is modified in accordance with standard formulae in use at the various depots, and, in addition, special modifications are made upon the prescriptions o f physicians. The following are formulae now in use at the Straus milk depots in New Y ork: Formulw for modified milks. Formula No. 1(Dr. Arthur R. Green) : Ounces. M ilk ________ ___ __________________________________ 96 Cane sugar.________________________________________ 2. 5 Salt_______________________________________ . 083 Oat water______________________________ Formula No. 2 (Dr. Rowland G. Freeman) : M ilk ________________________________________________ 64 Limewater__________________________________________ 4 Milk sugar_____________________ _______________ ____ 6 Filtered water______________________________________ 60 Formula No. 3 (Dr. A. Jacobi) : M ilk_______________________________ 1________________ 64 Barley water__________________________________ 64 Cane sugar__________________________________________ 4 Table salt_____ i___________ ________ ________________ *30 Formula No. 4 (Dr. Rowland G. Freeman) : Cream (16 per cen t)_______________________________ x 10§ M ilk _____________________________&_________________ 21i Milk sugar__________________________________________ 6$ 4 Limewater_______________ _________ J:-----------------------Filtered water---------------------------------------------------------- 92 Formula No. 5 (Dr. Arthur R. Green) : Cream (16 per cen t)_________________ 1_____________ 4 M ilk __________________________________ —____________ # 16 Limewater_______________________________ 6 Milk sugar------------------6 Filtered water------------------------------------------------------------102 The three former mixtures are placed in 6-ounce bottles, the two latter in 3-ounce bottles and pasteurized by exposure o f 20 minutes to 157° F. Whole milk is also pasteurized in 8 and 16 ounce bottles. Practically all infants’ milk depots in the United States are under general medical supervision, and, in addition, many depots are in direct charge o f graduate nurses who prepare the milk and give instructions to mothers in the care o f infants. In some instances, visiting nurses also enter the homes o f the children for the purpose o f imparting instruction. It frequently happens that several physicians will volunteer to give a few hours each week to the baby clinics, and when this is done the clinics are held at the milk station, at stated hours, either daily or on certain days, the hours being made to conform to the proffered services o f physicians. The baby clinic necessarily develops into a mothers’ “ consultation ” and these usually lead to the public https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 1Grains. 32 26 BABY-SAVING CAMPAIGNS. lectures to mothers which, although held in connection with the gen eral organization controlling the milk stations, are themselves given in a church or a schoolroom. The natural growth o f the work and methods is perhaps best seen by the following description o f develop ments in the case of a few typical cities, such as Indianapolis, New York, and Philadelphia: OPERATION IN CERTAIN CITIES. Campaign in Indianapolis.—An interesting letter, accompanied by a report on the work o f the stations comes from Indianapolis. Dr. H. G. Morgan, health officer, writes: “ The Indianapolis City Board o f Health is working in conjunction with the Children s Aid Associa tion in the oare o f infants in summer. I f there is any one feature o f the work I would especially recommend, it would be an increase in the number o f nurses.” The report o f the association follow s: The pure-milk stations o f the Children’s Aid Association were open and in operation daily during the year 1912. The most important feature o f this department is the educational work of trained, graduate nurses. In the early part of the year we had two such nurses, in May there were three, through the summer there were five, and then in the fall the number began to be decreased until in December we had only one. These nurses made during the year 4,929 professional visits to the homes o f babies, besides attending clinics and helping many babies in other ways outside o f their homes. Where special modifications were prescribed by the physicians, either private or as members of the medical staff, the nurses visited the homes and showed the mothers how to prepare the milk according to directions. More complex modi fications for very sick babies were made by the nurse at the central station and distributed through the regular distributing stations. Nursing or prospective mothers were registered in some cases, to the number o f 63, and received the same personal attention o f the nurse, if required, as did the babies. Most of the clinics o f the year were held at the central station in the Bald win Block. Some, however, were held at the branch distributing stations as occasion required. During the lighter seasons o f work two clinics a week were held, but in the summer clinics were held daily except Sundays and holidays. These clinics were in charge o f physicians, one or two being present each day. In all 210 clinics were held and 882 children examined. The milk for children who required special feeding was distributed through milk stations, of which during the summer there were five. Two others were open for a short period, but were discontinued on account of the expense in reaching them in proportion to the number o f children obtaining milk there. At each o f these stations a woman was employed at a small monthly fee to distribute milk, check up the return o f bottles, a plan which was found to be more economical than in using salaried nurses for this purpose. In this* way the larger stations near the center o f the city can be maintained economically, but small stations, and at a distance from the center o f the city where con siderable time is required daily to haul the milk, are too expensive. To be con ducted economically some way o f distribution through a retail distributing milk company is necessary to make it possible to reach the babies scattered over the city who need the help o f the milk stations. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 27 BABY-SAVING CAMPAIGNS. The milk used in this work was obtained principally from -------—. Both of these herds consist o f high-grade cattle, tuberculin tested, properly housed, grain fed ; and the milk was handled with such care, being bottled at the dairy in bottles furnished by the association and shipped in ice, that the tests for cleanliness were uniformly excellait. During the year approximately 46,000 quarts of this milk were used. Six public educational meetings for mothers were held in the summer, one at the Jewish Federation, South Meridian Street, two at Mayor Chapel, Norwood and West Streets, one at Christamore Settlement, and one at the Church o f the Assumption, Blaine Avenue, West Indianapolis. These meetings were addressed by physicians on subjects o f practical interest to mothers on the care of small babies. The aggregate attendance at the meetings was 117, which indicates a fair beginning. The total expense for the year amounted to $8,317.56, o f which the greater part was used for milk and for personal service o f trained nurses. This ex pense was covered in part by a city appropriation, through the department o f health, of $4,000; by receipts from sales of milk amounting to $1,827.07; by specific contributions from churches, lodges, Sunday school classes, and in dividuals aggregating $900 for certain stations or certain babies; the balance being provided through the general contributions to the Children’s Aid Associa tion. Voluntary services o f many kinds, professional and otherwise, and useful materials have been generously donated. For all these kindnesses and to all those who have assisted, the association is deeply grateful. Milk Commission. Statistics, January 11 to December 81, 1912. W O B K DONE. Number o f babies helped— Feeding cases_________________________________ ___________ _________ Nonfeeding cases_!_________ ______ ________________________________ 468 568 T o t a l___________________________________________________________ 1,036 Visits of trained nurses to the homes o f children_____________ _________ 4,928 Number of clinics held, doctor and nurse attending____________________ 210 Number of children examined at clinics_________ i________________ _____ 882 Special treatment given by nurses____________________________________ 895 Special day cases (sick babies cared for during the day by nurses)____ 245 Special modifications made by nurses__________________________________ 950 Quarts of milk distributed to feeding cases___________________ ________ 45, 912 Deaths among feeding cases___ 1_____________ ______ _______1__________ 14 Nursing mothers registered______ _____________________ 63 16 Mothers’ meetings held__________________________________________ :_____ Attendance_______________________________ I ___________________________ 117 E X PE N S E S. Milk account------------------------------------------------------------------------------------ $5,640.91 Salaries ___________________________________________________________ 2,178. 00 Car fare ____________________________ ____ _________ 1_____________ 155.00 Printing and stationery_________ ______________________ ____________ 71.00 Feeding supplies__________________ i ________________________ _______ 15.00 M iscellaneous_____________________________________________________ 87.85 Total. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 8,317.56 28 BABY-SAVING CAMPAIGNS. Campaign in New York City in 1911.1—The 27 stations founded by the milk committee were situated in the most congested parts of the city. The object of the committee’s campaign was to make a demonstration of the value o f milk stations in reducing infant mortality, to show that these stations should be situated in the most densely populated districts o f the city, and that the ordinary store was suited for a milk station. The plan of campaign was as follow s: Each station was in charge o f a graduate nurse, especially chosen for her knowledge of infant hygiene, for her interest in the problem, and her willingness to,give herself as well as her time to the work. She was assisted by a matron. In certain districts where the population was almost entirely foreign and where English was spoken and understood as rarely as in Italy or Russia, a matron was selected, when pos sible, who was able to talk the language of the district. When two or more languages must be spoken an interpreter was provided in addition. Each nurse canvassed her district from house to house, looking for babies, leaving the folder o f the station with the mother, and offering to help her keep her baby well. That was the great thing the stations tried to teach—to pre vent sickness. The windows of each station were adorned with placards in various languages inviting mothers to make use of it. The outside of each station was painted a light, bright blue, and the “ blue fronts ” became a regular expression of the district, being incorporated into many foreign languages. The milk-committee stations tried first and foremost to encourage maternal nursing. Mothers were told how necessary it was and how it would save the baby many o f the dangers of the hot weather. Not only were they urged to nurse their babies, but they were taught to care for themselves so that they could nurse them. They were told what to eat and, more important, what not to eat and drink. When breast milk seemed to be failing they were pro vided with milk and, if necessary, nourishing food, to try to increase the ability to nurse. When nursing was impossible, artificial feeding was ordered by the doctor in attendance at the station. Each baby was treated as an individual and the food ordered according to its individual needs. Let us trace a baby through its whole progress at the station. The doctor was in attendance at definite hours twice or three times a week. I f a new baby was brought to the clinic it was seen by the physician and its food ordered by him. I f brought in at another time, after a preliminary talk from the nurse in which the whole system was explained, the mother was asked if she wanted to enroll her baby. I f so, it was stripped and weighed by the nurse and the weight recorded on the individual chart. The nurse’s record and the history card were then filled out and the nurse ordered a temporary feeding for the child, according to instructions very carefully prepared by the supervising physician and indorsed by the medical council. If the baby was sick it was sent to a station where a doctor was in attendance that day, or the station doctor was communicated with and arranged to see the baby. Its milk having been ordered, the mother procured her supply of milk bottles, barley flour, etc., and returned to her home, whither the nurse speedily followed her. A t this visit she was taught how to prepare the food and in her own home given a lesson in general hygiene. The formulae ordered for the babies were o f the simplest kind possible. Whole-milk mixtures were used almost exclusively. She was then told to bring the baby back to the station on the next clinic day and to come every morning for her supply of milk. She was also urged, at the first sign o f illness, however slight, to report 1 “ Infant M ortality and M ilk Stations,” Special R eport o f the Committee fo r the Reduc tion o f Infant M ortality, New York M ilk Committee, 1912. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVIN'G CAMPAIGN'S. 29 at once to the station. On clinic days every baby was stripped, weighed, and examined by the station physician, its progress discussed with the mother, any necessary changes ordered, and the nurse instructed what to do. Very sick babies were referred to hospitals or to private physicians. I f the mother was unable to buy milk, through an arrangement with the Charity Organization Society, the Association for Improving the Condition o f the Poor, and the United Hebrew Charities, such cases were immediately repotted to them, and were at once investigated. * * * As the nurse went about from house to house, from family to family, she found many expectant mothers. Part of the campaign was to get in touch with these women and to try to advise and teach them so that they might pass successfully through their pregnancy and be in physical condition to nurse their babies. * * * The milk used came from tuberculin-tested herds and was o f the highest standard. It was sold for 7 cents a quart. The contract for this milk was awarded after bids had been asked for from the chief milk dealers of this city. A constant watch was kept on the quality of this milk. Bacterial counts were made daily from samples taken from various stations. * * * in order to estimate the mortality among the babies in the areas under the influence o f the milk stations, the following method was adopted: A map was made and plotted out showing the location o f the station and the number o f babies enrolled in each block surrounding the station. In this way the actual sphere of influence of the station was determined. A few babies came from longer dis tances and therefore from outside the district. In order to determine the mor tality in the district thus established, a search o f the records at the health department and a tabulation of all deaths occurring in the months o f June to November were made for the years 1910-11. In order to determine the infant mortality it was necessary to tabulate the births by blocks in the same area. * * * The following conclusions seem to be warranted: First. That milk stations did have a distinct influence in diminishing the mortality among the babies in the districts in which they were situated. Second. That the milk stations did not indirectly encourage artificial feed ing—32.4 per cent of all babies under 1 year of age were entirely breast fed; 60.6 were partiy breast fed. Third. That home modification, even among the very poor and ignorant, is possible. Fourth. That the results, as shown by the mortality and by the condition of the surviving babies at the end o f the period o f demonstration, prove that as good results can be obtained as when already modified milk is distributed. Campaign in Philadelphia.1—A conference was held early in the summer (1909) at which plans were considered for reducing infant mortality. As a result, the Modified Milk Society, various settlements, and a number o f women’s clubs conducted work along independent lines. The health department placed its medical inspectors in the most congested parts o f the city to canvas fo r sick babies and to instruct mothers in their care. Milk dealers were provided with bags upon which were printed simple directions as to the care o f the milk and the feeding of the baby. In 1910 a conference was called by the mayor. This was attended by repre sentatives of some 200 agencies, the object being to bring about a better working relation between the various organizations engaged in summer work for mothers and children. As a result o f this conference a bureau o f registration 1 “ Infant M ortality and Milk Stations,” Special R eport o f the Committee fo r the Reduc tion o f Infant M ortality, New York M ilk Committee, 1912, p. 90. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 30 BABY-SAYING CAMPAIGNS. and information was established at the city ball. A directory was published and distributed giving the names of the agencies and the kind of service each was prepared to render. The Modified Milk Society established 10 distributing stations and later opened 8 more. The city council appropriated funds to maintain a corps o f eight nurses, and by utilizing the medical inspectors and district physicians, a temporary division o f child hygiene was established. This division began inten sive work in June in four o f the most congested wards. Other organizations assisted by furnishing nurses, who reported daily to the health department and worked with their nurses. Previous to the closing o f the schools in the four wards selected, demonstra tions were given to girls in the grammar schools in the care o f babies. This work was done by medical inspectors and school nurses through the coopera tion of the school authorities. A house-to-house canvass was carried on in the district by the health department nurses to instruct mothers in their homes. At the central office a careful system o f record keeping for each case was in stalled. Day and night telephone service was established for receiving requests for aid in emergency cases. The police and fire departments cooperated by in structing all police stations and fire houses to forward by telephone any request for medical or nursing aid. A large number o f bulletins, posters, and circulars were distributed, chiefly through the police department. Free ice was distributed, midwives were brought under inspection, and several baby farms were closed. There was a reduction o f 40 per cent in the deaths o f children under 2 years in the four wards where the work was concentrated. In the city itself, during the three summer months, there was an increase o f 132 deaths over those in 1909, though the proportion of the total deaths which occurred under 1 year fell 0.5 per cent. In 1911 a still more vigorous campaign was waged. A “ milk show ” was held, which was attended by 110,681 people. The city council voted $5,000 for the summer work and the nursing staff was increased. The work was carried on in four wards. The mayor appointed a strong commission to investigate and report upon the whole subject of milk supply. The refrigeration o f milk in transit was required for the first time. In the four wards where the nurses were working there was a reduction o f 11.3 per cent in all deaths under 1 year from the 1910 figures and of 34.6 per cent in diarrheal deaths under 2 years. L IT T L E M O TH ER LEAGUES. “ Little Mother Leagues ” and “ Little Mother Classes ” in the pub-' ljc schools represent efforts made in New York, N. Y., Kansas City, Mo., Cleveland, Ohio, and Milwaukee, Wis., to carry instruction into the home from another angle. “ Little Mothers ” are the school girls who have to help care for babies or for younger children at home. O f course the schools o f every city have many such, and as they live in all parts o f the town and come from every class, it follows that to reach them is to influence an ever-widening circle o f mothers and homes where instruction is most needed. The policy in New York City was to organize these school girls who were caretakers o f little https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVING CAMPAIGNS. 31 children into groups and teach them the care o^ babies. These groups were called “ leagues ” and the whole organization was “ The Little Mothers’ League.” Dr. Josephine Baker, o f the New York division of child hygiene, in a paper before the International Congress of Hygiene and Demography, in September, 1912, says: The aid of over 20,000 girls from 12 to 14 years of age was enlisted and made o f practical value by the formation of “ Little Mothers’ Leagues.” These are still one o f the most important branches o f our work. The girls are taught all practical methods o f baby hygiene and feeding. The potential value o f training young girls for intelligent motherhood is not only o f immense im portance, but the immediate results have been striking in the improved care that is given to the babies who are directly under the care of these young girls. As true prevention work, it ranks o f first importance in the prevention o f infant mortality in this and the next generation. In all, 239 o f these leagues were found in 1911, and practically an equal number have been organized this year (1912). Weekly meetings are held for instruction. Each league is under the supervision o f a doctor and a nurse from the division o f child hygiene. Each weekly lesson takes up some particular phase o f baby care. The doctor gives a short, simple talk ; then, with the nurse, demonstrates his subject. Our outline embraces the importance o f breast feeding, hygiene o f the home, clean liness, ventilation, etc., hygiene o f the infant, including bathing, dressing, and value o f fresh air, infant feeding, with methods o f milk modification. The lessons are simple and practical, and the children are required to carry out each part of the work. Babies are not lacking for demonstration purposes, for nearly every little mother brings her own charge to the meetings, and often the rivalry is great to have “ my baby ” chosen as an object lesson o f health and right living. The members write and act little plays, the play always hinging upon some newly discovered way to keep the baby well. The real iniquity o f lollypops and dill pickles as baby food is being uncovered, and these and kindred baby pacifiers o f former days are being relegated to oblivion. In Kansas City and in Milwaukee all girls desiring to enter these classes are enrolled, whether or not they are caretakers o f babies at home. The health department undertakes to teach baby hygiene through the public schools to all girls who care to avail themselves of the opportunity by joining the classes—a step, in short, toward the movement in French and German schools in education for mother hood.1 In Cleveland, Ohio, instruction is given to girls in the seventh and eighth grades by the introduction o f an infant hygiene division in the domestic science department o f the schools. On June 9, 1913, there were 48 classes a week, with 884 girls taking the work. The course consists o f six lessons, as follow s: Lesson I.—How to keep baby well. Causes and prevention o f high death rate. 1 A t the last International Congress o f School Hygiene, at Paris, on the proposition o f Dr. Pinard, a resolution was passed tliat in schools fo r girls the care o f infants should form an integral part o f obligatory instruction in all the prim ary schools, and examina tions should be passed in these subjects,— Am erican Journal o f Sociology, January, 1912* https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAYING CAMPAIGNS. 32 Lesson II.— Growth, and development o f normal baby. Lesson III.