and set in hot water until the temperature of the milk is 98 degrees. A higher or lower temperature is absolutely injurious to the infant." QUANTITY OF FOOD FOR EACH FEEDING. The number of feedings in 24 hours has been given on page 96. Doctor Fry believes that a frequent cause of failure to raise babies on modified milk is that they are overfed. He considers one to two tablespoonfuls sufficient for each feeding during the first few weeks of life. "At one month of age give two to three tablespoonfuls; at six weeks three to four tablespoonfuls; at two months four to five tablespoonfuls. Increase the quantity at the rate of one ounce each month up to six months of age. Two tablespoonfuls make an ounce. Another trouble is the When nursing at the baby gets the food into its stomach too fast. breast the baby requires from fifteen to twenty minutes to suck the nourishment. When fed with the bottle it often obtains its food in five minutes." In this connection it should be remembered that no substitute for human milk as yet prepared can take the place of a sound mother's milk, and that as long as we are compelled to resort to infant feeding we should feel our way gradually, bearing in mind Biedert's conclusions, that a bottle-fed infant thrives best when the minimum amount of food necessary for development is given. If in the course of feeding symptoms of diarrhea, with green stools, appear, it is best to stop the milk altogether and feed the baby with albumen water, barley water or rice water and consult a physician at once. Barley water is made as follows: Take two tablespoonfuls of pearl barley, add one quart of water, boil for three hours, add enough water to keep the quantity to one quart, strain through coarse muslin. Keep well covered in refrigerator, warm to 98 degrees before using it. Rice water is made in the same manner. CARE OF THE NURSERY REFRIGERATOR, NURSING BOTTLES, NIPPLES, UTENSILS, ETC. It is absolutely essential that intelligent and careful attention should be paid at home to the cleanliness of bottles, nipples, dippers, cooking utensils, etc. The nursery refrigerator must be metal lined and kept clean, aired free from odors and well supplied with ice (unless the place in which it is kept has a temperature less than 50 degrees). "The bottles can be cleaned as follows: Rinse with the brush in cold water in which a little washing soda is dissolved, then wash and brush thoroughly with soap and hot water and rinse again in sterile water. * Or the bottles as soon as emptied can be filled with cold water to which a little bicarbonate of soda is added. Before being refilled they should be thoroughly washed with a brush and hot soap suds and then boiled for twenty minutes. Never let a nursery bottle stay dirty after use until the milk dries in it. The neck of the bottle should be large enough to permit easy cleaning and it should have no corners or angles on the inside. The nipples should be of rubber and made so that they can be easily turned inside out for cleaning. New nipples should always be boiled before use. Immediately after use the nipples should be washed in soda water and kept in a solution of boric acid and when wanted again they should be rinsed in water." Attention to these details should not be neglected, as the life of the infant depends upon absolute cleanliness of the food at all times, and especially during the warm months. From what has been said on this subject it is evident 1. That no effort should be spared to secure the enactment of more stringent laws regulating the production and sale of pure milk and cream. 2. The establishment of day nurseries, where the infants of those who are obliged to go out to their work may be properly cared for, is urgently called for. 3. The establishment of dispensaries, where intelligent instructions are given in infant feeding, and modified milk sold at reasonable rates, would be in the interest of public health and humanity. It is gratifying to note that such a Dispensary was started April 13, 1908, in connection with the Neighborhood House in Southwest Washington. According to Dr. Wm. J. French, up to October 1, 1908, 261 infants and children have been treated. There were but 3 deaths. The Records of the Health Office show that during 1907 there were 50 deaths in Southwest Washington in children under 10 years of age, while during the year 1908 there were but 29 deaths in children of the same age period, in spite of the very hot summer. Dr. French very justly considers the clean, pure milk, and the instructions furnished by the Dispensary factors in this marked reduction of mortality rates. THE PREVENTION OF PERMANENT DISABILITIES IN CHILDHOOD. The writer, in his sociological studies of physically defective persons who contribute such a large contingent to our charitable institutions, has felt convinced that many of these partial and complete disabilities could have been prevented by proper care and treatment in childhood. It is now well known that many of the joint deformities in children