Part II are to be followed here, but with a baby the in- (Part 3)

the nurses or attendants go from one sick-room to the Safeguard other. A sheet hung across the doorway of. the pa- suSapended tient's room, and kept wet with a deodorant or with wet sheet piam water, is an additional safeguard. At the end of the convalescence, the nurse and pa- Care tient must take baths in bichloride of mercury, fol- leaving lowed by warm soap and water. Even the hair should roomick" De carefully washed, and afterward the clean clothing must be put on outside the sick-room. The utmost precautions regarding fumigation should be observed. Anything which can not be ren- CONTAGIOUS DISEASES 377 dered absolutely germ free must be destroyed. It is wise to provide the child with inexpensive toys and Precautions r . regarding books which may be burned when he leaves the sick- fumigation room. Most chambers are not very well planned for contagious disease. We hardly realize how many catch-alls for germs there are until we carry a patient through some such illness, and the question of disin- fection comes. A thorough fumigation with formaline vapor is probably effective enough to make the ordinary fur- Effective nishings safe for use, but unless one is assured of the furr»gatlori results, the risk seems hardly worth taking. If the walls are papered, it is much wiser to have them scraped and repapered or painted. Woodwork and paint should be washed with a disinfectant, as well as being subjected to the general fumigation. When a house is large enough, it is a very good plan to set aside one room as a "hospital ward." It An ideal should be sunny and airy, with facilities for easy venti- "hospital lation, and no furniture which can not be easily cleaned, in the Hardwood floors, painted walls, an iron bedstead, and ome no draperies are some of the essentials, all of which have been more fully discussed in a previous chapter. A bathroom or running water and a closet should be close by, and if there could be a separate staircase, so that the room could be completely isolated, the condi- tions would be still more ideal. DIPHTHERIA Diphtheria is also an infectious and contagious dis- ease, often resulting from imperfect sewage. Care- Search ful examination of drains and pipes should be made the x * m cause of wherever there is a case of diphtheria, in order that diphtheria the spreading of the disease may. be prevented. It attacks children of all ages, and adults as well, 378 CARE OF CHILDREN and one is not immune after one attack. It results from a micro-organism, which causes the growth of a false membrane over the lining of the throat. The tonsils are first attacked, and it is there that Symptoms we first notice the exudation, which is of a character- theria istic gray color. In children, there may be more delay in recognizing the disease, because they do not make us understand their symptoms. Any sore throat with spots on the tonsils should be regarded as suspicious, until it can be proved to be a simple disorder. The onset is very like acute tonsilitis, with head- The onset ^j^ chJUy sensations, and pain and soreness in the bones and muscles. The glands in the neck are usually somewhat enlarged and in very young children this may be the earliest noticeable sign. The temperature is not always high, though it may run to 105 °. The attack may begin twenty-four hours after exposure, or it may be three weeks before there is any sign of it. Examina- A suspected case of diphtheria should be immedi- tion of ately isolated, and a doctor will remove some of the exudation J ' exudation in the throat, and will subject it to micro- scopical examination, in order to pronounce definitely upon the nature of the trouble. In the meantime, the patient must be kept very quiet, great care must be taken to keep up his strength Treatment with nourishment, which should always be liquid, and generally some sort of stimulant will be ordered for the same purpose, as the prostration is extreme. The treatment of diphtheria consists of strict regard to hygienic conditions, in the administration of remedies to counteract the effect of the poisonous germs which produce the disease, and by operation, either intuba- tion or tracheotomy. The second form of treatment consists generally of the injection of what is called antitoxin serum. This CONTAGIOUS DISEASES 379 treatment is the result of investigations in bacteriolog- i • • 1 'Antitoxin ical laboratories, in order to find a fluid, which taken serum into the blood of a patient suffering with diphtheria would arrest the growth of the bacteria which cause the disease. This fluid is serum from an animal which has been rendered immune to the disease by inocula- tion with the poison which brings it about. When physicians began to use antitoxin, so many disorders seemed to arise in consequence that it came to be regarded very unfavorably by many persons. Its value as a remedial agent in all instances is per- haps not unquestionably established, since its opponents can still point to some cases where its administration has been attended with serious consequences. The conditions under which it is prepared have improved, serum in and the results are in general so good that with most dlPhthena physicians its use is a routine measure in cases of diphtheria. This treatment is, however, left entirely to the doctor's judgment, the attendant's part being to follow orders with explicit exactness. The throat and nose will require careful swabbing, and as the discharge is extremely poisonous, the nurse Bum the must be careful not to receive any of it on her face or ^dnose clothing. The cotton used for the throat as well as the swabs cloths which receive the expectoration must be burned. Bed, linen, dishes, and room must be most carefully disinfected