— Pattern demonstration. Each pupil cutting patterns for baby’s outfit. Lesson IV .— Feeding: Maternal nursing, artificial feeding, dan gers of patent foods. (Charts for five lessons.) Lesson V.—B ath: Things necessary, preparation, how much good it does baby. Lesson VI.— Common illness among babies. First home treatment in beginning o f intestinal disturbances. VISITIN G NURSES. VALUE OF SERVICE IN PRENATAL AND POSTNATAL WORK. The warning note against placing too much dependence upon the simple pure-milk station which comes up from so many cities is struck with more certain sound from a number of cities which place practically all o f the emphasis upon visiting nurses and the instruc tion o f the mothers in the homes. In an address before the International Congress o f Hygiene and Demography, held in Washington in September, 1912, Dr. Josephine Baker, director of child hygiene, department of health, city of New York, on the reduction o f infant mortality in New York City said: The evolution o f the infants’ milk station is essential. Pure milk, however desirable, will never alone solve the infant-mortality problem. Under our system o f home visiting to instruct mothers in the care of babies we have demonstrated that babies may be kept under continuous supervision at the cost of 60 cents per month per baby, and the death rate among babies so cared for by us has been 1.4 per cent. The death rate among babies under the care o f the milk stations has been 2.5 per cent, and the cost $2 per month per baby. Without overlooking the value o f pure milk, I believe this problem must pri marily be solved by educational measures. In other words, the solution o f the problem o f infant mortality is 20 per cent pure milk and 80 per cent training of the mothers. The infants’ milk stations will serve their wider usefulness when they become educational centers for prenatal instruction and the encour agement o f breast feeding and teaching better hygiene, with the mother in structed to buy the proper grade of milk at a place most convenient to her home. The value o f pure milk where babies can not be breast fed, how ever, must not be underestimated. No amount of cleanliness or care on the part o f the mother can entirely offset the dangers that come through polluted milk from dirty dairies. The city health officers, placing most stress upon nurses and instrucion, do not go so far as to recommend that the milk problem be allowed to take care of itself. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAYING CAMPAIGNS. 33 “ The Work of the Public Welfare Committee of Essex County for the Reduction of Infant Mortality in Newark,” written by Dr. Julius Levy, says: Our survey of the infant-mortality problem in Newark revealed the following facts: During the past decade there were more deaths o f infants under 1 year of age than from tuberculosis in all forms and at all ages. That is why the section on health o f the public-welfare committee felt called upon to devote itself to the subject. While it was found that the greater part o f these deaths occurred in about four districts, the clinics and hospitals were often not in the center o f these dis tricts and therefore not where they could do the greatest amount o f good. It was found, further, that the doctors and nurses usually could not speak the language o f the mothers; and so at best could have very little effect in eliminat ing what I believe is the greatest single factor in this problem—ignorance made hidebound by prejudice. It was further found that though modified milk could be obtained at a milk depot, relatively very few mothers could avail themselves o f it on account o f the distance, and though certified milk has been sold here for more than 15 years, practically all of the mothers in' districts o f highest mortality were buying, very filthy store or bottle milk. The one fact, however, that was most astound ing of all, was that while there has been a reduction of infant mortality in Newark during the past 10 years and though certified milk has been introduced and a milk depot operated, the infant mortality from diarrheal diseases showed a very marked increase in the first half of the past decade and was actually higher at the end of the decade than at the beginning. The reduction o f infant mortality has been due to factors not directly influenced by milk supply and feeding. As a result of these and other studies and observations, we were convinced that milk is not the greatest single factor in the infant-mortality problem and that the distribution o f modified milk is not the way to solve this complex problem. Indeed, I have long felt that the milk depot, in the first place, in creases the number o f artificially fed, and, secondly, does not reach the infants that require it most—those with the most ignorant and indifferent mothers— nor, indeed, when the mortality among infants is highest, before the third month of life. Our plan found its basis in the common knowledge, obtained both empirically and biologically, that mothers’ milk is the only proper food fo r infants; that mothers can nurse their infants successfully in greater numbers and for longer periods than obtains to-day—that the failure to nurse wholly or partly is due, in large part, to ignorance, inherited prejudices and superstitious beliefs that are fostered by anxious grandmothers, ignorant midwives, and I am sorry to admit, indifferent doctors; in a lesser degree to the equally preventable social and economic conditions o f overwork, undernourishment, tuberculosis and other debilitating diseases. Our plan is nothing more than to try to induce mothers to accept our knowledge of the importance o f maternal nursing and its rationale, of the hygiene of infancy, of the importance o f obtaining a clean tuberculintested milk and then taking proper care of it in the home. Our method has for its fundamental thought that mothers can only be convinced o f these somewhatrecently emphasized facts by doctors and nurses who see the mothers fre quently, know their customs, habits, and prejudices, speak their language—yes; 94219°—13----- 3 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 34 BABY-SAYING CAMPAIGNS. and even their dialect. Our ultimate purpose is to conduct our work in such a manner that the public and the authorities will be convinced that infantwelfare work is o f such value and importance to the entire community that it shall become a part o f the municipal activity for the conservation o f public health. W ORK IN DIFFERENT CITIES. • Boston is one of the cities where special attention has been given to the question of nurses and in a letter to this bureau, dated February 25, 1913, the health department says: At present we have 10 nurses in the division o f child hygiene doing pre natal and postnatal work. The work consists in instructing and advising ex pectant mothers and mothers o f young infants, and in visiting regularly such mothers to see that proper care and attention is given to the child. This con tinues during the first year o f infancy. Special attention is given to bottle-fed infants, as the mortality among these has been high, as you will note by the reports I am sending. The recent law passed by the Massachusetts Legislature compelling physicians to report births within 48 hours after birth has been a great aid in this work. The board o f health is at this time making estimates as to the cost o f pro viding milk stations in this city, as in New York, and believes that this will help greatly during the summer months in saving the lives o f infants. During the summer months it is recommended that mothers take their in fants on the Floating Hospital, which is a large steamer supported by public contributions. The steamer leaves the wharf daily at 9 a. m. cruising about the harbor and at times anchoring in the lower bay and returning about 5 p. m. Physicians and nurses are in attendance on this steamer to take care o f on an average 200 per day. This is shown to be very beneficial and a great aid in the campaign to save the lives o f babies. The instructions to the Boston nurses are thus condensed in the re port o f the department: These nurses will be expected to have accurate information concerning every baby in the district assigned to them. Breast-fed babies will cause little or no anxiety. The nurse will visit these cases to make sure that breast feeding is maintained; to advise the mother on the care o f the breasts, and on general hygienic rules for the preservation of her milk and the care o f the baby. Bottle babies who are under the care of the family physician will be visited by the nurse to make sure that such care is continuous; the services o f the nurse will be offered to the tired-out mother in assisting in preparing the baby’s food and in carrying out the directions of the family physician. It is expected that the bulk o f the work will be among the bottle babies o f those who are unable to employ a physician. Recommendations will be made to these mothers to place their babies under the care of the nearest pediatric clinic at once be fore they show any signs of illness. Every assistance will be rendered these mothers by the nurses in carrying out the advice and instructions given at the c lin ic , and unceasing attention will be given by the nurses to the sick babies of this class, particularly during the summer months. The division o f child hygiene is entitled only to a portion o f the money ap propriated for the maintenance o f the board of health. The erection of tents at the seashore, the employment o f additional nurses in such tents to assist in https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVIN'G CAMPAIGNS. 35 the care of sick babies, the maintenance of milk stations have been considered, but the amount of money available for this division prohibits the undertaking o f such projects this year. In Bridgeport, Conn., a nurse visits all the families where a new born baby has arrived, and where her services are likely to be an advantage, and gives advice and instruction in the care o f the baby. Leaflets containing such information printed in the mother’s own language are left with the mother. Where breast feeding is impos sible the nurse urges the mother to send daily to the milk station for the baby’s milk supply. Fall River, Mass., reports: Since last July a visiting nurse has been employed who is continually visit ing the homes o f newly born infants whose addresses are furnished her daily. She supplements the verbal instructions to the mother by explaining and dem onstrating the proper care o f infants, urging breast feeding, modification of milk, etc. Since the nurse’s employment the mortality among infants has been very materially reduced, and we hope during the coming year, by an appropria tion asked for, to be able to employ an additional nurse. In Jacksonville, Fla., the city health department directs nurses em ployed by private organizations. Jersey City, N. J., Cambridge, Mass., Duluth, Minn., Evansville, Ind., Fort Worth, Tex., Grand Rapids, Mich., Memphis, Tenn., Rochester, N. Y., and other cities resort pri marily to the nurse system. The health officer at Grand Rapids says: “ I will recommend a special feature that we have used in our city for the past two years for general adoption, as follows: The visitation by trained nurses within 21 hours to every household re porting a birth.” Some cities do not attempt to visit the homes o f all newly born infants but have various methods o f selecting by districts or other wise; for instance, the Los Angeles, Cal., authorities report that: During the school vacation the municipal nurses make home calls on all maternity cases, in the house courts and in the congested districts, reporting to the milk station all cases where breast feeding is impossible, obtaining modified milk for infants, or assistance where mothers need such. The report from Richmond, Va., states that: We believe the instructive end o f the work to be all important, and we have nurses for this purpose (five in number) at the present time. Babies are selected by assuming that all babies in some districts should be under super vision and that all twins and illegitimate babies are proper subjects wherever found. This information is obtained from our certificates o f births, while babies in special districts are located both by birth certificates and by houseto-house canvass. * * * I have been for some time convinced o f the infec tious origin of a very considerable part o f infantile diarrhea. For this reason our nurses are now told to give special instructions regarding the disinfection o f diapers. The other points covered by them are, o f course, seeing that the baby gets proper food and clothing—both as regards warmth o f clothing in winter and as little clothing as possible in summer. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 36 BABV-SAVING CAMPAIGNS. The health department o f Kansas City, Mo., writes this Bureau, under date o f March IT, 1913, as follow s: I would say that we were among the first of the western cities to take up the work o f prevention o f the number of infant deaths during the hot summer months, and we have established stations over the city, with nurses and phy sicians attending, where the poor can go to receive medical advice and exami nation of the baby, and, if placed on artificial feeding, to get pure milk at cost. We also give milk to those mothers who are unable to purchase the same, and instructions are given by the nurse at the dispensary how to prepare milk for modification. We intend to employ six nurses and utilize six o f the medical school inspec tors this summer at our stations to care for those babies who become ill. It is my opinion that, in order to cut down the death rate among infants under one year old, prenatal instructions should be given at all dispensaries, and that a follow-up system should be employed among parents where births are registered in certain districts which have a high death rate. They should be visited by nurses and carefully looked after, with instructions how to raise the baby intelligently and not to remove the child from breast feeding unless there is good reason for doing so. I think a false security has been given out over the United States with regard to milk stations saving babies, and this false idea should be corrected in the minds of many who have expected to accomplish the object sought. I can not help but emphasize that prenatal instruction, with advice from competent authority regarding the sanitation of the home, will in time bring about the desired results, rather than a dependence upon the milk depots. Johnstown, Pa., begins this year with a visiting nurse under the control of the Civic Club. Smaller cities make a beginning by em ploying a nurse, whereas a more elaborate plan o f campaign would not be possible. Montclair, N. J., reports for 1912: Prevention of infant mortality.—Nurse gave part o f her time to the instruc tion of mothers in the proper modification o f milk for infant feedings. A clinic was maintained and milk sugar and other supplies were furnished when needed. The total clinic attendance was 286, and the number of feedings taught was 414. Dr. Charles V. Chapin, health officer o f Providence, R. L, says, “ We attempted for two years to distribute clean milk to the babies o f the poor, but we decided the money could be better spent on trained nurses.” Writing to this Bureau, under dates o f February 19, and May 5, 1913, Dr. Chapin says: I would say that most of the baby-saving work in this city is carried on by the Providence District Nursing Association. They employ five nurses for this purpose all the year around, and are likely to put on another during the sum mer. A very large number o f babies are referred to the nurses by the doctors, and are cared for under the direction of the latter. Some o f the most effective work is in connection with babies attended by midwives, amounting to about 25 per cent of all. The midwives report each birth immediately, and a nurse employed by this department at once visits each case and refers all that need them to the district nurses. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAYING CAMPAIGNS. 37 There are two consultations maintained by the Congress o f Mothers and the district nurses, and another is projected for the coming summer. Three very efficient dispensaries are maintained by different agencies. There is no very pressing need for milk stations in this city, but the estab lishment o f one or two on a small scale is being considered. * * * Milk inspection in Providence is not a function of the health department. The milk inspector is an independent officer elected by the board o f aldermen. Our inspector is a very efficient officer, and has done much to improve our milk supply. Unfortunately more and more o f our milk is railroad milk, coming chiefly from Connecticut, but a large amount is still brought in by the producers themselves or their neighbors. The milk inspector has done much by personal visits to the farms and insistence on essentials: (1) sterile utensils, (2) ice, (3) clean barns. A “ call dow n ” when “ bacteria run u p ” is his motto. The midwives are required to report all births immediately on postal cards. They report very well, as a rule. About 25 per cent o f all births are by mid wives. The baby nurse o f the health department promptly visits all babies, and turns over to the district nurses all cases needing attention. The District Nursing Association has five baby nurses. They not only supervise all mid wives’ babies under my general supervision, but they look after a large number who are referred by physicians. All these nurses apply treatment for ophthalmia, but call in the health de partment oculist whenever it is at all necessary, or get the child to the hospital. Dr. Chapin has issued, for 1913, from the health department a “ List o f Milk Dealers W ho Produce the Milk Which They Sell.” It is issued for the convenience o f physicians and nurses, and gives the name o f each local dealer, the analysis o f the milk he handles, both as to fats and total solids, and the bacteria count per cubic centimeter, giving the lowest, highest, and average for his product. It thus serves as a guide in the selection of milk for bottle-fed babies wherever found in the town. Montclair, N. J., in its annual report gives a somewhat similar sur vey of the milk, as does Erie, Pa. The Nashville, Tenn., city health department reports: In connection with tbe operation of tbe milk dispensaries, the district nurs ing feature with home modification, distribution of literature, organizing of clubs, instructions given by lectures and personal work of the nurses, we also furnished gowns, napkins, and other articles o f clothing where needed. In con nection with this we also looked after expectant mothers, referring them to hospitals for confinement, or where this was impractical we furnished phys ician, nurse, or sterile sheets and all accessories to insure against infection in their homes. For the year 1913 we have increased our nursing force to four, we will operate four milk stations, and in the future will use these stations as a basis of operation in our baby-saving work. You also asked, “ What special feature o f your system would you recommend for general adoption?” I be lieve the making o f milk dispensaries the basis of operation to be the best way to handle this work. W e have furnished from stations modified milk free, and this work is strictly a part of the operation o f the health department, and has no connection further than cooperation with private charity. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 38 BABY-SAVING CAMPAIGNS. PRENATAL WORK. When it is realized that practically 38 per cent o f deaths under 1 year o f age are due to causes mainly dependent upon the health and condition o f the mother during her pregnancy and confinement; that within the registration area o f the United States, o f 154,873 infants under 1 year o f age, who died in the year 1910, 14,946, or nearly 10 per cent, lived less than one day; that 36,351, or practically 23.5 per cent, lived less than one week, it will be seen that the infant mortality problem can not be solved adequately by any measures which leave out of their scope some attention to the care o f expectant mothers. Since the above sentence was written “ Mortality statistics ” for 1911 has been issued by the Bureau o f the Census, showing a more distressing situation than was revealed by the figures for 1910: With an increased death registration area (now covering 63 per cent o f the total population) there was a decrease in deaths of children under 1 year to 149,322 as against 154,373 in 1910. But those who lived less than one day increased not only relatively but absolutely, i. e., from 14,946, or not quite 10 per cent, in 1910 to 18,074, or 12.1 per cent; those living less than one week increased from 36,351, or 23.5 per cent, in 1910 to 40,883, or 27.4 per cent, in 1911. These figures show that the efforts made to save babies through pure milk and more intelligent care have produced results, while the lack of organized effort to reach prenatal conditions for a very considerable period or over any extended area has further emphasized its need. This has been realized by a number o f cities, as is shown by the following list, which is not, however, claimed or assumed to be in any way complete: New York, N. Y.— The department o f health is working in coop eration with the New York Milk Committee in a system o f prenatal work among mothers, and the department intends to take up this work first in connection with the Infants Milk Stations and later with a special force o f nurses. The New York Association for Improving the Condition o f the Poor, the pediatric department of the New York Medical Clinic, and the New York Diet Kitchen include prenatal instruction in their work. The Sixth Annual Report of the New York Milk Committee, 1912, contains the following statement on prenatal prevention o f infant mortality: During tlie summer o f 1911, as part o f the milk-station work, an experiment was tried looking to the reduction of the deaths of babies under 1 month o f age. Appalling as is the fact that from 1 in every 10 to 1 in every 6 bahies die during the first year o f life, even more terrible is it that nearly 1 in 3 of all these deaths occurs during the first month of life. The baby does not even have the chance of a good start. This is generally admitted to depend largely on conditions acting before and during the birth o f the baby, and it https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis b a b y - s a v in g c a m p a i g n s . 