SANITATION IN AND ABOUT THE HOUSE

The bearing of intelligently located houses of proper construction on health is not so generally understood, even by physicians, as the facts warrant, and, of course, is even less well recognized by the non-medical public. It is true that some attention has been given to the matter of location, but even in this connection there prevails a woful ignorance among all classes as to just how the diseases are transmitted that are most influenced in this way. As a result of recent advances in medicine it has been clearly shown that at least some of the diseases that are most influenced by locality may be easily avoided, and as a consequence we find that the views of the modern sanitarians have necessarily undergone a certain amount of change in this direction. On the other hand recognition of the necessity of hygienic construction has not been sufficiently accentuated,—since it is possible by proper attention to the details of building to do away entirely with at least two of the diseases that have heretofore been the principal drawbacks to life in all tropical and sub-tropical countries. Much importance likewise attaches to houses being thoroughly ventilated, and to their being sufficiently roomy to properly accommodate their inmates. The following table shows the striking relationship that mortality bears to over-crowding:—

Relation of Death-rate to Density of Population.

Many other statistics could be quoted, but all follow the general trend of those just given.

Choice of Site.—In our rural districts the inhabitants have a wide latitude in the matter of the selection of the location for their houses, and it is usually the case that our people are sufficiently intelligent to make the best use of their opportunities in this direction. It may, however, be mentioned that it is generally considered that building-sites in the neighborhood of cemeteries are not favorable locations, nor should houses be erected in the vicinity of a manufacturing plant that gives off injurious gases, or obnoxious materials of other kinds. Inasmuch as we now know that malaria is transmitted by a certain mosquito, and that by properly screening the house their attacks may be avoided, the necessity no longer exists for avoiding the vicinity of lakes and rivers as building-sites; such localities being as a rule pleasant and often picturesque, they would naturally under ordinary circumstances be selected, and there now remains no reason why this may not be done,—provided that the house is so constructed that mosquitoes can be effectually prevented from gaining entrance.

Of much importance is the selection of a locality where good and pure water can be easily procured, as otherwise disastrous consequences are sure to follow.

The soil should be of a light and porous character, easily permeable by water, and free from the decomposing remains of excretions of man or animals. There is much reason for the belief also that the level of the ground-water plays a somewhat important part in the salubrity of any given locality, and it is generally considered that this should be at least ten feet below the surface. It is generally thought, and probably with truth, that those sites are most healthful which have their location on a basis of granite, or other rock-foundation; in such localities there is usually a considerable slope of the general surface of the ground, with the result that water rapidly runs off after rains, and consequently stagnant pools, which might serve as a breeding place for mosquitoes and bacteria, do not form. Soils through which water easily permeates are likewise, as a rule, healthy, though this depends in a measure upon whether or not they contain a very considerable proportion of vegetable matter. Clay foundations are healthful where there is a considerable slope to the surface of the ground, but where this does not exist the soil is damp, owing to its impermeability, and often has stagnant pools upon its surface. Marls and alluvial soils are not regarded as being wholesome, but it is not unlikely that their bad reputation is largely due to the fact that they generally exist in the neighborhood of rivers and other considerable bodies of water where mosquitoes are numerous. There are no reasons going to show that cultivated lands are unhealthy—even where they receive yearly abundant additions of manure. Where it is necessary to build in damp localities the site should be thoroughly drained, and the space upon which the house is constructed should be carefully covered with some impermeable cement.

Building Materials.—Of all building materials, the one most commonly employed in America is wood. This arises from the fact that in the past we have had unlimited quantities of timber from which lumber could be procured at a price so reasonable that no other material could ordinarily be considered. That the wooden house has some advantages cannot be denied; its walls rapidly cool following the torrid days that so commonly occur during the summer in almost all portions of the United States, and it is usually well ventilated as a result of the numerous fissures naturally existing in its structure.

Next to wood, bricks are most commonly used for building purposes, and have many advantages, among which are their handsome effect, their stability, and their being poor conductors of heat; the last mentioned is of considerable importance, since it keeps both heat and frost from rapidly permeating the interior, and as a consequence houses constructed of this material are cooler in summer and warmer in winter.