before being used again. With children, the disease progresses so rapidly that sometimes the breathing and swallowing are al- most entirely obstructed by the swelling of the air- passages before the real nature of the trouble is recognized. In such a case a metal tube is sometimes inserted, either through an incision made from the intuba- outside into the breathing passage, which is called {richest- tracheotomy, or through the mouth, a process known omy Atmos- 380 CARE OF CHILDREN as intubation. An atmosphere of steam greatly re- lieves the difficult breathing, as it does in bronchitis or in croup. The tent and vaporizer described in the foregoing phere of pages on croup may be used here with good results. If any drug is used in this connection, it should be one prescribed by a physician. As with scarlet fever, the complications are to be most carefully guarded against. The heart becomes The weak very weak, and any violent exertion, such as sitting heart with 111 • r diphtheria up suddenly or reaching for something, is an actual danger. Even very mild cases may be followed by a slight temporary paralysis, more often manifested in the throat, when it interferes with speech in small measure and with swallowing to a considerable degree. The general condition after diphtheria is one of great exhaustion, and associated as it is with weakness of the heart, it needs time and rest and nourishing food in order that health may be firmly re-established. While scarlet fever and diphtheria are most serious and heart diseases and are sometimes attended by alarming con- nurSng" sequences, it is a comfort to remember that they may these dis- take a mild form, when recovery is speedy and un- eases 1 eventful. This does not mean that care and watchful- ness can be relaxed in any case, but it will perhaps re- move some of the unreasoning horror, which really incapacitates a mother from making her best effort. VII PROBLEMS OF PUBERTY Development of the Child— Puberty— Instruction to the Child— Masturba- tion—Menstruation— Bathing during Menstruation DEVELOPMENT OF THE CHILD THE physical and mental development of children proceeds along certain well-defined lines — as their relations to their environment become more com- plex, their needs are correspondingly multiplied. The first requirements are the nourishment of the body and the growth of its tissues to fit it for its place festive6 in life, hence the early development of function is tract largely confined to the digestive tract — the increase in the size of the stomach, the appearance of teeth, and the gradually acquired ability to take and digest a varied diet. Locomotion opens the world to the child, putting it Locomo- into communication with things and persons outside it- self. The relation, however, lacks the personal element. It is Nature, not personality, that impresses him ; in fact, he is living outside the world of social relations. The power of observation comes to him before he The power understands what he sees, and the last faculties to de- £fODobserva' velop are those that concern his life with his fellows. Interest in them, friendliness and affection are aroused first, and Nature reserves her gift of sexual power till she has fortified her children to withstand its dangers, and has given them power and knowledge to use it wisely. This is what puberty ought to mean — a (381) 382 CARE OF CHILDREN What Pu- coming into the full inheritance of vigor, strength and means power, and that is what it can mean, if we ever open our eyes and see where Nature and the evolution of her laws are leading us. PUBERTY The age oi The "age of puberty" extends over the years be- puberty tween thirteen or fourteen and sixteen, various circum- stances modifying the time of development, climate, race, occupation, and method of living causing great differences. The changes that are taking place are those concerned in the growth and development of the gen- erative organs, but this rapid growth entails very sig- nificant changes in the mental and nervous nature, which make the need of oversight and careful guid- ance especially important. In either sex, the changes are preparatory to the establishment of the function of reproduction. In both man and woman there is the growth of Physical nair about the pubis and in the armpits. With males the"boy "* ^s growth is found also on the face and chin, and often exists more generally over the surface of his body than on that of the female. The shoulders broad- en, the vocal cords lengthen and the voice grows deeper. The changes in the generative organs are the increase in size, the strengthening of muscular power, and the secretion of the fluid containing the repro- ductive germ. The physical changes in woman are somewhat changes1 in more general, because her form must be adapted for the girl the work of child-bearing. There is a general filling out of the frame and a broadening of the hips as the pelvis increases in size. The breasts rapidly begin to develop, and the quality of the voice is altered. The internal changes, however, are more marked. PROBLEMS OF PUBERTY 383 Immature ova are present in the ovaries from birth, but at this time there is established the periodic dis- charge of one or more of these ova, which, with the bloody fluid that accompanies it, constitutes men- struation. If these functional changes were all, there would be reason enough for increased care regarding the Mental and . . -. . . . fe . , , spiritual hygienic conditions, m the lives of young girls and changes boys at this period, but the differences that become manifest in their tastes, in their characteristics and in their attitude toward their fellows in the family and out of it, denote a modification in the nervous system which works the miracle of transforming the boy to a man