39 is exactly during this time that the least systematic effort has been made to improve conditions. This preliminary attempt to meet this condition, which was carried on by two special nurses, promised such excellent results that it was decided to make this our chief work during 1912. * * * The attempt is being made to reach expectant mothers as early as possible during their pregnancy. The nurse comes in touch with these women through cooperation with the city milk stations, relief organizations, settlements, churches, charity organizations, etc. Each woman is visited in her home by the nurse, who explains the purpose o f her visit and gains her confidence by showing interest and a desire to help. Thus the nurse is able to appreciate the actual conditions o f life and to give advice which can be followed under existing conditions. The expectant mother is told how important it is fo r her to put herself in as good physical condition as possible, both for her own sake and for that o f her unborn child. She is taught how to keep herself in this condition, what to eat, what not to eat, what kind o f work she should avoid, and all the details which a woman in better financial circumstances would be told by her phy sician. She is encouraged to begin early to provide for the arrival of her baby. She is told what clothes it will need, and she is shown how to make them. The subject o f her confinement is discussed. She is advised as to what arrangements she should make and encouraged to make them well in advance. The greatest stress is laid upon the value o f nursing, both for the mother’s sake and that o f the baby. All the instruction that is given is of a practical character and the reason for doing certain things is always explained carefully by the nurse. With each expectant mother is left a post card addressed to the nurse and filled out by her, to be sent to her headquarters if she is needed at any time. Visits are made every 10 to 12 days—oftener if needed. Examination o f the urine is made at each visit, and if any abnormalities are found it is imme diately reported to the office. The physician then visits the case, if necessary, or advises the nurse what to do under the circumstances. The object o f this campaign is to show that, under existing conditions, the mortality during the first month o f life can be greatly reduced; also that the number of stillbirths and premature births can be reduced. With this idea in mind any woman is accepted as a patient, regardless o f whether she is to be confined by a physician, in a hospital, or by a midwife. Whenever advice can be given on this subject a physician or a hospital is urged. Every effort is made to persuade the woman to put herself under the care o f whoever is to have charge o f her confinement at an early date. An effort is made to utilize the facilities already at hand, and whenever minor ailments or diffi culties arise during the pregnancy the case is referred to a dispensary or to the physician, and the nurse’s duty is not done until she sees that this advice is carried out. It is only in exceptional cases that the committee’s physician cares for these women. * * * Up to December 31, 1912, 1,375 women had been watched, helped, and cared for through their pregnancies and for a month after the baby was born. * * * Results among supervised cases, as compared with the borough o f Man hattan, show reduction of 32 per cent in deaths under 1 month and o f 28 per cent in stillbirths among 1,398 babies, with two deaths among 1,375 mothers. * * * Also it is encouraging to see that over 92 per cent o f the babies living at the end of one month were being nursed entirely; that only 3.7 per cent were alto gether deprived o f the breast. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 40 BABY-SAVIN' G CAMPAIGNS. Kansas City, Mo.—The health department contemplates the estab lishment of several stations in those districts where mortality was highest last year, where expectant mothers can receive advice from the doctors and nurses in attendance. Indianapolis, Ind.— On a small scale; the funds allowed are not sufficient to carry on the work in any extensive way. The expectant mothers in the poor quarters o f the city are instructed at different times during their pregnancy, the majority from the third month on to term, others varying from the sixth to the eighth month and just before delivery. They are instructed as to proper care o f themselves in regard to exercise, need o f rest, freedom from worry. They are also instructed as to the care o f the baby, its feeding, and the need o f general hygienic precautions. In some cases the expectant mother is taken to the country or to the summer mission for rest. Providence, R. I.—Health department issues a leaflet containing advice to women who are about to become mothers. Baltimore, Md.— The Maryland Association for the Study and Prevention of Infant Mortality visits and instructs all expectant mothers registered in four leading hospitals. Chicago, 111.—The Mary Crane Day Nursery carries on prenatal work for the women o f the Hull House Neighborhood. The Visiting Nurse Association gives some instruction. St. Louis, Mo.— The Visiting Nurse Association carries on pre natal work as a part o f their daily routine. The social service depart ment of Washington University sends a nurse to visit all women who register in the obstetrical clinic. Detroit, Mich.—Pregnancy clinics are in operation in connection with the stations o f the Babies’ Milk Fund. Richmond, Va.—To a limited extent the health department carries on prenatal work. The nurses visit expectant mothers and give advice covering the usual well-known points. Louisville, Ky.— The Babies’ Milk Fund Association does a certain amount o f prenatal work in connection with other éducational effort. Milwaukee, Wis.— The Milwaukee Child Welfare Division pur poses sending out a folder containing instructions to expectant mothers, and has opened classes for mothers at three o f its stations. The Milwaukee Maternity Hospital and Free Dispensary Associa tion is also active in this work. Nashville, Tenn.—In connection with the operation o f the milk dispensaries the health department looks after expectant mothers, referring them to hospitals for confinement, or where this is imprac ticable, furnishes physician, nurse, sterile sheets, and all accessories to insure against infection in their homes. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAYING CAMPAIGNS. 41 Cincinnati, Ohio.—Extensive work toward caring for and educat ing expectant mothers is carried on by private organizations. Fall River, Mass.—The District Nursing Association does excellent work in caring for expectant mothers. Buffalo, N. Y.— The Visiting Nurse Association carries on prenatal work as part of the regular routine. Boston, Mass.— The Boston Board of Health has a prenatal and postnatal subdivision of its division o f child hygiene. Systematic and extensive work is carried on by the committee on infant social service in the Women’s Municipal League, by the pregnancy clinic o f the Boston Lying-in Hospital, and by South End House, one of the social settlements. Inasmuch as this feature in the work of the prevention o f infant mortality is comparatively new, the methods and instruction required under it are difficult o f access. We here reproduce1 the prenatal bulletin o f the city o f Providence, R. I., issued in 1910, and also the circular of the Oregon State Board o f Health, very recently issued, believing that these will be especially acceptable to health officers in the smaller cities. EFFECT OF HOUSING CONDITIONS ON INFANT MORTALITY. In organizing a baby-saving campaign the first and main point of attack is usually the milk supply. There seems to be general agree ment that this emphasis is justified, but there are also warnings from health experts against classing milk as the sole factor which brings about the high death rate among babies. A large number of diseaseproducing conditions are covered by the term “ bad housing condi tions.” In a broad sense the remedy lies in having better building regulations, more supervision o f tenement construction, more serious study o f the congestion question in the large cities, and the field is so large that it is not possible to accomplish much in a quick cam paign, beyond what good may result from giving the question pub licity. But many o f the accompanying evils, such as bad ventilation and lack o f cleanliness, are being attacked through the influence of the visiting nurses, through instructions to “ little mothers ” and through educational printed matter, and doubtless the effort has an effect in lowering the death rate from “ bad-air” diseases, such as pneumonia and bronchitis, which make up approximately 15 per cent of the total causes o f infant mortality. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 1 See Appendix, pp. 90 and 91. b a b y - s a v in g c a m p a i g n s . 42 FIGHT AGAINST FLIES, GARBAGE DUST, ETC. ACCUMULATION, While it is quite generally agreed that the germ o f cholera in fantum originates with the cow excreta, and that dirty milk is the principal carrier of the infection, it is by no means admitted that it is the only carrier—the house fly, as a death distributor, is only recently receiving the attention it deserves. Flies carry the infec tion not only to exposed milk but directly to the baby’s mouth or to the nipple of its bottle. To limit the breeding o f flies is the essential thing, and this can be done most effectually by giving the health office o f the city power to enforce the collection o f garbage and regulation o f the city dumps. Insistence upon screens for the baby’s rooms and for the baby’s bed is a part o f the campaign against infant mortality. Not only the flies, but dust, as is now well-known, is a carrier o f enteritis germs and through this the breast-fed child no less than the bottle-fed is exposed to the dangers o f this summer terror. When it is understood that this germ when developed can and does use dust particles as a vehicle upon which to ride from pastures to the dusty streets and thence into homes, however carefully guarded and protected its little ones may be, the importance o f permitting the health department to have supervisory control over street sprinkling in poor residence districts during June, July, August, and September becomes very apparent. The need for this precaution will be more readily understood when it is realized that the infant death rate in the hot weeks almost invariably falls for a few days after a general dust-settling rain. STABLES AND STABLE FLIES. Upon the opening o f summer a thorough listing o f all horse stables and livery barns, whether public or private, is made by cities like Seattle and Indianapolis, and complete measures for the control o f the fly-breeding places instituted. Whether or not the stable fly is the only carrier of infantile paralysis it is certainly one, probably the principal carrier. Certain cities have issued circulars with mag nified cuts o f the stable fly to show the distinction between that and the common house fly. This distinction is not generally known and is not readily ascertainable by the eye. In fair weather the stable fly rarely enters the house; just before a rain or a storm it does enter the house and the common saying that “ just before a storm the flies bite ” is indicative o f this. The house fly does not “ bite ” ; it is always the stable fly that bites and it is its bite which is so often fatal to small children. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVING CAMPAIGNS. 43 Below is the form o f stable score card used in Seattle, Wash., in its inspection service to eradicate the breeding places o f flies and control stable flies : DEPARTM ENT OF H EALTH AND SANITATION, CITY OF SEATTLE. DIVISION OF INSPECTION. Stable score card. Owner or lessee of stable.................. ....................... „..... Location.................................................... , .......... Number of horses.................................... IIII.IIiNÛmber ôfcows. 1111111111! 11. 111111111111............. ............................................................board or private.............. .......... Date of inspection............................................................................................... ’ V ""i9Î" ' * Score. Perfect. Character of building........................................ If of first class construction of frame or masonry. . . . . in If poorly constructed.......................................... a If dilapidated............................................. ? Floors, cemmt with proper gutters and catch basin, and sewer or cesspool connection................................................... Cement, badly laid........................................ a Cement, broken....................................... ? Wood, tightly laid, as per ordinance.............................. 8 n W ood, open cracks................................... __ Manure box, strictly fly proof, with vent...................... Manure box, with any part open.............................. a Manure box. tight without vent...................... 4n Surroundings, perfectly clean....................... If there is water on lot....................... in If there is manure scattered about......................... 3 If premises are disorderly.............................. a Allowed. 10 10 50 30 100 If any manure be on premises, exposed to flies, score will be limited to 49. If floors are not properly cleaned, deduct 5 from total. Filthy catch basins, deduct 5 from total. FRESH-AIR CAMPS AND HOSPITALS. Fresh-air camps have been operated during the summer months with good results in many cities. These are usually private philan thropies. Although prevention is the chief end and aim o f all work in behalf o f children, nevertheless there must be hospital accommodations for those cases o f illness which can not be properly cared for at home. As a city grows a hospital o f some sort sooner or later becomes a necessity. However small such a hospital, it may contain from the first beds for children. As an example o f what is possible on a large scale, Cleveland, Ohio, has a finely equipped Babies’ Hospital, devoted entirely to the care of infants and young children. In almost any hospital it is possible to turn over to the exclusive use o f children some of the beds and facilities, so that in case o f emergency there will be some place where sick children may be taken care of. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 44 BABY-SAYING CAMPAIGNS. EDUCATIONAL WORK THROUGH THE DISTRIBUTION OF CIRCULARS, PAMPHLETS, ETC. The volume o f printed instructions annually issued, as well as the character o f the material, improves each year. State boards of health have issued exceedingly valuable pamphlets appealing alike to city authorities to bestir themselves and to parents to instruct themselves in the care o f babies. These two audiences have not always been kept distinct, as much material directed at both is sometimes contained in the same pamphlets. The North Carolina State Board o f Health issued in 1912, as Special Bulletin No. 10, a pamphlet on “ The Baby,” using most effectively a cartoon o f a mother gazing into the empty cradle. A part o f the legend is “ In future men will stop locking the stable door after the horse is stolen. They will not be content with spend ing on a funeral the money that would have saved the child; they will not tolerate the thought that a poor mother must bear 10 chil dren to raise 5.” “ Save the Baby ” articles are prepared by a num ber o f the State boards, and furnished to the papers throughout the State. In North Carolina these are included from time to time in the State Board of Health’s “ Daily Press Service ” publications. In other States as Iowa, Idaho, etc., where the general scheme is adopted the articles are prepared only on special occasions. A bibliography o f these State and city publications would be valuable and may form a part o f this report next year, but can not be at tempted now. Some cities, notably Chicago and Seattle, issue weekly or monthly bulletins which in addition to statistical matter contain much that is instructive as to the care o f babies’ food. The health officer of Washington, D. C., issues instructive pam phlets on such subjects as the care of milk, the fly menace, methods o f destroying flies, etc. Lectures to mothers and moving-picture films, illustrative o f the principles of baby hygiene, are also among the educational features which some cities have successfully adopted. O f prime importance are the folders addressed to mothers and dealing directly with the care and feeding o f the child. These are mailed immediately upon receipt o f notice o f birth o f a child, or are delivered by the nurse who calls as the result of such birth notifica tion. Such folders are issued in all o f the principal languages spoken in the locality, as, for instance: Bridgeport, Conn., prints in four languages; Providence, It. I., in five; the State Board o f Health of Pennsylvania publishes such circulars of instructions in five or six languages, and furnishes these to the various cities o f the State. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAYING CAMPAIGNS. 45 Likewise the Department of Health of New York issues a pam phlet on “ How to Save the Babies,” which is distributed through the city health bureaus. Selected copies o f these circulars in various languages will be found in the appendix. The importance of having these instructions in many languages will be apparent. It very often happens that the mother does not understand the language either of the visiting nurse or o f the physician, and is hence thrown back, as soon as they leave the house, upon her own resources, or left to the mercy o f advisory neighbors as ignorant as herself. It may fre quently happen, also, that where health officers have no means or opportunity o f doing anything more they can have such circulars distributed among mothers, or have the material printed in the local papers. Experience has shown that the editor, for instance, o f the Italian paper is glad to print this material if the copy is furnished to him in Italian; the publisher o f the Yiddish paper is entirely willing to publish it if it can be furnished to him in Yiddish, etc. It should be noted that these “ Care o f the Baby ” and “ Save the Baby ” circulars frequently contain some information as to the care o f the mother immediately before the birth o f the child. CONCLUSION. It is evident that no universal program for civic baby-saving work can be laid down, because each community must begin at the point which is practicable or most urgent as shown by local conditions, but the following summary is offered as universally applicable: (1) A continuous graphic statement o f the births and deaths o f babies, kept by means o f different-colored pins to be placed day by day on a city ward map or, preferably, a block map showing each dwelling, is a simple means o f keeping informed as to the points of danger.1 (2) Complete registration of births is necessary in order that the baby may be brought under observation as soon after birth as possible. (3) The appeal to mothers to nurse their babies can not be made too strong, since it is estimated that bottle-fed babies have only onetenth the chance to live that breast-fed babies have. (4) A clean milk supply is a fundamental need. The ideal is: Nothing short of clean milk for everybody. This calls for intelli gent and effective inspection of farms, the means o f transportation and the shops where milk is sold. Milk stations for distributing clean milk to babies, maintained by private philanthropy, are a useful beginning. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 1 See page 14. 46 BABY-SAYING CAMPAIGNS. (5) The organization o f “ little Mother Leagues ” or similar classes in the public schools, through which girls from 12 to 14 years o f age lire taught all practical methods of home making, including baby hygiene and feeding, ranks as important work in the prevention of infant mortality in this and in the next generation. (6) A ll efforts for civic cleanliness serve the babies no less than the rest o f the population. In conclusion, as summing up the significance o f the work de scribed in this publication it seems fitting to recall the statement of a great sanitary authority that the infant death rate is the truest index o f the welfare o f any community. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis APPENDIX. HOW TO SAVE THE BABIES—IT IS NOT THE BABIES BORN BUT THE BABIES SAVED THAT COUNT. [Suggestions to Mothers from the New York State Department o f Health. Eugene H Porter, A. M., M. D., commissioner. W ritten by H. L. K. Shaw, M. D., consulting pedia trician and issued by the division o f publicity and education o f the State department o f health, Albany.] SAVE THE BABIES. This booklet is prepared and placed at the free disposal o f the mothers o f the State o f New York to assist them in the care o f them selves during pregnancy and in the care o f the baby after it is born. Copies can be obtained through the local health officer or the registrar or direct from the State Department o f Health, Albany, N. Y. A t present it is published only in English; as the need is demon strated it will be issued in other languages. It is by no means in tended to take the place o f the physician, whose advice should be frequently sought and followed. It is the desire o f the commissioner o f health that a copy o f these suggestions be placed in the hands of every expectant mother, or that it reach her as soon as possible after the birth o f her child. The local registrar or health officer will cooperate in seeing that this wish is fulfilled. HOW TO SAVE THE BABIES. Do you know that out o f every five deaths in New York State' one is that o f a baby less than a year old? A large percentage o f these are due to causes which could and should be prevented. An epidemic o f smallpox gives rise to startling headlines in the newspapers and the entire community is aroused and alarmed. Pub lic opinion demands prompt and vigorous action on the part o f the health officers. Yet the number o f deaths in this disease is exceed ingly small in comparison with the number o f preventable deaths among infants. The New York State Department o f Health is endeavoring to “ save the baby ” and enlists your support. A large number o f deaths among infants indicates the existence o f insanitary conditions or o f ignorance that will affect not alone the little children but the entire community. The most important factor in the solution of this problem is the mother. She is the natural caretaker of her baby. A lower death https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 47 48 BABY-SAYING CAMPAIGNS. rate among the babies can only be accomplished through intelligent motherhood, maternal nursing, cleanliness and fresh air, and pure and properly prepared milk for the babies who have to be artificially fed. The following suggestions are made in order that the mother can intelligently prepare and care for her baby. BEFORE THE BABY COMES. Health o£ mother.—A poorly fed or sickly mother can not give birth to a vigorous, healthy infant and successfully nurse it. Such a mother rarely carries her baby for the full 280 days. A woman who has had repeated miscarriages or whose labors have' come on before time should, early in pregnancy, consult her physician in order that the underlying cause can be cured or alleviated. During preg nancy, and especially in the latter months, the expectant mother must have abundant rest and spare herself as much as possible. An extra amount o f sleep is required by the pregnant woman, and a daytime rest for an hour or two is desirable. Select and consult your physi cian early in pregnancy. Keep yourself in good health. Hard house hold labor or factory work during the latter months o f pregnancy tend to bring about miscarriages or the birth o f puny and undersized children. Exercise.— Exercise in the open air in the form o f walks should be taken throughout the entire course o f pregnancy. Violent exercise in any form should be prohibited, and unnecessary stair climbing must be avoided in the latter months. The sewing machine must not be used toward the end of pregnancy. , 1 When labor is threatened before the proper time the mother should go at once to bed and remain perfectly quiet until the danger is well DRSSCCu Care of nipples.— Small, flattened, or depressed nipples should be drawn out with the forefinger and thumb and held for five minutes night and morning during the two months preceding labor. The nipples should be carefully anointed each nignt with white vaseline and washed each morning with castile soap and warm water. This will soften and remove the milk which is secreted in the latter part of pregnancy5 and which, i f not removed would form hard crusts and Ulcerate the soft tissue beneath. Proper attention to the care o f the nipples during pregnancy will make the act of nursing one ox pleasure and satisfaction instead o f one o f pain and discomfort. Diet.—The diet should be carefully regulated. A full, whole some, and liberal diet is essential. This depends on the woman s tastes and habits, as food which agrees with one will not agree with another. Highly seasoned or very rich food should be avoided as well as fatty foods and coarse vegetables. . . The following dietary is recommended during pregnancy and nursing: •Soup.—Any kind. . A Fish.— Fresh fish of any kind, boiled or broiled. Raw oysters and raw clams. \ x . . « Meats.— Chicken, beef, ham or bacon, veal, lamb, tender lean mut ton. Red meat should be allowed in moderation and only once a day. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAYING CAMPAIGNS. 49 Cereals.— Hominy, oatmeal, farina, cream o f wheat, rice mush, shredded wheat biscuits, etc. Breads.— Stale bread, com bread, Graham bread, rye bread, brown bread, toast, crackers. Vegetables.—Potatoes, onions, spinach, cauliflower, asparagus, green corn, green peas, beans, lettuce, or other salads with oil. Desserts.— Plain puddings, custard, junket, ripe raw fruits, stewed fruits, ice cream. No pastry. Drinks.— Tea and coffee very sparingly, never more than one cup a day. No alcoholic beverages, beer, etc. A t least two quarts o f water a day. Milk, buttermilk, cocoa, malted milk. At least one satisfactory movement o f the bowels should take place daily; if there is any difficulty about this consult a doctor. WHEN THE BABY COMES. Send for the doctor.— Send for the doctor when the labor pains begin. He prefers being called too early than too late. A sudden gush o f water signifies that the membranes have ruptured, and the mother should go to bed at once. The bed should be prepared as follows: Place a rubber sheet or three thicknesses o f newspapers next to the mattress and over this a clean sheet. Next place three thicknesses o f newspapers over the middle and edge o f the side o f the bed and cover with a folded sheet, and then cover with a clean sheet. This top layer o f papers and sheets can be easily removed after the labor and the mother lies on a clean dry sheet. Everything should be in readiness for the reception and care o f the baby. A warmed flannel blanket in which to place the baby after birth, and hot-water bottles to surround it, i f the room is cold, are desirable. The baby should be exposed as little as possible during the bath, and the clothes and diapers should be warmed. Every thing that comes in contact with the baby should be scrupulously clean. Save the baby’s eyesight.— The mother should insist that a drop o f silver solution, as provided free o f charge by the New York State department o f health, be placed in the baby’s eyes. This will pre vent blindness. I f the baby weighs less than four pounds it can best be taken care o f in incubators, which are to be found in any wellequipped hospital. Your physician is required to make a prompt report o f the birth to the registrar or local board o f health. This is a matter o f great importance, and don’t let him forget it. The mother should remain in bed for at least two weeks after confinement. The womb does not return to its normal state for five or six weeks, and no hard work or active exercise should be taken during this period. AFTER THE BABY COMES. Nurse your baby.— I f you love your baby, nurse it. Mothers1, milk is nature’s food, and no other food is as good. The chances o f your baby living are nine times greater on breast milk than cow’s milk or any other kind o f food. Even though you have but little 94219°—13-----4 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAYING CAMPAIGNS. 50 milk at first, do not get discouraged. Be patient and try, try again. There are very, very few mothers whose breasts will not give suffi cient milk if they will but encourage the baby to suck. This keeps the milk flowing and increases its flow. Even though you feel weak you can nurse your baby without danger to yourself. Only a few serious diseases forbid nursing. I f you are in doubt consult your doctor. His advice is better than that of your neighbors. Nurse your baby until the tenth month.— I f you really can not nurse him as long, give him your milk as long as you can, for every drop he gets adds to his strength for his hard fight in life as no other food does or ever will. Keep your bowels regular. Constipa tion in the mother often causes colic in the baby. Follow the dietary shown on a preceding page and eat three plain, well-cooked meals a day at regular intervals. Drink plenty of water, but avoid tea, coffee, and beer. So long as the mother keeps well the baby will be well. Nurse the baby regularly.— Feed him by the clock. From birth to three months feed every two and a half hours during the day with only one nursing between 1(1.30 p. m. and 6 a. m. After the third month feed him every three hours and do not nurse during the night. D o not let the baby remain at the breast more than 20 minutes. Never allow the baby to sleep at the breast at night. When the baby cries between feedings give him pure, warmed water without any thing in it. Then let him alone. The mother should wash the nipple with plain, cold water before each nursing. Wean gradually by substituting bottle feedings for breast meals— one each day during the first week o f weaning, two each day during the second week, and so on until all are bottle feedings. I f possible do not wean during the hot summer. WHEN THE MOTHER CAN NOT NURSE THE BABY. Substitute for mother’s milk.— Cow’s milk is the only good substi tute for mother’s milk. It should come from healthy, consumption-free, and clean-kept cows and be promptly cooled. It should be milked in a clean stable by clean milkmen and bottled in clean bottles. It must be kept con tinually on ice until used for the baby. Common store or milkman’s milk is not safe food for the baby, even though it tastes and looks good. The patent baby foods, condensed milk, etc., harm the babies in most cases and shouid not be used. They often make the baby fat, but not strong. I f you can not afford the best milk get the best you can from a milkman whom you know to be clean. Place in a clean dish and boil the milk from 5 to 10 minutes. Cool as quickly as possible by placing the dish in another filled with ice water. As soon as the milk is cooled prepare the food as directed by the doctor, using only clean dishes. The food is then poured in the nursing bottles and clean cotton batting is used for stoppers. These bottles are kept on ice i f possible. Homemade ice box.—A cheap ice box can be made as follows: Get a box about 18 inches square from your grocer and put 3 inches o f sawdust in the box. Place two pails in the sawdust, one inside the other, and fill the space between the outer pail and the box with saw- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVING CAMPAIGNS. 51 dust. The nursing bottles filled with milk are placed in the inner pail and the pail is surrounded with cracked ice. The inner pail should have a tin cover. Nail several thicknesses o f newspapers on the under surface o f the cover o f the box. This ice box should be kept covered and in a shady, cool place. Care of nursing bottles.—The bottles should be cleaned immedi ately after feeding by first rinsing with clear water and then soak ing in soda, borax, or soap water. Then clean well with a clean brush and rinse with boiled water. They should be filled with boiled water until ready, for use. Use only nipples which are slipped over the neck o f the bottle. Nipples with tubes are convenient for a lazy mother, but they can not be cleansed thoroughly and may mean death to the baby. After each feeding cleanse the nipple thoroughly inside and outside. Boil the nipple at least once daily, and keep it dry in a clean covered cup or glass. Early feeding.— Feed the baby one part milk and two parts water during the first month at intervals not less than two and a half hours and in amounts not more than four ounces (eight tablespoons). During the second and third months use one part milk and one part water at three-hour intervals and five ounces (10 tablespoons) in amount. After the fourth month give two parts milk and one part water at three-hour intervals and six ounces (12 tablespoons) in amount, in creasing one ounce at each meal during each succeeding month. Bar ley water or oatmeal water can be used to dilute the milk. One level teaspoon o f granulated sugar should be added to every three ounces (six tablespoons) o f diluting solution (water, barley, or oatmeal water). Warm the bottle to about body heat before giving it to the child, by placing the bottle in a dish o f hot water. I f the milk is not sweet do not give it to the baby. Wash your hands before touching the nipple. Shake the bottle before using. Never put the nipple in your own mouth to find out whether the milk is warmed enough. Try it on your wrist. Hold the baby in your arms while feeding it, and do not allow the baby to drink from the bottle longer than 20 minutes. I f he does not take the whole feeding throw it out and do not save for the next time. * Don’t overfeed.—Never coax the baby to take more food than he wants. Too much food and too frequent feedings overtax the diges tion and lead to stomach and intestinal disturbances. This is what makes the baby cry. He cries because he has indigestion from too much food, not because he is hungry. Boil a pint of water every morning and put in clean bottle. Keep in cool place. Warm it be fore giving to the baby. Give as much as he will take between feedings. After the eleventh month.—A well cooked cereal (farina, cream of wheat, strained oatmeal, etc., cook three hours) can be given once a day after the eleventh month in place o f the noonday feeding. Beef juice with stale bread crumbs, broths, or a soft-boiled egg can be given in addition to the cereal after the twelfth month. A wellbaked potato, boiled rice, rare roast beef, custard, com starch, rice pudding, baked apple, apple sauce, stewed prunes,' and bread and butter can be given after the fifteenth month. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 52 BABY-SAYING CAMPAIGNS. Ham, bacon, or pork, cabbage, pickles, tea, coffee, or beer, bananas, berries, cake, candy, or ice cream should not be given to babies or little children. Teething.—Teething rarely causes serious illness. I f the child seems to be ill, do not put it down to teething, but consult the doctor. Diarrhea.— As soon as the baby has diarrhea or vomiting, stop all food at once and give only boiled water or clear barley water until the doctor sees the baby. Fresh air.— Give the baby pure fresh air day and night and keep the windows open but screened to exclude flies and mosquitoes. Keep the baby in the open air when possible, but avoid the sun during hot weather. Select the shady side of the street. Avoid infection.—Keep the rooms free from soiled clothes and rubbish. Do not encourage the baby to play with cats or dogs ; they often have disease germs in their fur. D o not let the child crawl around on a dirty floor or dusty carpet. Do not let it put playthings into its mouth. Bath.—Every child should have one tub bath daily. On very warm days the 10-minute spongings with cool soda water (one tea spoonful o f bicarbonate o f soda to a pint o f water) will add greatly to the baby’s comfort. Clothes.— Do not put too many clothes on the baby. A band, shirt, petticoat, and dress are all that, are needed in the house. Dur ing very hot days a napkin, band, and a thin muslin slip are all that b^by needs. Sleep.— Be sure the baby gets two naps a day and at least twelve hours o f sleep at night. Do not let him sleep on a feather pillow. The baby should sleep in a bed or crib by itself—never in bed with its mother. Do not rock or jounce the baby and remember that constant handling is harmful. Keep the baby and bedclothes clean. Diapers should be carefully washed as soon as they become soiled and then dried in the open air. D o not use a diaper a second time before washing it. Soothing sirups.—Under no circumstances should soothing sirups be given to the baby. They contain opium and are dangerous. Good habits.—Train thè baby into good habits. D o not get the child into the habit o f expecting to be carried about if it cries. Tram the baby to go to sleep by itself in the dark. A well-trained baby makes a well-behaved child. RECIPES. Barley water.—This is often used instead of water to dilute the milk and tends to make the curds o f the milk more digestible. One heaping tablespoonful of barley flour and a pinch o f salt are mixed with a little water into a thin paste and added to 1 quart o± boiling water. Stir well and boil for 20 ^minutes. Add enough water to make 1 quart. Pearl barley requires more cooking. It should be boiled for at least 3 hours and must be strained before using. Make f resli ¿oily, Oatmeal water.—This is used in the same way as barley water, but it has a laxative effect. Stir two tablespoonfuls o f oatmeal and a pinch o f salt in a quart o f boiling w ater and let it simmer fo r three https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAYING CAMPAIGNS. 53 hours. Replace the water that evaporates so that there will be a quart when done. Strain. Make fresh daily. Egg water.—T o be used when the baby can not digest milk. Stir the white o f one egg into 1 pint o f boiled water, add a pinch o f salt, shake thoroughly, and strain. This should be kept in the ice box or other cool place. Beef juice.— Take rare broiled beef and cut into small pieces and press out the blood. This can be diluted with plain boiled water or barley water. Broths.—Take 1 pound o f meat, free from fat, and cook for 3 hours in 1 quart of water. Add water from time to time so that there will be 1 quart o f broth. Cool, remove fat, strain, and add a little salt. Whey.—Warm one pint of milk to blood heat and add one tea spoonful essence of pepsin or junket tablet. Let it stand until it jellies and then break up the curds with a fork. Strain through a cloth. What goes through is called whey and is used when babies can not digest cow’s milk. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis [Leaflet issued by New York City Department o f H ealth.] TEN REASONS W HY A MOTHER SHOULD NURSE HER BABY. 1. One death out o f every five which occur at all ages is that o f a baby under 1 year o f age. 2. In the city o f New York during 1910, 4,794 babies under 1 year o f age died from bowel trouble, and 9 out o f every 10 of these babies were bottle fed. 3. Out o f the 16,213 babies under 1 year o f age who died from all causes in New York city during 1910, one-third died before they were 1 month old. 4. A large proportion o f these babies would have lived if they had been nursed by their mothers. 5. Mother’s milk is the only safe food for a baby during the first six months o f its life. I f the weather is warm the baby should not be weaned until it is at least 9 months old. Cow’s milk or prepared food can never equal breast milk as the proper food for the baby. 6. Breast-fed babies rarely have bowel trouble. Bottle-fed babies rarely escape having it, particularly during warm weather. 7. Babies fed on breast milk show the best development; the teeth will appear at the proper time, the muscles and bones will be stronger, and walking will not be delayed. 8. A breast-fed baby is not so likely to have bronchitis or croup, and i f attacked by any disease has a much better chance o f living than a bottle-fed baby. 9. Pneumonia in babies is fatal more often in bottle-fed babies than in breast-fed babies. 10. Your baby will have the best chance of living that you can give it if it is breast fed. Surely these facts are worth considering before deciding not to nurse your baby. Issued by order o f the board o f health. 54 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis F orm 20. [C ircular issued by the Pennsylvania Department o f H ealth.} SAVE THE BABIES. RULES TO BE OBSERVED IN THE CARE AND MANAGEMENT OF INFANTS DURING THE SUMMER. The hot weather o f this season o f the year is extremely dangerous to the lives of infants and young children, not only because o f the depressing effects o f high atmospheric temperature in general, but more especially because o f the effect o f hot weather upon all perish able articles o f food, among which cow’s milk holds the first place. It is therefore highly important that cow’s milk to be used for infant’s food should be the purest and freshest that you can afford to buy. During the hot weather ice is absolutely necessary for the preservation o f milk, and all milk used for food should be cooled by ice as soon as it comes from the cow and should be kept next to the ice until ready to be used. A little money spent for ice may prevent illness and its much greater expense for medicine, nursing, and medi cal attendance. As water is often a carrier o f disease it is safest to use only boiled water for drinking or the preparation o f a baby’s food. The following rules will aid you in keeping your baby well during the hot weather: Breast feeding.—Every mother should endeavor to nurse her baby. Breast milk is the natural food o f the newborn baby. There is no other food that can compare with it. A breast-fed baby has a much greater chance o f living than a bottle-fed baby. Immediately after birth do not give any kind o f artificial food to the baby, while waiting for the breast milk to come. Put the baby to the breast every four hours, and give nothing else but water that has been boiled. The baby needs nothing else, and will not starve. After the milk comes into the breast nurse the baby every two hours during the day and two or three times at night. Don’t nurse the baby whenever he cries; a moderate amount o f cry ing helps to develop the lungs. Babies who are nursed irregularly, or whenever they cry, are likely to get indigestion and then cry the harder from pain. Nurse regularly and the baby will soon learn to expect its nursing only at the proper intervals. Give the baby a little boiled water several times a day. After the baby is 2 months old lengthen the time between feeding to 2^ or 3 hours, with only one or two feedings at night. Do not wean the baby as long as he is gaining and never do so ex cept by advice o f your doctor. Do not follow the advice o f friends or neighbors about weaning. I f the baby remains well but after a time stops gaining in weight, do not think that your milk is o f no value, but consult your doctor about adding one or two bottles to help you out. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 55 56 BABY-SAVIN'G CAMPAIGNS. Bottle feeding.—I f it becomes necessary to feed the baby either entirely or only in part upon the bottle, remember that the greatest cleanliness is necessary in all details o f the feeding. As soon as a bottle is finished, it should be thoroughly washed with cold water, then cleansed with hot water and borax (1 teaspoonful to a pint of water) and put aside for further cleansing, before being used again. I f you have only a few bottles and it becomes necessary to use the same bottle for the next feeding, boil it for a few minutes before putting fresh food into it. Never let the baby nurse from the re mains o f a bottle which he has not finished at once. Take it away from the crib, pour out the milk, and cleanse at once. Stale milk curds sticking to the inside o f a bottle after a few hours become poisonous and may contaminate fresh milk coming in contact with them. It is better to have as many bottles as the number of the baby’s daily feedings, so that all the bottles can be boiled together be fore the food is prepared in the morning. Nipples.— The simpler the nipple the safer for the baby. Do not use complicated nipples, and under no circumstances buy a bottle with a long rubber tube attached to the nipple. It can not be kept clean and will certainly cause bowel trouble. After the bottle is fin ished the nipple should be removed at once, turned inside out over the finger and scrubbed with cold water and a brush kept only for this purpose. After use, always boil the brush. The cleansed nipple should be kept in fresh borax water (1 tea spoonful o f borax to a pint o f water) in a covered glass. Rinse the nipple in boiling water before using it. Do not put the nipple into your own mouth to find out whether the milk is warmed enough. Let a few drops o f the milk fall on your wrist; i f it feels too hot to your wrist it is too hot for the baby’s mouth. No general instructions can be given about the preparation o f a milk mixture for your baby. Each baby needs a combination suited to his digestion. The mixture upon which some other baby is thriv ing may be too strong or too weak for your baby". Let the doctor tell you how to mix the food. I f it is necessary to use cream in the mixture do not buy cream—it is likely to be stale—but get it by pouring off half a pint from the top o f a quart bottle o f milk, after cleansing the lip o f the bottle. Do not be guilty o f constantly changing food for the baby as mothers are apt to do through the advice o f “ good ” neighbors. Fol low the instructions of your doctor. During the summer the baby’s food should be brought to a scald after it is prepared. It should then be poured into the clean bottles, corked with baked clean cotton wool and kept next the ice until needed. D o not heat a bottle when you go to bed and keep it in bed until nursing time, because you do not want to go to the ice box for it and heat it when the baby needs it. This is a certain way to make the baby sick. Bowel movement.—A bottle-fed baby should have at least one and not more than two or three bowel movements a day. I f the milk is clean to start with and has been kept cold, and all the feed ing utensils cleaned as you have just been told, the baby’s move ments should be yellow in color, and not too hard to be passed https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVIN'G CAMPAIGNS. 57 easily. I f the movements become greenish in color, but not more frequent than two or three a day, give one or two teaspoonsful of castor oil. I f the color does not improve'after the oil has worked off, consult your doctor. A t this time he will be able to prevent the serious bowel trouble with which the baby is threatened. I f the movements remain green in color and increase in number to five or six or more in the 24 hours, your baby is beginning to have bowel trouble, or summer diarrhea. Stop milk at once, give pure boiled water instead and call the doctor. It may not be too late. Do not begin milk feeding again until the doctor orders it. You will not starve your baby by stopping the m ilk; every drop o f milk that goes into his mouth after this warning simply adds to the poison already there. You will cause serious or fatal illness by keeping up milk food after the bowels become loose and the movements green in color. Vomiting.— A bottle-fed baby should not vomit if its food is pure and properly adjusted to its needs. I f vomitings occur it is usually a sign of approaching illness, either o f one o f the serious diseases o f childhood, or more commonly in hot weather, of summer diarrhea. Vomiting due to this cause may be the first sign o f trouble and the bowels may not become loose until several days later. I f vomiting is repeated, stop milk feeding, give boiled water, cool or o f the tem perature at which the milk is given, and consult your doctor at once. Clothing. D o not put too much clothing on the baby in summer. During the hottest weather, remove most o f the clothes; a thin loose shirt and a diaper are sufficient during the day and on very hot, close nights. ’ Never use clothing made with tight waistbands. Petticoats and skirts should be supported by straps over the shoulders. Bathing.— Bathe the baby every day. In hot weather a quick sponging all over later in the day will give comfort and make him sleep better. Wash the baby each time the diaper is changed and dry the parts thoroughly before using powder. Wash all soiled diapers and boil them. Never use a dried wet diaper without first washing it. Flies.— Be careful to exclude flies from the baby’s bottle and food and do not allow them to light on the baby’s lips while sleeping. Flies carry disease to thousands of infants every summer. Fresh air.— Fresh air is as important for the baby’s health as fresh food. During the summer, keep the baby out of doors as much as possible. Keep the baby out o f the kitchen; he may get a “ sun stroke ” from too much heat indoors. Eruptions of the skin.—I f the baby has an eruption or breaking out o f the skin, consult a doctor. Do not think that every rash is prickly heat; it may be some serious disease like scarlet fever, measles, smallpox, or chickenpox. I f a baby is worth having it’s worth saving. H alf o f the babies that die in Pennsylvania each summer could be saved by following the advice given in this circular. Issued May 15, 1909. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis [C ircular issued by Pennsylvania Department o f H ealth.] F o r m 20B.— Italian. SALVATE I BAMBINI. CONSIGLI E SUGGERIMENTI PER LA CURA DEI BAMBINI DURANTE L’ESTATE. Il caldo della stagione estiva è assai pericoloso per la vita dei bam bina di tenera età, specialmente per i neonati, non tanto per le con seguenze dell’ alta temperatura in generale, quanto, ed in modo spe ciale, per l’effetto che il caldo può avere su tutti quei cibi che possono andare soggetti a decomposizione. Fra questi, il latte di vacca occupa il primo posto. È, di conseguenza, d’importanza massima che il latte di vacca che voi destinate all’ allattamento dei bambini sia il più puro ed il più fresco che i vostri mezzi vi permattano di comprare. Durante la stagione calda, il ghiaccio è assolutamente necessario per mantenere fresco il latte. Questo, quando viene usato come cibo, deve essere raffreddato col ghiaccio non appena munto dalla vacca e deve essere tenuto in ghiaccio fino al momento in cui è usato. Pochi soldi spesi per un po’ di ghiaccio possono tener lontane le malattie e qualunque spesa per visite mediche, medicinali o altro da esse derivanti. Sic come l’acqua, spesso e volentieri, è veicolo d’infezione e, quindi di malattie, si deve usare soltanto acqua bollita, quando deve essere bevuta, oppure una qualunque altro preparazione speciale per bambini. I seguenti consigli e suggerimenti vi aiuteranno a mantenere i vostri bambini in buone condizioni di salute durante il caldo dell’ estate : Allattamento.—Ogni madre deve fare il possibile di allattare da se il proprio bambino. Il latte materno è il cibo naturale del neonato e non vi è alcun altro cibo che può reggere al paragone. Un bambino che ha succhiato il latte dal seno materno ha molte più possibilità di vita di qualunque altro bambino allattato col biberon. A l bambino appena nato non date mai cibo artificiale. Avvicinatelo alla mam mella ogni quattro ore e non dategli altro che acqua che sia stata ben bollita. Il neonato non ha bisogno di piu’ e siate pur sicuri che esso non morrà certamente per mancanza di nutrimento. Non appena la mammella à colma di latte, allattate il neonato ogni due ore, durante il giorno, e due o tre volte durante la notte. Non allattate il neonato ogniqualvolta esso piange o grida.— Il piangere moderato è una delle funzioni che, nel neonato, contri buisce ad accrescere lo sviluppo dei suoi polmoni. Quei bambini ai quali il latte non vien dato regolarmente oppure ad ogni minimo ac cenno di pianto, possono spesso andar soggetti ad indigestione ed alle sue conseguenze. Allattate il bambino regolarmente e vedrete ch’esso 58 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAYING CAMPAIGNS. 59 imparerà do se stesso a chiederlo a tempo debito. Dategli pure spesso un poco d’acqua durante il giorno ed abbiate cura ch’essa sia stata prima ben bollita. Lo svezzamento del bambino non deve assolutamente avvenire du rante il suo sviluppo e se non prima non si è consultato in proposito un medico. Non state ad ascoltare i consigli e gli avvertimenti di amiche e di vicine, quando si tratta di svezzare il bambino. Se esso gode buona salute puranco non aumentando affatto di peso, non state a credere che la potenza benefica del vostro latte sia venuta meno. Consigliatevi invece con un medico e domandategli se una o due bot tiglie di latte possono aiutarvi ad assolvere il compito materno. Allattamento col biberon.— Qualora sia realmente necessario allatare il bambino, interamente o in parte, col biberon, tenete ben pre sente che la pulizia è cosa prima ed indispensabile in tutti i processi dell’ allattamento. Non appena il biberon è vuoto, deve essere ben lavato con acqua fredda e poscia accuratamente pulito con acqua calda e borace (un cucchiaino sciolto in una pinta d’acqua). Più tardi, al momento in cui è necessario usarlo nuovamente, il biberon deve essere di nuovo lavato e pulito. Nel caso che voi abbiate poche bottiglie soltanto, e che sia indispensabile usare la stessa bottiglia, tenetela in un recipiente d’acqua bollente per qualche minuto, prima di mettervi dentro altro latte. Abbiate bene cura di non dare mai al bambino il rimenente di un biberon vuotato solo in parte. Togliete questo biberon dalla culla, vuotatelo del contenuto e pulitelo im mediatamente. I filamenti del latte stantio o acido che rimangono attaccati al vetro divengono ricettacolo d’infezione e possono, di conseguenza, contaminare il latte fresco che ad essi va ad aggiungersi. È quindi consigliabile avere tante bottiglie per quante volte, durante il giorno, voi devete allattare il bambino. In questa guisa voi le potreste lavare e pulire insieme in acqua bollente ogni mattina. Capezzoli di gomma.—Più semplice è questo capezzolo, tanto più consigliabile esso è per la salute del bambino. Non usate altri capez zoli e per nes suna ragione al mondo comprate biberons che abbiano tubi di gomma attaccati al capezzolo. Essi non possono essere mai tenuti abbastanza puliti e possono quindi causare disturbi viscerali. Esaurito il contenuto di un biberon, liberatelo immediatamente del capezzolo. Ciò fatto, col dito rovesciate questo capezzolo, come fareste con un guanto e pulitelo bene, in acqua fredda, con uno spazzolino che avrete cura di conservare esclusivamente per questo uso. E necessaria pulire lo spazzolino con acqua bollente ogni volta che lo si usa. Il capezzolo, una volta pulito, deve essere costantemente tenuto in una soluzione d’ acqua e di borace (un cucchiaino di borace in una pinta d’acqua) in un recipiente di vetro ben chiuso. Quindi, prima di essere nuovamente usato, è necessario sciacquarlo in acqua bollente. Non mettete mai in bocca il capezzolo artificiale per accertarvi se il latte è caldo abbastanza.—A ll’ uopo basterà che lasciate cadere qualche goccia sul vostro polso. Se è troppo calda vuol dire ne che è troppo calda per la bocca del neonato. Non é possibile dare, in generale, consigli e suggerimenti circa il modo in cui deve essere^fatta una preparazione di latte per il vostro bambino. Ogni bambino ha una costituzione fìsica speciale ed abbisogna di una speciale preparazione adatta alle sue facoltà di- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 60 BABY-SAVING CAMPAIGNS. gestive. Una preparazione che può essere buona per questo o quel bambino può essere troppo pesante o troppo leggera per il vostro. Lasciate che il medico vi consigli a questo proposito. Se é indispen sabile usare della crema, non comprate mai della crema bell’e fatta— può benissimo essere stantia o acida. Prendetela invece dalla parte superiore della bottiglia del latte (quelle da un quarto) e soltanto dopo aver bene puliti gli orli del recipiente. Durante l’estate, il latte destinato ai bambini deve essere alquanto riscaldato dopo la sua preparazione. Ciò fatto, esso deve essere versato in un recipiente ben pulito ed accuratamente chiuso da turaccioli di cotone sterilizzato, recipiente che deve essere costantemente mantenuto nel ghiaccio fino a quando il suo contenuto non viene usato. Non riscaldate mai la bottiglia allatto di andare a letto, ne’ tenetela mai con voi fino al momento opportuno, affine di ris parmiarvi l’incomodo di andarla a togliere dal ghiaccio e riscaldarla. Ricordatevi che questa trascuratezza e negligenza, spesso e volentieri, sono cause prime delle malattie dei figli vostri. F u n zion e dei visceri.—Un bambino allattato artificialmente, cioè col biberon, dovrebbe, in condizioni normali, evacuare almeno una volta al giorno ma non più di due. Se, a buon conto, il latte è buono ed è stato mantenuto in fresco e se tutti gli altri ingredienti per l’allattamento sono stati anch’essi mantenuti nel modo dovuto, gli escrementi del bambino dovrebbero essere di color gialliccio e non troppo duri, in guisa tale da renderne difficile l’uscitta. .Se gli escrementi diventano di color verdiccio ma l’evacuazione non avviene più di due o tre volte al giorno, sarà bene somministrare al bambino un cucchiaino d’olio di ricino. Se, con totto l’olio, il colore degli escrementi non tende a migliorare, consultate subito il vostro medico. Se lo farete immediatamente il medico sarà in grado di poter scongiurare a tempo quella serie complicazioni e malattie viscerali che minacciano di solito i bambini. Se gli escrementi rimarranno di color verdiccio e le evacuazioni aumenteranno sì da raggiungere il numero di cinque o sei nel periodo di ventiquattro ore, il vostro bambino soffre di visceri o è affetto da diarrea estiva. In questo caso non date più latte al bambino, ma soltanto acqua ben bollita fino a quando non arriverà il medico. Non sarà mai troppo tardi. Non incominciate di nuovo l’allattamento fino a quando il medico non ve lo avrà permesso. State pur sicuri che il vostro bambino non morirà d’inedia se avrete sospeso l’allattamento e ricordate invece che ogni goccia di latte che date al bambino, in queste contingenze, non fa altro che peggiorare il suo stato. In queste condizioni, con tinuando l’allattamento voi causerete serii e gravi danni al bambino. Vomito.—Un bambino allattato artificialmente, cioè col biberon, non vomita se il latte è puro e nella quantità adattata al suo fisico. Il vomito, di solito, è il primo indizio di una malattia, sia essa una della più pericolose oppure^ se nell’ estate, una diarrea estiva. Il vomito che avviene in queste condizioni può essere il primo indizio d’indisposizione e può far sì che i visceri non riprendano la loro funzione normale se non dopo parecchi giorni. Se il vomito si ripete, sospendete l’allattamento e date al bambino acqua soltanto, ma che sia stata prima bollita, tanto fresca quanto della temperatura solita del latte e consultate immediàmente il vostro medico. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAYING CAMPAIGNS. 61 Vestiti.—Non vestite di troppi panni il vostro bambino durante l’estate. Nei giorni di temperature torrida, liberatelo di gran parte dei panni che l’avvolgono ; una leggera camiciola aperta ed un panno lino sono più che sufficienti durante giornate e nottate afose. Non usate mai vestitini stretti alla vita. Sottanine e camiciole devono essere a spalla. Bagni.—Fate fare al bambino un bagno al giorno. Nelle giornate calde passategli sollecitamente su tutto il corpo una spugna bagnata. Il bambino ne risentirà subito il benefico effetto e dormirà meglio. Ogni volta che il pannolino è bagnato d’urina bisogna cambiarlo, dopo aver lavate bene ed accuratamente asciugate con cipria le parti basse del bambino. Lavate sempre in acqua bollente tutti i pannolini sporchi e non usate mai pannolini che sono stati bagnati d’urina e che sono asciutti senza essere stati lavati. L e m osche.—Abbiate cura di tener le mosche lontano dalle bot tiglie del latte e da qualunque altro cibo destinato ai bambini. Scacci atele quando le vedete posare sul volto dei vostri piccoli# ricordatevi che le mosche, ogni anno, sono causa di molte malattie a migliaia di bambini. A ria fresca.—L ’aria fresca è un così importante fattore nelle buone condizioni di salute del bambino quanto lo è ih latte fresco. Durante l’estate, cercate per quanto più vi è possibile di tenerli all’ aperto. Teneteli sempre lontano dalla cucina. Il troppo calore, in luoghi chiusi può essere spesso causa di malesseri. Eruzioni cutanee. (Sfogo della pelle.) Se vedete dello sfogo sulla faccia e sul corpo del bambino, chiamate il medico. Non tutte le eruzioni- cutanee sono causate dal calore. Lo sfogo potrebbe benissimo essere indizio di malattie gravi, quali la febbre scarlattina, il morbillo, il vaiuolo, la varicella. Se desiderate con tanta ansia avere un bambino, perchè non alle varlo e mantenerlo come si deve? La metà dei casi di mortalità di neonati nella^ Pennsylvania potrebbero essere evitati se si seguissero i consigli ed i suggerimenti contenuti in questa circolare. Issued May 15, 1909. Translated May 20, 1912. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis [C ircular issued by Pennsylvania Department o f Health.] Fobm 20 A—German. (g a tte t bie Säuglinge! Siegeln, bielde bei ber fliege tmb S3e|anblung too» flehten ¿Httbero hmfjrenb beö 9omntet§ befolgt toerben füllten. Ta8 heiße SBctter biefer ^aßreSgeit ift äußerft gefährlich für baS Sebett bon (Säuglingen unb flehten Stübern, meßt nur toegen ber nteberbrüdenben SBirfung ^oi»er atmofphärifcher Temperatur tut allgemeinen, fonbem meßr htSbefonbere toegen ber SBirfung ber peilen SBitterung auf alte leidet öerberbenben Nahrungsmittel, unter benen ®uljmilch ben erften ¿ßlaß entnimmt. @S ift beSßalb überaus toidßtig, baß ^ußmilch, toelcße gur Nahrung bon flehten tinbem gebraucht toirb, fo rein unb frifch ift, toie man fie nur laufen famt. SBäßrenb beS heißen SBetterS ift ©iS abfolut notßtoenbig gur ©rßaltung bou SNildj, mtb alte SNildj, toelcße gur Nahrung bertoenbet toirb, fotCte bureß ©iS ab* gefühlt toerben, fobalb fie bon ber ®uß fommt, unb in ber Nähe bon ©iS gehalten toerben, bis fie gebraucht toirb. ©in toenig (55elb baS für ©iS beranSgabt toirb, mag ¿ranfßeit berhüten unb ihre biet größeren Soften für SNebigin, pflege unb ärgtliche ¿Beßanblmtg. T a SBaffer oft ein ®ranfßeitSträger ift, fo berfährt man am fießerften, nur gefoeßteb SBaffer gnm Trinfen ober gur Zubereitung bon Naß* rung für ben Säugling gn gebrauchen. T ie fotgenben Negetn toerben bagn halfen, bie Säuglinge toährenb beS heißen SBetterS gn erhalten: S t i l l e n an ber 93ruft. — $ebeSNutterfotttefichbeftreben,ihr®htbgnfängen. SNuttermilcß ift bie natürliche Nahrung für baS neugeborene ®inb. ®eine anbere Nahrung läßt fich bamit bergleicßen. ©in ®inb, baS an ber SNutterbmft anfge* gogen toirb, hat eine bebeutenb beffere SluSficßt, gn leben, als ein ®htb, toetcheS an ber glafcße aufgegogen ift. SNan gebe bem ®htbe nnmittetbar nach ber ©ebnrt feine fünfttiche Nahrung, toährenb man auf baS kommen ber ÜNuttermilch toartet. Sege baS ®htb alle oier Stunben an bie ¿Bruft unb gib ihm toeiter nichts als abgefochteS SBaffer. TaS ®inb brauet nichts StnbereS unb toirb feinen junger leiben. SBenn bie SNitcß in ber ¿Bruft fommt, fänge baS ®inb alle gtoei Stunben toährenb beS TageS nnb gtoei bis brei ¿Nal toährenb ber Nacht. Stille baS ®inb nicht jebeSmal toenn eS fchreit, mäßiges Schreien förbert bie ©nttoicflnng ber Snngen. ®inber, bie unregelmäßig gefüllt toerben, ober jebeS ¿Nal toenn fie fchreien, toerben ßöcßft toaßrfcßehtlich Unberbaulicßfeit befommen nnb fchreien bann nur noch heftiger infolge üon Schmergen. Stille baS ®inb regelmäßig, nnb eS toirb fich halb baran getoößnen, bie Nahrung nur in ben rechten Ztoifcßenräumen gn ertoarten. ©ib bem ®htbe mehrere ¿Nafe beS TageS ein toenig abgefochteS SBaffer. ©nttoößne baS ®inb nicht, fo lange eS gunimmt, nnb tßue eS nicht, außer auf ärgtlichen Natß.' ^Befolge in biefer ¿Begießung nicht ben Natß bon greunben ober Nachbarn. ¿Bleibt baS ®inb gefnnb, hört eS aber nach einer getoiffen Zeit auf, an ©etoießt gngnneßmen, fo glaube nicht, baß bie ¿Nilcß toertßloS ift, fonbem gieße 62 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAYING CAMPAIGNS. 63 einen Slrgt gu Statt)e unb Befrage iijn, ob e§ meisltch ift, eine ober gmei gtafchen gur Slu§hülfe t)ingugufügen. Slufjiehen an ber gtafd)e. — SSirb e§ notfjtnenbig, ba§ ®inb gang unb gar ober theitmeife an ber f^Xafc^e anfgugie^en, fo benfe baran, baf) bie größte Sieinlichfeit in alten (Singetfjeiten ber @rnä|rnng notijmenbig ift. ©obalb bie §lafdhe leer ift, fottte fie grünbtidj mit tattern Gaffer gemäßen unb bann mit heifjem SSaffer unb S3oraj (1 ^eetöffet für eine ^ßinte SSaffer) gereinigt merben, etje fie mieber ge* Brauet mirb. SSenn man nur ein paar glafcfjen |at unb biefetBe gtafcpe ba§ näcXifte SJtal gebrauchen rnuf}, fo foche man biefetBe etliche Minuten au§, epe man neue Staprung in biefetBe pineinttiut. SJtan taffe ba§ ®inb nie bie ÜBerrefte au§ einer $tafdhe trinfen, metche e§ ba§ erfte SJtat nicht gleich geteert hat. Stimm bie Stafche bont ®inberbett tjinmeg, gief)e bie SfJlitdh au§ unb nimm fogteid) bie Stei* nigung Oor. Stbgeftanbene SJtilch gerinnt, fept fich im Innern ber gtafdhe feft, mirb nach etlichen ©tunben giftig nnb Oerunreinigt frifdhe SJtilct), metdhe in S3erüi)= rung mit berfetben fommt. (£§ ift Beffer, fo biete gtafchen gu hüben, at§ bie §tn* gabt ber SJtat)tgeiten be§ ®inbe§ Beträgt, fo baf) atte fylafdhen gufammen au§gefo(f)t merben fömten, ehe man bie Nahrung be§ SJtorgen§ gnbereitet. © au g hü tchen (N ipples).— $ e einfacher ba§ ©aughütcfjen, um fo fixerer für ba§ ®inb. S3rauche feine fompligirten ©aughütdhen nnb fanfe unter feinen Urnftän* ben eine gtafche mit einem taugen ®ummifdhtau<h, meldher an bem ©augpütchen be= feftigt ift. S)erfetBe fann nicht rein gehalten merben unb mirb ftcherlicf) ©törung in ben ©ebärmen herbormfen. ©obalb ba§ ®inb mit ber gtafcfje fertig ift, fottte ba§ ©aughütdhen abgenommen, ba§ innere mit bem Ringer nach auf3en gemanbt unb mit fattem SSaffer abgeBürftet merben; für biefen Ztoecf fottte man eine Be* fonbere SJurft hatten. Stach bem (Gebrauch fodhe man bie S3urft au§. $)a§ gereinigte ©aughütdhen fottte in frif<he§ SSorajmaffer (1 Stheetöffet S3ora£ auf eine ^inte SSaffer), in ein gugebecfte§ ®ta§ getegt merben. SSor bem Gebrauch fpüte man ba§ ©aughütdhen in fodhenbent SSaffer au§. Stimm ba§ ©aughütdhen nicht in beinen eigenen SJtunb, um au§gufinben ob bie SJtilch marrn genug ift. Sah etliche tropfen bon ber SJtilch auf bein §anbgelenf fatten; menn e§ gn hetfj für bein §anbgelenf füptt, fo ift e§ auch gn fjeiji für ben SJtunb be§ ®inbe§. $ür bie Zubereitung einer SJtitdhmifdhung für ba§ ®inb taffen fich feine attge* meinen $nftraftionen geben. $ebe§ ®inb Braucht eine (Kombination, metdhe feiner SSerbauung angepa|t ift. SJie SJtifchung, metdhe für ein anbereä fin b guträgtid) ift,. mag für bein fin b gu ftarf ober gu fd)mach fein, grage ben SDoftor, mie bie Stahrnng gu mifchen ift. SSenn e§ nothmenbig ift, bei ber SJtifchung Stahrn gn bermenben, fo fanfe feinen Stahrn — berfelbe ift rnögtidhermeife abgeftanben — fonbern berfchaffe bir benfelben, inbem bu nach Steinigung be§ glafchenranbeä eine hatbe $inte bon ber Oberfläche einer Duartftafdhe SJtild) abgie|eft. SSedhfete nicht beftänbig mit ber Stahrnng für ba§ fin b , mogu SJtütter auf ben Statt) „guter" Stadjbam leicht geneigt finb. ^Befolge bie Slnmeifungen beine§ ®oftor§. SSährenb be§ @ommer§ fottte bie Stahrnng für ba§ ^inb, nach ihrer Zuberei* tung, auf ben ©iebepunft gebracht merben. ©obann fottte fie in reine gtafchen gegoffen, mit reiner SSatte berfchtoffen nnb bi§ gum (gebrauch w ber Stähe be§ @ife§ gehalten merben. SJtache bie gtafcpe nicht heif), ehe bu bidh gur Stut)e tegft, nnb behalte fie nicht im S3ett, bi§ bie Zeit gum ©tüten be§ ßinbeä fommt, meil bu nicht gum @i§fdhranf gehen mittft, menn ba§ ^inb biefetBe braucht. 2)ie3 ift eiu fidherer SSeg, ba§ ^inb franf gu machen. © t u h l g a n g . — (£in @inb, metdhe§ an ber gtafche aufgegogen ift, fottte menigften§ einmal unb nicht mehr at§ gmei* bi§ breimal täglich @tu|tgang hoben. SSenn bie SJtitch beim Slnfang rein ift unb fühl gehalten mirb unb atte Fütterung§uten* filien gereinigt finb, mie foeben angegeben, fottte ber ©tuMgang be§ ^inbe§ eine https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 64 BABY-SAYING CAMPAIGNS. gelbliche garbe haben unb nicht zu i)art fein, fo ba| berfelbe leicht abgeführt toer* ben fann. SBemt ber (Stuhlgang eine grünliche garbe annimntt, aber nicht t)äufi= ger als tfod* bis breintai beS SageS eintritt, fo gib einen bis jn)ei<^ eeiöffel SRicinuSöl. SBenn fidj bie garbe nicht beffert, nachbem baS Öel geioirft ^at, fo gie^e ben S oftor gii Sftathe. Bu biefer Beit toirb er im Staube fein, bie erften Sarmbefchtoerben zu berijüten, oon benen baS ®inb bebrofit ift. SSenn ber (Stuhl* gang eine grüne garbe behält nnb bis anf fünf ober fedjS ober mehr SJial in 24 Stunben fteigt, fängt baS ®inb an Sarmftörungen ober Som m erdiarrhöe z« be= fomnten. £>öre fogleich mit SJtilch auf, gib anftatt beffen reines gelochtes SBaffer unb ziehe ben Softor $u Sfkttje. ©S mag nicht zu fpät fein. gange nicht toieber an, bem ®inbe SDHtch ju geben, bis ber Softor eS oerorb* net. SaS ®inb toirb feinen junger leiben, toenn man aufhört, bemfetben 9Jäl<h §n geben; jeher Stopfen SCRiitf), m elier nach biefer SBarmtng in feinen SJiunb gei)t, Oermehrt baS (gift, meines bereits ba ift; g ft ber Stuhlgang loS nnb grün in garbe, fo toirb man burch Verabreichung oon mehr SKüchNahrung eine emfte ober üerhängnifjoolle ®ranfheit herüorrufen. ©r b r e d) e n . — ©in tin b , toelcheS an ber glafdje aufgezogen toirb, füllte fidj nicht brechen, toenn bie Nahrung rein nnb feinen Vebürfniffen in ber rechten SBeife an* gebaut ift. ' SBenn ©rbredjen eintritt, fo ift bieS getoöijnlich ein Beiden einer heraus nahenben gefährlichen tinberfranfheit, ober Oon (Sommerdiarrhoe, toie eS bei hei|em SBetter mehr allgemein ber galt ift. ©rbredjen, toelcheS biefer Itrfache gu (grunbe liegt, mag baS erfte Beiden oon Störung fein nnb Stuhlgang mag nicht bis etliche Sage fpäter eintreten. SBenn fidj baS Vredjen toieberholt, ftetCe bie gütterung mit SCRildh ein, gib abgefod)teS SBaffer, fühl ober in ber Semberatur, toie bie äßitch gegeben ift, nnb ziehe fogleidj einen Slrzt z« Siathe. $ l e i b u n g . — Biehe bem ¡ftinbe im Sommer nicht zu Oiete Kleiber an. ©ntfeme toährenb beS hei^eften SBetterS bie meiften Kleiber; ein bünneS lofeS £emb nnb eine SBinbel genügen toährenb beS XageS nnb in fehr heilen, fchtoülen Mächten. (gebrauche nie Kleiber mit engen Seibdjen. Unterröcfe nnb |>emben füllten burch Präger über bie Schultern gehalten toerben. V a b e n . — S3abe baS ®inb jeben Sag. S3ei heif ent SBetter Oerfchafft ein fdjnelleS Slbtoafchen mit bem Schtoamm fpäter am Sage Sinbermtg unb förbert ben Schlaf. SBafche baS Sinb jebeS SJial toenn bie SBinbeln getoedjfelt toerben, unb trodne bie Sheile oor bem (gebrauch üon Sßulüer grünblich ab. SBafche alle befdjmuhten SBinbeln unb foche fie ans. (gebrauche nie eine getrodnete naffe SBinbel, ohne fie erft z« toafdjen. g liegen.— Sei üorfidjtig, ba| feine gliegen in bie glafd^e nnb Nahrung beS ®inbeS gelangen, auch laffe man biefelben nicht auf ben Sichen beS ®inbeS fi|en, toenn eS fdjläft. gliegen finb bie Ueberträger zahdofer ®ranfheiten. g r i f d) e S n f t. — g r if fe Suft ift ebenfo tüidjtig für bie (gefunbljeit beS ®inbeS, toie frifche Nahrung. §alte baS ®inb toährenb beS Sommers fo Oiel als möglich in ber frifchen Suft. £alte baS ®inb anS ber ®üd;e — eS möchte OieHeicht einen Sonnenftich infolge z« Oiel £>i|e im £aufe befommen. ^ a u t a u S f d) Ia g . — SBenn baS ®inb einen SluSfdjiag ober SluSbruch ber ^aut be= fommt, fo ziehe einen Slrzt zu Sftathe. (glaube ni^t, ba| jeher ¿autauSfhlag ¿i|blafen (p r ic k ly heat) finb; eS mag eine gefährliche^ranfheit fein, toie Schar* lachfteber, Wafern, Vlattern ober §ühnerf)oden. SBenn eS fi<h lohnt, ein tin b z« hoi)en' f° io^nt e§ M and) baffetbe zu erljat* ten. S ie £ätfte ber tinber, bie jeben Sommer in $ennft)iüanien fterben, fönnten burch Vefolgung ber Stathf^läge, toeldie in biefem Bi^iular ertheilt toerben, ge* rettet toerben. ©rlaffen am 15. SJiai 1909. Ueberfeüt am 1. iguni 1912, https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis [Circular issued by Pennsylvania Departm ent o f Health.] F orm 20 C.— Polish. STRZEZ SW E DZIECI. R E G U L A M IN L E T N IC H M A J ^ -C Y B Y C P R Z E S T R Z E G A N Y P O D C Z A S M I E S I E f iY C E L E M U C H R O N IE N IA D Z IE C I P R Z E D C H O R O B A M I. Gorqce powietrze w tej porze roku jest najbardziej niebezpiecznem dla zycia niemowl^t i malych dzieci, nie tylko z przyczyny oci^zalej i wysokiej atmosferycznej temperatury w ogolnosci, lecz wi§cej z wplywu jakie gor^ce powietrze wyAviera na wszystkie pokarmy, ktore tatwo poddaj% si§ zepsuciu a mi^dzy ktoremi krowie mleko zajmuje pierwsze miejsce. Dlatego tez jest bardzo wazne, azeby krowie mleko, ktore ma bye uzyte za pokarm dla niemowl^t, bylo najezystsze i najswiezsze na jakie nas tylko stac. Podczas upalu lod jest konieeznie potrzebny do zakonserwowania mleka, a mleko przeznaczone na pokarm ma bye lodem wystudzone zaraz po odebraniu od krowy i utrzymane zimiio az do przyrz^dzenia. Mala suma pieni^dzy wydana na lod moze zapobiec, wi§kszemu wydatkowi na lekarstwa, opiek§ i lekarza (lekarska opieka). Z powodu iz woda jest cz§sto roznosicielk^, chorob, jest bezpieczniej uzywac tylko goto wanej wody do picia lub tez przyrz^dzonego pokarmu do picia dla dziecka. Nast§pujace reguly pomog% do utrzymania zdrowia dzieci podczas upalow. Karmienie piersia.