Other materials occasionally used are concrete, granite, marble, and sandstone, any of which, on account of their durable character and the beauty that they lend to structures made from them, may be selected for building purposes, but inasmuch as they are rarely used in rural districts, a detailed consideration of their peculiar advantages for building purposes is not deemed here necessary.

The internal wall-coating of houses deserves more consideration than is commonly accorded it, since the dyes used for coloring wall-paper and curtains in some instances contain noxious materials. Chief among those that are dangerous are the bright green pigments which commonly contain arsenic as their principal constituent; where these or other poisonous substances are employed in interior decorations the air, wherever the room is kept closed, may become more or less impregnated with poisonous gases, and serious consequences to the inmates may ensue.

Screening Indispensable to Health.—Nothing is more important in connection with house construction than having every opening thoroughly screened. We have learned that both malaria and yellow fever are transmitted always by certain kinds of mosquitoes, and it therefore, becomes a matter of the greatest importance to effectually prevent the entrance of these insects. It cannot be too strongly insisted upon that we absolutely know that the statement just made is correct, and that avoiding the diseases referred to becomes as a consequence entirely a matter of preventing the entrance of mosquitoes into houses.

The Anopheles mosquito, which is the one that transmits malaria, often exists in localities where the more common varieties do not occur, and on account of the habits of this insect their presence is liable to be overlooked. They seldom attempt to bite during the day, and it is only rarely the case that they try to do so at night in a well lighted room;—particularly where movement of any kind is going on. During the day this mosquito remains perfectly quiet in the dark corners of the house, and is very fond of resting on cobwebs, presenting, when doing so, an appearance strikingly similar to that of fragments of leaves, soot or of other natural objects that are frequently found suspended on such structures. On account of these peculiarities and for the further reason that the insect bites mainly just following daybreak, when the victim is profoundly unconscious in sleep, its presence often remains undetected, and as a consequence we occasionally hear from those who do not take the trouble to inform themselves that malaria exists in this or that locality where mosquitoes do not occur.

The yellow-fever mosquito bites for the most part during the day, but will do so at any time when there is light. In districts where this disease occurs it is quite as important to prevent its entrance as that of the malarial mosquito. Not only does screening prevent malaria and yellow fever, but it keeps out flies and other insects that unquestionably bring with them the germs of other diseases.

There now remains no doubt that several affections, notably typhoid fever and dysentery, are frequently communicated by means of the common house-fly, which spends its time alternately on the fecal material around privies or in other filth, and in our kitchens and dining-rooms; it is one of the most astounding evidences of the power of habit, in the face of common sense and ordinary decency, that we have not long ago taken active steps to rid ourselves of its disgusting presence. Fortunately in screens we have a perfect barrier to the entrance of flies, and no house can be considered complete without being thoroughly equipped with these all-necessary appliances.

It is scarcely possible to overestimate the economy that results from the use of screens; among the various means employed for conserving the public health they take first rank, and undoubtedly insure those who live in houses to which they have been added an immunity against the costly effects of disease that could scarcely be computed. A house would be more habitable without chairs, beds, or tables than screens, since in the absence of the former we may be healthy, though somewhat uncomfortable, but without the latter serious disorders are pretty certain, sooner or later, to make their appearance.

It is of considerable importance to use a screen the mesh of which is sufficiently fine. Where mosquitoes exist, the screen should be of such fineness that at least sixteen, or better eighteen meshes be in each inch of the gauze. Where it is absolutely certain that mosquitoes are not to be feared, the spaces may be somewhat larger—but always of such size as will prevent the entrance of the smallest fly.

Air-space Required.—It is of much importance from a hygienic standpoint that the rooms of dwellings should be sufficiently large. The height should never be less than eight feet, and the living-room should be made as large as circumstances will permit. Bed-chambers should contain at least 1,000 cubic feet of air space for each adult, with somewhat less for children, though it should never be forgotten that the more the better; this means that each person should have the equivalent of a room which is at least 10 x 12 x 9 feet.