are amenable to treatment and that a ruptured child or person may be radically cured. As a member of the Board of Charities he recommended that the physicians to the poor and agents of the Associated Charities be requested to encourage the parents of such children to authorize operative procedures or hospital treatment, for the prevention of permanent disabilities. The result, within the past year, more than justifies a general acceptance of these principles. The records of the Children's Hospital reveal the gratifying fact that the operations for the radical cure. of hernia, for example, have increased from 9 in 1907 to 25 in 1908, and that every child was discharged as cured. The increase in the number of joint cases and deformities treated is also very marked. In order to determine the number of physically defective children in our graded public schools the Health Officer and the Board of Education authorized a general medical survey of the pupils. The examination was conducted by the Medical Inspectors of the Schools under the general direction of Dr. Henry C. Macatee, Assistant Secretary of the President's Homes Commission. The results have been tabulated by him and will be found in Table A. From this table we learn that, out of 43,005 pupils in the graded schools, 13,407 were colored and 29,598 were white. Among the colored children 3,784 instances of the defects listed in the table were encountered, or a relation of 28.2%; among the white pupils 11,520 notations of defects, a relation of 38.9% to the whole were encountered. The difference in percentage of defects between white and colored children is solely due to better condition of the teeth in the colored children. Total defects noted, 15,304, or 35.5% of the pupils examined. These percentages, high as they may appear, are very much lower than the rates reported from New York. Omitting from this consideration the 6,698 pupils who probably needed only dental care—a matter of importance, however, to the general health -we still have to deal with 8,606 pupils, or 20% of the total, whose physical condition should be a matter of grave concern to the parents. Of this number 149 were crippled, 272 deformed, 461 had strabismus (squint), 312 had discharging ears, 835 defective hearing, 2,176 defective vision, 2,062 were "mouth breathers," 703 were undersized, 727 ill nourished and 934 were anemic. It was not deemed best to conduct physical examinations involving the removal of clothing and hence the number of ruptured children could not be determined, but, judging from the reports of the agents of the Associated Charities, the number is sufficiently great for serious consideration. It will be readily conceded that every crippled or deformed child should, if possible, be spared from permanent disability, and no thoughtful parent should hesitate to act when attention is directed to the serious consequences of neglect. Poverty is no excuse for the "do nothing system," as the medical charities offer adequate facilities for treatment of persons unable to pay for the same. Nor is there an excuse for not attempting to cure discharging ears, defective hearing or vision, since every observer is familiar with the sad consequences of such defects in the ultimate struggle for existence. Parents may not know that a child afflicted with a squint, harelip or cleft palate may be transformed into a vicious character, because it is the object of constant ridicule within and without school; and that all of this could be avoided by a timely operation. Parents are probably not aware that many of the nervous affections and even mental defects in boys are due to some slight malformation of the genital organs, for which the Hebrews instituted circumcision. Nor is it generally known that anemic and ill nourished children and those suffering from enlarged tonsils, cervical glands, or post-nasal growths, and the majority of "mouth breathers" are peculiarly susceptible to disease in general and to tuberculosis in particular. Lastly, there is no good reason why special attention should not be given to the physical development of undersized children or those affected with slight muscular deformities, which, if left uncorrected, will be a source of regret and even reproach to the teacher and parent. The remedy lies chiefly in education, and for this purpose the study of hygiene should be made an important part of the school curriculum. In this way the parents may be reached through the child. Instructive visiting nurses should be appointed for the schools so that they may follow the child to the home and point out to the parents the desirability of securing prompt professional advice in all cases where it is indicated, and especially in instances where neglect is likely to result in permanent disability. In this general educational campaign the Medical Inspectors of Schools, teachers, social settlement workers, agents and friendly visitors of the Associated Charities can render a distinct service to the child and the State. |