— Kazda matka powinna si§ starac aby karmic dziecko piersi^,. Pokarm z piersi jest naturalnym dla nowonarodzonego dziecka. Niema innego pokarmu ktoryby mogl bye porownywany. Dziecko karmione piersia ma wi^ksze szanse do zycia. Natychmiast po urodzeniu nie dac dziecku zadnego sztucznego pokarmu, nim nadejdzie pokarm piersi. Przykladac dziecko do piersi co cztery godziny, a poic niczem innym tylko wod$ przegotowan^. Dziecku nie potrzeba nic wi§cej i ono z glodu nie umrze. Gdy nadejdzie pokarm do piersi karmic dziecko co dwie godziny podczas dnia, a dwa lub trzy razy w nocy. Nie karmic dziecka kiedy tylko zaplacze, umiarkowany placz pomaga do rozszerzania pluc. Dzieci karmione nieregulamie i kiedy tylko zaplacz^, podpadajq, niestrawnosci, a wtedy piaezij, z bolu. Karmic regulamie, a dziecko nauezy si§ spodziewac pokarmu tylko w oznaezonym czasie. ... Dac dziecku pic troch§ gotowanej wody kilka razy na dzien. 94219°—13---- 5 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 65 66 B A B Y -S A V IN 'G C A M P A IG N S . Gdy dziecko dojdzie do dwoch miesi©cy, przedluzyc czas karmienia od 2 | do 3-ch godzin dziennie a tylko raz lub dwa razy na noc. M e odlgezac dziecka od piersi gdy dziecko zyskuje a w kazdym razie uczynic to za porada lekarza. M e sluchaj porady s^siadow lub przyjaciol w odlaczeniu od piersi dziecka. Jezeli dziecko pozotaje zdrowe, ale po pewnym czasie nie zy skuje na wadze me sadz iz pokarm twoj nie jest pozytecznym ale poradiz si© lekarza, co do dodania jednej lub dwuch flaszeczek mleka celem wzmocnienia. Karmienie flaszka.—Jezeli koniecznie potrzeba dziecko karmic calkowicie lub cz©sciowo flaska, pami©tac nalezy aby zachowac, jak najwi©ksza czystosc we wszystkich szczegolach. Gdy tylko flaszka jest proznq, trzeba ja starannie wyplukac zimna woda, a potem wymyc gor^cq, z buraksem (lyzeczk© boraksu do pol kwarty wody) i odlozyc na bok do dalszego czyszczenia zanim b©dzie znowu uzytaJezeli ma si© tylko par© flaszek i potrzeba uzyc te same flaszki do nast©pnego karmienia, trzeba ja przez kilka minut wygotowac zanim si© do niej swiezy pokarm naleje. M gdy nie j)owawac dziecku ostatkow pokarmu w flaszce jezeli go przedtem nie spozylo. Wziasc natychmiast flaszk© z kolyski, wylac mleko i wyczyscic odrazu flaszk©. Zwietrzale mleko zsiada si© i lepi na wn©trzu flaszki a po uplywie kilku godzin staje si© trujacem i moze zanieczyscic swieze mleko. Najlepiej miec tyle flaszek ile si© razy dziecko karmi dziennie, a wtedy mozna wszystkie razem wygotowac zanim si© przygotuje pokarm z rana. Smoczki gumowe.— Czem prostszy smoczek tem bezpieczniejszy dla dziecka. Nie uzywac zkomplikowanych smoczkow a pod zadnym warunkiem nie kupowac flaszki z dluga gumowa rurka przyezepiona do smoczka. Takowa nie moze bye wyczyszczona i napewno sprowadzi zaburzenie zolgdka. Gdy flaszka wyprozniona smoczek ma bye natychmiast zdj©ty odwrocony na palcu i wyczyszczony w zimnej wodzie szczotkq,, tylko do tego przeznaczonaPo wyczyszeceniu potrzeba szczotk© zawsze gotowac. Oczyszczony smoczek umiescic w swiezej boraksowej wodzie (lyzeczk boraksu do pol kwarty wody) w zakrytej szklance. Wyplukac smoczek w goracej wodzie przed uzyeiem. M e wkladaj nigdy smoczka do swych ust aby si© przekonac czy mleko jest dose cieple. Spusc kilka kropel mleka na r©k©, jezeli mleko parzy wtedy jest za gorace dla dziecka. Nie mozna podac szczegolowych przepisow dla przyrz^dzenia pokarmu dla dzieci. Kazde dziecko potrzebuje odmiany stosownej do jego strawnosci. Mieszanina na ktorej jedno dziecko chowa si© dobrze, moze bye za mocne lub tez za slab© dla drugiego. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis B A B Y -S A Y IN G C A M P A IG N S . 67 Niech lekarz osgflzi jak przyrz^dzic pokarm. Gdy smietana jest potrzebna w przyrz^dzaniu, nie nalezy tejze kupowac, gdyz moze by $tar% najlepiej zlac pot kwaterki z kwartowej butelki mleka po oczyszczeniu nakrywki z flaszki. Nie zmieniac ci^gle pokarmu dla dziecka jawo matki zwykle ezynig,, przez porad§ dobrych s^siadow. Trzymac si§ przepisow lekarza. Podczas lata pokarm dziecka powinien bye przegotowany po przyrzadzeniu. Wlany w czyste flaszki, zakorkowany czyst% pazonq, bawelna i trzymany przy lodzie az do uzyeia. Nie grzac flaszki gdy si§ odchodzi spac i nie trzymac w tozku aby nie wystygla, gdy si§ nie chce isc do lodowni i zagrzewac, gdy dziecko pokarmu potrzebuje, bo w ten sposob najpewniej mozna przyprowadzic choroby dziecku. Rozwolnienie zoladka.— Dziecko karmione flasks powinno miec stolec przynajmniej raz na dzien a nie wi§cej jak dwa albo trzy. Jezeli mleko jest czyste i utrzymane czysto- i zimno a wszystkie naezynja czys'zczone w sposob przedtem podany. Dziecka stolec powinien bye austryackiego koloru i nie za twardy. Jezeli stolec zmienia si§ na (ajryski) kolor lecz nie powtarza si§ wi§cej jak dwa lub trzy razy dziennie, dac jedn$ lub dwie lyzeczki rycynowego oleju. Gdy kolor si$ nie zmieni po uzyciu oleju poradz si§ lekarza, W tym czasie on b§dzie zdolny zapobiec powaznej cborobie kiszek zagrazaj^cej dziecku. Jezeli stolec pozostaje zielonego koloru i cz§sciej si§ powtarza, pi§c lub szesc razy dziennie (na 24 godzin), twoje dziecko dostaje choroby letniej. Zatrzymac mleko natychmiast a dac. gotowan% wod§ i zawolac doktora, a moze nie b^dzie za pozno. Nie dac pokarmu mlecznego az doktor pozwoli. Dziecko si§ nie zaglodzi przez wstrzymanie mleka, a kazda kropla mleka podana do ust dziecka po tym ostrzezeniu tylko dodawataby trucizn§, juz tarn si§ znajdujacej. Bytaby to przyezyna powaznej lub fatalnej choroby przez danie mleka. Przyczynilabys si§ do powaznej a moze i fatalnej choroby dajac dziecku mleko, za pokarm, moze nastapic rozwolnienie zoladka, a stolec bylby zielony. Wymioty.— Dziecko karmione butelk^ nie powinno wymiotowac. jezeli pokarm jest czysty i nalezycie przyrz^dzony do potrzeb dziecka. Jezeli wymioty si§ zdarzg., to jest cZysty objaw zblizajacej si§ choroby, moze bye, albo jedna z powaznych chorob dziecinnych, lub tez wi§cej rozpowszechnionej w czasach gor^ezki letniej (diarrhea). Wymioty z tej przyezyny mog§. bye pierwszsj, oznak^, zaburzenia, rozwolnienie moze nastapic w kilka dni pozniej. Jezeli wymioty si§ powtorz^, przestac karmic mlekiem, dac gotowan^, wod§ studzon^, lub tej samej temperatury co podawane mleko i poradzic si§ natychmiast doktora. Ubranie.— Nie wkiadac za wiele ubrania na dziecko podczas letnich miesi§cy. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 68 B A B Y -S A Y IN G C A M P A IG N S . Podczas najwi§kszej gor^czki, zdjxjc jak najwi§cej sukieniek. a takze tylko cienka i luzna koszulka i pieluszka zupelnie wystarczy podczas dnia, a takze w bardzo gorjee i duszne noce. Nigdy nie uzywac ciasnego ubrania, spodniezki i snkienki powinne si§ zwieszac z ramion. Kapiel.—K^pac dziecko codziennie. Podczas wielkich upalów szybkie wycieranie calego ciala przy koñcu dnia orzezwi dziecko i pomoze mu spokojnie spac. Umyc dziecko po zmianie kazdej pieluchy, wytrzec starannie przed uzyeiem proszku. Prac zwalane pieluchy i wygotowac je. . Nigdy nie zakladac suszonej pieluchy, wpierw potrzeba j% wyprac. Muchy.— Zachowac najwi§ksz% ostroznosc aby muchy nie siadaly na flaszee i pokarmie dziecka i nie pozwolic im usi^sc na ustach dziecka podczas snu. Muchy niosg, zaraz§ tysi^com niemowl^t co lato. áwieze powietrze.— Swieze powietrze jest tak potrzebne ku zdrowiu dziecka jak zdrowy pokarm. Podczas lata umiescic dziecko o ile moznosci na dworze. Nie trzymac dziecka w kuchni, ono moze takze dostac udaru slonecznego z bytniego gorjea w domu. Wyrzuty skóme.—Jezeli dziecko ma wysepk§ lub p^kniecie skóry, porad si§ lekarza. Nie mysl, iz kazdy wyrzut jest wysepkg, lub krost^ z gorjea, moze to bye powazna choroba, jako szkarlatyna, odra lub ospa. Jezeli warto miec dziecko, warto je tez odpowiednio wychowac. Polowa dzieci, które umieraj^ w Pennsylwanii kazdego lata, moznaby ocalic przez zachowanie powyzszyeh rad podanych w tym cyrkularzu. Wydane 15-go Maja 1909. 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b j ik j ib bbkbd d k i o ik j ik b 118 D B iK p ’ B y s , D i 3y a *too**i! y 33y a * a i y i » * ' ? ? j*»p i y o * n o y 3 b *3 i n *8 b ^ k i * r o «3 J ” P ‘ . ] y ^ o p 8 * i i y o *8 o s y i D D B * a i y o ^ 8 n y 3i y Q 3iK j**t j y i K i D B i ’ i p o * v 33*0*113860 y S y s o * o n *8 B *3 / l y a y n j y o * * n 1*8 I » ii? 0 8 a 118 i y o * * i B i y *0 **3 i y i o y a y n 3 u k b jy iy * *a**a n a y is a 1 ly s iy o ly o 8 8 i y s * 8 i o y i B 3 * i i a y 3 i n *8 i y i i ^ n s a o y i y * * *n a o * 8 i i .n y o y a B 0 8 S T i 8 o i y & * « i y a p y ^ B y ? y ^ > 8 b o *k i i .i y n 8B o y ia o n io y a m * 8 i * » y a T ? . 0*18 o n *8 b o* 8 i i i n *8 i K B y o i y & * 8 T i y B 3 y p * i a y 30 *i 8 8 j y o * n o y 3 b *3 m *8 P * i 3y m y n . i ” b o * o *»i b i i t y o '* o * * a i y i i k b 3 *b o *h *h k i *k y o * n s »o b i i yo* ob iyp by . i y o * a * p j *8 *o**a * i a a ^ y n - T ^ y a ^ y*B i * m o y i n y o ’ iK *o**a * i o S « n i ^ i i o y n [y i ,01811 y 3*1 **03*8 S y *B I S JIB " l ’ B 0 *3y 38 i „ 8 j y 3*1 p iv b k V D 83 * i B 8 B 3y p * i a V jo in ly o y s o * P *11 3 3 *3 Y kb *11 z iy s iy p 0**0 021*7 5 n o K iy o ,a*m i y i *1*18 3 ^ o*d*ik jm B8n * o * u *1 0*18 .a * in i y i j ib y ^ o * i 8 y o D 3i y m i**t jy p o y j y B * n iib i *k 3 ^ o*d*ik i y i y * 18 b *3 o p s y i .i ^ o p ^ i K o o np3s-*P y 4 D p ^ s jyp*o*a i y i 8 o p ^ s ^ 8 » d / j y ^ n a , i y a * s o y ^ is p o *1» 1*1 B * * n p 38 i p b -iy i i 8 , i **b o * 118 ‘ l y o s a 3y * t?B ly e y w iy s y iy a s .iy a y i y a iw n 78i jy a iy a * i8 .b b is iy iy n y D **a**a i y i 8*70* D y y a 'i y i a y o y iy jib jy 3y *^ B j y i * * a i s D * i 8 3 *b o * H 8 B 0**1 .iy 3y * p s l o y m y n jyB**? o-*a **a i y i e\*i8 l y n y a o * ly ^ K t **i a *3 » n b o w . i y a n j y i y * i y i 3*p l y i s y r i a i s iy a * * n p 3« i p 1*8 d k i n a iy n o y i *8 ,*a**a 8 y o K n i s n a i y n o y a * i8 3 B 3y p y 3 l y a ^ K i i 8 *3**n*7*D3y 6 j*k i y a i 8 o o * y o P y n i y i 3*P J i . i ^ i p i * s i y t y * n 1*8 j y a y 3 y 3 a i y i i i y o * 7'y i i n o » i o y i i y 3*7^ B , j 8 D p n .s ^ n ‘p y i a y o •)y38*o>*D8P co'*m3nyi https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis .1912 ,110*11 iyoi jjn tCircuiar issued by Pennsylvania Departm ent o f Health.] F orm 20 D.— Slovak. ZACH RÀN TE D ETI. P R A V ID L À , K T O R ^ M I T R E B A SA R IA D IT P R I O P A T R O V A S Ì A K O JE N Ì N EM LU VN AT V LETE. Horuqe pocasie tohoto obdobia je vermi nebezpecné zivotu nemluvnat a malych dietok, a to nielen nàsledkom stiesnujucich ucinkov vysokej vzdusnej temperatury vo vseobecnosti, ale zvlast pre ucinok, aky ma horuce pocasie na vsetky zàhube^ podliehajuce clànky po trà vné medzi którymi na prvom mieste stoji kravské mlieko. Je preto najvys dòlezité, aby kravské mlieko, ktore ma sluzitf za potràvu nemluvnatàm, bolo to najcistejsie a najcerstvejsie, ake vòbec mozno kùpit’. Pocas horuceho pocasia l ’ad je nezbqtue potrebny k zachovaniu mlieka a vsetko mlieko, ktore ma sluzit’ za pokrm, ma bvt’ najprv l’adom vychladené, akonàhle vynde z kravy a pri l’ade ma byt drzané do tych cias, kym ho nedàme k pouzitiu. Tych malo penazi, co stoji l’ad, móze zabrànit’ nemoci, a o mnoho viac stoja liekv, osetrovanie a opatera lekarska. A pretoze voda je casto nosicom nemoci, je najbezpecnejsie uzivat’ vodu len v stave pre vare nom tak na pitie, ako i pri pripravovani detského pokrmu. Nasledovné pravidlà pomòzu Vàm udrzat’ Yase dietky v zdravi pocas horuceho pocasia: . . .. Kojenie.—Kazdà matka ma kojit’ svoje nemluvna mliekom svojim. Prsné mlieko je prirodzenou potràvou novonarodeného decka. Ziaden iny pokrm nevyrovnà sa tejto. Prsy zivené diet’a mà o mnoho vàcsiu moznost’, ze ostane na zive, ako diet’a chované flaskou. Po narodeni, kym cakàte na prlchod prsného mlieka, nedàva] te dietku ziadnej umelej potràvy. Vezmite si dietko k prsiam kazdé styri hodiny a nedàva] te mu nic ineho ako vodu, ktora boia prv prevarenà. Nemluvna nepotrebuje nic iného a nezahynie hladom. Ked pri de mlieko do prs, dajte nemluvnatu cicat’ bazdé dve hodiny cez den a v noci dva lebo tri razy. Nekojte dieta zavse, ked’ krici.—Mierne mnoztvo knku napomaha vyvoj pl’uc. Nemluvnatà, kojené nepravidelne, alebo zavse, akonàhle sa daju do kriku, obycajne trpia na nezàzivnost a potom nàsledkom boPov kricia este vacsmi. Kojte pravidelne vzdy v riadnych prestàvkach. Dà vaj te dietku trocha prevarenej vody niekol’ko razy cez den. Ked nemluvna je dvamesacné predlzte cas medzi kojenim na 2 i poi lebo tri hodiny cez den a v noci dajte mu prse len raz lebo dva razy. Neodstavujte diet’a, kym toto priberà na sebe a necinte tak nikdy prv, kym sa neporadite so svojim lekàrom. Nenasledujte radu priatel’ov alebo susedov straniva odstavenia, Ak dieta zostàva zdravé, ale po istom case prestane priberat’ na vàhe, nehl’adajte https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 71 72 B A B Y -S A V IN G C A M P A IG N S . prícinu toho, akoby mlieko Vase nebolo viac dobré ale porad’te sa s lekárom, ci nemáte si pribrat’ jednu lebo dve flasky na vypomoc. Zivenie flaskou.— Ak sa stane potrebnym, krmit’ nemluvña úplne lebo ciastocne flaskou, památajte, ze pri takómto zivení je potrebná cistota vo vsetkych podrobnostiach. Akonáhle sa flaska vyprázdni, vypláchnite ju studenou vodou, za tym vymyte ju horúcou vodou a boraxom (1 cajová lyzka do 1 pajntky vody) a odlozte ju k d’alsiemu vymytiu. Ak máte len màio flasiek a stane sa potrebnym pouzit’ tú istú flasku k nasledujúcemu kojeniu, dajte ju na niekol’ko minút do vriacej vody a len potom naplñte ju cerstvou. Nikdy nedajte diet’at’u pozívat’ pozostatky z flasky, ktorú ono nevyprázdnilo naraz. Yezmite flasku z kolísky, vylejte z nej pozostalé mlieko a vycistite ju bezodkladne. Tvarózky zo starého mlieka, nalepené na vnútornych stenách flasky stami sa po niekol’ko hodinách jedovatymi a mòzu zanecistit’ cerstvé mlieko, akonáhle s tymto prídu do styku. Je lepsie mat’ tol’ko flasiek, kol’ko razy dávame diet’at’u denne potravu. Takze vsetké flasky mózu byt’ kazdé ráno pred pripravením potravy spolu vyvarené. Cmúlky.— Cím jednoduchsí je cmúlok, tym bezpecnejsí je pre nemluvña. Neuzívajte komplikovanych cmúlkov a za ziadnych okolností nekupujte flasku s dlhou ku cmúlku pripojenou gummovou rúrkou. Taká flaska nemoze byt udrzovaná v cistote a iste zapríciní brusné nesnádze. Akonáhle je flaska vyprázdnená, cmúlok má byt’ ihned’ odstráneny, obrát’te ho rubom na palei, osuchaj te kefkou namocenou v studenej vode. Kefka táto má byt drzaná jedine k tomuto úcelu. Po pouzití vyvarte kefku v horúcej vode. Yycisteny cmúlok má byt drzany v cerstvej boraxovej vode (1 cajová lyzka boraxu do 1 pajntky vody) v zakrytom pohári. Vypláchnite cmúlok vo vriacej vode pred kazdym pouzitím. Neberte cmúlok do svojich úst za úcelom, aby ste sa presvedeili, ci je mlieko dost’ teplé. Nechajte padnút’ niekol’ko kvapók mlieka na svoje zápástie, ako pocítite, ze je vel’mi horúce na zápástí, je vel’mi horúce pre ústocká decka. Pre prípravu mliecnej miesaniny pre diet’a neplatia ziadne vseobecné pravidlá. Kazdé diet’a potrebuje slozku primeranú jeho zázivnosti. Slozka, ktorá je dobrá pre druhé dieta, móze byt prisilnou lebo prislabou pre Yase decko. Porad’te sa preto lekára, ako máte pripravit’ pokrm. Ak je potrebná smotánka, nekupujte túto—bude pravdepodobne starà—ale získajte si ju tak, ze slejete asi polpajntky s vrchu kvartovej flasky mlieka, ale' prv ocistite okraj flasky. Neprehreste sa stálym menením potravy pre decko, ako to zvycajne matky rady robievajú na radu “ dobrych ” susedov. Nasledujte úpravy svojeho lekára. Y lete pokrm pre nemluvña po jého pripravení má byt’ prineseny do stavu oparenia. Potom nech sa vleje do cistych flasiek, tieto zapehajú sa suchou bavlnou a drzia sa pri l’ade az do casu pouzitia. Nesohrievajte flasku, ked idete do postele, a ne-drzte ju v posteli, kym nepríde cas kojenia, pretoze sa Yám nechce íst’ po ñu do skrine s l’adom a sohrievat’ ju, kedy nemluvña ju potrebuje. Toto je isty sposob urobit’ diet’a chorym. Stolica.— Flaskou krmené diet’a má mat’ raz a nie viac ako dva lebo trirazy denne stolicu. Ak mlieko je cisté pri zaciatku, drzané bolo v chláde a vstké nádoby sú ciste, íako Yám o tom hore bolo pove- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis B A B Y -S A V IN 'G C A M P A IG N 'S . 73 dañé, stolica diet’at’a má byt’ zltej barvy, nie vel’mi tvrdá, aby snadno vysla. Ak stolica stane sa zelenkavou, ale nie castej sou, ako dva lebo tri razy denne, dajte decku jednu lebo dve cajové lizky kastorového oleja. Ak barva stolice po tomto sa nezlepsí, poradte sa s lekárom. V tomto case lekár bude este v stave zabránit’ váznejsej brusnej nemoci, ktorá diet’at’u hrozí. Ak barva stolí zostáva i d’alej zelenou a diet’a ide na stolicu castejsie, pát’, sest’ lebo i viac razy v behu 24 hodín, diet’a Vase dostáva brusnú nesnádz, alebo letnú nemoc. Zastavte mlieko doraz a miesto neho dávajte diet’at’u prevarenú cistú vodu a povolajte lekára. Mozno, nebude este neskoro. Nezacnite krmit’ s mlekom prv, kym Yám tak nenariddi lekár. Zastavenim mlieka neublizite diet’at’u: kazdá kvapka mlieka, ktorá sa po tejto vystrahe dostane do.úst nemluvñat’a mení sa na jed a zhorsuje stav diet’at’a. Zapríciníte váznu ba aj osudnú nemoc, ak i d’alej budete dávat’ decku mlieko potom, ked crevá stand sa vol’nymi a stolica barvy zelenej. Dávenie.— Flaskou krmené nemluvña nemalo by dávit’, ak potrava jeho je cistá a primerane pripravená k jeho protrebám. Ak nastane dávenie, je to dl’a vstkého predzvest’ bliziacej sa choroby, lebo jednej z tych váznejsích detskych nemoci, lebo nemoci takzvanej letnej, ktorá v horúcom období je castou. Dávenie z tejto príciny moze byt’ prvym znakom nesnádze a crevá nestanú sa vol’nejsími len po niekol’ko dñov. Ak dávenie sa opakuje, zastavte dávat’ diet’at’u mlieko, dávajte mu prevarenú vodu, studenú alebo takej temperatúry, v akej my bolo dávané mlieko a porad’te sa bezodkladne s lekárom. Odev.— Nedávajte mnoho siat na nemluvña v lete. Pocas najhorúcejsej povetrnosti, odstráñte s neho vácsinu satociek; tenká vol’ná kosielka a plienka postací vo vel’mi horúcich dñoch a vel’mi horúcich nociach. Nikdy neuzívajte siat s úzkymi pásy. Kosielky a suknicky so strapcami na ramenách sa odporúcajú. Kúpanie.— Kúpajte dieta kazdy deñ. Y horúcom pocasí v tielko nemluvñat’a s mokrou spongiou. To ho obscerství a bude lepsie spat’. Umyte diet’a za kazdym, ked’ mu dávate druhú plienku a ususte najprv dobre ciastku tela, ktorú posypete prachom. Yyperte zanecistené plienky. Nikdy neuzívajte ususenú zanecistenú plienku, kym ju prv nevyperiete. Muchy.— Dávajte pozor, aby muchy nesadaly na flasku die’tat’a a jeho potravu, tiez aby nesadaly na rty nemluvñat’a, ked’ toto spí. Muchy prinásajú tisícim a tisícim nemluvñatám nemoc kazdé leto. íerstvé povetrie.— Cerstvé povetrie je práve tak dolezitym pre zdravie nemluvñat’a, ako cerstvá potrava. V lete drzte diet’a nakol’ko mozno vonká. Nezdrzujte sa s deckom v kuchyni — moze dostat’ “ slnecny úpal’ ” od vel’kej horúcosti dnuká. Ko¿né vyrááky.—Ak diet’a má vyrázku alebo pukliny kozné, porad’te sa s lekárom. Nemyslite si, ze kazdá cervená skvma je nicim inym, ako vypretinou, moze to byt’ príznakom váznej nemoci, jako sarlach, záskrt, kiahne malé alebo ovcie. Ak hodné je mat’ diet’a, je hodno ho zachránit’. Polovica detí, ktoré zomrú v Pennsylvanii kazdé leto, mohla by byt’ zachránená nasledovaním rád v tomto obezníku. Yydany 15. mája, 1909. Opraveny 1. júna, 1912. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis [Issued by Providence (R . I.) Health Departm ent.] G ENERAL DIRECTIONS FOR FEEDING CHILDREN. YOUNG [These directions are not intended to take the place o f the fam ily physician. consult your doctor in regard to the feeding o f your child.] Always From 12 to 15 months.—Accustom the child to drink from cup and take food from a spoon. Five meals should be given in 24 hours. Breakfast.— Cup o f cow’s milk, a saucer o f oatmeal or barley-flour jelly, with milk, or cream o f wheat with milk. The oatmeal jelly is made by putting two-thirds o f a cup o f rolled oats and 1 teaspoonful o f salt into 3 cups o f boiling water. Let it boil 2 minutes, then cook over hot water for 4 hours. Strain. What goes through is oatmeal jelly, and may be kept in a cool place. Make a fresh supply every day. Milk may be warmed to suit taste; it should not be iced. Forenoon lunch.— Cup of cow’s milk. Dinner.— Broth or beef juice, bread a day old crumbed in milk. Afternoon lunch.— Cup of milk. Supper.— Bread crumbed in milk. I f possible, give two to four tablespoons of orange juice or other fruit juice in season before morning lunch. Be sure the fruit is sound and ripe. Do not give fruit juice at same time as milk. Water may be given as desired, but sparingly at meals. From 15 to 18 months-^-Breakfast.— Cup of cow’s milk, saucer o f oatmeal jelly with milk, or flour or Indian meal gruel, with milk, small piece o f bread a day old with butter. Forenoon lunch.— Cup of milk, small piece o f bread and butter. Dinner.— Broth or beef juice with boiled rice or barley, and a small piece o f bread and butter. Afternoon lunch.— Cup of milk. Supper.— Cup of milk, bread a day old and butter, a little apple sauce or pulp of stewed prunes or baked apples with skin and seeds removed. Water may be given as desired, but sparingly at meals. From 18 months to 2 years.— Breakfast.—-Cereal and milk. Cup o f milk. Bread a day old and butter. Lunch.— Cup o f milk with bread and butter or simple crackers, or Indian-meal johnny cakes and milk, or corn bread and milk. Dinner.— Broth with boiled rice or barley, or eggs, soft boiled or poached, baked or mashed potatoes with butter and salt, bread and butter. Afternoon lunch.— Piece o f bread and butter. Supper.—Milk, bread and butter, or milk toast, pulp o f baked apple, apple sauce, stewed prunes or ripe fruit according to season. Water may be given as desired, but sparingly at meals. 74 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis B A B Y -S A V IN G C A M P A IG N S . 75 From 2 to 3 years.—Additions to the diet must be gradually made by selecting articles from the list below, always giving small portions at first, and never trying two new articles at one meal. A ll food must be finely cut or mashed, and well chewed. Select from the following articles: Milk, eggs, soft boiled, poached or scrambled, or mutton or lamb chops, baked or mashed potatoes, young peas or beans, scraped beef, white meat o f chicken, boiled fish, oatmeal, hominy, wheat-germ, cream o f wheat (all these cereals being thoroughly cooked); broths and soups; white and graham bread a day old, toast, zwiebach, plain crackers, milk toast, junket, plain cus tard, corn-starch pudding, bread pudding, blanc mange, ice cream, rice pudding; oranges, baked apples, apple sauce, stewed prunes, and pulp o f peaches and pears if ripe and sound. From 3 to 6 years.— From 3 to 6 years select in addition from the following articles: Beef steak, roast lamb, stew o f mutton or beef, hash of mutton, beef or fish; bacon, mutton or lamb chop, corned beef; baked beans, string beans, spinach, asparagus, summer or winter squash, beets, tapioca pudding, molasses ginger bread, sugar or molasses cookies, grapes (with seeds and skin removed), ripe bananas (not more than 1 in one day), melons. During the 3 to 6 years four meals should be given at regular in tervals, as 7 a. m., 10.30 a. m. (a smaller meal than the other three), 1.30 p. m. and 5. p. m. The following is suitable for a child of 4 years: Breakfast.—H alf an orange, two tablespoonfuls of cereal with milk and sugar or salt, glass o f milk, bread and butter. Forenoon lunch.— Glass of milk or cup o f broth, bread and butter or crackers. Dinner.— Two tablespoonfuls o f stewed meat finely cut, tablespoon ful o f baked potato with butter and salt, a tablespoonful o f green peas well mashed, bread and butter, a cup custard. Supper.