Heating.—Americans are extravagant in the matter of heating to a degree that astonishes the average foreigner, and it is by no means sure that we do not go to unhygienic extremes in this direction. It is not, perhaps, true that the excessive heat itself could be considered as especially hurtful, but it is too often the case that the conditions required to secure the degree of heat preferred by us are incompatible with proper ventilation, and hence are to be condemned. It is generally considered that the temperature of living-rooms should be somewhere about 70°F.; for many persons this is lower than would be entirely comfortable, and as a consequence our houses in the winter are frequently kept nearer 80°F. than the figure just given. The reader should be urged to see to it that, at whatever temperature his habitation is kept, a sufficient amount of ventilation be secured.

There are many different methods of heating, the most satisfactory of which are by means of hot water or steam; a modified form of the latter is the so-called vapor method, which in recent years has proven extremely satisfactory. Hot air, supplied by a furnace is also extensively used, and for the reason that by this method fresh air from the outside is constantly brought into the house, it is theoretically to be commended; practically, however, a considerable difficulty is experienced in securing an equable distribution of this heat throughout the various parts of the house, and as a consequence it has not achieved the popularity that it would otherwise have done.

Inasmuch as the installation of plants for heating by the methods just referred to entails quite an expense, and for the further reason that they require coal for satisfactory operating, they have not been employed in the rural districts of America to any considerable extent. The farmer, for the most part, depends on the old open fireplace where wood is plentiful and the weather does not become excessively cold, while in those portions of the country where the temperatures in winter go very low, the stove is generally employed. Of the two methods, the former is much the more hygienic where it can be used successfully, but over a greater portion of the United States this cannot be done owing to the cold winter climate.

The principal objection to the stove lies in the fact that the heat that comes from it is very dry, and that where its walls have to be heated excessively, unpleasant odors are apt to be generated; the former is usually and ought always to be obviated by keeping upon the stove a vessel of water, the vapors from which moisten the atmosphere, and the latter by having the stove of such size that it will not require excessive heating in order to warm the room in which it is placed. Wherever possible the open fireplace is to be preferred to the stove for the reason that it very thoroughly ventilates the room.

Ventilation.—In order that the health of the inmates may be conserved proper ventilation of all habitations is essential. However cold the weather may be, an abundance of fresh air should be allowed to enter all parts of the house. In the average wooden dwelling there are so many cracks that good ventilation is generally secured without opening doors or windows, but where the construction does not permit this, openings for the entrance of air should be left in the most convenient and suitable places. Windows may be slightly raised and draughts prevented by proper screening, or what is even better, rooms should be so constructed that they have openings at the top and at the bottom to allow free ventilation. Openings towards the upper portion of rooms are especially important in hot weather, as the warm air rises to the ceiling and escapes only very slowly where such exits do not exist. Lowering windows from the top aids materially in allowing the hot air to escape, but this is not altogether so satisfactory as having openings higher up on the walls, or in the ceiling.

Disposal of Sewage.—No problem that confronts the dweller in the rural district is of greater importance than the proper disposal of sewage. It is unfortunately impossible in most instances for the farmer to have in his house a system of water-works, and, therefore, all dish-waters and slops are thrown into the yard, and a privy is used instead of a modern water-closet. Where the lay of the land is such that water readily runs off, or the soil is of a character that permits rapid absorption, throwing slops on the ground around the house may not constitute a danger to the inmates, but nothing is more certain than that the old fashioned privy is a dire menace to the health of all those in its vicinity.

Not only are infectious materials brought into houses by flies, from fecal matter and other excretions, but they are carried away by the rains and sometimes contaminate sources of water-supply. It is furthermore extremely probable that bacteria in particles of dust from dried fecal material may be carried by the winds from privies into wells and houses, and as a consequence diseases may be spread; of perhaps still more importance—and certainly of far greater moment all over the southern portions of the country—is the fact that hook-worm disease and other infections caused by animal parasites are transmitted from man to man as the result of our adherence to the old fashioned privy.