and the girl to a woman. This rapid evolution is not without its painful side. The grace and unconsciousness of childhood are gone ; a keener sensitiveness, a fear of criticism, and often an occasional deep depression of spirits make them- selves felt. There is besides a deepening joy in exist- ence. A feeling of responsibility has awakened, which may have interfered with the child's spontaneity, but high ideals, ambition, and the desire for the best things of life are stirring within the heart, and the time is ripe for fixing the nobler aspirations. These feelings are not well defined ideas in the child's mind, which is chiefly a seething chaotic mass awaiting creation. INSTRUCTIONS TO THE CHILD As the child approaches the age of puberty, spec- ulations inevitably arise in his mind about the prob- problem of J r the repro- lems of life, which have to do with his own develop- auction of ment and with the reproduction of the race. This is the time when he should have careful, conscientious instruction from his parents or other close friends, 384 CARE OF CHILDREN before unscrupulous enlightenment of most repulsive detail has been given him by vulgar and perhaps debased comrades. There is no reason why this knowledge should The simple come with a shock to a child, if due preparation for it tkSisTrom has been made by the parents. Life is always an inter- low"? and esting subject to him, and it may be studied and its animals different processes explained with absolute simplicity in plants and in the lower animals. He will make no application to human functions until the questionings begin to stir and then he will draw his conclusions quite naturally, and there will be a much less violent adjustment of his point of view. A child who knows Miss Morley's "Song of Life," ,. or who has been shown how some plants bear both The old- r fashioned pistillate and staminate flowers, and the methods of deceptions fertilization when these flowers are borne by different plants, can not long be deceived by the tiresome plati- tude about the new baby's journey in the doctor's bag. Deception is not necessary. It often does not deceive, but almost invariably destroys confidence. It is often legitimate to refuse to answer a child's questions, but one gains more by telling him that he must wait till he is older than by a falsehood that may seem plausi- ble, but which he will inevitably recognize later as a deliberate untruth. Nature's work is the mother's best assistant, and work'the the view that one gets of life processes in that way ™e°stther's has a beauty and a dignity which one can ill spare, assistant but which in our halting human account of them we do not always convey. Reverent, dignified, straight- forward expression is what a child should receive. There should be no veiled language, but the portion of the fact which is to be given should be told with simple exactitude. PROBLEMS OF PUBERTY 885 Above all he should be made to feel that the ques Donotdis- tioning is expected and that the feelings that prompt confidence it are understood, and that the parents are his natural child16 confidants, with whom he can talk over his perplexi- ties. When the mother observes the first changes which accompany puberty, she should explain to the boy or ^h girl the meaning of them. In the case of the boy plaining i • i r ±i • At a ji • the mean- there is not the same necessity for this that there is mg of the with a girl, though we must not lose sight of the fact changes that the same sort of forces are seething within his nature and the time is perhaps more critical with him than with his sister. The external signs may distress her exceedingly, and if the menstrual flow comes on before she understands about it there may be serious consequences resulting from her ignorance. She may resort to hot water or sea baths or some such violent measure, which will very probably check the flowing, and the nervous shock may have serious consequences. Not to explain the changes is, besides, unfair treatment — which we should above all things avoid in our dealings with children. We have spoken of the gradual evolution of the faculties of a child in the order of their complexity. In the beginning of each, instinct rules its use until reason enters in. , The full development of the sexual power brings The in- with it a riotous flood of sensations. The child who ^capacV has always been swayed bv his sensations, who has ty for sen . . sation gained his knowledge and had his pleasure through the sense-perceptions, finds that with the door to adult life thrown open to him the capacity for sensu- ous enjoyment has deepened. This realization of the character of the sexual l7 Vol. 3 386 CARE OF CHILDREN Teaching self- control When the develop- ment has been un- even The old fable of woman's creation Mother- hood not woman's sole end life may be delayed long past the age of puberty, and certainly will not be felt till the development of the sexual function is complete, but certain teachings can forewarn him of the need of self-control and of the danger of following the guidance of instinct. The surest safeguard, the best preparation that can be given a child for the conflict between these surging forces that rise to do battle within him is that health of mind and body which comes from well-balanced development. When the physical and emotional sides have been hedged in and their expression restricted or limited tp the playtime, when it is as a rule quite undirected, there are fewer pleasurable activities to absorb the attention, and considerations of the new sensations are held in exaggerated importance. On the other hand the mind is incapable of forming judgments or of exerting will power if the physical education has been at the expense of or unaccompanied by the intel- lectual.