—Milk, bread and butter, cooked fruit. Do not give articles on the following list till the child is 4 years or older: Fried meats and vegetables, tomatoes, carrots, turnips, egg plant, or green corn, hot bread or hot rolls, buckwheat or other griddle cakes, fruit cakes, candy, and nuts. Never give children wine, beer, or cider. Do not give celery, cucumbers, lettuce, radishes, cabbage, onions, or pies, tarts, doughnuts, tea, or coffee until the child is 7 years old. Tea and coffee should even then be weak. When children are constipated, do not dose them with medicines but consult a physician. I f children over 2 years o f age are con stipated give them more vegetables, ripe fruit, stewed prunes, oat meal, molasses gingerbread, rye mush and molasses, rye bread and graham bread. Avoid wheat bread and crackers. P r o v id e n c e , May, 1911. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis [H ow to take care o f babies.— F r en c h . C ircular issued by Providence (R . I.) Health Department. ] COMMENT PRENDRE SOIN DES BÉBÉS. POUR CONSERVER UN BÉBÉ EN BONNE SAN TÉ. 1. Donnez à l’enfant de l’air pur et le jour et la nuit. 2 . Ne lui donnez d’autre aliment que le lait de sa nourrice, le biberon ou autre nourriture d’après ordonnance du médecin. 3. S’il pleure, s’il est agité ou nerveux, ne lui offrez que de l’eau. • 4. Donnez-lui suffisamment de sommeil, qu’il dorme au moins deux fois par jour. 5. Ne le surchargez pas trop d’habits. 6 . Baignez-le tous les jours. 7. Laissez-le seul et tranquille. COM MENT PRENDRE S O IN DES BÉBÉS PENDANT LES CH ALEU RS. Pour prévenir la diarrhée, la maladie, la mort, le Bureau de Santé prescrit les règles suivantes : Air.—-Que l’enfant dorme ou non, il a besoin d’air pur et le jour et la nuit. Ne permettez pas au bébé de stationner dans une chambre fermée, ni dans un appartement où se fait cuisine ou lavage. Faites le sortir à une heure matinale, évitez que le soleil lui donne dans les yeux. Gardez-le dehors durant les nuits très chaudes. Veillez à la propreté et au bon air de la maison. En temps chaud ouvrez portes et fenêtres tant la nuit que le jour. Ayez toujours une fenêtre ouverte dans la chambre. Nourriture et eau—Excès de nourriture: Diarrhée.—Autant que faire se peut, chaque mere doit allaiter son enfant ; la meilleure nour riture pour un enfant au-dessous d’un an est le lait de sa mère. Une des principales causes de maladie chez les jeunes enfants pro vient de l ’excès de nourriture, ce qui très souvent occasionne la diarrhée, les maladies de langueur et parfois la mort. La diarrhée ne provient pas de la dentition mais plutôt de l ’excès de nourriture, de nourriture trop fréquente, du manque _d’eau à boire, du manque de sommeil, ou de ce que l ’enfant soit manié trop souvent. Heures pour allaiter.—Le moyen d’éviter la diarrhée et la maladie est de nourrir l’enfant à la mamelle et de le nourrir très régulière ment. Règles pour nourrir Venfant suivant Vâge.—Depuis la naissance et pendant les deux ou trois mois consécutifs, allaiter l’enfant toutes les deux heures. A partir de deux mois et demi jusqu’à cinq, l’allaiter toutes les deux heures et demie. A dater de six mois jusqu’à douze, toutes les trois heures seulement. Ces régies doivent être observées pendant la journée, depuis six heures du matin jusqu’à six heures du 16 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis B A B Y -S A V IN G C A M P A IG N S . 77 soir. L ’enfant ne doit pas être allaité plus de deux fois pendant la nuit. Eveillez l’enfant régulièrement pour le nourrir durant le jour, mais non pas entre dix heures du soir et six heures du matin. Quand l ’enfant est élevé à la mamelle laissez-le se satisfaire, quand il en a pris suffisamment faites-le attendre jusqu’à l ’heure règlemen taire pour l’allaitement suivant. ' S’il pleure ou s’il est nerveux, impa tient, donnez-lui de l’eau froide, bien pure, sans mélange ni addition de sucre ou d‘autre chose. Sevrage.— Ne sevrez jamais un enfant au commencement de l ’été. En le sevrant donnez-lui du lait de vache dilué, une fois le jour d’abord, puis d’avantage jusqu’à sevrage complet. Enfants élevés au biberon.—Le meilleure nourriture pour un enfant élevé au biberon est le lait de vache, frais et non écrémé, préparé d’après prescriptions du médecin. Ce lait ne doit jamais être servi a un enfant très jeune sans être mélangé d’une certaine quantité d’eau. Ne donnez jamais à l’enfant de lait condensé, ni pain, vian.de, pommes de terre, bonbons ou autre chose analogue sans l’avis du docteur. Conservation du lait.—Le lait destiné aux enfants ne doit pas subir le contact de l’air, mettez-le dans un endroit frais, autrement il s’aigrirait et rend l’enfant malade. En été munissez-vous de glace, si faire se peu, et autant que possible maintenez-y le lait, ou à prox imité. A défaut de glace entourez l ’ustensile contenant le lait d’un linge bien imbibé d’eau froide. Les enfants au biberon devront être nourris aussi régulièrement que ceux à la mamelle. Nettoyage des biberons.— Servez-vous d’une brosse pour nettoyer les biberons, rinsez-les d’abord à l ’eau froide, ensuite à l’eau chaude contenant du soda, rinsez-les plusieurs fois, ensuite emplissez les biberons d’eau en y ajoutant encore une pincée de soda, laissez-y l’eau jusqu’au moment de se servir du biberon. Ne laissez jamais le lait y séjourner, ne vous servez pas de biberon à long tube. Tetines.— Ayez au moins deux nipples. Quand l’enfant a été nourri et que le biberon est lavé, retournez le nipple, lavez-le dans de l’eau chaude, maintenez-le ensuite dans un bol d’eau de soda jusqu’à nouvel usage. Veillez à ce que l’enfant ne prenne pas sa nourriture trop vite, des vomissements pourraient se produire. Sommeil— Lit. —Ne faites jamais servir à l’enfant un oreiller-de plumes, ne le couchez pas-non plus sur un lit recouvert de caoutchouc ou de toile cirée; un tel lit échauffe le dos et la tête de l’enfant et le rend susceptible de prendre froid quand il se lève. Le meilleur lit pour un enfant est celui d’excelsior recouvert de mousseline (cheese cloth). Cet excelsior se vend dans tout magasin à quelques cents le sac et le prix de la mousseline est de trois ou quatre cents la verge. Ce genre de lit est toujours propre, frais et confor table, il contribue à fortifier l’enfant et le préserver de la toux et des refroidissements. Vu son prix peu dispendieux, si ce lit se trouve sali ou taché, matelas et excelsior se renouvelle à peu de frais. Ce mode de lit est spécialement recommandé en été pour des enfants malades. Ne bercez pas Venfant.—Habituez de bonne heure l ’enfant à s’endormir sans être bercé. Veillez à ce qu’il sommeille dans la matinée et l’après-midi et cela sans lui faire prendre la mamelle ou le biberon. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 78 B A B Y -S A Y IN G C A M P A IG N S . Pleurs.— Très souvent les enfants pleurent quand on les couche; laissez-les tranquilles sans leur parler, ni les manier, leurs pleurs cesseront pour faire place au sommeil. Laissez l’enfant crier un peu, ses poumons s’en trouvent mieux et ces cris ne nuisent nullement à l’enfant. . . ¡¡¡p S Laissez Venfant seul et tranquille.— Quand l’enfant est eveille ne le tenez pas toujours dans vos bras ou sur les genoux ; le faire passer d’un bras dans un autre et d’une personne à une autre, le rend de mfl.nva.isft humeur, nerveux et malade. L ’enfant aime a jouer seul, par conséquent laissez-le livrer à lui-même, que quelqu’un l’observe et le surveille mais ne le manie pas incessamment. Vêtements.—Ne surchargez pas l’enfant de vêtements pendant les chaleurs surtout, il ne doit porter ni bandes, ni ceinture piquée. E x cepté le cas où l’enfant serait très délicat, son habillement doit con sister en une chemise, un jupon, une robe en coton et une serviette ou couche. Les serviettes soient en “ diaper cloth ” ou coton flanelle et non en laine ou caoutchouc. Les serviettes^ devront être changées aussitôt mouillées et immédiatement lavées à l’eau chaude. Après chaque selle, l’enfant devra être bien lavé; il arrive assez souvent qu’il soit écorché, et cela, soit parce qu’il n’est pas bien lavé, soit parce que la poudre est appliquée avant entière propreté, soit^ encore parce que les couches ne sont pas lavées mais seulement sechees et usagees de nouveau. Bain.—Le bébé doit être baigné à heure fixe tous^ les matins, la température de l’eau sera de deux degrés plus elevee que celle de l’enfant. Faites l ’essai de cette eau sur votre figure afin de vous convaincre qu’elle n’est pas trop chaude. Servez-vous du savon “ Ivory ” ou “ Castile.” . k Régies pour enfants malades.— Si l’enfant est indispose pendant les chaleurs, déshabillez-le à l ’exception de la serviette et revétez-le d’une robe de nuit. S’il est fiévreux et brûlant, appliquez-lui plusieurs compresses d’eau froide, laissant l’eau s’évaporer, ce qui diminuera sa température. Faites lui boire de l’eau froide si possible. S’il vomit, ce qui arrive souvent, ne lui faites prendre ni nourriture, ni remède; donnez-lui une cuillerée à thé d’eau de chaux toutes les heures jusqu’à l’arrivé du médecin. S’il souffre de convulsions, donnez-lui un bain chaud, faites couler de l’eau froide sur sa tête, administrez-lui ensuite une injection de savon et d’eau. , N’arrêtez pas les vomissements en lui faisant prendre aucun the ou cordial; vomissements et diarrhée sont les suites d’une indigestion, il faut qu’il s’en débarrasse. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis [Issued by Bridgeport, Conn., Departm ent o f Health, 1911.] SUMMER CARE OF BABIES. The proper food for babies is mother’s milk. Nurse your baby, if possible—Ten bottle-fed babies die to one that is breast-fed. Nurse the baby regularly at certain hours, and not every time it cries. Once in two^or three hours is often enough to nurse it until it is 4 or 5 weeks old; after that not so often. Nurse the baby until it is 8 or 9 months old. Do not wean your baby during the hot weather. Many infants are killed every year by bringing them to the table with the family and giving them food for which the little stomachs are not fitted. While you nurse your baby do not give it a morsel o f solid food or give it either tea, coffee, or beer. Wait until the baby gets teeth before giving food which needs to be chewed. I f breast milk fails, feed your baby cow’s milk from a clean bottle. Bottle-fed babies must be given only good milk, which is kept con stantly covered and on ice. I f the milk can not be kept properly covered, it should be boiled as soon as received. To keep milk sweet for your baby, put the milk which the baby will need during the next 24 hours in a bottle with tight cork or a glass jar having tight cover. The bottle or jar and the cover must be boiled before the milk is poured in. Set a pan o f cold water on the stove. Put in vessel, with top loosely screwed on, containing baby’s milk. When water boils take out the vessel with baby’s milk, open, add a little less than one-half teaspoonful o f baking soda to one quart o f milk. Put back the cover of the vessel. Do not allow any one to touch the milk unless using it for the baby. Don’t overfeed the baby.—-A newborn baby’s stomach will hold from two to three tablespoonsful, and not more than this amount; rather less should be given at a time during the first week or so of a bottle-fed baby’s life. As the baby grows the quantity should be gradually increased, so that at the end o f the first month it may be taking about four tablespoonsful at a meal. Some children will require more, and others will not stand so much, but there is more danger o f giving too much at a time than too little. Weigh the baby each week.—A healthy baby should gain a pound a week at this period o f life. I f your baby does not gain this, con sult your doctor about the food to be given and ‘ be guided by his advice. I f the baby cries, remember that if it has been fed regularly it is not crying from hunger. It may be thirsty. It may have colic. See that its hands and feet are warm. That it is not too hot (sweating). That its diaper is soft, clean, and dry, That no pins are wounding it, 79 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 80 B A B Y -S A Y IN G C A M P A IG N S . To prepare milk for baby’s meal.—T o each cup of milk add two cups o f water and white sugar (sometimes sugar of milk is better), enough to make it as sweet as breast milk. Pour it into bottle. Heat this milk until it is as warm as breast milk. Put rubber nipple on bottle. Don’t feed a baby under 6 months of age with a spoon.— buck ing is the natural way by which a baby takes its food. It needs the sucking action o f the lips and mouth and tongue to mix its foods with the fluids o f the mouth and for the proper development o f the mouth and teeth. Don’t use a tube on the bottle.—Use a nipple. Don’t forget to wash bottle and nipple after using.— Babies often get “ sore mouth,” “ wind colic,” and “ summer complaint ” from a want o f care o f the nursing bottle. Cleanse the bottle immediately after feeding. Cleanse the nipple thoroughly outside and inside. Nipples with tubes are convenient for a lazy mother, but mean death to the baby. To prepare barley water for the baby.—When the baby is 4 or 5 weeks old, barley water should be used in the place o f plain water. Put two tablespoonsful o f pearl barley into four cups of cold water; boil an hour or more until the amount o f water is reduced to two cups; then strain through a clean cloth; add a pinch of salt and sweeten to breast-milk taste. Add this to a cup of scalded cow’s milk, as before described, and begin feeding this strength. Use more cow’s milk gradually and less barley water until at about 6 months o f age the child is getting two-thirds milk and one-third barley water. This will make as good food as the baby can get during teething and wean ing. After this time then one can use pure milk, scalded as before; bread and milk; rice and milk; baked potatoes and milk; oatmeal porridge (well cooked) and milk (the milk always to be scalded, not boiled). No other foods are necessary, except those mentioned above. Bathing.—Keep the baby clean and it will stand the heat better. It should have at least one full bath every day, and oftener during extreme heat. Never bathe the baby within an hour after feeding it. Bathe first; feed afterwards. Clothing and fresh air.—Dress as lightly as possible in hot weather. Keep the baby in the open air out of the hot sun. At night keep the windows open, but have them screened, and keep out the flies. When the weather turns suddenly cool care must be taken to avoid chilling. A thin, soft, flannel binder wound two or three times around the body should be worn. This binder should be only wide enough to cover the belly, and should be wound smooth and free from creases or folds and fitted with a few stitches of soft darning cotton; no pins. Do not let the baby sleep in the same bed with any other per son.— I f there is no crib, the mother should put a couple o f chairs at her bedside, with a soft covering on them, and let the baby sleep there. It will be more comfortable on a summer night than lying against the hot body o f its mother and will not be so apt to disturb others or to be disturbed. The backs o f the chairs will keep the baby from falling, and the mother can readily reach over to care for it when necessary. I f the baby vomits, has a diarrhea, or seems sick, stop all milk and give nothing but warm water in the nursing bottle, and send for the doctor. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis (Issued b y Department of Health, Bridgeport, Conn., 1911.) r\ y m pa .l^ o anytaio aya n« D»a.»»n a»e aaianBa yj»taa»n n ayaya:i jnys t»« o»»pa>baayatr n /p^iy» n« ay an« »a»»a ay»»« tu»n ,d o *>3 taaiaa »»a »11 B>a»»a byaBa 1*3 ay tyn fyo ayay» a n p« »jyaana» yB»nya p« j ’ ayobyjya ia»»a »a oanyjay »»« ay t»a tyay:i is anya n« tyaaiotr *vn p« ayaB »»ns p« ^b° pm .o»»aty ayaB aag n« Dy na »a»»a »a aanr .aa$ b * an ayaaB3 jtabB jyaBii ep»e aya£ ay»e .lyiyayn ya»»n »a p« »a»»a ay»’« an aanyneay .tab« lyatjayo p n am tt«» ais »»t aaayaa tyo bbii ta»oaya aya’ iaya a»bany» jyayn ayaa»p yby’a «ajy^o yati'ap yay»»t a»a b »j i »t bobb bbii ,n»Btp n i a»a tyo p« y»b»OBe aya ,t»»b» ya»bBa typyia P ’P ilhitt ta»3 an»« an»« a$$t »a»»a ay»»« bjph an»« ajyanyii ,n»Bt? an»« a»a an»« aya»»« ay:n»»s a^n »a»»a >a t»a Basil .ay»a ayaB yfi$P ,yyna ♦ tyayn ay»»pis no yatyn .^ya^a yj»»a s pa ab»o-mp a»o »a»»a ay»»« aanyjay ,aSaya ^»o aaiaa jyn Bpyayais ]ya^«ny^ j>ajyats» n« yabyn ,ab»o yau tyaya tyo no a»a»»a ^ya^a aaBpyJ ay no »apyay^is a u tyayn lya^nya a»i ]yp ^»o »a a»i« .t»»« *i»i« p« .ay Bbsnay jyo »n a'jga jyayn »a»»a »a yatyn ,n*7»o »a p»a« aa»a ,»a»»a ay»»« a»a b »t ^»o »a iya^«n is ai« p«‘ ayaB ,iyBBaa lyaay ib a»o tyaBa b P« ^yanat? 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ytt»aa titt m a ’^p ayacaya >a Battala a t ^ ,p t t'anA a a ayatj ,aai^ tyma tran « a » a n a^ttn .ayayn aya tyn .ty3’i>3 »a tyayaioiay i» aanpD B’D tyayatyayB n ania an»tt ayatt ,tyetj sptn ay »aia^ypaya tya^aaya i» tycttsantt jyo tio _,a^«p aa^si^B aayiiayayn ayà aia« “b^o ina aya« un» anyaay:i»ia« ayaaa ayjy^yattba ayan tyami s ty^tjaa «ia«a ti« pn a aya jypyaya ì» ai« anya Bina p n a«a sia^a ayaaa aytyn pysayp yanp ; ^>yn«a yami aia aynypiatyyaaya«11» pytrainp jn$ atjba a^ypmyaaiatj p u .03»a t” p «a 13 ti« ay an« ]i« .aya ]i« ty»iai« aia tya«btp tana aya aa attjii atjt li*« ayay3ayasi« inn ty^iat? a«B « aya ani« u tyaya»i» ayaia n i>tjT ,yfy»ni tyan ì» ni aas3 ayait « p « ayayiipya ty3iay3 an ayn ay .jya«^»» «ina«a tana »a iyaytat^ i» yaya_3« aamya jut an ayn ay p« ,ayaia aya jia ayBayp tyDnn aya na an a ia aya ty^yn ty^iatr n tia tyai’ t-ayasin »a .pn i» aayattiya p ’^« aya« ,3iaii3 ti« ay tyn ani« i» tyaipi» tysyp aan1? ayn ayaia n ti« ,iyb«a tyr«a a»3 ti« *i^ia n atj a^«n ,ps«ap tin i» a3mi> ayatj aaiaps1? ,aayaa m a n an« .a^ap^a aya ¿aia p « ^ya^aant aya t»« ayaen jromen ni aaya38 a a ani« https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis R [Summer Care o f Babies— S la v i s h . Issued by Bridgeport, Conn., Departm ent o f Health.] OPATRÉNÁ DIETACH V LETÉ. Zvlastno jedená dietach je materinské mléko. Ak len mozno, dajte dietatu prsé.—Desat rázy telko dietata zomru. co z flasky piju, ako co prsé dostanú. Dajté dietatu jest’ porádné, y istim case a ne vzdy ked placé. Jedon ráz kazdé^ dve alebo try hodiny je dostatocné, kim je dieta stiry lebo pet’ tizdne staro; zatim ne tak caste. Dajte dietatu prsé kim jé^ osem lebo devat mesacno. Ne odviknujte dieta v horucim povetré. Mnoho diety zomrú kazdy rok skrz teho ze ich nehaju s rodicám ku stolu sednut, a daju im táke jedla, prektoré maly zaludok je nésúcy. Kim dieta pri prsach nedajté mu any len kustyk celistvého jedla, any kávu, teú cy pivo. Cakajte kim dieta má zuby na také jedla ktore potrebno zut’. Ak nématé mleko v prsach, dajte dietatu mleko z cistej flasky. Dieta, ktoro z flasky pijé musy len dobro mleko dostávat, ktoto je vzdy zakryto a na ladé. Ked nemozete mleko patricne zakryt, to ma byt uvareno, ak skoro ho dostaneté. Aby mleko slatké zostalo pre dieta, dajte mleko, ktoré pre dieta potrebno na nasledné 24 hodiny, do tuhé zapchatej flasky, lebo do skleneho krcaha, ktory je tuhé zakrity. Flaska alebo krcah musy byt vyvareny, kim mléko do teho lejeté. Dajté hrnec zimnej vody na pec a dajté do hrncu flasku s mlekom, otvorté a dajte malou lizickou pekacej sody ku jednim kvarte mleká. Zapchajte zasek flasky a nedovolté nikomu sa dotknut mleka, kim ho pre dieta ne béreté. Nedajté dietatu pri moc.—Éaludok novorodeneho dietata zdrzy dva lebo try lyzicám a né viac, ako telo. Rácej by ste maly mené dat’ y najprvsich tizdnach novorodeneho dietata, ktoro z flasy pijé. Ako dieta narastné dávka moze byt postupné zvyssená tak ze na koncù prvseho mesiaca ak styry lyzican moze dostat kázdy ráz. Daktoré diety viac poziadaju, druhé any telko ne zdrzia, ale vzdy nebezpecnejsie viac dat’ na jedon ráz, ako menéj. Vazite dieta kazdy tizden.—Zdravo dieta o jedon funt má rástnut’ kazdy tizden y timto casu zi vota. Ak nerastné telko, opitajté sa Vaseho lekára jako jedaná máté mu dat’ á srobté ako on vám porády. Ked dieta place, památájté, ze ked dieta dostane poriadné jest’, to neplace, z hladu. Mozno, ze je smádno. Mozno ze má krcé v bruché. Pozorujté aby ruky a nohy boly teplé. Aby nebolo pry horuco [ùpoténo]. Aby ho spendliky nepichnulv. Pripravéná mleká pre dieta.—Ku kazdyn hrnceku mléka dajté dvà hrnceky vody a telo bjéleho cukru [dakedy mlekovv cukor je lepsy], aby tako téplo bolo ako mleko prsach, potom daj té" ma flasku cuclik. 83 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 84 BABY-SAYING CAMPAIGNS. Nedajté dietatu pod §est mesiacoch jest’ s lyzicou.—Cicaná^ je prirodny sposob, ako má dieta dostat’ svoj potrav. Pry cicania péry, ústá a jazyk zmésaju jedená so slinim ustách a ucinkuju patricne rozvinuta ustách a zubách. Ne uzivajte rúrku na flaské, len cuclik. Nezabudnité flasku a cuclik za uzivamia umyt.—Diety castné dostanú “ bolenia ustách,” “ vetrové krcy ” a “ letnú nemoc ” skrz teho, ze flaska je nedrzaná v patricnom poriadku. Vycistté flasku bezodkládné po uzivania. Vycistté cuclik uplné z nútra a z vonká. Cucliky s rurkou sú pobodlé pre lenivu matkú, ale aj usmrtnú dieta. Ako má byt pripravéná jacmenova voda pre dieta.—Ak je dieta stiry lebo pet tizdné staro, davajté mu jacmenovu vodu mesto obicajnej vody. Dajté dvá lyzicé perloveho jacmená ku stiry hmcykam vody, nehajté jednu lebo viac hodiny varit’,kim nezostané viac ako dvá hrncike vody. Potom precedaj té cez cistu handricku, vlozté kvapku soly a srobté ho tak sladko, ako mléko prsach. Ku timto prilejté jedon hrncek mleko kravej, tak obáréno ak vysse spisano, a tak zacinajte dávat dietatu. Postúpné berte viac kraveho mléka a menej jacmenov-ej vody, takom sposobom, ze ked je dieta sest mesiacno dostané dva tretiny mléka a jednu tretinu jacmenovej vody. T o je najlepsy potràv, co dieta len dostat moze v case kedy mu zuby idu a pri odviknutia. Za timto casom uz mozete dávát cisto mléko, obaréno ako vysse spisano ; chléb s inlékom ; ryzu pecené bandurky s mlékom ; dobre uvarenu múku ovosá s mlékom ; mléko vzdy má byt obaréno a nie uvareno. Insé jedená ako te vysse spomuté su nepotrebné. Kúpania.—Drzte dieta v cistoté a lahksé vydrzy horúcost. Aspon jedon ráz kázdv den treba dieta okupát, a vica rázy vo velmy horúcom povetré. Nekupajté dieta nikdy prevj ako celu hodinu za jedená. Prvej ho kupajté a potom da vaj te jest. Sáty a crstvy zdúch.—V horúcom povetré dajte také lahké saty ak len mozno. Drzte dieta na crstvom vzdúché a nie na slunkú. V nocy nehajte obloky otvorené, ale preci zavojené aby muchy nemohly sa dnuka dostat’. Ked povétre na zimmé sa obraty, mavajte pozor aby so dieta ne prechladlo. Ténka flanelovat pántla dva alebo try rázy okolo tele okrútena ma byt. Ta pantla nemá byt sirsa, len aby bruch zakryla a musy byt hldaka bez kreé a záhyby, a pripnutá s nekolkim nitkam makej cernej i ne uziva jte spendliky. Né nehajte dieta spat s druhym v tej samej postely.—Ak nemáté postelku to matká nech polozy kelokolvek stolce ku svojej postely, nech ich s mekou pokrivkou zákrije a dieta tam polozy. Tak mu tam lepsie budé v letnej nocy, ako kedb pri horueym telé matkej lezalo, a nebudé vyrusat nikoho a samo tez nebudé vyrusano. Zadok stoica ochrány dieta aby néspadlo a matká má ho pri ruké, ak mu daco potrebno. Ak dieta vráca, má behácku alebo nemoenim vyzerá nedávajté mléka a nic inso len téplu vodu z flaskej z ktorej cicalo a zaslité po vlekára. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis [Summer Care o f Babies— H u n ga ria n . Issued by Bridgeport, Conn., Department o f Health.] A CSECSEMOK NYARI GONDOZASA. A csecsemo tulajdonkepeni Taplaleka az Any atej. Ha scak lehetseges, szoptassa a gyermeket.