As will be explained in the chapter devoted to the common communicable diseases, the eggs of the hook-worm pass from the intestine along with the feces of those who are victims of this parasite and reaching the ground, hatch out in the course of a few days minute hook-worm embryos, which crawl away and permeate the soil in the vicinity; later collecting in little pools that form after rains, or in dew-drops during the night, they attach themselves to the skin of barefooted children who come in contact with such collections of water, and boring into the body ultimately, through a circuitous route, reach the intestines. Here they undergo further development, and in a short time become mature hook-worms, which in their turn lay eggs, and the life cycle begins over again. It is thus seen that a child having hook-worm disease becomes a menace, on account of the privy, to its brothers and sisters, and of course quite commonly receives back into its own body, worms that had previously escaped as eggs.

In the same way eggs of the two common tapeworms pass out with the feces, and the offal containing them being eaten by hogs in the one case, or being scattered in the vicinity and taken in with grass by cows in the other, have their shells dissolved off as soon as they reach the stomachs of these animals, and there are liberated small embryos that bore through the walls of the stomach and later find their way into the muscular tissues of these beasts, and there lie dormant until eaten by man with imperfectly cooked meat; after being swallowed, the embryo parasite passes to the intestine and soon becomes a fully developed tapeworm.

Particular reference at this point should be directed to the evil effects, which are even still greater than those that come from the privy, of permitting children and hired helpers to scatter their feces indiscriminately in corners of the yard, the apple-orchard, or in the horse-lot; under such circumstances, where hook-worm disease is once introduced, the soil in the course of a short time becomes thoroughly permeated with the embryos of this worm, and, as a consequence, all of the children who play in the infected area barefooted, as is customary in the country, are sooner or later infected with these parasites. It is thus seen that soil-pollution from fecal material is a most dangerous thing, and, particularly in the southern portion of the United States, deserves the most earnest consideration of everyone. We should see to it that our children only evacuate their bowels in properly constructed closets; and it is the duty of the head of every family to provide such a place for the accommodation of those who are dependent on him.

Proper Construction of Out-door Privies.—The most practical and generally satisfactory device heretofore invented for the disposal of the sewage of communities unprovided with water-works is what is known as the Rochdale, or dry-closet, system. By this system a privy, at a distance from the dwelling, is constructed in the ordinary manner, with the exception that instead of being open at the back it is tightly closed. In the space beneath the seat receptacles are placed for receiving the urine and feces. These may consist of pails of wood or better of galvanized iron; or a single box occupying the whole space. If wooden receptacles are used, they should be thoroughly coated on the inside with tar, to prevent both leakage and the soaking of the liquids into the wood. One such structure, which the writer knows has been wholly satisfactory has a brick foundation with walls two feet high around the front and sides, within which rests a shallow tarred box. It ensures perfect cleanliness.

In any case this space under the seat is tightly closed, being guarded by doors that open outward, through which the pails or box may be introduced and removed for emptying.

Each privy contains a box in which is placed either wood ashes or dry powdered earth, with a small shovel by which a sufficient quantity of the dust to cover the deposit is thrown into the pail after each evacuation. It is remarkable how completely this shovelful of earth or ashes destroys all disagreeable smell. The privy should be provided with at least two opposite windows, both of which should be thoroughly screened. The entrance should have a door that is closed with a spring, so that it cannot be carelessly or accidentally left open when vacant. At intervals the pails containing the feces are removed, and the contents are carried to a distance and buried.

Another plan that is quite satisfactory where iron pails are used, is to place a quantity of water in the vessels for receiving the feces, and then to pour in a small quantity of kerosene; the latter substance forms a layer over the water that keeps out flies, and does away largely with the disagreeable odors that are likely to emanate.

If any contagious disease exists among those who use such a closet, the fecal material should be carefully sterilized before being removed, as by means of corrosive sublimate, carbolic acid, chlorinated lime, or any one of the many commercial disinfectants containing crysylic acid, all of which may be obtained at any drug store. If carbolic acid or other liquid antiseptics be used the amount by volume should be equal to about five per cent. of the material to be treated; the proportion of corrosive sublimate should be at least 1 to 1,000 where this disinfectant is used. Along with whatever antiseptic is chosen, water should be added in sufficient quantity to permit the whole to be rendered semi-fluid, and the mixture should then be thoroughly stirred, and the chemical left to act for some hours before emptying the receptacle. By far the most satisfactory method of sterilizing infected material, however, is by boiling, since disease-germs are killed by such a temperature in a few moments. Where iron receptacles are used, therefore, the simplest method is to set them upon an open fire in the yard for a little while.