—Tizszer annyi halaleset fordnl eld a palackon nevelt gyermek kozot, mint azok kozt, kik anyatejjel vannak taplalva. Etesse a gyermeket rendesen bizonyos meghatarozott orakban es nem mindenkor, ha sir. Ket vagy harom orankint egy szoptatas elegendo, mig a gyermek ot vagy hat hetes; azutan nem sziikseges o annyit etetni. Szoptassa a gyermeket nyolc vagy kilenc honapos koraig. Ne szoktassa el a gyermeket forro idoszakban. Szamos gyermek hal el evente azaltal, hogy a nagyokkal egyiitt iil asztalhoz es olyan etket kap, a mit kis gyomra el nem bir. A mig a gyermek anyatejet iszik ne adjon neki egy harapasnyi szilard etelt, sem pedig teat, kavet vagy sort. Varjon mig megjon a gyerek foga, ha olyan etelt akar adni, a mit meg kell ragni. Ha nines anyatej, adjon a gyermekenek tehentejet tiszta palackbol. Ha a gyermek palackbol iszik, esakis jo tejet kell neki adni es az allandoan zarva es jegen tartandc. Ha a tej nincsen kellden lefedve. rogton megfdzendo, a mint megkapja. Hogy a gyermek teje meg ne romoljek, tegye a legkozelebbi 24 orara sziikseges tejet palackba, mely szorosan bedugaszolando, vagy pedig szorosan fedett korsoba. A palack vagy a korso, valamint a fedo, kifozendo, mielott beleonti a tejet. Tegyen fel egy fazek hideg vizet a kemenezere, abba helyezze a gyermek tejet tartalmazo edenyt, lazan elzarva azt. Mikor a viz felfott, vegye ki a gyermek tejet tartalmazo edenyt, bontsa ki es adjon egy fel teas kanalnyi szodat minden kvart tejhez. Ezutan zarja el megint az edenyt es ne nyuljon senki sem a tejhez, esak mikor mar a gyermeknek adjak. Ne etesse tul a gyermeket.—Az ujsziildtt csecemo ket vagy harom kanalnyit elbir, tobbet nem. Inkabb kevesebbet kell adni ennel, a palackon nevelt gyermeknek az elso hetekben, egy etkezesre. A mint a gyermek megno, az adag is nagyobb lehet, ugy hogy az elso honap vegen negy evokanalnyit kaphat egy etkezesre. Nemely gyermeknek ennel tobb kell, nemelyiknek meg kevesebb, de mindig veszelyesebb tobbet adni, mint kevesebbet. Mazsalja meg a gyermeket minden heten.—Az egeszseges csecsemonek minden heten egy fonttal kell gyarapodnia. Ha az On-e nem novekszik ilyen aranvban, kerdezze meg az orvost a taplaleka felol, es cselekedjek utasitasa szerint. Ha a gyermek sir, ne feledje, hogy ha rendesen van taplalva,/akkor nem sir ehsegtol. Lehet, hogy szomjas. Lehet, hogy hasgdrese van. Tartsa melegen kezet, labat. Ne tartsa tulmelegen (izzadasig). Haskdtoje puha, tiszta es szaraz legyen. Ne sertse valamelyik tii. . , . . A tej elkeszitese a gyermek reszere.—Minden pohar tejhez adjon ket pohar vizet es annyi feher enkrot (vagy neha jobb a- tejeukor) https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 85 86 BABY-SAVING CAMPAIGNS. hogy olyan édes legyen, mint az anyatej. óntse egy palaczkba és melegitse az anyatej hómérsékére. Alkalmazzon gummi szopókát a palaczkra. Hat hónapon alúl ne etesse a gyermeket kanállal.—A csecsemo természetes étmódja a szopás. Az ajkak, a száj és a nyely szopc mozdulata szükséges ahhoz, hogy az étel a száj nyálkáival keveródjón és hogy a száj és a fogazat kellóen kifejlódjék. Ne használjon csóvet a palackon.—Használjon szopókát. Ne feledje el a palackot és a szopókát használat után megmosni.— A gyermek gyakran kap “ szájfájást,” “ szeleket ” vagy “ nyári bajt,” mert a palack nincsen kelló rendben tartva. Tisztitsa a palackot azonnal használat után. Tisztitsa a szopókát alaposan kivül és belül. Csóvel ellátott szopókák igen kényelmesek a lusta anyára nézve, de a gyérmeknek halált jelentenek. Hogyan készitendó a gyermek részére árpaviz.— Mikor a gyermek négy vagy ót hetes a kozónséges viz helyett árpa-vizet adjunk neki. Tegyen négy csésze hideg vizbe két evókanállal gyóngy-árpát, fózze egy óra hosszat vagy tovább, úgy hogy a vizból csak két csészényi marad. Azután szürje át tiszta ruhán; vegyen egy csipetnyi sót és édesitse meg az anyatej ízére. Ehez óntsón egy csészével a fentebb leirt módon melegitett tehén-tejet és evvel kezdje az etetést. Fokozatosan vegyen tóbb tejet és kevesebb árpa-vizet, ugy hogy mikor a gyermek már vagy hat hónapos, két harmad tejet és egy harmad árpa-vizet kap majd. Ez a legjobb táplálék a mi csak adható a gyermeknek fogzás és elszoktatás idjén. Mikor ez az ido elmúlt tiszta tej használható, az elóbb leirt módon felmelegitve, tejes kenyér, tejes rizs, sült burgonya tejjel, jól megfótt zabliszt tejjel (a tej mindenkor melegitve és nem m egfózve). Az emlitetten kivül más táplálék nem szükséges. Fürdés.—Tartsa a gyermekét tisztán és jobban fogja türni a hóséget. Legalább egyszer naponta teljesen megfürdendó, rendkivüli hóségben még gyakrabban. Ne füróssze a gyermeket evés után egy órán belül. Elószór legyen a fürdés, azután az evés. Ruházat és szabad levegó.—Meleg idóben a ruházat oly kónnyü legyen, mint csak lehetséges. Tartsa a gyermeket a szabad levegón, de ne legyen a forró napon. Éjjel tartsa az ablakokat nyitva, de behálózva, hogy a legyek be ne johessenek. Mikor az idójárás hirtelen lehül, cvakodni kell a hüléstól. Használjon vékony, puha kótót, mely kétszer vagy háromszor átéti a testet. Az ilyen kótót csak olyan széles legyen, hogy a hast befedje és simán, ráncz s csomó nélkül, rácsavarando, azután illessze oda néhány óltéssel pamutcémával, ne használjon tüt. A gyermek ne aludjék más valakivel egy ágyban.—Ha nines gyermekágya, toljon az any a két széket az ágya mellé, tegyen reájuk puha takarót és fektesse oda a gyermeket. Ez egy nyári éjszakán sokkal kényelmesebb lesz, mint mikor az anyja meleg testéhez dól, azonfelül pedig sem nem zavar másokat, és nines megzavarva maga sem. A szék háta megóvja az eséstol és az anyja kezénél van, ha szükséges valami. Ha a gyermek hány, hasmenése van, vagy betegnek látszik, ne adjon neki semmiféle tejet és semmi mást, mint meleg vizet a szopó palackkal s küldjón az orvosért. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis [ Summer care o f babies— Ita lia n i. Issued by Brldgeport, Conn., Department o£ H ealth.] CURA ESTIVA DEI BAMBINI. Il nutrimento adatto pei bambini è il latte della madre. Allevate il vostro bambino voi stessa, se ciò è possibile.—La mor talità dei bambini è in queste proporzioni: che per ogni uno che ne muore, che e stato allattato a petto, ne muoino dieci che sono stati allattati con la bottiglia. Allattate il bambino regolarmente a ore fisse, e non ogni volta che piange. Bisogna allattare il bambino una volta ogni due o tre ore finche egli ha l ’età di quattro o cinque settimane; dopo di questa età lo si deve allattare non tanto spesso. Si deve dare il latte al bambino finche egli raggiunge gli otto o nove mesi. Non si svezza il bambino durante la stagione calda. Molti ragazzi muoiono ogni anno pel fatto che essi sono messi a tavola con la famiglia, e si da loro del cibo non adatto ai loro piccoli stomachi. Finche voi allattate il vostro bambino non gli date un boccone di cibo solido, nè gli date tè, caffè o birra. Aspettate finché egli abbia messo i denti prima di dargli del cibo che ha bisogno di esser masticato. Se vi manca il latte del petto date al vostro bambino latte di vaw a con una bottiglia pulita. I bambini che sono allevati col latte delle bottiglie debbono avere soltanto latte buono, e questo deve esser mantenuto sempre coperto e in ghiaccio. Se il latte non può esser mantenuto coperto come si deve, lo si deve bollire appena ricevuto. Per mantener dolce il latte pel vostro bambino si metta in una bottiglia o in un boccaccio di vetro a coperchio ben stretto, il latte di cui il bambino avrà bisogno per le prossime 24 ore. Tanto la bot tiglia e il sughero, quanto il boccaccio e il coperchio debbono bollirsi prima che vi si versi dentro il latte. Si ponga sulla stufa una casseruola con acqua fresca. V i si ponga dentro il recipiente col latte del bambino, col coperchio avvitato lento. Quando l’acqua bolle toglietene il recipiente col latte del bambino, apritelo, aggiungetevi poco meno di mezzo cucchiarino di bicarbonato di soda per ogni litro di latte, e quindi si ricopra il recipiente. Non permettete a nessuno di toccare il latte, altro che quando serve pel bambino. Non nutrite troppo il bambino.—Lo stomaco di un neonato può contenerne da due a tre cucchiai da tavola, e non più di tanto. Du rante la prima settimana, più o meno, della vita di un bambino che è allevato col latte di bottiglia, bisognerebbe dargliene anche meno di questo. A misura che il bambino cresce, la quantitità deve crescere gradatamente, cosi che alla fine del primo mese il bambino debba tro varsi a prendere circa quattro cuccùiai da tavola per volta. Alcuni bambini possono averne bisogno di più, mentre altri non possono sostenerne tanto, ma vi è sempre più pericolo a darne troppo alla volta https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 87 88 BABY-SAVIN'G CAMPAIGNS. Pesate il bambino ogni settimana.—Un bambino di buona salute dovrebbe guadagnare durante questo periodo, una libbra per setti mana. Se il vostro bambino non cresce tanto consultate il medico pel cibo che bisogna dargli, e fatevi guidare dal suo consiglio. Se il bambino piange, ricordatevi che se è stato nutrito regolar mente non piange per fame. E può aver sete. O può avere una colica. Badate che abbia le mani e piedi caldi. Che non stia troppo caldo, da sudare. Che la sua biancheria sia morbida, pulita e asciutta. Che non vi siano spilli che lo pungano. Come si prepara il latte per nutrire il bambino.— Ad ogni tazza di latte si aggiungano due tazze di acqua, e del zucchero bianco (qualche volta il zucchero di latte è migliore) abbastanza da renderlo dolce come il latte di petto. Si versi quindi nella bottiglia e si riscaldi questo latte finche esso sia tanto caldo quanto il latte di petto. Si inetta quindi alla bottiglia il capezzolo di gomma. Non si usi il cucchiaio nel nutrire un bambino al di sotto dei sei mesi.—U succhiar è il mezzo naturale che un bambino adopera per nutrirsi. Perchè il nutrimento si mischi coi fluidi della bocca, e per 1’ adeguato sviluppo della bocca e dei denti vi è bisogno dell’ atto succhiativo delle labbra, della bocca e della lingua. Non si usi un cannello sulla bottiglia, si usi un capezzolo. Non dimenticate di lavare la bottiglia e il capezzolo dopo che ve ne siete servita.— Spesso i bambini pigliano “ mali alla bocca,” “ coliche flatulenti” e “ sciolte estive” per difetto di cura della bottiglia da allattamento. Si pulisca la bottiglia immediatamente dopo l’allattamento. Si pulisca ben bene il capezzolo, di fuori e di dentro. I capezzoli col tubo sono comodi per una madre pigra, ma significano la morte del bambino. Come si prepara l’acqua di orzo pel bambino.—Quando il bambino ha quattro o cinque settimane, invece di acqua semplice si deve usare acqua di orzo. Si mettano due cucchiai da tavola di orzo mondato, in quattro tazze di acqua fresca, e si faccia bollire per un ora o più finché 1’ acqua si restringa a due tazze. Si passi quandi per un panno pulito, vi si aggiunga un pizzico di sale, e si addolcisca tanto da avere il sapore di latte di petto. Si aggiunga questo ad una tazza di latte di vacca, riscaldato come si è detto innanzi e s’incominci a nutrire il bambino con queste proporzioni. A poco a poco, gradatamente si usi più latte di vacca e meno acqua di orzo finche, quando il bambino ha circa sei mesi si abbia la proporzione di due terzi di latte, ed un terzo di acqua di orzo. Questo sarà un nutrimento abbastanza buono per lui durante il periodo della dentizione e dello svezzamento. Passato questo periodo gli si potrà dare latte puro, riscaldato come si è deto innanzi; pane e latte; riso e latte; latte con patate infornate; bro detto di oatmeal ben cotto, e latte (il latte sempre riscaldato, non bollito). Non vi è necessità di altri cibi salvo quelli di sopra menzionati. Bagni.— Si mantenga il bambino pulito, ed egli sopporterà il caldo assai meglio. Egli dovrebbe avere almeno un bagno completo ogni giorno, e più d’uno durante i calori estremi. Non si dia mai il bagnò https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVING CAMPAIGNS. 89 al bambino entro l’ora nella quale egli ha avuto il latte. Gli si da prima il bagno e poi da succhiare. * Panni ed aria fresca.— Quando fa caldo si vesta il bambino quanto più leggermente è possible, si tenga il bambino all’aria aperta, ma non al sole ardente. La notte si tengano le retine e si evitino le mosche. Quando il tempo si raffredda tutto a un tratto bisogna aver cura di evitare che il bambino si raffreddi. Bisognerebbe in tal caso avvolgerne il corpo due o tre volte con una sottile e morbida fascia di flanella. Questa fascia dovrebb’essere abbastanza larga da coprir la pancia, e dovrebb’essere avvolta liscia e senza crespe o piegature, aggiustata con qualche punto di cotone morbido da rammendare e senza spilli. Non fate dormire il bambino nello stesso letto, assieme ad altri.— Se non si ha una culla, la madre dovrebbe mettere accanto al suo letto un paio di sedie con popravi-una morbida copertura, e farvi dormire il bambino. In una notte estiva starà a miglior agio che non stando presso il caldo corpo della madre, e sarà più difficile che dia fastidio agli altri o che ne riceva. Le spalliere delle sedie eviteranno che il bambino cada, e la medre è sempre a portata per prenderne cura, ove mai fosse necessario. Se il bambino vomicasse, avesse diarrea, o sembrasse malaticcio, non gli date più latte, non gli date che acqua tiepida nella bottiglia da allattare, e mandate a chiamare il dottore. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis fLeaflet issued by Providence, R. I., H ealth Departm ent.] ADVICE TO THOSE ABOUT TO BECOME MOTHERS. Before the birth o f her baby, there are some things which may be done by the mother to make her more likely to be well herself and to have a healthy child. F ood — The food o f the mother should be abundant, plain, without much spice and seasoning, and with not more than one cup o f coffee or tea at a meal, and none between meals. I f she wants more to drink, there is nothing better for her than milk. Meat should not be eaten oftener than once a day. The more water that is taken the better. Bowels.—It is very .important to have a movement of the bowels every day. Strong medicines must not, -however, be used to open the bowels; costiveness can be avoided by sufficient exercise and suitable food, as brown bread, stewed vegetables, fruit, and abundance of water. Work.—The woman may do her usual work, but should not work hard enough to get very tired. Work in store and mills is not good, and it should be stopped as soon as possible, at least four weeks before the expected birth o f the baby. She should go out o f doors every day, but mtist not run for cars, or jump, or overexert herself in any way. Once in four weeks, at the time when the woman would have been unwell if she were not to have a baby, she should be even more careful than usual about overexertion, because at these times there is more danger of miscarriage. Clothing.—A ll clothing should be loose. As soon as she begins to show her condition, the mother should leave off her corsets, and have nothing about the waist that is at all tight. A loose corset waist should be worn to which side garters should be attached instead of wearing circular ones about the legs. Baths.—-It is important to keep the skin in a healthy condition, and this is best done by frequent oathing. Sea bathing is not good, however, because it is too violent. Nipples.— Nothing should be put on the nipples until the last month. Then they should be washed every day with clean soap and water and boracic acid solution put on them. Get some boracic acid from the drug store and put a heaping tablespoonful in a pint bottle and fill with warm water, or better, put in warm water two-thirds and alcohol one-third. I f they are small or turned in they should once every day be gently pulled out, so as to make them ready for the baby to nurse. Food for baby.—No food is as good for a baby as its mother’s milk. This is why so many more bottle-fed babies are sick and die than breast-fed babies. For this reason the mother ought to try to nurse her baby as long as she has any milk at all. One or two feed ings a day from the breast are a great deal better than none at all. Keep the body well nourished before the birth o f the baby in order to secure a good supply of milk. Regular nursing and corn-meal gruel, a pint or more a day, are the best things to mate more milk. P r o v i d e n c e , 1910. 90 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis [Published by the Oregon State B oard o f H ealth.] TO EXPECTANT MOTHERS. Too frequently the expectant mother receives no advice from a physician or anyone else competent, presuming the condition to be a perfectly normal one that needs no assistance. This is far from true. So many little conditions arise that intelligent care and in struction would prevent not only great discomfort but lower the mortality rate in these conditions. The first and commonest symptom is nausea. This is purely reflex and while no specific drug will cure the condition, by proper advice in the way o f diet and the addition o f some simple stomachics or some drug furnishing temporary rest to the organs will accomplish wonders. Next is the obstinate constipation. Any milk laxative, such as the compound licorice powder or phenolax wafers not only adds to the comfort o f the mother but assists in the development of a healthy child. The most serious o f all are the kidney complications. These are usually brought on by cold drafts; exposure, such as sitting on damp ground or being chilled by long rides or drenched with rain. The presence o f albumin denotes the possibility o f convulsions, and urine analysis should, from the fourth to the ninth month, be made at least every two weeks. * * * Next in importance is the care o f the nipples. By persistent use o f alcohol or glycerol of tannin, the skin can be hardened and prevent painful fissures that too frequently follow. The duration o f the normal pregnancy is 280 days. Near the ter mination o f that time, the mother should have ready a quiet room apart from the rest o f the house and other children, if possible, be cause rest is above all things most desirable in the new mother. She should have ready rubber sheet to protect the bedding; binders, three or more, made o f old toweling, to perfectly support the relaxed abdo men and not only derive perfect comfort but also to preserve a more comely appearance in after years; clean basins and pads, that can be made from the ordinary cotton covered with newspapers and steri lized afterwards by dry heat in the oven. Also, plenty o f clean cloths and sterile oil. For the baby she should have at least four dozen napkins; four soft binders to bind its little abdomen and protect the cord. Shirts supported by straps from the shoulders, skirts always made with the body and not with a band that must be bound tightly around the ribs to hold in place; soft pillows, soft covers, and knit wrapping blanket. These, together with sacks, wrappers, bibs, and caps, complete the new wardrobe. The baby’s basket should be one specifically for its own use. This should contain large and small safety pins, talcum powder, a soft hairbrush, castile soap, blunt scissors for the nails, old linen for clean- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 91 92 BABY-SAVING CAMPAIGNS. ing the mouth, soft towels for the bath, cold cream or cocoa butter, and a bath blanket. The feeding of the baby then is of the most importance. Unfortu nately, there are two classes o f mothers: the one who, either from a life o f idleness or lack o f exercise, secretes insufficient milk for the baby’s food, and the other, who from overwork, lack of proper diet, and lack o f sleep confronts the same condition. No milk, no matter how carefully prepared, is as good for the baby as mother’s milk. However, when this is impossible, the next best substitute is cow’s milk. The milk of a mother is alkaline. The milk o f a cow is acid. The milk of the cow contains much more casein, so o f necessity must be modified some. In the city every mother who must raise her child on a bottle should use nothing but certified milk. A little in quiry on her part will tell you just what to use. In country districts or small towns it is possible for intelligent parents to see to it that the milk for their baby comes from cows that are free from tuberculosis or any other disease, that the hair is clipped away from the cow’s udders, that the milking is done in narrow-mouthed buckets covered with clean cloth, so that there is no possibility of excretions from the cow or dirt from the stable contaminating the milk. It is an unfortu nate fact that the mortality rate in infants is higher in the country nearer the center o f production of raw cow’s milk than it is in cities, and this is due only to carelessness. I f a bottle must be used, keep it scrupulously clean, with a large nipple fitting directly over the bottle. Under no condition should the old rubber tube be used. A t the completion o f each feeding the bottle and nipple should be boiled and then kept waiting for use in an ordinary solution o f bicarbonate of soda, which keeps it sweet and clean. The capacity o f a newborn babe’s stomach is, during the first week, 1| fluid ounces; during the second week, 2 £ ounces; from the third and fourth week about 3 ounces; at the third month, 5 ounces; at the ninth month, 12 ounces. A study o f this table will easily con vince you that most babies are overfed. The newborn babe should, during the first three days of its existence, have no other food save that which comes from the mother’s breast. The use o f cloth filled with sugar or a diluted solution o f brandy is absolutely criminal. Next to dirt, the greatest murderer o f newborn babies is the house fly. One speck on the baby’s nipple may be sufficient to start an attack o f intestinal trouble that would result fatally. The per nicious habit o f too many mothers is the throwing o f soiled napkins in some comer o f the kitchen or back porch, thereby furnishing food for flies, and in turn to be transferred to the milk, the baby’s nipple, or even direct to the baby’s face, thereby setting up an infection that will assist materially in increasing infant mortality. A ll babies should early become accustomed to an abundance of fresh air. Night air will not hurt babies any more than adults,* un less it is last night’s air shut up in some close room. Accustom them to sleeping with all the windows open, or better yet, to taking their daily naps on the porch, protected only from drafts. See that no single day passes that the infant does not have at least two hours out doors, breathing in all the ozone that the Creator intended it should have. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BABY-SAVING CAMPAIGNS. 93 A proper cart or large basket or crib for sleeping is incomparably better than the old cradle, as the digestion is more perfect in children, as in adults, when they are not constantly throwing their center o f gravity outside their bodies. Whenever possible a graduate nurse should be in charge o f the mother and babe. Where it is not possible, a person o f wide experi ence, who has had it thoroughly impressed upon her mind that clean liness is next i f not equal to godliness, is the only one to be safely trusted. A normal child should weigh at birth 7f pounds; at the end of the second week, 9| pounds; at the end of the third week, 11 pounds; at the end o f the fourth week, 12£ pounds; and at the end o f one year, 21 pounds. These are perfectly normal averages, but variations can not but occur. It is important that the mother, following the birth o f her child, shall have ample opportunity for rest. She should stay in bed at least two weeks. The habit o f entertaining friends the following day or for several days after can not be too strongly condemned. She should have ample opportunity to sleep, for this will bring back color to her cheeks more quickly than malt or any other medicines masquerading under the name o f tonics. The diet for the first few days until milk appears in the breast, which is usually 48 hours after, should be liquid entirely. After this a liberal diet o f easily assimilated foods usually solves the prob lem o f the milk supply. There is no other condition in life where absolute cleanliness is so essential as it is in this condition for the welfare o f mother as well as the babe. A quiet life during the period that the mother is nursing the babe will not only add to her comfort and happiness but to that of her babe as well. Late suppers, dances, improper diet, and overwork all tend to de crease the quantity and quality o f her milk, as well as to affect the digestion and disposition o f the child. A prolonged rest will avoid many o f the displacements with the accompanying discomforts or even surgical operations that too frequently follow childbirth. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis O https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis
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