A privy constructed after the manner just described possesses some advantages even over the regulation water-closets that are used in cities, since they are cheaper in original cost, require less repairs, and are uninjured by a freezing temperature. The amount of care required to keep them in proper condition is not excessive, and they are so infinitely superior from a hygienic standpoint to the old-time privy that no sort of comparison is possible.

It should always be remembered that the principal advantages of this closet are that where it is used we are able to collect all of the evacuations, which may then be properly deodorized with soil or ashes, and that it may then be finally disposed of in such a way that it cannot be reached by hogs or other animals; of very great importance also is the screening of the closet, since only in this way is it possible to prevent flies from gaining entrance to the fecal material in the receiving pails.

Water supply.[2]—In the location of houses and schools an eye should always be had to selecting a site where it is possible to obtain good, pure water. To those fortunate dwellers in the mountainous regions of our country this is usually a matter of little difficulty, since it is always possible to find a location in the neighborhood of which the purest spring water may be obtained. In less favored regions the well becomes the main reliance, while cisterns are used in some portions of our country, in which water is collected during the rainy seasons of the year. Of the two, the former is undoubtedly to be preferred, provided a pump be used instead of the old fashioned bucket. The writer is strongly of the opinion that a very large proportion of the contamination to which sources of water-supply are subject comes from the bucket being drunk from or handled by persons with contagious diseases, or from germs being blown into the well with dust, or carried in by means of insects and small animals. It is inconceivable that any appreciable amount of contamination from the surface can reach the underground streams that supply wells in localities that are thinly populated, though it is unquestionably true that a well might be infected as a result of the entrance of surface-water where its top is not properly protected. On the other hand we have in an open well or cistern every facility afforded for the entrance of bacteria.

It is unquestionably of the utmost importance that wells be carefully covered over, and every precaution should be taken to prevent surface-water leaking into them around their edges. In order to comply with these conditions a pump is essential, since it is the only means by which water can be brought to the surface without exposing the contents of the well to contamination. It is likewise of the first importance to have the walls of the well curbed to a sufficient depth to prevent the possibility of seepage from the surface. It is, of course, also quite necessary that the well be of sufficient depth—the lower we go the more likely are we to secure a perfectly pure water. In regions where the water rises to within eight or ten feet, or less, of the surface, the possibility of the well being contaminated during the rainy season by seepage is considerably increased, and the waters of such wells should be used only after analyses have shown that they are pure; where this cannot be done, the water should be boiled before being drunk. Of course, the possibilities of contamination are greatly increased if the locality be thickly inhabited.

As has been before remarked, cisterns are more liable to contamination from the air than are wells, chiefly owing to the fact that they are supplied by water that is conducted into them by gutters from the tops of houses. There is no question that during the dry seasons dust containing many kinds of bacteria is deposited all over the tops of houses and remains there until washed away by the rains. While it is true that the sunlight quickly kills most germs that produce disease a certain number of them would inevitably escape, and having gained entrance to a cistern, would be likely to multiply and later cause trouble. It is thus seen that however pure the rain-water may originally have been—and it is among the purest of all waters—it is likely to become contaminated in the process of collection, and may ultimately in this way become the source of disease. Where any doubt exists as to the purity of such water it should be boiled before use.

Surface-streams also occasionally supply drinking-water in rural districts, and while the use of such waters may not always be attended by danger, their contamination by disease-producing germs is much more to be feared than when they are derived from wells or springs; where streams arise from and keep their course through uninhabited districts the probabilities are strong that their waters are pure and fit for use, but where they run through cultivated fields, and particularly where they pass in the neighborhood of houses, their waters should never be looked upon as being drinkable,—except after being boiled or properly filtered. Inasmuch as adequate filtration is exceedingly difficult to carry out, and requires a somewhat extensive and costly plant, this is, as a rule, not feasible for the dweller in country districts, and boiling, therefore, remains the only satisfactory method of rendering the water fit for use where doubt exists as to its purity.

Location of Pens and Stables for Animals.—Animals should always be housed at some little distance from the dwelling. While it is true that man does not often contract directly diseases from hogs, sheep, horses and cattle, there are some maladies of a most serious character that come to us in this way, and we should, therefore, always guard against their occurrence by removing ourselves as far as is possible from sources of possible infection. The matter also has an æsthetic side, as odors of a disagreeable character may prove very annoying where animals are kept too close to the house. It is likewise of importance that stables should be, if possible, on lower ground than the dwelling, since during rains materials from their dung may be washed around and under the house, and may possibly gain access to the well.

Every care should be taken to keep hog-pens and stables clean, since otherwise very foul smells are engendered that oftentimes find their way to neighboring houses. There is also a suspicion that some of the germs that produce disease find the conditions suitable for their stables and pig-sties.

In this connection it might be well to warn those unacquainted with the subject against the all too common practice of close association with dogs, since it is well established that in addition to hydrophobia they may transmit, while apparently in perfect health, maladies of a deadly character to the human being. It cannot be too often emphasized that the less intimate our association with the lower animals is, the greater the likelihood of our escaping many serious diseases.

CHAPTER IV

HYGIENE OF INFANCY AND CHILDHOOD

No characteristic of the Caucasian mind is more marked, and none more universally affects his actions than a constant, gnawing suspicion that the things going on around him are not being done in the proper way, and consequently an irrepressible desire to experiment, and if possible, to change everything. Such a spirit is unquestionably the basis of what we call progress, and, in so far as it conduces to the health and happiness of mankind, is entitled to our most hearty commendation. On the other hand, it cannot be denied that too often we endeavor to bring about changes with but an imperfect understanding of the basic principles at issue, and naturally, under such circumstances, our efforts are crowned with anything but success. In other words, an enlightened investigation of the whys and wherefores of any existing state of affairs may and often does, lead to improvement, while, on the other hand, ignorant meddling is likely to be followed by disastrous consequences.

Nowhere do we see the bad results of false conceptions more marked than in our treatment of infants and children.

We should rear our children with as little interference as possible, allowing them the utmost freedom compatible with their safety, and permitting them to do those things that nature and instinct demand. Above all let them sleep as much and as long as they will, insist that they live in the open air, and encourage them in every possible way to perfect their physical education by those active amusements that they instinctively prefer. After they have established a sound and rugged constitution ample time will be left for them to develop mentally.

Feeding of Nursing Infants.—The most important thing in connection with the feeding of infants is to always remember that nature has provided in their mother's milk, when sufficiently abundant and normal in quality, everything in the way of food and drink that they require. During the three days that usually intervene between birth and the coming of the milk in the mother's breast, infants may be given from time to time small quantities of pure water, but under no circumstances should anything else be allowed. During this period the child may be put to the breast four or five times in the twenty-four hours, for, while it gets but little in the way of nourishment, there is even at this time a watery fluid secreted in the breast that goes far towards supplying everything that the infant needs for the time being.

A child should never nurse longer than twenty minutes at one time. It is likewise of importance that the time of nursing be strictly regulated.

Particularly during the first year it is of the utmost importance to watch with an intelligent eye the growth and development of the child. Where the milk agrees with it it has a good color and gains regularly in weight; it cries but little, and is good natured, and thoroughly contented. Should it, on the other hand, lose weight, appear fretful and listless, and sleep badly, there is something wrong, and the mother should at once have her milk examined by a competent physician.

In case the mother does not give sufficient nourishment there is no objection to partially feeding the infant on modified cow's milk—the method of the preparation of which will be considered later on.

Where colic occurs it generally means that the infant is getting a diet too rich in albuminous foods, which should be corrected by advising the mother to take an abundance of out-door exercise, and to avoid all causes of worry so far as is possible.

Vomiting freely is a very common occurrence in small children, and is usually the result of too much food being taken at a time. It also occurs, particularly some time after feeding, as a result of indigestion, which is frequently the consequence of the milk being too rich in fats. Wherever an infant shows signs of trouble it is well to advise the mother to use a diet less rich in meats, and to caution her against over-eating.

Children should be weaned at the end of their first year. This had best be brought about gradually, by, in the beginning, feeding the child once daily, and then gradually increasing the frequency, at the same time proportionately leaving off the nursing. Where children are not thriving, it is often a good practice to wean earlier, in which case modified cow's milk, taken from a bottle, must be substituted.

Artificial Feeding.—While it is true that children often thrive for a time on the various baby-foods with which the market is so abundantly supplied, it is, nevertheless, the case that where fed in this way they are very apt to develop rickets or scurvy, and not uncommonly show evidences of bad nutrition in loss of weight and strength, becoming peevish and fretful, and sleeping badly.

Much better than any of the artificial foods is properly modified cow's milk, which, with care, may be prepared in such a manner as to take the place of mother's milk in the vast majority of instances. In order, however, that this be successfully carried out, much care and attention is necessary.

It is highly necessary in feeding infants by the bottle to remember that cleanliness in everything connected with the process only makes success possible, and in no particular does this apply with greater force than in connection with the proper care of the bottle and nipple. In every case immediately after use they should both be put in water, which should then be brought to a boiling temperature, and both should then be kept in a saturated solution of boric acid. The nipple, after being placed on the bottle, should not come in contact with anything but the infant's mouth. Bottles that have no neck are much to be preferred to others, as they can be readily cleansed. There is on the market at the present time a bottle called the “Hygeia,” which possesses the necessary qualifications in a perfectly satisfactory way.

When children who have nursed at the mother's breast reach the age of weaning it is of importance to remember that they cannot eat without digestive disturbances the modified cow's milk of a strength that would otherwise correspond to their age; they should invariably under such circumstances begin with a milk prepared by the formula used for a child several months younger, after which the proportion of milk may be gradually increased until it is used in a pure state.

During very warm weather it is well to reduce the amount of fat by using the whole milk instead of the top portions, as heretofore described. The same precaution should be followed where children have acute diseases, and the total quantity taken should be less than under ordinary circumstances. Where infants have acute indigestion, accompanied by vomiting and diarrhœa, all milk should be for the time withheld,—boiled water being substituted; some hours later barley water may be given, but no milk for at least twenty-four hours. Where children have loss of appetite, it is well to give less cream, and the intervals between food should be increased.

Sterilized (Pasteurized) Milk.—During epidemics of dysentery, diarrhœa, typhoid fever, scarlet fever, and diphtheria, as well as in those instances where it is suspected that the cow is not healthy, or where the milk has to be kept for considerable periods of time, it is well to sterilize it by heating. The most effective method of accomplishing this is by boiling the milk for an hour or so, but inasmuch as it is believed to be then not quite so wholesome as when less heat is employed, a process known as pasteurization is frequently used; this consists in heating the milk for thirty minutes to from 155° to 160°F.,—such temperatures killing all of the ordinary germs, but not altering the milk so completely as when it is boiled.

Peptonized Milk.—It now and then happens that children fail to thrive where all of the precautions heretofore referred to have been strictly adhered to, and under such circumstances good results are frequently secured by subjecting the milk to a process known as peptonization. This consists in the addition of a digestive ferment, obtained from the pancreas of lower animals, together with ordinary cooking-soda. In carrying out the process the milk, whether whole or modified, is placed in a clean bottle, and the peptonizing powder added after having been rubbed up with a teaspoonful of milk. The container is then placed in a pitcher of water at a temperature of 110°F., which is about as warm as the hand can bear comfortably, and is here left for from ten to twenty minutes if only partial peptonization is desired, or for a couple of hours should it be wished to complete the process. The peptonized milk may be prepared at each feeding, or the whole amount for the day may be made at one time in the morning; in the latter case, where it is desired to have the milk only partially peptonized, the ferment should be destroyed by boiling after it has been allowed to act for from ten to twenty minutes.

Feeding after the First Year.—As the infant is weaned other food should be gradually added; this should still consist largely of milk, to which some time later may be added gruels prepared from well-cooked oats or barley, beef-juice, or the white of an egg slightly cooked. The various broths may also be allowed. Children relish very much all fruit-juices, and they may be given in moderation without harm, and even with benefit in many cases. As the child grows older, the various cereals should form a greater and greater proportion of its diet, but due care should be exercised in always seeing to it that they are thoroughly cooked; in order to be digestible for children such substances should be cooked at least three or four hours before eaten.

General Hygiene of Infant Life.—In order for children to be healthy, the greatest regularity is necessary in their habits. They should arise at a certain hour in the morning and go to bed at a fixed time at night. Their clothing should be loose, and not too tight fitting, and should at all times correspond to the state of the weather. Nothing is more common, and nothing produces irritability, loss of sleep, and even serious general disturbances in infants, more frequently than too much clothing. It is generally customary to use from the time of birth and during the period of infancy a flannel band around the child's abdomen. Just how this acts is not clear, but there seems good reason for the belief that in some unexplained way the practice has the effect of warding off intestinal disturbances, and is, therefore, to be recommended.

Napkins should be changed when soiled, and then should be immediately placed in water, in which they should remain until washed out; under no circumstances should they be left lying around the nursery.

When the weather permits, the child should be kept as much out-of-doors as is possible. For the first few days of the infant's life, particularly if the weather be cool, it should, of course, be kept indoors, but even then free access of air should be allowed. There is no objection whatever to the infant sleeping out-of-doors—in fact, where this is feasible, it generally shows improvement as soon as the practice is commenced. When out-of-doors, it is of course necessary to see that the sun does not shine directly into the infant's face, and wetting should, of course, be avoided; also the hood of the carriage should be arranged to prevent strong winds from blowing on the child.

The nursery should be well aired, a window being left up at night except during severe weather.

Sleep.—Nothing is more important for the proper development of a child than for it to have an abundance of sleep. During the first few months of its life it sleeps practically all of the time—the period becoming gradually lessened as it grows older. Infants should be suffered to sleep just as much as is possible, it being not only unjustifiable but absolutely criminal to interfere with them in this particular in the slightest degree. Not only is it necessary that infants have all the sleep that they desire, but it is true throughout childhood, a fact to which many foolish parents seem utterly oblivious. How often do we see a child scarcely more than an infant aroused in the morning and sent off to school, and how frequently do we hear misguided parents boast of their inflexible rules in enforcing such evil practices. Truly man comes hard by the knowledge that nature is much wiser than he, and the vast majority never learn the fact at all.

As soon as the child is able to crawl, it should be placed on a clean quilt or blanket on the floor, and allowed to move about to its heart's content. When it is able to walk, allow it to run about and play to its full capacity—as in such exercises consists the great school of its physical being, the school upon which will depend its strength and health in after life. Allow the child to keep up his play as long as he has any inclination to do so, and never be so foolish as to confine him in the house when he wishes to be out under the blue heavens, for here only will it be possible for him or her to develop into a real man or woman. Allow this to go on until the child of its own accord comes and asks to be taught other things, for not until then is its outside education nearing completion, and not until then is it possible for him to take interest in and learn things connected with books. No boy should ever be sent to school before he is twelve or fourteen years of age; girls, on account of their maturing earlier, may begin a couple of years sooner.

The whole science and art of properly raising children consists in feeding them good clean food in proper amounts, in never allowing them to be awakened, and in permitting them to play in the open air to their hearts' content.

Teething.—Teething is a subject which has at all times interested both doctor and layman, and in its supposed relation to all kinds of disorders of infancy has undoubtedly exercised an influence over the popular imagination out of all proportion to its real importance. Too often it has happened that this perfectly normal, and usually by no means serious, process, has been held responsible for grave diseases in children—diseases which in reality were the consequence of neglect and mismanagement in the far more serious matters of food, sleep, out-of-door exercises, and general hygiene. It cannot, however, be denied—particularly in respect to nervous children—that teething appears occasionally to induce unpleasant disturbances, such as fretfulness, broken sleep, digestive disorders, and occasionally fever; as a rule such symptoms persist only for a few days, if the infant be properly looked after. The treatment should consist in lancing the gums should they become much swollen, and the withholding of the usual amount of food, particularly where intestinal disturbances occur. The ages at which the teeth usually come are as follows: