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+The Project Gutenberg EBook of The Eugenic Marriage, Volume I. (of IV.), by 
+W. Grant Hague, M.D.
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: The Eugenic Marriage, Volume I. (of IV.)
+       A Personal Guide to the New Science of Better Living and Better Babies
+
+Author: W. Grant Hague, M.D.
+
+Release Date: October 21, 2006 [EBook #19594]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK EUGENIC MARRIAGE ***
+
+
+
+
+Produced by K.D. Thornton, Jason Isbell, Keith Edkins and
+the Online Distributed Proofreading Team at
+http://www.pgdp.net
+
+
+
+
+
+Transcriber's note: A few typographical errors have been corrected: they
+are listed at the end of the text.
+
+[Illustration: Eugenics Hath Its Own Reward]
+
+The Eugenic Marriage
+
+A Personal Guide to the
+New Science of Better
+Living and Better Babies
+
+By W. GRANT HAGUE, M.D.
+
+College of Physicians and Surgeons (Columbia University), New York; Member
+of County Medical Society, and of the American Medical Association
+
+In Four Volumes
+
+VOLUME I
+
+New York
+
+THE REVIEW OF REVIEWS COMPANY
+
+1916
+
+Copyright, 1913, by W. GRANT HAGUE
+
+Copyright, 1914, by W. GRANT HAGUE
+
+       *       *       *       *       *
+
+
+                                                                        [i]
+INDEX OF THE FOUR VOLUMES
+
+NOTE--The Roman numerals I, II, III and IV indicate the volume; the Arabic
+figures 1, 2, 3, etc., indicate the page number.
+
+Accidents and emergencies, IV, 629.
+
+Accouchement Beds, how to prepare, I, 65.
+
+Acne, IV, 576.
+
+Adenoids, IV, 519; how to tell when child has, IV, 520; treatment of, IV,
+521.
+
+Adentitis, acute, IV, 558; causes of, IV, 558; symptoms of, IV, 558;
+treatment of, IV, 558.
+
+Advice to young wives, III, 357.
+
+After-birth, expulsion of, I, 101.
+
+After-pains, I, 103.
+
+Age at which to marry, III, 331.
+
+Albumen water, II, 245.
+
+Alcohol, in patent medicines, III, 455.
+
+Alcoholic drunkenness, I, 44; Dr. Branthwaite on, I, 45; Dr. Sullivan on,
+I, 44.
+
+Amenorrhea, causes, II, 192; absence of menstruation, II, 191; treatment
+of, II, 192.
+
+Anemia, severe, IV, 567; simple, IV, 565; treatment of various forms, IV,
+567.
+
+Anesthetics, new, IV, 654; use of in confinements, I, 112.
+
+Angina, IV, 508.
+
+Anti-meningitis, serum, IV, 656.
+
+Aperient waters, abuse of in constipation, III, 326.
+
+Appendicitis, IV, 546; treatment of, IV, 546.
+
+Appetite, loss of, II, 287; poor, II, 286; treatment for loss of, II, 288.
+
+Arrest of hemorrhage, IV, 635.
+
+Artificial Food, II, 249; formulæ for, II, 253; mistakes in preparing, II,
+267.
+
+Aseptic surgery, IV, 653.
+
+Baby, amusing the, II, 217; bathing the, II, 213; care of eyes, II, 215;
+care of genital organs, II, 216; care of mouth and teeth, II, 215; care of
+newly-born, II, 210; care of skin, II, 216; clothing of, II, 214;
+constipation in bottle-fed, II, 309; food for first year, II, 261; fresh
+air for, II, 232; how it gets nourishment in womb, II, 183; how long it
+should sleep, II, 236; how to weigh, II, 220; hygiene and development of,
+II, 209; intervals of feeding, II, 225; night-clothes of, II, 215;
+overfeeding the, II, 224; proper way to lay in bed, II, 235; what to
+prepare for the coming, II, 209; why it cries, II, 237.
+
+Baby's comforter, II, 241.
+
+Bacteria, what happens if we inhale, III, 410.
+
+Barley gruel, II, 244.
+
+Barley water, II, 244, 256.
+
+                                                                       [ii]
+Bath, bran, IV, 591; cold, for reducing fever, IV, 590; cold sponge or
+shower, IV, 592; during pregnancy, I, 76; hot air or vapor, IV, 591; hot,
+IV, 591; mustard, IV, 590; tepid, IV, 592; various kinds of, IV, 590.
+
+Bathing, the baby, II, 213.
+
+Bed, proper way to lay baby in, II, 235.
+
+Bed-wetting, IV, 580.
+
+Beef juice, II, 262.
+
+Beef or meat pulp, II, 244.
+
+Bichloride of mercury solution, IV, 627.
+
+Binder, how to apply, I, 66.
+
+Birth, management of, I, 99.
+
+Birth-chamber, the, I, 61.
+
+Birth marks, I, 128.
+
+Bites, dog, IV, 638.
+
+Blackheads, IV, 576.
+
+Blood, children suffering from poor, IV, 566; poor, IV, 565.
+
+Boils, IV, 559.
+
+Boracic Acid, solution of, IV, 626.
+
+Bottle-feeding, method of, II, 256; what a mother should know about, II,
+264.
+
+Bowels, daily movement necessary, II, 307; how to wash out, IV, 586;
+importance of clean, II, 306.
+
+Boy, building of, II, 139; chancre, the, II, 145; gonorrhea or "clap," II,
+142; sex-hygiene for, II, 139; social evil, II, 141; sources of immorality,
+II, 141; syphilis or "pox," II, 144.
+
+Brain, complications of in syphilis, II, 146.
+
+Bran, as a food, II, 292; bath, IV, 591; muffins, recipe for, II, 311.
+
+Branthwaite, Dr., on alcoholic drunkenness, I, 45.
+
+Bread, II, 273.
+
+Breasts, care of when weaning, I, 125; colostrum in, I, 108; how long
+should baby stay at, II, 225; putting baby to after labor, I, 108.
+
+Bronchitis, IV, 511; chronic, IV, 515; diet for, IV, 513; drugs in, IV,
+514; external applications for, IV, 514; inhalations for, IV, 513; in older
+children, IV, 512; symptoms of in infants, IV, 512; treatment of IV, 512.
+
+Broncho-Pneumonia, acute, IV, 516; symptoms of, IV, 516; how to tell when
+child has, IV, 517; treatment of child with, IV, 517.
+
+Bruise, or contusion, IV, 633.
+
+Burbank, Luther, on education, I, 24.
+
+Burning Clothing, how to extinguish, IV, 641.
+
+Burns, and scalds, IV, 641.
+
+Calomel, II, 297; how to take, II, 297.
+
+Cancer, in women, III, 442; what every woman should know about, III, 442.
+
+Carron oil, solution of, IV, 627.
+
+Castor oil, II, 295; how to give dose of, II, 296.
+
+Catarrh, acute nasal, IV, 500; symptoms of, IV, 500.
+
+Catarrh powders, III, 458.
+
+Cathartics, calomel, II, 295; castor oil, II, 295; citrate of magnesia, II,
+298; how to give children, II, 295.
+
+Cereals, II, 273.
+
+Chancre, the, II, 145.
+
+Change of life, conduct during, III, 446; the menopause, III, 443; symptoms
+of, III, 444.
+
+Cheerful wife and mother, III, 400.
+
+Chicken broth, II, 244.
+
+                                                                      [iii]
+Chicken-pox, IV, 606; symptoms of, IV, 607.
+
+Child, the delicate, II, 281; diet of sick, II, 279; most helpless living
+thing, II, 279; rate of growth of, II, 221; sick, should be in bed, II,
+277; washing mouth and eyes after birth, I, 102.
+
+Child-Birth, I, 61; fear of, I, 111.
+
+Children, acute intestinal diseases of, IV, 529; constipation in, II, 303;
+hysterical, II, 293; rheumatism in, IV, 569; temperature in, II, 217; with
+whom milk does not agree, IV, 535.
+
+Cholera infantum, IV, 540.
+
+Chlorosis, IV, 566; symptoms of, IV, 566.
+
+Chronic Nasal catarrh, IV, 503; treatment of, IV, 504.
+
+Circumcision, should it be advised, II, 169.
+
+Citrate of magnesia, II, 295; how to take, II, 298.
+
+Clap, or gonorrhea, II, 142.
+
+Clothing, baby's, II, 214.
+
+Coddled egg, II, 245.
+
+Cold-pack, IV, 589.
+
+Colds, catching, IV, 497.
+
+Colic, IV, 544; symptoms of, IV, 545; treatment of, IV, 545.
+
+Colitis, chronic, IV, 538.
+
+Colon, irrigation of, IV, 587.
+
+Colostrum, uses of, I, 108.
+
+Condensed milk feeding, II, 227; objections to, II, 257.
+
+Confinement, choice of physician, I, 69; convalescing after, I, 131;
+domestic problem following first, I, 131; how to calculate date of, I, 66;
+how to prepare bed for, I, 65; lacerations during, I, 116; how long woman
+should stay in bed after, I, 114; position and arrangement of bed for, I,
+64; preparations for, I, 61; selection of a nurse, I, 70; use of
+anesthetics in, I, 112; what to provide for, I, 62.
+
+Confinement chamber, presence of friends in, I, 113; presence of relatives
+in, I, 113.
+
+Constipation, II, 315; abuse of cathartics and aperient waters, II, 326;
+always harmful, II, 321; chief cause of, II, 315; cost of, II, 317;
+diseases of women and, II, 320; during pregnancy, I, 84; in bottle-fed
+infants, II, 309; in breast-fed infants, II, 308; in girls between 16 and
+20, II, 321; in children over two years old, II, 309; in infants and
+children, II, 303; lack of bulk in food, II, 326; lack of exercise and, II,
+325; lack of water, II, 325; negligence of, II, 324; pregnancy and, II,
+321; significance of, II, 305; social exigencies and, II, 319; treatment
+of, II, 323; treatment of obstinate, II, 311.
+
+Consumption cure, III, 461.
+
+Consumptives, information for and those living with, III, 421.
+
+Contagious diseases, IV, 599; conduct and dress of nurse for, IV, 600;
+convalescence after, IV, 603; rules to be observed in treatment, IV, 599;
+what isolation means, IV, 600.
+
+Contusion, or bruise, IV, 633.
+
+Convulsions, IV, 577; treatment of child with, IV, 579.
+
+Cord, cutting, the, I, 102; dressing the, II, 210.
+
+Cough, treatment of, IV, 505; nervous or persistent, IV, 504.
+
+                                                                       [iv]
+Cream, for constipation in infants, II, 309.
+
+Croup, false, IV, 506; treatment of false, IV, 507; spasmodic, IV, 507;
+treatment of spasmodic, IV, 507.
+
+Deaf and dumb, I, 37.
+
+Detention, symptoms of, II, 219; treatment of, II, 219.
+
+Desserts, II, 273.
+
+Diarrhoea, inflammatory, IV, 535; summer, IV, 539; symptoms of summer, IV,
+540; treatment of inflammatory, IV, 537; treatment of summer, IV, 541.
+
+Diet, of nursing mother, I, 121; of the pregnant woman, I, 77; of sick
+child, II, 279; for constipated child, II, 310; older children, II, 271.
+
+Dinner, the first after labor, I, 109.
+
+Diphtheria, IV, 610; symptoms of, IV, 611; treatment of, IV, 613.
+
+Disease, how we catch, III, 409; tendency to, III, 416; vice and, I, 4; of
+womb, ovaries or fallopian tubes, II, 199.
+
+Disinfecting, Clothing and linen, IV, 601; mouth and nose, IV, 602; sick
+chamber, IV, 604.
+
+Dislocations, IV, 640.
+
+Dog-bites, IV, 638.
+
+Douche, how to give after labor, I, 108; the use of when pregnant, I, 76.
+
+Draw-sheet, the, I, 65.
+
+Dried bread, II, 245.
+
+Dusting and cleaning, II, 391.
+
+Dysentery, cause of, IV, 535; symptoms of, IV, 536.
+
+Dysmenorrhea, II, 193.
+
+Ear, foreign bodies in, IV, 631; inflammation of, IV, 556; method of
+removing foreign bodies, IV, 632; treatment of inflammation, IV, 556.
+
+Earache, IV, 555.
+
+Ears, do not box, IV, 554; do not pick, IV, 554; let them alone, IV, 554.
+
+Eczema, IV, 562; of the face, IV, 563; rubrum, IV, 563.
+
+Education, and the educator, I, 29; eugenics and, I, 4; Dr. C. W. Saleeby
+on, I, 22; Dr. Helen C. Putnam on, I, 27; Havelock Ellis on, I, 33; Herbert
+Spencer on, I, 35; Luther Burbank on, I, 24; Wm. D. Lewis on, I, 25; true
+province of, I, 35; what place sex hygiene will find in, II, 162; Ella
+Wheeler Wilcox on, I, 22.
+
+Educational systems, difficulty in devising, I, 27; inadequate, I, 22.
+
+Efficiency, requisites of, III, 346.
+
+Egg, coddled, II, 245; white of, II, 262.
+
+Ellis, Havelock, on Education, I, 33.
+
+Emergencies and accidents, IV, 629.
+
+Enema, High, IV, 588; hot, 586.
+
+Enteritis, cause of, IV, 535; symptoms of, IV, 536.
+
+Entero-colitis, IV, 535.
+
+Enuresis, IV, 580.
+
+Environment, I, 3.
+
+Eruptions of the skin, II, 145.
+
+Establishing toilet habits, II, 240.
+
+Eugenic clubs, mother's, I, 54.
+
+Eugenic idea, the, I, 9.
+
+Eugenic principle, I, 10.
+
+Eugenics, I, 12; definition of, I, 12; education and, I, 21; and history,
+I, 5; husband and, I, 19; marriage and, I, 11; motherhood and, I, 16;   [v]
+parenthood and, I, 15; the unfit and, I, 37; what every mother should know
+about, I, 47.
+
+Exercise enough for husband, III, 347; lack of and constipation, III, 347.
+
+Eye, foreign bodies in, IV, 630; method of removing foreign bodies from,
+IV, 631.
+
+Fake medical treatment, for venereal diseases, II, 167.
+
+Father and the boy, II, 163.
+
+Fault-finding, III, 350.
+
+Feeble-minded, the, I, 37; Dr. John Punton on, I, 42; Dr. Max Schlapp on,
+I, 39; segregation and treatment of, I, 42.
+
+Feeding, artificial, II, 249; artificial from birth to twelfth month, II,
+254; the delicate child condition which will justify artificial, II, 266;
+during second year formulæ for artificial, II, 253; how to prepare milk
+mixtures, II, 259; intervals of, II, 225; overfeeding, II, 223; regularity
+of, II, 227; what a mother should know about, II, 264; why regularity is
+important, II, 228.
+
+Felon, run-around, or whitlow, IV, 640; treatment of, IV, 641.
+
+Female, beginning of, disease, III, 434; chief cause of diseases, III, 436;
+diseases are avoidable, III, 439; generative organs, II, 178; weakness
+cures, III, 470; what woman with disease should do, III, 441.
+
+Fermentation, of the stomach, II, 304.
+
+Fertility, conditions which affect women, II, 196.
+
+Fever, cold packs for, IV, 589; cold sponging for reducing, IV, 589; ice
+cap for reducing, IV, 589; methods of reducing, IV, 589.
+
+Finger, biting the nails, IV, 585.
+
+Fit, the, only shall be born, I, 10.
+
+Fits, IV, 577.
+
+Fly, dangerous house, IV, 645; to kill, IV, 648.
+
+Fomentations, hot, IV, 593.
+
+Food, allowable during first year, II, 261; bran as a, II, 292; formulæ for
+baby, II, 243.
+
+Foodstuffs, IV, 647.
+
+Foreign bodies, in nose, IV, 632; in throat, IV, 633.
+
+Formative period, the, III, 339.
+
+Fraudulent testimonials, III, 467.
+
+Friends, choosing your, III, 367; your husband's, III, 363.
+
+Fruits, II, 273.
+
+Garbage, IV, 647.
+
+Gastric indigestion, acute, IV, 527; treatment of, IV, 527.
+
+Gastro duodenitis, IV, 547.
+
+Generative organs, female, II, 178.
+
+Genital organs, care of, II, 26.
+
+Girl, what a mother should tell her little, II, 173.
+
+Glands, swollen, IV, 558; treatment of swollen, IV, 558.
+
+Gleet, II, 143
+
+Gonorrhea, symptoms of in a man, II, 142; wife infected with, II, 147.
+
+Good health, requirements of, II, 316.
+
+Government investigation of patent medicines, IV, 486.
+
+                                                                       [vi]
+Habits, of delicate child, II, 285.
+
+Hair, falls out in syphilis, II, 146.
+
+Headache, IV, 585; during pregnancy, I, 83; remedies, III, 457; treatment
+of, IV, 585.
+
+Heartburn, during pregnancy, I, 84.
+
+Hemorrhage, arrest of, IV, 635; nasal, IV, 522.
+
+Heredity, I, 3; and eugenics, I, 16; function of education, I, 32.
+
+Hiccough, IV, 523.
+
+High School, system fallacious, I, 29.
+
+Hives, IV, 559; cause of, IV, 559; treatment of, IV, 559.
+
+Home, good housekeeper, III, 389; owning a, III, 400; the ideal, III, 393;
+what makes the, III, 394.
+
+Honeymoon, the, III, 335; marital relations during, III, 336.
+
+Hot pack, IV, 589.
+
+Housefly, dangerous, IV, 645.
+
+Housekeeper, what constitutes an efficient, III, 390.
+
+Husband, and home, III, 404; is he to blame, II, 151; the, and eugenics, I,
+19.
+
+Hysterics, and children, II, 293; treatment of, II, 294.
+
+Ice-cap, for reducing fever, IV, 589.
+
+Ileo-colitis, chronic, IV, 538; treatment of, IV, 539.
+
+Imperial Granum, II, 245.
+
+Incontinence, IV, 580.
+
+Indigestion, acute gastric, IV, 527; acute intestinal, IV, 532; symptoms of
+acute intestinal, IV, 532; treatment of acute gastric, IV, 527; treatment
+of acute intestinal, IV, 533.
+
+Infants, constipation in bottle-fed, II, 309; jaundice in, IV, 547;
+mortality of, I, 2; records of, II, 222.
+
+Infection, direct, IV, 499.
+
+Infectious diseases, IV, 599.
+
+Inflammatory diarrhea, IV, 535.
+
+Influenza, IV, 608; symptoms of, IV, 608; treatment of, IV, 609.
+
+Injections, oil, II, 312.
+
+Insane, care of, I, 43.
+
+Insomnia, during pregnancy, I, 86.
+
+Interior organs, complications of in syphilis, II, 146.
+
+Intermittent fever, IV, 571.
+
+Intestinal diseases of children, IV, 529.
+
+Intestinal Indigestion, acute, IV, 532; symptoms of acute, IV, 532;
+treatment of, IV, 533.
+
+Intestinal worms, IV, 548.
+
+Jaundice, catarrhal, IV, 547; in infants, IV, 546; in older children, IV,
+547.
+
+Junket, II, 244.
+
+Kelly pad, the, I, 65.
+
+Knowledge, two ways of gaining, III, 377.
+
+Labor, after-pains, I, 103; beginning of, I, 95; clothing during, I, 95;
+conduct during second stage of, I, 96; conduct immediately following, I,
+103; douching after, I, 107; first breakfast after, I, 105; first dinner
+after, I, 109; first lunch after, I, 109; first stage of, I, 96; importance
+of emptying bladder after, I, 106; the Lochia, or discharge after, I, 104;
+management of, I, 93; putting baby to breast after, I, 108; second stage
+of, I, 96.
+
+Lacerations during confinement, I, 116.
+
+                                                                      [vii]
+La Grippe, IV, 608; treatment of, IV, 609.
+
+Laryngitis, acute catarrhal, IV, 506; treatment of, IV, 507.
+
+Leucorrhea, cause of sterility, II, 201; in girls, II, 190.
+
+Lewis, Wm. D., on education, I, 25.
+
+Life and insurance, III, 400.
+
+Lithia water, III, 458.
+
+Lochia, or discharge after labor, I, 104.
+
+Lunch, the first after labor, I, 109.
+
+Malaria, intermittent fever, IV, 571; serum for, IV, 656; treatment of, IV,
+571.
+
+Malformation, II, 201.
+
+Man, building a, II, 151.
+
+Marital relations, when they are painful, III, 337; when they should be
+suspended, III, 337.
+
+Marriage, and motherhood, I, 2; best age for, III, 331; certificate and
+vice, I, 15; certificate, utility of, I, 13; evils of early, III, 333;
+failures in, I, 2.
+
+Mastitis, in infancy, IV, 553; in young girls, IV, 554.
+
+Masturbation, or self-abuse, II, 157.
+
+Meats, medical essentials of good, III, 393; preparation and selection of,
+III, 390.
+
+Measles, IV, 616; complications in, IV, 618; Koplik's spots in, IV, 617;
+rules of department of health, IV, 619; symptoms of, IV, 616; treatment of,
+IV, 618.
+
+Medical, letter brokers, III, 482; reliable advice, III, 486.
+
+Medicine chest, contents of family, IV, 629.
+
+Medicine concern run by women, III, 475.
+
+Menstruation, II, 187; irregular, II, 187; painful, II, 193; should not be
+accompanied with pain, II, 189; symptoms of, II, 189; treatment for
+painful, II, 194; why it occurs every 28 days, II, 180.
+
+Milk, children with whom it does not agree, IV, 535; difference between
+human and cows, II, 252; mixture, how to prepare, II, 259; peptonized, II,
+262.
+
+Mind, training the, III, 360.
+
+Miscarriage, II, 202; after treatment of, II, 205; causes of, II, 203;
+course and symptoms of, II, 204; what to do when threatened with, II, 204;
+tendency to, II, 206; womb displacement in, II, 198.
+
+Mosquitoes, regarding, IV, 572; rules of Department of Health, IV, 574.
+
+Mother, the cheerful, III, 400; education of the, II, 277; existence of the
+average, III, 437; what she should know about eugenics, I, 47; what she
+should tell her little girl, II, 173; what she should tell her daughter,
+II, 173.
+
+Motherhood, eugenics and, I, 16; function of, I, 17; preparing for, II,
+187.
+
+Mothers, eugenic clubs, I, 54; girls must not become, II, 184.
+
+Moths, IV, 648.
+
+Mouth, how to disinfect, IV, 601; sore, IV, 523; treatment for ulcers in,
+IV, 525; treatment of sore, IV, 524.
+
+Mucous patches, and ulcers, II, 145.
+
+Mumps, IV, 605; symptoms of, IV, 605.
+
+Mustard bath, IV, 590.
+
+Mustard paste, how to make, IV, 593.
+
+                                                                     [viii]
+Mustard pack, how to prepare and use, IV, 594.
+
+Mutton Broth, II, 244.
+
+Napkins, sanitary, I, 66.
+
+Nasal discharge, chronic, IV, 502.
+
+Nausea, during pregnancy, I, 80.
+
+Nettle-rash, IV, 559; cause of, IV, 559; treatment of, IV, 559.
+
+Night losses, or "wet dreams," II, 158.
+
+Nightmare or night terrors, IV, 583; treatment of, IV, 581.
+
+Nipples, care of, I, 121; cracked, I, 122; tender, I, 122; treatment of
+cracked, I, 122; what mother should know about bottle and, II, 264.
+
+Normal salt, solution of, IV, 627.
+
+Nose, chronic discharge of, IV, 503; complications of in syphilis, II, 146;
+foreign bodies in, IV, 632.
+
+Nose-bleeds, IV, 522.
+
+Nosophobia, or the dread of disease, III, 380.
+
+Nursery maid, qualifications of, I, 129.
+
+Nursing mothers, I, 121; diet of, I, 121; mastitis in, I, 122; nervous, I,
+126.
+
+Oatmeal water, for constipation in infants, II, 309.
+
+Oat-water, II, 244.
+
+Obstetrical outfits, ready to purchase, I, 63.
+
+Oil injections, II, 312.
+
+Oiled silk, IV, 594; what it is and why it is used, IV, 594.
+
+Orange juice, II, 262; for constipation in infants, II, 309.
+
+Organs, transplanting from dead to living, IV, 655.
+
+Otitis, acute, IV, 556.
+
+Ovaries, disease of, II, 199; function of, II, 179.
+
+Overeating, II, 289; III, 327; symptoms of, II, 290.
+
+Overfeeding the baby, II, 223.
+
+Parents, and the Boy, II, 153; a word to, II, 161; eugenics and, I, 15.
+
+Parotitis, epidemic, IV, 605.
+
+Patent Medicines, and education, III, 493; and eugenics, III, 494; and the
+newspaper, III, 484; conspiracy against freedom of press, III, 483; dangers
+of, III, 489; fraudulent testimonials, III, 467; intoxicating effects of,
+III, 453; government investigation of, III, 486; pure food and drug act,
+III, 452, 490.
+
+Patent Medicine Evil, III, 451, 489; and the duty of mothers III, 489; what
+mothers should know about the, III, 451.
+
+People, two kinds of, III, 363.
+
+Peptonized milk, II, 262.
+
+Physicians, what they are doing, IV, 649.
+
+Pimples, IV, 576.
+
+Pneumonia, IV, 516.
+
+Poultices, IV, 593.
+
+Pox, or syphilis, II, 144.
+
+Precautions to be observed, IV, 647.
+
+Pregnancy, avoidance of drugs during, I, 90; clothing during, I, 77;
+constipation during, I, 84; headache during, I, 83; heartburn during, I,
+84; hygiene of, I, 75; insomnia during, I, 86; minor ailments of, I, 76;
+morning nausea, I, 80; sexual intercourse during, I, 76; social side of, I,
+79; undue nervousness during, I, 82; vagaries of, I, 90; vaginal discharge,
+I, 88; varicose veins, cramps and neuralgia during, I, 85.
+
+                                                                       [ix]
+Pregnant, few ailing women become, III, 435; conduct of woman, I, 75; diet
+of woman, I, 77; mental state of woman, I, 78; when woman should first call
+upon physician, I, 68.
+
+Prickly Heat, IV, 560; treatment of, IV, 560.
+
+Principle, differences of, III, 344.
+
+Privy Vaults, IV, 647.
+
+Procreative Function, abuse of, II, 153; III, 440.
+
+Procreative Power, period of, II, 155.
+
+Puberty, age of, II, 179; period of in the female, II, 178.
+
+Pulse, rate in children and adults, II, 221.
+
+Punton, Dr. John, on feeble-minded, I, 42.
+
+Pure Food and Drug Act, III, 452, 490.
+
+Putnam, Dr. Helen C., on education, I, 27.
+
+Quacks, how they dispose of confidential letters, III, 481.
+
+Quarrel, the first, III, 349.
+
+Quinsy, IV, 523.
+
+Race Culture, I, II.
+
+Radium, IV, 652.
+
+Rashes, of childhood, IV, 574; other, IV, 575; treatment of, IV, 576.
+
+Records, Infant, II, 222.
+
+Rectal Irrigations, to reduce fever, IV, 590.
+
+Reproductive Organs, changes in, II, 178; function of the, II, 179.
+
+Resolves, making, III, 371.
+
+Rest and recreation, III, 398.
+
+Rest and sleep, III, 347.
+
+Rheumatism, in children, IV, 569; treatment of acute attack, IV, 570;
+treatment of tendency to, IV, 570.
+
+Rhinitis, chronic, IV, 503.
+
+Rice water, II, 244.
+
+Ringworm, of the scalp, IV, 561.
+
+Rubbers, practice of wearing needs consideration, IV, 498.
+
+Run-around, or felon, IV, 640; treatment of, IV, 641.
+
+Rupture, IV, 551.
+
+Saleeby, Dr. C.W., on education, I, 22.
+
+Sanitary napkins, how to prepare, I, 66.
+
+Santonin, for worms, IV, 549.
+
+Scalds and burns, IV, 641.
+
+Scalp, ringworm of, IV, 561; wounds of, IV, 640.
+
+Scarlet Fever, IV, 620; complications in, IV, 621; eruptions, IV, 621;
+measures to prevent spread of, IV, 621; treatment of, IV, 622.
+
+Scarlatina, IV, 620.
+
+Scientific Dressing, III, 427.
+
+Schlapp, Dr. Max, on the feeble-minded, I, 39.
+
+Self-abuse or Masturbation, II, 155.
+
+Self-culture, young wife's incentive to, III, 379.
+
+Serum, Anti-meningitis, IV, 656; for malaria, IV, 656.
+
+Sexual excesses, II, 159; treatment of, II, 160.
+
+Sexual intercourse, during pregnancy, I, 76.
+
+Shock, the condition of, IV, 637.
+
+Sitz bath, during pregnancy, I, 87.
+
+"606," IV, 655.
+
+Skin, care of, II, 216; care of in contagious diseases, IV, 602; eruptions
+of, II, 145.
+
+Sleeplessness, causes of, IV, 583; treatment of, IV, 583.
+
+Social Evil, what parents should know about, II, 161.
+
+Solutions, normal salt, IV, 627; various, IV, 626.
+
+Soothing syrup, III, 458.
+
+Sore Mouth, IV, 523; treatment of, IV, 524.
+
+                                                                        [x]
+Sore throat, IV, 508.
+
+Sowing wild oats, II, 167.
+
+Spasms, IV, 577.
+
+Spencer, Herbert, on education, I, 35.
+
+Spermatozoa, functions of the, II, 181; the male, or papa egg, II, 181.
+
+Sprains, IV, 639.
+
+Sprue, IV, 525; treatment of, IV, 525.
+
+Stables, IV, 646.
+
+Sterility, II, 195; causes of, in women, II, 198.
+
+Sterilizing, food for day's feeding, II, 260.
+
+Stomach, diseases of, IV, 527; fermentation of, II, 304; function of the,
+II, 304.
+
+Stomach bitters, alcohol in, III, 455.
+
+Stomatitis, IV, 523.
+
+Story, Dr. Thomas A., on education, I, 26.
+
+Study habit, the, III, 374.
+
+Sullivan, Dr., on alcoholic drunkenness, I, 44.
+
+Success, attainment of, III, 345; formula of, III, 373.
+
+Summer Diarrhea, IV, 539; symptoms of, IV, 540; treatment of, IV, 541.
+
+Summer diseases of intestines, IV, 529.
+
+Surgery, aseptic, IV, 653.
+
+Syphilis, or the "pox," II, 144.
+
+Tape worms, IV, 551.
+
+Teeth, care of the, II, 219; how they come, II, 218.
+
+Temperature, in children, II, 217.
+
+Thiersch's solution, IV, 627.
+
+Thought, bad habits of, III, 360; what is a, III, 359.
+
+Thread worm, IV, 549.
+
+Throat, foreign bodies in, IV, 633; sore, IV, 508.
+
+Thrush, IV, 525; treatment of, IV, 525.
+
+Thumb-sucking, IV, 585.
+
+Tonsilitis: Angina, "sore throat," IV, 508; treatment of acute, IV, 510.
+
+Transplanting organs of dead to living, IV, 655.
+
+Tuberculosis, best treatment for, III, 418; facts about, III, 414.
+
+Turpentine stupe, the, IV, 594.
+
+Typhoid, how to keep from spreading, IV, 625; how to prevent getting, IV,
+624; symptoms of, IV, 623; vaccine in, IV, 654.
+
+Ulcers, in mouth, IV, 525; mucous patches and, II, 144.
+
+Vacant lots, IV, 647.
+
+Vaccination, method of, II, 299; symptoms of successful, II, 299; time for,
+II, 299; treatment, II, 300.
+
+Vaccine in typhoid fever, IV, 654.
+
+Vapor bath, IV, 591.
+
+Varicella, IV, 606.
+
+Varicose veins, during pregnancy, I, 85.
+
+Vegetables, II, 272.
+
+Venereal Diseases, fake medical treatment for, II, 167; ten million victims
+of, I, 11.
+
+Vomiting, of children between feedings, II, 226; significance of after
+feeding, II, 230.
+
+Washing dishes, III, 391.
+
+Water, drink plenty of, III, 429.
+
+Weaning, I, 123; care of breasts when, I, 125; menstruation and, I, 124;
+methods of, I, 123; rapid, when it is necessary, I, 124; when to start, I,
+124.
+
+Wedding night, its medical aspect, III, 334.
+
+What to eat and wear in hot weather, III, 426.
+
+When delays are dangerous, III, 423.
+
+Whey, II, 244.
+
+Whitlow, or felon, IV, 640.
+
+                                                                       [xi]
+Whooping Cough, IV, 613; symptoms of, IV, 614; treatment of, IV, 615.
+
+Wife, her part, III, 353; the cheerful, III, 400; the indifferent, III,
+401; what she owes to herself, III, 357.
+
+Wifehood, first weeks and months of, III, 336.
+
+Wilcox, Ella Wheeler, on education, I, 23.
+
+Womb, function of, II, 180; how baby gets nourishment in, II, 183; how held
+in place, II, 189.
+
+Women, ailing, are inefficient, III, 434; diseases of, III, 433; who don't
+want children, III, 439; medicine concern run by, III, 475; most popular,
+III, 365; use of patent medicines in diseases, III, 473.
+
+Work, must be interesting, III, 351.
+
+Working for something, III, 395.
+
+Worms, intestinal, IV, 548; round, IV, 548; symptoms of tape, IV, 551;
+symptoms of thread, IV, 549; tape, IV, 551; thread, IV, 549; treatment of
+round, IV, 549.
+
+Worry, freedom from, III, 348.
+
+Wound, cleaning a, IV, 637; closing and dressing a, IV, 637; removal of
+foreign bodies from, IV, 636.
+
+Wounds, IV, 634; of the scalp, IV, 640.
+
+X-Ray, treatment and diagnosis, IV, 652.
+
+       *       *       *       *       *
+
+
+VOLUME I
+
+       *       *       *       *       *
+
+
+                                                                       [xv]
+TABLE OF CONTENTS
+
+EUGENICS. RACE CULTURE
+
+CHAPTER I
+
+CONDITIONS WHICH HAVE EVOLVED THE SCIENCE OF EUGENICS
+
+Infant mortality--Marriage and
+motherhood--Heredity--Environment--Education--Disease and
+vice--History--Summary ... PAGE 1
+
+CHAPTER II
+
+THE EUGENIC IDEA
+
+The value of human life--The eugenic principle--"The fit only shall
+live"--Eugenics and marriage--The venereal diseases--The utility of
+marriage certificates--The marriage certificates and vice--Eugenics and
+parenthood--The principle of heredity--Eugenics and motherhood--Eugenics
+and the husband ... PAGE 9
+
+CHAPTER III
+
+EUGENICS AND EDUCATION
+
+The present educational system is inadequate--Opinions of Dr. C.W. Saleeby,
+Ella Wheeler Wilcox, Luther Burbank, William D. Lewis, Elizabeth Atwood,
+Dr. Thomas A. Story, William C. White, Dr. Helen C. Putnam--Difficulty in
+devising a satisfactory educational system--Education an important
+function--The function of the high school--The high school system
+fallacious--The true function of education ... PAGE 21
+
+CHAPTER IV
+
+EUGENICS AND THE UNFIT
+
+The deaf and dumb--The feeble-minded--A New York magistrate's
+report--Report of the Children's Society--The segregation and treatment of
+the feeble-minded--What the care of the insane costs--The
+alcoholic--Drunkenness ... PAGE 37
+
+CHAPTER V
+
+WHAT EVERY MOTHER SHOULD KNOW ABOUT EUGENICS
+
+PAGE 47
+
+                                                                      [xvi]
+CHILD-BIRTH
+
+CHAPTER VI
+
+PREPARATIONS FOR THE CONFINEMENT
+
+The birth chamber--What to provide for a confinement--Ready to purchase
+obstetrical outfits--Position and arrangement of the bed--How to properly
+prepare the accouchement bed--The Kelly pad--The advantages of the Kelly
+pad--Should a binder be used--Sanitary napkins--How to calculate the
+probable date of the confinement--Obstetrical table--When should a pregnant
+woman first call upon her physician--Regarding the choice of a
+physician--How to know the right kind of a physician for a confinement--The
+selection of a nurse--The difference between a trained and a maternity
+nurse--Duties of a confinement nurse--The requisites of a good confinement
+nurse--The personal rights of a confinement nurse--Criticizing and
+gossiping about physicians ... PAGE 61
+
+CHAPTER VII
+
+THE HYGIENE OF PREGNANCY
+
+Daily conduct of the pregnant woman--Instructions regarding household
+work--Instructions regarding washing and sweeping--Instructions regarding
+exercise--Instructions regarding passive exercise--Instructions regarding
+toilet privileges--Instructions regarding bathing--Instructions regarding
+sexual intercourse--Clothing during pregnancy--Diet of pregnant
+women--Alcoholic drinks during pregnancy--The mental state of the pregnant
+woman--The social side of pregnancy--Minor ailments of pregnancy--Morning
+nausea, or sickness--Treatment of morning nausea, or sickness--Nausea
+occurring at the end of pregnancy--Undue nervousness during pregnancy--The
+100% baby--Headache--Acidity of the stomach, or
+heartburn--Constipation--Varicose veins, cramps,
+neuralgias--Insomnia--Treatment of insomnia--Ptyalism, or excessive flow of
+saliva--Vaginal discharge, or leucorrhea--Importance of testing urine
+during pregnancy--Attention to nipples and breasts--The vagaries of
+pregnancy--Contact with infectious diseases--Avoidance of drugs--The danger
+signals of pregnancy ... PAGE 75
+
+CHAPTER VIII
+
+THE MANAGEMENT OF LABOR
+
+When to send for the physician in confinement cases--The preparation of the
+patient--The beginning of labor--The first pains--The meaning of the term
+"labor"--Length of the first stage of labor--What the first stage of [xvii]
+labor means--What the second stage of labor means--Length of the second
+stage--Duration of the first confinement--Duration of subsequent
+confinements--Conduct of patient during second stage of labor--What a labor
+pain means--How a willful woman can prolong labor--Management of actual
+birth of child--Position of woman during birth of child--Duty of nurse
+immediately following birth of child--Expulsion of after-birth--How to
+expel after-birth--Cutting the cord--Washing the baby's eyes immediately
+after birth--What to do with baby immediately after birth--Conduct
+immediately after labor--After pains--Rest and quiet after labor--Position
+of patient after labor--The Lochia--The events of the following day--The
+first breakfast after confinement--The importance of emptying the bladder
+after labor--How to effect a movement of the bowels after
+labor--Instructing the nurse in details--Douching after labor--How to give
+a douche--"Colostrum," its uses--Advantages of putting baby to breast early
+after labor--The first lunch--The first dinner--Diet after third day ...
+PAGE 93
+
+CHAPTER IX
+
+CONFINEMENT INCIDENTS
+
+Regarding the dread and fear of childbirth--The woman who dreads
+childbirth--Regarding the use of anesthetics in confinements--The presence
+of friends and relatives in the confinement chamber--How long should a
+woman stay in bed after confinement--Why do physicians permit women to get
+out of bed before the womb is back in its proper place?--Lacerations, their
+meaning, and their significance--The advantage of an examination six weeks
+after the confinement--The physician who does not tell all of the truth ...
+PAGE 111
+
+CHAPTER X
+
+NURSING MOTHERS
+
+The diet of nursing mothers--Care of the nipples--Cracked nipples--Tender
+nipples--Mastitis in nursing mothers--Inflammation of the breasts--When
+should a child be weaned?--Method of weaning--Nursing while
+menstruating--Care of breasts while weaning child--Nervous nursing
+mothers--Birthmarks--Qualifications of a nursery maid ... PAGE 121
+
+CHAPTER XI
+
+CONVALESCING AFTER CONFINEMENT
+
+The second critical period in the young wife's life--The domestic problem
+following the first confinement ... PAGE 131
+
+       *       *       *       *       *
+
+
+                                                                      [xix]
+INTRODUCTION
+
+Despite the fact that much has been written during the past two or three
+years with reference to Eugenics, it is quite evident to any one interested
+in the subject that the average intelligent individual knows very little
+about it so far as its scope and intent are concerned. This is not to be
+wondered at, for the subject has not been presented to the ordinary reader
+in a form that would tend to encourage inquiry or honest investigation. The
+critic and the wit have deliberately misinterpreted its principles, and
+have almost succeeded in masking its supreme function in the garb of folly.
+
+The writer has yet to meet a conscientious mother who fails to evince a
+reasonable degree of enthusiastic interest in eugenics when properly
+informed of its fundamental principles.
+
+The eugenic ideal is a worthy race--a race of men and women physically and
+mentally capable of self-support. The eugenist, therefore, demands that
+every child born shall be a worthy child--a child born of healthy, selected
+parents.
+
+No one can successfully assail the ethics of this appeal. It is morally a
+just contention to strive for a healthy race. It is also an economic
+necessity as we shall see.
+
+The history of the world informs us that there have been many civilizations
+which, in some respects, equalled our own. These races of people have all
+achieved a certain success, and have then passed entirely out of existence.
+Why? _And are we destined to extinction in the same way?_ We know that the
+cause of the decline and ultimate extinction of all past civilizations was
+due primarily to the moral decadence of their people. Disease and vice
+gradually sapped their vitality, and their continuance was impossible. [xx]
+It would seem to be the destiny of a race to achieve material prosperity at
+the expense of its morality. When conditions render possible the fulfilment
+of every human desire, the race exhausts its vitality in a surfeitment of
+caprice. The animal instincts predominate, and the potential vigor of the
+people is exhausted in contributing to its own amusement. Each succeeding
+civilization has reached this epochal period, and has fallen, victim of the
+rapacity of stronger and younger invading antagonists, _themselves to
+succumb to the same insidious process_.
+
+The present civilization has reached this epochal--this transition--period.
+In one hundred years from now we shall either have accomplished what no
+previous civilization accomplished, or we shall have ceased to exist as a
+race. Our success depends on the response of the people to the eugenic
+appeal. Few appreciate the responsibility involved.
+
+It is not necessary, however, to combat or deplore the evils of the past.
+Civilization has failed in the task of race-maintenance; it failed,
+however, in ignorance. We cannot plead the same excuse. We are face to face
+with conditions that we must solve quickly or our destiny will be decreed
+before we apply the remedy.
+
+A function of the eugenist is to gather and attest statistics, and to
+establish conclusions based on these statistics. It has been conclusively
+demonstrated that, if the race continues to progress as it exists now--that
+is, if conditions remain the same, and our standard of enlightenment, so
+far as racial evolution is concerned, does not prompt us to adopt new
+constructive measures--_every second child born in this country, in fifty
+years, will be unfit; and, in one hundred years, the American race will
+have ceased to exist_. We mean by this that every second child born will be
+born to die in infancy, or, if it lives, will be incapable of self-support
+during its life, because either of mental degeneracy or physical
+inefficiency. This appalling situation immediately becomes a problem of
+civilization. No state can exist under these conditions. If these
+statistics are reliable--and we know they are true and capable of
+verification by any individual who will go to the trouble of          [xxi]
+investigating them--it is self-evident that a radical change must
+immediately be instituted to obviate the logical consequences that must
+follow as a sequence. The eugenic demand, that "every child born shall be a
+worthy child," is, therefore, the solution of the problem.
+
+This does not imply, however, that the eugenist must solve the elementary
+problem of how the state will ensure its own salvation by guaranteeing
+worthy children. Worthy children can come only from fit and worthy (clean
+and healthy) parents. It becomes the imperative function of the state--the
+function on which the very life of the state depends--to see that every
+applicant for marriage is possessed of the qualities that will ensure
+healthy, worthy children. We must, therefore, sooner or later devise a
+system of scientific regulation of marriage, and it is at this point we
+stumble against the problem that has prompted the ebullitions of the wit
+and the sarcasm of the critic. A casual reference to the science
+immediately suggests to the layman an impossible or quixotic system of
+marriage by force. Even the word "eugenics" is associated in the minds of
+many otherwise estimable old ladies, and others who should know better,
+with a species of malodorous free love, and their hands go up in holy
+horror at the intimation of a scientific regulation of this ancient
+function.
+
+Unfortunately, the popular mind has received the impression that this
+incident constitutes the sum total of the eugenic idea, while the truth is
+that the eugenist is only slightly concerned with its modus operandi. This
+feature has been so magnified by widely published disingenuous discussion
+that it has assumed the aspect of a test problem, a judgment on which shall
+decide the utility of the science itself. Should this decision be
+unfavorable, it would seem, according to its exponents, that it would not
+be worth while promulgating the doctrines of the science beyond this point.
+It is as though we were asked to deny ourselves the inspiration and
+pleasure of a trip abroad because the morning of the day on which the ship
+sailed happened to be cloudy.
+
+It is certainly no part of the function of the eugenist to uproot    [xxii]
+instinct, or to trample into the dust age-long rights, though the instinct
+is simply the product of an established habit, based on an erroneous
+hypothesis, and the so-called rights simply acquired privileges, because
+the intelligence that would have builded differently was not awakened.
+Eugenic necessity will render imperative the state's solution of this
+fundamental problem, for the reason that civilization will be driven to
+demand its just inheritance--the right to exist. The eugenist will not be
+compelled to open the door; it will be opened for him. We can afford,
+therefore, to wait with supreme confidence, because the good sense of the
+people will not always submit to the tactics of the jester when it needs a
+saviour.
+
+The eugenist does not seek to interfere with the liberties of the rising
+generation: a boy may choose whom he will; the girl may select the one who
+appeals to her most, and they may enjoy all the vested rights and romance
+that custom has decreed the lover; but, when they resolve to marry, _the
+state must decide their qualifications for parenthood_. This must be the
+crucial test of the future. The life of the state depends on it. The
+continuance of the race must be the supreme object of all future
+constructive legislation. We must recognize that "life is the only wealth,"
+and that every other criterion of an advanced civilization must measure its
+success according to its wealth in worthy parenthood.
+
+The eugenist does not even dictate what the test for parenthood shall be.
+Common sense, however, suggests that it will assume some form that will
+eliminate those physically or mentally diseased. He believes that, when the
+people are sufficiently educated to appreciate the object in view, they
+will devise a system that will meet with universal approval.
+
+Eugenics concerns itself with problems on which the destiny of the race
+depends. It must not, therefore, be limited to questions relative to mating
+and breeding. Every factor that contributes to the well-being and uplifting
+of the race, every subject that bespeaks physical or mental regeneration,
+that aids moral and social righteousness and salvation, and promises a
+greater social happiness and contentment, has a eugenic             [xxiii]
+significance. So long as there exists an unsupported mother or a suffering
+child; so long as we rely on hospitals and prisons, penitentiaries and the
+police, to minister to the correction and regeneration of the unfit and
+degenerate; so long as we tolerate grafting politicians and deprive the
+poor of breathing spaces, sanitary appliances, and a hygienic environment;
+so long as war and pestilence deprive posterity of the best of the race for
+parenthood; so long as we emphasize rescue rather than prevention, so long
+must the eugenist strive unceasingly to preach his propaganda of race
+regeneration.
+
+The scope of eugenics is too far-reaching in its beneficent purpose to be
+fettered by the querulous triflings of the ancient or intellectual prude;
+nor should it be belittled by the superficial insight of the habitual
+scoffer. It is not a fantasy nor an idle dream. It is not even an
+inspiration. The destiny of the race has brought us face to face with
+conditions unparalleled in the history of this civilization, and the very
+existence of the race itself may be wholly dependent on the foresight of
+the minds that have made the science of eugenics possible.
+
+A brief consideration of the conditions that actually exist, with which we
+are face to face, and which certainly justify the existence of a science
+whose function it should be to demand serious investigation of methods of
+race regeneration, may help the reader to an intelligent and practical
+understanding of the tremendous importance of the subject.
+
+It has been already remarked that, at the present rate of decrease, the
+birth-rate will be reduced to zero within a century. If the birth-rates in
+England, Germany, and France should continue to decrease as they have since
+1880, there would be no children born, one hundred years hence, in these
+countries. While we do not assert, and probably none of us believes that
+either or all of these nations will actually be out of existence in a
+hundred years--unquestionably because we feel, at least we hope, that our
+methods will be so changed in that time that the necessary modification
+will ensure a continuance of the race, nevertheless, the fact remains that
+_the inevitable result of continuing along present lines will be     [xxiv]
+that, within the period of one hundred years, these peoples will cease to
+perpetuate themselves_.
+
+It is not necessary to enquire closely into the various causes for this
+unparalleled situation. The falling birth-rate in itself is not the prime
+cause. Even admitting that there are enough babies born, too many of them
+are born only to die in infancy. We need no further proof of the urgent
+need for conscientious inquiry, call it by what name you please. The
+science of common sense is all-sufficient. The seemingly intelligent
+individual who can only find material for ribaldry in this connection is a
+more serious buffoon than he imagines. It is apparent that our methods are
+wrong. Any constructive effort to correct them is commendable. When it is
+stated that 20 per cent. of the American women are unable to bear children,
+and that 25 per cent. of all the others are unwilling to assume the burden
+and responsibility of motherhood, we partly realize the gravity of the
+case.
+
+On the other hand, statistics show that the majority of men have acquired
+disease before they marry, and that a very large percentage of these men
+convey contagion to their wives. This condition, to a very large extent,
+accounts for the inefficiency of women as mothers. It is responsible for at
+least 75 per cent. of the sterility that exists. The effect of this
+deplorable condition is directly responsible, also, for the ill health that
+afflicts women and that renders necessary the daily operations of a serious
+nature that are conducted in every hospital in every city in the civilized
+world. As a result of the dissemination of this poison, children are born
+blind, or are born to die, or, if they live, they are compelled to carry
+all through their helpless lives the stigma of disease and degeneration. It
+would surely seem that the individual to whom God has given intelligence
+and a conscience cannot think of these, the saddest facts in human
+experience, without resentment and humility. _Surely the time has arrived
+when every boy should know, from his earliest youth, that there is here on
+earth an actual punishment for vicious living as frightful as any that the
+mind of man can conceive._ [Page xxv]
+
+When we inquire into the cause of this trend toward race degeneracy, we
+find that poverty and the inability of the workingman to support large
+families, luxurious living, and the life of ease and amusement on the part
+of the women of wealth; the fact that an increasingly large number of women
+have entered professions that prevent motherhood, and that the number of
+apartment-houses where children are not wanted are on the increase, all
+play their part. In this age of intense living, it is not to be wondered at
+that many shrink from the responsibility of rearing children, and the same
+conditions that contribute to this decadent ideal intensifies sex-hunger,
+and it is this dominating passion that tolerates and makes possible the
+most frightful crime of the age--infanticide. Greece and Rome paved the way
+for their ultimate annihilation when their beautiful women ceased to bear
+children and their men sought the companionship of courtesans.
+
+Baby contests have demonstrated that only one child in ten was found to be
+good enough to justify a second examination. In a test examination in the
+public schools, only eight in five thousand were competent to qualify in
+all the tests. One of these eight was a Chinese boy and another an
+American-born son of a native Greek. Of the twenty million school-children
+in the United States, not less than 75 per cent. need immediate attention
+for physical defects.
+
+While man has been assiduously improving everything else, he has neglected
+to better his own condition. Every animal that man has taken from its
+native haunts and domesticated, he has efficiently improved. He has even
+produced more marvelous results by the application of the same principles
+to the vegetable kingdom. In his haste to civilize himself, however, he has
+failed to apply the principles that are essential to self-preservation. It
+is regrettable, also, to know that, while the government has spent many
+thousands of dollars in sending out literature to the farmers, instructing
+them how to raise profitable crops and to breed prize horses and pigs,
+absolutely none of the public money has been used in instructing American
+mothers how to raise healthy children. [Page xxvi]
+
+A distinguished insurance expert has proved that there was an increase of
+nearly 100 per cent. in the mortality from degenerative diseases in the
+United States between 1880 and 1909. The growing prevalence of these
+diseases indicates a falling-off in the vitality of the race. It means that
+the diseases of old age are invading the younger ranks.
+
+The Life Extension Institute, of New York City, in its recent report,
+states that "forty of every hundred men and women employed in the Wall
+Street district require medical attention; twenty of the forty need it
+immediately, and ten of the forty must have it to avert serious results."
+
+There are from one-quarter to three-quarters of a million of preventable
+deaths every years in this country. That number of individuals could have
+been saved with proper care and attention to health in the early stages of
+disease, or before it gained a start. Practically all the diseases that
+carry business men off prematurely are curable in the early stages.
+
+Of the percentage of Wall Street men who need medical attention
+immediately, most have kidney or heart disease. The others are victims of
+typical unhygienic habits, such as fast, gluttonous eating, neglect of
+exercise, too much tobacco and liquor, and bad posturing in the office. The
+business man considers these trifles, but they count heavily.
+
+Business efficiency is greatly increased, first, by selecting men
+physically fit for work, and, second, by keeping them in that condition.
+There is a tremendous waste from inefficiency constantly going on, due to
+impaired health. Wall Street has an astonishing corps of neurasthenics.
+
+We need a broader interpretation of the term Eugenics, so that we may gain
+a more sympathetic and tolerant audience. The remedy does not lie in an
+academic discussion of these problems; to continue the debate behind closed
+doors will not lead anywhere: the public must be educated to a just
+appreciation of existing conditions and the remedy must be the product of
+effort on its part.
+
+Any condition that fundamentally means race deterioration must be   [xxvii]
+rendered intolerable. The prevalant dancing craze is an anti-eugenic
+institution, as is the popularity of the delicatessen store. No sane person
+can regard with complacency the vicious environment in which the future
+mothers of the race "tango" their time, their morals, and their vitality
+away. We do not assume to pass judgment on the merits of the dance; we do,
+however, emphatically condemn the surroundings.
+
+The moving-picture shows, vaudeville entertainments, dancing carnivals, the
+ease of travel, the laxity of laws, the opportunities for promiscuous
+interviews, all tend to give youth a false impression of the reality of
+life and to make the path of the degenerate easy and attractive.
+
+The history of civilization is, curiously enough, the story of masculine
+brutality, self-indulgence, and vice. The history of the world also proves
+that woman's sphere has been to submit patiently and silently to injustice
+and imposition. _Practical eugenics is the first worthy effort in the
+history of all time to hold men and women responsible for their mode of
+living._ It is a mighty problem. There is no greater nor more difficult one
+to be solved. It has taken eons to bring men to the point of questioning
+their right to do as they please; it will take time to compel them to
+realize their disgrace and acknowledge their duty. When we consider that
+there are eighty thousand women condemned to professional moral degradation
+in the City of London, and that every so-called civilized city on the globe
+contributes its pro rata share to this army of potential mothers, we begin
+to appreciate the vastness of the task.
+
+Eugenics has already accomplished what no other movement has ever
+accomplished: it has created the spirit that gave birth to the thought of
+men's responsibility, and it has taught us that the female of the race has
+rights. We can now speak without fear; the light is no longer hidden.
+
+Women must realize, however, that they have contributed, and continue to
+contribute, to race degeneracy. We hear and read much about the double
+standard of morals. As long as woman are willing to marry their daughters
+to reformed rakes, providing they have money and social position,  [xxviii]
+so long shall we have a double standard. So long as young society women go
+into hysterics over pedigreed dogs and horses and then marry men reeking in
+filthy unfitness for parenthood, mothers cannot expect any other standard
+of morals. So long as one marriage in twelve ends in divorce, the ethics of
+the female need enlightenment. We shall not get another standard of morals
+until women themselves demand it and insist on it. If they lend themselves
+to breaking down the conspiracy of silence, the women may solve the
+marriage problem by refusing to marry rakes.
+
+We need a more liberal construction of the intent of eugenics in order to
+clarify the obtuse minds so that its propaganda of education may be easily
+and justly comprehended.
+
+There is no field for speculation in the analysis of right living. It
+conforms to the law of cause and effect. It is positively concrete in
+substance. A recital of the life history of Jonathan Edwards, in comparison
+with that of the celebrated "Jukes" family, emphasises this assumption with
+a degree of positiveness that is tragic in its significance.
+
+Jonathan Edwards was born in England in Queen Elizabeth's time. He was a
+clergyman and he lived an upright life. So did his wife. His son came to
+the United States, to Hartford, Connecticut, and became an honorable
+merchant. His son, in turn, also became a merchant, upright and honored.
+His son, again, became a minister, and so honored was he that Harvard
+University conferred two degrees on him on the same day; one in the morning
+and one in the afternoon. This learned man again had a son, and he became a
+minister. Jonathan Edwards was his name.
+
+Now let us see, in 1900, what this one family, started by a man in England
+who lived an upright life and gave that heritage to his children, produced:
+1,394 descendants of this man have been traced and identified; 295 were
+college graduates; 13 were college presidents; 65 were professors; 60 were
+physicians; 108 were clergymen; 101 were lawyers; 30 were judges; 1 was
+Vice-President of the United States; 75 were Army and Navy officers; [xxix]
+60 were prominent authors; 16 were railroad and steamship presidents; and
+in the entire record not one has been convicted of a crime.
+
+Twelve hundred descendants have been traced from the one man who founded
+the "Jukes" family. This record covers a period of seventy-five years; out
+of these, 310 were professional paupers, who spent an aggregate of two
+thousand three hundred years in poorhouses; 50 were evil women; 7 were
+murderers; 60 were habitual thieves; and 130 were common criminals.
+
+It has been estimated that this one family was an economic loss to the
+state, measured in terms of potential usefulness wasted; costs of
+prosecution; expenses of maintenance in jails, hospitals and asylums; and
+of private loss through thefts, and robberies, of $1,300,000 in
+seventy-five years, or more than $1,000 for each member of the family.
+
+_It would seem to be worth while to be well born, after all._
+
+In order to succeed in the regeneration of the race, we must believe that
+race regeneration is possible, and, that it is worth while. We must preach
+its principles as we would a religion. The power of knowledge is a mighty
+lever. We are living in a period of transition, but we are nearer the
+future than the past.
+
+We are told by the average individual that it will be impossible to arouse
+the public to an intelligent appreciation of the scope of race
+regeneration. When the writer conceived the happy phrase, "Better Babies,"
+a few years ago, he builded better than he knew. It has become the slogan
+of splendid achievement already, and there are a multitude of signs and
+tokens that the propaganda is established on a sure foundation.
+
+If the annihilation of all past civilizations was due to the refusal of its
+members to breed for posterity, may we not reasonably assume that we have,
+according to our statistics, reached the same crisis? If this is logical
+reasoning, and every factor warrants this conclusion, have we not reached
+the time when the perpetuation of the race is the most serious question of
+our times? Is it not a problem for the enthusiastic and immediate     [xxx]
+support of every statesman, politician, teacher, and preacher alike? Can
+any question be of more importance? What will our marvelous material
+splendor avail if the race is destined to immediate extinction?
+
+We need the assistance of every intelligent citizen, we need most, the
+awakening impulse of the mothers of the race. We who are alive are
+responsible for environment and nurture, and we must believe that the
+purpose to be achieved is of supreme importance. Every mother, through the
+power of knowledge, may become a practical eugenist. It is to aid her in an
+intelligent appreciation of the practical intent of the science that this
+work is presented.
+
+  W. GRANT HAGUE, M.D.
+
+  New York City.
+
+       *       *       *       *       *
+
+
+                                                                        [1]
+THE EUGENIC MARRIAGE
+
+CHAPTER I
+
+    "Nations are gathered out of nurseries."
+
+    CHARLES KINGSLEY.
+
+    "To be a good animal is the first requisite to success in life, and to
+    be a nation of good animals is the first condition of national
+    prosperity."
+
+    HERBERT SPENCER.
+
+CONDITIONS WHICH HAVE EVOLVED THE SCIENCE OF EUGENICS
+
+    INFANT MORTALITY--MARRIAGE AND
+    MOTHERHOOD--HEREDITY--ENVIRONMENT--EDUCATION--DISEASE AND
+    VICE--HISTORY--SUMMARY.
+
+There has been evinced during recent years a desire to know something more
+definite about the science of eugenics.
+
+Eugenics, simply defined, means "better babies." It is the art of being
+well born. It implies consideration of everything that has to do with the
+well-being of the race: motherhood, marriage, heredity, environment,
+disease, hygiene, sanitation, vice, education, culture,--in short,
+everything upon which the health of the people depends. If we contribute
+the maximum of health to those living, it is reasonable to assume that the
+future generation will profit thereby, and "better babies" will be a direct
+consequence.
+
+We are frequently told that we must take the world as we find it. This has
+been aptly termed, "the motto of the impotent and cowardly." "Life is what
+we make it," is the more satisfying assertion of the optimist, and most [2]
+of us seem to be trying to make existence more tolerable and more happy. It
+is encouraging to know that intelligent men and women to-day seek an
+opportunity to devote serious consideration to the betterment of the race,
+while yet the pursuit of wealth and pleasure are enticing and strenuous
+occupations.
+
+It would be superfluous in a book of this character to enter into any
+lengthy explanation as to how the science of eugenics proposes to work out
+its problems. We hope only to excite the interest of mothers in the
+subject, and to instruct them in its rudiments and principles.
+
+It will be of distinct advantage, however, first to briefly consider the
+conditions,--which are known to all of us,--which have led up to the
+present status of the subject.
+
+INFANT MORTALITY.--No elaborate argument is necessary to prove that the
+present infant mortality, in every civilized country, is too high. It is
+conceded by every authority interested in the subject, no matter what
+explanation he offers, or what system he advances as a solution of the
+problem.
+
+MARRIAGE AND MOTHERHOOD.--Every intelligent person knows that most young
+girls enter into the marriage relationship without a real understanding of
+its true meaning, or even a serious thought regarding its duties or its
+responsibilities. We know that their home training in domestic science is
+generally not adequate, and that their educational equipment is
+inefficient. We also know that economic necessity has deprived them of the
+tutelage essential to social progress and physical health, and has endowed
+them with temperamental characteristics undesirable in the mothers of the
+race. Maternity is thrust upon these physically and mentally immature young
+wives, and they assume the principal rôle in a relationship that is onerous
+and exacting. We know that the duties of wife and mother require an
+intelligence which is rendered efficient only by maturity and experience.
+We know that many, if not most, young wives acquire habits which undermine
+their health and their morals unwittingly, and we also know that the
+product of this inefficiency results in the decadence and the           [3]
+degeneration of the race.
+
+HEREDITY.--Much remains inexplicable at the present time regarding this
+intensely interesting department of science. We do know, however, that its
+truths are being investigated and tabulated. Our present knowledge of its
+principles has demonstrated the existence of laws from which we can
+ethically deduce explanations of conditions which were, in the past, not
+amenable to any classification. These relate to individual and racial
+characteristics. We are beginning to learn that we can modify these
+characteristics by proper selection, by environment, and by education. This
+process will, to an eminent degree, redound to the permanent advantage of
+mankind. We may reasonably aspire to a system of race-culture which will
+eliminate the undesirable or unfit, and conserve all effort in the
+propagation of the desirable or fit. This is a consummation to be desired,
+and if by any system of eugenics the promise of the future is realized it
+is deserving of the intelligent interest and the active coöperation of
+every aspiring mother.
+
+ENVIRONMENT.--By environment we mean the provision of suitable surroundings
+in its largest sense. A child to be fit and efficient must be born of
+selected parentage, the home surroundings must be desirable, the
+educational possibilities must be advantageous, the sanitary and hygienic
+conditions must be suitable, opportunities for physical and spiritual
+culture must be provided, and the State must ensure justice and the right
+to achieve success. We know that--generally speaking--these conditions do
+not exist. We know that the dregs of the human species--the blind, the
+deaf-mute, the degenerate, the imbecile, the epileptic, the criminal
+even,--are better protected by organized charity and by the State than are
+the deserving fit and healthy. We know that in the slums thousands of
+desirable children waste their vitality in the battle for existence, and we
+know that, though philanthropy and governmental supervision and protection
+are afforded the deaf, the dumb, the blind and degenerate child, no helping
+hand is held out to save the healthy and efficient child, who must pay in
+disease and inefficiency the price of his normality in degrading toil,  [4]
+in factory and pit, where child labor is tolerated. We need the awakening
+which is the promise of the eugenist, that these wrongs will be righted,
+not by the statesmanship which believes that empires are founded and
+maintained by the power of material might, but by a process which will
+ennoble selected motherhood and give to every child born its due and its
+right.
+
+EDUCATION.--The present system of education is one of the great reflections
+on the intelligence of the human race. One of the greatest of contemporary
+writers has characterized it as "a curse to modern childhood and a menace
+to the future." Even the humblest of us--who would willingly believe the
+system efficient, who have no desire to invite criticism as to our
+opinion--are forced to acknowledge that there is something wrong with the
+educational system now in vogue. The writer is disposed to believe,
+however, that the fault is not wholly one of art. The conditions with which
+education has to contend are essentially hypothetical. It may be that the
+laws of heredity and psychology, when fixed, will evolve, at least, a more
+rational and a more ethical hypothesis. So far as eugenics is concerned
+with education, its limitation is defined and fixed. If the innate ability
+is not possessed by the child, no system of instruction, and no art of
+pedagogy, will ever draw it out. When the proper material is supplied by an
+adequate system of race culture, science may probably supply the requisite
+complementary data which will ensure an educational system that will really
+educate.
+
+DISEASE AND VICE.--The eugenic idea is more directly concerned with disease
+which tends to deteriorate the racial type. The average parent has no means
+of adequately estimating the significance of this type of disease. It has
+been estimated that one-half of the total effort of one-third of the race
+is expended in combating conditions against which no successful effort is
+possible. Think what this means. The struggle of life is a real struggle,
+even with success as an incentive and as a possible reward. It becomes a
+tragedy when we think of the wasted years, the hopeless prayers and the
+anguish of those who fight the battle which is predestined to end in    [5]
+apparent failure. We are disposed to doubt the justice of the Omnipotent
+Mind who created us and left us seemingly alone--derelicts in the eddies of
+eternity.
+
+This is but a finite fault, however. The truth is that the scheme of the
+universe is unalterable, we are but part of the whole and must share in the
+evolution of the process. An apparent failure is not necessarily a
+discreditable one. Most lives are failures, if appraised by human estimate.
+Take for example the life of a young wife who marries a man with disease in
+his blood. She begins her wedded life with certain commendable ideals. She
+is young, enthusiastic, ambitious, strong, and she inherently possesses the
+right to aspire to become an efficient home-maker and a good mother. She
+gives birth to a child, conceived in love, and during her travail she
+beseeches her Creator to help her and to help her baby, as all women do at
+such a time. Her baby is born blind and it is a weak and puny mite. The
+mother recovers slowly, but she is never the same vigorous and ambitious
+woman. Later her strength fades away, her enthusiasm falters, the home is
+blighted and seems a desecrated spot. The baby is a constant worry, it is
+always sick, it needs expensive care and it exhausts the physical remnant
+of its mother's health. It finally dies and is laid away, not forgotten,
+but a sad, sad memory. The ailing and dispirited mother is informed that
+she must submit to an operation if she desires to regain her health, if not
+to save her life. She returns from the hospital--not a woman--a blighted
+thing, an unsexed substitute for what once was a happy, sunny, healthy,
+innocent girl.
+
+This is not an overdrawn tale,--it is a true story, a common, every-day
+story. Who was to blame? Why were her prayers not heard? Why, indeed? One
+might as well ask why seemingly splendid civilizations decayed into
+forgotten dust, or why empires rotted away. The answer is the same.
+
+HISTORY.--From the eugenists' standpoint history is prolific only in
+negation. A correct interpretation of its pages teaches us that it has not
+taught the lesson of the "survival of the fittest," but rather the survival
+of the strongest. That the strongest is not always the "fittest" needs  [6]
+no commentary. That the fit should survive is the genetic law of nature,
+and it has been strictly obeyed by biology and humanity when these sciences
+have adhered to, and have been under the jurisdiction of the natural law.
+
+When religious schisms swayed the world, the stronger party, in material
+strength or in actual numbers, massacred the weaker, which was frequently
+the fitter from the standpoint of desirability as progenitors of the race.
+Thus posterity was deprived of what probably was the representative,
+potential strength of generations.
+
+At a later date religious schism changed her _modus operandi_ but
+accomplished the same pernicious purpose, as the following shows:
+
+"Whenever a man or woman was possessed of a gentle nature that fitted him
+or her to deeds of charity, to meditation, to literature or to art, the
+social condition of the time was such that they had no refuge elsewhere
+than in the bosom of the Church. But the Church chose to preach and exact
+celibacy, and the consequence was that these gentle natures had no
+continuance, and thus, by a policy, was brutalized the breed of our
+forefathers."
+
+When religion was not the dominating power, mankind was ruled by militant
+tyrants. The non-elect were slaves,--uneducated, uncivilized, debased and
+diseased. The elect were licentious and indolent. Neither class practised
+any domestic virtues, or respected the institution of motherhood. The
+process of the selection of the fittest for survival for the purpose of
+parentage, and for the consummation of the evolutionary gradation, through
+which the human race is apparently destined to pass, was again in abeyance
+for a series of generations.
+
+In our own times, the fate of nations and the destiny of their people would
+seem to depend upon the size of the fighting force and the efficiency of
+the ships we build; our ability to dicker and barter, to gain a
+questionable commercial supremacy, and the loquaciousness of our
+politicians. This, at least, is the criterion upon which the modern
+statesman estimates the quality of present-day civilization. He is not  [7]
+apparently interested in the story of the ages. The progress of God's
+supernal scheme through æons of bigotry and darkness neither suggests nor
+inspires in him a loftier constructive analysis. He is content to leave the
+destiny of nations to tons of material, tons of men and tons of talk.
+
+Nowhere do we find any reference to the quality of the blood-stream of the
+people. Nor does it seem to have been discovered by those who wield
+authority, that the glory of a nation depends upon its brains, not its
+bulk; nor do they apprehend that the greatness of a people is not in its
+past history, but in its ever-existing motherhood; and that its battles, in
+the future, must be fought, not on battlefields, but in its nurseries. When
+we judge our national worth and wealth by the quality of our maternal
+material, and estimate our greatness and our glory by the record of our
+infant mortality, we will have carved an enduring niche in the celestial
+scheme that will be unchangeable and for all time.
+
+There are in Britain to-day over a million and a quarter females of
+marriageable age in excess of the number of marriageable males. A war
+between Britain and Germany would unquestionably be the bloodiest war in
+all history, and it probably would be the last one, because it would only
+end in the dominance of one power over all the others. If we concern
+ourselves only with Britain--from the eugenic standpoint--who would dare
+compute the ratio of marriageable females over the males after the war was
+over? The consequence of such a war on posterity would be tragic. It would
+mean the annihilation of the fittest for fatherhood for generations. Only
+the unfit would be left from which to begin a new breed.
+
+The multitude of females who would necessarily be left unable to
+participate in the highest function of womanhood would have to be
+self-supporting. The economic problem would, therefore, have a far-reaching
+influence and even if solved adequately as an economic problem, it could
+never be solved satisfactorily as a sociological, or as a problem in
+eugenics.
+
+Infant mortality is too high. Apart from the statistical proof which    [8]
+shows it, we may rightly construe as further proof of it, the widespread
+effort being made in every civilized country in the world to ameliorate the
+condition.
+
+The laws and ethics of marriage are inadequate. Its true purpose is
+frustrated and racial and individual injustice and imperfection are the
+products of existing conditions.
+
+Motherhood, in its every aspect is not, and has not in the past, been
+elevated to the plane which a true estimate of its supreme importance to
+the race justifies.
+
+Heredity as a scientific principle is undeveloped, and because of
+maladministration in past generations, the present generation is
+endeavoring to do the work, the fruits of which it should be enjoying.
+
+Environment in its highest sense is impossible because of inadequate laws,
+imperfect hygienic and sanitary knowledge, incomplete education, vice and
+disease.
+
+If there was not some supremely important, cardinal error somewhere, it is
+reasonable to suppose that in one or other of the departments of human
+effort we would have reached the summit of idealism. The State, as an
+institution, would have evolved a perfection which would enable it to exist
+as an independent mechanism, complete and ideal in all its ramifications.
+We have had no such state, however. The highest type of empire has been
+ludicrously dependent upon the minor exigencies of individual human
+existence.
+
+Science would have evolved the superman, but history, as we have seen, has
+persistently deprived science of the material wherewith to contribute him.
+
+The institution of marriage would have been a fixed and an inviolable
+guarantee of the happiness of the home, but human wisdom has erred and the
+solution is as yet apparently undiscovered.
+
+Investigation into every field of human effort shows that the ultimate aim
+in view, if any, was something other than the welfare of the race, as a
+race or as individuals.
+
+       *       *       *       *       *
+
+
+                                                                        [9]
+CHAPTER II
+
+    "The public health is the foundation on which reposes the happiness of
+    the people and the power of a country. The care of the public health is
+    the first duty of a statesman."
+
+    LORD BEACONSFIELD.
+
+THE EUGENIC IDEA
+
+    THE VALUE OF HUMAN LIFE--THE EUGENIC PRINCIPLE--"THE FIT ONLY SHALL
+    LIVE"--EUGENICS AND MARRIAGE--THE VENEREAL DISEASES--THE UTILITY OF
+    MARRIAGE CERTIFICATES--THE MARRIAGE CERTIFICATES AND VICE--EUGENICS AND
+    PARENTHOOD--THE PRINCIPLE OF HEREDITY--EUGENICS AND
+    MOTHERHOOD--EUGENICS AND THE HUSBAND.
+
+The eugenist believes the cardinal error of the past has been a failure to
+recognize the worth or value of human life. In the past human lives have
+counted for absolutely nothing. As we have seen, each generation has
+practically deprived posterity of the best of its breed, and we shall see,
+when we consider the facts which affect the present vitality of the race,
+that the same preposterous conditions still exist.
+
+It is not necessary to waste the reader's time in an effort to prove,
+simply from an argumentative standpoint, the logic of the eugenic idea.
+There is no existing economic problem that has established itself so firmly
+in the hearts of the people who understand it, as has the study of race
+culture. It is not the subject, but its scope of application, that is new.
+Biologically, we see the manifestations of eugenics on every side. In the
+flower garden we breed for beauty, in the orchard for quality. In the
+poultry yard and on the stock farm the same process weeds out the unfit and
+cultivates the desirable. The value of the eugenic idea is most strikingly
+illustrated in the cultivation, or breeding, of the horse from a primitive
+creature into the splendid animals which represent the various types of
+equine present-day perfection. It has taken generations of the most    [10]
+painstaking intelligence to understand the traits which had to be evolved
+in scientific mating to reach the present standard. If the same rules, or
+lack of rules, applied to the mating of horses as applied to ourselves,
+there would be few, if any, "thoroughbreds" among them. The principle which
+we must recognize is that "Life is the only wealth."
+
+Progress and efficiency will be ensured and of an enduring character, when
+all human effort is consecrated to this fundamental principle as a basic
+law, and not till then.
+
+To cultivate the human race on prescribed scientific principles will be the
+supreme science of all the future, the object and the final goal of all
+honest governmental jurisprudence, and the ultimate judge of all true
+constructive legislation.
+
+THE EUGENIC PRINCIPLE
+
+The eugenic principle is, that "the fit only shall live." This does not
+mean that the unfit must die, but that only the fit shall be born.
+Occasionally, as a product of bad environment, or faulty training, or
+eccentricity, a horse gives evidence of vicious traits, but the scientific
+breeder never mates him. He is allowed to die out. If he were permitted to
+father a race, his progeny would develop murderous characteristics that
+would retard the type for generations.
+
+THE FIT ONLY SHALL BE BORN.--This implies the exclusion of those, as
+parents, who are incapable of creating fit children. Fit children are
+children who are physically and mentally healthy. Parents who are unfit to
+create physically and mentally healthy children are those diseased in body
+or mind, especially if the disease is of the type which science has proved
+to be transmissible, or which directly affects the vitality of the child.
+In such a category we place those who are deaf, dumb, blind, epileptic,
+feeble-minded, insane, criminal, consumptive, cancerous, haemophilic,
+syphilitic, or drunkards, and those known to be victims of disease of  [11]
+any other special type.
+
+It must not be inferred that the above classification is made arbitrarily.
+There are many arguments which may be advanced limiting the eugenic
+applicability of certain of these diseased conditions. These, however, do
+not directly come within the province of the mother. They may be safely
+left to special state regulation. We simply make the assertion that no
+mother would willingly, or designedly, ally her offspring with any member
+of society afflicted with any of the diseases enumerated.
+
+EUGENICS AND MARRIAGE.--The eugenic idea, practically applied to the
+institution of marriage, means that no unfit person will be allowed to
+marry. It will be necessary for each applicant to pass a medical
+examination as to his, or her, physical and mental fitness. This is
+eminently a just decree. It will not only be a competent safeguard against
+marriage with those obviously diseased and incompetent, but it will render
+impossible marriage with those afflicted with undetected or secret disease.
+Inasmuch as the latter type of disease is the foundation for most of the
+failures in marriage, and for most of the ills and tragedies in the lives
+of women, it is essential to devote special consideration to it in the
+interest of the mothers of the race.
+
+It is estimated that there are more than ten million victims of venereal
+disease in the United States to-day. In New York City alone there are two
+million men and women--not including boys and girls from six to twelve
+years of age--actively suffering from gonorrhea and syphilis. Eight out of
+every ten young men, between seventeen and thirty years of age, are
+suffering directly or indirectly from the effects of these diseases, and a
+very large percentage of these cases will be conveyed to wife and children
+and will wreck their lives. No one but a physician can have the faintest
+conception of the far-reaching consequences of infection of this character.
+The great White Plague is merely an incident compared to it. These diseases
+are largely responsible for our blind children, for the feeble-minded, for
+the degenerate and criminal, the incompetent and the insane. No other  [12]
+disease can approximate syphilis in its hideous influence upon parenthood
+and the future. The women of the race, and particularly the mothers, should
+fully appreciate the real significance of the situation as it applies to
+them individually. That they do not appreciate it is well known to every
+physician and surgeon.
+
+It is first necessary to state certain medical facts regarding these
+diseases. They exist for years after all symptoms have disappeared; no
+evidences exist even to suggest to the patient that he, or she, is not
+entirely cured. After the germs have been in the patient for some time they
+lose a certain degree of their virility, and a condition of immunity is
+established. In other words the tissue ceases to be a favorable medium for
+the development, or activity, of the germs. If these germs, however, are
+conveyed to another person, who has never had the disease, or whose tissue
+is not immune, they will immediately resume their full activity and
+virulence, and will establish the disease, frequently in its most violent
+form, in the person so infected. The startling deduction which we must draw
+from these facts is, that a man may infect his wife, and may thereby be the
+direct cause of wrecking her entire life, and may, in addition, as a
+consequence of the infection, cause a child to be born blind, without even
+remotely suspecting that he is in any way responsible for it. In the light
+of this knowledge, what is the percentage risk a young girl takes when she
+selects a husband, remembering that eight out of every ten husbands bring
+these germs to the marriage bed? Reread the true story of the young woman
+on page five, accept my assurance that there are thousands and thousands of
+such cases, and ask yourself, who is to blame? We may certainly assure
+ourselves that no man living would wilfully desecrate his bride. He did not
+know,--did not even suspect that the disease he had years ago was still in
+his system. Society is to blame--you and I--the laxity of the law is the
+culprit. Had he been compelled to pass a physical examination before
+marriage he would have been told the truth.
+
+It is a notorious fact, that in every civilized city in the world, the
+number of operations that are daily performed on women, is increasing  [13]
+appallingly. Every surgeon knows that nine-tenths of these operations are
+caused, directly or indirectly, by these diseases, and in almost every case
+in married women, they are obtained innocently from their own husbands. It
+is rare to find a married woman who is not suffering from some ovarian or
+uterine trouble, or some obscure nervous condition, which is not amenable
+to the ordinary remedies, and a very large percentage of these cases are
+primarily caused by infection obtained in the same way.
+
+When a girl marries she does not know what fate has in store for her, nor
+is there any possible way of knowing under the present marriage system. If
+she begets a sickly, puny child,--assuming she herself has providentially
+escaped immediate disease,--she devotes all her mother love and devotion to
+it, but she is fighting a hopeless fight, as I previously explained when I
+stated that one-half of the total effort of one-third of the race is
+expended in combating conditions against which no successful effort is
+possible. Even her prayers are futile, because the wrong is implanted in
+the constitution of the child, and the remedy is elsewhere. These are the
+tragedies of life, which no words can adequately describe, and compared to
+which the incidental troubles of the world are as nothing.
+
+So long as these conditions exist need we not tremble for the future of the
+race? Is not this future welfare a personal issue, or can we trust the
+future of our daughters to the same indiscriminate fate that has written
+the pages of history in the past?
+
+This problem has been debated from every possible angle without our
+reaching any seemingly practical solution. The promise of emancipation,
+however, came with the dawn of eugenics. It is the only solution that gives
+promise of immediate and reasonable success. For that reason alone it
+should receive the active support of every good mother in all lands.
+
+THE UTILITY OF MARRIAGE CERTIFICATES.--There would seem to be no question
+as to the utility of marriage certificates. We must remember, however, that
+there is a distinction between marriage and parenthood, and that       [14]
+eugenics is concerned only with parenthood. It is interested in the
+institution of marriage to the extent only that it may, by some system of
+regulation, be a positive and fixed factor in the production of exclusively
+healthy children. The eugenist demands fit children. If society can ensure
+fit children, as a consequence of any marriage system which may or may not
+include medical certification, the eugenic aim is fully met. At the present
+time the giving of a marriage certificate, which is really a permit to
+marry, would seem to be the most practical way promptly to accomplish the
+eugenic purpose. We should promptly question the honor of any prospective
+husband disposed to evade the examination simply because he was not
+compelled to obey by a legislative enactment.
+
+We believe that when the public is educated to the truth and intent of
+eugenics, there need be no compulsory examination. Men and women will, of
+their own accord, desire to know if their marriage will jeopardize the
+race. There will be questions of heredity to elucidate, questions of
+inherited insanity, poison taints, of blindness and deafness, or it may be
+of drunkenness.
+
+Further, marriage certificates, or permits, must be considered in regard to
+the future conduct of those to whom we refuse permits to marry. A refusal
+of the permission to marry will not change the desire to marry. Many, of
+course, to whom a permit is refused, will accept the situation, will be
+thankful to be possessed of the knowledge of their incompetency in order
+that they may seek medical aid. These individuals will remain under medical
+supervision until their ailments are cured and their competency
+established. In this way the eugenic aim is materially furthered. Others
+may not abide by the decree which forbids marriage. It would wholly defeat
+the eugenic idea if the unfit children were to continue to be born
+illegitimately. These individuals will comprise the few--probably the
+present unfit members of society--and the final solution of the matter must
+remain a question of education and evolution. When public opinion is
+educated to the degree necessary to establish a system of eugenic
+self-protection, we shall be provided with a race of children whose    [15]
+culture will achieve the ideal of parenthood by a process of education
+rather than legislation.
+
+THE MARRIAGE CERTIFICATE AND VICE.--If a prenuptial examination were made
+compulsory there is no doubt of the very prompt and salutory effect it
+would have on present-day vice. It has often been said that "You cannot
+legislate virtue or sobriety into a people." We are familiar too with the
+maxim that "You can lead a horse to the well, but you cannot make him
+drink." You can lead a horse to the well, however, and lo! he drinks. If
+you lead him at the right time he will always drink. If we legislate at the
+psychological moment we can legislate virtue and sobriety into a people.
+
+A very large percentage of existing vice is the immediate product of
+ignorance, and the larger percentage of the remainder is the result of
+propinquity and the idea that it will never be found out. Very little of it
+is the outcome of innate degeneracy. It is an acquired degeneracy we must
+guard against, and that is the special educational motive of eugenics.
+Young men will be taught the truth about vice, and if they have been
+victims in the past, they will willingly submit themselves to a _competent_
+investigation of their fitness for marriage. If they are still pure, the
+desire to remain so, in order to be eligible for parenthood, will guard
+them against the risk of contamination. This will not only result in a
+distinct improvement of the moral tone, but the potential possibilities to
+posterity will be incalculable. Legislation might therefore be the vehicle
+through which eugenic education could enlighten and evolve a fit race.
+
+EUGENICS AND PARENTHOOD
+
+If the supreme end is a better race we must recognize that the great need
+for society to-day is to educate for parenthood. History teaches that a
+civilization that dissipates its virility in profligacy or spends its
+energy in political and commercial trickery, and gives no thought to the
+character of the men and women it produces, is destined to total failure.
+Parenthood and birth--in these we have the eugenic instruments of the  [16]
+future. The only permanent way to cure the ills of the world is to prevent
+the multiplication of people below a certain standard. The elevation and
+the actual preservation of the race depends upon rendering it impossible
+for the unfit coming into existence at all. In other words the unfit or
+unworthy must be rejected, not necessarily as individuals, but as parents.
+
+Eugenics is allied to the principle of heredity,--the principle that
+enables us to modify conditions so as to ensure the right children being
+born. The propaganda against infant mortality is directed only toward the
+provision of a good environment,--so that children, when born, may survive
+and attain the maximum of their hereditary promise. The two campaigns are
+essentially complementary. The one applies only before birth, the other
+after birth. The statistics of infant mortality unfortunately show that it
+is not a process that extinguishes the unfit only. The healthy succumb to
+unfavorable environment and it was to amend this condition that the
+campaign against infant mortality was undertaken. The two campaigns appeal
+to the same creed: that parenthood is the supreme function of the race,
+that it must not be indifferently undertaken; that it demands the most
+careful preparation; that it is a duty which can only be carried out
+eugenically by the highest attainable health of body and mind and emotions.
+
+EUGENICS AND MOTHERHOOD.--Any plan or scheme which has for its object race
+regeneration must concern itself with the health, the education, and the
+psychology of woman; the environment which shall surround her period of
+motherhood, and her selection of the fathers of the future. Society must
+safeguard her in all her relations. The race to-morrow are the babies of
+to-day. The wealth of a nation therefore is the type of baby that will
+constitute its civilization from generation to generation, and absolutely
+nothing else counts. We hear much about race suicide, but is it not
+monstrous to cry for more babies when we do not know how to keep alive
+those we have? It is a fact that everywhere the birth rate of the Caucasian
+people is on the decline. Our birth rate as a whole, however, is ample;[17]
+it is the death rate that is significant and appalling. When we remember
+that one-third of all the babies born die before they reach the age of five
+years; and that the deaths of babies under one year of age comprise about
+one-fourth of the total death-roll; and that fully one-half of all these
+deaths are needless and unnecessary, wherein is the wisdom of working for a
+higher birth rate if it is merely that more may die?
+
+The majority of babies are born physically healthy, but because of our
+destructive process, we proceed to annihilate hundreds of thousands of them
+yearly, and because of defective environment and education we render
+thousands of others, including the fit and unfit, inefficient and
+incompetent as propagating factors. It is to remove this disastrous stigma
+on our intelligence that we have been forced to study the conditions which
+the eugenic idea represents. When these principles are understood and
+believed, and when they are acted upon, infant mortality will cease to
+exist.
+
+It was the design of the Creator that human motherhood should be an exalted
+occupation. He placed in her care to nurture and to love, the most helpless
+living thing. Few have regarded a baby from this viewpoint and fewer still
+understand its supreme significance. That it is the most utterly helpless
+thing possessing life is a self-evident fact, and that it should be
+destined to be King of all mammalian tribes as well as Lord of all the
+earth is a superlative paradox. Because of its utter inability to care for
+itself it is more in need of care than any other representative of the
+animal world. It is not only in need of immediate care, but it demands care
+longer than the young of any other species.
+
+It stands to reason, therefore, that the function of motherhood must be
+reckoned with in any scheme of race regeneration; that it must be provided
+with the most favorable environment; and that it must be relieved of any
+condition which would materially retard the meeting of the obligation to
+its fullest possible extent. In an ideal eugenic sense the state must
+ensure sustenance to those deprived of ample food and raiment, and     [18]
+science must continue to solve the problem of a fitter sanitary and
+hygienic environment for the congested and densely populated zones of
+habitation. Philanthropy must not continue to be wholly misdirected, it
+must extend its aid to the deserving healthy and fit, as well as to be
+exclusively the protecting agency of the diseased and unfit. If life is the
+only wealth, and the preservation of childhood the highest duty of society
+and the state,--which it would seem to be, since the continuance and
+preservation of the race is obviously essential to the continuance of the
+state itself,--the life of every child must be considered an economic as
+well as a moral trust. If, therefore, every child is sacred, every mother
+is equally sacred. If every child is to be cared for, every mother must be
+cared for. If the state cannot afford to provide for what is imperatively
+essential to its own continuance, it might as well go out of existence, as
+it inevitably will in the end on any other basis, and as all preceding
+states have done.
+
+Mothers must not be dependent upon their children's labor for their
+maintenance, because if children are compelled to work, they will not be
+able to work in the future,--and adult efficiency is necessary to the
+well-being of the individual, the race, and the state.
+
+No mother should work, because in the care of her children she is already
+doing the supreme work. The proper care of children is so continuous and
+exacting a task, and of such importance to posterity, that it must be
+regarded as the highest and foremost work--and adequate in itself--and its
+efficiency must not be hampered by mothers having to do anything else.
+
+Motherhood must not be financially insecure, because this would defeat its
+eugenic purpose. Society, therefore, as a matter of self-preservation, must
+ensure to woman her mental and economic security. Civilization's margin is
+large enough to provide this. We spend large amounts on luxuries and evils
+which are contrary to the genesis of self-preservation, while motherhood is
+its basic necessity. When public opinion is educated in the essentials of
+eugenics much of this can be, and will be diverted to a nobler purpose. The
+total cost necessary to ensure the adequate care of dependent          [19]
+motherhood would be a mere fraction of the national expenditure, and not a
+tithe of what we spend in pension allowances yearly. The latter is regarded
+as an honorable debt and is at best the direct product of a decadent ideal,
+while motherhood constitutes the very germ of the only altruistic idealism
+for all the future.
+
+We concede, therefore, that the children and the mothers must be provided
+for, not only as a product of the true construction of the ethics of
+sociology, but in obedience to the fundamental law of a moral system of
+eugenics. We must go further and assert that children must be cared for
+through the mother. It has been the practice to divorce the improvident
+mother from her dependent children. This has been demonstrated to be not
+only an altruistic fallacy. It has proved to be an economic blunder.
+
+There is another type of evil which largely menaces the eugenic ideal of
+motherhood. It is those cases where married women who have children are
+compelled to be the bread winners of the family as well as its mothers. No
+woman can earn support for herself and children outside of her home and
+competently assume the responsibilities of motherhood at the same time.
+Whatever aid a mother renders to the state, as a result of effort in
+factory or shop, is of infinitely less value, from an economic standpoint,
+than her contribution as mother in caring for her own children in her own
+home. A careful study of infant mortality, and the conditions of child
+life, so far as survival value is concerned, condemns in the strongest and
+most vital sense this whole practice. The preservation of the race is the
+essential requisite, and it is the vital industry of any people. Any
+seeming economic necessity which destroys that industry is one that will
+contribute largely to the downfall of the people as a race.
+
+EUGENICS AND THE HUSBAND.--The question of the husband's moral and parental
+obligation, as dictated by the marriage institution and constitution, may
+be left out of this discussion. We may assert, however, that we do not
+believe the eugenic principle intends, in devising ways and means for  [20]
+the adequate protection, in its completest sense, of motherhood, to relieve
+the father of any of his moral or parental obligations. These obligations
+will be justly defined, and as previously stated, will be the subject of
+special state legislation. No legislation of an economic character can
+detract from the performance of a moral obligation, and by no process of
+sophistication can modern statesmanship accomplish the dethronement of
+motherhood. The duty of the father is to support his children and the
+mother of his children, and the duty of the state is to see that this is
+done. The fundamental law of the eugenist must be to recognize that
+fatherhood is a deliberate and responsible act, for which a fixed
+accountability must be maintained. Whatever legislation is undertaken in
+this connection must be with the object in view of strengthening the
+efforts of the right kind of father and husband, and of rendering more
+difficult the path of the irresponsible father and husband. If the supreme
+duty of a state is the maintenance of justice, its whole effort in the
+future will be to legislate in harmony with the eugenic principle.
+
+       *       *       *       *       *
+
+
+                                                                       [21]
+CHAPTER III
+
+    "I hope to live to see the time when the increased efficiency in the
+    public health service--Federal, State and municipal--will show itself
+    in a greatly reduced death rate. The Federal Government can give a
+    powerful impulse to this end by creating a model public health
+    service."
+
+    EX-PRESIDENT TAFT.
+
+EUGENICS AND EDUCATION
+
+    THE PRESENT EDUCATIONAL SYSTEM IS INADEQUATE--OPINIONS OF DR. C. W.
+    SALEEBY, ELLA WHEELER WILCOX, LUTHER BURBANK, WILLIAM D. LEWIS,
+    ELIZABETH ATWOOD, DR. THOMAS A. STORY, WILLIAM C. WHITE, DR. HELEN C.
+    PUTNAM--DIFFICULTY IN DEVISING A SATISFACTORY EDUCATIONAL
+    SYSTEM--EDUCATION AN IMPORTANT FUNCTION--THE FUNCTION OF THE HIGH
+    SCHOOL--THE HIGH SCHOOL SYSTEM FALLACIOUS--THE TRUE FUNCTION OF
+    EDUCATION.
+
+The fundamental law of eugenics demands that all education be exerted for
+parenthood. We have proved that the child is not only essential to the life
+of the state, but is the state. Consequently any function other than
+parenthood is a non-essential so far as organic existence is dependent upon
+it. Education can, therefore, have no higher or more righteous motive than
+as a contributory agency in the perpetuation of the function upon which all
+existence depends. If the only function of education is to make one a
+worthy citizen, or to make him, or her, self-supporting, or able to bear
+arms in defense of his country, rather than a perfect link in the complete
+chain of enduring life, its purpose is being perverted. It is not
+sufficient to provide a girl, for instance, with an exclusive environment
+which regards her simply as a muscular entity, as is the tendency in some
+of the "best" girls' schools to-day; nor to fit her as a domestic or
+society ornament; nor must she be regarded simply as an intellectual
+machine, as is done under the system styled "the higher education of
+women." Any one of these is an example of misdirected excess and is    [22]
+only part of the whole. None of these systems strives to develop the
+emotional side of the complex female character, and any educational system
+which ignores the emotions is not only inadequate but reprehensible in the
+highest degree. The ideal which will strive for education for ultimate
+parenthood will more completely solve the question of complete (eugenic)
+living.
+
+THE PRESENT EDUCATIONAL SYSTEM IS INADEQUATE.--There is no question that
+education, as conducted at the present time, is one of the most disastrous
+institutional fallacies of modern civilization. In support of this
+contention, we are prompted to quote at length from various authorities
+bearing on this subject.
+
+Dr. C. W. Saleeby, an international authority on education, writes as
+follows:
+
+"A simple analogy will show the disastrous character of the present
+process, which may be briefly described as 'education' by cram and emetic.
+It is as if you filled a child's stomach to repletion with marbles, pieces
+of coal and similar material incapable of digestion--the more worthless the
+material the more accurate the analogy--then applied an emetic and
+estimated your success by the completeness with which everything was
+returned, more especially if it was returned 'unchanged,' as the doctors
+say. Just so do we cram the child's mental stomach, its memory, with a
+selection of dead facts of history and the like (at least when they are not
+fictions) and then apply a violent emetic called an examination (which like
+most other emetics causes much depression) and estimate our success by the
+number of statements which the child vomits onto the examination paper--if
+the reader will excuse me. Further, if we are what we usually are, we
+prefer that the statements shall come back 'unchanged'--showing no sign of
+mental digestion. We call this 'training the memory.' The present type of
+education is a curse to modern childhood and a menace to the future. The
+teacher who cannot tell whether a child is doing well without formally
+examining it, should be heaving bricks, but such a teacher does not exist.
+In Berlin they are now learning that the depression caused by these    [23]
+emetics (examinations) often lead to child suicide--a steadily increasing
+phenomenon mainly due to educational overpressure and worry about
+examinations.
+
+"Short of such appalling disasters, however, we have to reckon with the
+existence of this enormous amount of stupidity, which those who fortunately
+escaped such education in childhood have to drag along with them in the
+long struggle towards the stars. This dead weight of inertia lamentably
+retards progress.
+
+"If you have been treated with marbles and emetics long enough, you may
+begin to question whether there is such a thing as nourishing food; if you
+have been crammed with dead facts, and then compelled to disgorge them, you
+may well question whether there are such things as nourishing facts or
+ideas."
+
+The gifted writer, Ella Wheeler Wilcox, in an editorial in the _New York
+American_, expressed herself recently in the following terms:
+
+"A wave of dissatisfaction is sweeping over the country regarding our
+school system. And eventually this will cause a change to be made. The
+larger understanding of mothers regarding education will result in the
+personal element entering into the training of children.
+
+"When women have a voice in the affairs of the nation there will be more
+teachers, larger salaries, fewer pupils in each department, and more
+attention will be given to the temperaments and varying dispositions of
+children by their instructors.
+
+"Instead of regarding the little ones who enter public schools as machines
+which must be taught to go according to one rule, each child will be
+studied as a threefold being, and his mind, body and spirit will be cared
+for and developed according to his own peculiar needs. All this will come
+slowly, but it will come.
+
+"Before children enter the public schools there should be a great sifting
+process under the direction of a national board of scientific men. The
+brain equipment of each child, the tendencies given it at birth, should be
+tested; then the nervous, hysterical and erratic minds ought to be     [24]
+placed in a school by themselves, under the care of men and women who know
+the law of mental suggestion.
+
+"Quiet, loving, wholesome rules, followed day after day and month after
+month, would bring these children out into the light of self-control and
+concentration. The hurried, crowding, exciting methods of the public
+schools are disastrous to fully half of the unformed minds sent into the
+intellectual maelstrom which America provides under the name of Public
+Schools.
+
+"For the well-born, normal-minded, healthy-bodied child, who has wise and
+careful guardians or parents to assist in his mental guidance, the public
+school forms a good basis on which to build an education. For the average
+American child of excitable nerves and precocious tendencies, it is like
+deep surf swimming for the inexperienced and adventurous bather.
+
+"The great foundation of education--character--is not taught in the public
+schools. There is no systematized process of developing a child's power of
+concentration; there is not time for this in the cramming process now in
+vogue and with the enormous pressure placed on teachers. No teacher can do
+justice to more than fifteen children through the school hours. In many of
+our public schools there are fifty and sixty children under one instructor.
+This is fatal to the nervous system of the teacher and deprives the pupils
+of that personal sympathy which is of such vital importance."
+
+Luther Burbank, the famous California horticulturist, declares that the
+great object and aim of his life is to apply to the training of children
+those scientific ideas which he has so successfully employed in working
+transformation in plant life.
+
+In an editorial, entitled, "Teaching Health," the _New York Globe_ states,
+"Anatomy and physiology are reasonably exact sciences, and nine-tenths of
+the hygienic abuses against which the doctors are preaching would be
+prevented if the laity had an elementary knowledge of physiology. Such an
+educational reform could be carried out without causing any clash whatever
+between the warring medical sects." [Page 25]
+
+William D. Lewis, Principal of the William Penn School, Philadelphia, in an
+article entitled: "The High School and the Girl," in a recent issue of the
+_Saturday Evening Post_, wrote in part as follows:
+
+... "The first thing that society wants of our girl is good health. This is
+the first essential for her efficient service and personal happiness in
+shop, office, store, school or home. The future of the race so far as she
+represents it, depends upon her health. What is the high school doing to
+improve the girl's health? In the overwhelming majority of cases absolutely
+nothing. On the other hand, it is subjecting her to a regimen planned for
+boys, without the slightest consideration of the physical and functional
+differences between the sexes.
+
+"It pays no attention to the curvature of the spine developed by the
+exclusively sit-at-a-desk-and-study-a-book type of education bequeathed to
+the girlhood of the nation by the medieval monastery: It ignores the
+chorea, otherwise known as St. Vitus' dance developed by overstudy and
+underexercise; it disregards the malnutrition of hasty breakfasts, and
+lunches of pickles, fudge, cream-puffs and other kickshaws, not to mention
+the catch penny trash too often provided by the janitor or concessionaire
+of the school luncheon, who isn't doing business for his health or for
+anybody else's; it neglects eye-strain, unhygienic dress, uncleanly habits,
+anemia, periodic headaches, nervousness, adenoids, and wrong habits of
+posture and movements.... If you believe that the high school is a social
+institution with a mission of public service, regardless of the relation of
+that service to Latin or Algebra, then you must agree that it should look
+after what everyone recognizes as the foremost need of the adolescent girl.
+
+"One fact that every educator in both camps knows is that the home is not
+attending to the health of the adolescent girl. This problem is pressing
+upon us now largely because of the revolutions in living conditions that
+has come within the last quarter of a century."
+
+In a report of a recent Conference on the Conservation of School       [26]
+Children held at Lehigh University by the American Academy of Medicine, the
+following items appear.
+
+Four great reasons why medical inspection in schools is needed were brought
+out by Dr. Thomas A. Story of New York, who spoke from the educator's
+standpoint:
+
+"The first reason is concerned with communicable diseases, and the second
+with remediable incapacitating physical defects. It was reported in 1906
+that over twenty per cent. of the children in the schools of New York City
+had defective vision, and over fifty per cent. had defective teeth. These
+defective conditions are amenable to treatment whereby the functional
+efficiency of the pupil is improved. He is capable of better work and the
+school efficiency is advanced.
+
+"The third reason is concerned with irremediable physical defects. The
+cripples, the deformed and the delinquents whose incapacitating defects are
+permanent should be found and classified. This enables special instruction
+and opens up educational possibilities otherwise unattainable, besides
+removing retarding factors in the progress of the normal pupil.
+
+"The fourth reason is concerned with the development of hygienic habits in
+the school child, and through the child, of the community. Medical
+inspection which influences the health habits of the masses is a matter of
+supreme importance. The teacher will have pupils of cleaner habits and
+healthier, with fewer interruptions and disturbances from absences.
+
+"To make medical inspection successful physical examinations should uncover
+the anatomic, physiologic, and hygienic conditions. Every piece of advice
+given to a pupil that can be followed up should be followed up and the
+result recorded. No system of medical inspection in schools can be complete
+and permanently successful which does not eventually educate the parent and
+child to a sympathetic and coöperative relationship with the system.
+Medical inspection is a force working for a better general education in
+personal hygiene and should coördinate with the class room instruction.
+Hence it must be a system in sympathetic relationship with the general [27]
+management of the school, and should be under the same responsible control.
+Since it is an educational influence and so directly related to the success
+of the school, it ought to be a part of the school organization."
+
+A paper was read by Dr. Helen C. Putnam of Providence, R. I., on "The
+Teaching of Hygiene for Better Parentage." She said:
+
+"Life is a trust from fathers and mothers beginning before history; to be
+guarded and bettered in one's turn, and passed along to children's
+children. A definite conception of this trust is essential to right living.
+Educators are finding that well directed correlation of human life, with
+phenomena of growing things in school gardens and nature studies, develops
+a wholesome mental attitude. Since tens of millions of our population have
+only fractions of primary schooling, there is where the teaching must
+begin. These primary years are the time to lay foundations before a wrong
+bias is established.
+
+"Education for parenthood cannot be completed at this early age. The
+strategic years for making it most effective are from sixteen to
+twenty-four, when home-making instincts are waking and strongest. We have
+15,000,000 young people of these ages in no schools, and eligible for such
+instruction. All state boards of education were recently petitioned by the
+American Association for Study and Prevention of Infant Mortality to urge
+the appointment of commissions on continuation schools of home-making, to
+investigate conditions and needs in their respective states and to report
+plans for meeting them effectively through such continuation schools or
+classes."
+
+DIFFICULTY IN DEVISING A SATISFACTORY EDUCATIONAL SYSTEM.--It will be
+observed that each of these authoritative writers criticises the system of
+education now in vogue. The criticism is not, nor could it justly be,
+specialized. It is simply an expression, from different viewpoints, of the
+feeling that we are not doing ourselves justice as yet, we are groping
+after something better. It may be, as I have previously stated, that no[28]
+satisfactory system of education will be evolved until the laws of kindred
+sciences, which have organic relationship to what we understand as
+education, are fixed and better understood. We are just beginning to
+appreciate the true meaning of environment. We know little about heredity,
+but enough to appreciate its vital importance. Psychology is a realm of
+much hope, but we have only tasted of its surface promise and know little
+of the mysteries it may unfold. Eugenics, the infant giant of science,
+promises to establish the race on an enduring foundation. These sciences
+have laws which we do not yet understand; they relate to that part of human
+evolution which mind dominates. The quality of the mind's dominion depends
+upon the mind's education and environment, and since the laws of these
+sciences, upon which a perfect system of education depends, have not been
+revealed, it is quite evident that all past systems of education have been
+more or less deficient. It is further evident that evolution has suffered
+as a result of the mind's imperfect education,--a condition that is
+manifest all around us.
+
+It must be appreciated, however, that we are discussing a large subject. If
+we understood all there is to know about environment; if we knew the laws
+of heredity, and psychology, and eugenics, and then could apply them, and
+educate the product of this combination of forces, we would be very near to
+the super-man. One must have a sober mental horizon to evolve the picture
+which would be the product of the above solution and then to estimate its
+meaning on human happiness and progress. We are approaching the ethics of
+right living,--of justice and truth,--the divine in man. At no time in the
+history of man has civilization been so near a solution of life's supreme
+problem as at the present moment.
+
+Education is an important function in life's scheme, and while we may
+regret that it is not possible to formulate a system that would be perfect
+and capable of immediate application, we can continue to work patiently and
+hopefully, with assurance that in the near future the problem will be
+satisfactorily solved. When heredity, psychology, and eugenics combine [29]
+to dictate the system, we shall doubtless find, that, in the beginning, it
+will be a system of individualization. In the interest of health and of
+justice, and consequently of efficiency, this would seem to be the natural
+and the logical lead.
+
+So long as human nature is as it is, we must meet conditions as they exist.
+We know as parents, and some of us know as physicians, that a task easily
+performed by one individual, without any apparent harmful results, will tax
+the capacity of another individual to the very utmost. Any educational
+system which does not recognize this law, is vicious. Yet such is the
+system in vogue to-day in America. We must adapt the burden to the
+endurance of the pupil. The administration of an educational machinery must
+solve this problem from the individual standpoint.
+
+In the departmental work in our public schools there seems to be no system.
+Each teacher prescribes home work without any knowledge of what others of
+the same grade do, and without any apparent consideration in favor of the
+individual pupil. The result is that the total amount for each night is
+absurdly in excess of the capacity of the ordinary, or for that matter the
+extraordinary, pupil. This engenders nervousness and irritability, and is
+contrary to the ethics of education,--the fundamental law of which should
+be the preservation of good health. We must have regard for the physical
+and mental health of each pupil, and as the capacity of each pupil is
+different, the system is committing an egregious wrong by sacrificing the
+weaker instead of adapting the burden according to the strength and
+endurance of the bearer.
+
+THE HIGH SCHOOL SYSTEM FALLACIOUS.--Even the high schools do not seem to be
+wisely availing themselves of their opportunity from the eugenic or
+economic standpoint. According to the report of the Commissioner of
+Education of the United States the percentage of pupils studying some of
+the more important subjects in the year 1909-1910 is stated as follows:[30]
+
+Latin, French and German         83 per cent.
+Algebra and Geometry             88  "    "
+English Literature               57  "    "
+Rhetoric                         57  "    "
+History                          55  "    "
+Domestic Economy,--including
+  sewing, cooking and household
+  economies                       4  "    "
+If only barely four per cent. of the girls in our high schools are studying
+subjects which directly contribute to their efficiency as home-makers, what
+are the prospects for worthy parenthood in the light of the fact that
+seventy-five per cent. of all women between the ages of twenty and
+twenty-four are married?
+
+The function of the high school, so far as girls are concerned, is to
+conserve health, to train for domestic efficiency and motherhood, and if
+necessary for economic independence. It must also furnish the stimulus for
+mental culture and direct a proper aspiration for social enlightenment. The
+curriculum should include biology, hygiene, psychology, home beautifying,
+the story-telling side of literature, music and a few other studies tending
+to make woman more like woman than she is to-day. When we have this,
+teaching for mothercraft will be more nearly realized.
+
+From the eugenic standpoint the present system of education is not
+satisfactory. To attain our end it is essential to devise other means of
+education. It must be remembered, however, that no system of education
+alone can ever enable us to achieve our end, no matter how perfect the
+system may be. Education can only draw out what is in the child; it cannot
+draw out what is not there. What the child is, depends upon its heredity.
+The pedagogic ability of the school-master will never make a genius.
+
+A child's mind may be likened to a block puzzle, each block representing a
+part of a picture, which can only be completed when they are all arranged
+in their correct places. Each block is an ancestral legacy,--the child's
+heritage--and to find its proper place in order to complete the        [31]
+character picture--to solve the riddle of the jumbled blocks,--is the duty
+of the educator. He can only manipulate what is there, and the test of his
+system will depend upon his ability to solve the puzzle of the ancestral
+blocks. We must divorce ourselves from the idea that a child's mind, at the
+beginning, is an empty space, to be filled in with knowledge according to
+the ability of the teacher; or that it is like a sheet of paper, to be
+written upon. Education, and the educator, is absolutely limited to
+"drawing out" what heredity put there. Education frequently is given credit
+which rightly belongs to nature. A child cannot do certain things until
+nature intends that it should. A baby cannot possibly walk until the
+nervous mechanism which controls the function of walking is developed. Many
+children walk at the first attempt, simply because they did not make the
+first attempt until after nature had perfected the mechanism and the innate
+ability to walk was already there. Suppose we tried to teach that baby to
+walk a month before nature was ready; each day we patiently coax it to
+"step out," we guide it from support to support, and we protect it from
+stumbling. Some day it walks, and we congratulate ourselves on the victory,
+when as a matter of fact, we not only had nothing to do with it but were
+impertinent meddlers, not instructors. Nature was the teacher and she was
+quite capable of completing the task without our aid. It is reasonable also
+to assume that any effort to force a natural function is quite likely to do
+much harm. We have found this to be so in various departments of education
+when the system was wrongly conceived. In physical culture this principle
+has been demonstrated over and over again.
+
+If our ancestral legacy is a good one, our picture blocks will be numerous
+and it will be possible for the proper system of education, aided by a
+suitable environment, to arrange them into many designs. If, on the other
+hand, our heredity did not endow us abundantly the number of our picture
+blocks may be limited to three or four, and they will be easily arranged so
+as to form a simple picture. The one represents a child whom heredity has
+richly endowed, the other one whom it has meagerly supplied with innate[32]
+possibilities. Heredity therefore dictates the function of education; and
+the school-master can only fashion the picture put there. If the ancestral
+blocks are not there with which to make an elaborate picture he must
+content himself with what is there,--he or his art cannot create others.
+When he congratulates himself on achieving a wonderful result in graduating
+a particularly brilliant student, he is taking to himself unmerited honors.
+If his individual ability is responsible in one instance, why not apply the
+same system to all pupils? If this system is responsible for the brilliancy
+of one pupil, why does not the same system make all brilliant? The reader
+knows the answer,--because heredity did not endow them equally. Men are not
+born equal, despite the Declaration of Independence.
+
+The school-master is not responsible for the apt and the inapt pupil. He is
+responsible for his system which dictates how he will differentiate between
+the apt and the inapt pupil, in order to achieve the best results without
+injustice to either.
+
+The inefficient teacher is a dangerous equation in the school system. I
+mean by inefficiency, the quality of being temperamentally unsuited to the
+profession. There are a large number of anemic, hysterical young women
+teaching in the public schools of our cities who should not be there. They
+should not be there in justice to themselves, nor should they be there in
+justice to their pupils. A strict, yearly medical examination should be
+made of the teachers to decide their physical and psychical fitness to fill
+their positions adequately. One teacher, physically or psychically
+inefficient, can do an inconceivable amount of harm in one school term. We
+cannot afford to experiment along this line. It means too much, and even at
+the price of one unhappy child it is too much to pay. The teacher who feels
+that she is not suited to the work; who has constantly to hold herself and
+her temper under control; whose nerves are such that she cannot do justice
+to herself, whose sense of justice is capable of perversion on purely
+sentimental grounds; or who has lost--or never possessed--the gift of
+maintaining discipline, should promptly find another position. She is  [33]
+earning her salary under false pretenses, and that alone condemns her. I
+believe, that a large percentage of the inefficiency of the New York
+Schools is due, not to the academic or scholastic inability of the average
+teacher, but to the average female teacher's physical, and especially her
+psychical unfitness to teach. We must concede, however, that in many
+instances the teacher's unfitness is a direct product of the pernicious
+system itself.
+
+[Illustration: _From "The Village of a Thousand Souls," Gesell, American
+Magazine_
+
+Evidence of a Feeble Mind
+
+A dirty shack in a mud hole in the country is merely another reflection of
+the same condition that causes the slums of the city. In our glowing spirit
+of humanity we cry out to raise up "the submerged tenth." Rather, should we
+not stamp them out of existence--treat them as a menace, and not as a thing
+of pity?
+
+Men, in general, rise; their minds are subjectively or objectively educated
+to their mental limit. They cannot go beyond it. "The submerged tenth"
+exists because its mental limit is low--often close to the upper margins of
+feeble-mindedness--and because it is mentally incapable of rising to
+anything else.]
+
+[Illustration: _From "The Village of a Thousand Souls," Gesell, American
+Magazine_
+
+Evidence of a Vigorous Mind
+
+The family that is vigorous, healthy in mind and body, "up and coming,"
+reflects itself in a hundred different ways. Small matter whether or not it
+is "an old family," has wealth, social position, a college education. A
+daughter's or a son's happiness, the real, deep-down-inside happiness that
+is worth while, may be more certainly insured by marrying with an eye to
+mentality and stock than by a marriage into a so-called "first family."
+
+Eugenics hath its reward.]
+
+Under an ideal system of education the child would be left absolutely free
+until the age of seven. We do not believe that the physical apparatus of
+the mind is prepared for educational interference before that age, and we
+know that the growth of the brain, physiologically and anatomically, is not
+complete until after the seventh year.
+
+The greater portion of a child's education necessarily depends upon its
+environment. Heredity and environment, therefore, are the two factors which
+determine the characters of any living thing. Heredity gives to the child
+its potential greatness,--its promise of greatness. Whether these potential
+qualities ever become real depends upon environment. A child may have the
+hereditary (innate) ability to become a Shakespeare, but if his environment
+is not suitable to the development of this potential greatness, he will
+never realize his hereditary promise. In other words, the innate qualities
+which he has, and which will make of him a Shakespeare are never "drawn
+out" or educated. Hence he can never become great until environment
+furnishes the means to him.
+
+Environment, including education, does not add to the potential qualities
+of inheritance. Education can only educate what heredity gives; it can give
+or add nothing itself; it simply educates what is there already. There is
+plenty of material, but it is not the right material. What educators want
+is the right kind of material--the material which the eugenists will
+eventually supply. Or as Mr. Havelock Ellis has expressed it:
+
+"Education has been put at the beginning, when it ought to have been put at
+the end. It matters comparatively little what sort of education we give[34]
+children; the primary matter is what sort of children we have to educate.
+That is the most fundamental of questions. It lies deeper even than the
+great question of Socialism versus Individualism, and indeed touches a
+foundation that is common to both. The best organized social system is only
+a house of cards if it cannot be constructed with sound individuals; and no
+individualism worth the name is possible unless a sound social organization
+permits the breeding of individuals who count. On this plane Socialism and
+Individualism move in the same circle."
+
+Education, then, as an exclusive factor, cannot achieve our ideal of
+race-culture. In order that education may achieve a large measure of
+success, it must have the proper material, and the right material can only
+come as a result of the working out of the eugenic principle. Then--in the
+aftertime--our educational efforts will not be wasted and misdirected, as
+they are almost wholly to-day.
+
+If we could transmit our acquired characteristics, education would have a
+relatively smaller, and a much more fixed function in the "general scheme,"
+but we cannot. We can only transmit what was inherent in us when created.
+This simply means that, at the moment of conception, the child is
+created,--it is a completed whole,--what it is to be is fixed at that
+moment, its inherent capacities are formed. Nothing can affect it, in this
+sense, after that moment. No act of either parent can have any influence on
+it. Whatever ability the father or mother possessed of an innate character
+is transmitted to the child at the instant of conception and that innate
+legacy constitutes the working instrument of the child for all time. It
+cannot be added to by education, or by environment, but both of these may
+have a large influence in deciding whether it will be developed to its
+highest possible limit of attainment.
+
+Education, mental, moral and physical, is limited by this inability to
+transmit acquired character to the persons educated. Each generation must,
+therefore, begin, not where their parents left off, but at the point   [35]
+where they began. The same difficulties and the same problems must be met
+at the beginning of each generation.
+
+THE TRUE PROVINCE OF EDUCATION.--Education may justly be the instrument,
+however, which will educate public opinion to a true appreciation of the
+function of race culture. In this way the cause of the eugenist will
+greatly prosper, and the race will profit through the effort which will
+further the conservation of the best and most fit specimens for parenthood.
+So also may education, through the molding of public opinion, create sound
+opinion,--when each individual will be a center of eugenic enthusiasm.
+Especially does this responsibility fall upon parents and those who are in
+charge of childhood. The young must be taught the supreme sanctity of
+parenthood. They must be instructed in eugenic principles in a way that
+will impart to them the definite knowledge that it is the highest and
+holiest science. The eugenic education of children is the real beginning at
+the beginning, the indispensable necessity, if race culture is to assume
+its transcendent role in modern civilization. It is urgently necessary for
+both sexes but more especially for girls. "Urgently necessary," because,
+though Herbert Spencer wrote the following criticism nearly fifty years
+ago, the conditions are much the same to-day:--
+
+... "But though some care is taken to fit youth of both sexes for society
+and citizenship, no care whatever is taken to fit them for the position of
+parents. While it is seen that, for the purpose of gaining a livelihood, an
+elaborate preparation is needed, it appears to be thought that for the
+bringing up of children, no preparation whatever is needed. While many
+years are spent by a boy in gaining knowledge of which the chief value is
+that it constitutes 'the education of a gentleman'; and while many years
+are spent by a girl in those decorative acquirements which fit her for
+evening parties; not an hour is spent by either in preparation for that
+gravest of all responsibilities--the management of a family. Is it that
+this responsibility is but a remote contingency? On the contrary, it is
+sure to develop on nine out of ten. Is it that the discharge of it is easy?
+Certainly not. Of all functions which the adult has to fulfill, this is the
+most difficult. Is it that each may be trusted by self-instruction to  [36]
+fit himself, or herself, for the office of parent? No; not only is the need
+for such self-instruction unrecognized, but the complexity of the subject
+renders it the one of all others in which self-instruction is least likely
+to succeed."
+
+It must be our highest educational aim to cultivate or create the eugenic
+sense. In this way, and in this way only, may we feel satisfied that the
+foundation, upon which shall be erected the generations that are yet to
+come, will be of an enduring character.
+
+       *       *       *       *       *
+
+
+                                                                       [37]
+CHAPTER IV
+
+    "It is only because we are accustomed to this waste of life and are
+    prone to think it is one of the dispensations of Providence that we go
+    on about our business, little thinking of the preventive measures that
+    are possible."
+
+    CHARLES E. HUGHES.
+
+EUGENICS AND THE UNFIT
+
+    THE DEAF AND DUMB--THE FEEBLE-MINDED--A NEW YORK MAGISTRATE'S
+    REPORT--REPORT OF THE CHILDREN'S SOCIETY--THE SEGREGATION AND TREATMENT
+    OF THE FEEBLE-MINDED--WHAT THE CARE OF THE INSANE COSTS--THE
+    ALCOHOLIC--DRUNKENNESS.
+
+In order to achieve success in eugenics we must strive to encourage the
+parenthood of the worthy or fit, and to discourage the parenthood of the
+unworthy or unfit. The unfit are those, as previously explained, who,
+because of mental or physical disability, are unable to create fit or
+healthy children.
+
+THE DEAF AND DUMB.--The condition known as deaf-mutism is due to innate
+defect in about half of all cases. Deaf children have one or two deaf
+parents or grandparents. There may be two or three such children in a
+family. That the deaf should not marry is generally conceded by those who
+work amongst them. It should be our aim to discourage the intimate
+association of the adolescent deaf and dumb in institutions. It has been
+found that such intimate association frequently results in marriage. They
+should be educated and instructed in the knowledge that they cannot marry.
+When they understand the eugenic principle upon which this social law is
+constructed they will be amenable to reason. No process of suasion will be
+necessary, however, if their intimate association is prevented.
+
+THE FEEBLE-MINDED.--This includes the criminal, the imbecile, the insane,
+and the epileptic. The feeble-minded, technically speaking, belong to the
+degenerate class. They enter life mentally deficient, not necessarily  [38]
+diseased. They should, therefore, be regarded as fit subjects for
+educational modification rather than for penal correction or punishment. It
+is conservatively estimated that there are five million feeble-minded
+people in the United States to-day and not one-eighth of them are receiving
+adequate treatment or education. Recent statistics, from various countries,
+show that the percentage of deficient or feeble-minded children is
+decidedly on the increase. According to a bulletin issued by the United
+States Bureau of Education (August, 1912) there are 15,000,000 school
+children suffering from physical defects which need immediate attention and
+which are prejudicial to health. It would seem as though the time had
+passed for anything other than radical measures in the interest of the
+race.
+
+Apart from the eugenic fact that these feeble-minded children are not fit
+subjects for parenthood, they are a constantly contaminating influence on
+society morally, and are a detriment and a hindrance to social and economic
+advancement. One illustration of this contaminating process, which is of
+serious eugenic import, is the presence of these deficient children in our
+public schools. By reason of their lack of attention and concentration,
+their mental or psychic insufficiency, their moral delinquency, and
+uncontrollable instincts and impulses, they are a menace to the well-being
+and to the progress of the normal or fit pupils; they retard and undermine
+the discipline of the schoolroom, and they affect the efficiency of the
+teachers. They are allowed to stay in school because of the indifference of
+the authorities, or because of the influence and social standing, or
+political "pull" of the parents, despite the recognition of the injustice
+done. Many of the parents of these children seek medical advice but,
+because of absurdly inadequate civic or state provision for such cases, the
+physician is practically helpless. Most of these irresponsible children are
+allowed to wander through the years unrestrained and unprotected. They
+easily become the victims of vice and crime, and eventually they become
+degenerates and end their lives in insane institutions. Because of the
+stigma of degeneration these feeble-minded individuals fall into the   [39]
+hands of the law and are thereby robbed of the medical assistance which
+society should afford them in the early years when improvement is yet
+possible.
+
+The following report which recently appeared in one of the daily papers is
+interesting and suggestive in this connection. One of the New York City
+Magistrates, in his annual report, said: "There is growing up in this city
+a menacing army of boys and young men who are the most troublesome element
+we have to deal with.... From the ranks of these rowdies that are organized
+in bands, or bound up with chums or pals, come most of the crop of
+burglars, truck thieves, holdup men, gun-bearers, so-called 'bad men' and
+other criminals and dangerous characters. Without reverence for anything,
+subject to no parental control, cynical, viciously wise beyond their years,
+utterly regardless of the rights of others, firmly determined not to work
+for a living, terrorizing the occupants of public vehicles and disturbing
+the peace of the neighborhoods, they have no regard for common decency."
+
+But it is to the records of the Children's Society that one must go for
+reliable statistics of the potential criminal, as there the only systematic
+study of their conditions is made and recorded by one of the greatest
+neurologists in the country, Dr. Max Schlapp, of New York. As a specialist
+in nervous diseases he has been connected with the Children's Society and
+the Children's Court, where he has had wide opportunities for observing the
+relation between delinquence and mental defectiveness. In cases of
+viciousness or feeble-mindedness exhaustive studies have been made by Dr.
+Schlapp. And the extent to which society is daily at the mercy of
+uncontrolled potential criminality is alarming.
+
+"Feeble-minded children and feeble-minded men," says Dr. Schlapp, "are
+roaming about the streets of New York to-day as free agents. Parents are
+not compelled by law to put a feeble-minded child in custody. Yet that
+feeble-minded child unsuspected as such, amiable and care-free as he
+usually is, is potentially a criminal, and at any moment may commit a
+crime. That child is permitted to grow up without restraint, except    [40]
+such as the parents exercise, and this has no effect whatever in these
+cases. The child is allowed to marry and bring forth children of his own
+kind, more feeble-minded and more dangerous. There is no system designed to
+pick out from the community persons so afflicted, and no law whatever to
+prevent their untrammelled movements.
+
+"The city street is a recruiting ground for the gangster because it is full
+of defective children, mental and moral, who are potential criminals. This
+question has never been seriously considered. When brought under corrective
+restraint it has hitherto long been the custom to herd all the cases
+together while serving time. But in 1894 the German Government woke up to
+the fact that 3 to 7 per cent. of city children and those of isolated rural
+communities contain the 'moron,' or intellectually defective type, together
+with the moral imbecile."
+
+Investigation showed recently that in a reformatory near Berlin 63 per
+cent. of the inmates were abnormal, while over 50 per cent. were seriously
+defective or menaces to society. This has since been shown to exist in all
+the leading nations--England, France, Italy, where, by the way, the
+Camorrist type is the equivalent for our New York gangster. In the Elmira
+Reformatory 38 per cent. are, as a rule, feeble-minded and consist of types
+that repeat their offense against society or commit some other crime.
+
+There is only one way to prevent these types from becoming a menace.
+Restrain them while they are still developing; keep them from becoming free
+agents in the community they menace. Types continually come up in the
+Children's Society and the Children's Court. They are carefully studied.
+From the actions of the child, from his parents and family history, from
+the frequency with which he repeats some offense particularly pleasing to
+him, and by virtue of psychological tests and careful medical examinations
+the examiners are able to pick out children who should receive scientific
+care and treatment.
+
+"The characteristics of the feeble-minded are usually deceiving. One
+expects to find them with low brows and furtive looks and more or less
+vicious in appearance after they develop criminal tendencies. One would[41]
+expect them to show stupidity at a glance. On the contrary, they are
+sometimes bright on the surface, amiable, good-tempered under trying
+conditions, and almost likeable for their external social side. This is
+particularly true of the high grade defectives. The lower order may be
+taciturn, gloomy and retiring, and these traits may be noticed almost from
+infancy. But as they grow up their social nature may be developed, and they
+too may give the appearance of amiableness. One notable thing about them is
+their pose of frank innocence. In this they are engaging, and almost
+convincing.
+
+"The street type that makes a gangster is practically the same if cruder in
+development. These children usually exhibit absolutely no sign of affection
+for their parents, no sympathy, and are notably cruel toward animals. One
+boy we had in the Children's Society persistently killed all the dogs and
+cats his family kept. Finally, when they ceased keeping the animals he got
+at the canary cage and killed the bird by pulling the feathers out singly.
+He had no compunction about lying, and looked you right in the eye when he
+lied. Otherwise he was charming and natural."
+
+While moral insanity is hereditary, yet it can be produced in one
+generation. An alcoholic man with clean antecedents may leave tainted
+descendants. The only way to combat these conditions in the city is to have
+strict registration of all feeble-minded and insane. The state should
+discover them, examine them through public officials, and segregate them.
+Not only physicians, but school teachers and officials in public
+institutions should detect them. There should be in each state an
+institution for feeble-minded delinquents.
+
+The history of the average "gangster" shows a taint of alcoholism. This is
+further aggravated by living under immoral surroundings, where petty crimes
+like stealing and lying are considered "smart." This is the starting point
+of the New York "gangster." He is handicapped, and under ancestral
+disabilities and the disadvantages of environment that is pernicious, he
+cannot get very far. A boy usually qualifies with a gang on his own    [42]
+personality and tastes. He will often wander from one gang to another until
+he has found his particular atmosphere. The best will never find any one
+gang congenial enough to hold him, and he finally emerges a decent citizen.
+It is all a process of finding himself. The aim of the police should be to
+discount as much as possible any swaggering and false hero worship.
+
+The time has come when this great nation should take national cognizance of
+this problem. There should be a national institution on some isolated
+island. Civilization is coming to recognize such a necessity. With a close
+eye on the tide of immigration and a careful segregation of these defective
+types, we should soon rid ourselves of what is now growing to be a serious
+menace to the home and the nation.
+
+THE SEGREGATION AND TREATMENT OF THE FEEBLE-MINDED.--Dr. John Punton, of
+Kansas City, Mo., in an able and exhaustive article on "The Segregation and
+Treatment of the Feeble-Minded," writes as follows:
+
+"Your attention is directed to a recent report issued by Wentworth E.
+Griffin, Chief of Police of Kansas City, Mo., in which he claims that
+recently within six months' time no less than 2,480 juveniles were arrested
+charged with crimes ranging from vagrancy to murder and that the majority
+of these boys and girls were not normal children, but degenerates who
+required medical rather than penal treatment. 'Boys and girls,' says he,
+'should not receive correction in the city jails, the work house or
+reformatories. These should be the last resort. To correct a boy you must
+have an idea of his mental processes. It is natural that the parents
+understand something of the child and use that knowledge to make a good boy
+out of him. Certainly it cannot be done in the reformatories, for although
+the authorities there are competent, they are hardly medical psychologists.
+In my opinion, if any progress is to be made it is the parent and the
+doctor that must do the work, not the police and the courts.'
+
+"That our Chief of Police deserves credit for not only publishing this
+report, but also for the advanced position he takes in recognizing the
+appropriate care and treatment of the juvenile offender, is certain,   [43]
+for he understands the fact that the parents are often the chief culprits
+in the child's delinquency and that medical rather than penal treatment is
+more often indicated than is at present allowed or practiced.
+
+"When we come to inquire into the cause of feeble-mindedness, alcoholic
+heredity, syphilitic heredity, and consanguineous marriages are found to be
+the chief etiological factors. Bourneville claims that 48 per cent. of the
+idiots and imbeciles are the offspring of alcoholic parents.... Acute and
+chronic diseases in the parents, fright, shock, injuries, parental neglect,
+faulty education, poverty, malnutrition, social dissipation and lack of
+proper control are all well-known factors in the production of
+feeble-mindedness.
+
+"Segregation of the feeble-minded is advocated by medical authority the
+world over, and when this is done they can be made under appropriate
+medico-pedagogic treatment to become largely self-supporting.
+
+"As an economical as well as a humane measure, the various States can well
+afford to make such provision, more especially for the large body of
+feeble-minded who are now without any medical care whatever. Moreover,
+where it is possible, laws prohibiting the marriage of such as well as all
+other defectives should be passed and enforced."
+
+WHAT THE CARE OF THE INSANE COSTS.--The total cost of the care of the
+insane, in this country, has been estimated to be $165,000,000 a year. In
+estimating the cost of the insane we must take into account the value or
+worth of each adult to the State. This value has been computed to be $700 a
+year. If, upon this basis, we count the adult membership of the insane
+class between the ages of eighteen and forty-five, we find that their worth
+is roughly about $132,000,000.
+
+The cost of maintenance in the various insane institutions is about
+thirty-three millions of dollars a year. It would be quite possible to
+justly increase this total by estimating the worth of the help whose whole
+time is devoted to the care of the insane. If these individuals worked at
+some other trade or profession, their time would. be of value to the   [44]
+state in general--not to a class who should be non-existent. The cost to
+the state of the potential criminal is not included in this estimate.
+
+From the above figures it may be observed that it costs more to simply
+maintain the insane each year than it costs to work the Panama Canal; or to
+pay for the total cost of the Executive, Legislative and Judicial
+departments of our government. The total cost is more than the entire value
+of the wheat, corn, tobacco, and dairy and beef products exported each year
+from this country.
+
+ALCOHOLIC DRUNKENNESS.--Alcoholism is a sign and a symptom of degeneracy
+and is a distinct indication of unfitness for parenthood. The only cure for
+alcoholism is to prohibit parenthood. It has been proved that alcohol taken
+into the stomach can be demonstrated in the testicle or ovary within a few
+minutes, and, like any other poison, may injure the sperm or the germ
+element therein contained. As a result of this intoxication of the primary
+elements, children may be conceived and born who become idiots, epileptics
+or feeble-minded. It is asserted that 48 per cent. of all the idiots and
+imbeciles are the offspring of alcoholic parents.
+
+Recent experiments show that parental alcoholism alone can determine
+degeneration. Mr. Galton quoted the case of a man who, "after begetting
+several normal children became a drunkard and had imbecile offspring"; and
+another case has been recorded of a healthy woman who, when married to a
+drunkard, had five sickly children, dying in infancy, but in a later union
+with a healthy man bore normal and vigorous children.
+
+Dr. Sullivan found on inquiry that:
+
+.... "Of 600 children born of 120 drunken mothers 335 died in infancy or
+were still-born, and that several of the survivors were mentally defective,
+and as many as 4.1 per cent. were epileptic. Many of these women had female
+relatives, sisters or daughters, of sober habits and married to sober
+husbands. On comparing the death rate amongst the children of the sober
+mothers with that amongst the children of the drunken women of the same
+stock, the former was found to be 23.9 per cent., the latter 55.2 per
+cent., or nearly two and a half times as much. It was further observed [45]
+that in the drunken families there was a progressive rise in the death rate
+from the earlier to the later born children."
+
+Dr. Sullivan cites as a typical alcoholic family one in which the first
+three children were healthy, the fourth was of defective intelligence, the
+fifth was an epileptic idiot, the sixth was dead born, and finally the
+productive career ended with an abortion.
+
+The nervous systems of many children of alcoholic parents are wrecked for
+life; many die in convulsions as infants. Many, however, who do not die,
+live as epileptics. This action of alcohol on the health and vitality of
+the race is the most serious of the evils that intemperance brings on the
+community. The tendency of all children of alcoholics is toward nervous
+disorders of a grave type.
+
+Statistics show a very high rate of still-births and abortions among the
+children of drunken mothers, show that drunken women must not be permitted
+to become mothers.
+
+Dr. Branthwaite in a lecture stated: "In my judgment, habitual drunkenness,
+so far as women are concerned, has materially increased, during the last
+twenty-five years, which I have spent entirely amongst drunkards and
+drunkenness. These people are not in the least affected by orthodox
+temperance efforts; they continue to propagate drunkenness, and thereby
+nullify the good results of temperance energy. Their children, born of
+defective parents, and educated by their surroundings grow up without a
+chance of decent life, and constitute the reserve from which the strength
+of our present army of habitual drunkards is maintained. Truly we have
+neglected in the past, and are still neglecting, the main source of
+drunkard supply--the drunkard himself; crippled that and we should soon see
+some good results from our work."
+
+Dr. Fleck, another authority, says: "It is my strong conviction that a
+large percentage of our mentally defective children, including idiots,
+imbeciles and epileptics, are the descendants of drunkards."
+
+Therefore the chronic inebriate must not become a parent.
+
+       *       *       *       *       *
+
+
+                                                                       [47]
+CHAPTER V
+
+    "The real undermining of health is not seen. It is done in an insidious
+    way. It has to be carefully ferreted out."
+
+    DR. HARVEY W. WILEY.
+
+WHAT EVERY MOTHER SHOULD KNOW ABOUT EUGENICS
+
+In the preceding pages we have written about eugenics as a science; it is
+our intention now to point out briefly in just what way eugenics directly
+concerns the mothers of to-day. In the first place let us try to appreciate
+what it will mean to the race if "the fit only are born." "Fit" children,
+it will be recalled, means children born healthy of healthy, selected
+parents, parents with a good ancestral history, conveying to their
+offspring a reasonably adequate legacy. If the "fit only are born" we start
+with a healthy stock. What a significant and tremendous advantage this is.
+At once we rid the world of the potential inefficients--the feeble-minded,
+the insane, the criminal, the deaf-mute, the drunkard. If we are correct in
+assuming that the reason why all former civilizations have failed and
+passed away, was because they bred a race of people physically and mentally
+unfit to survive, the demand of the eugenist that only "fit children shall
+be born" will strike at the very root of this evil. If we uproot the cause
+of racial degeneration we begin the building of a race that should not
+degenerate. If we establish a race that will not degenerate, it must gain
+strength and virility with each generation.
+
+This assumption is logically correct, but we must do more than breed "fit"
+children. We must take care of them after they are born. We must furnish
+them with a good environment (see page 3). Heredity without favorable
+environment counts for very little,--we must never forget that. Heredity
+and environment are the two important determining factors in the life of
+every child born. If eugenics furnishes the heredity by ensuring the   [48]
+birth of the "fit" only, it depends upon the mothers of the race to provide
+the environment. Every mother must know how to take the best care of
+herself and of her child. This book is devoted to instructing her in the
+details of this duty.
+
+We cannot hope, however, to reach this high altruistic plane by simply
+taking the first step in the right direction. We who are alive to-day must
+begin the work, and leave it to posterity to carry forward. We must do our
+part. Every mother must become an enthusiastic eugenist. If she begins to
+teach, and preach, and practise its principles now, she will contribute to
+the heredity of unborn generations. To those of us who are alive to-day,
+environment is the vastly more important consideration, for our heredity is
+fixed and beyond the power of control. The question of eugenics for the
+present generation, therefore, is a question of environment.
+
+All our efforts must be directly in developing what heredity gives our
+children. We are wholly responsible for that. We must feed and clothe them
+properly; we must provide air spaces and playgrounds for exercise; we must
+educate them, and protect them from disease; and we must safeguard the
+birth of future generations by keeping our race stream pure. This is no
+small task, and the only way it will ever be satisfactorily accomplished is
+for each mother to realize her individual trust. The average individual
+does not realize the actual conditions that prevail. When recently the
+question of the public health was investigated by competent authorities,
+and the report furnished to the United States Senate, it caused a
+tremendous sensation. If that is possible in a body composed of men who are
+supposed to be intelligent and wide-awake to existing conditions, how much
+more significant and appalling it should be to the average mother whose
+interest is centered in her own home.
+
+According to the statistics and statements given in that document the
+annual financial loss from needless deaths and accidents alone amounted to
+$3,000,000,000. [Page 49]
+
+Acute diseases are held responsible for a large part of the loss. Chronic
+diseases are responsible for the greatest part of the waste of life, and
+they are believed to be increasing in their ravages. Minor ailments,
+believed to be nine-tenths preventable, are now costing the nation many
+dollars through incapacitation of persons and through leading to serious
+illness. Industrial accidents, largely preventable, are also exacting a
+heavy toll annually.
+
+That this great waste of life and health and the national economic loss
+that results can be modified by national action is asserted. Here are to be
+found the reasons advanced for a great national department of health. The
+work of this department would be varied. It would include direct work in
+promoting health on the part of the government, such as administering the
+food and drug act; aiding the healing and educational agencies, both city
+and State; obtaining information concerning the cause and prevention of
+diseases, and disseminating scientifically proved information on all health
+subjects.
+
+It is maintained that the movement for the conservation of health is the
+most momentous of the conservation movements in this country, and that of
+all the national wastes which are to be condemned, this waste of health is
+the gravest.
+
+Many startling statements are set forth in the document. Dr. Charles
+Wardell Stiles, of the United States Public Health and Marine Hospital
+Services, declares that "The United States is seven times dirtier than
+Germany and ten times as unclean as Switzerland." He declares that: "Lack
+of interest in preventive measures against diseases is slaughtering the
+human race." He takes the position that the real trouble is not so much
+race suicide as race slaughter, and that it is rather that too many
+children are allowed to die than that not enough children are born.
+
+It is estimated that tuberculosis, a preventable disease, costs the nations
+$1,000,000,000 annually. Typhoid fever is estimated by Dr. George M. Kober,
+dean of the medical department of Georgetown University, to cost over
+$300,000,000 annually. [Page 50]
+
+In connection with acute diseases this statement is made: "The loss from
+tuberculosis has been reduced to half of what it was thirty years ago.
+Nevertheless, of the 90,000,000 people now living in the United States at
+least 5,000,000 will be lost through this disease because adequate effort
+is not made to prevent it. Besides the economic waste through deaths from
+any disease, the waste through sickness from the same disease is also
+colossal."
+
+Great as are the reductions in the rates of infant mortality by improved
+milk and water supplies and by educational campaigns, the present rate is
+still enormous.
+
+"If some witch or wizard could conjure up the unnecessary babies' funerals
+annually occurring in this country it would be found that the little
+hearses would reach from New York to Chicago. If we should add the mourning
+mothers and friends, it would make a cortége extending across the
+continent."
+
+While the death rates from acute diseases have been greatly reduced, the
+rates from chronic diseases have been steadily increasing. Cancer is one of
+the chronic diseases apparently on the increase.
+
+That the annual death toll and the 3,000,000 constant sick beds could be
+reduced from one-fourth to one-half by proper measures is asserted. In
+other words, there might be saved every day, as many lives as perished on
+the _Titanic_, with the consequent enormous economic saving.
+
+These are surely impressive statements. It would seem as though it should
+be a simple task to pass a Public Health Bill, establishing a bureau in
+Washington, with a representative in the cabinet, whose sole duty it would
+be to preserve the public health. It has proved rather the reverse,
+however. We have been able to inaugurate various species of
+conservation,--of lands, of forests, of water,--but the conservation of
+human life is not important enough. Even though states and empires depend
+upon their people for their very existence, our statesmen feel that human
+life is too cheap, too common, to take immediate steps in this direction.
+
+If women--especially mothers--would devote themselves to the eugenic   [51]
+end of legislation, men would soon obey. The application of eugenics to the
+human species, coming, almost in the spirit of an inspiration, at the time
+when women are about to be enfranchised, is significant. It may be that
+destiny has decreed that the one shall be the complement of the other; it
+is certainly beyond contradiction that in eugenics the women of the earth
+have a divine weapon with which to wage a righteous and an awaking
+propaganda of truth.
+
+A mother should be interested in every phase of the subject. Her daughter's
+success in marriage should intimately concern her. Her health and her
+happiness in that sphere should elicit her deepest maternal consideration.
+She may rightly hope to be proud of her daughter's offspring, and to find
+pleasure in the society of her grandchildren. She should, therefore, devote
+all her efforts to ascertain the truth, with reference to the physical and
+mental equipment of her future son-in-law; his ability adequately to
+support a family; his sobriety, his disposition, associates, etc., should
+all be carefully considered and pondered over. This is not going far
+enough, however; we must know positively that he is not diseased,--that he
+is not a victim of gonorrhoea or syphilis.
+
+When parents weigh in the balance the possibility of a wrecked life, of
+destroying the right to have children, or of bringing them into the world
+blind or diseased; of permanently destroying the hope of happiness, peace,
+and success, no combination of advantages in a son-in-law is deserving of
+the slightest consideration. We are treating of the sacred things of
+life--of life itself. If parents combine to crucify and betray their
+daughters--to sell them body and soul into bondage for social or other
+advantages; if they preserve silence when they should speak and thereby
+take all the sunshine, for all eternity, out of one existence; then, if on
+their death-beds these daughters should accuse them, the guilty knowledge
+that they were responsible will be the sting that will blast their hope of
+peace and forgiveness here and in the worlds to come.
+
+When mothers realize that, every day, in every large hospital in every city
+in the civilized world some woman (a daughter of some mother) is being [52]
+unsexed because of these unjustly obtained diseases, surely their voices
+shall speak in no uncertain way.
+
+Another eugenic suggestion that should deeply concern every good mother is,
+that the mother's milk is the private property of the babe, and whoever
+deprives the babe of this, the sole right it possesses, is not only a thief
+but a scoundrel. A curious and significant fact was discovered by
+investigators when studying the question of infant mortality a few years
+ago. It was found from a mass of statistics that there were two recent
+instances when the death rate of infants decreased suddenly and quite
+decidedly. The first instance was when the Civil War in this country caused
+a cotton famine in England. As a result of the famine the factories of
+Lancashire were all closed and the employees being then without work
+remained at home. As a large percentage of the workers were married women
+with children they had the time and the opportunity to nurse their children
+regularly. Despite the fact that these women were starved and badly clad
+and deprived of the comforts of home, the death rate of the infants dropped
+steadily to an unprecedently low mark.
+
+A number of years later, when the German army surrounded Paris during the
+Franco-Prussian War the besieged inhabitants of the capital suffered from
+hunger and disease. The death rate of the adult population increased
+enormously while the death rate of the infants dropped markedly.
+
+The explanation of this curious phenomenon was simply that while times were
+normal the women labored outside of their homes and as a consequence the
+babies were not fed regularly and when fed were not fed mothers' milk. It
+demonstrated a truth that we are apt to lose sight of, that mothers' milk,
+even the milk from badly-nourished, poverty-stricken mothers is infinitely
+better than an abundant supply of artificial food combined with neglect. In
+view of the fact that there is a distinct tendency to evade this maternal
+duty these facts should be suggestive and important. It is the duty of the
+mother with any eugenic sense to preach and to practise this gospel.   [53]
+Paris learned the lesson of the siege because though she has the smallest
+birth-rate to-day, she nevertheless has the smallest infant death-rate of
+any large city in Europe.
+
+The writer believes that in eugenics the women of the race have the
+instrument wherewith to save the world. He is assured that it is the
+supreme potential agency for the betterment of the race, and that mankind
+will never be inspired with a holier cause. He believes that through all
+the ages the human race has been growing better, coming nearer the truth,
+and that as a result of this patient progress, there has been evolved the
+eugenic idea that is to solve the problems of the human family. If the "fit
+only are born" think of the possibilities of education and of environment.
+Each child is born with a great potential promise, and endowed with a
+reasonably good heredity, the whole effort of that child will be toward a
+higher moral attainment. If the effort of the individuals of the race is to
+achieve a high moral success, the quality of the civilization of future
+generations will be far superior to the type with which we are familiar.
+
+Eugenics gives to women the supreme civilizing instrument of the future. It
+places the burden of the morality of the home and of the race on their
+shoulders. If we deny the writing on the wall it does not render the
+warning negative. The signs of the times are epochal. The great political
+parties are realizing, for the first time in history, that new and
+important issues concerning the family, the home, and the children, in
+other words the nation's manhood and womanhood, must be considered and
+included in their platforms. They know that the time has gone when
+statesmen will exclusively decide what shall be done with the sons and
+daughters which women bring into the world. They know that the mothers of
+the race must have a voice in deciding for peace or war since they create
+every soldier that will lie dead when war is over. Women will help decide
+the question of taxation by government and by trusts, because they know
+that it comes out of their incomes and they need it all for their children.
+Women know that their cause is the cause of freedom, and freedom is the[54]
+cause of the eugenist. They know that the function of government should be
+justice and no code of justice can have higher ethics than the ethics of
+eugenism.
+
+MOTHERS' EUGENIC CLUBS.--There should be established in every community a
+mothers' eugenic club. The object of the club should be to further the
+eugenic idea. Papers should be prepared, read, and discussed on subjects
+having a eugenic interest.
+
+One of the main aims of these clubs should be to interest the local
+Congressman and the member of the State Legislature in eugenics. In all
+probability they will know nothing specific about race-culture--unless they
+are exceptional men--in which case it will be the duty of the members of
+the club to educate them. The object of such education of course would be
+to ensure that they will act intelligently when any legislative proposal is
+made having a eugenic interest. Find out what they know about the public
+health as contained in the report on page 48, and if they will vote in
+favor of a Public Health Bureau. You should know how your representatives
+stand on the Pure Food and Drugs Act; if they really appreciate the
+significance of the measure; if they would be in favor of pensioning
+mothers and widows who have children depending upon them; what their views
+are regarding compulsory marriage licenses; the reporting of venereal
+diseases to the local health authorities; if they would favor the
+segregation of the feeble-minded and their maintenance and treatment by the
+state; if they endorse the eugenic principle that "the fit only shall be
+born," and if they really understand just what that means.
+
+If the mothers in every community would take this step, they could control
+the legislation affecting such subjects in a comparatively short time. If
+the various States concede to women the right to vote--as they will sooner
+or later--such mothers' clubs would have a large and intelligent share in
+educating the women's votes on questions which directly concern their own
+immediate and remote welfare.
+
+The question of education would concern these clubs and much could be done
+by mothers to direct the authorities as to just what is needed to educate
+for [Page 55] parenthood, along the lines suggested elsewhere in this book.
+
+A mothers' eugenic club would rightly become an instrument for good in all
+local sociological interests. It could maintain a trained nurse to care for
+the sick and helpless, to teach the people how to live, and how to care for
+their homes and their children. The members themselves could visit the
+poor, the needy, and the sick.
+
+There are so many people in the world who are near the brink of
+failure,--so many who need a little hope infused into their lives,--and so
+many who are really deserving of help and sympathy and inspiration. The
+women who do this work for the work's sake are amply repaid by the good
+they find to do. The doing of such work is a consecration and an education.
+Life means more, and the whole temperament reflects a truer sympathy and a
+stronger purpose.
+
+There are many mothers, for example, who are willing to do what is
+essential in the interest of their children, but they do not know what
+should be done. These people cannot afford a physician or a nurse to teach
+them, nor do they even know that their methods are wrong or that they need
+any instruction. We must carry the information and the explanation to them.
+We must show them the need for a change of methods. This is the work for
+those charitably disposed women who desire some worthy purpose in life, who
+really wish to do some genuine good. All the equipment they need is good
+common sense. They will explain why it is essential to pasteurize the milk
+before feeding it to the baby because most of the milk used by the poor is
+unfit for use as a baby food. They will show how to keep the nipples and
+the bottles clean, and they will give them lessons on how to prepare the
+food to the best advantage. They will instruct them how to dress the baby
+in hot weather, and they will explain why it is necessary to provide the
+baby with all the fresh air possible. They will gain the confidence of
+these mothers and they will tell them all they know, in tactful and
+diplomatic and common-sense language so that they may appreciate the
+eugenic reasons for everything they do regarding the care and well-being of
+the baby. In every city in the country this work is needed and is      [56]
+waiting for the missionaries who will volunteer. To teach mothers the need
+for boiled water as a necessary drink for baby and older children is alone
+a worthy avocation. To impress upon one of these willing but ignorant
+mothers the absolute necessity for washing her hands before preparing
+baby's food, that she must keep a covered vessel in which the soiled
+napkins are placed until washed, that she should frequently sponge her baby
+in hot weather,--and explain thoroughly why these are important
+details,--is a work of true religious charity. They should be taught to rid
+their houses of flies, and especially to keep them from the baby and from
+its food, bottles, and nipples. They should be instructed to discontinue
+milk at the first sign of intestinal trouble, to give a suitable dose of
+castor oil, and to put the child on barley water as a food until the danger
+is passed. They should be taught to know the serious significance of a
+green watery stool, that it is the one danger signal in the summer time
+that no mother can ignore without wilfully risking the life of her baby.
+They should be shown how to prepare special articles of diet when they are
+needed. If every mother were educated to the extent as indicated in the
+above outline the appalling infant mortality would fall into
+insignificance. It is not a difficult task, nor would it take a long time
+to carry out; it is the work for willing women who have time and who
+perhaps spend that time in less desirable but more dramatic ways. It is
+education that is needed, and it is education that is willingly received,
+as all mothers are ready to devote their time in the acquirement of
+knowledge that will help them save their offspring. This is the eugenic
+opportunity and it is an opportunity that should devolve upon the women of
+the race.
+
+Such a mothers' club would receive the willing financial support of the men
+of the community. It should be placed upon a sound financial basis because,
+to be successful, it would have to bestow much material aid. I know of
+clubs that are self-supporting, however. Each club needs a leader to begin
+it; will the reader be that one in her Community?
+
+A Mothers' Eugenic Club would of course discuss the practical side of  [57]
+the eugenic question: the proper feeding and clothing of children; hygiene,
+sanitation, housekeeping and homemaking, and the efficiency and health of
+each member of the home, and all other topics of interest to every wife and
+mother. The writer believes that in the very near future we shall have a
+Mothers' Eugenic Club in every community in the United States; that these
+clubs will be guided by, and be an instrument of, a National Eugenic
+Bureau, composed of women, that will coöperate and harmonize the work as a
+whole, so that the conservation of human life will be effected to its
+maximum extent; that the excessive infant mortality will be overcome,
+because ignorant and incompetent mothers--the greatest cause of infant
+mortality--will be educated and instructed in the rudiments of eugenics and
+will consequently, to a large extent, cease to be ignorant and incompetent;
+that the desecration of young wives will stop, and stop forever, because
+vice and disease will be branded and exposed; that the feeble-minded, the
+deaf-mute, the imbecile, and the insane, will no longer be allowed to
+propagate their kind, to the permanent detriment of the race.
+
+When such clubs are established, and when all mothers do their individual
+duty in the interest of the race, we shall begin to see the dawn of a
+promise that will achieve its supreme success in the generations that will
+people the earth in the eugenic aftertime.
+
+       *       *       *       *       *
+
+
+                                                                       [61]
+CHILD-BIRTH
+
+CHAPTER VI
+
+    "Solicitude for children is one of the signs of a growing civilization.
+    To cure is the voice of the past; to prevent, the divine whisper of
+    to-day."
+
+    KATE DOUGLAS WIGGIN.
+
+PREPARATIONS FOR THE CONFINEMENT
+
+    THE BIRTH CHAMBER--WHAT TO PROVIDE FOR A CONFINEMENT--READY TO PURCHASE
+    OBSTETRICAL OUTFITS--POSITION AND ARRANGEMENT OF THE BED--HOW TO
+    PROPERLY PREPARE THE ACCOUCHMENT BED--THE KELLY PAD--THE ADVANTAGES OF
+    THE KELLY PAD--SHOULD A BINDER BE USED?--SANITARY NAPKINS--HOW TO
+    CALCULATE THE PROBABLE DATE OF THE CONFINEMENT--OBSTETRICAL TABLE--WHEN
+    SHOULD A PREGNANT WOMAN FIRST CALL UPON HER PHYSICIAN--REGARDING THE
+    CHOICE OF A PHYSICIAN--HOW TO KNOW THE RIGHT KIND OF A PHYSICIAN FOR A
+    CONFINEMENT--THE SELECTION OF A NURSE--THE DIFFERENCE BETWEEN A TRAINED
+    AND A MATERNITY NURSE--DUTIES OF A CONFINEMENT NURSE--THE REQUISITES OF
+    A GOOD CONFINEMENT NURSE--THE PERSONAL RIGHTS OF A CONFINEMENT
+    NURSE--CRITICIZING AND GOSSIPING ABOUT PHYSICIANS.
+
+THE BIRTH CHAMBER
+
+The room in which the confinement is to take place should be selected with
+care. In many cases there will be no choice for the reason that there will
+be only one suitable bedroom available. Where practicable however a room
+having the following accessories, or as many of them as is possible, should
+be given the preference.
+
+    1.--Good light, and a southern exposure.
+
+    2.--Capable of being well ventilated and well heated if necessary.
+
+    3.--Running water if plumbing is modern.
+
+    4.--Fairly large size (not a hallroom).
+
+    5.--A quiet room, free from street noises.
+
+If the house is a private one the room should be on the second floor. If
+the home is in an apartment house the confinement chamber should be as [62]
+far removed from the living-room as circumstances will permit,--especially
+if there are other children who will make more or less continuous noise.
+
+All unnecessary furniture, pictures and draperies should be taken out of
+the room a few days before the confinement is due; the room itself, and
+everything left in it, should be thoroughly cleaned and aired. A small
+table for holding instruments, sterilizing basins, etc., should be provided
+and in readiness.
+
+WHAT TO PROVIDE FOR A CONFINEMENT.--The following articles should be in
+readiness at all confinements:--
+
+    1.--Douche pan.
+
+    2.--Bed pan.
+
+    3.--Douche bag (fountain syringe) with glass douche tube.
+
+    4.--One rubber sheet 1½ yards square.
+
+    5.--Two bed pads, one yard square, made of absorbent cotton or old
+    clean cloths, covered with washed cheese cloth and stitched here and
+    there to hold in place.
+
+    6.--One dozen clean towels.
+
+    7.--One-half dozen clean sheets.
+
+    8.--A hot water bottle.
+
+    9.--One pound absorbent cotton (good quality).
+
+    10.--Five yards sterile gauze.
+
+    11.--Four quarts of hot, and as much cold water, that has been boiled.
+
+    12.--One-half dozen papers assorted safety pins.
+
+    13.--One box sanitary pads.
+
+    14.--Four pieces of unbleached cotton or muslin, one and one-quarter
+    yards long.
+
+    15.--Four ounces powdered boracic acid.
+
+    16.--Four ounces of brandy or whisky.
+
+    17.--One jar of white vaseline (unopened).
+
+    18.--One cake of castile soap.
+
+    19.--Two or three agate or china hand basins.
+
+    20.--One slop jar.
+
+    21.--One pan under bed for after birth.
+
+The physician will direct that certain additional articles be provided
+according to his individual taste and custom. These will include an    [63]
+antiseptic and ergot; any other requisite found necessary can be sent for,
+or the physician can supply it, as he invariably has in his bag whatever
+may be required in complicated cases or in an emergency. All the items
+enumerated in the above list are absolutely essential, they may not all be
+used but it would not be safe to undertake a confinement without providing
+the essential requisites. Many maternity outfits are prepared ready for use
+and can be obtained at the larger drug stores, costing from $10 to $25. The
+articles in the above list can be bought for about $6, not including those
+articles which the patient is assumed to have. The following are samples of
+the ready-to-purchase outfits:
+
+READY-TO-PURCHASE OBSTETRICAL OUTFITS
+
+          OUTFIT NO. 1
+  1 Sterilized Bed Pad (30 inches square).
+  2 dozen Sterilized Vulva Pads.
+  2 Sterilized Mull Binders (18 inches wide).
+  5 yards Sterilized Gauze.
+  1 pound Sterilized Absorbent Cotton (½ pound).
+  Rubber Sheet, 1½ yards by 2 yards, Sterilized.
+  Douche Pan, Sterilized.
+  1 Tube K-Y Lubricating Jelly.
+  Sterilized Nail Brush.
+  Boric Acid, Powdered.
+  Tinct. Green Soap.
+  Bichloride Tablets.
+  Lysol.
+  Tube Sterilized Tape.
+          PRICE $10.00.
+
+          OUTFIT NO. 2.
+  2 Sterilized Bed Pads (30 inches square).
+  2 dozen Sterilized Vulva Pads.
+  2 Sterilized Mull Binders (18 inches wide).
+  6 Sterilized Towels.
+  10 yards Sterilized Gauze.
+  [Page 64]
+  1 pound Sterilized Absorbent Cotton (½ pound).
+  Rubber Sheet, 1 yard by 1½ yards, Sterilized.
+  Rubber Sheet, 1½ yards by 2 yards, Sterilized.
+  4 quart Sterilized Douche Bag with glass nozzle.
+  Douche Pan, Sterilized.
+  Sterilized Nail Brush.
+  2 Agate Basins, Sterilized.
+  Safety Pins.
+  2 Tubes Sterilized Petrolatum.
+  1 Tube K-Y Lubricating Jelly.
+  Boric Acid, Powdered.
+  100 grms. Chloroform (Squibb's).
+  Fl. Ext. Ergot.
+  Tinct. Green Soap.
+  Bichloride Tablets.
+  Lysol.
+  Tube Sterilized Tape.
+  Sterilized Soft Rubber Catheter.
+  Sterilized Glass Catheter.
+  Stocking Drawers, Sterilized.
+  Talcum Powder.
+  Bath Thermometer.
+          PRICE $19.50.
+
+These materials, being cleansed and sterilized, are ready for use at any
+time.
+
+These complete outfits are packed in neat boxes, thus enabling the contents
+to be kept intact until needed.
+
+THE POSITION AND ARRANGEMENT OF THE BED.--The bed should be a substantial
+single bed. If a double one is used, prepare the side for the confinement
+which will permit the physician to use his right hand,--that will be the
+right side of the patient as she lies in bed. One objection to a double bed
+is its tendency to sag. This tendency can be obviated however by placing an
+ironing board under the spring from side to side, or by using shelves from
+a book case. This expedient will support the mattress, thereby rendering
+the bed firm and free from any sagging tendency. The position of the bed in
+the room should be such that the patient will not directly face the window
+light, nor be in a direct draught between the window and the door. It  [65]
+should be so arranged that the nurse can get easily to either side,
+consequently it must not be pushed against the wall.
+
+HOW TO PREPARE THE ACCOUCHMENT BED.--Over the mattress place the rubber
+sheet so that its center will be exactly under the hips of the patient. Pin
+with large safety pins each corner of the rubber sheet to the mattress; now
+put the sheet on exactly as you do when making an ordinary bed. On top of
+the sheet, and in the middle of the bed (again where the patient's hips
+will rest), place a draw sheet. A draw sheet is a sheet folded once, placed
+across the bed, and pinned tightly with large safety pins to the mattress
+at each side. The advantage of this sheet is, that it can be removed when
+necessary, leaving the original clean sheet on the bed, without disturbing
+the patient. Be particular not to have the top of the draw sheet higher
+than the middle of the patient's back. Place the pad,--previously prepared
+for the purpose,--on the draw sheet and level with the top of the draw
+sheet.
+
+Most physicians carry with them to all confinements a _Kelly pad_. A Kelly
+pad is a rubber pad with inflated sides, which is put under the patient's
+hips, and which retains all the discharges incident to a confinement so
+that when it is removed the bed is clean and fresh. The advantage of the
+Kelly pad is twofold; first, it ensures a clean, compact, systematic
+confinement; second, its use subjects the patient to the least necessary
+movement at a time when movement is distressing, painful, and frequently
+dangerous. If a Kelly pad is not used, it is desirable to place under the
+pad (between the pad and the draw sheet) a piece of oil cloth or rubber
+sheeting, or a number of newspapers will do. This will prevent, to a
+considerable degree, the discharges from soaking through the pad on to the
+draw sheet and sheet and mattress below.
+
+After the confinement is over and the patient is clean, remove the Kelly
+pad, and the pad below if necessary, or the pad and newspapers if these are
+used,--place a clean pad under the patient and you are ready to place the
+binder on if a binder is to be used. [Page 66]
+
+SHOULD A BINDER BE USED?--Medically a binder is not necessary, neither is
+it objectionable from a medical standpoint. It is supposed to hold the
+flaccid, empty womb in place. This it does not do and we are of the
+opinion, that it, in many instances, according to how it is put on,
+compresses the womb out of place. The binder is certainly appreciated by
+most patients because of its snug, comfortable feeling; and in cases when
+the abdominal wall is fat and the muscles soft, it holds them together in a
+way that is impossible by the use of any other device. To claim that the
+binder prevents hemorrhages is absurd. Our personal rule is to put one on
+if the patient wants one, or if she has previously had one. To be
+effective, in any sense, the binder should extend from the waist line down
+to halfway between the hips and knees and should be snugly, but not too
+tightly pinned.
+
+SANITARY NAPKINS.--These can be purchased already prepared in most drug
+stores, or they can be made in the following manner: Take an ordinary grade
+of cheese cloth, wash it, and when dry, cut it into half yard squares. In
+the center of each square place a strip, six or eight inches long, of
+absorbent cotton and fold the gauze lengthwise over it so as to make a pad.
+These can be used as napkins, and after they are soiled can be burned. It
+is absolutely wrong to use rags or any old cloths for napkins, as the
+patient can be infected and made seriously sick by this procedure.
+
+HOW TO CALCULATE THE PROBABLE DATE OF THE CONFINEMENT.--The duration of
+pregnancy extends for 280 days from the end of the last menstruation. Add
+seven days to the date of the last menstruation, and from that date count
+ahead nine months, or backward three months and you may have the probable
+date of the confinement. Should you pass this time you will probably go on
+for two additional weeks. The reason for this is that the most susceptible
+time for conception to occur is either during the week following
+menstruation or a few days before menstruation. If, therefore, you pass the
+above probable date which was calculated from the end of the last
+menstruation, it shows that conception did not take place during the   [67]
+week following that menstruation; and the assumption will be that it took
+place a few days before the next menstruation, which will be about two
+weeks later than the date as calculated above.
+
+If, for example, a pregnant woman was last sick from January 1st to 5th we
+add seven days to the 5th, which is the 12th, to which we add nine months,
+which will give us, as the probable date of confinement, October 12th.
+Should she go a few days over the 12th, the probability is that the
+confinement will take place on October 26th.
+
+  TABLE FOR CALCULATING THE DATE OF CONFINEMENT
+  -----------------------------------------------------------------
+  JAN.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  OCT.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
+  -----------------------------------------------------------------
+  JAN.  21 22 23 24 25 26 27 28 29 30 31
+  OCT.  28 29 30 31  1  2  3  4  5  6  7   NOV.
+  -----------------------------------------------------------------
+  FEB.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  NOV.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
+  -----------------------------------------------------------------
+  FEB.  21 22 23 24 25 26 27 28
+  NOV.  28 29 30  1  2  3  4  5            DEC.
+  -----------------------------------------------------------------
+  MAR.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  DEC.   6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
+  -----------------------------------------------------------------
+  MAR.  21 22 23 24 25 26 27 28 29 30 31
+  DEC.  26 27 28 29 30 31  1  2  3  4  5   JAN.
+  -----------------------------------------------------------------
+  APR.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  JAN.   6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
+  -----------------------------------------------------------------
+  APR.  21 22 23 24 25 26 27 28 29 30
+  JAN.  26 27 28 29 30 31  1  2  3  4      FEB.
+  -----------------------------------------------------------------
+  MAY.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  FEB.   5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
+  -----------------------------------------------------------------
+  MAY.  21 22 23 24 25 26 27 28 29 30 31
+  FEB.  25 26 27 28  1  2  3  4  5  6  7   MAR.
+  -----------------------------------------------------------------
+  JUNE   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  MAR.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
+  -----------------------------------------------------------------
+  JUNE  21 22 23 24 25 26 27 28 29 30
+  MAR.  28 29 30 31  1  2  3  4  5  6      APR.
+  -----------------------------------------------------------------
+  JULY   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  APR.   7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
+  -----------------------------------------------------------------
+  JULY  21 22 23 24 25 26 27 28 29 30 31
+  APR.  27 28 29 30  1  2  3  4  5  6  7   MAY
+  -----------------------------------------------------------------
+  AUG.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  MAY    8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
+  -----------------------------------------------------------------
+  AUG.  21 22 23 24 25 26 27 28 29 30 31
+  MAY   28 29 30 31  1  2  3  4  5  6  7   JUNE
+  -----------------------------------------------------------------
+  SEPT.  1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  JUNE   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
+  -----------------------------------------------------------------
+  SEPT. 21 22 23 24 25 26 27 28 29 30
+  JUNE  28 29 30  1  2  3  4  5  6  7      JULY
+  -----------------------------------------------------------------
+  OCT.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  JULY   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
+  -----------------------------------------------------------------
+  OCT.  21 22 23 24 25 26 27 28 29 30 31
+  JULY  28 29 30 31  1  2  3  4  5  6  7   AUG.
+  -----------------------------------------------------------------
+  NOV.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  AUG.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
+  -----------------------------------------------------------------
+  NOV.  21 22 23 24 25 26 27 28 29 30
+  AUG.  28 29 30 31  1  2  3  4  5  6     SEPT.
+  -----------------------------------------------------------------
+  DEC.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  SEPT.  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
+  -----------------------------------------------------------------
+  DEC.  21 22 23 24 25 26 27 28 29 30 31
+  SEPT. 27 28 29 30  1  2  3  4  5  6  7   OCT.
+  -----------------------------------------------------------------
+
+                                                                       [68]
+The foregoing table affords us a handy means of finding the probable date
+of confinement at a glance.
+
+Find the date of the last day of the last menstrual period in the upper
+row; the date immediately below it is the probable date of confinement.
+
+For example if the last menstrual period was from Jan. 1st to 5th, we find
+January 5th and below it we note October 12th as the probable date of
+confinement.
+
+WHEN SHOULD A PREGNANT WOMAN FIRST CALL UPON HER PHYSICIAN?--The earliest
+indication of pregnancy is the interruption of menstruation. When
+menstruation fails to appear at its regular time in a young married woman
+whose past menstrual history is good,--i.e., she has been sick every month
+regularly and without pain since she began menstruating as a girl,--the
+assumption would naturally be that she was pregnant. Menstruation may
+however "miss" one month for other reasons than pregnancy just at this
+time, as is explained elsewhere, so it is wise to defer a positive
+assumption on such an important matter. When the second menstruation does
+not appear, and there are no specific reasons for its failure to appear, it
+may be safely assumed that pregnancy has taken place. A visit to the family
+physician one week after the second menstruation should have appeared, or
+at least long enough to feel absolutely certain that the sickness is not
+coming around, is not only necessary, but is the essential and correct step
+to take for a number of very good reasons. If a woman for example has not
+had a baby, how does she know she can have one? It is quite possible to
+become pregnant and yet it may be wholly impossible to give birth to a
+child. It is necessary to be constructed normally, or as near what is
+regarded as normal as is possible, in order safely to assume the
+responsibility of carrying a pregnancy to a successful completion. No one
+but a physician, who is skilled and familiar in the knowledge of what
+constitutes the proper size, and shape, and quality, and relations, one
+with another, of your bones, and ligaments, and muscles, can tell      [69]
+whether you can safely be permitted to carry a pregnancy to term or not. If
+the anatomical conditions are not just right; if circumstances from a
+medical standpoint are not favorable; if your personal risk is too
+hazardous; if, in other words, medical science should decide that you are
+one of the very few women who cannot have a baby, is it not of very great
+importance that you should know this as soon as possible? Does not that
+fact alone render your early call upon your physician imperative? A
+physician can bring out facts, relating to the personal and family history,
+and habits, of the prospective mother, which will enable him to formulate
+advice which will prove of the highest value from the very beginning of
+pregnancy. Instructions carried into effect at this early date, as to
+personal conduct, exercise, diet, etc., will have a distinctly beneficial
+influence, not only on the patient's health and the character of her
+confinement, but on the physical vitality of the coming baby.
+
+REGARDING THE CHOICE OF A PHYSICIAN.--This is a matter that should receive
+the most careful consideration. While it is just to admit that every
+physician is capable of successfully conducting maternity cases, there are
+certain characteristics in the individual temperament that would seem to
+indicate that some physicians are better adapted to this special work.
+
+Trustworthiness is an imperative essential in a physician who assumes the
+responsibility of confinement engagements. He must be clean in his personal
+habits as well as morally. He should possess the virtue of patience and be
+tactful, and above all he should be made to feel that he has your implicit
+confidence. If you will analyze these qualifications you will understand
+just what they imply. The physician who has the reputation of having the
+largest practice is not necessarily the man you want, nor does it imply
+that he is the best fitted to conduct your case to your satisfaction. The
+fact that he is a very busy man may be distinctly detrimental to your best
+interests. If the physician has the reputation of being an excellent
+doctor, but, "You can't always depend on him,--he may be out of town, or he
+may send his assistant, or substitute," you don't want him; it is too  [70]
+important an event to you to take a chance with. Rely rather upon the man
+who, though his charge may be a little higher, is known to be trustworthy;
+who will take a personal interest in you, and is known to be patient and
+capable.
+
+THE SELECTION OF A NURSE.--A choice must be made between having a trained
+nurse and what is known as a maternity, or monthly, nurse. The choice may
+be dictated by the financial means of the patient. A trained nurse is paid
+from $25 to $30 per week, while a maternity nurse usually gets $15 per
+week.
+
+A trained nurse is a graduate from a hospital where she has successfully
+completed a course of training. She is to be preferred, if she can be
+afforded, for the reason that she has been trained to obey absolutely the
+orders of a physician, and because she has the requisite knowledge to
+detect emergencies, and the necessary skill and experience to enable her to
+act intelligently of her own initiative in any emergency.
+
+The maternity nurse, on the other hand, has not had an adequate training
+and is absolutely helpless, so far as medical knowledge is concerned, in a
+real emergency. Her experience is limited to what she has picked up in the
+various cases she has had. She, as a rule, has chosen this means of
+obtaining a living as a result of some domestic financial affliction. She
+does not understand the laws of sterilization and has not been trained to
+obey, without question, the instructions of a physician. The maternity
+nurse follows a routine which she is incapable of modifying to suit the
+particular case. She has old-fashioned ideas and notions which she carries
+out as a matter of course, and she overestimates the great importance of
+her experience to the extent of wholly disregarding the advice of the
+physician. She assumes the care of the patient and baby, and regards this
+as her right, and as a result she is frequently responsible for much injury
+to the mother and child. Despite these objections we have worked with many
+of these nurses who were to be preferred to trained nurses. It is the
+individual after all that counts, and if a maternity nurse, though
+technically untrained, is adaptable, tactful, and will consent to be   [71]
+instructed to the extent of obeying without argument, she can become
+invaluable, and her skill and experience will carry her creditably over
+many trying incidents. The objection of the medical profession to an
+untrained nurse is based, not so much on her lack of ability, as upon her
+propensity to indiscriminate and indiscreet talk,--they have not been
+trained to know the value of professional silence, nor have they had the
+necessary education which would have enabled them to acquire through their
+experience the knowledge that "silence is golden" at all times. A trained
+nurse possesses the requisite knowledge, but may have an objectionable
+individuality. An untrained nurse may have sufficient knowledge, and what
+she lacks she may make up for in being congenial and adaptable. While the
+trained nurse strictly attends exclusively to the mother and the baby, a
+maternity nurse as a rule attends to the household duties in addition. She
+cooks the meals of the entire family, and dresses and cares for the other
+children if there is no one else to do it. The duties of a maternity nurse
+can be specified and agreed upon, and the terms arranged when she is
+engaged. The duties of a trained nurse are fixed by nursing laws and
+medical rules and cannot be changed or modified by private agreement. These
+laws and rules, however, are not sufficiently arbitrary to make it
+impossible for the nurse to be obliging, courteous, and
+sincere,--qualifications which every patient has a right to expect, and a
+right to insist upon from every graduate nurse.
+
+The selection of a nurse should receive careful consideration. She should
+be known to be honest, honorable, competent, healthy, and personally clean
+in habits and dress, and she should be tactful, obliging, and she should
+attend to her own affairs strictly. She should not be a gossip; she should
+not shirk her work or pry into family affairs that do not concern her; and
+she should not drag into the conversation her own personal or family
+secrets.
+
+The nurse has certain rights which the patient should willingly recognize.
+She is entitled to a comfortable bed, sufficient sleep, good food, and
+exercise in the open air every day. These are essential in order that  [72]
+she maintain her own health, as well as keep at the highest point of
+efficiency.
+
+When you select your physician consult with him regarding your nurse. If
+you know personally a capable nurse, there is no objection to selecting
+her, and no physician will oppose this procedure if you assume the
+responsibility of her capability.
+
+There are many advantages, however, in permitting the physician to provide
+a nurse. He assumes the responsibility of the nurse's capability, and it is
+safe to assume he will not recommend one whom he knows to be personally
+objectionable, or professionally incapable. Every physician acquires
+certain individual methods in the conduct of maternity cases, which
+experience has taught him to be successful. A competent knowledge of these
+methods by the nurse greatly facilitates the details and ensures a
+harmonious conduct of the entire case,--facts which accrue to the comfort
+and the well-being of the patient.
+
+It is not out of place here to warn a young wife against being advised by a
+neighbor or a busybody, as to whom she should select as physician or nurse.
+You must not depend upon the gossip of the neighborhood. The physician or
+nurse whom you are told by one of these irresponsible individuals not to
+take, may be the one above all others whom you should take. When you hear a
+gossiping woman decry a physician, depend upon it, she owes him
+something,--most often it is a bill, but it may only be a grudge. There is
+no class of men in any community who are maligned and abused so much as are
+physicians. They seem to be the choice victims of the enmity and spite of
+every malicious feminine tongue. A woman should think twice before she
+utters a criticism regarding the work of a physician. She would, if she but
+knew how quickly she brands and advertises herself as irresponsible and
+lacking in ordinary courtesy and good breeding, as she is not qualified to
+criticise the professional capability of a physician, nor is she qualified
+to estimate the extent of the wrong she perpetrates. There is no class of
+men who do more conscientious work, day after day, than do physicians, [73]
+and there is no class of men who are more deserving of the commendation of
+the entire community than the thousands of self-sacrificing, underpaid
+members of the medical profession. Be suspicious therefore when you hear a
+criticism, and be very, very sure before you utter one,--rather give him
+the benefit of the doubt and you will do no wrong, and it may be at some
+future date you will be thankful you did not criticise.
+
+       *       *       *       *       *
+
+
+                                                                       [75]
+CHAPTER VII
+
+THE HYGIENE OF PREGNANCY.
+
+    DAILY CONDUCT OF THE PREGNANT WOMAN--INSTRUCTIONS REGARDING HOUSEHOLD
+    WORK--INSTRUCTIONS REGARDING WASHING AND SWEEPING--INSTRUCTIONS
+    REGARDING EXERCISE--INSTRUCTIONS REGARDING PASSIVE
+    EXERCISE--INSTRUCTIONS REGARDING TOILET PRIVILEGES---INSTRUCTIONS
+    REGARDING BATHING--INSTRUCTIONS REGARDING SEXUAL INTERCOURSE--CLOTHING
+    DURING PREGNANCY--DIET OF PREGNANT WOMEN--ALCOHOLIC DRINKS DURING
+    PREGNANCY--THE MENTAL STATE OF THE PREGNANT WOMAN--THE SOCIAL SIDE OF
+    PREGNANCY--MINOR AILMENTS OF PREGNANCY--MORNING NAUSEA, OR
+    SICKNESS--TREATMENT OF MORNING NAUSEA, OR SICKNESS--NAUSEA OCCURRING AT
+    THE END OF PREGNANCY--UNDUE NERVOUSNESS DURING PREGNANCY--THE 100 PER
+    CENT. BABY--HEADACHE--ACIDITY OF THE STOMACH, OR
+    HEARTBURN--CONSTIPATION--VARICOSE VEINS, CRAMPS,
+    NEURALGIAS--INSOMNIA--TREATMENT OF INSOMNIA--PTYALISM, OR EXCESSIVE
+    FLOW OF SALIVA--VAGINAL DISCHARGE, OR LEUCORRHEA--IMPORTANCE OF TESTING
+    URINE DURING PREGNANCY--ATTENTION TO NIPPLES AND BREASTS--THE VAGARIES
+    OF PREGNANCY--CONTACT WITH INFECTIOUS DISEASES--AVOIDANCE OF DRUGS--THE
+    DANGER SIGNALS OF PREGNANCY.
+
+CONDUCT OF THE PREGNANT WOMAN
+
+The young wife will arrange her daily routine according to the physician's
+instructions, which, by the way, she should faithfully carry out. If you
+are one of the fortunate many who enjoy reasonably good health, you have
+doubtless been told to follow a plan very similar to the one we shall now
+briefly outline.
+
+For the first six months she can safely continue to do her household work.
+It is to her advantage to do so for many reasons, but especially because it
+helps to keep her physically in good condition, and because it keeps her
+mind engaged, thus avoiding a tendency to nervous worry. After the sixth
+month it is desirable to give up the heavier part of the work. Washing and
+sweeping should be absolutely prohibited. Moving furniture or heavy trunks
+must not be done by the prospective mother, but all light work can and [76]
+should be indulged in to the very end. Find time to spend at least one hour
+and a half in the open air every day. Unless there is a medical reason
+against active exercise there is nothing so beneficial to the pregnant
+woman as walking, nor is there any substitute for it. A drive or motor ride
+into the country, or a car ride around town, is an excellent device against
+ennui and is highly desirable during this time, but not as a substitute for
+the daily long walk. A pregnant woman must keep her muscles strong and in
+good tone if she hopes to do her share toward having a short and easy
+confinement. She must keep active to ensure perfect action of all her
+organs--the stomach must digest; the bowels and kidneys must act perfectly;
+the heart, and lungs, and nerves must be supplied with good blood and fresh
+air; the appetite must be keen, and the sleep sound. Walking in the open
+air will do all this and nothing else can, to the same satisfactory degree.
+
+Light passive exercise at home is desirable to those very few who cannot
+walk in the open air, but at best it is a poor substitute. It is necessary
+to avoid any exercise or any labor of the following character from the very
+beginning of pregnancy: stretching, lifting, jarring, jumping, the use of
+the sewing machine, bicycling, riding, and dancing.
+
+She should continue to employ the same toilet privileges she has been
+accustomed to except the use of the vaginal douche, which must be stopped
+from the date of the first missed menstrual period. This is the only safe
+rule to follow and no exception should be made to it except upon the advice
+of a physician.
+
+Bathing during the entire course of pregnancy is a highly necessary duty.
+It is particularly advantageous during the later months because it relieves
+the kidneys at a time when they are called upon to perform an excess of
+work. The temperature of the bath should be warm and rapidly cooled at the
+finish. Brisk rubbing with a course towel will ensure the proper reaction.
+
+Sexual intercourse must be restricted during pregnancy; and it should be
+wholly abstained from during what would have been the regular menstrual
+periods, if pregnancy had not occurred, for the reason that abortion is[77]
+apt to take place. It is most harmful during the early and late months of
+pregnancy. Sexual intercourse is distasteful to most and harmful to every
+pregnant woman.
+
+CLOTHING DURING PREGNANCY.--The clothing should be so constructed as to
+relieve any undue pressure on the breasts or abdomen. For this reason it
+should be suspended from the shoulder. When it is appreciated that clothing
+supported by the waist crowds the growing womb, and exerts pressure upon
+the kidneys, and is responsible for many of the kidney complications that
+occur during pregnancy, no further reason need be given for discarding all
+clothing, except very light garments, that are not held by some device
+whose support is from the shoulders. A specially constructed linen waist is
+made and sold for this purpose. It is fashioned so that all the lower
+garments and the garters can be fastened to, and supported by it. Corsets
+should be absolutely discarded from the very first day of pregnancy.
+
+In a large woman with a lax abdomen, a properly made abdominal support will
+not only be a great comfort but of real advantage. It should exert a
+support upward by lifting the abdomen, not by constricting it. It should
+therefore be obtained from a reliable dealer and be made and applied to
+effect the above object,--otherwise it may do more harm than good.
+
+DIET OF PREGNANT WOMEN.--Some degree of digestive disturbance and loss of
+appetite is the rule early in pregnancy. By the fourth month these
+conditions invariably cease, and the appetite and the ability to digest
+will greatly improve. The diet from the very beginning of pregnancy should
+be plain and easily digested. It is not possible to formulate an absolute
+table of what or what not to eat, as the same foods do not agree equally
+well with all patients. The individual taste should be catered to within,
+reason, and the meals should be taken at regular intervals. Articles of
+diet that experience shows do not agree with the patient should be rigidly
+excluded from the menu. A varied diet of nutritious character is essential
+during pregnancy in order to ensure good blood, health, and strength. A
+monotonous diet, or a diet composed largely of stale tea, coffee, and  [78]
+cake, is not permissible, and may do untold harm. Pastries and desserts of
+all kinds should be excluded. In the later weeks of pregnancy, because of
+the large size of the womb, the diet should be cut down as the stomach is
+interfered with in the process of digestion. Should the patient at any time
+during pregnancy experience a loss of appetite, or an actual disgust for
+food as sometimes occurs, it is preferable to suggest a change of scene and
+surroundings rather than the use of medicine. A short vacation, a change of
+table, new scenery, will promptly effect a cure. This condition is mental
+rather than physical; the patient allows herself to become introspective;
+the daily routine becomes monotonous and stale; hence a change of a few
+days will be all that is necessary. If it is not possible for the patient
+to obtain a change of scene, a complete change of diet for a few days will
+often tide over the difficulty. We have known patients to take kindly to an
+exclusive diet of kumyss, or matzoon, or predigested foods, with stale
+toast or zwieback, to which can be added stewed fruits. Alcoholic drinks
+should be left out entirely.
+
+THE MENTAL STATE OF THE PREGNANT WOMAN.--The coming baby should be the text
+of many interesting, spontaneous talks between the young couple from the
+time when it is first known that a new member of the family is on its way.
+The husband should feel that he is a party to the successful consummation
+of the little one's journey. He can contribute enormously to this end. It
+should be his duty, born of a sincere affection and love, to formulate the
+programme of events which has for its main object the wife's entire mental
+environment. He should encourage her to live up to the physician's
+instructions, and arrange details so that she will obtain the proper
+exercise daily. He should read to her in the evening, and arrange his own
+business affairs so that he will be with her as much as is possible. In
+many little ways he can impress upon her the fact that they both owe
+something to the unborn babe and that each must sacrifice self in its
+behalf. His principal aim, of course, will be that she will not worry or
+have cause to worry. He will so direct her mental attitude that she will
+dwell only upon the bright side of the picture; she will thus strive to[79]
+realize the hope that the baby will be strong and healthy, and she will,
+prompted by his encouragement and devotion, try to do her duty faithfully.
+Working together in this way, much can be done that means far more than we
+know of, and in the end the little one comes into the world a welcome baby,
+created in love and born into the joy of a happy, harmonious, contented
+home.
+
+THE SOCIAL SIDE OF PREGNANCY.--The social side of the question should not
+be overlooked or neglected at this time. Here again the imperative
+necessity arises to warn the young wife against certain individuals who
+seem to have a predilection toward recounting all the terrible experiences
+they have heard regarding confinements. It is astonishing to learn how
+diversified a knowledge some women burden themselves with in this
+connection. They can recount case after case, with the harrowing details of
+a well-told tale, and seem to delight in so doing. Every physician has met
+these women. The young wife must not permit or encourage any reference to
+her condition. Simply refusing to discuss the question is the only sure
+method of preventing its discussion. She will find among her friends a few
+who have her best interests at heart, and these few will strive sincerely
+to be of real usefulness to her. If she will keep in mind that the most
+important element in the success of the whole period, and consequently the
+degree of her own health, happiness, and comfort, as well as that of her
+unborn baby, is the character of her own thoughts from day to day, and
+month to month, she will be complete master of the situation. By constantly
+dwelling on happy thoughts, reading encouraging and inspiring books,
+admiring and studying good pictures, working with cheerful colors in sunny
+rooms, exercising, dieting, and sleeping in a well-aired room, she will
+have no cause to regret her share in the task before her, or the kind of
+baby she will bring into the world.
+
+MINOR AILMENTS OF PREGNANCY.--There are certain minor ailments which it
+would be well to be familiar with lest a little worry should creep into the
+picture.
+
+Maternity is not only a natural physiological function, but it is a    [80]
+desirable experience for every woman to go through. The parts which
+participate in this duty have been for years preparing themselves for it.
+Each month a train of congestive symptoms have taxed their working
+strength; pregnancy is therefore a period of rest and recuperation,--a
+physiological episode in the life history of these parts. If any ailment
+arises during pregnancy it is a consequence of neglect, or injury, for
+which the woman herself is responsible,--it is not a natural accompaniment
+of, or a physiological sequence to pregnancy. Find out, therefore, wherein
+you are at fault, rectify it, and it will promptly disappear.
+
+MORNING NAUSEA OR SICKNESS.--So-called morning nausea or sickness is very
+frequently an annoying symptom. It is present as a rule during the first
+two or three months of pregnancy. How is it produced and how can it be
+remedied?
+
+It is produced most frequently by errors in diet. It may be caused by an
+unnatural position of the womb or uterus, by nervousness, constipation, or
+by too much exercise or too little exercise. The physician should be
+consulted as soon as it is observed to be a regular occurrence. He will
+eliminate by examination any anatomical condition which might cause it; or
+will successfully correct any defect found. When the cause is defined his
+instructions will help you to avoid any error of diet, constipation, or
+exercise. Many cases will respond to a simple remedy,--a cup of coffee,
+without milk, taken in bed as soon as awake will often cure the nausea. The
+coffee must be taken while still lying down,--before you sit up in bed. If
+coffee is not agreeable any hot liquid, tea, beef tea, clam bouillon, or
+chicken broth, or hot water may answer the purpose, though black coffee,
+made fresh, seems to be the most successful. Ten drops of adrenalin three
+times daily is a very certain remedy in some cases, though this should be
+taken with your physician's permission only. If the nausea occurs during
+the day and is accompanied with a feeling of faintness, take twenty drops
+of aromatic spirits of ammonia in a half glass of plain water or Vichy
+water. Sometimes the nausea is caused by the gradual increase of the   [81]
+womb itself. This is not usually of a persistent character and disappears
+as soon as the womb rises in the abdominal cavity at the end of the second
+month.
+
+Nausea frequently does not occur until toward the end of pregnancy. In
+these cases the cause is quite different. Because of the size of the womb
+at this time the element of compression becomes an important consideration.
+The function of the kidneys, bowels, bladder, and respiration may be more
+or less interfered with, and it may be desirable to use a properly
+constructed abdominal support, or maternity corset. These devices support
+and distribute the weight, and prevent the womb from resting on or
+compressing, and hence interfering with, the function of any one organ. If
+the womb sags to one side, thereby retarding the return circulation of the
+blood in the veins from the leg, it may cause cramps in the leg, especially
+at night, or it may cause varicose veins, or a temporary dropsy. The
+correct support will prevent these troublesome annoyances; a properly
+constructed maternity corset is often quite effective. The diet should
+receive some special attention when these conditions exist. Any article of
+diet which favors fermentation (collection of gas) in the stomach or bowel
+should be excluded. These articles are the sugars, starches, and fats. It
+can readily be understood that if the bowels should be more or less filled
+with gas, or if they should be constipated, it will cause, not only great
+distress, but actual pain. Regulation of the diet, therefore, and exercise
+(walking best of all) will contribute greatly to the avoidance of these
+unnecessary sequelae.
+
+It must be kept in mind that the entire apparatus of the body is
+accommodating a changed condition, and though that condition is a natural
+one, it requires perfect health for its successful accomplishment. This
+means a perfect physical and mental condition,--a condition that is
+dependent upon good digestion, good muscles, healthy nerves, clean bowels,
+and so on. The slightest deviation from absolute health tends to change the
+character of the body excretions, the quality of the blood, etc. If the
+excretions are not properly eliminated, the blood becomes impure, and so we
+sometimes get itching of the body surfaces, especially of the abdomen  [82]
+and genitals; neuralgias, especially of the exposed nerves of the face and
+head; insomnia and nervousness. These are all amenable to cure, which again
+means, as a rule, correct diet and proper exercise as the principal
+remedial agencies.
+
+UNDUE NERVOUSNESS DURING PREGNANCY.--This is very largely a matter of will
+power. Some women simply will not exert any effort in their own behalf.
+They are perverse, obstinate, and unreasonable. The measures which
+ordinarily effect a cure, they refuse to employ. It is useless to argue
+with them; drugs should never be employed; censure and affection are
+apparently wasted on them; they cannot even be shamed into obedience. The
+maternal duty they owe to the unborn child does not seem to appeal to them.
+We do not know of any way to handle these women and to our mind they are
+wholly unfit to bring children into the world. Fortunately these women are
+few in number. The maternal instinct will, and does, guide most women into
+making sincere efforts to restrain any undue nervous tendency, and to be
+obedient and willing to follow instructions. There is nothing so beneficial
+in these cases as an absolutely regulated, congenial, daily routine, so
+diversified as to occupy their whole time and thought to the exclusion of
+any introspective possibility. Frequent short changes to the country or
+seashore to break the monotony, give good results in most of these cases.
+The domestic atmosphere must also be congenial and the husband should
+appreciate his responsibility in this respect.
+
+Women of this type should have their attention drawn to the following facts
+in this connection: While the most recent investigations of heredity prove
+that a woman cannot affect the potential possibilities of her child, she
+can seriously affect its physical vitality. The following illustration may
+render our meaning clear: suppose your child had the inborn qualities
+necessary to attain a 100 per cent. record of achievement in the struggle
+of life; anything you may or may not do cannot affect these qualities--the
+child will still have the ability to achieve 100 per cent. Inasmuch,
+however, as a mother can affect the health or physical qualities of her[83]
+child she is directly responsible, through her conduct, as to whether her
+child will ever attain the 100 per cent. record, or if it does, she is
+responsible for the character of its comfort, its health, its enjoyment,
+all through its life's struggle toward the 100 per cent. achievement
+record. She may so compromise its physical efficiency that it will succumb
+to disease as a consequence of the ill health with which its mother
+unjustly endowed it, even though it possess the ability to attain the 100
+per cent. if it lived.
+
+We often see brilliant children who are nervous and physically unfit, and
+we see others of more ordinary mental achievement who are healthy and
+robust animals. The one is the offspring of parents possessing unusual
+mental qualities but who are physically unable or unwilling to render
+justice to their progeny; the other parents may be less gifted mentally,
+but they are healthy and they are willing to give their best in conduct and
+in blood to their babies. Many of these brilliant children never achieve
+their potential greatness because they fall by the wayside owing to
+physical inability, while the healthy little animals achieve a greater
+degree of success because of the physical vitality which carries them
+through. To achieve a moderate success and enjoy good health is a better
+eugenic ideal than the promise of a possible genius never attained because
+of continuous physical inefficiency.
+
+The nervous and willful mother should therefore consider how much depends
+upon her conduct. It cannot be too frequently reiterated and emphasized
+that every mother should do her utmost to guard and retain her good health.
+Good health means blood of the best quality and this is essential to the
+nourishment of the child. To keep in good health does not mean to obey in
+one respect and fail in other essentials. It means that you must obey every
+rule laid down by your physician, willingly and freely in your own interest
+and in the interest of your unborn babe. In no other way may you hope to
+creditably carry out the eugenic ideal that "the fit only shall be born."
+
+HEADACHE.--This is a symptom of great importance. If it occurs         [84]
+frequently, without apparent cause, the physician should be consulted at
+once, as it may indicate a diseased condition of the kidneys, and
+necessitate immediate treatment. Headaches may, of course, be caused in
+many ways and most frequently they do not have any serious significance,
+but they must always be brought to the attention of the physician. As a
+rule they are caused by errors of diet,--too much sugar, candy, for
+instance, late and indigestible suppers, indiscriminate eating of rich
+edibles, etc.,--or they may be products of nervous excitement (too little
+rest), as shopping expeditions, strenuous social engagements, late hours,
+etc.
+
+ACIDITY OF THE STOMACH, AND SO-CALLED HEARTBURN.--These are sometimes in
+the early months of pregnancy annoying troubles. The following simple means
+will relieve temporarily: A half-teaspoonful of bicarbonate of soda or
+baking soda in a glass of water or Vichy water; or a half teaspoonful of
+aromatic spirits of ammonia in Vichy, or plain water; or a tablespoonful of
+pure glycerine. The best remedy is one tablespoonful of Philip's Milk of
+Magnesia taken every night for some time just before retiring.
+
+Heartburn is the result of eating improper food, or a failure to digest the
+food taken. Starchy foods should be avoided. Meats and fats should be taken
+sparingly. Avoid also the et ceteras of the table, as pickles, sauces,
+relishes, gravies, mustard, vinegar, etc. Good results follow dry
+meals,--meals taken without liquids of any kind. Live on a simple, easily
+digested, properly cooked diet. Chew the food thoroughly, take plenty of
+time and be cheerful.
+
+CONSTIPATION DURING PREGNANCY.--Most women are as a rule more or less
+constipated during pregnancy. It is caused by failure to take the proper
+amount of outdoor exercise, to take enough water daily, to live on the
+proper diet, to live hygienically, or because of wrong methods of dress. It
+is most important that the bowels should move thoroughly every day.
+Pregnancy no doubt aggravates constipation by diminishing intestinal
+activity. Consequently there is a greater need for activity on the part of
+the woman, and open air exercise is the best way to accomplish this.   [85]
+She should eat fruits, fresh vegetables, brown or Graham bread, or bran
+muffins, figs, stewed prunes, and any article of diet which she knows from
+experience works upon her bowel. She should drink water freely; a glass of
+hot water sipped slowly on arising every morning or one-half hour before
+meals, is good. Mineral waters, Pluto, Apenta, Hunyadi, or one teaspoonful
+of sodium phosphate, or the same quantity of imported Carlsbad salts in a
+glass of hot water one-half hour before breakfast, answers admirably. If
+the salts cannot be taken a three- or five-grain, chocolate-coated, cascara
+sagrada tablet, may be taken before retiring, but other cathartics should
+not be taken unless the physician prescribes them. Rectal injections should
+be avoided as a cure of constipation during pregnancy. They are very apt to
+irritate the womb and if taken at a time when the child is active, they may
+annoy it enough to cause violent movement on its part, and these movements
+may cause a miscarriage. See article on "Constipation in Women."
+
+VARICOSE VEINS, CRAMPS, AND NEURALGIA OF THE LIMBS.--When cramps or painful
+neuralgia occur repeatedly in one or both legs, some remedial measures
+should be tried. Inasmuch as the cause of this condition is a mechanical
+one, it would suggest a mechanical remedy. The baby habitually seeks for
+the most comfortable position, and having found it stays there until
+conditions render it uncomfortable. He does not consult you in the matter,
+but he may be subjecting you to untold misery and pain. The child may rest
+on the mother's nerves or blood-vessels as they enter her body from her
+lower limbs. If the pressure is sufficient, it can interfere quite
+seriously with the return blood supply, because veins which carry back to
+the heart the venous or used blood, are vessels with thin, soft,
+compressible walls, while arteries which carry blood away from the heart
+cannot be compressed easily, because their walls are hard and tense. The
+condition therefore is that more blood is being sent into the limb than is
+being allowed to return; in this way are produced varicose veins. If these
+varicose veins burst or rupture we have ulcers, which may quickly heal,[86]
+or they may refuse to heal, and become chronic. A dropsical condition of
+the leg may follow, and because of interference with the circulation of the
+blood we get cramps and neuralgias. How can we remedy this painful
+condition?
+
+Sometimes we don't succeed, but at least we can try. So long as the cause
+exists, it is self-evident that rubbing the limb with any external
+application, will not give any permanent relief, though it is well to try.
+When rubbing, to relieve cramps at night, always rub upward. It is not a
+condition that calls for medicine of any kind, while hot baths and hot
+applications will only make the trouble worse. The remedy that promises the
+quickest and longest relief is for the patient to assume the knee-chest
+position for fifteen minutes, three times a day, till relief is permanently
+established. The patient rests on her knees in bed, and bends forward until
+her chest rests on the bed also. The incline of the body in this position
+is reversed; hips are highest, the head lowest. The baby will seek a more
+comfortable position and this new position may relieve the pressure and
+cure the condition. Doing this three times daily for fifteen minutes gives
+relief to the leg by reestablishing a normal blood circulation, and very
+soon the baby finds a new position that does not interfere with its
+mother's blood supply, and the cramps, and neuralgia and dropsy, and maybe
+the varicose veins will soon show improvement. Wearing the proper kind of
+abdominal support may help, as explained on page 77. If the varicose veins
+are bad, it is desirable to wear silk rubber stockings or to bandage the
+limbs.
+
+INSOMNIA DURING PREGNANCY.--Insomnia or sleeplessness is sometimes a
+vexatious complication during pregnancy. It seldom if ever becomes of
+sufficient importance or seriousness to interfere with the pregnancy or the
+health of the patient. Nevertheless, a period of sleeplessness lasting for
+two or three weeks is not a pleasant experience to a pregnant woman. It is
+most often met with during the latter half of pregnancy.
+
+There can be no question that every case of insomnia has definite cause,
+and can be relieved if we can find the cause. The only way to find it  [87]
+is to systematically take up the consideration of each case, and this is
+best done by the physician. He must have patience and tact; you must answer
+each question truthfully and fully. Your diet, personal conduct, exercise,
+condition of bowels, mental environment, domestic atmosphere, everything,
+in fact, which has any relation to you or your nerves, must be inspected
+with a magnifying glass. Some little circumstance, easily overlooked, of
+seemingly no importance, may be the cause of the trouble. You may need more
+outdoor exercise, or you may need less outdoor exercise. You may need more
+diversion, more variety, or you may need less. You may need a sincere,
+honest, tactful, patient confidant and friend, or you may need to be saved
+from your friends. You may be exhausting your vitality and fraying your
+nerves by social exigencies,--those empty occupations which fill the lives
+of so many fussy, loquacious females,--echoless, wasted, babbling moments,
+of supreme important to the social bubbles who ceaselessly chase them but
+of no more interest to humanity than the wasted evening zephyrs that play
+tag with the sand eddies on the surface of the dead and silent desert. You
+may have wandered from the narrow limitations of the diet allowable in
+pregnancy, or you may be the victim of an objectionably sincere relation
+who pesters you with solicitous inquiries of a needless character. Whatever
+it is, rectify it. A good plan to follow on general principles is to take a
+brisk evening walk with your husband just before bedtime, and at least two
+hours after the evening meal. Follow this with a sitz bath as soon as you
+return from the walk.
+
+A sitz bath is a bath taken in the sitting position with the water reaching
+to the waist line. It should last about fifteen minutes and the water
+should be comfortably hot. It is sometimes found that this form of bath
+creates too much activity on the part of the child and defeats the purpose
+in view. This is apt to be the case in very thin women when the abdomen is
+not covered by a sufficient layer of fatty tissue. These women will find it
+advisable to take, in place of the sitz bath, a sponge bath in a warm room,
+using the water rather cool than hot but in a warm room. Rub your skin [88]
+briskly but waste no time in getting into bed. A glass of hot milk, before
+going to bed, or when wakeful during the night, may serve as a preventive.
+When these measures fail the physician should be called upon to advise and
+prescribe.
+
+PTYALISM, OR AN EXCESSIVE FLOW OF SALIVA.--This is a common condition in
+pregnancy, but cannot be prevented. It is of no importance other than that
+it is a temporary annoyance.
+
+Itching of the abdomen can usually be allayed by a warm alcohol rub,
+followed by gently kneading the surface of the abdomen with warm melted
+cocoa butter, just before retiring.
+
+A VAGINAL DISCHARGE.--Soon after pregnancy has taken place the woman may
+notice a discharge. It may be very slight or it may be quite profuse. In
+some cases it does not exist at all during the entire period. As a rule the
+discharge is more frequent and more profuse toward the end of pregnancy.
+
+If the discharge exists at any time,--and it is no cause for worry or alarm
+if it does exist,--inform your physician. He will advise you what to do,
+because it is not wise for you to begin taking vaginal douches or
+injections without his knowledge, and at a time when they may do you
+serious harm. Should itching occur as a result of any vaginal discharge the
+following remedial measures may be employed:
+
+A solution of one teaspoonful of baking soda to a douche bag of tepid water
+may be allowed to flow over the parts, or cloths saturated with this
+mixture may be laid on the itching part. A solution of carbolic acid in hot
+water (one teaspoonful to one pint of hot water), is also useful, or a wash
+followed by smearing carbolic vaseline over the itching parts. If your
+physician should suggest a mild douche for itching of the vagina as the
+result of a discharge, it may be promptly relieved by using Borolyptol in
+the water. Buy a bottle and follow directions on the label.
+
+TESTING URINE IN PREGNANCY--IMPORTANCE OF.--One of the most important
+duties, if not the most important, of both the physician and the patient is
+to have the urine of the pregnant woman examined every month during the[89]
+first seven months and every two weeks during the last two months. The
+urine examined during the first seven months should be the first urine
+passed on the day it is sent for examination. During the last two months of
+pregnancy the patient should pass all her water into a chamber for an
+entire day, and take about three ounces of this mixed water for
+examination. She should measure the total quantity passed during these days
+and mark it with her name on the label of the bottle. The physician will
+thus have an absolute record and guide of just how the kidneys are acting,
+and as they are the most important organs to watch carefully during every
+pregnancy, the greatest care should be taken to see that failure to note
+the first symptom of trouble does not take place.
+
+ATTENTION TO NIPPLES AND BREAST.--The physician should inspect the breasts
+and nipples of every pregnant woman when she first visits his office.
+Frequently the nipples are found to have been neglected, probably subjected
+to pressure by badly fitting corsets or too tight clothing. Instructions
+gently to pull depressed nipples out once daily, if begun early, will
+result in marked improvement by the end of pregnancy. During the latter
+part of pregnancy the breasts should be carefully and thoroughly bathed
+daily in addition to the daily bath. This special bath should be with a
+solution of boric acid (one teaspoonful to one pint of water). After the
+bath apply a thin coating of white vaseline to the nipples. It may be
+necessary to resort to the following mixture to harden the nipples and to
+make them stand out so that the child can get them in its mouth: Alcohol
+and water, equal parts into which put a pinch of powdered alum; this
+mixture should be put in a saucer and the nipples gently massaged with it
+twice daily. A depressed nipple may also be drawn out by means of a breast
+pump. If the nipples are not pulled out the child will be unable to nurse.
+It may then be necessary to put the child on the bottle and when the
+nipples are ready he may not take them after being used to the rubber
+nipple. The breasts may become caked and as a caked breast is a very
+painful and serious ailment it is wise to attend to this matter in     [90]
+time.
+
+THE VAGARIES OF PREGNANCY.--Certain foolish, old-fashioned ideas, have
+crept into the minds of impressionable people regarding pregnancy, which
+are aptly termed vagaries. It is believed by some that if the pregnant
+woman is the victim of fright, or is badly scared, or witnesses a
+terrifying or tragic sight, her child will be, in some way, affected by it.
+If the incident is not of sufficient gravity to cause an abortion or a
+miscarriage it will not, in any way mark, or affect the shape of the child
+in the womb.
+
+It is believed by some that a child can be marked by reason of some event
+occurring to the mother while carrying it. This is not so; a child cannot
+be marked by any experience or mental impression of the mother. Some
+believe that the actual character of a child can be changed by influences
+surrounding the mother while carrying it. The character of a child cannot
+be changed one particle after conception takes place, no matter how the
+mother spends her time in the interim.
+
+It should be carefully understood that the character of the baby is
+entirely different from the physical characteristics of the baby. Were this
+not so it would be futile on the part of the mother to discipline or
+sacrifice herself in the interest of her baby. The baby's character will
+reflect the qualities of the combined union of mother and father. The
+baby's physical characteristics will largely depend upon the treatment
+accorded it by the mother during its intro-uterine life. Hence we lay down
+rules of conduct, diet and exercise in order to produce a good, sturdy
+animal, while the character or mind of the animal is a part of the
+fundamental species already created. In other words, no matter how much
+care you bestow upon a rose bush, its flower will still be a rose,--it may
+be a better rose, a stronger, sturdier rose, a better smelling and a more
+beautiful rose, but it is still a rose.
+
+CONTACT WITH INFECTIOUS DISEASES.--The pregnant woman should be warned
+against the danger of coming in contact with any person suffering from any
+infectious or contagious diseases. To become the victim of one of these[91]
+diseases near the time of labor would be a dangerous complication not only
+to the mother, but to the child. A woman is more liable to catch one of
+these diseases during the last month of pregnancy than at any other time.
+The most dangerous diseases at this period are Scarlet Fever, Diphtheria,
+Erysipelas, and all diseased conditions where pus is present.
+
+AVOIDANCE OF DRUGS.--It is a safe rule during pregnancy to avoid absolutely
+the taking of all medicines unless prescribed by a physician.
+
+THE DANGER SIGNALS OF PREGNANCY.--The following conditions may be of very
+great importance and may be the danger signals of serious coming trouble.
+They must not therefore be neglected or lightly considered. When any of
+them make their appearance send for the physician who has charge of your
+case, at once, and follow his advice whatever it may be.
+
+    1. Any escape of blood from the vagina, whether in the form of a sudden
+    hemorrhage or a constant leaking, like a menstrual period.
+
+    2. Headache, constant and severe.
+
+    3. Severe pain in the stomach.
+
+    4. Vertigo or dizziness.
+
+    5. Severe sudden nausea and vomiting.
+
+    6. A fever, with or without a chill.
+
+       *       *       *       *       *
+
+
+                                                                       [93]
+CHAPTER VIII
+
+THE MANAGEMENT OF LABOR
+
+    WHEN TO SEND FOR THE PHYSICIAN IN CONFINEMENT CASES--THE PREPARATION OF
+    THE PATIENT--THE BEGINNING OF LABOR--THE FIRST PAINS--THE MEANING OF
+    THE TERM "LABOR"--LENGTH OF THE FIRST STAGE OF LABOR--WHAT THE FIRST
+    STAGE OF LABOR MEANS--WHAT THE SECOND STAGE OF LABOR MEANS--LENGTH OF
+    THE SECOND STAGE--DURATION OF THE FIRST CONFINEMENT--DURATION OF
+    SUBSEQUENT CONFINEMENTS--CONDUCT OF PATIENT DURING SECOND STAGE OF
+    LABOR--WHAT A LABOR PAIN MEANS--HOW A WILLFUL WOMAN CAN PROLONG
+    LABOR--MANAGEMENT OF ACTUAL BIRTH OF CHILD--POSITION OF WOMAN DURING
+    BIRTH OF CHILD--DUTY OF NURSE IMMEDIATELY FOLLOWING BIRTH OF
+    CHILD--EXPULSION OF AFTER-BIRTH--HOW TO EXPEL AFTER-BIRTH--CUTTING THE
+    CORD--WASHING THE BABY'S EYES IMMEDIATELY AFTER BIRTH--WHAT TO DO WITH
+    BABY IMMEDIATELY AFTER BIRTH--CONDUCT IMMEDIATELY AFTER LABOR--AFTER
+    PAINS--REST AND QUIET AFTER LABOR--POSITION OF PATIENT AFTER LABOR--THE
+    LOCHIA--THE EVENTS OF THE FOLLOWING DAY--THE FIRST BREAKFAST AFTER
+    CONFINEMENT--THE IMPORTANCE OF EMPTYING THE BLADDER AFTER LABOR--HOW TO
+    EFFECT A MOVEMENT OF THE BOWELS AFTER LABOR--INSTRUCTING THE NURSE IN
+    DETAILS--DOUCHING AFTER LABOR--HOW TO GIVE A DOUCHE--"COLOSTRUM," ITS
+    USES--ADVANTAGES OF PUTTING BABY TO BREAST EARLY AFTER LABOR--THE FIRST
+    LUNCH--THE FIRST DINNER--DIET AFTER THIRD DAY.
+
+WHEN TO SEND FOR THE PHYSICIAN IN CONFINEMENT CASES.--The physician should
+be notified just as soon as it is known that labor has begun. The adoption
+of this course is necessary for a number of reasons. It is only just that
+he should have an opportunity to arrange his work so that he may be at
+liberty to give his whole time to your case when he is wanted. He may not
+be at home at the moment, but can be notified, and can arrange to be on
+hand when your case progresses far enough to need his personal attention.
+It will relieve your mind to be assured that he will be with you in plenty
+of time. [Page 94]
+
+Don't worry unnecessarily if he does not come immediately when you notify
+him, provided you notify him at the beginning of labor. There is plenty of
+time. You have a lot of work to do before he can be of any help. Many women
+entertain the idea that a physician can immediately perform some kind of
+miracle to relieve them of all pains at any stage in labor. This is a
+mistaken idea. No physician can hasten, or would if he could, a natural
+confinement. He waits until nature accomplishes her work, and he simply
+watches to see that nature is not being interfered with. If something goes
+wrong, as it does now and again; or if the pains become too weak, or if the
+proper progress is not being made, he may help nature or take the case out
+of her hands and complete the confinement. If it is thought best to do
+this, there will be plenty of time.
+
+THE PREPARATION OF THE PATIENT AND THE CONDUCT OF ACTUAL LABOR.--It is
+assumed that the patient has adhered to the instructions of the physician
+given during the early days of her pregnancy. These instructions included
+directions as to exercise, diet, bathing, etc.
+
+Having calculated the probable date of the confinement, it is the better
+wisdom to curtail all out-of-door visiting, shopping, social engagements,
+etc.,--everything in fact out-of-doors except actual exercise, for two
+weeks previous to the confinement date. The usual walk in the open air
+should be continued up to the actual confinement day. The daily bath may be
+taken, and it is desirable that it should be taken, up to and on the
+confinement day.
+
+THE MEANING OF THE TERM "LABOR."--By labor is meant, the task or work
+involved in the progress by means of which a woman expels from her womb the
+matured ovum or child. After the child has been carried in the womb for a
+certain time (estimated to be 280 days) it is ripe, or fully matured, and
+is ready to be born. The womb itself becomes irritable because it has
+reached the limit of its growth and is becoming overstretched. Any slight
+jar, or physical effort on the part of the patient, or the taking of a
+cathartic, is apt to set up, or begin the contractions which nature has
+devised as the process of "labor" by which the womb empties itself.    [95]
+
+THE BEGINNING OF LABOR.--When the first so-called pains of actual labor
+begin they are not always recognized as such. The explanation of this
+seeming paradox is that the "pains" are not always painful. A woman will
+experience certain undefined sensations in her abdomen; to some, the
+feeling is as if gas were rumbling around in their bowels; to others, the
+feeling is as if they were having an attack of not very painful abdominal
+colic; while others complain of actual pain. The fact that these sensations
+continue, and that they grow a little worse; and that the day of the
+confinement is due, or actually here, impresses them that something unusual
+is taking place; then, and not till then, does the knowledge that labor is
+really approaching dawn upon them.
+
+In due time one of these new sensations, which constitute the first stage
+of labor, will be more emphatic; there will be a little actual pain so that
+she will feel like standing still, holding her breath and bearing down.
+That is the first real labor pain and marks the beginning of the second
+stage of labor, and may be the first absolute sign that will leave no doubt
+in her mind that labor has begun.
+
+The nurse will now inquire into the condition of the patient's bowels. If
+they have not already moved freely that day, she will give the patient a
+rectal injection of one pint of warm soap suds into which one teaspoonful
+of turpentine is put. After the bowels have been thoroughly cleansed, the
+patient will be made ready for the confinement. The clothing necessary
+consists of dressing gown, night gown, stockings and slippers. These are
+worn as long as the patient is out of bed, when all but the night gown will
+be discarded. The entire body of the patient, from the waist line to the
+knees, should be thoroughly cleansed, paying particular attention to the
+private parts; first with warm water and castile soap, and then rendered
+aseptic by washing with four quarts warm boiled water into which has been
+put one teaspoonful of Pearson's Creolin. A soft napkin is then wrung out
+of water that has been boiled and cooled to a suitable temperature, and
+laid over the genital region, and held in place by a dry clean napkin, [96]
+and allowed to remain there until the physician takes personal charge of
+the case.
+
+LENGTH OF THE FIRST STAGE OF LABOR.--There is no definite or even
+approximate length of time for the first stage of labor,--that, you may
+recall, was the more or less painless stage, or as it has been termed, the
+"getting-ready" stage. Inasmuch as it is an unimportant and practically
+painless stage, most patients do not mind it. They continue to be up and
+around and work as usual.
+
+The first stage of labor is utilized by nature in opening the mouth of the
+womb.
+
+The second stage of labor is utilized by nature in expelling the child into
+the outer world.
+
+LENGTH OF THE SECOND STAGE OF LABOR.--After the second stage has begun, the
+length of time necessary to end the labor, assuming everything is normal,
+depends upon the strength and frequency of the pains. The stronger and more
+frequent the pains, the quicker it will be over. First confinements
+necessarily take longer, because the parts take more time to open up, or
+dilate, to a degree sufficient to allow the child to be born. In subsequent
+confinements, these parts having once been dilated yield much easier, thus
+shortening the time and the pains of this, the most painful, stage of
+labor. The average duration of labor is eighteen hours in the case of the
+first child, and about twelve hours with women who have already borne
+children. The time, however, is subject to considerable variation, in
+individual cases, as has been pointed out.
+
+CONDUCT OF THE PATIENT DURING THE SECOND STAGE OF LABOR.--She should remain
+up, out of bed, as long as she possibly can. The object of this is because
+experience shows that the labor pains are stronger, and more frequent, when
+in the upright position. Even though this procedure would seem to invite
+more constant suffering, it must be remember that labor is a physiological,
+natural process, that there is nothing to fear or dread; and if the patient
+is in good health, it is to her advantage to have it over soon, rather than
+to encourage a long drawn out, exhausting labor. When the pains come   [97]
+she should be told to hold on to something, to hold her breath as long as
+possible, and to bear down. A good plan is to roll up a sheet lengthwise,
+and throw it over the top of an open door and let her grasp both ends
+tightly and bear down; or she can put her arms over the shoulders of the
+nurse and bear down. Instruct her to hold her breath as long as she can,
+bearing down all the time, and when she can't hold it any longer, tell her
+to let up, and then take a quick deep breath and bear down again, repeating
+this programme until the pain ceases. Tell her specifically to be sure to
+keep bearing down till the end of the pain, because the most important
+time, and the few seconds during which each pain does most of its work
+during the second stage of labor, is at the very end of each pain. When a
+woman understands that these instructions are for her good, and that they
+are given with the one purpose of saving her pain, and shortening the
+length of labor, she will try to obey. Each pain is intended by nature to
+do a certain amount of work, and each pain will accomplish that work if the
+woman does not prevent it; and if she does prevent it, she is only fooling
+herself, because the next pain will have to do what she would not allow the
+former to do, and so on according to how she acts.
+
+THE CARRIERS OF HERITAGE
+
+[Illustration: Here is the actual bridge from this generation to the next.
+
+Into these two little bodies--the larger not over one-twenty-fifth of an
+inch in diameter--is condensed the multitude of characteristics transmitted
+from one generation to another.
+
+The vital part of the _Ovum_ is the _Nucleus_, which contains the actual
+bodies that carry heritage--the little grains that are the mother's
+characteristics--_Chromosomes_. This nucleus is nourished by oils, salts
+and other inclusions, known as _Cytoplasm_. Floating in the cytoplasm may
+be found a tiny body known as the _Centrosome_, which acts as a magnet in
+certain phases of cell development. Around this whole mass is a _Cell
+Wall_, more or less resisting and protective.
+
+The _Spermatozoan_ is structurally much different from the ovum, but it
+also has its nucleus and chromosomes, which carry to the child the
+transmittable characteristics of the father.
+
+The ovum is usually comparatively large and stationary, and whatever motion
+is therefore necessary to bring it into contact with the male cell devolves
+upon the latter, which possesses what is known as a _locomotor tail_. In
+addition there are usually many sperms to one ovum, so that the chances are
+that at least one male cell will reach the egg and effect fertilization,
+and the beginning of a new life.
+
+The diagrams on the opposite page show the actual steps by which the
+spermatozoan unites with the ovum. It is the very first stage of the
+process of cell multiplication that results in the offspring.]
+
+THE FORMATION OF A NEW LIFE
+
+[Illustration: _Reproduced by permission from "Genetics," Walters, The
+Macmillan Co._]
+
+HOW A WILLFUL WOMAN CAN PROLONG LABOR.--For a certain time, during the
+second stage of labor, a willful, unreasonable woman, can work against
+nature and save herself a little pain by prolonging the issue; but there
+will come a time when, the head having reached a certain position, the
+expulsive pains will be so great that she won't be able to control them and
+nature then seems to take her revenge. So if a woman holds back, and begins
+to cry, and scream, when she feels a pain coming, she renders the pain to a
+large degree negative, she prolongs her labor, adds to the total number of
+pains, exhausts herself, and endangers the life of her child. It must,
+however, be remembered in all justice that this is a time when it is much
+easier to preach than to practice.
+
+Every confinement is a new experience; no matter how many a physician may
+have seen, there are no two alike. It is one of the interesting        [98]
+psychological problems in medicine to observe the conduct of women during
+their first confinement.
+
+Some are calm, exhibiting a degree of self-control that is admirable. They
+are willing to be instructed, and they recognize that the advice is given
+for their benefit. They conscientiously try to obey suggestions, and they
+make praiseworthy efforts to keep themselves under control. They are
+stoics.
+
+Others collapse at once; they go to pieces under the slightest excuse, and
+frequently without as much as an excuse. As soon as the pain begins, they
+willfully ignore all the instructions given and desperately and foolishly
+try to escape what they cannot escape. In this unreasonable selfishness
+they resent advice, and at the same time they implore you to "do something"
+for them. There is absolutely no excuse for this kind of conduct; and any
+prospective mother who, because of a willful trait in her disposition,
+refuses to profit by the kindly professional advice of her physician or
+nurse, should at least have some consideration for her unborn babe. It may
+seem unkind to criticise the conduct of any woman at such a time. It is not
+prompted by a lack of patience or justice however. These women permit, in
+spite of every assurance to the contrary, an unreasonable fear to overwhelm
+them; and because of this fear they refuse to be guided into a path of
+conduct that will save them suffering and shorten the pains which they
+complain of. It is our conviction that if a woman would try to follow the
+advice of the physician at this time, at least half of all the seeming
+suffering would be avoided. We are glad to be able to truthfully state that
+this type of woman is vastly in the minority.
+
+When the second stage has advanced far enough, the patient will decide to
+go to bed. It may be necessary to put her in bed earlier, if her pains are
+very strong, as there is always a possibility of suddenly expelling the
+child under the influence of a strong pain. She will, as previously stated,
+discard all clothing, except her night gown, which can be folded up to her
+waist line and let down as far as necessary after the confinement is over.
+The obvious advantage of this arrangement is that the gown remains     [99]
+unsoiled, and saves what would be needless trouble if it proved necessary
+to change the night gown at a time when the tired-out patient needs rest.
+Much aid may be afforded the woman at this stage by twisting an ordinary
+bed sheet and putting it around one of the posts or bars of the foot of the
+bed. The patient may then pull on the ends during the pain; she may also
+find much comfort and aid by bracing her feet on the foot of the bed while
+pulling. It is desirable to instruct the nurse to press on the small of the
+back during these pains. Some women appreciate a hot water bottle in this
+region. If the pains are hard the patient may perspire freely; it is always
+refreshing occasionally to wipe the face and brow off with a cloth wrung
+out of cold water. Cramps of the limbs may be relieved by forcibly
+stretching the leg and pulling the foot up toward the knee. From this time
+until the child and after-birth are born the physician will take active
+charge of the case.
+
+THE MANAGEMENT OF THE ACTUAL BIRTH OF THE CHILD.--Near the end of the
+second stage of labor it will be observed that the pains have grown strong,
+expulsive, and more frequent. Very soon the advancing head will begin to
+push outward the space between the front and back passage; the rectum is
+pushed outward and the lips of the vagina open. If an anesthetic is to be
+used these are the pains that call for it. A few drops may be dropped
+singly on a small clean handkerchief held up by the middle over the nose,
+its ends falling over the face. A few drops will just take the edge off the
+pains, and render them quite bearable. As soon as the pain is over the
+patient should rest, relax completely, and not fret and exhaust herself
+worrying about the pains to come. It is astonishing how much actual rest a
+woman can get between pains if she will only try; and it is astonishing how
+much concentrated mischief a willful, unreasonable woman can do in the same
+time. She will not try to rest, but cries and moans and pleads for
+chloroform, until she succeeds in giving everyone except the physician and
+nurse the impression that she is suffering unnecessarily. Her husband or
+her mother, whichever is present, gets nervous; they begin to wonder  [100]
+if the physician is really trying to help; assume a long, sad, serious
+face! forget their promise to look cheerful, and mayhap offer sympathy to
+the woman. It is a trying moment and needs infinite patience and tact. The
+physician attends strictly to his duty, which will now be to guard the
+woman against exerting too great a force during the last few pains. About
+this time, or before it in many instances, the "waters will break." This
+means simply that the bag or membrane in the contents of which the child
+floated burst because of the pressure of a pain. This is a perfectly
+natural procedure and should not cause any worry: simply ignore it as if it
+had no bearing on the labor in any way. As soon as the oncoming head has
+dilated the passage sufficiently, so that the edges of the entrance to the
+vagina will slip over the head without tearing, the physician allows the
+head to be born. It takes some time to do this, and he must hold the head
+back until just the right moment. It is best not to let the head slip
+through at the height of a pain, or rupture is sure to occur. Wait till it
+will slip through as a pain is dying out, and if you have waited long
+enough and handled the head skillfully, the conditions will be just right
+at a certain moment to permit this without tearing the parts. There are
+some cases where a tear, and a good tear, is impossible to guard against.
+It is not a question of patience, or tact, or skill; it is a combination of
+conditions which patience, tact, and skill are powerless against.
+
+POSITION OF WOMAN DURING BIRTH OF CHILD.--The position of the woman is a
+matter of choice and is not contributory to the results at all. She can lie
+on her back, which is the ordinary way, or on her side, as the physician or
+the patient prefer. As soon as the head is born the physician should see
+that the cord is not round the child's neck; if it is, release it. The
+shoulders will most likely be born with the next or succeeding pain. The
+physician will permit the lower shoulder to slip over the soft parts first;
+this is done by retarding the upper shoulder by pushing it gently behind
+the pubic bone of the mother. When the shoulders are through, the rest[101]
+of the body of the child slips out without effort.
+
+DUTY OF NURSE IMMEDIATELY FOLLOWING BIRTH OF CHILD.--As soon as the child
+is born the nurse should sit by the side of the mother and hold the womb
+until the after-birth is expelled. The womb can be easily felt in the lower
+part of the woman's abdomen as a hard mass. It feels about the size of an
+extra large orange. The object of holding it is to prevent the possibility
+of an internal hemorrhage. It can be readily appreciated that the interior
+of a womb, immediately after a child is born, is simply a large bleeding
+wound. So long as the womb remains firmly contracted there is very little
+chance for an extensive bleeding to take place. As a rule the womb remains
+sufficiently contracted to preclude a hemorrhage until the after-birth is
+out. After the after-birth is expelled, the womb usually closes down firmly
+and the liability to bleed is very much reduced. Because there is a
+distinct chance or tendency for the womb to bleed freely during the time
+the after-birth remains in, it is customary, as stated above, to watch it
+closely and to hold it securely. It is best held with the right hand. The
+fingers should surround the top of the womb and exert a slight downward
+pressure. Should it show any tendency to dilate or fill with blood, get it
+between the fingers and the thumb and squeeze it, pushing downward at the
+same time.
+
+EXPULSION OF AFTER-BIRTH.--The after-birth is usually expelled in about
+twenty minutes after the child is born. Great care should be experienced in
+its expulsion. It should not be pulled at any stage of its expulsion. If it
+does not come easily give it a longer time,--it takes time for the womb to
+detach itself from the after-birth; and some after-births are very firmly
+attached. Eventually it will come out with a little encouragement in the
+way of frictional massage of the womb through the abdominal walls. If the
+membranes remain in the womb after the body of the after-birth is out, do
+not pull on them. Take the after-birth up in the palm of your hand and turn
+or twist it around, and keep turning it around gently, thereby loosening
+the membranes from the womb instead of pulling them, which would surely
+break them, leaving the broken ends in the womb, and, as a result, the[102]
+chance of developing serious trouble.
+
+The patient should now be given one teaspoonful of the fluid extract of
+ergot, which should be repeated in an hour. Should there be an excessive
+flow of blood after this period it may be again repeated at the third hour.
+
+CUTTING THE CORD.--As soon as the child is born, and of course long before
+the after-birth is expelled, the physician will tie the cord. This is best
+done at two places, one about two inches from the child, and the other two
+or three inches nearer the mother. Cut the cord about one-half inch beyond
+the first ligature, which will be between the two ligatures. The cord
+should be tied with sterile tape made for the purpose, or heavy twisted
+ligature silk, or a narrow, ordinary, strong tape, previously boiled. It
+should be tied firmly and inspected a number of times within one hour of
+its birth. It is possible for a baby to lose enough blood from a cord badly
+tied to cause its death. A very good way to ensure against such an accident
+is to cut the cord one inch from the ligature nearest the baby, then turn
+this inch backward and retie with the same ligature, thus making a double
+tie at the same spot. Cut the cord with scissors that have been boiled and
+reserved for this purpose.
+
+WASHING BABY'S EYES AND MOUTH IMMEDIATELY AFTER BIRTH.--As soon after birth
+as is practicable, wash the baby's eyes with a saturated solution of
+boracic acid.
+
+Immediately after the eyes have been washed the physician will drop into
+them a solution of silver nitrate, three drops of a two per cent. solution
+in each eye, or argyrol, three drops 20 per cent. solution. This precaution
+is taken against possible infection during labor and, as explained
+elsewhere, it is a preventive against certain diseased conditions which, if
+present, would result in blindness.
+
+The physician should then wind a little sterile cotton round his moistened
+little finger, dip it in the boracic solution, and holding the baby up by
+the feet head down, insert this finger into the throat, thus clearing it of
+mucus. The tongue and mouth may be gently washed with the same        [103]
+solution.
+
+After the baby has cried lustily as an evidence of life and strength, he
+should be wrapped up in a warm blanket quickly, and immediately put in a
+cozy basket in a warm place, and left there undisturbed, with his eyes
+shaded from the light until the nurse is ready to attend to him. The baby
+should be laid on his right side.
+
+CONDUCT IMMEDIATELY FOLLOWING LABOR.--As soon as the physician is satisfied
+that the patient is well enough to be left in care of the nurse or
+attendant, every effort should be made to favor a long, refreshing sleep.
+Nothing will contribute to the patient's well-being so much as a quiet,
+restful sleep after labor. The nurse will therefore take the baby into
+another room, fix the mother comfortably, and give her a glass of warm
+milk,--draw the shades or lower the light and tell the tired-out mother to
+go to sleep. As a rule she will sleep easily, as she is sore and exhausted.
+
+AFTER-PAINS.--In women who have had children the womb does not as a rule
+contract down as firmly as after the first confinement. This condition
+permits of slight relaxation of the muscular wall, at which times there is
+a slight oozing of blood. This blood collects and forms clots in the
+uterine cavity which acts as irritants, exciting contractions in the effort
+to expel them. These contractions cause what are commonly known as
+"after-pains." These pains last until the womb is free from blood-clots.
+They may be severe the first twenty-four hours and then gradually die out
+during the following two or three days. Ordinarily in uncomplicated
+confinements they rarely annoy the patient longer than a few hours. It is a
+rare exception to observe them after the first confinement.
+
+REST AND QUIET AFTER LABOR.--Sometimes the birth chamber is the rendezvous
+for all the inquisitive ladies in the neighborhood. No one should be
+permitted in the lying-in chamber until the patient is sitting up, except
+the husband and the mother. This should be made an absolute rule in every
+confinement. This is a period that demands the maximum of uninterrupted
+rest and repose. The world and all its concerns should remain a blank to a
+woman during the whole period of her confinement. This is the only
+successful means of obtaining mental rest. The husband and mother     [104]
+should be instructed to present themselves just often enough to demonstrate
+their interest in the welfare of the patient and the baby.
+
+POSITION OF THE PATIENT AFTER LABOR.--After delivery a woman should be
+instructed to lie on her back, without a pillow, for the first night. On
+the following morning she may have a pillow, but she must remain on her
+back for the first week. Sometimes an exception may be made to this rule by
+letting the patient move around on the side, with a pillow supporting the
+back, on the fourth day. These exceptional cases are those whose womb has
+contracted firmly, as shown by the quick change in the amount and color of
+the lochia. Women should be told why they must remain on their backs as
+explained in the chapter: "How long should a woman remain in bed?"
+
+THE LOCHIA.--The discharge which occurs after every labor is called the
+lochia. Its color is red for the first four or five days; for the
+succeeding two or three days it is yellow; for the remainder of its
+existence it is of a whitish color. It lasts from ten days to three weeks.
+
+The odor of the lochia is at first that of fresh blood; later it has the
+odor peculiar to these parts. If at any time the odor should become foul or
+putrid it is a danger signal to which the nurse should immediately draw the
+physician's attention.
+
+If the amount of the lochia should be excessive it should be investigated.
+
+THE EVENTS OF THE DAY FOLLOWING LABOR.--We will assume that the patient
+enjoyed a long sleep and wakes up refreshed, and with a thankful feeling
+that all is over and that baby is safely here. She will want to see and
+caress baby, of course. Lay the baby down in bed beside her and let her
+love and mother it. Tell her not to lift it, for the strain might injure
+her, then quietly steal away for ten or fifteen minutes, for these are
+precious, sacred moments. Motherhood--that angel spirit, whose influence
+every human heart has felt--that guards and guides the world in its
+sheltering arms--is born in its divine sense, into the heart of every woman
+for the first time, as she gazes in ecstasy and wonder at her         [105]
+first-born. She feels that she has begotten a trust,--a trust direct from
+her Creator, and she makes a silent resolve, as she gently and timidly
+feels the softness of baby's cheek, that she will watch over it, and guide
+it, and do all a mother can for it, with God's help. It is good for the
+race that mothers do feel this way: and it is good for all concerned that
+they be given the opportunity to be so inspired.
+
+Just as gently take the baby away at the expiration of the allotted time.
+Take it with a cheerful, smiling word, and do not comment upon mother's
+happy, thoughtful face, she will quickly collect herself and enter into the
+spirit of quiet congratulation that should now permeate the home.
+
+THE FIRST BREAKFAST AFTER LABOR.--If the patient has passed a comfortable
+night, feels well, and is free from temperature, and has a normal pulse,
+breakfast will consist of a cup of warm milk, or a cup of cocoa made with
+milk, a piece of toasted bread, and a light boiled egg; or if preferred a
+cereal with milk and toasted bread. This will be the breakfast for the two
+following days also. The milk, or the cocoa (whichever is taken), must be
+sipped, while the attendant supports the patient's head. The cereal, or the
+egg (whichever is taken), must be fed to the patient out of a spoon. The
+patient must not make any physical effort to help herself; she must remain
+relaxed. Even when she sips her milk, or cocoa, she must not make any
+effort to raise her head; the nurse must support its entire weight. This
+will be the absolute routine of every meal until the physician gives
+permission to change the procedure. It is a waste of time to formulate
+rules only to disobey them.
+
+Shortly after breakfast the patient's toilet should be attended to. She
+should have her hair combed, and her face and hands washed. The hair on the
+right half of her head should be combed while the head rests on the left
+side, and vice versa. The water used for washing the hands and face should
+be slightly warmed. It is best to keep the hair braided and to consult the
+wishes of the patient as to the frequency of combing it. [Page 106]
+
+THE IMPORTANCE OF EMPTYING THE BLADDER AFTER LABOR.--An effort should be
+made now to have the patient urinate. This is very important at this time,
+as it is not an uncommon experience to find that the abdominal muscles are
+so worn out and overstrained with the fatigue of labor that they refuse to
+act when an effort is made to urinate. As a consequence the bladder becomes
+distended and may have to be emptied by other means. This condition is a
+temporary and a painless one, and will rectify itself in a day or two;
+meantime, if this accident has occurred, it is essential that the bladder
+should be emptied from time to time until the patient can do it herself. To
+test this function place the patient on the bed pan into which a pint of
+hot water has been put, and give her a reasonable time to make the effort
+to pass her water. Should she fail, take an ordinary small bath towel and
+wring it out of very hot water, just as hot as she can tolerate, and spread
+it over the region of the bladder and genitals: if there is running water
+in the room, turn it on full and let it run while the towel is in position
+as above. If the bladder is full, there is a peculiar, irresistible desire
+to urinate when one hears running water. If this effort fails, report the
+fact to the physician when he makes his daily call; he will draw the urine
+and it will be part of his daily duty to give specific instructions
+regarding this function until nature reëstablishes it.
+
+No particular attention need be paid to the bowels for the first two days.
+On the morning of the third day, if they have not acted of their own
+accord, the physician will give the necessary instructions to move them.
+The means necessary to accomplish the first movement after a confinement is
+a matter of choice. The old-time idea was to use castor oil, and while
+other remedies are now more or less fashionable, castor oil is still an
+excellent agent. Enemas are frequently used, but their use is questionable
+in this instance, inasmuch as a movement has not taken place for three
+days, the object is to clean out the whole length of the intestinal tract,
+and an enema is limited to part of the large intestine only,--according to
+how it is given. If the small intestines are not thoroughly emptied,  [107]
+particles of food may remain there, and if so, they will putrify and the
+patient runs the risk of developing gas,--sometimes to an enormous extent.
+This affliction is painful, and dangerous, and nearly always unnecessary.
+It is always, therefore, more safe, and more desirable, to use some agent
+by the mouth, and we know of no better one than castor oil; and as castor
+oil can be so masked as to be practically tasteless at any drug-store soda
+fountain there can be small objection to it. My custom is to send the nurse
+or husband with an empty glass to the drug store to have the mixture made
+there and brought back ready for use. We have frequently obtained it in
+this way and given it to the patient without her knowing what it was. The
+best time to give castor oil is two hours after a meal, and two hours
+before the next meal--i.e., on an empty stomach. It works quicker and does
+not nauseate when the stomach is empty.
+
+INSTRUCTING THE NURSE IN DETAILS.--The nurse will attend to the patient's
+discharges by changing the napkins frequently. The bruised parts should be
+washed twice daily, for the first three or four days. If the nurse is a
+trained graduate nurse a few directions will suffice. If she is not a
+trained nurse the physician should be explicit in his instructions. It
+would be better if he actually showed her just how he wanted this work
+done. The best way to cleanse the vulvæ or privates is to take an ordinary
+douche bag at the proper height (about three feet) and allow the solution
+(1 to 2,000 bichlorid) to run over the parts into the douche pan, but do
+not touch any part of the patient with the nozzle of the douche bag. While
+she is directing the water with the left hand she should have a piece of
+sterile cotton in the right hand with which she will gently mop the parts.
+This method ensures disengaging any clotted blood and is aseptic. Dry the
+parts afterwards with a soft sterile piece of gauze and apply a clean
+sterile napkin.
+
+DOUCHING AFTER LABOR.--A nurse should never give a vaginal douche without
+instructions from the physician. Douches are not necessary in the
+convalescence of ordinary uncomplicated confinement cases. When it is [108]
+necessary to give vaginal douches after a confinement, there are good
+reasons why they should be given, and it is therefore absolutely essential
+that they should be given properly, and with the highest degree of aseptic
+precautions. If these rules are not observed, the danger of causing serious
+trouble is very great, and as the physician is directly responsible for the
+conduct of the case, he should in justice to himself and his patient, do
+the douching himself.
+
+HOW TO GIVE A DOUCHE.--The proper way to give a vaginal douche after a
+confinement, when the parts are bruised and lacerated, and when, as a
+consequence, the possibility of infection is very great, is as follows:
+
+Instruct the nurse to boil and cool about two quarts of water and have
+another kettle of water boiling. Boil the douche bag and its rubber tubing
+and the glass douche tube (do not use the hard rubber nozzle that comes
+with the ordinary douche bag). Drain off the water after it has boiled for
+ten minutes, but instruct the nurse not to touch the bag or tube, to leave
+them in the pan, covered, till the physician uses them. When the physician
+calls, place the patient on a clean warm douche pan while he is sterilizing
+his hands and making the solution ready. While he is douching the patient
+the nurse will hold the bag. The bag should not be held higher than two
+feet above the level of the patient.
+
+ADVANTAGES OF PUTTING BABY TO THE BREAST EARLY AFTER BIRTH.--The patient
+can now take, and will likely be ready for, an hour's nap. After the rest
+it is desirable to put the baby to the nipple, first carefully cleaning the
+nipple with a soft piece of sterile gauze dipped in a saturated solution of
+boracic acid. The reasons for this are as follows:
+
+1st. There is in the breasts of every woman after confinement a secretion
+known as "colostrum" which has the property of acting as a laxative to the
+child, in addition to being a food.
+
+2nd. It is advisable that the child's bowels should move during the first
+twenty-four hours and the colostrum was put there partly for that purpose.
+
+3rd. The act of suckling has a well-known influence on the womb, in   [109]
+that it distinctly aids in contracting it, and thereby expelling
+blood-clots and small shreds of the after-birth which might cause trouble
+if left in.
+
+4th. By nursing the colostrum out of the breasts, it will favor and hasten
+the secretion of milk.
+
+5th. It is frequently easier for the baby to get the nipple before the
+breast is full of milk, and having once had the nipple it will be easier to
+induce him to take it again when it is more difficult to get.
+
+THE FIRST LUNCH AFTER LABOR.--Lunch will be next in order, and that should
+consist of a clear soup,--chicken broth, mutton broth, beef broth with a
+few Graham wafers or biscuits, and a cup of custard or rice pudding. This
+will be the lunch for the two following days also. The same precautions are
+to be observed in giving this as were observed with breakfast and as will
+be observed with all other meals as clearly stated before, and repeated
+again, so that no mistake may be made. In the middle of the afternoon the
+patient can take a cup of beef tea or a cup of warm milk.
+
+THE FIRST DINNER AFTER LABOR.--Dinner will consist of more broth, or a
+plate of clear consomme with a dropped egg, or a cereal, a little boiled
+rice with milk, and stewed prunes, or a baked apple.
+
+After the bowels have moved, on the third day, and provided the temperature
+and pulse have been normal since the confinement, the patient can be put on
+an ordinary mixed diet, particulars regarding which are given on page 121
+under the heading "Diet for the nursing mother."
+
+       *       *       *       *       *
+
+
+                                                                      [111]
+CHAPTER IX
+
+CONFINEMENT INCIDENTS
+
+    REGARDING THE DREAD AND FEAR OF CHILDBIRTH--THE WOMAN WHO DREADS
+    CHILDBIRTH--REGARDING THE USE OF ANESTHETICS IN CONFINEMENTS--THE
+    PRESENCE OF FRIENDS AND RELATIVES IN THE CONFINEMENT CHAMBER--HOW LONG
+    SHOULD A WOMAN STAY IN BED AFTER A CONFINEMENT?--WHY DO PHYSICIANS
+    PERMIT WOMEN TO GET OUT OF BED BEFORE THE WOMB IS BACK IN ITS PROPER
+    PLACE?--LACERATIONS, THEIR MEANING AND THEIR SIGNIFICANCE--THE
+    ADVANTAGE OF AN EXAMINATION SIX WEEKS AFTER THE CONFINEMENT--THE
+    PHYSICIAN WHO DOES NOT TELL ALL OF THE TRUTH
+
+REGARDING THE MORE OR LESS PREVALENT DREAD OR FEAR OF CHILDBIRTH.--Much has
+been written, and much more could be written upon this subject. Inasmuch as
+this book is largely intended for prospective mothers to read and profit
+thereby, and is not for physicians and nurses whose actual acquaintance
+with confinement work would render such comments superfluous, it will not
+be out of place to consider this phase of the subject briefly, from a
+medical standpoint. When one considers that "a child is born every minute"
+as the saying goes, and which is approximately true, and at the same time
+remembers that statistics prove, as near as can be estimated, that there is
+only one death of a mother in twenty thousand confinements, it would really
+seem as though we were "looking for trouble" to even regard the subject as
+worthy of the smallest consideration. It is much more dangerous to ride
+five miles on a railroad, or on a street car, or even take a two-mile
+walk,--the percentage possibility of accident is decidedly in your favor to
+stay at home and have a baby. Almost any disease you can mention has a
+higher, a much higher fatality percentage than the risks run by a     [112]
+pregnant woman. The real justification for actual fear of serious trouble
+is so small that it barely exists. These are facts that cannot be argued
+away by any specious if or and. Why, therefore, should there be any real
+fear?
+
+Did you ever hear of the remarks made by a famous philosopher who was given
+a dinner by his friends in celebration of his 85th birthday? In replying to
+the eulogisms of his friends he said in part:
+
+"As I look back into those blessed years that have faded away, I can recall
+a lot of troubles and many worries as well as much happiness and pleasure,
+and thinking of it all this evening I can truthfully say my worst troubles
+and worries never happened."
+
+So it is with the woman who for weeks or months has made her own life
+wretched, and possibly the life of her husband and friends, the same in
+imagining all kinds of dreadful things that never take place. It is
+undoubtedly an exhibition of weakness, an evidence of failure in the
+development of self-control. Childbirth is a natural process,--there is
+nothing mysterious about it. If you do your part you have no cause to
+fear,--the very fact, however, that you entertain a dread of it, shows that
+you are not doing your part. One of the saddest parts of life, one of the
+real tragedies of living, is the fact that most of us have to live so long
+before we really begin to profit by our experiences. Could we only be
+taught to learn the lesson of experience earlier, when life is younger and
+hope stronger, we would have so much more to live for and so many more
+satisfied moments to profit by. One of the most valuable lessons experience
+can teach any human being is not to worry and fret about the future. You
+can plant ahead of yourself a path of roses and be cheerful, or you can
+plant a bed of thorns and reap a thorny reward. Cultivate the spirit of
+contentment, devote all your energy to making the actual present
+comfortable. Don't fret about what is going to bother you next week,
+because, as the philosopher said, most of the troubles we anticipate and
+worry about never occur, but the worry kills.
+
+REGARDING THE USE OF ANESTHETICS IN CONFINEMENTS.--Anesthetics are as a
+rule given in all confinements that are not normal. To make this      [113]
+statement more plain it may be said, that, when it is necessary to use
+instruments, or to perform any operation of a painful character, it is the
+invariable rule to give anesthetics. As to the wisdom of giving an
+anesthetic when labor is progressing in a normal and satisfactory manner,
+there is a difference of opinion. Much depends upon the disposition of the
+patient and the viewpoint of the physician in charge of the case. It is a
+fact that a large number of confinements are easy and are admitted to be
+so, by the patients themselves, and in which it would be medically wrong to
+give an anesthetic. In a normal confinement, however, when the pains are
+particularly severe and the progress slow, there is no medical reason why
+an anesthetic could not be given to ease the pain. In these cases it is not
+necessary to render the patient completely unconscious. Sufficient
+anesthetic to dull each pain is all that is necessary, and as this can be
+accomplished with absolute safety by the use of an anesthetic mixture of
+alcohol, ether and chloroform, there can be no possible objection to it.
+The use of an anesthetic, however, is a matter that must be left entirely
+to the judgment of the physician as there are frequently good reasons why
+it should not be given under any circumstances.
+
+THE PRESENCE OF FRIENDS AND RELATIVES IN THE CONFINEMENT CHAMBER.--It is a
+safe rule to exclude every one from the confinement room during the later
+stages of labor. Sometimes it is desirable to make an exception to this
+rule in the interest of the patient, by permitting the mother or husband to
+remain. If this exception is made, however, they must be told to conduct
+themselves in a way that will tend to keep the patient in cheerful spirits.
+They must not sympathize, or go around with solemn, gloomy faces.
+Cheerfulness and an encouraging word will tide over a trying moment when
+the reverse might prove disastrous.
+
+Practically the same rule applies to the entire period of convalescence
+during which time the patient is confined to bed. This is a very important
+episode in a woman's life and the consequences may be serious if it is
+misused in any way. Friends and relatives do not appreciate the       [114]
+absolute necessity of guarding the patient from small talk and gossip, and
+an unwitting remark may cause grave mental distress, which may retard the
+patient's convalescence and disastrously affect the quality and quantity of
+her milk, thereby injuring the child.
+
+HOW LONG SHOULD A WOMAN STAY IN BED AFTER A CONFINEMENT?--To answer this
+question by stating a specific number of days would be wrong, because, few
+women understand the need for staying in bed after they feel well enough to
+get up. If any answer was given, it should be at least fourteen days, and
+it would be nearer the truth medically to double that time. Let us consider
+what is going on at this period. The natural size of the unimpregnated womb
+is three by one and three-quarter inches, and its weight is one to two
+ounces. The average size of the pregnant womb just previous to labor is
+twenty by fourteen inches, and its weight about sixteen ounces. We have,
+therefore, an increase of about 600% to be got rid of before it assumes
+again its normal condition. This decrease cannot be accomplished quickly by
+any known medical miracle. Nature takes time and she will not be hurried:
+she will do it in an orderly, perfect manner if she is allowed to. The womb
+will again find its proper location and will resume its work, in a
+painless, natural way, in due time, if all goes well. The uterus or womb is
+held in its place by two bands or ligaments, one on either side, and is
+supported in front and back by the structures next to it. These bands keep
+the womb in place in much the same way as a clothes pin sits on a clothes
+line, and it will retain its proper place provided everything is just
+right. After labor, it is large and top heavy. If you put a weight on the
+top of a clothes pin as it sits on a clothes line, what will take place? It
+will tilt one way or the other, and if the weight is heavy, it will turn
+completely over. So long as the woman lies in bed the womb will gradually
+shrink back to its proper size and place; if she sits up or gets out of bed
+too soon, the weight of the womb, being top heavy, will cause it to tilt
+and sag out of its true position. As soon as it does this the weight of the
+bowels and other structures above will push and crowd it further out  [115]
+of place. This crowding and tilting interferes with the circulation in the
+womb and its proper contraction is interfered with, and thus is laid the
+foundation for the multitude of womb troubles that exist.
+
+It is a mechanical as well as a medical problem. Being partly mechanical,
+it is subject to the rules that govern mechanical problems. The importance
+of this dual process will be appreciated by considering the following fact.
+Many medical conditions tend to cure or rectify themselves because nature
+is always working in our behalf if we give her a chance. Take for example
+an ordinary cold. You can have a very severe cold and you can neglect it,
+and in spite of your neglect you will get well. It is not wise to neglect
+colds, nevertheless, it is true that nature will cure, unaided, a great
+many diseased conditions, if she has half a chance. This, to a very large
+extent, is the secret of Christian Science, yet the principle is known to
+everyone. A mechanical condition, on the other hand, has absolutely no
+tendency to get well of its own accord, or without mechanical aid. This is
+why Christian Science cannot cure a broken leg. It is this principle that
+makes diseases of the womb so persistent, and so stubborn of cure. When a
+womb once becomes slightly displaced, the tendency always is for it to grow
+worse and never to cure itself. The longer it lasts the worse it gets. Its
+cure depends upon mechanically putting it back in place and holding it long
+enough there to permit nature to reëstablish its circulation, and by toning
+and strengthening it so that when the mechanical support is taken away it
+will retain its position. There is no other possible way of doing it. Now
+since it has been proved that nature takes many days to contract a pregnant
+womb, a woman is taking a risk, and inviting trouble by getting out of bed
+before that time.
+
+WHY DO PHYSICIANS PERMIT WOMEN TO GET UP BEFORE THE WOMB IS BACK IN ITS
+PROPER PLACE?--Without offering the excuse that a woman will not stay in
+bed as long as a physician knows she should, there is, however, a large
+degree of truth in this excuse. And we are of the opinion that, if a
+physician made it a rule to keep all his confinement cases in bed for one
+month, [Page 116] he would very soon find himself without these patients.
+
+Experience has taught us, however, that it is safe, under proper
+restrictions, and in uncomplicated confinements, to allow patients to sit
+up in bed on the 12th and in certain cases on the 10th day, and to get out
+of bed on the 12th or 14th day. When the patient is allowed to sit up, out
+of bed, it should not be for longer than one or two hours, and during that
+time she should sit in a comfortable rocking or Morris chair, which should
+be placed by the side of the bed. Each day the time can be lengthened, and
+the distance of the chair from the bed increased. This procedure gives her
+the opportunity to walk a little further each day, thereby to test her
+strength and ability to use her limbs. On the fourth day, if all has gone
+well, she may stay up all day and she may walk more freely about the room.
+She should be just to herself, however. As soon as she is fatigued she
+should not make any effort to try to "work it off." When a feeling of
+fatigue appears she should rest completely. If she has any pain or distress
+she should acquaint the physician with it at once. She should not try to
+hide anything on the mistaken idea that "it isn't much." She does not know,
+and she is not supposed to know what the pain may mean; it may be
+exceedingly significant. Many women have saved themselves needless
+suffering, and their husbands unnecessary expenditure of money, by calling
+the physician's attention to conditions, which in time would have been
+serious, and would have necessitated long, expensive treatment.
+
+LACERATIONS DURING CONFINEMENT, THEIR MEANING AND THEIR SIGNIFICANCE.--The
+only interest a laceration or a tear has to a physician, is whether the
+laceration or tear is of sufficient importance to need surgical
+interference. The laceration can take place at the mouth of the womb, or on
+the outside, between the vagina and rectum.
+
+Those of the mouth of the womb always take place, in every confinement, to
+some degree. They are never given any attention at the time of the
+confinement, unless under extraordinary circumstances, such as a more or
+less complete rupture of the womb, and this is such a rare accident   [117]
+that most physicians practice a lifetime and never see or hear of one
+single case. Those on the outside are always attended to immediately after
+labor, or should be, unless they are very extensive and the patient is not
+in condition to permit of any immediate operative work. In such a case it
+is best to leave it alone until the patient is in condition to have it
+operated on at a later date.
+
+It is distinctly preferable to have it attended to immediately after labor
+when it is possible, and it is possible in a very large percentage of the
+cases. The explanation of this is because it is practically painless then,
+owing to the parts having been so stretched and bruised that they have
+little or no feeling. If it is left for a day or two and then repaired, it
+will be more painful, because the parts will have regained their
+sensitiveness. Another good reason in favor of immediate repair is that a
+much better and quicker union will take place than if postponed.
+
+When a patient is torn, but not to the degree necessary to stitch, it is to
+her advantage to be told to lie on her back and keep her knees together for
+twelve hours, thus keeping the torn edges together and at rest, thereby
+favoring quick and healthy repair of the tear. Some physicians go as far as
+to bind the patient's knees together so she cannot separate them during
+sleep.
+
+It is the custom of every conscientious physician to request every woman he
+confines to report at his office six or eight weeks after labor. The reason
+for this is to find out by examination the character and extent of the
+lacerations of the mouth of the womb. No physician can tell at the time of
+labor just how much damage has been done, because the mouth of the womb, at
+the time of labor, is so stretched and thinned out, that it is impossible
+to tell. After the womb has contracted to about its normal size, it is a
+very simple matter for any physician to tell exactly the character and
+extent of the lacerations. Most of these tears need absolutely no
+attention; there are a few however that do. This is a very important matter
+for two very good reasons.
+
+1st. Every woman should know, and is entitled to know, just what      [118]
+condition she is in, because if she has been torn to an extent that needs
+attention, and is left in ignorance of it, her physical health may be
+slowly and seriously undermined and the cause of it may not be understood
+or even guessed at. A woman who becomes nervous and irritable, loses vim
+and vitality, has headaches, backaches and anemia, and no symptoms, or few,
+that point to disease of the womb, will suffer a long time before she seeks
+relief of the right kind, and will be astonished and outraged when she is
+told that it all results from a bad tear of her womb that she knew nothing
+about.
+
+2nd. A physician should in justice to himself insist on this late
+examination, because if a woman is told, at some subsequent time, by
+another physician that she is badly torn, and she was not told of it by the
+physician who confined her, she is very apt to form an unjust opinion of
+his work and to entertain an unfriendly feeling toward him as a man.
+
+Some physicians also, to their discredit, are not slow in permitting an
+unjust opinion of a colleague to be spread around, by preserving a silence,
+when an explanation would result in an entirely different opinion by the
+patient. They permit it to be inferred that the physician was responsible
+for the tear, when such is not the case. No physician on earth can prevent
+a tear of the mouth of the womb and this should be explained to the
+patient. Where the physician is at fault is in the failure to examine his
+patients when it is possible to tell that a tear of any consequence exists.
+If such an examination is made, he is in a position to state that a tear
+exists of sufficient extent to justify careful attention. Immediate
+operation is seldom necessary, and if the patient is comparatively young,
+it may not be wise to operate, because if pregnancy takes place within a
+reasonable time the womb will again tear. She should be told, however, that
+should she not become pregnant during the next three years she should be
+examined from time to time, and if the condition of her womb, or her health
+suggest it, she should have the tear attended to. If after this explanation
+she neglects herself she must blame herself, she will at least have no[119]
+cause to harbor any resentment against her physician who has done all any
+physician is called upon to do under the circumstances. Another important
+reason for finding out the character of the laceration is because these
+lacerations of the mouth of the womb frequently cause sterility.
+
+       *       *       *       *       *
+
+
+                                                                      [121]
+CHAPTER X
+
+NURSING MOTHERS
+
+    THE DIET OF NURSING MOTHERS--CARE OF THE NIPPLES--CRACKED
+    NIPPLES--TENDER NIPPLES--MASTITIS IN NURSING MOTHERS--INFLAMMATION OF
+    THE BREASTS--WHEN SHOULD A CHILD BE WEANED?--METHOD OF WEANING--NURSING
+    WHILE MENSTRUATING--CARE OF BREASTS WHILE WEANING CHILD--NERVOUS
+    NURSING MOTHERS--BIRTH MARKS--QUALIFICATIONS OF A NURSERY MAID.
+
+THE DIET OF NURSING MOTHERS.--A nursing mother should eat exactly the same
+diet as she has always been accustomed to before she became pregnant. If
+any article of diet disagrees with her she should give up that particular
+article. She should not experiment; simply adhere to what she knows agreed
+with her in the past. More, rather than less, should be taken, especially
+more liquids as they favor milk-making. It is sometimes advisable to drink
+an extra glass of milk in the mid-afternoon and before retiring. If milk
+disagrees, or is not liked, she may take clear soup or beef tea in place of
+it. In a general way milk in quantities not over one quart daily, eggs,
+meat, fish, poultry, cereals, green vegetables, and stewed fruit constitute
+a varied and ample dietary to select from.
+
+Every nursing mother should have one daily movement of the bowels; she
+should get three or four hours' exercise in the open air every day; and she
+should nurse her child regularly.
+
+The diet of the nursing mother during the period immediately after
+confinement is given elsewhere.
+
+Alcohol, of all kinds, should be absolutely avoided during the entire
+period of nursing.
+
+Drugs of every variety, or for any purpose, should never be taken unless by
+special permission of her physician.
+
+CARE OF THE NIPPLES.--As soon as the mother has had a good sleep after the
+confinement the nipples should be washed with a saturated solution of [122]
+boracic acid, and the child allowed to nurse. The milk does not come into
+the breast for two or three days, but the child should nurse every four
+hours during that time. There is secreted at this time a substance called
+colostrum. This is a laxative agent which nature intends the child should
+have as it tends to move the bowels and at the same time it appeases the
+hunger of the infant. It also accustoms the child to nursing and gradually
+prepares the nipples for the work ahead of them.
+
+After each nursing the nipples should be carefully washed with the same
+solution and thoroughly dried.
+
+CRACKED NIPPLES.--Cracked nipples often result from lack of care and
+cleanliness. If they are not cared for as described above they are very apt
+during the first few days to crack. They should never be left moist. They
+should be washed and dried after every feeding. If the breasts are full
+enough to leak they should be covered with a pad of sterile absorbent
+gauze.
+
+Nursing mothers should guard against cracked nipples, as they are
+exceedingly painful; frequently necessitating a discontinuance of nursing;
+and may produce abscess of the breast.
+
+TREATMENT OF CRACKED NIPPLES.--In addition to washing the nipples, drying
+them thoroughly, and placing a pad of dry gauze over them after each
+feeding, they should be painted with an 8 per cent. solution of nitrate of
+silver twice daily. Before the next feeding, after the silver has been
+used, they should be washed with cooled boiled water. If the cracks are
+very bad it may be necessary to use a nipple-shield over them while nursing
+for a few days.
+
+TENDER NIPPLES.--Many women complain of the pain caused by the baby when it
+is first put to the breast. These nipples are not cracked, they are simple
+hypersensitive. They should be thoroughly cleansed and dried as above and
+painted with the compound tincture of benzoin. They should be washed off
+with the boracic acid solution before each feeding. After a few days under
+this treatment the tenderness will leave them.
+
+MASTITIS IN NURSING MOTHERS.--When inflammation of the breast takes   [123]
+place in a nursing mother it is the result of exposure to cold, or it may
+result from injury. If infection occurs and an abscess develops, it results
+from the entrance, through the nipples, or cracks, or fissures in the
+nipple, of bacteria into the breast. There is fever, with chills and
+prostration, and very soon it is impossible to nurse the child because of
+the pain. Nursing should be immediately discontinued, the breast supported
+by a bandage and the milk drawn, with a breast pump, at the regular nursing
+intervals. An ice-bag should be constantly applied to the painful area and
+the bowels kept freely open with a saline laxative. When the fever and the
+pain subside nursing may be resumed.
+
+If the gland suppurates in spite of treatment it must be freely opened and
+freely drained.
+
+WEANING
+
+WHEN TO WEAN THE BABY.--Medically there is no exact time at which the baby
+should be weaned. Certain conditions indicate when it should be undertaken.
+It is desirable to wean the baby between the tenth and twelfth months. A
+month or two one way or another will not make much difference if the mother
+and child are in good condition. It should be weaned between the periods of
+dentition rather than when it is actively teething. The time of year is
+important. It would be better to wean it before the hot weather if it is
+strong and has been accustomed to taking other food than the breast milk.
+On the other hand it would be decidedly better to defer the weaning until
+the fall, rather than risk weaning at the tenth or twelfth months if these
+fall during the height of the hot weather.
+
+METHODS OF WEANING.--The best way to wean is to do it gradually. It is not
+desirable to take the mother's milk away suddenly unless there is a very
+good reason for it. The child should be fed small portions of suitable
+other food at the beginning of the tenth month. By the end of the tenth
+month he should be taking a feeding two or three times a day of food other
+than the breast milk. This feeding may be given in a bottle. In some  [124]
+cases the mother may be able to feed the child with a spoon instead of the
+bottle. The substitute feedings allowable at this age are given in another
+chapter.
+
+TIMES WHEN RAPID WEANING IS NECESSARY.--There are times when the child must
+be weaned suddenly, as, for example, at the death of the mother, serious
+sickness of the mother, or in cases where for any cause the mother suddenly
+loses her milk. In these cases it is best to wean at once. If an infant
+refuses to take the bottle under such circumstances, the best plan to
+adopt, and the wisest one in the long run, is to starve the child into
+submission. If he gets absolutely nothing but the bottle he will shortly
+take it without protest. If a meddling individual attempts to feed the
+child some other food and tries to coax it to take the bottle in the
+meantime, much harm may result; it is safe only to fight it out for a day
+or two and win than to half starve the child and lose in the end.
+
+The child should be weaned if it is not gaining in weight. This may
+indicate a deficient quality of the mother's milk, or it may indicate a
+lack of proportion between the child and mother. If a robust child is
+depending upon the nourishment furnished by a mother who is not in good
+physical condition the milk may not be adequate in quality and quantity.
+The child will not therefore develop normally and it may be necessary to
+wean it.
+
+If the mother becomes pregnant it will be necessary to wean, because
+pregnancy invariably affects the quality of the milk. It is a very good
+habit to accustom the child to take its daily supply of water from a bottle
+from a very early age. This procedure will make it easier to wean at any
+time.
+
+Menstruation is not an indication for weaning as has been explained. If,
+however, the return of menstruation affects the milk so that it disagrees
+with, or fails to satisfactorily nourish the child, it may be necessary to
+wean, but not unless.
+
+The best reason for weaning a child at the twelfth month is that a mother's
+milk after that time is not adequate in quality for a child of that age. A
+child at one year of age has grown beyond the capability of its mother[125]
+to nurse it: nature demands a stronger and a more substantial food than any
+mother can supply. A mother who nurses her child beyond that period is not
+only injuring herself, but she is cheating her child. The exception to this
+rule is, as has been explained, the second summer.
+
+The child will evidence its dissatisfaction with the breast supply if it is
+not enough; it will not gain in weight, it will be irritable and fretful,
+it will tug long and tenaciously at the nipple, it will be unwilling to
+cease nursing after it should have finished, and it will drop the nipple
+frequently with a dissatisfied cry. These are all signs of insufficient
+nourishment, and to the observant mother they will at once indicate that
+the child must be weaned and fed upon a mixed diet.
+
+CARE OF BREASTS WHILE WEANING CHILD.--The process of weaning should cause
+little or no discomfort. If the weaning is gradual it is necessary to press
+out enough milk to relieve the tension from time to time. It usually takes
+three or four days.
+
+If it is necessary to wean abruptly, as it is occasionally, there may be
+considerable distress. In these cases it is necessary to massage the
+breasts completely,--until all the milk is out, or as much as it is
+possible to get out,--then rub the breasts with warm camphorated oil, and
+bind them firmly. When the breasts are massaged for any reason, the rubbing
+should be toward the nipple and it should be done gently. If there are any
+hard lumps, or caked milk, in the breasts, they must be massaged until
+soft, and the binding renewed. It may be necessary to repeat this process
+for a number of days. In binding the breasts use a large wad of absorbent
+cotton at the sides, under the arms, to support the breasts, and another
+wad between the breasts. This renders the binding more effective; permits
+the binder to be put on tighter; and prevents it from cutting into the
+skin. When weaning has to be done quickly the patient should absolutely
+abstain from all liquids. A large dose of any saline, Pluto, Apenta, or
+Hunyadi Water, or Rochelle salts, or Magnesium Citrate, should be given
+every morning for four or five days. [Page 126]
+
+If the weaning is gradually undertaken the child should be allowed to nurse
+less frequently. One less nursing every second day until two nursings daily
+are given. Keep the two daily nursings up for one week and then discontinue
+them, after which the above measures may be adopted. To dry the milk up,
+the breasts may be anointed with the following mixture: Ext. Belladonna, 2
+drams; Glycerine, 2 ounces; Oil of Wintergreen, 10 drops.
+
+NERVOUS NURSING MOTHERS.--Nervousness, considered not as the product of a
+diseased condition, but as a temperamental quality, is an unfortunate
+affliction in some nursing mothers. Let us illustrate just how this
+characteristic is detrimental to the helpless baby. A mother was instructed
+to give her baby a half teaspoonful of medicine one-half hour after each
+feeding. She was told how to give it, and how to hold the baby when giving
+it. She was also told that the baby would not like it, and would try to
+eject it from its mouth rather than swallow it, and that when it did
+swallow it, it would make a little choking noise in its throat, but not to
+mind these, to go ahead and give it, as the baby could not strangle or
+choke. It was essential to give the baby this medicine, and hence the
+physician explicitly instructed her in these details. What was the result?
+On the following day when the physician called, and found the baby much
+worse, the mother said: "Oh, doctor! I couldn't give the medicine, the baby
+wouldn't take it, she nearly strangled to death when I tried to give it."
+The physician asked for the medicine and placing the baby over his knee,
+gave it without the slightest trouble, much to the mother's amazement. The
+servant girl who was a hard-headed, cool, Scotch girl, was instructed and
+shown how to give the medicine, which she did successfully. The mother was
+temperamentally nervous, was easily excited and became helpless the moment
+the baby objected, though she was a strong, robust, healthy woman.
+
+Another mother was carefully instructed to drop into the eye of her baby
+two drops of medicine every four hours. She was told and apparently
+appreciated the urgent necessity of the medication as her baby's eye  [127]
+was badly infected. She was further told that if she did exactly as shown,
+the eye would be better in two or three days, and if she did not, the other
+eye would become infected, and blindness might result. She undertook to
+carry out the directions faithfully. She absolutely failed, however, to
+carry out the instructions. Her husband informed the physician on the
+following day that she became so nervous and excited that she utterly
+failed to treat the eye once, and when he and a sister offered their
+assistance she became so unreasonable in her fear that "they might hurt the
+baby" that it was impossible to do anything with her. Her sister was
+finally shown how to do it and carried the case through quite successfully.
+
+Inasmuch as this book is intended to convey helpful instruction to every
+mother, the author would suggest to those of this type the necessity of
+resisting this tendency. It is a matter of will power, just make up your
+mind not to be silly and if you find that you cannot trust yourself to
+follow instructions, let someone else do it. When the physician tells you a
+certain thing must be done, and that no harm can result, do it, and don't
+imagine all kinds of impossible happenings.
+
+So much anguish and annoyance is caused in this world by imagining and
+anticipating trouble, that half the pleasure of life is denied us. You
+cannot do your whole duty by a helpless baby if you do not reason and act
+upon sound judgment. Many babies are lost by mothers being afraid to do
+what should be done, and what they know should be done. It is not what the
+doctor does that brings a baby through a dangerous sickness; it is the
+faithfulness of the nurse in carrying out his instructions that is
+responsible for the outcome. A timid, halting, doubting nurse can quickly
+undo all a physician hopes to accomplish; while a prompt, faithful nurse,
+with initiative, and good judgment, can save a little life in a crisis,
+even in the absence of the physician. Follow instructions implicitly, even
+though the carrying out of the instructions seem to cause the baby pain and
+suffering,--it is for the baby's best interest.
+
+                                                                      [128]
+BIRTH MARKS.--Much has been written on this subject which a later study of
+biology and eugenics have shown to be utterly false. Let us consider the
+actual facts. The baby is already a baby, floating in a fluid of its own
+manufacture. It has absolutely no connection with its mother except by
+means of its umbilical cord,--which is composed of blood vessels. The blood
+in these vessels is the child's blood and never at any time does it even
+mix with the blood of the mother. It is sent along these vessels into the
+placenta, or after-birth, in which it circulates in small thin vessels, so
+close to the mother's blood that their contents can be interchanged. Yet
+the two streams never actually mix. The carbonic acid and waste products,
+in the child's blood, are taken up by the mother's blood, and given in
+exchange oxygen and food, which is returned to nourish the child. There is
+absolutely no nervous connection between the mother and the child. How then
+is it possible for the mother to affect her child in any way except insofar
+as the quality of its nourishment is concerned? Nor can a mother affect her
+child in any other sense. If the intermingling of blood could affect a
+child's education we would frequently resort to surgery. In the article on
+Eugenics, under the heading, "Education and Eugenics," it is explained that
+the child is "created" at the moment of conception; that absolutely nothing
+can affect it after it is created; that no influence of the mother or
+father can in any way affect it for better or worse. A mother cannot create
+in her child any quality which she may desire no matter how she conducts
+herself. It was formerly thought that a mother could for example create a
+musical genius by devoting all her time to the study of music while she
+carried the unborn child; or that she could make a historian of it if she
+studied history; or an artist if she studied paintings. We now know this to
+be wholly wrong and for very excellent reasons.
+
+The mother must realize that the only aid she can bestow upon her unborn
+child is to give it the best possible nourishment. She must provide good
+blood because the quality of the maternal blood stream bespeaks a healthy
+or unhealthy, a fit or unfit, child. Whatever the child is to be is   [129]
+already fixed, its innate characteristics art part of itself. Whether it
+will have the vitality to develop its inherent possibilities depends, to a
+great degree, upon its intra-uterine environment,--and its intra-uterine
+environment depends upon the health of its mother and the quality of the
+blood she is feeding it upon. After birth its health, its success, its
+efficiency, depends upon the care it gets and the quality of its mother's
+milk. A mother therefore must be in good physical and mental health if she
+hopes to do her full duty as a mother.
+
+QUALIFICATIONS OF A NURSERY MAID.--When a helper, or maid, is employed to
+aid in caring for the baby, much precaution should be exercised in
+selecting her. The association of the nursery maid and the child, is
+necessarity an intimate one, and she should be willing to submit to a
+medical examination to prove her physical fitness. Her lungs should be
+examined thoroughly, so also should the condition of her mouth, throat and
+nose be known. An observant and tactful mother will also find out if there
+are any other objectionable conditions existing, which would render her
+unfit for the position. A nursery maid should be naturally fond of
+children, she should be industrious, and sensible; of quiet tastes and good
+disposition. Her work should be a pleasure not a task.
+
+       *       *       *       *       *
+
+
+                                                                      [131]
+CHAPTER XI
+
+CONVALESCING AFTER CONFINEMENT
+
+    THE SECOND CRITICAL PERIOD IN THE YOUNG WIFE'S LIFE--THE DOMESTIC
+    PROBLEM FOLLOWING THE FIRST CONFINEMENT.
+
+The first three or four months following the first confinement is the
+second important period in the young wife's life. In one sense it is the
+most critical period. The first important period you will remember we
+stated to be the first few months after marriage. During these months the
+young wife passed through the period of adaptation. She found out that
+matrimony was not all sunshine and happiness. She learned that her husband
+was not the paragon she had idealized. She discovered his human side. She
+met daily trials and annoyances incident to domestic life. She found her
+level, and, in finding it, she discovered herself. She is not very safely
+anchored yet but she is trying to succeed and the future promises well.
+Some day she awakes to the knowledge that she is pregnant and a multitude
+of new speculations enter into the situation. She finds she must go on
+striving and hoping and praying that she may have the strength and courage
+to do her part. Time passes, and if she is an ordinary woman she scarcely
+does justice to herself. Her duties are exacting, and her physical
+condition is not given the study and care which she ought to give it. She
+does not understand the importance of the hygiene of pregnancy, and the day
+of the confinement finds her more or less exhausted, and worn out. She
+passes through the crisis of maternity, however, and spends the customary
+ten days in bed. At the end of that period the nurse and physician leave
+her to face the most important problem of life alone. She is a mother, and
+has in her exclusive charge a human life.
+
+Let us exactly understand what the real situation is. It would not further
+the object of this book or help in the solution of the problem the author
+has in mind to depict a false situation. We must concede the following[132]
+facts to be true, if we understand the subject:
+
+1. That the mothers of the human race are, in the vast majority, the poor.
+
+2. That they are uneducated in the sense that they are not versed in the
+science of hygiene and sanitation, and consequently health preservation.
+
+3. That even the fairly well educated are innocently ignorant of the
+science of heredity, environment, hygiene, sanitation and health
+preservation.
+
+4. That to benefit the majority we must depict conditions as they exist
+among the poor, and reason from that standard.
+
+Such books as have been written on this subject have based their facts upon
+too high a plane. Their remedies are beyond the means and the understanding
+of the average poor mother. Their analogies are based upon conditions that
+exist among the better class. The average poor housewife gets no practical
+assistance or help from their deductions, because her environment precludes
+any utilization of the data furnished; the data is not practical in her
+particular case.
+
+Our young mother is in all probability a physically and mentally immature
+girl. She most likely entered the marriage relationship without a real
+understanding of its true meaning, or even a serious thought regarding its
+duties or its responsibilities. She was not taught the true meaning of
+motherhood before actual maternity was thrust upon her. She has probably
+innocently acquired habits which are detrimental to her health and her
+morals; and she has no conception of the fundamental duties of a homemaker.
+Yet into the keeping of this woman a human life has been given.
+
+Her home surroundings are not such as to inspire confidence or from which
+to elicit encouragement. It has been a struggle to make ends meet; to keep
+the peace; to be hopeful and cheerful. If she has succeeded in keeping her
+home neat and clean and comfortable, it has been at the expense of her not
+too robust constitution. If she has made efforts to observe the amenities
+of life, to be true as wife, companion and confidant, it has taxed her[133]
+nerves, her courage and her vitality. She has frequently been at the
+breaking point but she has kept up because she felt it was her duty, and
+because there was nothing else to do.
+
+As she rests from her weary labor during the first long days after getting
+out of bed, the loneliness of it all crushes her. She is weak, nervous, and
+discouraged, and her white, wan face, with its tired, appealing eyes,
+bespeaks her anemic and hopeless condition. She is only a child herself,
+yet fate has crowned her with the holy diadem of motherhood. There are
+thousands of such mothers and yet posterity need not despair. This is just
+the beginning, and from such beginnings have sprung the heroes of the race.
+If the reader has carefully read the chapter on Heredity she will
+understand that the temporary condition of this mother is not important so
+far as the destiny of the child is concerned. The really important question
+is, How will this mother develop? The environment of the child depends upon
+the conditions with which its mother surrounds it. If she is a failure, the
+child's environmental influences will be unfavorable; if she proves worthy
+of her trust, if she progresses and masters her difficulties; if she is a
+good mother and a good homemaker the child's surroundings and influences
+will be favorable to the full development of its hereditary endowment. But
+it must be remembered that even an unfavorable environment need not prevent
+the hereditary promise from dominating the life of the individual.
+
+To return to our girl mother, upon whose slender shoulders the weight of a
+great responsibility rests,--we wish to concede that her burden is great.
+Her home duties are rendered more onerous because of her physical weakness
+and disability. The strain of nursing her fretful child is taxing her
+vitality and her nerves to the limit. Her disposition is imposed upon by
+the exactions of an uncomprehending husband. She is inclined to fretfulness
+and melancholia by the seeming uncharitableness of fate and fortune. Her
+moments of introspection are almost bitter. It is a critical period,--she
+has reached the breaking point. [Page 134]
+
+Such moments are apt to be epochal. The turning of the wheel of fortune
+will decide the destiny of a human soul.
+
+It may be a friend who will supply the needed inspiration that will
+revitalize hope, and courage, and the determination to succeed. Or it may
+be a prayer, breathed in the silence of despair that will inspire the
+courage to fight on, and change the complexion of life.
+
+Once again we would advise such a young wife to calmly think matters over;
+to find out "what she is working for"; to assemble her ideals and to "know
+what she wants." There is nothing organically wrong. It is a condition, not
+a disease. She is discouraged, despondent, nervous and weak. The
+discouragement, despondency, and nervousness is a result of reduced
+physical vitality and lack of system. She is not efficient because she is
+not a trained worker. She is easily discouraged because anemia or
+bloodlessness fails to supply the oxygen necessary to a fight. There is no
+period in a woman's life when she is more apt to fall into a rut than at
+this time. Every element, spiritual and physical, which is necessary to
+stagnation and indifference is present, and it will take a bold and brave
+effort to resist the temptation to failure which has encompassed her.
+
+How can we suggest a remedy? She must first regain her health. She has
+simply a condition to combat, not a disease, and a definite system, a well
+laid out plan strictly adhered to will effect the result. She must regain
+her health, because, without health, she cannot hope to be efficient in
+work or agreeable in disposition, and she owes both to herself, to her
+husband and to her child. She must get out of doors. She must walk in the
+open air. There is absolutely nothing in life that will effect so
+miraculous a transformation in a discouraged, tired, weary and sick woman,
+as systematic daily walks in the open air. She must walk briskly, however,
+and she must desire to get well. We cannot get well if we do not wish to
+get well. One who walks with a purpose will walk erect, firmly and briskly;
+she will hold her chest up, and will breathe deeply, and she will drink in
+hope, and health, and happiness. It takes time to regain strength     [135]
+after the strain of pregnancy and labor. Many women complain that they feel
+weak and do not regain strength quickly, but they make no effort. They must
+make a beginning. Sitting around waiting for it to come will not bring it.
+If they cannot walk a mile, they must walk half that distance to begin
+with; the five mile walk will follow in time. Many young mothers get into
+the habit of taking baby out in his carriage for an airing, and regard this
+as exercise for themselves. They join the baby brigade and parade up and
+down the block, or select a sunny spot where there are others on a like
+quest, and sit around exchanging confidences. These outings usually
+degenerate into gossiping parties and are a dangerous and questionable
+practice. They are no doubt good for the baby, but they are morally and
+physically bad for the young mother. This daily habit is called exercise,
+but it is in no sense physical exercise. The young mother should select a
+certain time each day, immediately after a nursing when baby is likely to
+sleep, and devote this period to walking. One hour each day will accomplish
+much in regaining and establishing health and strength, and appetite for
+the mother. No indoor work can take the place of a walk out of doors. It is
+a duty on the part of the nursing mother to do this. It will enable her to
+supply better milk; it will banish her tendency to nervousness; it will
+ensure a good appetite, good spirits, and sound sleep. It will make her a
+better mother and a better wife. Many young wives sow the first seeds of
+discontent, and ultimate failure during the natural depression that follows
+maternity.
+
+She must adopt system in the performance of her household duties. A good
+plan is to set aside a certain definite time for meals, when to begin
+cooking and when to end washing the dishes. Then arrange regarding the
+general household duties. Make a schedule for a week devoting each day to a
+certain task so that at the end of the week all the essential work will
+have been completed. By systematizing work in this way a great deal of
+ground can be covered and as time passes it will become easier, as many
+helpful ways will suggest themselves whereby time will be economized. [136]
+
+Adopt a system with the baby. Many mothers are worn-out, nervous wrecks for
+no other reason than a lack of system in the management of the daily life
+of their offspring. If system is not adopted in feeding and caring for an
+infant it becomes irritable. To a sick, tired, weary mother an irritable
+child is an unspeakable torture. Begin right. Give it adequate, but no
+unnecessary attention. Nurse it every two hours, and at no other time. Wake
+it to nurse at its regular time. It will in a few days acquire the habit of
+feeding regularly and will sleep between feedings. Do not overfeed it.
+Remember babies never die from starvation, but many do by overkindness, and
+overfeeding is the most prolific cause of infant mortality known. Read the
+article on "How long should a baby nurse?" Keep the baby clean, comfortable
+and happy and you will not have a fretful child, but one that will be a
+constant inspiration and incentive to you.
+
+Find time to rest, take a mid-day nap. Get off occasionally to the country
+or the sea shore for a day or two. Keep up your interest in your personal
+appearance, be neat and clean, and invite the attention of your husband
+during the evening hour. Don't let him grow away from you. Be cheerful,
+encourage him to tell of his hopes and plans, and show an interest in his
+health and in his work. Do not forget the dominating influence on your
+efficiency, and on your happiness which the study habit possesses. Interest
+yourself in some art, cultivate your mind, and soon, sooner than you think,
+you will have forgotten your troubles and you will have regained your
+health.
+
+There is no other way to do it. There is no royal way in which it can be
+done which is not open to the poorest mother.
+
+An ocean voyage, a trip to Europe, a society Doctor, a professional
+masseur, beauty experts and miracle workers cannot accomplish more than you
+can in your poor apartment, if you "go about it in the right way and in the
+right spirit." Keep in mind always, that: "failure exists only in
+acknowledging it." Every task that is worth while is won by self-sacrifice,
+by self-abnegation, by patient, persistent, enthusiastic effort, and in no
+other way. The joy of consummation is reward enough for all human
+sacrifice.
+
+       *       *       *       *       *
+
+
+Corrections made to printed original.
+
+Index: Constipation, in breast-fed infants: 'in-infants' (line-break) in
+original
+
+Ibid.: Gleet; Mucous patches; Pox; Vol II: Vol I. in original
+
+Ibid.: Sanitary napkins; I, 66: I, 63 in original
+
+Ibid.: Sexual intercourse; I, 76: I, 78 in original
+
+Page 23: whether there is such a thing: 'think' (hand-corrected) in
+original
+
+Page 40: recruiting ground for the gangster: 'ganster' in original
+
+Page 65: incident to a confinement: 'confiement' in original
+
+Ibid.: The advantage of the Kelly pad: 'paid' in original
+
+Page 89: the patient should pass: 'pateint' in original
+
+Page 93: Advantages of Putting Baby to Breast: 'Adantages' in original
+
+Page 127: anguish and annoyance: 'anoyance' in original
+
+
+
+
+
+
+End of the Project Gutenberg EBook of The Eugenic Marriage, Volume I. (of
+IV.), by W. Grant Hague, M.D.
+
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+<pre>
+
+The Project Gutenberg EBook of The Eugenic Marriage, Volume I. (of IV.), by 
+W. Grant Hague, M.D.
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: The Eugenic Marriage, Volume I. (of IV.)
+       A Personal Guide to the New Science of Better Living and Better Babies
+
+Author: W. Grant Hague, M.D.
+
+Release Date: October 21, 2006 [EBook #19594]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK EUGENIC MARRIAGE ***
+
+
+
+
+Produced by K.D. Thornton, Jason Isbell, Keith Edkins and
+the Online Distributed Proofreading Team at
+http://www.pgdp.net
+
+
+
+
+
+
+</pre>
+
+<table border="0" cellpadding="10" style="background-color: #ccccff;">
+  <tr>
+    <td width="25%" valign="top">
+      Transcriber's note:
+    </td>
+    <td>
+        A few typographical errors have been corrected. They
+        appear in the text <ins class="correction"
+             title="explanation will pop up">like this</ins>, and the
+        explanation will appear when the mouse pointer is moved over the marked
+        passage.
+    </td>
+  </tr>
+</table>
+  <div class="figcenter" style="width:50%;">
+      <a href="images/v1frontis.jpg"><img width="100%" src="images/v1frontis.jpg"
+      alt="Eugenics Hath Its Own Reward" /></a>
+    <h4>Eugenics Hath Its Own Reward</h4>
+  </div>
+<h1>The Eugenic Marriage</h1>
+
+<h2>A Personal Guide to the<br />
+New Science of Better<br />
+Living and Better Babies</h2>
+
+<h3>By W. GRANT HAGUE, M.D.</h3>
+
+<h4>College of Physicians and Surgeons (Columbia
+University), New York; Member of County Medical
+Society, and of the American Medical Association</h4>
+
+<h2>In Four Volumes</h2>
+
+<h2>VOLUME I</h2>
+
+<h4>New York</h4>
+
+<h3>THE REVIEW OF REVIEWS COMPANY</h3>
+
+<h4>1916</h4>
+
+<p class="center" style="margin-top: 2em;">Copyright, 1913, by <font class="sc">W. Grant Hague</font></p>
+
+<p class="center" style="margin-top: 2em;">Copyright, 1914, by <font class="sc">W. Grant Hague</font></p>
+
+  <br clear="all" />
+<hr class="full" />
+
+<p><!-- Page i --><span class="pagenum"><a name="pagei"></a>[i]</span></p>
+
+<h3>INDEX OF THE FOUR VOLUMES</h3>
+
+<font class="sc">Note</font>&mdash;The Roman numerals I, II, III and IV indicate the
+volume; the Arabic figures 1, 2, 3, etc., indicate the page number.
+
+  <p>Accidents and emergencies, IV, 629.</p>
+
+  <p>Accouchement Beds, how to prepare, I, <a href="#page65">65</a>.</p>
+
+  <p>Acne, IV, 576.</p>
+
+  <p>Adenoids, IV, 519; how to tell when child has, IV, 520; treatment of,
+  IV, 521.</p>
+
+  <p>Adentitis, acute, IV, 558; causes of, IV, 558; symptoms of, IV, 558;
+  treatment of, IV, 558.</p>
+
+  <p>Advice to young wives, III, 357.</p>
+
+  <p>After-birth, expulsion of, I, <a href="#page101">101</a>.</p>
+
+  <p>After-pains, I, <a href="#page103">103</a>.</p>
+
+  <p>Age at which to marry, III, 331.</p>
+
+  <p>Albumen water, II, 245.</p>
+
+  <p>Alcohol, in patent medicines, III, 455.</p>
+
+  <p>Alcoholic drunkenness, I, <a href="#page44">44</a>; Dr. Branthwaite
+  on, I, <a href="#page45">45</a>; Dr. Sullivan on, I, <a
+  href="#page44">44</a>.</p>
+
+  <p>Amenorrhea, causes, II, 192; absence of menstruation, II, 191;
+  treatment of, II, 192.</p>
+
+  <p>Anemia, severe, IV, 567; simple, IV, 565; treatment of various forms,
+  IV, 567.</p>
+
+  <p>Anesthetics, new, IV, 654; use of in confinements, I, <a
+  href="#page112">112</a>.</p>
+
+  <p>Angina, IV, 508.</p>
+
+  <p>Anti-meningitis, serum, IV, 656.</p>
+
+  <p>Aperient waters, abuse of in constipation, III, 326.</p>
+
+  <p>Appendicitis, IV, 546; treatment of, IV, 546.</p>
+
+  <p>Appetite, loss of, II, 287; poor, II, 286; treatment for loss of, II,
+  288.</p>
+
+  <p>Arrest of hemorrhage, IV, 635.</p>
+
+  <p>Artificial Food, II, 249; formulæ for, II, 253; mistakes in preparing,
+  II, 267.</p>
+
+  <p>Aseptic surgery, IV, 653.</p>
+
+  <p>Baby, amusing the, II, 217; bathing the, II, 213; care of eyes, II,
+  215; care of genital organs, II, 216; care of mouth and teeth, II, 215;
+  care of newly-born, II, 210; care of skin, II, 216; clothing of, II, 214;
+  constipation in bottle-fed, II, 309; food for first year, II, 261; fresh
+  air for, II, 232; how it gets nourishment in womb, II, 183; how long it
+  should sleep, II, 236; how to weigh, II, 220; hygiene and development of,
+  II, 209; intervals of feeding, II, 225; night-clothes of, II, 215;
+  overfeeding the, II, 224; proper way to lay in bed, II, 235; what to
+  prepare for the coming, II, 209; why it cries, II, 237.</p>
+
+  <p>Baby's comforter, II, 241.</p>
+
+  <p>Bacteria, what happens if we inhale, III, 410.</p>
+
+  <p>Barley gruel, II, 244.</p>
+
+  <p>Barley water, II, 244, 256.</p>
+
+<p><!-- Page ii --><span class="pagenum"><a name="pageii"></a>[ii]</span></p>
+
+  <p>Bath, bran, IV, 591; cold, for reducing fever, IV, 590; cold sponge or
+  shower, IV, 592; during pregnancy, I, <a href="#page76">76</a>; hot air
+  or vapor, IV, 591; hot, IV, 591; mustard, IV, 590; tepid, IV, 592;
+  various kinds of, IV, 590.</p>
+
+  <p>Bathing, the baby, II, 213.</p>
+
+  <p>Bed, proper way to lay baby in, II, 235.</p>
+
+  <p>Bed-wetting, IV, 580.</p>
+
+  <p>Beef juice, II, 262.</p>
+
+  <p>Beef or meat pulp, II, 244.</p>
+
+  <p>Bichloride of mercury solution, IV, 627.</p>
+
+  <p>Binder, how to apply, I, <a href="#page66">66</a>.</p>
+
+  <p>Birth, management of, I, <a href="#page99">99</a>.</p>
+
+  <p>Birth-chamber, the, I, <a href="#page61">61</a>.</p>
+
+  <p>Birth marks, I, <a href="#page128">128</a>.</p>
+
+  <p>Bites, dog, IV, 638.</p>
+
+  <p>Blackheads, IV, 576.</p>
+
+  <p>Blood, children suffering from poor, IV, 566; poor, IV, 565.</p>
+
+  <p>Boils, IV, 559.</p>
+
+  <p>Boracic Acid, solution of, IV, 626.</p>
+
+  <p>Bottle-feeding, method of, II, 256; what a mother should know about,
+  II, 264.</p>
+
+  <p>Bowels, daily movement necessary, II, 307; how to wash out, IV, 586;
+  importance of clean, II, 306.</p>
+
+  <p>Boy, building of, II, 139; chancre, the, II, 145; gonorrhea or "clap,"
+  II, 142; sex-hygiene for, II, 139; social evil, II, 141; sources of
+  immorality, II, 141; syphilis or "pox," II, 144.</p>
+
+  <p>Brain, complications of in syphilis, II, 146.</p>
+
+  <p>Bran, as a food, II, 292; bath, IV, 591; muffins, recipe for, II,
+  311.</p>
+
+  <p>Branthwaite, Dr., on alcoholic drunkenness, I, <a
+  href="#page45">45</a>.</p>
+
+  <p>Bread, II, 273.</p>
+
+  <p>Breasts, care of when weaning, I, <a href="#page125">125</a>;
+  colostrum in, I, <a href="#page108">108</a>; how long should baby stay
+  at, II, 225; putting baby to after labor, I, <a
+  href="#page108">108</a>.</p>
+
+  <p>Bronchitis, IV, 511; chronic, IV, 515; diet for, IV, 513; drugs in,
+  IV, 514; external applications for, IV, 514; inhalations for, IV, 513; in
+  older children, IV, 512; symptoms of in infants, IV, 512; treatment of
+  IV, 512.</p>
+
+  <p>Broncho-Pneumonia, acute, IV, 516; symptoms of, IV, 516; how to tell
+  when child has, IV, 517; treatment of child with, IV, 517.</p>
+
+  <p>Bruise, or contusion, IV, 633.</p>
+
+  <p>Burbank, Luther, on education, I, <a href="#page24">24</a>.</p>
+
+  <p>Burning Clothing, how to extinguish, IV, 641.</p>
+
+  <p>Burns, and scalds, IV, 641.</p>
+
+  <p>Calomel, II, 297; how to take, II, 297.</p>
+
+  <p>Cancer, in women, III, 442; what every woman should know about, III,
+  442.</p>
+
+  <p>Carron oil, solution of, IV, 627.</p>
+
+  <p>Castor oil, II, 295; how to give dose of, II, 296.</p>
+
+  <p>Catarrh, acute nasal, IV, 500; symptoms of, IV, 500.</p>
+
+  <p>Catarrh powders, III, 458.</p>
+
+  <p>Cathartics, calomel, II, 295; castor oil, II, 295; citrate of
+  magnesia, II, 298; how to give children, II, 295.</p>
+
+  <p>Cereals, II, 273.</p>
+
+  <p>Chancre, the, II, 145.</p>
+
+  <p>Change of life, conduct during, III, 446; the menopause, III, 443;
+  symptoms of, III, 444.</p>
+
+  <p>Cheerful wife and mother, III, 400.</p>
+
+  <p>Chicken broth, II, 244.</p>
+
+<p><!-- Page iii --><span class="pagenum"><a name="pageiii"></a>[iii]</span></p>
+
+  <p>Chicken-pox, IV, 606; symptoms of, IV, 607.</p>
+
+  <p>Child, the delicate, II, 281; diet of sick, II, 279; most helpless
+  living thing, II, 279; rate of growth of, II, 221; sick, should be in
+  bed, II, 277; washing mouth and eyes after birth, I, <a
+  href="#page102">102</a>.</p>
+
+  <p>Child-Birth, I, <a href="#page61">61</a>; fear of, I, <a
+  href="#page111">111</a>.</p>
+
+  <p>Children, acute intestinal diseases of, IV, 529; constipation in, II,
+  303; hysterical, II, 293; rheumatism in, IV, 569; temperature in, II,
+  217; with whom milk does not agree, IV, 535.</p>
+
+  <p>Cholera infantum, IV, 540.</p>
+
+  <p>Chlorosis, IV, 566; symptoms of, IV, 566.</p>
+
+  <p>Chronic Nasal catarrh, IV, 503; treatment of, IV, 504.</p>
+
+  <p>Circumcision, should it be advised, II, 169.</p>
+
+  <p>Citrate of magnesia, II, 295; how to take, II, 298.</p>
+
+  <p>Clap, or gonorrhea, II, 142.</p>
+
+  <p>Clothing, baby's, II, 214.</p>
+
+  <p>Coddled egg, II, 245.</p>
+
+  <p>Cold-pack, IV, 589.</p>
+
+  <p>Colds, catching, IV, 497.</p>
+
+  <p>Colic, IV, 544; symptoms of, IV, 545; treatment of, IV, 545.</p>
+
+  <p>Colitis, chronic, IV, 538.</p>
+
+  <p>Colon, irrigation of, IV, 587.</p>
+
+  <p>Colostrum, uses of, I, <a href="#page108">108</a>.</p>
+
+  <p>Condensed milk feeding, II, 227; objections to, II, 257.</p>
+
+  <p>Confinement, choice of physician, I, <a href="#page69">69</a>;
+  convalescing after, I, <a href="#page131">131</a>; domestic problem
+  following first, I, <a href="#page131">131</a>; how to calculate date of,
+  I, <a href="#page66">66</a>; how to prepare bed for, I, <a
+  href="#page65">65</a>; lacerations during, I, <a href="#page116">116</a>;
+  how long woman should stay in bed after, I, <a href="#page114">114</a>;
+  position and arrangement of bed for, I, <a href="#page64">64</a>;
+  preparations for, I, <a href="#page61">61</a>; selection of a nurse, I,
+  <a href="#page70">70</a>; use of anesthetics in, I, <a
+  href="#page112">112</a>; what to provide for, I, <a
+  href="#page62">62</a>.</p>
+
+  <p>Confinement chamber, presence of friends in, I, <a
+  href="#page113">113</a>; presence of relatives in, I, <a
+  href="#page113">113</a>.</p>
+
+  <p>Constipation, II, 315; abuse of cathartics and aperient waters, II,
+  326; always harmful, II, 321; chief cause of, II, 315; cost of, II, 317;
+  diseases of women and, II, 320; during pregnancy, I, <a
+  href="#page84">84</a>; in bottle-fed infants, II, 309; in breast-fed <ins
+  class="correction" title="'in-infants' (line-break) in original"
+  >infants</ins>, II, 308; in girls between 16 and 20, II, 321; in children
+  over two years old, II, 309; in infants and children, II, 303; lack of
+  bulk in food, II, 326; lack of exercise and, II, 325; lack of water, II,
+  325; negligence of, II, 324; pregnancy and, II, 321; significance of, II,
+  305; social exigencies and, II, 319; treatment of, II, 323; treatment of
+  obstinate, II, 311.</p>
+
+  <p>Consumption cure, III, 461.</p>
+
+  <p>Consumptives, information for and those living with, III, 421.</p>
+
+  <p>Contagious diseases, IV, 599; conduct and dress of nurse for, IV, 600;
+  convalescence after, IV, 603; rules to be observed in treatment, IV, 599;
+  what isolation means, IV, 600.</p>
+
+  <p>Contusion, or bruise, IV, 633.</p>
+
+  <p>Convulsions, IV, 577; treatment of child with, IV, 579.</p>
+
+  <p>Cord, cutting, the, I, <a href="#page102">102</a>; dressing the, II,
+  210.</p>
+
+  <p>Cough, treatment of, IV, 505; nervous or persistent, IV, 504.</p>
+
+<p><!-- Page iv --><span class="pagenum"><a name="pageiv"></a>[iv]</span></p>
+
+  <p>Cream, for constipation in infants, II, 309.</p>
+
+  <p>Croup, false, IV, 506; treatment of false, IV, 507; spasmodic, IV,
+  507; treatment of spasmodic, IV, 507.</p>
+
+  <p>Deaf and dumb, I, <a href="#page37">37</a>.</p>
+
+  <p>Detention, symptoms of, II, 219; treatment of, II, 219.</p>
+
+  <p>Desserts, II, 273.</p>
+
+  <p>Diarrh&#339;a, inflammatory, IV, 535; summer, IV, 539; symptoms of
+  summer, IV, 540; treatment of inflammatory, IV, 537; treatment of summer,
+  IV, 541.</p>
+
+  <p>Diet, of nursing mother, I, <a href="#page121">121</a>; of the
+  pregnant woman, I, <a href="#page77">77</a>; of sick child, II, 279; for
+  constipated child, II, 310; older children, II, 271.</p>
+
+  <p>Dinner, the first after labor, I, <a href="#page109">109</a>.</p>
+
+  <p>Diphtheria, IV, 610; symptoms of, IV, 611; treatment of, IV, 613.</p>
+
+  <p>Disease, how we catch, III, 409; tendency to, III, 416; vice and, I,
+  <a href="#page4">4</a>; of womb, ovaries or fallopian tubes, II, 199.</p>
+
+  <p>Disinfecting, Clothing and linen, IV, 601; mouth and nose, IV, 602;
+  sick chamber, IV, 604.</p>
+
+  <p>Dislocations, IV, 640.</p>
+
+  <p>Dog-bites, IV, 638.</p>
+
+  <p>Douche, how to give after labor, I, <a href="#page108">108</a>; the
+  use of when pregnant, I, <a href="#page76">76</a>.</p>
+
+  <p>Draw-sheet, the, I, <a href="#page65">65</a>.</p>
+
+  <p>Dried bread, II, 245.</p>
+
+  <p>Dusting and cleaning, II, 391.</p>
+
+  <p>Dysentery, cause of, IV, 535; symptoms of, IV, 536.</p>
+
+  <p>Dysmenorrhea, II, 193.</p>
+
+  <p>Ear, foreign bodies in, IV, 631; inflammation of, IV, 556; method of
+  removing foreign bodies, IV, 632; treatment of inflammation, IV, 556.</p>
+
+  <p>Earache, IV, 555.</p>
+
+  <p>Ears, do not box, IV, 554; do not pick, IV, 554; let them alone, IV,
+  554.</p>
+
+  <p>Eczema, IV, 562; of the face, IV, 563; rubrum, IV, 563.</p>
+
+  <p>Education, and the educator, I, <a href="#page29">29</a>; eugenics
+  and, I, <a href="#page4">4</a>; Dr. C. W. Saleeby on, I, <a
+  href="#page22">22</a>; Dr. Helen C. Putnam on, I, <a
+  href="#page27">27</a>; Havelock Ellis on, I, <a href="#page33">33</a>;
+  Herbert Spencer on, I, <a href="#page35">35</a>; Luther Burbank on, I, <a
+  href="#page24">24</a>; Wm. D. Lewis on, I, <a href="#page25">25</a>; true
+  province of, I, <a href="#page35">35</a>; what place sex hygiene will
+  find in, II, 162; Ella Wheeler Wilcox on, I, <a
+  href="#page22">22</a>.</p>
+
+  <p>Educational systems, difficulty in devising, I, <a
+  href="#page27">27</a>; inadequate, I, <a href="#page22">22</a>.</p>
+
+  <p>Efficiency, requisites of, III, 346.</p>
+
+  <p>Egg, coddled, II, 245; white of, II, 262.</p>
+
+  <p>Ellis, Havelock, on Education, I, <a href="#page33">33</a>.</p>
+
+  <p>Emergencies and accidents, IV, 629.</p>
+
+  <p>Enema, High, IV, 588; hot, 586.</p>
+
+  <p>Enteritis, cause of, IV, 535; symptoms of, IV, 536.</p>
+
+  <p>Entero-colitis, IV, 535.</p>
+
+  <p>Enuresis, IV, 580.</p>
+
+  <p>Environment, I, <a href="#page3">3</a>.</p>
+
+  <p>Eruptions of the skin, II, 145.</p>
+
+  <p>Establishing toilet habits, II, 240.</p>
+
+  <p>Eugenic clubs, mother's, I, <a href="#page54">54</a>.</p>
+
+  <p>Eugenic idea, the, I, <a href="#page9">9</a>.</p>
+
+  <p>Eugenic principle, I, <a href="#page10">10</a>.</p>
+
+  <p>Eugenics, I, <a href="#page12">12</a>; definition of, I, <a
+  href="#page12">12</a>; education and, I, <a href="#page21">21</a>; and
+  history, I, <a href="#page5">5</a>; husband and, I, <a
+  href="#page19">19</a>; <!-- Page v --><span class="pagenum"><a
+  name="pagev"></a>[v]</span> marriage and, I, <a href="#page11">11</a>;
+  motherhood and, I, <a href="#page16">16</a>; parenthood and, I, <a
+  href="#page15">15</a>; the unfit and, I, <a href="#page37">37</a>; what
+  every mother should know about, I, <a href="#page47">47</a>.</p>
+
+  <p>Exercise enough for husband, III, 347; lack of and constipation, III,
+  347.</p>
+
+  <p>Eye, foreign bodies in, IV, 630; method of removing foreign bodies
+  from, IV, 631.</p>
+
+  <p>Fake medical treatment, for venereal diseases, II, 167.</p>
+
+  <p>Father and the boy, II, 163.</p>
+
+  <p>Fault-finding, III, 350.</p>
+
+  <p>Feeble-minded, the, I, <a href="#page37">37</a>; Dr. John Punton on,
+  I, <a href="#page42">42</a>; Dr. Max Schlapp on, I, <a
+  href="#page39">39</a>; segregation and treatment of, I, <a
+  href="#page42">42</a>.</p>
+
+  <p>Feeding, artificial, II, 249; artificial from birth to twelfth month,
+  II, 254; the delicate child condition which will justify artificial, II,
+  266; during second year formulæ for artificial, II, 253; how to prepare
+  milk mixtures, II, 259; intervals of, II, 225; overfeeding, II, 223;
+  regularity of, II, 227; what a mother should know about, II, 264; why
+  regularity is important, II, 228.</p>
+
+  <p>Felon, run-around, or whitlow, IV, 640; treatment of, IV, 641.</p>
+
+  <p>Female, beginning of, disease, III, 434; chief cause of diseases, III,
+  436; diseases are avoidable, III, 439; generative organs, II, 178;
+  weakness cures, III, 470; what woman with disease should do, III,
+  441.</p>
+
+  <p>Fermentation, of the stomach, II, 304.</p>
+
+  <p>Fertility, conditions which affect women, II, 196.</p>
+
+  <p>Fever, cold packs for, IV, 589; cold sponging for reducing, IV, 589;
+  ice cap for reducing, IV, 589; methods of reducing, IV, 589.</p>
+
+  <p>Finger, biting the nails, IV, 585.</p>
+
+  <p>Fit, the, only shall be born, I, <a href="#page10">10</a>.</p>
+
+  <p>Fits, IV, 577.</p>
+
+  <p>Fly, dangerous house, IV, 645; to kill, IV, 648.</p>
+
+  <p>Fomentations, hot, IV, 593.</p>
+
+  <p>Food, allowable during first year, II, 261; bran as a, II, 292;
+  formulæ for baby, II, 243.</p>
+
+  <p>Foodstuffs, IV, 647.</p>
+
+  <p>Foreign bodies, in nose, IV, 632; in throat, IV, 633.</p>
+
+  <p>Formative period, the, III, 339.</p>
+
+  <p>Fraudulent testimonials, III, 467.</p>
+
+  <p>Friends, choosing your, III, 367; your husband's, III, 363.</p>
+
+  <p>Fruits, II, 273.</p>
+
+  <p>Garbage, IV, 647.</p>
+
+  <p>Gastric indigestion, acute, IV, 527; treatment of, IV, 527.</p>
+
+  <p>Gastro duodenitis, IV, 547.</p>
+
+  <p>Generative organs, female, II, 178.</p>
+
+  <p>Genital organs, care of, II, 26.</p>
+
+  <p>Girl, what a mother should tell her little, II, 173.</p>
+
+  <p>Glands, swollen, IV, 558; treatment of swollen, IV, 558.</p>
+
+  <p>Gleet, <ins class="correction" title="'I, 143' in original">II,
+  143</ins></p>
+
+  <p>Gonorrhea, symptoms of in a man, II, 142; wife infected with, II,
+  147.</p>
+
+  <p>Good health, requirements of, II, 316.</p>
+
+  <p>Government investigation of patent medicines, IV, 486.</p>
+
+<p><!-- Page vi --><span class="pagenum"><a name="pagevi"></a>[vi]</span></p>
+
+  <p>Habits, of delicate child, II, 285.</p>
+
+  <p>Hair, falls out in syphilis, II, 146.</p>
+
+  <p>Headache, IV, 585; during pregnancy, I, <a href="#page83">83</a>;
+  remedies, III, 457; treatment of, IV, 585.</p>
+
+  <p>Heartburn, during pregnancy, I, <a href="#page84">84</a>.</p>
+
+  <p>Hemorrhage, arrest of, IV, 635; nasal, IV, 522.</p>
+
+  <p>Heredity, I, <a href="#page3">3</a>; and eugenics, I, <a
+  href="#page16">16</a>; function of education, I, <a
+  href="#page32">32</a>.</p>
+
+  <p>Hiccough, IV, 523.</p>
+
+  <p>High School, system fallacious, I, <a href="#page29">29</a>.</p>
+
+  <p>Hives, IV, 559; cause of, IV, 559; treatment of, IV, 559.</p>
+
+  <p>Home, good housekeeper, III, 389; owning a, III, 400; the ideal, III,
+  393; what makes the, III, 394.</p>
+
+  <p>Honeymoon, the, III, 335; marital relations during, III, 336.</p>
+
+  <p>Hot pack, IV, 589.</p>
+
+  <p>Housefly, dangerous, IV, 645.</p>
+
+  <p>Housekeeper, what constitutes an efficient, III, 390.</p>
+
+  <p>Husband, and home, III, 404; is he to blame, II, 151; the, and
+  eugenics, I, <a href="#page19">19</a>.</p>
+
+  <p>Hysterics, and children, II, 293; treatment of, II, 294.</p>
+
+  <p>Ice-cap, for reducing fever, IV, 589.</p>
+
+  <p>Ileo-colitis, chronic, IV, 538; treatment of, IV, 539.</p>
+
+  <p>Imperial Granum, II, 245.</p>
+
+  <p>Incontinence, IV, 580.</p>
+
+  <p>Indigestion, acute gastric, IV, 527; acute intestinal, IV, 532;
+  symptoms of acute intestinal, IV, 532; treatment of acute gastric, IV,
+  527; treatment of acute intestinal, IV, 533.</p>
+
+  <p>Infants, constipation in bottle-fed, II, 309; jaundice in, IV, 547;
+  mortality of, I, <a href="#page2">2</a>; records of, II, 222.</p>
+
+  <p>Infection, direct, IV, 499.</p>
+
+  <p>Infectious diseases, IV, 599.</p>
+
+  <p>Inflammatory diarrhea, IV, 535.</p>
+
+  <p>Influenza, IV, 608; symptoms of, IV, 608; treatment of, IV, 609.</p>
+
+  <p>Injections, oil, II, 312.</p>
+
+  <p>Insane, care of, I, <a href="#page43">43</a>.</p>
+
+  <p>Insomnia, during pregnancy, I, <a href="#page86">86</a>.</p>
+
+  <p>Interior organs, complications of in syphilis, II, 146.</p>
+
+  <p>Intermittent fever, IV, 571.</p>
+
+  <p>Intestinal diseases of children, IV, 529.</p>
+
+  <p>Intestinal Indigestion, acute, IV, 532; symptoms of acute, IV, 532;
+  treatment of, IV, 533.</p>
+
+  <p>Intestinal worms, IV, 548.</p>
+
+  <p>Jaundice, catarrhal, IV, 547; in infants, IV, 546; in older children,
+  IV, 547.</p>
+
+  <p>Junket, II, 244.</p>
+
+  <p>Kelly pad, the, I, <a href="#page65">65</a>.</p>
+
+  <p>Knowledge, two ways of gaining, III, 377.</p>
+
+  <p>Labor, after-pains, I, <a href="#page103">103</a>; beginning of, I, <a
+  href="#page95">95</a>; clothing during, I, <a href="#page95">95</a>;
+  conduct during second stage of, I, <a href="#page96">96</a>; conduct
+  immediately following, I, <a href="#page103">103</a>; douching after, I,
+  <a href="#page107">107</a>; first breakfast after, I, <a
+  href="#page105">105</a>; first dinner after, I, <a
+  href="#page109">109</a>; first lunch after, I, <a
+  href="#page109">109</a>; first stage of, I, <a href="#page96">96</a>;
+  importance of emptying bladder after, I, <a href="#page106">106</a>; the
+  Lochia, or discharge after, I, <a href="#page104">104</a>; management of,
+  I, <a href="#page93">93</a>; putting baby to breast after, I, <a
+  href="#page108">108</a>; second stage of, I, <a
+  href="#page96">96</a>.</p>
+
+  <p>Lacerations during confinement, I, <a href="#page116">116</a>.</p>
+
+<p><!-- Page vii --><span class="pagenum"><a name="pagevii"></a>[vii]</span></p>
+
+  <p>La Grippe, IV, 608; treatment of, IV, 609.</p>
+
+  <p>Laryngitis, acute catarrhal, IV, 506; treatment of, IV, 507.</p>
+
+  <p>Leucorrhea, cause of sterility, II, 201; in girls, II, 190.</p>
+
+  <p>Lewis, Wm. D., on education, I, <a href="#page25">25</a>.</p>
+
+  <p>Life and insurance, III, 400.</p>
+
+  <p>Lithia water, III, 458.</p>
+
+  <p>Lochia, or discharge after labor, I, <a href="#page104">104</a>.</p>
+
+  <p>Lunch, the first after labor, I, <a href="#page109">109</a>.</p>
+
+  <p>Malaria, intermittent fever, IV, 571; serum for, IV, 656; treatment
+  of, IV, 571.</p>
+
+  <p>Malformation, II, 201.</p>
+
+  <p>Man, building a, II, 151.</p>
+
+  <p>Marital relations, when they are painful, III, 337; when they should
+  be suspended, III, 337.</p>
+
+  <p>Marriage, and motherhood, I, <a href="#page2">2</a>; best age for,
+  III, 331; certificate and vice, I, <a href="#page15">15</a>; certificate,
+  utility of, I, <a href="#page13">13</a>; evils of early, III, 333;
+  failures in, I, <a href="#page2">2</a>.</p>
+
+  <p>Mastitis, in infancy, IV, 553; in young girls, IV, 554.</p>
+
+  <p>Masturbation, or self-abuse, II, 157.</p>
+
+  <p>Meats, medical essentials of good, III, 393; preparation and selection
+  of, III, 390.</p>
+
+  <p>Measles, IV, 616; complications in, IV, 618; Koplik's spots in, IV,
+  617; rules of department of health, IV, 619; symptoms of, IV, 616;
+  treatment of, IV, 618.</p>
+
+  <p>Medical, letter brokers, III, 482; reliable advice, III, 486.</p>
+
+  <p>Medicine chest, contents of family, IV, 629.</p>
+
+  <p>Medicine concern run by women, III, 475.</p>
+
+  <p>Menstruation, II, 187; irregular, II, 187; painful, II, 193; should
+  not be accompanied with pain, II, 189; symptoms of, II, 189; treatment
+  for painful, II, 194; why it occurs every 28 days, II, 180.</p>
+
+  <p>Milk, children with whom it does not agree, IV, 535; difference
+  between human and cows, II, 252; mixture, how to prepare, II, 259;
+  peptonized, II, 262.</p>
+
+  <p>Mind, training the, III, 360.</p>
+
+  <p>Miscarriage, II, 202; after treatment of, II, 205; causes of, II, 203;
+  course and symptoms of, II, 204; what to do when threatened with, II,
+  204; tendency to, II, 206; womb displacement in, II, 198.</p>
+
+  <p>Mosquitoes, regarding, IV, 572; rules of Department of Health, IV,
+  574.</p>
+
+  <p>Mother, the cheerful, III, 400; education of the, II, 277; existence
+  of the average, III, 437; what she should know about eugenics, I, <a
+  href="#page47">47</a>; what she should tell her little girl, II, 173;
+  what she should tell her daughter, II, 173.</p>
+
+  <p>Motherhood, eugenics and, I, <a href="#page16">16</a>; function of, I,
+  <a href="#page17">17</a>; preparing for, II, 187.</p>
+
+  <p>Mothers, eugenic clubs, I, <a href="#page54">54</a>; girls must not
+  become, II, 184.</p>
+
+  <p>Moths, IV, 648.</p>
+
+  <p>Mouth, how to disinfect, IV, 601; sore, IV, 523; treatment for ulcers
+  in, IV, 525; treatment of sore, IV, 524.</p>
+
+  <p>Mucous patches, and ulcers, <ins class="correction" title="'I, 145' in original"
+  >II, 145</ins>.</p>
+
+  <p>Mumps, IV, 605; symptoms of, IV, 605.</p>
+
+  <p>Mustard bath, IV, 590.</p>
+
+  <p>Mustard paste, how to make, IV, 593.</p>
+
+<p><!-- Page viii --><span class="pagenum"><a name="pageviii"></a>[viii]</span></p>
+
+  <p>Mustard pack, how to prepare and use, IV, 594.</p>
+
+  <p>Mutton Broth, II, 244.</p>
+
+  <p>Napkins, sanitary, <ins class="correction" title="'I, 63' in original"
+  >I, <a href="#page66">66</a></ins>.</p>
+
+  <p>Nasal discharge, chronic, IV, 502.</p>
+
+  <p>Nausea, during pregnancy, I, <a href="#page80">80</a>.</p>
+
+  <p>Nettle-rash, IV, 559; cause of, IV, 559; treatment of, IV, 559.</p>
+
+  <p>Night losses, or "wet dreams," II, 158.</p>
+
+  <p>Nightmare or night terrors, IV, 583; treatment of, IV, 581.</p>
+
+  <p>Nipples, care of, I, <a href="#page121">121</a>; cracked, I, <a
+  href="#page122">122</a>; tender, I, <a href="#page122">122</a>; treatment
+  of cracked, I, <a href="#page122">122</a>; what mother should know about
+  bottle and, II, 264.</p>
+
+  <p>Normal salt, solution of, IV, 627.</p>
+
+  <p>Nose, chronic discharge of, IV, 503; complications of in syphilis, II,
+  146; foreign bodies in, IV, 632.</p>
+
+  <p>Nose-bleeds, IV, 522.</p>
+
+  <p>Nosophobia, or the dread of disease, III, 380.</p>
+
+  <p>Nursery maid, qualifications of, I, <a href="#page129">129</a>.</p>
+
+  <p>Nursing mothers, I, <a href="#page121">121</a>; diet of, I, <a
+  href="#page121">121</a>; mastitis in, I, <a href="#page122">122</a>;
+  nervous, I, <a href="#page126">126</a>.</p>
+
+  <p>Oatmeal water, for constipation in infants, II, 309.</p>
+
+  <p>Oat-water, II, 244.</p>
+
+  <p>Obstetrical outfits, ready to purchase, I, <a
+  href="#page63">63</a>.</p>
+
+  <p>Oil injections, II, 312.</p>
+
+  <p>Oiled silk, IV, 594; what it is and why it is used, IV, 594.</p>
+
+  <p>Orange juice, II, 262; for constipation in infants, II, 309.</p>
+
+  <p>Organs, transplanting from dead to living, IV, 655.</p>
+
+  <p>Otitis, acute, IV, 556.</p>
+
+  <p>Ovaries, disease of, II, 199; function of, II, 179.</p>
+
+  <p>Overeating, II, 289; III, 327; symptoms of, II, 290.</p>
+
+  <p>Overfeeding the baby, II, 223.</p>
+
+  <p>Parents, and the Boy, II, 153; a word to, II, 161; eugenics and, I, <a
+  href="#page15">15</a>.</p>
+
+  <p>Parotitis, epidemic, IV, 605.</p>
+
+  <p>Patent Medicines, and education, III, 493; and eugenics, III, 494; and
+  the newspaper, III, 484; conspiracy against freedom of press, III, 483;
+  dangers of, III, 489; fraudulent testimonials, III, 467; intoxicating
+  effects of, III, 453; government investigation of, III, 486; pure food
+  and drug act, III, 452, 490.</p>
+
+  <p>Patent Medicine Evil, III, 451, 489; and the duty of mothers III, 489;
+  what mothers should know about the, III, 451.</p>
+
+  <p>People, two kinds of, III, 363.</p>
+
+  <p>Peptonized milk, II, 262.</p>
+
+  <p>Physicians, what they are doing, IV, 649.</p>
+
+  <p>Pimples, IV, 576.</p>
+
+  <p>Pneumonia, IV, 516.</p>
+
+  <p>Poultices, IV, 593.</p>
+
+  <p>Pox, or syphilis, <ins class="correction" title="'I, 144' in original"
+  >II, 144</ins>.</p>
+
+  <p>Precautions to be observed, IV, 647.</p>
+
+  <p>Pregnancy, avoidance of drugs during, I, <a href="#page90">90</a>;
+  clothing during, I, <a href="#page77">77</a>; constipation during, I, <a
+  href="#page84">84</a>; headache during, I, <a href="#page83">83</a>;
+  heartburn during, I, <a href="#page84">84</a>; hygiene of, I, <a
+  href="#page75">75</a>; insomnia during, I, <a href="#page86">86</a>;
+  minor ailments of, I, <a href="#page76">76</a>; morning nausea, I, <a
+  href="#page80">80</a>; sexual intercourse during, <ins class="correction"
+  title="'I, 78' in original">I, <a href="#page76">76</a></ins>; social
+  side of, I, <a href="#page79">79</a>; undue nervousness during, I, <a
+  href="#page82">82</a>; vagaries of, I, <a href="#page90">90</a>; vaginal
+  discharge, I, <a href="#page88">88</a>; varicose veins, cramps and
+  neuralgia during, I, <a href="#page85">85</a>.</p>
+
+<p><!-- Page ix --><span class="pagenum"><a name="pageix"></a>[ix]</span></p>
+
+  <p>Pregnant, few ailing women become, III, 435; conduct of woman, I, <a
+  href="#page75">75</a>; diet of woman, I, <a href="#page77">77</a>; mental
+  state of woman, I, <a href="#page78">78</a>; when woman should first call
+  upon physician, I, <a href="#page68">68</a>.</p>
+
+  <p>Prickly Heat, IV, 560; treatment of, IV, 560.</p>
+
+  <p>Principle, differences of, III, 344.</p>
+
+  <p>Privy Vaults, IV, 647.</p>
+
+  <p>Procreative Function, abuse of, II, 153; III, 440.</p>
+
+  <p>Procreative Power, period of, II, 155.</p>
+
+  <p>Puberty, age of, II, 179; period of in the female, II, 178.</p>
+
+  <p>Pulse, rate in children and adults, II, 221.</p>
+
+  <p>Punton, Dr. John, on feeble-minded, I, <a href="#page42">42</a>.</p>
+
+  <p>Pure Food and Drug Act, III, 452, 490.</p>
+
+  <p>Putnam, Dr. Helen C., on education, I, <a href="#page27">27</a>.</p>
+
+  <p>Quacks, how they dispose of confidential letters, III, 481.</p>
+
+  <p>Quarrel, the first, III, 349.</p>
+
+  <p>Quinsy, IV, 523.</p>
+
+  <p>Race Culture, I, II.</p>
+
+  <p>Radium, IV, 652.</p>
+
+  <p>Rashes, of childhood, IV, 574; other, IV, 575; treatment of, IV,
+  576.</p>
+
+  <p>Records, Infant, II, 222.</p>
+
+  <p>Rectal Irrigations, to reduce fever, IV, 590.</p>
+
+  <p>Reproductive Organs, changes in, II, 178; function of the, II,
+  179.</p>
+
+  <p>Resolves, making, III, 371.</p>
+
+  <p>Rest and recreation, III, 398.</p>
+
+  <p>Rest and sleep, III, 347.</p>
+
+  <p>Rheumatism, in children, IV, 569; treatment of acute attack, IV, 570;
+  treatment of tendency to, IV, 570.</p>
+
+  <p>Rhinitis, chronic, IV, 503.</p>
+
+  <p>Rice water, II, 244.</p>
+
+  <p>Ringworm, of the scalp, IV, 561.</p>
+
+  <p>Rubbers, practice of wearing needs consideration, IV, 498.</p>
+
+  <p>Run-around, or felon, IV, 640; treatment of, IV, 641.</p>
+
+  <p>Rupture, IV, 551.</p>
+
+  <p>Saleeby, Dr. C.W., on education, I, <a href="#page22">22</a>.</p>
+
+  <p>Sanitary napkins, how to prepare, <ins class="correction" title="'I, 63' in original"
+  >I, <a href="#page66">66</a></ins>.</p>
+
+  <p>Santonin, for worms, IV, 549.</p>
+
+  <p>Scalds and burns, IV, 641.</p>
+
+  <p>Scalp, ringworm of, IV, 561; wounds of, IV, 640.</p>
+
+  <p>Scarlet Fever, IV, 620; complications in, IV, 621; eruptions, IV, 621;
+  measures to prevent spread of, IV, 621; treatment of, IV, 622.</p>
+
+  <p>Scarlatina, IV, 620.</p>
+
+  <p>Scientific Dressing, III, 427.</p>
+
+  <p>Schlapp, Dr. Max, on the feeble-minded, I, <a
+  href="#page39">39</a>.</p>
+
+  <p>Self-abuse or Masturbation, II, 155.</p>
+
+  <p>Self-culture, young wife's incentive to, III, 379.</p>
+
+  <p>Serum, Anti-meningitis, IV, 656; for malaria, IV, 656.</p>
+
+  <p>Sexual excesses, II, 159; treatment of, II, 160.</p>
+
+  <p>Sexual intercourse, during pregnancy, <ins class="correction"
+  title="'I, 78' in original">I, <a href="#page76">76</a></ins>.</p>
+
+  <p>Shock, the condition of, IV, 637.</p>
+
+  <p>Sitz bath, during pregnancy, I, <a href="#page87">87</a>.</p>
+
+  <p>"606," IV, 655.</p>
+
+  <p>Skin, care of, II, 216; care of in contagious diseases, IV, 602;
+  eruptions of, II, 145.</p>
+
+  <p>Sleeplessness, causes of, IV, 583; treatment of, IV, 583.</p>
+
+  <p>Social Evil, what parents should know about, II, 161.</p>
+
+  <p>Solutions, normal salt, IV, 627; various, IV, 626.</p>
+
+  <p>Soothing syrup, III, 458.</p>
+
+  <p>Sore Mouth, IV, 523; treatment of, IV, 524.</p>
+
+<p><!-- Page x --><span class="pagenum"><a name="pagex"></a>[x]</span></p>
+
+  <p>Sore throat, IV, 508.</p>
+
+  <p>Sowing wild oats, II, 167.</p>
+
+  <p>Spasms, IV, 577.</p>
+
+  <p>Spencer, Herbert, on education, I, <a href="#page35">35</a>.</p>
+
+  <p>Spermatozoa, functions of the, II, 181; the male, or papa egg, II,
+  181.</p>
+
+  <p>Sprains, IV, 639.</p>
+
+  <p>Sprue, IV, 525; treatment of, IV, 525.</p>
+
+  <p>Stables, IV, 646.</p>
+
+  <p>Sterility, II, 195; causes of, in women, II, 198.</p>
+
+  <p>Sterilizing, food for day's feeding, II, 260.</p>
+
+  <p>Stomach, diseases of, IV, 527; fermentation of, II, 304; function of
+  the, II, 304.</p>
+
+  <p>Stomach bitters, alcohol in, III, 455.</p>
+
+  <p>Stomatitis, IV, 523.</p>
+
+  <p>Story, Dr. Thomas A., on education, I, <a href="#page26">26</a>.</p>
+
+  <p>Study habit, the, III, 374.</p>
+
+  <p>Sullivan, Dr., on alcoholic drunkenness, I, <a
+  href="#page44">44</a>.</p>
+
+  <p>Success, attainment of, III, 345; formula of, III, 373.</p>
+
+  <p>Summer Diarrhea, IV, 539; symptoms of, IV, 540; treatment of, IV,
+  541.</p>
+
+  <p>Summer diseases of intestines, IV, 529.</p>
+
+  <p>Surgery, aseptic, IV, 653.</p>
+
+  <p>Syphilis, or the "pox," II, 144.</p>
+
+  <p>Tape worms, IV, 551.</p>
+
+  <p>Teeth, care of the, II, 219; how they come, II, 218.</p>
+
+  <p>Temperature, in children, II, 217.</p>
+
+  <p>Thiersch's solution, IV, 627.</p>
+
+  <p>Thought, bad habits of, III, 360; what is a, III, 359.</p>
+
+  <p>Thread worm, IV, 549.</p>
+
+  <p>Throat, foreign bodies in, IV, 633; sore, IV, 508.</p>
+
+  <p>Thrush, IV, 525; treatment of, IV, 525.</p>
+
+  <p>Thumb-sucking, IV, 585.</p>
+
+  <p>Tonsilitis: Angina, "sore throat," IV, 508; treatment of acute, IV,
+  510.</p>
+
+  <p>Transplanting organs of dead to living, IV, 655.</p>
+
+  <p>Tuberculosis, best treatment for, III, 418; facts about, III, 414.</p>
+
+  <p>Turpentine stupe, the, IV, 594.</p>
+
+  <p>Typhoid, how to keep from spreading, IV, 625; how to prevent getting,
+  IV, 624; symptoms of, IV, 623; vaccine in, IV, 654.</p>
+
+  <p>Ulcers, in mouth, IV, 525; mucous patches and, II, 144.</p>
+
+  <p>Vacant lots, IV, 647.</p>
+
+  <p>Vaccination, method of, II, 299; symptoms of successful, II, 299; time
+  for, II, 299; treatment, II, 300.</p>
+
+  <p>Vaccine in typhoid fever, IV, 654.</p>
+
+  <p>Vapor bath, IV, 591.</p>
+
+  <p>Varicella, IV, 606.</p>
+
+  <p>Varicose veins, during pregnancy, I, <a href="#page85">85</a>.</p>
+
+  <p>Vegetables, II, 272.</p>
+
+  <p>Venereal Diseases, fake medical treatment for, II, 167; ten million
+  victims of, I, <a href="#page11">11</a>.</p>
+
+  <p>Vomiting, of children between feedings, II, 226; significance of after
+  feeding, II, 230.</p>
+
+  <p>Washing dishes, III, 391.</p>
+
+  <p>Water, drink plenty of, III, 429.</p>
+
+  <p>Weaning, I, <a href="#page123">123</a>; care of breasts when, I, <a
+  href="#page125">125</a>; menstruation and, I, <a href="#page124">124</a>;
+  methods of, I, <a href="#page123">123</a>; rapid, when it is necessary,
+  I, <a href="#page124">124</a>; when to start, I, <a
+  href="#page124">124</a>.</p>
+
+  <p>Wedding night, its medical aspect, III, 334.</p>
+
+  <p>What to eat and wear in hot weather, III, 426.</p>
+
+  <p>When delays are dangerous, III, 423.</p>
+
+  <p>Whey, II, 244.</p>
+
+  <p>Whitlow, or felon, IV, 640.</p>
+
+<p><!-- Page xi --><span class="pagenum"><a name="pagexi"></a>[xi]</span></p>
+
+  <p>Whooping Cough, IV, 613; symptoms of, IV, 614; treatment of, IV,
+  615.</p>
+
+  <p>Wife, her part, III, 353; the cheerful, III, 400; the indifferent,
+  III, 401; what she owes to herself, III, 357.</p>
+
+  <p>Wifehood, first weeks and months of, III, 336.</p>
+
+  <p>Wilcox, Ella Wheeler, on education, I, <a href="#page23">23</a>.</p>
+
+  <p>Womb, function of, II, 180; how baby gets nourishment in, II, 183; how
+  held in place, II, 189.</p>
+
+  <p>Women, ailing, are inefficient, III, 434; diseases of, III, 433; who
+  don't want children, III, 439; medicine concern run by, III, 475; most
+  popular, III, 365; use of patent medicines in diseases, III, 473.</p>
+
+  <p>Work, must be interesting, III, 351.</p>
+
+  <p>Working for something, III, 395.</p>
+
+  <p>Worms, intestinal, IV, 548; round, IV, 548; symptoms of tape, IV, 551;
+  symptoms of thread, IV, 549; tape, IV, 551; thread, IV, 549; treatment of
+  round, IV, 549.</p>
+
+  <p>Worry, freedom from, III, 348.</p>
+
+  <p>Wound, cleaning a, IV, 637; closing and dressing a, IV, 637; removal
+  of foreign bodies from, IV, 636.</p>
+
+  <p>Wounds, IV, 634; of the scalp, IV, 640.</p>
+
+  <p>X-Ray, treatment and diagnosis, IV, 652.</p>
+
+  <br clear="all" />
+<hr class="full" />
+
+<h4>VOLUME I</h4>
+
+  <br clear="all" />
+<hr class="full" />
+
+<p><!-- Page xv --><span class="pagenum"><a name="pagexv"></a>[xv]</span></p>
+
+<h3>TABLE OF CONTENTS</h3>
+
+<h4><font class="sc">Eugenics. Race Culture</font></h4>
+
+<h4>CHAPTER I</h4>
+
+<h4><font class="sc">conditions which have evolved the science of eugenics</font></h4>
+
+  <p>Infant mortality&mdash;Marriage and
+  motherhood&mdash;Heredity&mdash;Environment&mdash;Education&mdash;Disease
+  and vice&mdash;History&mdash;Summary ... <font class="sc">page</font> <a
+  href="#page1">1</a></p>
+
+<h4>CHAPTER II</h4>
+
+<h4><font class="sc">the eugenic idea</font></h4>
+
+  <p>The value of human life&mdash;The eugenic principle&mdash;"The fit
+  only shall live"&mdash;Eugenics and marriage&mdash;The venereal
+  diseases&mdash;The utility of marriage certificates&mdash;The marriage
+  certificates and vice&mdash;Eugenics and parenthood&mdash;The principle
+  of heredity&mdash;Eugenics and motherhood&mdash;Eugenics and the husband
+  ... <font class="sc">page</font> <a href="#page9">9</a></p>
+
+<h4>CHAPTER III</h4>
+
+<h4><font class="sc">eugenics and education</font></h4>
+
+  <p>The present educational system is inadequate&mdash;Opinions of Dr.
+  C.W. Saleeby, Ella Wheeler Wilcox, Luther Burbank, William D. Lewis,
+  Elizabeth Atwood, Dr. Thomas A. Story, William C. White, Dr. Helen C.
+  Putnam&mdash;Difficulty in devising a satisfactory educational
+  system&mdash;Education an important function&mdash;The function of the
+  high school&mdash;The high school system fallacious&mdash;The true
+  function of education ... <font class="sc">page</font> <a
+  href="#page21">21</a></p>
+
+<h4>CHAPTER IV</h4>
+
+<h4><font class="sc">eugenics and the unfit</font></h4>
+
+  <p>The deaf and dumb&mdash;The feeble-minded&mdash;A New York
+  magistrate's report&mdash;Report of the Children's Society&mdash;The
+  segregation and treatment of the feeble-minded&mdash;What the care of the
+  insane costs&mdash;The alcoholic&mdash;Drunkenness ... <font
+  class="sc">page</font> <a href="#page37">37</a></p>
+
+<h4>CHAPTER V</h4>
+
+<h4><font class="sc">what every mother should know about eugenics</font></h4>
+
+<font class="sc">page</font> <a href="#page47">47</a>
+
+<p><!-- Page xvi --><span class="pagenum"><a name="pagexvi"></a>[xvi]</span></p>
+
+<h4><font class="sc">Child-Birth</font></h4>
+
+<h4>CHAPTER VI</h4>
+
+<h4><font class="sc">preparations for the confinement</font></h4>
+
+  <p>The birth chamber&mdash;What to provide for a confinement&mdash;Ready
+  to purchase obstetrical outfits&mdash;Position and arrangement of the
+  bed&mdash;How to properly prepare the accouchement bed&mdash;The Kelly
+  pad&mdash;The advantages of the Kelly pad&mdash;Should a binder be
+  used&mdash;Sanitary napkins&mdash;How to calculate the probable date of
+  the confinement&mdash;Obstetrical table&mdash;When should a pregnant
+  woman first call upon her physician&mdash;Regarding the choice of a
+  physician&mdash;How to know the right kind of a physician for a
+  confinement&mdash;The selection of a nurse&mdash;The difference between a
+  trained and a maternity nurse&mdash;Duties of a confinement
+  nurse&mdash;The requisites of a good confinement nurse&mdash;The personal
+  rights of a confinement nurse&mdash;Criticizing and gossiping about
+  physicians ... <font class="sc">page</font> <a href="#page61">61</a></p>
+
+<h4>CHAPTER VII</h4>
+
+<h4><font class="sc">the hygiene of pregnancy</font></h4>
+
+  <p>Daily conduct of the pregnant woman&mdash;Instructions regarding
+  household work&mdash;Instructions regarding washing and
+  sweeping&mdash;Instructions regarding exercise&mdash;Instructions
+  regarding passive exercise&mdash;Instructions regarding toilet
+  privileges&mdash;Instructions regarding bathing&mdash;Instructions
+  regarding sexual intercourse&mdash;Clothing during pregnancy&mdash;Diet
+  of pregnant women&mdash;Alcoholic drinks during pregnancy&mdash;The
+  mental state of the pregnant woman&mdash;The social side of
+  pregnancy&mdash;Minor ailments of pregnancy&mdash;Morning nausea, or
+  sickness&mdash;Treatment of morning nausea, or sickness&mdash;Nausea
+  occurring at the end of pregnancy&mdash;Undue nervousness during
+  pregnancy&mdash;The 100% baby&mdash;Headache&mdash;Acidity of the
+  stomach, or heartburn&mdash;Constipation&mdash;Varicose veins, cramps,
+  neuralgias&mdash;Insomnia&mdash;Treatment of insomnia&mdash;Ptyalism, or
+  excessive flow of saliva&mdash;Vaginal discharge, or
+  leucorrhea&mdash;Importance of testing urine during
+  pregnancy&mdash;Attention to nipples and breasts&mdash;The vagaries of
+  pregnancy&mdash;Contact with infectious diseases&mdash;Avoidance of
+  drugs&mdash;The danger signals of pregnancy ... <font
+  class="sc">page</font> <a href="#page75">75</a></p>
+
+<h4>CHAPTER VIII</h4>
+
+<h4><font class="sc">the management of labor</font></h4>
+
+  <p>When to send for the physician in confinement cases&mdash;The
+  preparation of the patient&mdash;The beginning of labor&mdash;The first
+  pains&mdash;The meaning of the term "labor"&mdash;Length of the first
+  stage of labor&mdash;What the first stage of labor <!-- Page xvii
+  --><span class="pagenum"><a name="pagexvii"></a>[xvii]</span>
+  means&mdash;What the second stage of labor means&mdash;Length of the
+  second stage&mdash;Duration of the first confinement&mdash;Duration of
+  subsequent confinements&mdash;Conduct of patient during second stage of
+  labor&mdash;What a labor pain means&mdash;How a willful woman can prolong
+  labor&mdash;Management of actual birth of child&mdash;Position of woman
+  during birth of child&mdash;Duty of nurse immediately following birth of
+  child&mdash;Expulsion of after-birth&mdash;How to expel
+  after-birth&mdash;Cutting the cord&mdash;Washing the baby's eyes
+  immediately after birth&mdash;What to do with baby immediately after
+  birth&mdash;Conduct immediately after labor&mdash;After pains&mdash;Rest
+  and quiet after labor&mdash;Position of patient after labor&mdash;The
+  Lochia&mdash;The events of the following day&mdash;The first breakfast
+  after confinement&mdash;The importance of emptying the bladder after
+  labor&mdash;How to effect a movement of the bowels after
+  labor&mdash;Instructing the nurse in details&mdash;Douching after
+  labor&mdash;How to give a douche&mdash;"Colostrum," its
+  uses&mdash;Advantages of putting baby to breast early after
+  labor&mdash;The first lunch&mdash;The first dinner&mdash;Diet after third
+  day ... <font class="sc">page</font> <a href="#page93">93</a></p>
+
+<h4>CHAPTER IX</h4>
+
+<h4><font class="sc">confinement incidents</font></h4>
+
+  <p>Regarding the dread and fear of childbirth&mdash;The woman who dreads
+  childbirth&mdash;Regarding the use of anesthetics in
+  confinements&mdash;The presence of friends and relatives in the
+  confinement chamber&mdash;How long should a woman stay in bed after
+  confinement&mdash;Why do physicians permit women to get out of bed before
+  the womb is back in its proper place?&mdash;Lacerations, their meaning,
+  and their significance&mdash;The advantage of an examination six weeks
+  after the confinement&mdash;The physician who does not tell all of the
+  truth ... <font class="sc">page</font> <a href="#page111">111</a></p>
+
+<h4>CHAPTER X</h4>
+
+<h4><font class="sc">nursing mothers</font></h4>
+
+  <p>The diet of nursing mothers&mdash;Care of the nipples&mdash;Cracked
+  nipples&mdash;Tender nipples&mdash;Mastitis in nursing
+  mothers&mdash;Inflammation of the breasts&mdash;When should a child be
+  weaned?&mdash;Method of weaning&mdash;Nursing while
+  menstruating&mdash;Care of breasts while weaning child&mdash;Nervous
+  nursing mothers&mdash;Birthmarks&mdash;Qualifications of a nursery maid
+  ... <font class="sc">page</font> <a href="#page121">121</a></p>
+
+<h4>CHAPTER XI</h4>
+
+<h4><font class="sc">convalescing after confinement</font></h4>
+
+  <p>The second critical period in the young wife's life&mdash;The domestic
+  problem following the first confinement ... <font class="sc">page</font>
+  <a href="#page131">131</a></p>
+
+  <br clear="all" />
+<hr class="full" />
+
+<p><!-- Page xix --><span class="pagenum"><a name="pagexix"></a>[xix]</span></p>
+
+<h3>INTRODUCTION</h3>
+
+  <p>Despite the fact that much has been written during the past two or
+  three years with reference to Eugenics, it is quite evident to any one
+  interested in the subject that the average intelligent individual knows
+  very little about it so far as its scope and intent are concerned. This
+  is not to be wondered at, for the subject has not been presented to the
+  ordinary reader in a form that would tend to encourage inquiry or honest
+  investigation. The critic and the wit have deliberately misinterpreted
+  its principles, and have almost succeeded in masking its supreme function
+  in the garb of folly.</p>
+
+  <p>The writer has yet to meet a conscientious mother who fails to evince
+  a reasonable degree of enthusiastic interest in eugenics when properly
+  informed of its fundamental principles.</p>
+
+  <p>The eugenic ideal is a worthy race&mdash;a race of men and women
+  physically and mentally capable of self-support. The eugenist, therefore,
+  demands that every child born shall be a worthy child&mdash;a child born
+  of healthy, selected parents.</p>
+
+  <p>No one can successfully assail the ethics of this appeal. It is
+  morally a just contention to strive for a healthy race. It is also an
+  economic necessity as we shall see.</p>
+
+  <p>The history of the world informs us that there have been many
+  civilizations which, in some respects, equalled our own. These races of
+  people have all achieved a certain success, and have then passed entirely
+  out of existence. Why? <i>And are we destined to extinction in the same
+  way?</i> We know that the cause of the decline and ultimate extinction of
+  all past civilizations was due primarily to the moral decadence of their
+  people. Disease and vice gradually sapped their vitality, and their <!--
+  Page xx --><span class="pagenum"><a name="pagexx"></a>[xx]</span>
+  continuance was impossible. It would seem to be the destiny of a race to
+  achieve material prosperity at the expense of its morality. When
+  conditions render possible the fulfilment of every human desire, the race
+  exhausts its vitality in a surfeitment of caprice. The animal instincts
+  predominate, and the potential vigor of the people is exhausted in
+  contributing to its own amusement. Each succeeding civilization has
+  reached this epochal period, and has fallen, victim of the rapacity of
+  stronger and younger invading antagonists, <i>themselves to succumb to
+  the same insidious process</i>.</p>
+
+  <p>The present civilization has reached this epochal&mdash;this
+  transition&mdash;period. In one hundred years from now we shall either
+  have accomplished what no previous civilization accomplished, or we shall
+  have ceased to exist as a race. Our success depends on the response of
+  the people to the eugenic appeal. Few appreciate the responsibility
+  involved.</p>
+
+  <p>It is not necessary, however, to combat or deplore the evils of the
+  past. Civilization has failed in the task of race-maintenance; it failed,
+  however, in ignorance. We cannot plead the same excuse. We are face to
+  face with conditions that we must solve quickly or our destiny will be
+  decreed before we apply the remedy.</p>
+
+  <p>A function of the eugenist is to gather and attest statistics, and to
+  establish conclusions based on these statistics. It has been conclusively
+  demonstrated that, if the race continues to progress as it exists
+  now&mdash;that is, if conditions remain the same, and our standard of
+  enlightenment, so far as racial evolution is concerned, does not prompt
+  us to adopt new constructive measures&mdash;<i>every second child born in
+  this country, in fifty years, will be unfit; and, in one hundred years,
+  the American race will have ceased to exist</i>. We mean by this that
+  every second child born will be born to die in infancy, or, if it lives,
+  will be incapable of self-support during its life, because either of
+  mental degeneracy or physical inefficiency. This appalling situation
+  immediately becomes a problem of civilization. No state can exist under
+  these conditions. If these statistics are reliable&mdash;and we know they
+  are true and capable of verification by any individual who will go <!--
+  Page xxi --><span class="pagenum"><a name="pagexxi"></a>[xxi]</span> to
+  the trouble of investigating them&mdash;it is self-evident that a radical
+  change must immediately be instituted to obviate the logical consequences
+  that must follow as a sequence. The eugenic demand, that "every child
+  born shall be a worthy child," is, therefore, the solution of the
+  problem.</p>
+
+  <p>This does not imply, however, that the eugenist must solve the
+  elementary problem of how the state will ensure its own salvation by
+  guaranteeing worthy children. Worthy children can come only from fit and
+  worthy (clean and healthy) parents. It becomes the imperative function of
+  the state&mdash;the function on which the very life of the state
+  depends&mdash;to see that every applicant for marriage is possessed of
+  the qualities that will ensure healthy, worthy children. We must,
+  therefore, sooner or later devise a system of scientific regulation of
+  marriage, and it is at this point we stumble against the problem that has
+  prompted the ebullitions of the wit and the sarcasm of the critic. A
+  casual reference to the science immediately suggests to the layman an
+  impossible or quixotic system of marriage by force. Even the word
+  "eugenics" is associated in the minds of many otherwise estimable old
+  ladies, and others who should know better, with a species of malodorous
+  free love, and their hands go up in holy horror at the intimation of a
+  scientific regulation of this ancient function.</p>
+
+  <p>Unfortunately, the popular mind has received the impression that this
+  incident constitutes the sum total of the eugenic idea, while the truth
+  is that the eugenist is only slightly concerned with its modus operandi.
+  This feature has been so magnified by widely published disingenuous
+  discussion that it has assumed the aspect of a test problem, a judgment
+  on which shall decide the utility of the science itself. Should this
+  decision be unfavorable, it would seem, according to its exponents, that
+  it would not be worth while promulgating the doctrines of the science
+  beyond this point. It is as though we were asked to deny ourselves the
+  inspiration and pleasure of a trip abroad because the morning of the day
+  on which the ship sailed happened to be cloudy.</p>
+
+  <p>It is certainly no part of the function of the eugenist to <!-- Page
+  xxii --><span class="pagenum"><a name="pagexxii"></a>[xxii]</span> uproot
+  instinct, or to trample into the dust age-long rights, though the
+  instinct is simply the product of an established habit, based on an
+  erroneous hypothesis, and the so-called rights simply acquired
+  privileges, because the intelligence that would have builded differently
+  was not awakened. Eugenic necessity will render imperative the state's
+  solution of this fundamental problem, for the reason that civilization
+  will be driven to demand its just inheritance&mdash;the right to exist.
+  The eugenist will not be compelled to open the door; it will be opened
+  for him. We can afford, therefore, to wait with supreme confidence,
+  because the good sense of the people will not always submit to the
+  tactics of the jester when it needs a saviour.</p>
+
+  <p>The eugenist does not seek to interfere with the liberties of the
+  rising generation: a boy may choose whom he will; the girl may select the
+  one who appeals to her most, and they may enjoy all the vested rights and
+  romance that custom has decreed the lover; but, when they resolve to
+  marry, <i>the state must decide their qualifications for parenthood</i>.
+  This must be the crucial test of the future. The life of the state
+  depends on it. The continuance of the race must be the supreme object of
+  all future constructive legislation. We must recognize that "life is the
+  only wealth," and that every other criterion of an advanced civilization
+  must measure its success according to its wealth in worthy
+  parenthood.</p>
+
+  <p>The eugenist does not even dictate what the test for parenthood shall
+  be. Common sense, however, suggests that it will assume some form that
+  will eliminate those physically or mentally diseased. He believes that,
+  when the people are sufficiently educated to appreciate the object in
+  view, they will devise a system that will meet with universal
+  approval.</p>
+
+  <p>Eugenics concerns itself with problems on which the destiny of the
+  race depends. It must not, therefore, be limited to questions relative to
+  mating and breeding. Every factor that contributes to the well-being and
+  uplifting of the race, every subject that bespeaks physical or mental
+  regeneration, that aids moral and social righteousness and salvation, and
+  promises a greater social happiness and contentment, has a eugenic <!--
+  Page xxiii --><span class="pagenum"><a
+  name="pagexxiii"></a>[xxiii]</span> significance. So long as there exists
+  an unsupported mother or a suffering child; so long as we rely on
+  hospitals and prisons, penitentiaries and the police, to minister to the
+  correction and regeneration of the unfit and degenerate; so long as we
+  tolerate grafting politicians and deprive the poor of breathing spaces,
+  sanitary appliances, and a hygienic environment; so long as war and
+  pestilence deprive posterity of the best of the race for parenthood; so
+  long as we emphasize rescue rather than prevention, so long must the
+  eugenist strive unceasingly to preach his propaganda of race
+  regeneration.</p>
+
+  <p>The scope of eugenics is too far-reaching in its beneficent purpose to
+  be fettered by the querulous triflings of the ancient or intellectual
+  prude; nor should it be belittled by the superficial insight of the
+  habitual scoffer. It is not a fantasy nor an idle dream. It is not even
+  an inspiration. The destiny of the race has brought us face to face with
+  conditions unparalleled in the history of this civilization, and the very
+  existence of the race itself may be wholly dependent on the foresight of
+  the minds that have made the science of eugenics possible.</p>
+
+  <p>A brief consideration of the conditions that actually exist, with
+  which we are face to face, and which certainly justify the existence of a
+  science whose function it should be to demand serious investigation of
+  methods of race regeneration, may help the reader to an intelligent and
+  practical understanding of the tremendous importance of the subject.</p>
+
+  <p>It has been already remarked that, at the present rate of decrease,
+  the birth-rate will be reduced to zero within a century. If the
+  birth-rates in England, Germany, and France should continue to decrease
+  as they have since 1880, there would be no children born, one hundred
+  years hence, in these countries. While we do not assert, and probably
+  none of us believes that either or all of these nations will actually be
+  out of existence in a hundred years&mdash;unquestionably because we feel,
+  at least we hope, that our methods will be so changed in that time that
+  the necessary modification will ensure a continuance of the race,
+  nevertheless, the fact remains that <i>the inevitable <!-- Page xxiv
+  --><span class="pagenum"><a name="pagexxiv"></a>[xxiv]</span> result of
+  continuing along present lines will be that, within the period of one
+  hundred years, these peoples will cease to perpetuate themselves</i>.</p>
+
+  <p>It is not necessary to enquire closely into the various causes for
+  this unparalleled situation. The falling birth-rate in itself is not the
+  prime cause. Even admitting that there are enough babies born, too many
+  of them are born only to die in infancy. We need no further proof of the
+  urgent need for conscientious inquiry, call it by what name you please.
+  The science of common sense is all-sufficient. The seemingly intelligent
+  individual who can only find material for ribaldry in this connection is
+  a more serious buffoon than he imagines. It is apparent that our methods
+  are wrong. Any constructive effort to correct them is commendable. When
+  it is stated that 20 per cent. of the American women are unable to bear
+  children, and that 25 per cent. of all the others are unwilling to assume
+  the burden and responsibility of motherhood, we partly realize the
+  gravity of the case.</p>
+
+  <p>On the other hand, statistics show that the majority of men have
+  acquired disease before they marry, and that a very large percentage of
+  these men convey contagion to their wives. This condition, to a very
+  large extent, accounts for the inefficiency of women as mothers. It is
+  responsible for at least 75 per cent. of the sterility that exists. The
+  effect of this deplorable condition is directly responsible, also, for
+  the ill health that afflicts women and that renders necessary the daily
+  operations of a serious nature that are conducted in every hospital in
+  every city in the civilized world. As a result of the dissemination of
+  this poison, children are born blind, or are born to die, or, if they
+  live, they are compelled to carry all through their helpless lives the
+  stigma of disease and degeneration. It would surely seem that the
+  individual to whom God has given intelligence and a conscience cannot
+  think of these, the saddest facts in human experience, without resentment
+  and humility. <i>Surely the time has arrived when every boy should know,
+  from his earliest youth, that there is here on earth an actual punishment
+  for vicious living as frightful as any that the mind of man can
+  conceive.</i> <!-- Page xxv --><span class="pagenum"><a
+  name="pagexxv"></a>[xxv]</span></p>
+
+  <p>When we inquire into the cause of this trend toward race degeneracy,
+  we find that poverty and the inability of the workingman to support large
+  families, luxurious living, and the life of ease and amusement on the
+  part of the women of wealth; the fact that an increasingly large number
+  of women have entered professions that prevent motherhood, and that the
+  number of apartment-houses where children are not wanted are on the
+  increase, all play their part. In this age of intense living, it is not
+  to be wondered at that many shrink from the responsibility of rearing
+  children, and the same conditions that contribute to this decadent ideal
+  intensifies sex-hunger, and it is this dominating passion that tolerates
+  and makes possible the most frightful crime of the age&mdash;infanticide.
+  Greece and Rome paved the way for their ultimate annihilation when their
+  beautiful women ceased to bear children and their men sought the
+  companionship of courtesans.</p>
+
+  <p>Baby contests have demonstrated that only one child in ten was found
+  to be good enough to justify a second examination. In a test examination
+  in the public schools, only eight in five thousand were competent to
+  qualify in all the tests. One of these eight was a Chinese boy and
+  another an American-born son of a native Greek. Of the twenty million
+  school-children in the United States, not less than 75 per cent. need
+  immediate attention for physical defects.</p>
+
+  <p>While man has been assiduously improving everything else, he has
+  neglected to better his own condition. Every animal that man has taken
+  from its native haunts and domesticated, he has efficiently improved. He
+  has even produced more marvelous results by the application of the same
+  principles to the vegetable kingdom. In his haste to civilize himself,
+  however, he has failed to apply the principles that are essential to
+  self-preservation. It is regrettable, also, to know that, while the
+  government has spent many thousands of dollars in sending out literature
+  to the farmers, instructing them how to raise profitable crops and to
+  breed prize horses and pigs, absolutely none of the public money has been
+  used in instructing American mothers how to raise healthy children. <!--
+  Page xxvi --><span class="pagenum"><a
+  name="pagexxvi"></a>[xxvi]</span></p>
+
+  <p>A distinguished insurance expert has proved that there was an increase
+  of nearly 100 per cent. in the mortality from degenerative diseases in
+  the United States between 1880 and 1909. The growing prevalence of these
+  diseases indicates a falling-off in the vitality of the race. It means
+  that the diseases of old age are invading the younger ranks.</p>
+
+  <p>The Life Extension Institute, of New York City, in its recent report,
+  states that "forty of every hundred men and women employed in the Wall
+  Street district require medical attention; twenty of the forty need it
+  immediately, and ten of the forty must have it to avert serious
+  results."</p>
+
+  <p>There are from one-quarter to three-quarters of a million of
+  preventable deaths every years in this country. That number of
+  individuals could have been saved with proper care and attention to
+  health in the early stages of disease, or before it gained a start.
+  Practically all the diseases that carry business men off prematurely are
+  curable in the early stages.</p>
+
+  <p>Of the percentage of Wall Street men who need medical attention
+  immediately, most have kidney or heart disease. The others are victims of
+  typical unhygienic habits, such as fast, gluttonous eating, neglect of
+  exercise, too much tobacco and liquor, and bad posturing in the office.
+  The business man considers these trifles, but they count heavily.</p>
+
+  <p>Business efficiency is greatly increased, first, by selecting men
+  physically fit for work, and, second, by keeping them in that condition.
+  There is a tremendous waste from inefficiency constantly going on, due to
+  impaired health. Wall Street has an astonishing corps of
+  neurasthenics.</p>
+
+  <p>We need a broader interpretation of the term Eugenics, so that we may
+  gain a more sympathetic and tolerant audience. The remedy does not lie in
+  an academic discussion of these problems; to continue the debate behind
+  closed doors will not lead anywhere: the public must be educated to a
+  just appreciation of existing conditions and the remedy must be the
+  product of effort on its part.</p>
+
+  <p>Any condition that fundamentally means race <!-- Page xxvii --><span
+  class="pagenum"><a name="pagexxvii"></a>[xxvii]</span> deterioration must
+  be rendered intolerable. The prevalant dancing craze is an anti-eugenic
+  institution, as is the popularity of the delicatessen store. No sane
+  person can regard with complacency the vicious environment in which the
+  future mothers of the race "tango" their time, their morals, and their
+  vitality away. We do not assume to pass judgment on the merits of the
+  dance; we do, however, emphatically condemn the surroundings.</p>
+
+  <p>The moving-picture shows, vaudeville entertainments, dancing
+  carnivals, the ease of travel, the laxity of laws, the opportunities for
+  promiscuous interviews, all tend to give youth a false impression of the
+  reality of life and to make the path of the degenerate easy and
+  attractive.</p>
+
+  <p>The history of civilization is, curiously enough, the story of
+  masculine brutality, self-indulgence, and vice. The history of the world
+  also proves that woman's sphere has been to submit patiently and silently
+  to injustice and imposition. <i>Practical eugenics is the first worthy
+  effort in the history of all time to hold men and women responsible for
+  their mode of living.</i> It is a mighty problem. There is no greater nor
+  more difficult one to be solved. It has taken eons to bring men to the
+  point of questioning their right to do as they please; it will take time
+  to compel them to realize their disgrace and acknowledge their duty. When
+  we consider that there are eighty thousand women condemned to
+  professional moral degradation in the City of London, and that every
+  so-called civilized city on the globe contributes its pro rata share to
+  this army of potential mothers, we begin to appreciate the vastness of
+  the task.</p>
+
+  <p>Eugenics has already accomplished what no other movement has ever
+  accomplished: it has created the spirit that gave birth to the thought of
+  men's responsibility, and it has taught us that the female of the race
+  has rights. We can now speak without fear; the light is no longer
+  hidden.</p>
+
+  <p>Women must realize, however, that they have contributed, and continue
+  to contribute, to race degeneracy. We hear and read much about the double
+  standard of morals. As long as woman are willing to marry their daughters
+  to reformed rakes, providing they have money <!-- Page xxviii --><span
+  class="pagenum"><a name="pagexxviii"></a>[xxviii]</span> and social
+  position, so long shall we have a double standard. So long as young
+  society women go into hysterics over pedigreed dogs and horses and then
+  marry men reeking in filthy unfitness for parenthood, mothers cannot
+  expect any other standard of morals. So long as one marriage in twelve
+  ends in divorce, the ethics of the female need enlightenment. We shall
+  not get another standard of morals until women themselves demand it and
+  insist on it. If they lend themselves to breaking down the conspiracy of
+  silence, the women may solve the marriage problem by refusing to marry
+  rakes.</p>
+
+  <p>We need a more liberal construction of the intent of eugenics in order
+  to clarify the obtuse minds so that its propaganda of education may be
+  easily and justly comprehended.</p>
+
+  <p>There is no field for speculation in the analysis of right living. It
+  conforms to the law of cause and effect. It is positively concrete in
+  substance. A recital of the life history of Jonathan Edwards, in
+  comparison with that of the celebrated "Jukes" family, emphasises this
+  assumption with a degree of positiveness that is tragic in its
+  significance.</p>
+
+  <p>Jonathan Edwards was born in England in Queen Elizabeth's time. He was
+  a clergyman and he lived an upright life. So did his wife. His son came
+  to the United States, to Hartford, Connecticut, and became an honorable
+  merchant. His son, in turn, also became a merchant, upright and honored.
+  His son, again, became a minister, and so honored was he that Harvard
+  University conferred two degrees on him on the same day; one in the
+  morning and one in the afternoon. This learned man again had a son, and
+  he became a minister. Jonathan Edwards was his name.</p>
+
+  <p>Now let us see, in 1900, what this one family, started by a man in
+  England who lived an upright life and gave that heritage to his children,
+  produced: 1,394 descendants of this man have been traced and identified;
+  295 were college graduates; 13 were college presidents; 65 were
+  professors; 60 were physicians; 108 were clergymen; 101 were lawyers; 30
+  were judges; 1 was Vice-President of the United States; 75 were Army and
+  Navy <!-- Page xxix --><span class="pagenum"><a
+  name="pagexxix"></a>[xxix]</span> officers; 60 were prominent authors; 16
+  were railroad and steamship presidents; and in the entire record not one
+  has been convicted of a crime.</p>
+
+  <p>Twelve hundred descendants have been traced from the one man who
+  founded the "Jukes" family. This record covers a period of seventy-five
+  years; out of these, 310 were professional paupers, who spent an
+  aggregate of two thousand three hundred years in poorhouses; 50 were evil
+  women; 7 were murderers; 60 were habitual thieves; and 130 were common
+  criminals.</p>
+
+  <p>It has been estimated that this one family was an economic loss to the
+  state, measured in terms of potential usefulness wasted; costs of
+  prosecution; expenses of maintenance in jails, hospitals and asylums; and
+  of private loss through thefts, and robberies, of $1,300,000 in
+  seventy-five years, or more than $1,000 for each member of the
+  family.</p>
+
+  <p><i>It would seem to be worth while to be well born, after all.</i></p>
+
+  <p>In order to succeed in the regeneration of the race, we must believe
+  that race regeneration is possible, and, that it is worth while. We must
+  preach its principles as we would a religion. The power of knowledge is a
+  mighty lever. We are living in a period of transition, but we are nearer
+  the future than the past.</p>
+
+  <p>We are told by the average individual that it will be impossible to
+  arouse the public to an intelligent appreciation of the scope of race
+  regeneration. When the writer conceived the happy phrase, "Better
+  Babies," a few years ago, he builded better than he knew. It has become
+  the slogan of splendid achievement already, and there are a multitude of
+  signs and tokens that the propaganda is established on a sure
+  foundation.</p>
+
+  <p>If the annihilation of all past civilizations was due to the refusal
+  of its members to breed for posterity, may we not reasonably assume that
+  we have, according to our statistics, reached the same crisis? If this is
+  logical reasoning, and every factor warrants this conclusion, have we not
+  reached the time when the perpetuation of the race is the most serious
+  question of our times? Is it not a problem for the enthusiastic and
+  immediate <!-- Page xxx --><span class="pagenum"><a
+  name="pagexxx"></a>[xxx]</span> support of every statesman, politician,
+  teacher, and preacher alike? Can any question be of more importance? What
+  will our marvelous material splendor avail if the race is destined to
+  immediate extinction?</p>
+
+  <p>We need the assistance of every intelligent citizen, we need most, the
+  awakening impulse of the mothers of the race. We who are alive are
+  responsible for environment and nurture, and we must believe that the
+  purpose to be achieved is of supreme importance. Every mother, through
+  the power of knowledge, may become a practical eugenist. It is to aid her
+  in an intelligent appreciation of the practical intent of the science
+  that this work is presented.</p>
+
+  <div class="poem">
+    <div class="stanza">
+      <p><font class="sc">W. Grant Hague, M.D.</font></p>
+    </div>
+
+    <div class="stanza">
+      <p>New York City.</p>
+    </div>
+  </div>
+  <br clear="all" />
+<hr class="full" />
+
+<p><!-- Page 1 --><span class="pagenum"><a name="page1"></a>[1]</span></p>
+
+<h2>THE EUGENIC MARRIAGE</h2>
+
+<h3>CHAPTER I</h3>
+
+<blockquote class="b1">
+
+  <p>"Nations are gathered out of nurseries."</p>
+
+  <p class="author"><font class="sc">Charles Kingsley</font>.</p>
+
+  <p>"To be a good animal is the first requisite to success in life, and to
+  be a nation of good animals is the first condition of national
+  prosperity."</p>
+
+  <p class="author"><font class="sc">Herbert Spencer</font>.</p>
+
+</blockquote>
+
+<h3>CONDITIONS WHICH HAVE EVOLVED THE
+SCIENCE OF EUGENICS</h3>
+
+<blockquote class="b1">
+
+  <p><b>Infant Mortality&mdash;Marriage and
+  Motherhood&mdash;Heredity&mdash;Environment&mdash;Education&mdash;Disease
+  and Vice&mdash;History&mdash;Summary.</b></p>
+
+</blockquote>
+
+  <p>There has been evinced during recent years a desire to know something
+  more definite about the science of eugenics.</p>
+
+  <p>Eugenics, simply defined, means "better babies." It is the art of
+  being well born. It implies consideration of everything that has to do
+  with the well-being of the race: motherhood, marriage, heredity,
+  environment, disease, hygiene, sanitation, vice, education,
+  culture,&mdash;in short, everything upon which the health of the people
+  depends. If we contribute the maximum of health to those living, it is
+  reasonable to assume that the future generation will profit thereby, and
+  "better babies" will be a direct consequence.</p>
+
+  <p>We are frequently told that we must take the world as we find it. This
+  has been aptly termed, "the motto of the impotent and cowardly." "Life is
+  what we make it," is the more satisfying assertion of the optimist, and
+  <!-- Page 2 --><span class="pagenum"><a name="page2"></a>[2]</span> most
+  of us seem to be trying to make existence more tolerable and more happy.
+  It is encouraging to know that intelligent men and women to-day seek an
+  opportunity to devote serious consideration to the betterment of the
+  race, while yet the pursuit of wealth and pleasure are enticing and
+  strenuous occupations.</p>
+
+  <p>It would be superfluous in a book of this character to enter into any
+  lengthy explanation as to how the science of eugenics proposes to work
+  out its problems. We hope only to excite the interest of mothers in the
+  subject, and to instruct them in its rudiments and principles.</p>
+
+  <p>It will be of distinct advantage, however, first to briefly consider
+  the conditions,&mdash;which are known to all of us,&mdash;which have led
+  up to the present status of the subject.</p>
+
+  <p><b>Infant Mortality.</b>&mdash;No elaborate argument is necessary to
+  prove that the present infant mortality, in every civilized country, is
+  too high. It is conceded by every authority interested in the subject, no
+  matter what explanation he offers, or what system he advances as a
+  solution of the problem.</p>
+
+  <p><b>Marriage and Motherhood.</b>&mdash;Every intelligent person knows
+  that most young girls enter into the marriage relationship without a real
+  understanding of its true meaning, or even a serious thought regarding
+  its duties or its responsibilities. We know that their home training in
+  domestic science is generally not adequate, and that their educational
+  equipment is inefficient. We also know that economic necessity has
+  deprived them of the tutelage essential to social progress and physical
+  health, and has endowed them with temperamental characteristics
+  undesirable in the mothers of the race. Maternity is thrust upon these
+  physically and mentally immature young wives, and they assume the
+  principal rôle in a relationship that is onerous and exacting. We know
+  that the duties of wife and mother require an intelligence which is
+  rendered efficient only by maturity and experience. We know that many, if
+  not most, young wives acquire habits which undermine their health and
+  their morals unwittingly, and we also know that the product <!-- Page 3
+  --><span class="pagenum"><a name="page3"></a>[3]</span> of this
+  inefficiency results in the decadence and the degeneration of the
+  race.</p>
+
+  <p><b>Heredity.</b>&mdash;Much remains inexplicable at the present time
+  regarding this intensely interesting department of science. We do know,
+  however, that its truths are being investigated and tabulated. Our
+  present knowledge of its principles has demonstrated the existence of
+  laws from which we can ethically deduce explanations of conditions which
+  were, in the past, not amenable to any classification. These relate to
+  individual and racial characteristics. We are beginning to learn that we
+  can modify these characteristics by proper selection, by environment, and
+  by education. This process will, to an eminent degree, redound to the
+  permanent advantage of mankind. We may reasonably aspire to a system of
+  race-culture which will eliminate the undesirable or unfit, and conserve
+  all effort in the propagation of the desirable or fit. This is a
+  consummation to be desired, and if by any system of eugenics the promise
+  of the future is realized it is deserving of the intelligent interest and
+  the active coöperation of every aspiring mother.</p>
+
+  <p><b>Environment.</b>&mdash;By environment we mean the provision of
+  suitable surroundings in its largest sense. A child to be fit and
+  efficient must be born of selected parentage, the home surroundings must
+  be desirable, the educational possibilities must be advantageous, the
+  sanitary and hygienic conditions must be suitable, opportunities for
+  physical and spiritual culture must be provided, and the State must
+  ensure justice and the right to achieve success. We know
+  that&mdash;generally speaking&mdash;these conditions do not exist. We
+  know that the dregs of the human species&mdash;the blind, the deaf-mute,
+  the degenerate, the imbecile, the epileptic, the criminal even,&mdash;are
+  better protected by organized charity and by the State than are the
+  deserving fit and healthy. We know that in the slums thousands of
+  desirable children waste their vitality in the battle for existence, and
+  we know that, though philanthropy and governmental supervision and
+  protection are afforded the deaf, the dumb, the blind and degenerate
+  child, no helping hand is held out to save the healthy and efficient
+  child, who must pay in disease and <!-- Page 4 --><span
+  class="pagenum"><a name="page4"></a>[4]</span> inefficiency the price of
+  his normality in degrading toil, in factory and pit, where child labor is
+  tolerated. We need the awakening which is the promise of the eugenist,
+  that these wrongs will be righted, not by the statesmanship which
+  believes that empires are founded and maintained by the power of material
+  might, but by a process which will ennoble selected motherhood and give
+  to every child born its due and its right.</p>
+
+  <p><b>Education.</b>&mdash;The present system of education is one of the
+  great reflections on the intelligence of the human race. One of the
+  greatest of contemporary writers has characterized it as "a curse to
+  modern childhood and a menace to the future." Even the humblest of
+  us&mdash;who would willingly believe the system efficient, who have no
+  desire to invite criticism as to our opinion&mdash;are forced to
+  acknowledge that there is something wrong with the educational system now
+  in vogue. The writer is disposed to believe, however, that the fault is
+  not wholly one of art. The conditions with which education has to contend
+  are essentially hypothetical. It may be that the laws of heredity and
+  psychology, when fixed, will evolve, at least, a more rational and a more
+  ethical hypothesis. So far as eugenics is concerned with education, its
+  limitation is defined and fixed. If the innate ability is not possessed
+  by the child, no system of instruction, and no art of pedagogy, will ever
+  draw it out. When the proper material is supplied by an adequate system
+  of race culture, science may probably supply the requisite complementary
+  data which will ensure an educational system that will really
+  educate.</p>
+
+  <p><b>Disease and Vice.</b>&mdash;The eugenic idea is more directly
+  concerned with disease which tends to deteriorate the racial type. The
+  average parent has no means of adequately estimating the significance of
+  this type of disease. It has been estimated that one-half of the total
+  effort of one-third of the race is expended in combating conditions
+  against which no successful effort is possible. Think what this means.
+  The struggle of life is a real struggle, even with success as an
+  incentive and as a possible reward. It becomes a tragedy when we think of
+  the wasted years, the hopeless prayers and the anguish of those who fight
+  <!-- Page 5 --><span class="pagenum"><a name="page5"></a>[5]</span> the
+  battle which is predestined to end in apparent failure. We are disposed
+  to doubt the justice of the Omnipotent Mind who created us and left us
+  seemingly alone&mdash;derelicts in the eddies of eternity.</p>
+
+  <p>This is but a finite fault, however. The truth is that the scheme of
+  the universe is unalterable, we are but part of the whole and must share
+  in the evolution of the process. An apparent failure is not necessarily a
+  discreditable one. Most lives are failures, if appraised by human
+  estimate. Take for example the life of a young wife who marries a man
+  with disease in his blood. She begins her wedded life with certain
+  commendable ideals. She is young, enthusiastic, ambitious, strong, and
+  she inherently possesses the right to aspire to become an efficient
+  home-maker and a good mother. She gives birth to a child, conceived in
+  love, and during her travail she beseeches her Creator to help her and to
+  help her baby, as all women do at such a time. Her baby is born blind and
+  it is a weak and puny mite. The mother recovers slowly, but she is never
+  the same vigorous and ambitious woman. Later her strength fades away, her
+  enthusiasm falters, the home is blighted and seems a desecrated spot. The
+  baby is a constant worry, it is always sick, it needs expensive care and
+  it exhausts the physical remnant of its mother's health. It finally dies
+  and is laid away, not forgotten, but a sad, sad memory. The ailing and
+  dispirited mother is informed that she must submit to an operation if she
+  desires to regain her health, if not to save her life. She returns from
+  the hospital&mdash;not a woman&mdash;a blighted thing, an unsexed
+  substitute for what once was a happy, sunny, healthy, innocent girl.</p>
+
+  <p>This is not an overdrawn tale,&mdash;it is a true story, a common,
+  every-day story. Who was to blame? Why were her prayers not heard? Why,
+  indeed? One might as well ask why seemingly splendid civilizations
+  decayed into forgotten dust, or why empires rotted away. The answer is
+  the same.</p>
+
+  <p><b>History.</b>&mdash;From the eugenists' standpoint history is
+  prolific only in negation. A correct interpretation of its pages teaches
+  us that it has not taught the lesson of the "survival of the fittest,"
+  but rather the survival of the <!-- Page 6 --><span class="pagenum"><a
+  name="page6"></a>[6]</span> strongest. That the strongest is not always
+  the "fittest" needs no commentary. That the fit should survive is the
+  genetic law of nature, and it has been strictly obeyed by biology and
+  humanity when these sciences have adhered to, and have been under the
+  jurisdiction of the natural law.</p>
+
+  <p>When religious schisms swayed the world, the stronger party, in
+  material strength or in actual numbers, massacred the weaker, which was
+  frequently the fitter from the standpoint of desirability as progenitors
+  of the race. Thus posterity was deprived of what probably was the
+  representative, potential strength of generations.</p>
+
+  <p>At a later date religious schism changed her <i>modus operandi</i> but
+  accomplished the same pernicious purpose, as the following shows:</p>
+
+  <p>"Whenever a man or woman was possessed of a gentle nature that fitted
+  him or her to deeds of charity, to meditation, to literature or to art,
+  the social condition of the time was such that they had no refuge
+  elsewhere than in the bosom of the Church. But the Church chose to preach
+  and exact celibacy, and the consequence was that these gentle natures had
+  no continuance, and thus, by a policy, was brutalized the breed of our
+  forefathers."</p>
+
+  <p>When religion was not the dominating power, mankind was ruled by
+  militant tyrants. The non-elect were slaves,&mdash;uneducated,
+  uncivilized, debased and diseased. The elect were licentious and
+  indolent. Neither class practised any domestic virtues, or respected the
+  institution of motherhood. The process of the selection of the fittest
+  for survival for the purpose of parentage, and for the consummation of
+  the evolutionary gradation, through which the human race is apparently
+  destined to pass, was again in abeyance for a series of generations.</p>
+
+  <p>In our own times, the fate of nations and the destiny of their people
+  would seem to depend upon the size of the fighting force and the
+  efficiency of the ships we build; our ability to dicker and barter, to
+  gain a questionable commercial supremacy, and the loquaciousness of our
+  politicians. This, at least, is the criterion upon which the modern
+  statesman estimates the quality of <!-- Page 7 --><span
+  class="pagenum"><a name="page7"></a>[7]</span> present-day civilization.
+  He is not apparently interested in the story of the ages. The progress of
+  God's supernal scheme through æons of bigotry and darkness neither
+  suggests nor inspires in him a loftier constructive analysis. He is
+  content to leave the destiny of nations to tons of material, tons of men
+  and tons of talk.</p>
+
+  <p>Nowhere do we find any reference to the quality of the blood-stream of
+  the people. Nor does it seem to have been discovered by those who wield
+  authority, that the glory of a nation depends upon its brains, not its
+  bulk; nor do they apprehend that the greatness of a people is not in its
+  past history, but in its ever-existing motherhood; and that its battles,
+  in the future, must be fought, not on battlefields, but in its nurseries.
+  When we judge our national worth and wealth by the quality of our
+  maternal material, and estimate our greatness and our glory by the record
+  of our infant mortality, we will have carved an enduring niche in the
+  celestial scheme that will be unchangeable and for all time.</p>
+
+  <p>There are in Britain to-day over a million and a quarter females of
+  marriageable age in excess of the number of marriageable males. A war
+  between Britain and Germany would unquestionably be the bloodiest war in
+  all history, and it probably would be the last one, because it would only
+  end in the dominance of one power over all the others. If we concern
+  ourselves only with Britain&mdash;from the eugenic standpoint&mdash;who
+  would dare compute the ratio of marriageable females over the males after
+  the war was over? The consequence of such a war on posterity would be
+  tragic. It would mean the annihilation of the fittest for fatherhood for
+  generations. Only the unfit would be left from which to begin a new
+  breed.</p>
+
+  <p>The multitude of females who would necessarily be left unable to
+  participate in the highest function of womanhood would have to be
+  self-supporting. The economic problem would, therefore, have a
+  far-reaching influence and even if solved adequately as an economic
+  problem, it could never be solved satisfactorily as a sociological, or as
+  a problem in eugenics.</p>
+
+  <p>Infant mortality is too high. Apart from the <!-- Page 8 --><span
+  class="pagenum"><a name="page8"></a>[8]</span> statistical proof which
+  shows it, we may rightly construe as further proof of it, the widespread
+  effort being made in every civilized country in the world to ameliorate
+  the condition.</p>
+
+  <p>The laws and ethics of marriage are inadequate. Its true purpose is
+  frustrated and racial and individual injustice and imperfection are the
+  products of existing conditions.</p>
+
+  <p>Motherhood, in its every aspect is not, and has not in the past, been
+  elevated to the plane which a true estimate of its supreme importance to
+  the race justifies.</p>
+
+  <p>Heredity as a scientific principle is undeveloped, and because of
+  maladministration in past generations, the present generation is
+  endeavoring to do the work, the fruits of which it should be
+  enjoying.</p>
+
+  <p>Environment in its highest sense is impossible because of inadequate
+  laws, imperfect hygienic and sanitary knowledge, incomplete education,
+  vice and disease.</p>
+
+  <p>If there was not some supremely important, cardinal error somewhere,
+  it is reasonable to suppose that in one or other of the departments of
+  human effort we would have reached the summit of idealism. The State, as
+  an institution, would have evolved a perfection which would enable it to
+  exist as an independent mechanism, complete and ideal in all its
+  ramifications. We have had no such state, however. The highest type of
+  empire has been ludicrously dependent upon the minor exigencies of
+  individual human existence.</p>
+
+  <p>Science would have evolved the superman, but history, as we have seen,
+  has persistently deprived science of the material wherewith to contribute
+  him.</p>
+
+  <p>The institution of marriage would have been a fixed and an inviolable
+  guarantee of the happiness of the home, but human wisdom has erred and
+  the solution is as yet apparently undiscovered.</p>
+
+  <p>Investigation into every field of human effort shows that the ultimate
+  aim in view, if any, was something other than the welfare of the race, as
+  a race or as individuals.</p>
+
+  <br clear="all" />
+<hr class="full" />
+
+<p><!-- Page 9 --><span class="pagenum"><a name="page9"></a>[9]</span></p>
+
+<h3>CHAPTER II</h3>
+
+<blockquote class="b1">
+
+  <p>"The public health is the foundation on which reposes the happiness of
+  the people and the power of a country. The care of the public health is
+  the first duty of a statesman."</p>
+
+  <p class="author"><font class="sc">Lord Beaconsfield</font>.</p>
+
+</blockquote>
+
+<h3>THE EUGENIC IDEA</h3>
+
+<blockquote class="b1">
+
+  <p><b>The Value of Human Life&mdash;The Eugenic Principle&mdash;"The Fit
+  Only Shall Live"&mdash;Eugenics and Marriage&mdash;The Venereal
+  Diseases&mdash;The Utility of Marriage Certificates&mdash;The Marriage
+  Certificates and Vice&mdash;Eugenics and Parenthood&mdash;The Principle
+  of Heredity&mdash;Eugenics and Motherhood&mdash;Eugenics and the
+  Husband.</b></p>
+
+</blockquote>
+
+  <p>The eugenist believes the cardinal error of the past has been a
+  failure to recognize the worth or value of human life. In the past human
+  lives have counted for absolutely nothing. As we have seen, each
+  generation has practically deprived posterity of the best of its breed,
+  and we shall see, when we consider the facts which affect the present
+  vitality of the race, that the same preposterous conditions still
+  exist.</p>
+
+  <p>It is not necessary to waste the reader's time in an effort to prove,
+  simply from an argumentative standpoint, the logic of the eugenic idea.
+  There is no existing economic problem that has established itself so
+  firmly in the hearts of the people who understand it, as has the study of
+  race culture. It is not the subject, but its scope of application, that
+  is new. Biologically, we see the manifestations of eugenics on every
+  side. In the flower garden we breed for beauty, in the orchard for
+  quality. In the poultry yard and on the stock farm the same process weeds
+  out the unfit and cultivates the desirable. The value of the eugenic idea
+  is most strikingly illustrated in the cultivation, or breeding, of the
+  horse from a primitive creature into the splendid animals which represent
+  the various types of equine present-day <!-- Page 10 --><span
+  class="pagenum"><a name="page10"></a>[10]</span> perfection. It has taken
+  generations of the most painstaking intelligence to understand the traits
+  which had to be evolved in scientific mating to reach the present
+  standard. If the same rules, or lack of rules, applied to the mating of
+  horses as applied to ourselves, there would be few, if any,
+  "thoroughbreds" among them. The principle which we must recognize is that
+  "Life is the only wealth."</p>
+
+  <p>Progress and efficiency will be ensured and of an enduring character,
+  when all human effort is consecrated to this fundamental principle as a
+  basic law, and not till then.</p>
+
+  <p>To cultivate the human race on prescribed scientific principles will
+  be the supreme science of all the future, the object and the final goal
+  of all honest governmental jurisprudence, and the ultimate judge of all
+  true constructive legislation.</p>
+
+<h4>THE EUGENIC PRINCIPLE</h4>
+
+  <p>The eugenic principle is, that "the fit only shall live." This does
+  not mean that the unfit must die, but that only the fit shall be born.
+  Occasionally, as a product of bad environment, or faulty training, or
+  eccentricity, a horse gives evidence of vicious traits, but the
+  scientific breeder never mates him. He is allowed to die out. If he were
+  permitted to father a race, his progeny would develop murderous
+  characteristics that would retard the type for generations.</p>
+
+  <p><b>The Fit Only Shall Be Born.</b>&mdash;This implies the exclusion of
+  those, as parents, who are incapable of creating fit children. Fit
+  children are children who are physically and mentally healthy. Parents
+  who are unfit to create physically and mentally healthy children are
+  those diseased in body or mind, especially if the disease is of the type
+  which science has proved to be transmissible, or which directly affects
+  the vitality of the child. In such a category we place those who are
+  deaf, dumb, blind, epileptic, feeble-minded, insane, criminal,
+  consumptive, cancerous, haemophilic, syphilitic, or drunkards, and <!--
+  Page 11 --><span class="pagenum"><a name="page11"></a>[11]</span> those
+  known to be victims of disease of any other special type.</p>
+
+  <p>It must not be inferred that the above classification is made
+  arbitrarily. There are many arguments which may be advanced limiting the
+  eugenic applicability of certain of these diseased conditions. These,
+  however, do not directly come within the province of the mother. They may
+  be safely left to special state regulation. We simply make the assertion
+  that no mother would willingly, or designedly, ally her offspring with
+  any member of society afflicted with any of the diseases enumerated.</p>
+
+  <p><b>Eugenics and Marriage.</b>&mdash;The eugenic idea, practically
+  applied to the institution of marriage, means that no unfit person will
+  be allowed to marry. It will be necessary for each applicant to pass a
+  medical examination as to his, or her, physical and mental fitness. This
+  is eminently a just decree. It will not only be a competent safeguard
+  against marriage with those obviously diseased and incompetent, but it
+  will render impossible marriage with those afflicted with undetected or
+  secret disease. Inasmuch as the latter type of disease is the foundation
+  for most of the failures in marriage, and for most of the ills and
+  tragedies in the lives of women, it is essential to devote special
+  consideration to it in the interest of the mothers of the race.</p>
+
+  <p>It is estimated that there are more than ten million victims of
+  venereal disease in the United States to-day. In New York City alone
+  there are two million men and women&mdash;not including boys and girls
+  from six to twelve years of age&mdash;actively suffering from gonorrhea
+  and syphilis. Eight out of every ten young men, between seventeen and
+  thirty years of age, are suffering directly or indirectly from the
+  effects of these diseases, and a very large percentage of these cases
+  will be conveyed to wife and children and will wreck their lives. No one
+  but a physician can have the faintest conception of the far-reaching
+  consequences of infection of this character. The great White Plague is
+  merely an incident compared to it. These diseases are largely responsible
+  for our blind children, for the feeble-minded, for the degenerate and
+  criminal, the incompetent and the insane. No other <!-- Page 12 --><span
+  class="pagenum"><a name="page12"></a>[12]</span> disease can approximate
+  syphilis in its hideous influence upon parenthood and the future. The
+  women of the race, and particularly the mothers, should fully appreciate
+  the real significance of the situation as it applies to them
+  individually. That they do not appreciate it is well known to every
+  physician and surgeon.</p>
+
+  <p>It is first necessary to state certain medical facts regarding these
+  diseases. They exist for years after all symptoms have disappeared; no
+  evidences exist even to suggest to the patient that he, or she, is not
+  entirely cured. After the germs have been in the patient for some time
+  they lose a certain degree of their virility, and a condition of immunity
+  is established. In other words the tissue ceases to be a favorable medium
+  for the development, or activity, of the germs. If these germs, however,
+  are conveyed to another person, who has never had the disease, or whose
+  tissue is not immune, they will immediately resume their full activity
+  and virulence, and will establish the disease, frequently in its most
+  violent form, in the person so infected. The startling deduction which we
+  must draw from these facts is, that a man may infect his wife, and may
+  thereby be the direct cause of wrecking her entire life, and may, in
+  addition, as a consequence of the infection, cause a child to be born
+  blind, without even remotely suspecting that he is in any way responsible
+  for it. In the light of this knowledge, what is the percentage risk a
+  young girl takes when she selects a husband, remembering that eight out
+  of every ten husbands bring these germs to the marriage bed? Reread the
+  true story of the young woman on page <a href="#page5">five</a>, accept
+  my assurance that there are thousands and thousands of such cases, and
+  ask yourself, who is to blame? We may certainly assure ourselves that no
+  man living would wilfully desecrate his bride. He did not know,&mdash;did
+  not even suspect that the disease he had years ago was still in his
+  system. Society is to blame&mdash;you and I&mdash;the laxity of the law
+  is the culprit. Had he been compelled to pass a physical examination
+  before marriage he would have been told the truth.</p>
+
+  <p>It is a notorious fact, that in every civilized city in the world, the
+  number of operations that are daily performed <!-- Page 13 --><span
+  class="pagenum"><a name="page13"></a>[13]</span> on women, is increasing
+  appallingly. Every surgeon knows that nine-tenths of these operations are
+  caused, directly or indirectly, by these diseases, and in almost every
+  case in married women, they are obtained innocently from their own
+  husbands. It is rare to find a married woman who is not suffering from
+  some ovarian or uterine trouble, or some obscure nervous condition, which
+  is not amenable to the ordinary remedies, and a very large percentage of
+  these cases are primarily caused by infection obtained in the same
+  way.</p>
+
+  <p>When a girl marries she does not know what fate has in store for her,
+  nor is there any possible way of knowing under the present marriage
+  system. If she begets a sickly, puny child,&mdash;assuming she herself
+  has providentially escaped immediate disease,&mdash;she devotes all her
+  mother love and devotion to it, but she is fighting a hopeless fight, as
+  I previously explained when I stated that one-half of the total effort of
+  one-third of the race is expended in combating conditions against which
+  no successful effort is possible. Even her prayers are futile, because
+  the wrong is implanted in the constitution of the child, and the remedy
+  is elsewhere. These are the tragedies of life, which no words can
+  adequately describe, and compared to which the incidental troubles of the
+  world are as nothing.</p>
+
+  <p>So long as these conditions exist need we not tremble for the future
+  of the race? Is not this future welfare a personal issue, or can we trust
+  the future of our daughters to the same indiscriminate fate that has
+  written the pages of history in the past?</p>
+
+  <p>This problem has been debated from every possible angle without our
+  reaching any seemingly practical solution. The promise of emancipation,
+  however, came with the dawn of eugenics. It is the only solution that
+  gives promise of immediate and reasonable success. For that reason alone
+  it should receive the active support of every good mother in all
+  lands.</p>
+
+  <p><b>The Utility of Marriage Certificates.</b>&mdash;There would seem to
+  be no question as to the utility of marriage certificates. We must
+  remember, however, that there is a distinction between marriage and
+  parenthood, and that <!-- Page 14 --><span class="pagenum"><a
+  name="page14"></a>[14]</span> eugenics is concerned only with parenthood.
+  It is interested in the institution of marriage to the extent only that
+  it may, by some system of regulation, be a positive and fixed factor in
+  the production of exclusively healthy children. The eugenist demands fit
+  children. If society can ensure fit children, as a consequence of any
+  marriage system which may or may not include medical certification, the
+  eugenic aim is fully met. At the present time the giving of a marriage
+  certificate, which is really a permit to marry, would seem to be the most
+  practical way promptly to accomplish the eugenic purpose. We should
+  promptly question the honor of any prospective husband disposed to evade
+  the examination simply because he was not compelled to obey by a
+  legislative enactment.</p>
+
+  <p>We believe that when the public is educated to the truth and intent of
+  eugenics, there need be no compulsory examination. Men and women will, of
+  their own accord, desire to know if their marriage will jeopardize the
+  race. There will be questions of heredity to elucidate, questions of
+  inherited insanity, poison taints, of blindness and deafness, or it may
+  be of drunkenness.</p>
+
+  <p>Further, marriage certificates, or permits, must be considered in
+  regard to the future conduct of those to whom we refuse permits to marry.
+  A refusal of the permission to marry will not change the desire to marry.
+  Many, of course, to whom a permit is refused, will accept the situation,
+  will be thankful to be possessed of the knowledge of their incompetency
+  in order that they may seek medical aid. These individuals will remain
+  under medical supervision until their ailments are cured and their
+  competency established. In this way the eugenic aim is materially
+  furthered. Others may not abide by the decree which forbids marriage. It
+  would wholly defeat the eugenic idea if the unfit children were to
+  continue to be born illegitimately. These individuals will comprise the
+  few&mdash;probably the present unfit members of society&mdash;and the
+  final solution of the matter must remain a question of education and
+  evolution. When public opinion is educated to the degree necessary to
+  establish a system of eugenic self-protection, we shall be <!-- Page 15
+  --><span class="pagenum"><a name="page15"></a>[15]</span> provided with a
+  race of children whose culture will achieve the ideal of parenthood by a
+  process of education rather than legislation.</p>
+
+  <p><b>The Marriage Certificate and Vice.</b>&mdash;If a prenuptial
+  examination were made compulsory there is no doubt of the very prompt and
+  salutory effect it would have on present-day vice. It has often been said
+  that "You cannot legislate virtue or sobriety into a people." We are
+  familiar too with the maxim that "You can lead a horse to the well, but
+  you cannot make him drink." You can lead a horse to the well, however,
+  and lo! he drinks. If you lead him at the right time he will always
+  drink. If we legislate at the psychological moment we can legislate
+  virtue and sobriety into a people.</p>
+
+  <p>A very large percentage of existing vice is the immediate product of
+  ignorance, and the larger percentage of the remainder is the result of
+  propinquity and the idea that it will never be found out. Very little of
+  it is the outcome of innate degeneracy. It is an acquired degeneracy we
+  must guard against, and that is the special educational motive of
+  eugenics. Young men will be taught the truth about vice, and if they have
+  been victims in the past, they will willingly submit themselves to a
+  <i>competent</i> investigation of their fitness for marriage. If they are
+  still pure, the desire to remain so, in order to be eligible for
+  parenthood, will guard them against the risk of contamination. This will
+  not only result in a distinct improvement of the moral tone, but the
+  potential possibilities to posterity will be incalculable. Legislation
+  might therefore be the vehicle through which eugenic education could
+  enlighten and evolve a fit race.</p>
+
+<h4>EUGENICS AND PARENTHOOD</h4>
+
+  <p>If the supreme end is a better race we must recognize that the great
+  need for society to-day is to educate for parenthood. History teaches
+  that a civilization that dissipates its virility in profligacy or spends
+  its energy in political and commercial trickery, and gives no thought to
+  the character of the men and women it produces, is destined to total
+  failure. Parenthood and birth&mdash;in these <!-- Page 16 --><span
+  class="pagenum"><a name="page16"></a>[16]</span> we have the eugenic
+  instruments of the future. The only permanent way to cure the ills of the
+  world is to prevent the multiplication of people below a certain
+  standard. The elevation and the actual preservation of the race depends
+  upon rendering it impossible for the unfit coming into existence at all.
+  In other words the unfit or unworthy must be rejected, not necessarily as
+  individuals, but as parents.</p>
+
+  <p>Eugenics is allied to the principle of heredity,&mdash;the principle
+  that enables us to modify conditions so as to ensure the right children
+  being born. The propaganda against infant mortality is directed only
+  toward the provision of a good environment,&mdash;so that children, when
+  born, may survive and attain the maximum of their hereditary promise. The
+  two campaigns are essentially complementary. The one applies only before
+  birth, the other after birth. The statistics of infant mortality
+  unfortunately show that it is not a process that extinguishes the unfit
+  only. The healthy succumb to unfavorable environment and it was to amend
+  this condition that the campaign against infant mortality was undertaken.
+  The two campaigns appeal to the same creed: that parenthood is the
+  supreme function of the race, that it must not be indifferently
+  undertaken; that it demands the most careful preparation; that it is a
+  duty which can only be carried out eugenically by the highest attainable
+  health of body and mind and emotions.</p>
+
+  <p><b>Eugenics and Motherhood.</b>&mdash;Any plan or scheme which has for
+  its object race regeneration must concern itself with the health, the
+  education, and the psychology of woman; the environment which shall
+  surround her period of motherhood, and her selection of the fathers of
+  the future. Society must safeguard her in all her relations. The race
+  to-morrow are the babies of to-day. The wealth of a nation therefore is
+  the type of baby that will constitute its civilization from generation to
+  generation, and absolutely nothing else counts. We hear much about race
+  suicide, but is it not monstrous to cry for more babies when we do not
+  know how to keep alive those we have? It is a fact that everywhere the
+  birth rate of the Caucasian people is on the decline. Our birth <!-- Page
+  17 --><span class="pagenum"><a name="page17"></a>[17]</span> rate as a
+  whole, however, is ample; it is the death rate that is significant and
+  appalling. When we remember that one-third of all the babies born die
+  before they reach the age of five years; and that the deaths of babies
+  under one year of age comprise about one-fourth of the total death-roll;
+  and that fully one-half of all these deaths are needless and unnecessary,
+  wherein is the wisdom of working for a higher birth rate if it is merely
+  that more may die?</p>
+
+  <p>The majority of babies are born physically healthy, but because of our
+  destructive process, we proceed to annihilate hundreds of thousands of
+  them yearly, and because of defective environment and education we render
+  thousands of others, including the fit and unfit, inefficient and
+  incompetent as propagating factors. It is to remove this disastrous
+  stigma on our intelligence that we have been forced to study the
+  conditions which the eugenic idea represents. When these principles are
+  understood and believed, and when they are acted upon, infant mortality
+  will cease to exist.</p>
+
+  <p>It was the design of the Creator that human motherhood should be an
+  exalted occupation. He placed in her care to nurture and to love, the
+  most helpless living thing. Few have regarded a baby from this viewpoint
+  and fewer still understand its supreme significance. That it is the most
+  utterly helpless thing possessing life is a self-evident fact, and that
+  it should be destined to be King of all mammalian tribes as well as Lord
+  of all the earth is a superlative paradox. Because of its utter inability
+  to care for itself it is more in need of care than any other
+  representative of the animal world. It is not only in need of immediate
+  care, but it demands care longer than the young of any other species.</p>
+
+  <p>It stands to reason, therefore, that the function of motherhood must
+  be reckoned with in any scheme of race regeneration; that it must be
+  provided with the most favorable environment; and that it must be
+  relieved of any condition which would materially retard the meeting of
+  the obligation to its fullest possible extent. In an ideal eugenic sense
+  the state must ensure sustenance to those deprived of ample food and
+  raiment, and science <!-- Page 18 --><span class="pagenum"><a
+  name="page18"></a>[18]</span> must continue to solve the problem of a
+  fitter sanitary and hygienic environment for the congested and densely
+  populated zones of habitation. Philanthropy must not continue to be
+  wholly misdirected, it must extend its aid to the deserving healthy and
+  fit, as well as to be exclusively the protecting agency of the diseased
+  and unfit. If life is the only wealth, and the preservation of childhood
+  the highest duty of society and the state,&mdash;which it would seem to
+  be, since the continuance and preservation of the race is obviously
+  essential to the continuance of the state itself,&mdash;the life of every
+  child must be considered an economic as well as a moral trust. If,
+  therefore, every child is sacred, every mother is equally sacred. If
+  every child is to be cared for, every mother must be cared for. If the
+  state cannot afford to provide for what is imperatively essential to its
+  own continuance, it might as well go out of existence, as it inevitably
+  will in the end on any other basis, and as all preceding states have
+  done.</p>
+
+  <p>Mothers must not be dependent upon their children's labor for their
+  maintenance, because if children are compelled to work, they will not be
+  able to work in the future,&mdash;and adult efficiency is necessary to
+  the well-being of the individual, the race, and the state.</p>
+
+  <p>No mother should work, because in the care of her children she is
+  already doing the supreme work. The proper care of children is so
+  continuous and exacting a task, and of such importance to posterity, that
+  it must be regarded as the highest and foremost work&mdash;and adequate
+  in itself&mdash;and its efficiency must not be hampered by mothers having
+  to do anything else.</p>
+
+  <p>Motherhood must not be financially insecure, because this would defeat
+  its eugenic purpose. Society, therefore, as a matter of
+  self-preservation, must ensure to woman her mental and economic security.
+  Civilization's margin is large enough to provide this. We spend large
+  amounts on luxuries and evils which are contrary to the genesis of
+  self-preservation, while motherhood is its basic necessity. When public
+  opinion is educated in the essentials of eugenics much of this can be,
+  and will be diverted to a nobler purpose. The total cost <!-- Page 19
+  --><span class="pagenum"><a name="page19"></a>[19]</span> necessary to
+  ensure the adequate care of dependent motherhood would be a mere fraction
+  of the national expenditure, and not a tithe of what we spend in pension
+  allowances yearly. The latter is regarded as an honorable debt and is at
+  best the direct product of a decadent ideal, while motherhood constitutes
+  the very germ of the only altruistic idealism for all the future.</p>
+
+  <p>We concede, therefore, that the children and the mothers must be
+  provided for, not only as a product of the true construction of the
+  ethics of sociology, but in obedience to the fundamental law of a moral
+  system of eugenics. We must go further and assert that children must be
+  cared for through the mother. It has been the practice to divorce the
+  improvident mother from her dependent children. This has been
+  demonstrated to be not only an altruistic fallacy. It has proved to be an
+  economic blunder.</p>
+
+  <p>There is another type of evil which largely menaces the eugenic ideal
+  of motherhood. It is those cases where married women who have children
+  are compelled to be the bread winners of the family as well as its
+  mothers. No woman can earn support for herself and children outside of
+  her home and competently assume the responsibilities of motherhood at the
+  same time. Whatever aid a mother renders to the state, as a result of
+  effort in factory or shop, is of infinitely less value, from an economic
+  standpoint, than her contribution as mother in caring for her own
+  children in her own home. A careful study of infant mortality, and the
+  conditions of child life, so far as survival value is concerned, condemns
+  in the strongest and most vital sense this whole practice. The
+  preservation of the race is the essential requisite, and it is the vital
+  industry of any people. Any seeming economic necessity which destroys
+  that industry is one that will contribute largely to the downfall of the
+  people as a race.</p>
+
+  <p><b>Eugenics and the Husband.</b>&mdash;The question of the husband's
+  moral and parental obligation, as dictated by the marriage institution
+  and constitution, may be left out of this discussion. We may assert,
+  however, that we do not believe the eugenic principle intends, in
+  devising ways <!-- Page 20 --><span class="pagenum"><a
+  name="page20"></a>[20]</span> and means for the adequate protection, in
+  its completest sense, of motherhood, to relieve the father of any of his
+  moral or parental obligations. These obligations will be justly defined,
+  and as previously stated, will be the subject of special state
+  legislation. No legislation of an economic character can detract from the
+  performance of a moral obligation, and by no process of sophistication
+  can modern statesmanship accomplish the dethronement of motherhood. The
+  duty of the father is to support his children and the mother of his
+  children, and the duty of the state is to see that this is done. The
+  fundamental law of the eugenist must be to recognize that fatherhood is a
+  deliberate and responsible act, for which a fixed accountability must be
+  maintained. Whatever legislation is undertaken in this connection must be
+  with the object in view of strengthening the efforts of the right kind of
+  father and husband, and of rendering more difficult the path of the
+  irresponsible father and husband. If the supreme duty of a state is the
+  maintenance of justice, its whole effort in the future will be to
+  legislate in harmony with the eugenic principle.</p>
+
+  <br clear="all" />
+<hr class="full" />
+
+<p><!-- Page 21 --><span class="pagenum"><a name="page21"></a>[21]</span></p>
+
+<h3>CHAPTER III</h3>
+
+<blockquote class="b1">
+
+  <p>"I hope to live to see the time when the increased efficiency in the
+  public health service&mdash;Federal, State and municipal&mdash;will show
+  itself in a greatly reduced death rate. The Federal Government can give a
+  powerful impulse to this end by creating a model public health
+  service."</p>
+
+  <p class="author"><font class="sc">Ex-President Taft</font>.</p>
+
+</blockquote>
+
+<h3>EUGENICS AND EDUCATION</h3>
+
+<blockquote class="b1">
+
+  <p><b>The Present Educational System is Inadequate&mdash;Opinions of Dr.
+  C. W. Saleeby, Ella Wheeler Wilcox, Luther Burbank, William D. Lewis,
+  Elizabeth Atwood, Dr. Thomas A. Story, William C. White, Dr. Helen C.
+  Putnam&mdash;Difficulty in Devising a Satisfactory Educational
+  System&mdash;Education an Important Function&mdash;The Function of the
+  High School&mdash;The High School System Fallacious&mdash;The True
+  Function of Education.</b></p>
+
+</blockquote>
+
+  <p>The fundamental law of eugenics demands that all education be exerted
+  for parenthood. We have proved that the child is not only essential to
+  the life of the state, but is the state. Consequently any function other
+  than parenthood is a non-essential so far as organic existence is
+  dependent upon it. Education can, therefore, have no higher or more
+  righteous motive than as a contributory agency in the perpetuation of the
+  function upon which all existence depends. If the only function of
+  education is to make one a worthy citizen, or to make him, or her,
+  self-supporting, or able to bear arms in defense of his country, rather
+  than a perfect link in the complete chain of enduring life, its purpose
+  is being perverted. It is not sufficient to provide a girl, for instance,
+  with an exclusive environment which regards her simply as a muscular
+  entity, as is the tendency in some of the "best" girls' schools to-day;
+  nor to fit her as a domestic or society ornament; nor must she be
+  regarded simply as an intellectual machine, as is done under the system
+  styled "the higher education of women." Any one of these is <!-- Page 22
+  --><span class="pagenum"><a name="page22"></a>[22]</span> an example of
+  misdirected excess and is only part of the whole. None of these systems
+  strives to develop the emotional side of the complex female character,
+  and any educational system which ignores the emotions is not only
+  inadequate but reprehensible in the highest degree. The ideal which will
+  strive for education for ultimate parenthood will more completely solve
+  the question of complete (eugenic) living.</p>
+
+  <p><b>The Present Educational System is Inadequate.</b>&mdash;There is no
+  question that education, as conducted at the present time, is one of the
+  most disastrous institutional fallacies of modern civilization. In
+  support of this contention, we are prompted to quote at length from
+  various authorities bearing on this subject.</p>
+
+  <p>Dr. C. W. Saleeby, an international authority on education, writes as
+  follows:</p>
+
+  <p>"A simple analogy will show the disastrous character of the present
+  process, which may be briefly described as 'education' by cram and
+  emetic. It is as if you filled a child's stomach to repletion with
+  marbles, pieces of coal and similar material incapable of
+  digestion&mdash;the more worthless the material the more accurate the
+  analogy&mdash;then applied an emetic and estimated your success by the
+  completeness with which everything was returned, more especially if it
+  was returned 'unchanged,' as the doctors say. Just so do we cram the
+  child's mental stomach, its memory, with a selection of dead facts of
+  history and the like (at least when they are not fictions) and then apply
+  a violent emetic called an examination (which like most other emetics
+  causes much depression) and estimate our success by the number of
+  statements which the child vomits onto the examination paper&mdash;if the
+  reader will excuse me. Further, if we are what we usually are, we prefer
+  that the statements shall come back 'unchanged'&mdash;showing no sign of
+  mental digestion. We call this 'training the memory.' The present type of
+  education is a curse to modern childhood and a menace to the future. The
+  teacher who cannot tell whether a child is doing well without formally
+  examining it, should be heaving bricks, but such a teacher does not
+  exist. In Berlin they are now learning that the depression caused <!--
+  Page 23 --><span class="pagenum"><a name="page23"></a>[23]</span> by
+  these emetics (examinations) often lead to child suicide&mdash;a steadily
+  increasing phenomenon mainly due to educational overpressure and worry
+  about examinations.</p>
+
+  <p>"Short of such appalling disasters, however, we have to reckon with
+  the existence of this enormous amount of stupidity, which those who
+  fortunately escaped such education in childhood have to drag along with
+  them in the long struggle towards the stars. This dead weight of inertia
+  lamentably retards progress.</p>
+
+  <p>"If you have been treated with marbles and emetics long enough, you
+  may begin to question whether there is such a <ins class="correction"
+  title="'think' (hand-corrected) in original">thing</ins> as nourishing
+  food; if you have been crammed with dead facts, and then compelled to
+  disgorge them, you may well question whether there are such things as
+  nourishing facts or ideas."</p>
+
+  <p>The gifted writer, Ella Wheeler Wilcox, in an editorial in the <i>New
+  York American</i>, expressed herself recently in the following terms:</p>
+
+  <p>"A wave of dissatisfaction is sweeping over the country regarding our
+  school system. And eventually this will cause a change to be made. The
+  larger understanding of mothers regarding education will result in the
+  personal element entering into the training of children.</p>
+
+  <p>"When women have a voice in the affairs of the nation there will be
+  more teachers, larger salaries, fewer pupils in each department, and more
+  attention will be given to the temperaments and varying dispositions of
+  children by their instructors.</p>
+
+  <p>"Instead of regarding the little ones who enter public schools as
+  machines which must be taught to go according to one rule, each child
+  will be studied as a threefold being, and his mind, body and spirit will
+  be cared for and developed according to his own peculiar needs. All this
+  will come slowly, but it will come.</p>
+
+  <p>"Before children enter the public schools there should be a great
+  sifting process under the direction of a national board of scientific
+  men. The brain equipment of each child, the tendencies given it at birth,
+  should be tested; then the nervous, hysterical and erratic minds <!--
+  Page 24 --><span class="pagenum"><a name="page24"></a>[24]</span> ought
+  to be placed in a school by themselves, under the care of men and women
+  who know the law of mental suggestion.</p>
+
+  <p>"Quiet, loving, wholesome rules, followed day after day and month
+  after month, would bring these children out into the light of
+  self-control and concentration. The hurried, crowding, exciting methods
+  of the public schools are disastrous to fully half of the unformed minds
+  sent into the intellectual maelstrom which America provides under the
+  name of Public Schools.</p>
+
+  <p>"For the well-born, normal-minded, healthy-bodied child, who has wise
+  and careful guardians or parents to assist in his mental guidance, the
+  public school forms a good basis on which to build an education. For the
+  average American child of excitable nerves and precocious tendencies, it
+  is like deep surf swimming for the inexperienced and adventurous
+  bather.</p>
+
+  <p>"The great foundation of education&mdash;character&mdash;is not taught
+  in the public schools. There is no systematized process of developing a
+  child's power of concentration; there is not time for this in the
+  cramming process now in vogue and with the enormous pressure placed on
+  teachers. No teacher can do justice to more than fifteen children through
+  the school hours. In many of our public schools there are fifty and sixty
+  children under one instructor. This is fatal to the nervous system of the
+  teacher and deprives the pupils of that personal sympathy which is of
+  such vital importance."</p>
+
+  <p>Luther Burbank, the famous California horticulturist, declares that
+  the great object and aim of his life is to apply to the training of
+  children those scientific ideas which he has so successfully employed in
+  working transformation in plant life.</p>
+
+  <p>In an editorial, entitled, "Teaching Health," the <i>New York
+  Globe</i> states, "Anatomy and physiology are reasonably exact sciences,
+  and nine-tenths of the hygienic abuses against which the doctors are
+  preaching would be prevented if the laity had an elementary knowledge of
+  physiology. Such an educational reform could be carried out without
+  causing any clash whatever between the warring medical sects." <!-- Page
+  25 --><span class="pagenum"><a name="page25"></a>[25]</span></p>
+
+  <p>William D. Lewis, Principal of the William Penn School, Philadelphia,
+  in an article entitled: "The High School and the Girl," in a recent issue
+  of the <i>Saturday Evening Post</i>, wrote in part as follows:</p>
+
+  <p>... "The first thing that society wants of our girl is good health.
+  This is the first essential for her efficient service and personal
+  happiness in shop, office, store, school or home. The future of the race
+  so far as she represents it, depends upon her health. What is the high
+  school doing to improve the girl's health? In the overwhelming majority
+  of cases absolutely nothing. On the other hand, it is subjecting her to a
+  regimen planned for boys, without the slightest consideration of the
+  physical and functional differences between the sexes.</p>
+
+  <p>"It pays no attention to the curvature of the spine developed by the
+  exclusively sit-at-a-desk-and-study-a-book type of education bequeathed
+  to the girlhood of the nation by the medieval monastery: It ignores the
+  chorea, otherwise known as St. Vitus' dance developed by overstudy and
+  underexercise; it disregards the malnutrition of hasty breakfasts, and
+  lunches of pickles, fudge, cream-puffs and other kickshaws, not to
+  mention the catch penny trash too often provided by the janitor or
+  concessionaire of the school luncheon, who isn't doing business for his
+  health or for anybody else's; it neglects eye-strain, unhygienic dress,
+  uncleanly habits, anemia, periodic headaches, nervousness, adenoids, and
+  wrong habits of posture and movements.... If you believe that the high
+  school is a social institution with a mission of public service,
+  regardless of the relation of that service to Latin or Algebra, then you
+  must agree that it should look after what everyone recognizes as the
+  foremost need of the adolescent girl.</p>
+
+  <p>"One fact that every educator in both camps knows is that the home is
+  not attending to the health of the adolescent girl. This problem is
+  pressing upon us now largely because of the revolutions in living
+  conditions that has come within the last quarter of a century."</p>
+
+  <p>In a report of a recent Conference on the <!-- Page 26 --><span
+  class="pagenum"><a name="page26"></a>[26]</span> Conservation of School
+  Children held at Lehigh University by the American Academy of Medicine,
+  the following items appear.</p>
+
+  <p>Four great reasons why medical inspection in schools is needed were
+  brought out by Dr. Thomas A. Story of New York, who spoke from the
+  educator's standpoint:</p>
+
+  <p>"The first reason is concerned with communicable diseases, and the
+  second with remediable incapacitating physical defects. It was reported
+  in 1906 that over twenty per cent. of the children in the schools of New
+  York City had defective vision, and over fifty per cent. had defective
+  teeth. These defective conditions are amenable to treatment whereby the
+  functional efficiency of the pupil is improved. He is capable of better
+  work and the school efficiency is advanced.</p>
+
+  <p>"The third reason is concerned with irremediable physical defects. The
+  cripples, the deformed and the delinquents whose incapacitating defects
+  are permanent should be found and classified. This enables special
+  instruction and opens up educational possibilities otherwise
+  unattainable, besides removing retarding factors in the progress of the
+  normal pupil.</p>
+
+  <p>"The fourth reason is concerned with the development of hygienic
+  habits in the school child, and through the child, of the community.
+  Medical inspection which influences the health habits of the masses is a
+  matter of supreme importance. The teacher will have pupils of cleaner
+  habits and healthier, with fewer interruptions and disturbances from
+  absences.</p>
+
+  <p>"To make medical inspection successful physical examinations should
+  uncover the anatomic, physiologic, and hygienic conditions. Every piece
+  of advice given to a pupil that can be followed up should be followed up
+  and the result recorded. No system of medical inspection in schools can
+  be complete and permanently successful which does not eventually educate
+  the parent and child to a sympathetic and coöperative relationship with
+  the system. Medical inspection is a force working for a better general
+  education in personal hygiene and should coördinate with the class room
+  instruction. Hence it <!-- Page 27 --><span class="pagenum"><a
+  name="page27"></a>[27]</span> must be a system in sympathetic
+  relationship with the general management of the school, and should be
+  under the same responsible control. Since it is an educational influence
+  and so directly related to the success of the school, it ought to be a
+  part of the school organization."</p>
+
+  <p>A paper was read by Dr. Helen C. Putnam of Providence, R. I., on "The
+  Teaching of Hygiene for Better Parentage." She said:</p>
+
+  <p>"Life is a trust from fathers and mothers beginning before history; to
+  be guarded and bettered in one's turn, and passed along to children's
+  children. A definite conception of this trust is essential to right
+  living. Educators are finding that well directed correlation of human
+  life, with phenomena of growing things in school gardens and nature
+  studies, develops a wholesome mental attitude. Since tens of millions of
+  our population have only fractions of primary schooling, there is where
+  the teaching must begin. These primary years are the time to lay
+  foundations before a wrong bias is established.</p>
+
+  <p>"Education for parenthood cannot be completed at this early age. The
+  strategic years for making it most effective are from sixteen to
+  twenty-four, when home-making instincts are waking and strongest. We have
+  15,000,000 young people of these ages in no schools, and eligible for
+  such instruction. All state boards of education were recently petitioned
+  by the American Association for Study and Prevention of Infant Mortality
+  to urge the appointment of commissions on continuation schools of
+  home-making, to investigate conditions and needs in their respective
+  states and to report plans for meeting them effectively through such
+  continuation schools or classes."</p>
+
+  <p><b>Difficulty in Devising a Satisfactory Educational
+  System.</b>&mdash;It will be observed that each of these authoritative
+  writers criticises the system of education now in vogue. The criticism is
+  not, nor could it justly be, specialized. It is simply an expression,
+  from different viewpoints, of the feeling that we are not doing ourselves
+  justice as yet, we are groping after something better. It <!-- Page 28
+  --><span class="pagenum"><a name="page28"></a>[28]</span> may be, as I
+  have previously stated, that no satisfactory system of education will be
+  evolved until the laws of kindred sciences, which have organic
+  relationship to what we understand as education, are fixed and better
+  understood. We are just beginning to appreciate the true meaning of
+  environment. We know little about heredity, but enough to appreciate its
+  vital importance. Psychology is a realm of much hope, but we have only
+  tasted of its surface promise and know little of the mysteries it may
+  unfold. Eugenics, the infant giant of science, promises to establish the
+  race on an enduring foundation. These sciences have laws which we do not
+  yet understand; they relate to that part of human evolution which mind
+  dominates. The quality of the mind's dominion depends upon the mind's
+  education and environment, and since the laws of these sciences, upon
+  which a perfect system of education depends, have not been revealed, it
+  is quite evident that all past systems of education have been more or
+  less deficient. It is further evident that evolution has suffered as a
+  result of the mind's imperfect education,&mdash;a condition that is
+  manifest all around us.</p>
+
+  <p>It must be appreciated, however, that we are discussing a large
+  subject. If we understood all there is to know about environment; if we
+  knew the laws of heredity, and psychology, and eugenics, and then could
+  apply them, and educate the product of this combination of forces, we
+  would be very near to the super-man. One must have a sober mental horizon
+  to evolve the picture which would be the product of the above solution
+  and then to estimate its meaning on human happiness and progress. We are
+  approaching the ethics of right living,&mdash;of justice and
+  truth,&mdash;the divine in man. At no time in the history of man has
+  civilization been so near a solution of life's supreme problem as at the
+  present moment.</p>
+
+  <p>Education is an important function in life's scheme, and while we may
+  regret that it is not possible to formulate a system that would be
+  perfect and capable of immediate application, we can continue to work
+  patiently and hopefully, with assurance that in the near future the
+  problem will be satisfactorily solved. When heredity, <!-- Page 29
+  --><span class="pagenum"><a name="page29"></a>[29]</span> psychology, and
+  eugenics combine to dictate the system, we shall doubtless find, that, in
+  the beginning, it will be a system of individualization. In the interest
+  of health and of justice, and consequently of efficiency, this would seem
+  to be the natural and the logical lead.</p>
+
+  <p>So long as human nature is as it is, we must meet conditions as they
+  exist. We know as parents, and some of us know as physicians, that a task
+  easily performed by one individual, without any apparent harmful results,
+  will tax the capacity of another individual to the very utmost. Any
+  educational system which does not recognize this law, is vicious. Yet
+  such is the system in vogue to-day in America. We must adapt the burden
+  to the endurance of the pupil. The administration of an educational
+  machinery must solve this problem from the individual standpoint.</p>
+
+  <p>In the departmental work in our public schools there seems to be no
+  system. Each teacher prescribes home work without any knowledge of what
+  others of the same grade do, and without any apparent consideration in
+  favor of the individual pupil. The result is that the total amount for
+  each night is absurdly in excess of the capacity of the ordinary, or for
+  that matter the extraordinary, pupil. This engenders nervousness and
+  irritability, and is contrary to the ethics of education,&mdash;the
+  fundamental law of which should be the preservation of good health. We
+  must have regard for the physical and mental health of each pupil, and as
+  the capacity of each pupil is different, the system is committing an
+  egregious wrong by sacrificing the weaker instead of adapting the burden
+  according to the strength and endurance of the bearer.</p>
+
+  <p><b>The High School System Fallacious.</b>&mdash;Even the high schools
+  do not seem to be wisely availing themselves of their opportunity from
+  the eugenic or economic standpoint. According to the report of the
+  Commissioner of Education of the United States the percentage of pupils
+  studying some of the more important subjects in the year 1909-1910 is
+  stated as follows: <!-- Page 30 --><span class="pagenum"><a
+  name="page30"></a>[30]</span></p>
+
+<pre>
+Latin, French and German         83 per cent.
+Algebra and Geometry             88  "    "
+English Literature               57  "    "
+Rhetoric                         57  "    "
+History                          55  "    "
+Domestic Economy,--including
+  sewing, cooking and household
+  economies                       4  "    "
+</pre>
+  <p>If only barely four per cent. of the girls in our high schools are
+  studying subjects which directly contribute to their efficiency as
+  home-makers, what are the prospects for worthy parenthood in the light of
+  the fact that seventy-five per cent. of all women between the ages of
+  twenty and twenty-four are married?</p>
+
+  <p>The function of the high school, so far as girls are concerned, is to
+  conserve health, to train for domestic efficiency and motherhood, and if
+  necessary for economic independence. It must also furnish the stimulus
+  for mental culture and direct a proper aspiration for social
+  enlightenment. The curriculum should include biology, hygiene,
+  psychology, home beautifying, the story-telling side of literature, music
+  and a few other studies tending to make woman more like woman than she is
+  to-day. When we have this, teaching for mothercraft will be more nearly
+  realized.</p>
+
+  <p>From the eugenic standpoint the present system of education is not
+  satisfactory. To attain our end it is essential to devise other means of
+  education. It must be remembered, however, that no system of education
+  alone can ever enable us to achieve our end, no matter how perfect the
+  system may be. Education can only draw out what is in the child; it
+  cannot draw out what is not there. What the child is, depends upon its
+  heredity. The pedagogic ability of the school-master will never make a
+  genius.</p>
+
+  <p>A child's mind may be likened to a block puzzle, each block
+  representing a part of a picture, which can only be completed when they
+  are all arranged in their correct places. Each block is an ancestral
+  legacy,&mdash;the child's heritage&mdash;and to find its proper place in
+  order to <!-- Page 31 --><span class="pagenum"><a
+  name="page31"></a>[31]</span> complete the character picture&mdash;to
+  solve the riddle of the jumbled blocks,&mdash;is the duty of the
+  educator. He can only manipulate what is there, and the test of his
+  system will depend upon his ability to solve the puzzle of the ancestral
+  blocks. We must divorce ourselves from the idea that a child's mind, at
+  the beginning, is an empty space, to be filled in with knowledge
+  according to the ability of the teacher; or that it is like a sheet of
+  paper, to be written upon. Education, and the educator, is absolutely
+  limited to "drawing out" what heredity put there. Education frequently is
+  given credit which rightly belongs to nature. A child cannot do certain
+  things until nature intends that it should. A baby cannot possibly walk
+  until the nervous mechanism which controls the function of walking is
+  developed. Many children walk at the first attempt, simply because they
+  did not make the first attempt until after nature had perfected the
+  mechanism and the innate ability to walk was already there. Suppose we
+  tried to teach that baby to walk a month before nature was ready; each
+  day we patiently coax it to "step out," we guide it from support to
+  support, and we protect it from stumbling. Some day it walks, and we
+  congratulate ourselves on the victory, when as a matter of fact, we not
+  only had nothing to do with it but were impertinent meddlers, not
+  instructors. Nature was the teacher and she was quite capable of
+  completing the task without our aid. It is reasonable also to assume that
+  any effort to force a natural function is quite likely to do much harm.
+  We have found this to be so in various departments of education when the
+  system was wrongly conceived. In physical culture this principle has been
+  demonstrated over and over again.</p>
+
+  <p>If our ancestral legacy is a good one, our picture blocks will be
+  numerous and it will be possible for the proper system of education,
+  aided by a suitable environment, to arrange them into many designs. If,
+  on the other hand, our heredity did not endow us abundantly the number of
+  our picture blocks may be limited to three or four, and they will be
+  easily arranged so as to form a simple picture. The one represents a
+  child whom heredity has richly endowed, the other one whom it has <!--
+  Page 32 --><span class="pagenum"><a name="page32"></a>[32]</span>
+  meagerly supplied with innate possibilities. Heredity therefore dictates
+  the function of education; and the school-master can only fashion the
+  picture put there. If the ancestral blocks are not there with which to
+  make an elaborate picture he must content himself with what is
+  there,&mdash;he or his art cannot create others. When he congratulates
+  himself on achieving a wonderful result in graduating a particularly
+  brilliant student, he is taking to himself unmerited honors. If his
+  individual ability is responsible in one instance, why not apply the same
+  system to all pupils? If this system is responsible for the brilliancy of
+  one pupil, why does not the same system make all brilliant? The reader
+  knows the answer,&mdash;because heredity did not endow them equally. Men
+  are not born equal, despite the Declaration of Independence.</p>
+
+  <p>The school-master is not responsible for the apt and the inapt pupil.
+  He is responsible for his system which dictates how he will differentiate
+  between the apt and the inapt pupil, in order to achieve the best results
+  without injustice to either.</p>
+
+  <p>The inefficient teacher is a dangerous equation in the school system.
+  I mean by inefficiency, the quality of being temperamentally unsuited to
+  the profession. There are a large number of anemic, hysterical young
+  women teaching in the public schools of our cities who should not be
+  there. They should not be there in justice to themselves, nor should they
+  be there in justice to their pupils. A strict, yearly medical examination
+  should be made of the teachers to decide their physical and psychical
+  fitness to fill their positions adequately. One teacher, physically or
+  psychically inefficient, can do an inconceivable amount of harm in one
+  school term. We cannot afford to experiment along this line. It means too
+  much, and even at the price of one unhappy child it is too much to pay.
+  The teacher who feels that she is not suited to the work; who has
+  constantly to hold herself and her temper under control; whose nerves are
+  such that she cannot do justice to herself, whose sense of justice is
+  capable of perversion on purely sentimental grounds; or who has
+  lost&mdash;or never possessed&mdash;the gift of maintaining discipline,
+  should promptly find another <!-- Page 33 --><span class="pagenum"><a
+  name="page33"></a>[33]</span> position. She is earning her salary under
+  false pretenses, and that alone condemns her. I believe, that a large
+  percentage of the inefficiency of the New York Schools is due, not to the
+  academic or scholastic inability of the average teacher, but to the
+  average female teacher's physical, and especially her psychical unfitness
+  to teach. We must concede, however, that in many instances the teacher's
+  unfitness is a direct product of the pernicious system itself.</p>
+
+  <div class="figcenter" style="width:50%;">
+      <a href="images/v1fig002l.jpg"><img width="100%" src="images/v1fig002l.jpg"
+      alt="Evidence of a Feeble Mind" /></a>
+    <p><i>From "The Village of a Thousand Souls," Gesell, American
+    Magazine</i></p>
+
+    <h4>Evidence of a Feeble Mind</h4>
+
+    <p>A dirty shack in a mud hole in the country is merely another
+    reflection of the same condition that causes the slums of the city. In
+    our glowing spirit of humanity we cry out to raise up "the submerged
+    tenth." Rather, should we not stamp them out of existence&mdash;treat
+    them as a menace, and not as a thing of pity?</p>
+
+    <p>Men, in general, rise; their minds are subjectively or objectively
+    educated to their mental limit. They cannot go beyond it. "The
+    submerged tenth" exists because its mental limit is low&mdash;often
+    close to the upper margins of feeble-mindedness&mdash;and because it is
+    mentally incapable of rising to anything else.</p>
+  </div>
+  <div class="figcenter" style="width:50%;">
+      <a href="images/v1fig002r.jpg"><img width="100%" src="images/v1fig002r.jpg"
+      alt="Evidence of a Vigorous Mind" /></a>
+    <p><i>From "The Village of a Thousand Souls," Gesell, American
+    Magazine</i></p>
+
+    <h4>Evidence of a Vigorous Mind</h4>
+
+    <p>The family that is vigorous, healthy in mind and body, "up and
+    coming," reflects itself in a hundred different ways. Small matter
+    whether or not it is "an old family," has wealth, social position, a
+    college education. A daughter's or a son's happiness, the real,
+    deep-down-inside happiness that is worth while, may be more certainly
+    insured by marrying with an eye to mentality and stock than by a
+    marriage into a so-called "first family."</p>
+
+    <p>Eugenics hath its reward.</p>
+  </div>
+  <p>Under an ideal system of education the child would be left absolutely
+  free until the age of seven. We do not believe that the physical
+  apparatus of the mind is prepared for educational interference before
+  that age, and we know that the growth of the brain, physiologically and
+  anatomically, is not complete until after the seventh year.</p>
+
+  <p>The greater portion of a child's education necessarily depends upon
+  its environment. Heredity and environment, therefore, are the two factors
+  which determine the characters of any living thing. Heredity gives to the
+  child its potential greatness,&mdash;its promise of greatness. Whether
+  these potential qualities ever become real depends upon environment. A
+  child may have the hereditary (innate) ability to become a Shakespeare,
+  but if his environment is not suitable to the development of this
+  potential greatness, he will never realize his hereditary promise. In
+  other words, the innate qualities which he has, and which will make of
+  him a Shakespeare are never "drawn out" or educated. Hence he can never
+  become great until environment furnishes the means to him.</p>
+
+  <p>Environment, including education, does not add to the potential
+  qualities of inheritance. Education can only educate what heredity gives;
+  it can give or add nothing itself; it simply educates what is there
+  already. There is plenty of material, but it is not the right material.
+  What educators want is the right kind of material&mdash;the material
+  which the eugenists will eventually supply. Or as Mr. Havelock Ellis has
+  expressed it:</p>
+
+  <p>"Education has been put at the beginning, when it ought to have been
+  put at the end. It matters <!-- Page 34 --><span class="pagenum"><a
+  name="page34"></a>[34]</span> comparatively little what sort of education
+  we give children; the primary matter is what sort of children we have to
+  educate. That is the most fundamental of questions. It lies deeper even
+  than the great question of Socialism versus Individualism, and indeed
+  touches a foundation that is common to both. The best organized social
+  system is only a house of cards if it cannot be constructed with sound
+  individuals; and no individualism worth the name is possible unless a
+  sound social organization permits the breeding of individuals who count.
+  On this plane Socialism and Individualism move in the same circle."</p>
+
+  <p>Education, then, as an exclusive factor, cannot achieve our ideal of
+  race-culture. In order that education may achieve a large measure of
+  success, it must have the proper material, and the right material can
+  only come as a result of the working out of the eugenic principle.
+  Then&mdash;in the aftertime&mdash;our educational efforts will not be
+  wasted and misdirected, as they are almost wholly to-day.</p>
+
+  <p>If we could transmit our acquired characteristics, education would
+  have a relatively smaller, and a much more fixed function in the "general
+  scheme," but we cannot. We can only transmit what was inherent in us when
+  created. This simply means that, at the moment of conception, the child
+  is created,&mdash;it is a completed whole,&mdash;what it is to be is
+  fixed at that moment, its inherent capacities are formed. Nothing can
+  affect it, in this sense, after that moment. No act of either parent can
+  have any influence on it. Whatever ability the father or mother possessed
+  of an innate character is transmitted to the child at the instant of
+  conception and that innate legacy constitutes the working instrument of
+  the child for all time. It cannot be added to by education, or by
+  environment, but both of these may have a large influence in deciding
+  whether it will be developed to its highest possible limit of
+  attainment.</p>
+
+  <p>Education, mental, moral and physical, is limited by this inability to
+  transmit acquired character to the persons educated. Each generation
+  must, therefore, begin, not where their parents left off, but at the
+  point where <!-- Page 35 --><span class="pagenum"><a
+  name="page35"></a>[35]</span> they began. The same difficulties and the
+  same problems must be met at the beginning of each generation.</p>
+
+  <p><b>The True Province of Education.</b>&mdash;Education may justly be
+  the instrument, however, which will educate public opinion to a true
+  appreciation of the function of race culture. In this way the cause of
+  the eugenist will greatly prosper, and the race will profit through the
+  effort which will further the conservation of the best and most fit
+  specimens for parenthood. So also may education, through the molding of
+  public opinion, create sound opinion,&mdash;when each individual will be
+  a center of eugenic enthusiasm. Especially does this responsibility fall
+  upon parents and those who are in charge of childhood. The young must be
+  taught the supreme sanctity of parenthood. They must be instructed in
+  eugenic principles in a way that will impart to them the definite
+  knowledge that it is the highest and holiest science. The eugenic
+  education of children is the real beginning at the beginning, the
+  indispensable necessity, if race culture is to assume its transcendent
+  role in modern civilization. It is urgently necessary for both sexes but
+  more especially for girls. "Urgently necessary," because, though Herbert
+  Spencer wrote the following criticism nearly fifty years ago, the
+  conditions are much the same to-day:&mdash;</p>
+
+  <p>... "But though some care is taken to fit youth of both sexes for
+  society and citizenship, no care whatever is taken to fit them for the
+  position of parents. While it is seen that, for the purpose of gaining a
+  livelihood, an elaborate preparation is needed, it appears to be thought
+  that for the bringing up of children, no preparation whatever is needed.
+  While many years are spent by a boy in gaining knowledge of which the
+  chief value is that it constitutes 'the education of a gentleman'; and
+  while many years are spent by a girl in those decorative acquirements
+  which fit her for evening parties; not an hour is spent by either in
+  preparation for that gravest of all responsibilities&mdash;the management
+  of a family. Is it that this responsibility is but a remote contingency?
+  On the contrary, it is sure to develop on nine out of ten. Is it that the
+  discharge of it is easy? Certainly not. Of all functions which the adult
+  has to fulfill, this is the <!-- Page 36 --><span class="pagenum"><a
+  name="page36"></a>[36]</span> most difficult. Is it that each may be
+  trusted by self-instruction to fit himself, or herself, for the office of
+  parent? No; not only is the need for such self-instruction unrecognized,
+  but the complexity of the subject renders it the one of all others in
+  which self-instruction is least likely to succeed."</p>
+
+  <p>It must be our highest educational aim to cultivate or create the
+  eugenic sense. In this way, and in this way only, may we feel satisfied
+  that the foundation, upon which shall be erected the generations that are
+  yet to come, will be of an enduring character.</p>
+
+  <br clear="all" />
+<hr class="full" />
+
+<p><!-- Page 37 --><span class="pagenum"><a name="page37"></a>[37]</span></p>
+
+<h3>CHAPTER IV</h3>
+
+<blockquote class="b1">
+
+  <p>"It is only because we are accustomed to this waste of life and are
+  prone to think it is one of the dispensations of Providence that we go on
+  about our business, little thinking of the preventive measures that are
+  possible."</p>
+
+  <p class="author"><font class="sc">Charles E. Hughes</font>.</p>
+
+</blockquote>
+
+<h3>EUGENICS AND THE UNFIT</h3>
+
+<blockquote class="b1">
+
+  <p><b>The Deaf and Dumb&mdash;The Feeble-minded&mdash;A New York
+  Magistrate's Report&mdash;Report of the Children's Society&mdash;The
+  Segregation and Treatment of the Feeble-Minded&mdash;What the Care of the
+  Insane Costs&mdash;The Alcoholic&mdash;Drunkenness.</b></p>
+
+</blockquote>
+
+  <p>In order to achieve success in eugenics we must strive to encourage
+  the parenthood of the worthy or fit, and to discourage the parenthood of
+  the unworthy or unfit. The unfit are those, as previously explained, who,
+  because of mental or physical disability, are unable to create fit or
+  healthy children.</p>
+
+  <p><b>The Deaf and Dumb.</b>&mdash;The condition known as deaf-mutism is
+  due to innate defect in about half of all cases. Deaf children have one
+  or two deaf parents or grandparents. There may be two or three such
+  children in a family. That the deaf should not marry is generally
+  conceded by those who work amongst them. It should be our aim to
+  discourage the intimate association of the adolescent deaf and dumb in
+  institutions. It has been found that such intimate association frequently
+  results in marriage. They should be educated and instructed in the
+  knowledge that they cannot marry. When they understand the eugenic
+  principle upon which this social law is constructed they will be amenable
+  to reason. No process of suasion will be necessary, however, if their
+  intimate association is prevented.</p>
+
+  <p><b>The Feeble-Minded.</b>&mdash;This includes the criminal, the
+  imbecile, the insane, and the epileptic. The feeble-minded, technically
+  speaking, belong to the degenerate <!-- Page 38 --><span
+  class="pagenum"><a name="page38"></a>[38]</span> class. They enter life
+  mentally deficient, not necessarily diseased. They should, therefore, be
+  regarded as fit subjects for educational modification rather than for
+  penal correction or punishment. It is conservatively estimated that there
+  are five million feeble-minded people in the United States to-day and not
+  one-eighth of them are receiving adequate treatment or education. Recent
+  statistics, from various countries, show that the percentage of deficient
+  or feeble-minded children is decidedly on the increase. According to a
+  bulletin issued by the United States Bureau of Education (August, 1912)
+  there are 15,000,000 school children suffering from physical defects
+  which need immediate attention and which are prejudicial to health. It
+  would seem as though the time had passed for anything other than radical
+  measures in the interest of the race.</p>
+
+  <p>Apart from the eugenic fact that these feeble-minded children are not
+  fit subjects for parenthood, they are a constantly contaminating
+  influence on society morally, and are a detriment and a hindrance to
+  social and economic advancement. One illustration of this contaminating
+  process, which is of serious eugenic import, is the presence of these
+  deficient children in our public schools. By reason of their lack of
+  attention and concentration, their mental or psychic insufficiency, their
+  moral delinquency, and uncontrollable instincts and impulses, they are a
+  menace to the well-being and to the progress of the normal or fit pupils;
+  they retard and undermine the discipline of the schoolroom, and they
+  affect the efficiency of the teachers. They are allowed to stay in school
+  because of the indifference of the authorities, or because of the
+  influence and social standing, or political "pull" of the parents,
+  despite the recognition of the injustice done. Many of the parents of
+  these children seek medical advice but, because of absurdly inadequate
+  civic or state provision for such cases, the physician is practically
+  helpless. Most of these irresponsible children are allowed to wander
+  through the years unrestrained and unprotected. They easily become the
+  victims of vice and crime, and eventually they become degenerates and end
+  their lives in insane institutions. Because of the stigma <!-- Page 39
+  --><span class="pagenum"><a name="page39"></a>[39]</span> of degeneration
+  these feeble-minded individuals fall into the hands of the law and are
+  thereby robbed of the medical assistance which society should afford them
+  in the early years when improvement is yet possible.</p>
+
+  <p>The following report which recently appeared in one of the daily
+  papers is interesting and suggestive in this connection. One of the New
+  York City Magistrates, in his annual report, said: "There is growing up
+  in this city a menacing army of boys and young men who are the most
+  troublesome element we have to deal with.... From the ranks of these
+  rowdies that are organized in bands, or bound up with chums or pals, come
+  most of the crop of burglars, truck thieves, holdup men, gun-bearers,
+  so-called 'bad men' and other criminals and dangerous characters. Without
+  reverence for anything, subject to no parental control, cynical,
+  viciously wise beyond their years, utterly regardless of the rights of
+  others, firmly determined not to work for a living, terrorizing the
+  occupants of public vehicles and disturbing the peace of the
+  neighborhoods, they have no regard for common decency."</p>
+
+  <p>But it is to the records of the Children's Society that one must go
+  for reliable statistics of the potential criminal, as there the only
+  systematic study of their conditions is made and recorded by one of the
+  greatest neurologists in the country, Dr. Max Schlapp, of New York. As a
+  specialist in nervous diseases he has been connected with the Children's
+  Society and the Children's Court, where he has had wide opportunities for
+  observing the relation between delinquence and mental defectiveness. In
+  cases of viciousness or feeble-mindedness exhaustive studies have been
+  made by Dr. Schlapp. And the extent to which society is daily at the
+  mercy of uncontrolled potential criminality is alarming.</p>
+
+  <p>"Feeble-minded children and feeble-minded men," says Dr. Schlapp, "are
+  roaming about the streets of New York to-day as free agents. Parents are
+  not compelled by law to put a feeble-minded child in custody. Yet that
+  feeble-minded child unsuspected as such, amiable and care-free as he
+  usually is, is potentially a criminal, and at any moment may commit a
+  crime. That child is permitted <!-- Page 40 --><span class="pagenum"><a
+  name="page40"></a>[40]</span> to grow up without restraint, except such
+  as the parents exercise, and this has no effect whatever in these cases.
+  The child is allowed to marry and bring forth children of his own kind,
+  more feeble-minded and more dangerous. There is no system designed to
+  pick out from the community persons so afflicted, and no law whatever to
+  prevent their untrammelled movements.</p>
+
+  <p>"The city street is a recruiting ground for the <ins
+  class="correction" title="'ganster' in original">gangster</ins> because
+  it is full of defective children, mental and moral, who are potential
+  criminals. This question has never been seriously considered. When
+  brought under corrective restraint it has hitherto long been the custom
+  to herd all the cases together while serving time. But in 1894 the German
+  Government woke up to the fact that 3 to 7 per cent. of city children and
+  those of isolated rural communities contain the 'moron,' or
+  intellectually defective type, together with the moral imbecile."</p>
+
+  <p>Investigation showed recently that in a reformatory near Berlin 63 per
+  cent. of the inmates were abnormal, while over 50 per cent. were
+  seriously defective or menaces to society. This has since been shown to
+  exist in all the leading nations&mdash;England, France, Italy, where, by
+  the way, the Camorrist type is the equivalent for our New York gangster.
+  In the Elmira Reformatory 38 per cent. are, as a rule, feeble-minded and
+  consist of types that repeat their offense against society or commit some
+  other crime.</p>
+
+  <p>There is only one way to prevent these types from becoming a menace.
+  Restrain them while they are still developing; keep them from becoming
+  free agents in the community they menace. Types continually come up in
+  the Children's Society and the Children's Court. They are carefully
+  studied. From the actions of the child, from his parents and family
+  history, from the frequency with which he repeats some offense
+  particularly pleasing to him, and by virtue of psychological tests and
+  careful medical examinations the examiners are able to pick out children
+  who should receive scientific care and treatment.</p>
+
+  <p>"The characteristics of the feeble-minded are usually deceiving. One
+  expects to find them with low brows and furtive looks and more or less
+  vicious in appearance <!-- Page 41 --><span class="pagenum"><a
+  name="page41"></a>[41]</span> after they develop criminal tendencies. One
+  would expect them to show stupidity at a glance. On the contrary, they
+  are sometimes bright on the surface, amiable, good-tempered under trying
+  conditions, and almost likeable for their external social side. This is
+  particularly true of the high grade defectives. The lower order may be
+  taciturn, gloomy and retiring, and these traits may be noticed almost
+  from infancy. But as they grow up their social nature may be developed,
+  and they too may give the appearance of amiableness. One notable thing
+  about them is their pose of frank innocence. In this they are engaging,
+  and almost convincing.</p>
+
+  <p>"The street type that makes a gangster is practically the same if
+  cruder in development. These children usually exhibit absolutely no sign
+  of affection for their parents, no sympathy, and are notably cruel toward
+  animals. One boy we had in the Children's Society persistently killed all
+  the dogs and cats his family kept. Finally, when they ceased keeping the
+  animals he got at the canary cage and killed the bird by pulling the
+  feathers out singly. He had no compunction about lying, and looked you
+  right in the eye when he lied. Otherwise he was charming and
+  natural."</p>
+
+  <p>While moral insanity is hereditary, yet it can be produced in one
+  generation. An alcoholic man with clean antecedents may leave tainted
+  descendants. The only way to combat these conditions in the city is to
+  have strict registration of all feeble-minded and insane. The state
+  should discover them, examine them through public officials, and
+  segregate them. Not only physicians, but school teachers and officials in
+  public institutions should detect them. There should be in each state an
+  institution for feeble-minded delinquents.</p>
+
+  <p>The history of the average "gangster" shows a taint of alcoholism.
+  This is further aggravated by living under immoral surroundings, where
+  petty crimes like stealing and lying are considered "smart." This is the
+  starting point of the New York "gangster." He is handicapped, and under
+  ancestral disabilities and the disadvantages of environment that is
+  pernicious, he cannot get very far. A boy usually qualifies with a gang
+  on his <!-- Page 42 --><span class="pagenum"><a
+  name="page42"></a>[42]</span> own personality and tastes. He will often
+  wander from one gang to another until he has found his particular
+  atmosphere. The best will never find any one gang congenial enough to
+  hold him, and he finally emerges a decent citizen. It is all a process of
+  finding himself. The aim of the police should be to discount as much as
+  possible any swaggering and false hero worship.</p>
+
+  <p>The time has come when this great nation should take national
+  cognizance of this problem. There should be a national institution on
+  some isolated island. Civilization is coming to recognize such a
+  necessity. With a close eye on the tide of immigration and a careful
+  segregation of these defective types, we should soon rid ourselves of
+  what is now growing to be a serious menace to the home and the
+  nation.</p>
+
+  <p><b>The Segregation and Treatment of the Feeble-Minded.</b>&mdash;Dr.
+  John Punton, of Kansas City, Mo., in an able and exhaustive article on
+  "The Segregation and Treatment of the Feeble-Minded," writes as
+  follows:</p>
+
+  <p>"Your attention is directed to a recent report issued by Wentworth E.
+  Griffin, Chief of Police of Kansas City, Mo., in which he claims that
+  recently within six months' time no less than 2,480 juveniles were
+  arrested charged with crimes ranging from vagrancy to murder and that the
+  majority of these boys and girls were not normal children, but
+  degenerates who required medical rather than penal treatment. 'Boys and
+  girls,' says he, 'should not receive correction in the city jails, the
+  work house or reformatories. These should be the last resort. To correct
+  a boy you must have an idea of his mental processes. It is natural that
+  the parents understand something of the child and use that knowledge to
+  make a good boy out of him. Certainly it cannot be done in the
+  reformatories, for although the authorities there are competent, they are
+  hardly medical psychologists. In my opinion, if any progress is to be
+  made it is the parent and the doctor that must do the work, not the
+  police and the courts.'</p>
+
+  <p>"That our Chief of Police deserves credit for not only publishing this
+  report, but also for the advanced position he takes in recognizing the
+  appropriate care and treatment <!-- Page 43 --><span class="pagenum"><a
+  name="page43"></a>[43]</span> of the juvenile offender, is certain, for
+  he understands the fact that the parents are often the chief culprits in
+  the child's delinquency and that medical rather than penal treatment is
+  more often indicated than is at present allowed or practiced.</p>
+
+  <p>"When we come to inquire into the cause of feeble-mindedness,
+  alcoholic heredity, syphilitic heredity, and consanguineous marriages are
+  found to be the chief etiological factors. Bourneville claims that 48 per
+  cent. of the idiots and imbeciles are the offspring of alcoholic
+  parents.... Acute and chronic diseases in the parents, fright, shock,
+  injuries, parental neglect, faulty education, poverty, malnutrition,
+  social dissipation and lack of proper control are all well-known factors
+  in the production of feeble-mindedness.</p>
+
+  <p>"Segregation of the feeble-minded is advocated by medical authority
+  the world over, and when this is done they can be made under appropriate
+  medico-pedagogic treatment to become largely self-supporting.</p>
+
+  <p>"As an economical as well as a humane measure, the various States can
+  well afford to make such provision, more especially for the large body of
+  feeble-minded who are now without any medical care whatever. Moreover,
+  where it is possible, laws prohibiting the marriage of such as well as
+  all other defectives should be passed and enforced."</p>
+
+  <p><b>What the Care of the Insane Costs.</b>&mdash;The total cost of the
+  care of the insane, in this country, has been estimated to be
+  $165,000,000 a year. In estimating the cost of the insane we must take
+  into account the value or worth of each adult to the State. This value
+  has been computed to be $700 a year. If, upon this basis, we count the
+  adult membership of the insane class between the ages of eighteen and
+  forty-five, we find that their worth is roughly about $132,000,000.</p>
+
+  <p>The cost of maintenance in the various insane institutions is about
+  thirty-three millions of dollars a year. It would be quite possible to
+  justly increase this total by estimating the worth of the help whose
+  whole time is devoted to the care of the insane. If these individuals
+  worked at some other trade or profession, their time <!-- Page 44
+  --><span class="pagenum"><a name="page44"></a>[44]</span> would. be of
+  value to the state in general&mdash;not to a class who should be
+  non-existent. The cost to the state of the potential criminal is not
+  included in this estimate.</p>
+
+  <p>From the above figures it may be observed that it costs more to simply
+  maintain the insane each year than it costs to work the Panama Canal; or
+  to pay for the total cost of the Executive, Legislative and Judicial
+  departments of our government. The total cost is more than the entire
+  value of the wheat, corn, tobacco, and dairy and beef products exported
+  each year from this country.</p>
+
+  <p><b>Alcoholic Drunkenness.</b>&mdash;Alcoholism is a sign and a symptom
+  of degeneracy and is a distinct indication of unfitness for parenthood.
+  The only cure for alcoholism is to prohibit parenthood. It has been
+  proved that alcohol taken into the stomach can be demonstrated in the
+  testicle or ovary within a few minutes, and, like any other poison, may
+  injure the sperm or the germ element therein contained. As a result of
+  this intoxication of the primary elements, children may be conceived and
+  born who become idiots, epileptics or feeble-minded. It is asserted that
+  48 per cent. of all the idiots and imbeciles are the offspring of
+  alcoholic parents.</p>
+
+  <p>Recent experiments show that parental alcoholism alone can determine
+  degeneration. Mr. Galton quoted the case of a man who, "after begetting
+  several normal children became a drunkard and had imbecile offspring";
+  and another case has been recorded of a healthy woman who, when married
+  to a drunkard, had five sickly children, dying in infancy, but in a later
+  union with a healthy man bore normal and vigorous children.</p>
+
+  <p>Dr. Sullivan found on inquiry that:</p>
+
+  <p>.... "Of 600 children born of 120 drunken mothers 335 died in infancy
+  or were still-born, and that several of the survivors were mentally
+  defective, and as many as 4.1 per cent. were epileptic. Many of these
+  women had female relatives, sisters or daughters, of sober habits and
+  married to sober husbands. On comparing the death rate amongst the
+  children of the sober mothers with that amongst the children of the
+  drunken women of the same stock, the former was found to be 23.9 per
+  cent., the latter 55.2 per cent., or nearly two and <!-- Page 45 --><span
+  class="pagenum"><a name="page45"></a>[45]</span> a half times as much. It
+  was further observed that in the drunken families there was a progressive
+  rise in the death rate from the earlier to the later born children."</p>
+
+  <p>Dr. Sullivan cites as a typical alcoholic family one in which the
+  first three children were healthy, the fourth was of defective
+  intelligence, the fifth was an epileptic idiot, the sixth was dead born,
+  and finally the productive career ended with an abortion.</p>
+
+  <p>The nervous systems of many children of alcoholic parents are wrecked
+  for life; many die in convulsions as infants. Many, however, who do not
+  die, live as epileptics. This action of alcohol on the health and
+  vitality of the race is the most serious of the evils that intemperance
+  brings on the community. The tendency of all children of alcoholics is
+  toward nervous disorders of a grave type.</p>
+
+  <p>Statistics show a very high rate of still-births and abortions among
+  the children of drunken mothers, show that drunken women must not be
+  permitted to become mothers.</p>
+
+  <p>Dr. Branthwaite in a lecture stated: "In my judgment, habitual
+  drunkenness, so far as women are concerned, has materially increased,
+  during the last twenty-five years, which I have spent entirely amongst
+  drunkards and drunkenness. These people are not in the least affected by
+  orthodox temperance efforts; they continue to propagate drunkenness, and
+  thereby nullify the good results of temperance energy. Their children,
+  born of defective parents, and educated by their surroundings grow up
+  without a chance of decent life, and constitute the reserve from which
+  the strength of our present army of habitual drunkards is maintained.
+  Truly we have neglected in the past, and are still neglecting, the main
+  source of drunkard supply&mdash;the drunkard himself; crippled that and
+  we should soon see some good results from our work."</p>
+
+  <p>Dr. Fleck, another authority, says: "It is my strong conviction that a
+  large percentage of our mentally defective children, including idiots,
+  imbeciles and epileptics, are the descendants of drunkards."</p>
+
+  <p>Therefore the chronic inebriate must not become a parent.</p>
+
+  <br clear="all" />
+<hr class="full" />
+
+<p><!-- Page 47 --><span class="pagenum"><a name="page47"></a>[47]</span></p>
+
+<h3>CHAPTER V</h3>
+
+<blockquote class="b1">
+
+  <p>"The real undermining of health is not seen. It is done in an
+  insidious way. It has to be carefully ferreted out."</p>
+
+  <p class="author"><font class="sc">Dr. Harvey W. Wiley</font>.</p>
+
+</blockquote>
+
+<h3>WHAT EVERY MOTHER SHOULD KNOW
+ABOUT EUGENICS</h3>
+
+  <p>In the preceding pages we have written about eugenics as a science; it
+  is our intention now to point out briefly in just what way eugenics
+  directly concerns the mothers of to-day. In the first place let us try to
+  appreciate what it will mean to the race if "the fit only are born."
+  "Fit" children, it will be recalled, means children born healthy of
+  healthy, selected parents, parents with a good ancestral history,
+  conveying to their offspring a reasonably adequate legacy. If the "fit
+  only are born" we start with a healthy stock. What a significant and
+  tremendous advantage this is. At once we rid the world of the potential
+  inefficients&mdash;the feeble-minded, the insane, the criminal, the
+  deaf-mute, the drunkard. If we are correct in assuming that the reason
+  why all former civilizations have failed and passed away, was because
+  they bred a race of people physically and mentally unfit to survive, the
+  demand of the eugenist that only "fit children shall be born" will strike
+  at the very root of this evil. If we uproot the cause of racial
+  degeneration we begin the building of a race that should not degenerate.
+  If we establish a race that will not degenerate, it must gain strength
+  and virility with each generation.</p>
+
+  <p>This assumption is logically correct, but we must do more than breed
+  "fit" children. We must take care of them after they are born. We must
+  furnish them with a good environment (see page <a href="#page3">3</a>).
+  Heredity without favorable environment counts for very little,&mdash;we
+  must never forget that. Heredity and environment are the two important
+  determining factors in the life of every <!-- Page 48 --><span
+  class="pagenum"><a name="page48"></a>[48]</span> child born. If eugenics
+  furnishes the heredity by ensuring the birth of the "fit" only, it
+  depends upon the mothers of the race to provide the environment. Every
+  mother must know how to take the best care of herself and of her child.
+  This book is devoted to instructing her in the details of this duty.</p>
+
+  <p>We cannot hope, however, to reach this high altruistic plane by simply
+  taking the first step in the right direction. We who are alive to-day
+  must begin the work, and leave it to posterity to carry forward. We must
+  do our part. Every mother must become an enthusiastic eugenist. If she
+  begins to teach, and preach, and practise its principles now, she will
+  contribute to the heredity of unborn generations. To those of us who are
+  alive to-day, environment is the vastly more important consideration, for
+  our heredity is fixed and beyond the power of control. The question of
+  eugenics for the present generation, therefore, is a question of
+  environment.</p>
+
+  <p>All our efforts must be directly in developing what heredity gives our
+  children. We are wholly responsible for that. We must feed and clothe
+  them properly; we must provide air spaces and playgrounds for exercise;
+  we must educate them, and protect them from disease; and we must
+  safeguard the birth of future generations by keeping our race stream
+  pure. This is no small task, and the only way it will ever be
+  satisfactorily accomplished is for each mother to realize her individual
+  trust. The average individual does not realize the actual conditions that
+  prevail. When recently the question of the public health was investigated
+  by competent authorities, and the report furnished to the United States
+  Senate, it caused a tremendous sensation. If that is possible in a body
+  composed of men who are supposed to be intelligent and wide-awake to
+  existing conditions, how much more significant and appalling it should be
+  to the average mother whose interest is centered in her own home.</p>
+
+  <p>According to the statistics and statements given in that document the
+  annual financial loss from needless deaths and accidents alone amounted
+  to $3,000,000,000. <!-- Page 49 --><span class="pagenum"><a
+  name="page49"></a>[49]</span></p>
+
+  <p>Acute diseases are held responsible for a large part of the loss.
+  Chronic diseases are responsible for the greatest part of the waste of
+  life, and they are believed to be increasing in their ravages. Minor
+  ailments, believed to be nine-tenths preventable, are now costing the
+  nation many dollars through incapacitation of persons and through leading
+  to serious illness. Industrial accidents, largely preventable, are also
+  exacting a heavy toll annually.</p>
+
+  <p>That this great waste of life and health and the national economic
+  loss that results can be modified by national action is asserted. Here
+  are to be found the reasons advanced for a great national department of
+  health. The work of this department would be varied. It would include
+  direct work in promoting health on the part of the government, such as
+  administering the food and drug act; aiding the healing and educational
+  agencies, both city and State; obtaining information concerning the cause
+  and prevention of diseases, and disseminating scientifically proved
+  information on all health subjects.</p>
+
+  <p>It is maintained that the movement for the conservation of health is
+  the most momentous of the conservation movements in this country, and
+  that of all the national wastes which are to be condemned, this waste of
+  health is the gravest.</p>
+
+  <p>Many startling statements are set forth in the document. Dr. Charles
+  Wardell Stiles, of the United States Public Health and Marine Hospital
+  Services, declares that "The United States is seven times dirtier than
+  Germany and ten times as unclean as Switzerland." He declares that: "Lack
+  of interest in preventive measures against diseases is slaughtering the
+  human race." He takes the position that the real trouble is not so much
+  race suicide as race slaughter, and that it is rather that too many
+  children are allowed to die than that not enough children are born.</p>
+
+  <p>It is estimated that tuberculosis, a preventable disease, costs the
+  nations $1,000,000,000 annually. Typhoid fever is estimated by Dr. George
+  M. Kober, dean of the medical department of Georgetown University, to
+  cost over $300,000,000 annually. <!-- Page 50 --><span class="pagenum"><a
+  name="page50"></a>[50]</span></p>
+
+  <p>In connection with acute diseases this statement is made: "The loss
+  from tuberculosis has been reduced to half of what it was thirty years
+  ago. Nevertheless, of the 90,000,000 people now living in the United
+  States at least 5,000,000 will be lost through this disease because
+  adequate effort is not made to prevent it. Besides the economic waste
+  through deaths from any disease, the waste through sickness from the same
+  disease is also colossal."</p>
+
+  <p>Great as are the reductions in the rates of infant mortality by
+  improved milk and water supplies and by educational campaigns, the
+  present rate is still enormous.</p>
+
+  <p>"If some witch or wizard could conjure up the unnecessary babies'
+  funerals annually occurring in this country it would be found that the
+  little hearses would reach from New York to Chicago. If we should add the
+  mourning mothers and friends, it would make a cortége extending across
+  the continent."</p>
+
+  <p>While the death rates from acute diseases have been greatly reduced,
+  the rates from chronic diseases have been steadily increasing. Cancer is
+  one of the chronic diseases apparently on the increase.</p>
+
+  <p>That the annual death toll and the 3,000,000 constant sick beds could
+  be reduced from one-fourth to one-half by proper measures is asserted. In
+  other words, there might be saved every day, as many lives as perished on
+  the <i>Titanic</i>, with the consequent enormous economic saving.</p>
+
+  <p>These are surely impressive statements. It would seem as though it
+  should be a simple task to pass a Public Health Bill, establishing a
+  bureau in Washington, with a representative in the cabinet, whose sole
+  duty it would be to preserve the public health. It has proved rather the
+  reverse, however. We have been able to inaugurate various species of
+  conservation,&mdash;of lands, of forests, of water,&mdash;but the
+  conservation of human life is not important enough. Even though states
+  and empires depend upon their people for their very existence, our
+  statesmen feel that human life is too cheap, too common, to take
+  immediate steps in this direction.</p>
+
+  <p>If women&mdash;especially mothers&mdash;would devote <!-- Page 51
+  --><span class="pagenum"><a name="page51"></a>[51]</span> themselves to
+  the eugenic end of legislation, men would soon obey. The application of
+  eugenics to the human species, coming, almost in the spirit of an
+  inspiration, at the time when women are about to be enfranchised, is
+  significant. It may be that destiny has decreed that the one shall be the
+  complement of the other; it is certainly beyond contradiction that in
+  eugenics the women of the earth have a divine weapon with which to wage a
+  righteous and an awaking propaganda of truth.</p>
+
+  <p>A mother should be interested in every phase of the subject. Her
+  daughter's success in marriage should intimately concern her. Her health
+  and her happiness in that sphere should elicit her deepest maternal
+  consideration. She may rightly hope to be proud of her daughter's
+  offspring, and to find pleasure in the society of her grandchildren. She
+  should, therefore, devote all her efforts to ascertain the truth, with
+  reference to the physical and mental equipment of her future son-in-law;
+  his ability adequately to support a family; his sobriety, his
+  disposition, associates, etc., should all be carefully considered and
+  pondered over. This is not going far enough, however; we must know
+  positively that he is not diseased,&mdash;that he is not a victim of
+  gonorrhoea or syphilis.</p>
+
+  <p>When parents weigh in the balance the possibility of a wrecked life,
+  of destroying the right to have children, or of bringing them into the
+  world blind or diseased; of permanently destroying the hope of happiness,
+  peace, and success, no combination of advantages in a son-in-law is
+  deserving of the slightest consideration. We are treating of the sacred
+  things of life&mdash;of life itself. If parents combine to crucify and
+  betray their daughters&mdash;to sell them body and soul into bondage for
+  social or other advantages; if they preserve silence when they should
+  speak and thereby take all the sunshine, for all eternity, out of one
+  existence; then, if on their death-beds these daughters should accuse
+  them, the guilty knowledge that they were responsible will be the sting
+  that will blast their hope of peace and forgiveness here and in the
+  worlds to come.</p>
+
+  <p>When mothers realize that, every day, in every large hospital in every
+  city in the civilized world some woman <!-- Page 52 --><span
+  class="pagenum"><a name="page52"></a>[52]</span> (a daughter of some
+  mother) is being unsexed because of these unjustly obtained diseases,
+  surely their voices shall speak in no uncertain way.</p>
+
+  <p>Another eugenic suggestion that should deeply concern every good
+  mother is, that the mother's milk is the private property of the babe,
+  and whoever deprives the babe of this, the sole right it possesses, is
+  not only a thief but a scoundrel. A curious and significant fact was
+  discovered by investigators when studying the question of infant
+  mortality a few years ago. It was found from a mass of statistics that
+  there were two recent instances when the death rate of infants decreased
+  suddenly and quite decidedly. The first instance was when the Civil War
+  in this country caused a cotton famine in England. As a result of the
+  famine the factories of Lancashire were all closed and the employees
+  being then without work remained at home. As a large percentage of the
+  workers were married women with children they had the time and the
+  opportunity to nurse their children regularly. Despite the fact that
+  these women were starved and badly clad and deprived of the comforts of
+  home, the death rate of the infants dropped steadily to an unprecedently
+  low mark.</p>
+
+  <p>A number of years later, when the German army surrounded Paris during
+  the Franco-Prussian War the besieged inhabitants of the capital suffered
+  from hunger and disease. The death rate of the adult population increased
+  enormously while the death rate of the infants dropped markedly.</p>
+
+  <p>The explanation of this curious phenomenon was simply that while times
+  were normal the women labored outside of their homes and as a consequence
+  the babies were not fed regularly and when fed were not fed mothers'
+  milk. It demonstrated a truth that we are apt to lose sight of, that
+  mothers' milk, even the milk from badly-nourished, poverty-stricken
+  mothers is infinitely better than an abundant supply of artificial food
+  combined with neglect. In view of the fact that there is a distinct
+  tendency to evade this maternal duty these facts should be suggestive and
+  important. It is the duty of the mother with any eugenic sense to preach
+  and to practise <!-- Page 53 --><span class="pagenum"><a
+  name="page53"></a>[53]</span> this gospel. Paris learned the lesson of
+  the siege because though she has the smallest birth-rate to-day, she
+  nevertheless has the smallest infant death-rate of any large city in
+  Europe.</p>
+
+  <p>The writer believes that in eugenics the women of the race have the
+  instrument wherewith to save the world. He is assured that it is the
+  supreme potential agency for the betterment of the race, and that mankind
+  will never be inspired with a holier cause. He believes that through all
+  the ages the human race has been growing better, coming nearer the truth,
+  and that as a result of this patient progress, there has been evolved the
+  eugenic idea that is to solve the problems of the human family. If the
+  "fit only are born" think of the possibilities of education and of
+  environment. Each child is born with a great potential promise, and
+  endowed with a reasonably good heredity, the whole effort of that child
+  will be toward a higher moral attainment. If the effort of the
+  individuals of the race is to achieve a high moral success, the quality
+  of the civilization of future generations will be far superior to the
+  type with which we are familiar.</p>
+
+  <p>Eugenics gives to women the supreme civilizing instrument of the
+  future. It places the burden of the morality of the home and of the race
+  on their shoulders. If we deny the writing on the wall it does not render
+  the warning negative. The signs of the times are epochal. The great
+  political parties are realizing, for the first time in history, that new
+  and important issues concerning the family, the home, and the children,
+  in other words the nation's manhood and womanhood, must be considered and
+  included in their platforms. They know that the time has gone when
+  statesmen will exclusively decide what shall be done with the sons and
+  daughters which women bring into the world. They know that the mothers of
+  the race must have a voice in deciding for peace or war since they create
+  every soldier that will lie dead when war is over. Women will help decide
+  the question of taxation by government and by trusts, because they know
+  that it comes out of their incomes and they need it all for their
+  children. Women know that their cause is the cause of freedom, and
+  freedom is the <!-- Page 54 --><span class="pagenum"><a
+  name="page54"></a>[54]</span> cause of the eugenist. They know that the
+  function of government should be justice and no code of justice can have
+  higher ethics than the ethics of eugenism.</p>
+
+  <p><b>Mothers' Eugenic Clubs.</b>&mdash;There should be established in
+  every community a mothers' eugenic club. The object of the club should be
+  to further the eugenic idea. Papers should be prepared, read, and
+  discussed on subjects having a eugenic interest.</p>
+
+  <p>One of the main aims of these clubs should be to interest the local
+  Congressman and the member of the State Legislature in eugenics. In all
+  probability they will know nothing specific about
+  race-culture&mdash;unless they are exceptional men&mdash;in which case it
+  will be the duty of the members of the club to educate them. The object
+  of such education of course would be to ensure that they will act
+  intelligently when any legislative proposal is made having a eugenic
+  interest. Find out what they know about the public health as contained in
+  the report on page <a href="#page48">48</a>, and if they will vote in
+  favor of a Public Health Bureau. You should know how your representatives
+  stand on the Pure Food and Drugs Act; if they really appreciate the
+  significance of the measure; if they would be in favor of pensioning
+  mothers and widows who have children depending upon them; what their
+  views are regarding compulsory marriage licenses; the reporting of
+  venereal diseases to the local health authorities; if they would favor
+  the segregation of the feeble-minded and their maintenance and treatment
+  by the state; if they endorse the eugenic principle that "the fit only
+  shall be born," and if they really understand just what that means.</p>
+
+  <p>If the mothers in every community would take this step, they could
+  control the legislation affecting such subjects in a comparatively short
+  time. If the various States concede to women the right to vote&mdash;as
+  they will sooner or later&mdash;such mothers' clubs would have a large
+  and intelligent share in educating the women's votes on questions which
+  directly concern their own immediate and remote welfare.</p>
+
+  <p>The question of education would concern these clubs and much could be
+  done by mothers to direct the authorities as to just what is needed to
+  educate for <!-- Page 55 --><span class="pagenum"><a
+  name="page55"></a>[55]</span> parenthood, along the lines suggested
+  elsewhere in this book.</p>
+
+  <p>A mothers' eugenic club would rightly become an instrument for good in
+  all local sociological interests. It could maintain a trained nurse to
+  care for the sick and helpless, to teach the people how to live, and how
+  to care for their homes and their children. The members themselves could
+  visit the poor, the needy, and the sick.</p>
+
+  <p>There are so many people in the world who are near the brink of
+  failure,&mdash;so many who need a little hope infused into their
+  lives,&mdash;and so many who are really deserving of help and sympathy
+  and inspiration. The women who do this work for the work's sake are amply
+  repaid by the good they find to do. The doing of such work is a
+  consecration and an education. Life means more, and the whole temperament
+  reflects a truer sympathy and a stronger purpose.</p>
+
+  <p>There are many mothers, for example, who are willing to do what is
+  essential in the interest of their children, but they do not know what
+  should be done. These people cannot afford a physician or a nurse to
+  teach them, nor do they even know that their methods are wrong or that
+  they need any instruction. We must carry the information and the
+  explanation to them. We must show them the need for a change of methods.
+  This is the work for those charitably disposed women who desire some
+  worthy purpose in life, who really wish to do some genuine good. All the
+  equipment they need is good common sense. They will explain why it is
+  essential to pasteurize the milk before feeding it to the baby because
+  most of the milk used by the poor is unfit for use as a baby food. They
+  will show how to keep the nipples and the bottles clean, and they will
+  give them lessons on how to prepare the food to the best advantage. They
+  will instruct them how to dress the baby in hot weather, and they will
+  explain why it is necessary to provide the baby with all the fresh air
+  possible. They will gain the confidence of these mothers and they will
+  tell them all they know, in tactful and diplomatic and common-sense
+  language so that they may appreciate the eugenic reasons for everything
+  they do regarding the care and well-being of the baby. In every city in
+  the country this work is needed and is <!-- Page 56 --><span
+  class="pagenum"><a name="page56"></a>[56]</span> waiting for the
+  missionaries who will volunteer. To teach mothers the need for boiled
+  water as a necessary drink for baby and older children is alone a worthy
+  avocation. To impress upon one of these willing but ignorant mothers the
+  absolute necessity for washing her hands before preparing baby's food,
+  that she must keep a covered vessel in which the soiled napkins are
+  placed until washed, that she should frequently sponge her baby in hot
+  weather,&mdash;and explain thoroughly why these are important
+  details,&mdash;is a work of true religious charity. They should be taught
+  to rid their houses of flies, and especially to keep them from the baby
+  and from its food, bottles, and nipples. They should be instructed to
+  discontinue milk at the first sign of intestinal trouble, to give a
+  suitable dose of castor oil, and to put the child on barley water as a
+  food until the danger is passed. They should be taught to know the
+  serious significance of a green watery stool, that it is the one danger
+  signal in the summer time that no mother can ignore without wilfully
+  risking the life of her baby. They should be shown how to prepare special
+  articles of diet when they are needed. If every mother were educated to
+  the extent as indicated in the above outline the appalling infant
+  mortality would fall into insignificance. It is not a difficult task, nor
+  would it take a long time to carry out; it is the work for willing women
+  who have time and who perhaps spend that time in less desirable but more
+  dramatic ways. It is education that is needed, and it is education that
+  is willingly received, as all mothers are ready to devote their time in
+  the acquirement of knowledge that will help them save their offspring.
+  This is the eugenic opportunity and it is an opportunity that should
+  devolve upon the women of the race.</p>
+
+  <p>Such a mothers' club would receive the willing financial support of
+  the men of the community. It should be placed upon a sound financial
+  basis because, to be successful, it would have to bestow much material
+  aid. I know of clubs that are self-supporting, however. Each club needs a
+  leader to begin it; will the reader be that one in her Community?</p>
+
+  <p>A Mothers' Eugenic Club would of course discuss <!-- Page 57 --><span
+  class="pagenum"><a name="page57"></a>[57]</span> the practical side of
+  the eugenic question: the proper feeding and clothing of children;
+  hygiene, sanitation, housekeeping and homemaking, and the efficiency and
+  health of each member of the home, and all other topics of interest to
+  every wife and mother. The writer believes that in the very near future
+  we shall have a Mothers' Eugenic Club in every community in the United
+  States; that these clubs will be guided by, and be an instrument of, a
+  National Eugenic Bureau, composed of women, that will coöperate and
+  harmonize the work as a whole, so that the conservation of human life
+  will be effected to its maximum extent; that the excessive infant
+  mortality will be overcome, because ignorant and incompetent
+  mothers&mdash;the greatest cause of infant mortality&mdash;will be
+  educated and instructed in the rudiments of eugenics and will
+  consequently, to a large extent, cease to be ignorant and incompetent;
+  that the desecration of young wives will stop, and stop forever, because
+  vice and disease will be branded and exposed; that the feeble-minded, the
+  deaf-mute, the imbecile, and the insane, will no longer be allowed to
+  propagate their kind, to the permanent detriment of the race.</p>
+
+  <p>When such clubs are established, and when all mothers do their
+  individual duty in the interest of the race, we shall begin to see the
+  dawn of a promise that will achieve its supreme success in the
+  generations that will people the earth in the eugenic aftertime.</p>
+
+  <br clear="all" />
+<hr class="full" />
+
+<p><!-- Page 61 --><span class="pagenum"><a name="page61"></a>[61]</span></p>
+
+<h2>CHILD-BIRTH</h2>
+
+<h3>CHAPTER VI</h3>
+
+<blockquote class="b1">
+
+  <p>"Solicitude for children is one of the signs of a growing
+  civilization. To cure is the voice of the past; to prevent, the divine
+  whisper of to-day."</p>
+
+  <p class="author"><font class="sc">Kate Douglas Wiggin</font>.</p>
+
+</blockquote>
+
+<h3>PREPARATIONS FOR THE CONFINEMENT</h3>
+
+<blockquote class="b1">
+
+  <p><b>The Birth Chamber&mdash;What to Provide for a
+  Confinement&mdash;Ready to Purchase Obstetrical Outfits&mdash;Position
+  and Arrangement of the Bed&mdash;How to Properly Prepare the Accouchment
+  Bed&mdash;The Kelly Pad&mdash;The Advantages of the Kelly
+  Pad&mdash;Should a Binder Be Used?&mdash;Sanitary Napkins&mdash;How to
+  Calculate the Probable Date of the Confinement&mdash;Obstetrical
+  Table&mdash;When Should a Pregnant Woman First Call Upon Her
+  Physician&mdash;Regarding the Choice of a Physician&mdash;How to Know the
+  Right Kind of a Physician for a Confinement&mdash;The Selection of a
+  Nurse&mdash;The Difference Between a Trained and a Maternity
+  Nurse&mdash;Duties of a Confinement Nurse&mdash;The Requisites of a Good
+  Confinement Nurse&mdash;The Personal Rights of a Confinement
+  Nurse&mdash;Criticizing and Gossiping About Physicians.</b></p>
+
+</blockquote>
+
+<h4>THE BIRTH CHAMBER</h4>
+
+  <p>The room in which the confinement is to take place should be selected
+  with care. In many cases there will be no choice for the reason that
+  there will be only one suitable bedroom available. Where practicable
+  however a room having the following accessories, or as many of them as is
+  possible, should be given the preference.</p>
+
+<blockquote class="b1">
+
+  <p>1.&mdash;Good light, and a southern exposure.</p>
+
+  <p>2.&mdash;Capable of being well ventilated and well heated if
+  necessary.</p>
+
+  <p>3.&mdash;Running water if plumbing is modern.</p>
+
+  <p>4.&mdash;Fairly large size (not a hallroom).</p>
+
+  <p>5.&mdash;A quiet room, free from street noises.</p>
+
+</blockquote>
+
+  <p>If the house is a private one the room should be on the second floor.
+  If the home is in an apartment house <!-- Page 62 --><span
+  class="pagenum"><a name="page62"></a>[62]</span> the confinement chamber
+  should be as far removed from the living-room as circumstances will
+  permit,&mdash;especially if there are other children who will make more
+  or less continuous noise.</p>
+
+  <p>All unnecessary furniture, pictures and draperies should be taken out
+  of the room a few days before the confinement is due; the room itself,
+  and everything left in it, should be thoroughly cleaned and aired. A
+  small table for holding instruments, sterilizing basins, etc., should be
+  provided and in readiness.</p>
+
+  <p><b>What to Provide For a Confinement.</b>&mdash;The following articles
+  should be in readiness at all confinements:&mdash;</p>
+
+<blockquote class="b1">
+
+  <p>1.&mdash;Douche pan.</p>
+
+  <p>2.&mdash;Bed pan.</p>
+
+  <p>3.&mdash;Douche bag (fountain syringe) with glass douche tube.</p>
+
+  <p>4.&mdash;One rubber sheet 1½ yards square.</p>
+
+  <p>5.&mdash;Two bed pads, one yard square, made of absorbent cotton or
+  old clean cloths, covered with washed cheese cloth and stitched here and
+  there to hold in place.</p>
+
+  <p>6.&mdash;One dozen clean towels.</p>
+
+  <p>7.&mdash;One-half dozen clean sheets.</p>
+
+  <p>8.&mdash;A hot water bottle.</p>
+
+  <p>9.&mdash;One pound absorbent cotton (good quality).</p>
+
+  <p>10.&mdash;Five yards sterile gauze.</p>
+
+  <p>11.&mdash;Four quarts of hot, and as much cold water, that has been
+  boiled.</p>
+
+  <p>12.&mdash;One-half dozen papers assorted safety pins.</p>
+
+  <p>13.&mdash;One box sanitary pads.</p>
+
+  <p>14.&mdash;Four pieces of unbleached cotton or muslin, one and
+  one-quarter yards long.</p>
+
+  <p>15.&mdash;Four ounces powdered boracic acid.</p>
+
+  <p>16.&mdash;Four ounces of brandy or whisky.</p>
+
+  <p>17.&mdash;One jar of white vaseline (unopened).</p>
+
+  <p>18.&mdash;One cake of castile soap.</p>
+
+  <p>19.&mdash;Two or three agate or china hand basins.</p>
+
+  <p>20.&mdash;One slop jar.</p>
+
+  <p>21.&mdash;One pan under bed for after birth.</p>
+
+</blockquote>
+
+  <p>The physician will direct that certain additional articles be provided
+  according to his individual taste and <!-- Page 63 --><span
+  class="pagenum"><a name="page63"></a>[63]</span> custom. These will
+  include an antiseptic and ergot; any other requisite found necessary can
+  be sent for, or the physician can supply it, as he invariably has in his
+  bag whatever may be required in complicated cases or in an emergency. All
+  the items enumerated in the above list are absolutely essential, they may
+  not all be used but it would not be safe to undertake a confinement
+  without providing the essential requisites. Many maternity outfits are
+  prepared ready for use and can be obtained at the larger drug stores,
+  costing from $10 to $25. The articles in the above list can be bought for
+  about $6, not including those articles which the patient is assumed to
+  have. The following are samples of the ready-to-purchase outfits:</p>
+
+<h4>READY-TO-PURCHASE OBSTETRICAL OUTFITS</h4>
+
+  <div class="poem">
+    <div class="stanza">
+      <p class="i8">OUTFIT NO. 1</p>
+      <p>1 Sterilized Bed Pad (30 inches square).</p>
+      <p>2 dozen Sterilized Vulva Pads.</p>
+      <p>2 Sterilized Mull Binders (18 inches wide).</p>
+      <p>5 yards Sterilized Gauze.</p>
+      <p>1 pound Sterilized Absorbent Cotton (½ pound).</p>
+      <p>Rubber Sheet, 1½ yards by 2 yards, Sterilized.</p>
+      <p>Douche Pan, Sterilized.</p>
+      <p>1 Tube K-Y Lubricating Jelly.</p>
+      <p>Sterilized Nail Brush.</p>
+      <p>Boric Acid, Powdered.</p>
+      <p>Tinct. Green Soap.</p>
+      <p>Bichloride Tablets.</p>
+      <p>Lysol.</p>
+      <p>Tube Sterilized Tape.</p>
+      <p class="i8">PRICE $10.00.</p>
+    </div>
+
+    <div class="stanza">
+      <p class="i8">OUTFIT NO. 2.</p>
+      <p>2 Sterilized Bed Pads (30 inches square).</p>
+      <p>2 dozen Sterilized Vulva Pads.</p>
+      <p>2 Sterilized Mull Binders (18 inches wide).</p>
+      <p>6 Sterilized Towels.</p>
+      <p>10 yards Sterilized Gauze.</p>
+<!-- Page 64 --><span class="pagenum"><a name="page64"></a>[64]</span>
+      <p>1 pound Sterilized Absorbent Cotton (½ pound).</p>
+      <p>Rubber Sheet, 1 yard by 1½ yards, Sterilized.</p>
+      <p>Rubber Sheet, 1½ yards by 2 yards, Sterilized.</p>
+      <p>4 quart Sterilized Douche Bag with glass nozzle.</p>
+      <p>Douche Pan, Sterilized.</p>
+      <p>Sterilized Nail Brush.</p>
+      <p>2 Agate Basins, Sterilized.</p>
+      <p>Safety Pins.</p>
+      <p>2 Tubes Sterilized Petrolatum.</p>
+      <p>1 Tube K-Y Lubricating Jelly.</p>
+      <p>Boric Acid, Powdered.</p>
+      <p>100 grms. Chloroform (Squibb's).</p>
+      <p>Fl. Ext. Ergot.</p>
+      <p>Tinct. Green Soap.</p>
+      <p>Bichloride Tablets.</p>
+      <p>Lysol.</p>
+      <p>Tube Sterilized Tape.</p>
+      <p>Sterilized Soft Rubber Catheter.</p>
+      <p>Sterilized Glass Catheter.</p>
+      <p>Stocking Drawers, Sterilized.</p>
+      <p>Talcum Powder.</p>
+      <p>Bath Thermometer.</p>
+      <p class="i8">PRICE $19.50.</p>
+    </div>
+  </div>
+  <p>These materials, being cleansed and sterilized, are ready for use at
+  any time.</p>
+
+  <p>These complete outfits are packed in neat boxes, thus enabling the
+  contents to be kept intact until needed.</p>
+
+  <p><b>The Position and Arrangement of the Bed.</b>&mdash;The bed should
+  be a substantial single bed. If a double one is used, prepare the side
+  for the confinement which will permit the physician to use his right
+  hand,&mdash;that will be the right side of the patient as she lies in
+  bed. One objection to a double bed is its tendency to sag. This tendency
+  can be obviated however by placing an ironing board under the spring from
+  side to side, or by using shelves from a book case. This expedient will
+  support the mattress, thereby rendering the bed firm and free from any
+  sagging tendency. The position of the bed in the room should be such that
+  the patient will not directly face the window light, nor be in a direct
+  draught <!-- Page 65 --><span class="pagenum"><a
+  name="page65"></a>[65]</span> between the window and the door. It should
+  be so arranged that the nurse can get easily to either side, consequently
+  it must not be pushed against the wall.</p>
+
+  <p><b>How to Prepare the Accouchment Bed.</b>&mdash;Over the mattress
+  place the rubber sheet so that its center will be exactly under the hips
+  of the patient. Pin with large safety pins each corner of the rubber
+  sheet to the mattress; now put the sheet on exactly as you do when making
+  an ordinary bed. On top of the sheet, and in the middle of the bed (again
+  where the patient's hips will rest), place a draw sheet. A draw sheet is
+  a sheet folded once, placed across the bed, and pinned tightly with large
+  safety pins to the mattress at each side. The advantage of this sheet is,
+  that it can be removed when necessary, leaving the original clean sheet
+  on the bed, without disturbing the patient. Be particular not to have the
+  top of the draw sheet higher than the middle of the patient's back. Place
+  the pad,&mdash;previously prepared for the purpose,&mdash;on the draw
+  sheet and level with the top of the draw sheet.</p>
+
+  <p>Most physicians carry with them to all confinements a <i>Kelly
+  pad</i>. A Kelly pad is a rubber pad with inflated sides, which is put
+  under the patient's hips, and which retains all the discharges incident
+  to a <ins class="correction" title="'confiement' in original"
+  >confinement</ins> so that when it is removed the bed is clean and fresh.
+  The advantage of the Kelly <ins class="correction" title="'paid' in original"
+  >pad</ins> is twofold; first, it ensures a clean, compact, systematic
+  confinement; second, its use subjects the patient to the least necessary
+  movement at a time when movement is distressing, painful, and frequently
+  dangerous. If a Kelly pad is not used, it is desirable to place under the
+  pad (between the pad and the draw sheet) a piece of oil cloth or rubber
+  sheeting, or a number of newspapers will do. This will prevent, to a
+  considerable degree, the discharges from soaking through the pad on to
+  the draw sheet and sheet and mattress below.</p>
+
+  <p>After the confinement is over and the patient is clean, remove the
+  Kelly pad, and the pad below if necessary, or the pad and newspapers if
+  these are used,&mdash;place a clean pad under the patient and you are
+  ready to place the binder on if a binder is to be used. <!-- Page 66
+  --><span class="pagenum"><a name="page66"></a>[66]</span></p>
+
+  <p><b>Should a Binder be Used?</b>&mdash;Medically a binder is not
+  necessary, neither is it objectionable from a medical standpoint. It is
+  supposed to hold the flaccid, empty womb in place. This it does not do
+  and we are of the opinion, that it, in many instances, according to how
+  it is put on, compresses the womb out of place. The binder is certainly
+  appreciated by most patients because of its snug, comfortable feeling;
+  and in cases when the abdominal wall is fat and the muscles soft, it
+  holds them together in a way that is impossible by the use of any other
+  device. To claim that the binder prevents hemorrhages is absurd. Our
+  personal rule is to put one on if the patient wants one, or if she has
+  previously had one. To be effective, in any sense, the binder should
+  extend from the waist line down to halfway between the hips and knees and
+  should be snugly, but not too tightly pinned.</p>
+
+  <p><b>Sanitary Napkins.</b>&mdash;These can be purchased already prepared
+  in most drug stores, or they can be made in the following manner: Take an
+  ordinary grade of cheese cloth, wash it, and when dry, cut it into half
+  yard squares. In the center of each square place a strip, six or eight
+  inches long, of absorbent cotton and fold the gauze lengthwise over it so
+  as to make a pad. These can be used as napkins, and after they are soiled
+  can be burned. It is absolutely wrong to use rags or any old cloths for
+  napkins, as the patient can be infected and made seriously sick by this
+  procedure.</p>
+
+  <p><b>How to Calculate the Probable Date of the
+  Confinement.</b>&mdash;The duration of pregnancy extends for 280 days
+  from the end of the last menstruation. Add seven days to the date of the
+  last menstruation, and from that date count ahead nine months, or
+  backward three months and you may have the probable date of the
+  confinement. Should you pass this time you will probably go on for two
+  additional weeks. The reason for this is that the most susceptible time
+  for conception to occur is either during the week following menstruation
+  or a few days before menstruation. If, therefore, you pass the above
+  probable date which was calculated from the end of the last menstruation,
+  it shows that conception did not take <!-- Page 67 --><span
+  class="pagenum"><a name="page67"></a>[67]</span> place during the week
+  following that menstruation; and the assumption will be that it took
+  place a few days before the next menstruation, which will be about two
+  weeks later than the date as calculated above.</p>
+
+  <p>If, for example, a pregnant woman was last sick from January 1st to
+  5th we add seven days to the 5th, which is the 12th, to which we add nine
+  months, which will give us, as the probable date of confinement, October
+  12th. Should she go a few days over the 12th, the probability is that the
+  confinement will take place on October 26th.</p>
+
+<pre>
+TABLE FOR CALCULATING THE DATE OF CONFINEMENT
+---------------------------------------------------------------------------------------------------------
+JAN.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
+OCT.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6  7   NOV.
+---------------------------------------------------------------------------------------------------------
+FEB.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
+NOV.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30  1  2  3  4  5            DEC.
+---------------------------------------------------------------------------------------------------------
+MAR.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
+DEC.   6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5   JAN.
+---------------------------------------------------------------------------------------------------------
+APR.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
+JAN.   6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4      FEB.
+---------------------------------------------------------------------------------------------------------
+MAY.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
+FEB.   5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28  1  2  3  4  5  6  7   MAR.
+---------------------------------------------------------------------------------------------------------
+JUNE   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
+MAR.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6      APR.
+---------------------------------------------------------------------------------------------------------
+JULY   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
+APR.   7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30  1  2  3  4  5  6  7   MAY
+---------------------------------------------------------------------------------------------------------
+AUG.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
+MAY    8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6  7   JUNE
+---------------------------------------------------------------------------------------------------------
+SEPT.  1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
+JUNE   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30  1  2  3  4  5  6  7      JULY
+---------------------------------------------------------------------------------------------------------
+OCT.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
+JULY   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6  7   AUG.
+---------------------------------------------------------------------------------------------------------
+NOV.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
+AUG.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6     SEPT.
+---------------------------------------------------------------------------------------------------------
+DEC.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
+SEPT.  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30  1  2  3  4  5  6  7   OCT.
+---------------------------------------------------------------------------------------------------------
+</pre>
+<p><!-- Page 68 --><span class="pagenum"><a name="page68"></a>[68]</span></p>
+
+  <p>The foregoing table affords us a handy means of finding the probable
+  date of confinement at a glance.</p>
+
+  <p>Find the date of the last day of the last menstrual period in the
+  upper row; the date immediately below it is the probable date of
+  confinement.</p>
+
+  <p>For example if the last menstrual period was from Jan. 1st to 5th, we
+  find January 5th and below it we note October 12th as the probable date
+  of confinement.</p>
+
+  <p><b>When Should a Pregnant Woman First Call Upon Her
+  Physician?</b>&mdash;The earliest indication of pregnancy is the
+  interruption of menstruation. When menstruation fails to appear at its
+  regular time in a young married woman whose past menstrual history is
+  good,&mdash;i.e., she has been sick every month regularly and without
+  pain since she began menstruating as a girl,&mdash;the assumption would
+  naturally be that she was pregnant. Menstruation may however "miss" one
+  month for other reasons than pregnancy just at this time, as is explained
+  elsewhere, so it is wise to defer a positive assumption on such an
+  important matter. When the second menstruation does not appear, and there
+  are no specific reasons for its failure to appear, it may be safely
+  assumed that pregnancy has taken place. A visit to the family physician
+  one week after the second menstruation should have appeared, or at least
+  long enough to feel absolutely certain that the sickness is not coming
+  around, is not only necessary, but is the essential and correct step to
+  take for a number of very good reasons. If a woman for example has not
+  had a baby, how does she know she can have one? It is quite possible to
+  become pregnant and yet it may be wholly impossible to give birth to a
+  child. It is necessary to be constructed normally, or as near what is
+  regarded as normal as is possible, in order safely to assume the
+  responsibility of carrying a pregnancy to a successful completion. No one
+  but a physician, who is skilled and familiar in the knowledge of what
+  constitutes the proper size, and shape, and quality, and relations, one
+  with another, of <!-- Page 69 --><span class="pagenum"><a
+  name="page69"></a>[69]</span> your bones, and ligaments, and muscles, can
+  tell whether you can safely be permitted to carry a pregnancy to term or
+  not. If the anatomical conditions are not just right; if circumstances
+  from a medical standpoint are not favorable; if your personal risk is too
+  hazardous; if, in other words, medical science should decide that you are
+  one of the very few women who cannot have a baby, is it not of very great
+  importance that you should know this as soon as possible? Does not that
+  fact alone render your early call upon your physician imperative? A
+  physician can bring out facts, relating to the personal and family
+  history, and habits, of the prospective mother, which will enable him to
+  formulate advice which will prove of the highest value from the very
+  beginning of pregnancy. Instructions carried into effect at this early
+  date, as to personal conduct, exercise, diet, etc., will have a
+  distinctly beneficial influence, not only on the patient's health and the
+  character of her confinement, but on the physical vitality of the coming
+  baby.</p>
+
+  <p><b>Regarding the Choice of a Physician.</b>&mdash;This is a matter
+  that should receive the most careful consideration. While it is just to
+  admit that every physician is capable of successfully conducting
+  maternity cases, there are certain characteristics in the individual
+  temperament that would seem to indicate that some physicians are better
+  adapted to this special work.</p>
+
+  <p>Trustworthiness is an imperative essential in a physician who assumes
+  the responsibility of confinement engagements. He must be clean in his
+  personal habits as well as morally. He should possess the virtue of
+  patience and be tactful, and above all he should be made to feel that he
+  has your implicit confidence. If you will analyze these qualifications
+  you will understand just what they imply. The physician who has the
+  reputation of having the largest practice is not necessarily the man you
+  want, nor does it imply that he is the best fitted to conduct your case
+  to your satisfaction. The fact that he is a very busy man may be
+  distinctly detrimental to your best interests. If the physician has the
+  reputation of being an excellent doctor, but, "You can't always depend on
+  him,&mdash;he may be out of town, or he may send his assistant, or <!--
+  Page 70 --><span class="pagenum"><a name="page70"></a>[70]</span>
+  substitute," you don't want him; it is too important an event to you to
+  take a chance with. Rely rather upon the man who, though his charge may
+  be a little higher, is known to be trustworthy; who will take a personal
+  interest in you, and is known to be patient and capable.</p>
+
+  <p><b>The Selection of a Nurse.</b>&mdash;A choice must be made between
+  having a trained nurse and what is known as a maternity, or monthly,
+  nurse. The choice may be dictated by the financial means of the patient.
+  A trained nurse is paid from $25 to $30 per week, while a maternity nurse
+  usually gets $15 per week.</p>
+
+  <p>A trained nurse is a graduate from a hospital where she has
+  successfully completed a course of training. She is to be preferred, if
+  she can be afforded, for the reason that she has been trained to obey
+  absolutely the orders of a physician, and because she has the requisite
+  knowledge to detect emergencies, and the necessary skill and experience
+  to enable her to act intelligently of her own initiative in any
+  emergency.</p>
+
+  <p>The maternity nurse, on the other hand, has not had an adequate
+  training and is absolutely helpless, so far as medical knowledge is
+  concerned, in a real emergency. Her experience is limited to what she has
+  picked up in the various cases she has had. She, as a rule, has chosen
+  this means of obtaining a living as a result of some domestic financial
+  affliction. She does not understand the laws of sterilization and has not
+  been trained to obey, without question, the instructions of a physician.
+  The maternity nurse follows a routine which she is incapable of modifying
+  to suit the particular case. She has old-fashioned ideas and notions
+  which she carries out as a matter of course, and she overestimates the
+  great importance of her experience to the extent of wholly disregarding
+  the advice of the physician. She assumes the care of the patient and
+  baby, and regards this as her right, and as a result she is frequently
+  responsible for much injury to the mother and child. Despite these
+  objections we have worked with many of these nurses who were to be
+  preferred to trained nurses. It is the individual after all that counts,
+  and if a maternity nurse, though technically untrained, is adaptable,
+  tactful, and will consent <!-- Page 71 --><span class="pagenum"><a
+  name="page71"></a>[71]</span> to be instructed to the extent of obeying
+  without argument, she can become invaluable, and her skill and experience
+  will carry her creditably over many trying incidents. The objection of
+  the medical profession to an untrained nurse is based, not so much on her
+  lack of ability, as upon her propensity to indiscriminate and indiscreet
+  talk,&mdash;they have not been trained to know the value of professional
+  silence, nor have they had the necessary education which would have
+  enabled them to acquire through their experience the knowledge that
+  "silence is golden" at all times. A trained nurse possesses the requisite
+  knowledge, but may have an objectionable individuality. An untrained
+  nurse may have sufficient knowledge, and what she lacks she may make up
+  for in being congenial and adaptable. While the trained nurse strictly
+  attends exclusively to the mother and the baby, a maternity nurse as a
+  rule attends to the household duties in addition. She cooks the meals of
+  the entire family, and dresses and cares for the other children if there
+  is no one else to do it. The duties of a maternity nurse can be specified
+  and agreed upon, and the terms arranged when she is engaged. The duties
+  of a trained nurse are fixed by nursing laws and medical rules and cannot
+  be changed or modified by private agreement. These laws and rules,
+  however, are not sufficiently arbitrary to make it impossible for the
+  nurse to be obliging, courteous, and sincere,&mdash;qualifications which
+  every patient has a right to expect, and a right to insist upon from
+  every graduate nurse.</p>
+
+  <p>The selection of a nurse should receive careful consideration. She
+  should be known to be honest, honorable, competent, healthy, and
+  personally clean in habits and dress, and she should be tactful,
+  obliging, and she should attend to her own affairs strictly. She should
+  not be a gossip; she should not shirk her work or pry into family affairs
+  that do not concern her; and she should not drag into the conversation
+  her own personal or family secrets.</p>
+
+  <p>The nurse has certain rights which the patient should willingly
+  recognize. She is entitled to a comfortable bed, sufficient sleep, good
+  food, and exercise in the open air <!-- Page 72 --><span
+  class="pagenum"><a name="page72"></a>[72]</span> every day. These are
+  essential in order that she maintain her own health, as well as keep at
+  the highest point of efficiency.</p>
+
+  <p>When you select your physician consult with him regarding your nurse.
+  If you know personally a capable nurse, there is no objection to
+  selecting her, and no physician will oppose this procedure if you assume
+  the responsibility of her capability.</p>
+
+  <p>There are many advantages, however, in permitting the physician to
+  provide a nurse. He assumes the responsibility of the nurse's capability,
+  and it is safe to assume he will not recommend one whom he knows to be
+  personally objectionable, or professionally incapable. Every physician
+  acquires certain individual methods in the conduct of maternity cases,
+  which experience has taught him to be successful. A competent knowledge
+  of these methods by the nurse greatly facilitates the details and ensures
+  a harmonious conduct of the entire case,&mdash;facts which accrue to the
+  comfort and the well-being of the patient.</p>
+
+  <p>It is not out of place here to warn a young wife against being advised
+  by a neighbor or a busybody, as to whom she should select as physician or
+  nurse. You must not depend upon the gossip of the neighborhood. The
+  physician or nurse whom you are told by one of these irresponsible
+  individuals not to take, may be the one above all others whom you should
+  take. When you hear a gossiping woman decry a physician, depend upon it,
+  she owes him something,&mdash;most often it is a bill, but it may only be
+  a grudge. There is no class of men in any community who are maligned and
+  abused so much as are physicians. They seem to be the choice victims of
+  the enmity and spite of every malicious feminine tongue. A woman should
+  think twice before she utters a criticism regarding the work of a
+  physician. She would, if she but knew how quickly she brands and
+  advertises herself as irresponsible and lacking in ordinary courtesy and
+  good breeding, as she is not qualified to criticise the professional
+  capability of a physician, nor is she qualified to estimate the extent of
+  the wrong she perpetrates. There is no class of men who do more
+  conscientious work, day <!-- Page 73 --><span class="pagenum"><a
+  name="page73"></a>[73]</span> after day, than do physicians, and there is
+  no class of men who are more deserving of the commendation of the entire
+  community than the thousands of self-sacrificing, underpaid members of
+  the medical profession. Be suspicious therefore when you hear a
+  criticism, and be very, very sure before you utter one,&mdash;rather give
+  him the benefit of the doubt and you will do no wrong, and it may be at
+  some future date you will be thankful you did not criticise.</p>
+
+  <br clear="all" />
+<hr class="full" />
+
+<p><!-- Page 75 --><span class="pagenum"><a name="page75"></a>[75]</span></p>
+
+<h3>CHAPTER VII</h3>
+
+<h3>THE HYGIENE OF PREGNANCY.</h3>
+
+<blockquote class="b1">
+
+  <p><b>Daily Conduct of the Pregnant Woman&mdash;Instructions Regarding
+  Household Work&mdash;Instructions Regarding Washing and
+  Sweeping&mdash;Instructions Regarding Exercise&mdash;Instructions
+  Regarding Passive Exercise&mdash;Instructions Regarding Toilet
+  Privileges&mdash;-Instructions Regarding Bathing&mdash;Instructions
+  Regarding Sexual Intercourse&mdash;Clothing During Pregnancy&mdash;Diet
+  of Pregnant Women&mdash;Alcoholic Drinks During Pregnancy&mdash;The
+  Mental State of the Pregnant Woman&mdash;The Social Side of
+  Pregnancy&mdash;Minor Ailments of Pregnancy&mdash;Morning Nausea, or
+  Sickness&mdash;Treatment of Morning Nausea, or Sickness&mdash;Nausea
+  Occurring at the End of Pregnancy&mdash;Undue Nervousness During
+  Pregnancy&mdash;The 100 Per Cent. Baby&mdash;Headache&mdash;Acidity of
+  the Stomach, or Heartburn&mdash;Constipation&mdash;Varicose Veins,
+  Cramps, Neuralgias&mdash;Insomnia&mdash;Treatment of
+  Insomnia&mdash;Ptyalism, or Excessive Flow of Saliva&mdash;Vaginal
+  Discharge, or Leucorrhea&mdash;Importance of Testing Urine During
+  Pregnancy&mdash;Attention to Nipples and Breasts&mdash;The Vagaries of
+  Pregnancy&mdash;Contact with Infectious Diseases&mdash;Avoidance of
+  Drugs&mdash;The Danger Signals of Pregnancy.</b></p>
+
+</blockquote>
+
+<h4>CONDUCT OF THE PREGNANT WOMAN</h4>
+
+  <p>The young wife will arrange her daily routine according to the
+  physician's instructions, which, by the way, she should faithfully carry
+  out. If you are one of the fortunate many who enjoy reasonably good
+  health, you have doubtless been told to follow a plan very similar to the
+  one we shall now briefly outline.</p>
+
+  <p>For the first six months she can safely continue to do her household
+  work. It is to her advantage to do so for many reasons, but especially
+  because it helps to keep her physically in good condition, and because it
+  keeps her mind engaged, thus avoiding a tendency to nervous worry. After
+  the sixth month it is desirable to give up the heavier part of the work.
+  Washing and sweeping should be absolutely prohibited. Moving furniture or
+  heavy trunks must not be done by the prospective mother, but all light
+  <!-- Page 76 --><span class="pagenum"><a name="page76"></a>[76]</span>
+  work can and should be indulged in to the very end. Find time to spend at
+  least one hour and a half in the open air every day. Unless there is a
+  medical reason against active exercise there is nothing so beneficial to
+  the pregnant woman as walking, nor is there any substitute for it. A
+  drive or motor ride into the country, or a car ride around town, is an
+  excellent device against ennui and is highly desirable during this time,
+  but not as a substitute for the daily long walk. A pregnant woman must
+  keep her muscles strong and in good tone if she hopes to do her share
+  toward having a short and easy confinement. She must keep active to
+  ensure perfect action of all her organs&mdash;the stomach must digest;
+  the bowels and kidneys must act perfectly; the heart, and lungs, and
+  nerves must be supplied with good blood and fresh air; the appetite must
+  be keen, and the sleep sound. Walking in the open air will do all this
+  and nothing else can, to the same satisfactory degree.</p>
+
+  <p>Light passive exercise at home is desirable to those very few who
+  cannot walk in the open air, but at best it is a poor substitute. It is
+  necessary to avoid any exercise or any labor of the following character
+  from the very beginning of pregnancy: stretching, lifting, jarring,
+  jumping, the use of the sewing machine, bicycling, riding, and
+  dancing.</p>
+
+  <p>She should continue to employ the same toilet privileges she has been
+  accustomed to except the use of the vaginal douche, which must be stopped
+  from the date of the first missed menstrual period. This is the only safe
+  rule to follow and no exception should be made to it except upon the
+  advice of a physician.</p>
+
+  <p>Bathing during the entire course of pregnancy is a highly necessary
+  duty. It is particularly advantageous during the later months because it
+  relieves the kidneys at a time when they are called upon to perform an
+  excess of work. The temperature of the bath should be warm and rapidly
+  cooled at the finish. Brisk rubbing with a course towel will ensure the
+  proper reaction.</p>
+
+  <p>Sexual intercourse must be restricted during pregnancy; and it should
+  be wholly abstained from during what would have been the regular
+  menstrual periods, if <!-- Page 77 --><span class="pagenum"><a
+  name="page77"></a>[77]</span> pregnancy had not occurred, for the reason
+  that abortion is apt to take place. It is most harmful during the early
+  and late months of pregnancy. Sexual intercourse is distasteful to most
+  and harmful to every pregnant woman.</p>
+
+  <p><b>Clothing During Pregnancy.</b>&mdash;The clothing should be so
+  constructed as to relieve any undue pressure on the breasts or abdomen.
+  For this reason it should be suspended from the shoulder. When it is
+  appreciated that clothing supported by the waist crowds the growing womb,
+  and exerts pressure upon the kidneys, and is responsible for many of the
+  kidney complications that occur during pregnancy, no further reason need
+  be given for discarding all clothing, except very light garments, that
+  are not held by some device whose support is from the shoulders. A
+  specially constructed linen waist is made and sold for this purpose. It
+  is fashioned so that all the lower garments and the garters can be
+  fastened to, and supported by it. Corsets should be absolutely discarded
+  from the very first day of pregnancy.</p>
+
+  <p>In a large woman with a lax abdomen, a properly made abdominal support
+  will not only be a great comfort but of real advantage. It should exert a
+  support upward by lifting the abdomen, not by constricting it. It should
+  therefore be obtained from a reliable dealer and be made and applied to
+  effect the above object,&mdash;otherwise it may do more harm than
+  good.</p>
+
+  <p><b>Diet of Pregnant Women.</b>&mdash;Some degree of digestive
+  disturbance and loss of appetite is the rule early in pregnancy. By the
+  fourth month these conditions invariably cease, and the appetite and the
+  ability to digest will greatly improve. The diet from the very beginning
+  of pregnancy should be plain and easily digested. It is not possible to
+  formulate an absolute table of what or what not to eat, as the same foods
+  do not agree equally well with all patients. The individual taste should
+  be catered to within, reason, and the meals should be taken at regular
+  intervals. Articles of diet that experience shows do not agree with the
+  patient should be rigidly excluded from the menu. A varied diet of
+  nutritious character is essential during pregnancy in order to ensure
+  good blood, health, and strength. A monotonous diet, or a diet composed
+  largely <!-- Page 78 --><span class="pagenum"><a
+  name="page78"></a>[78]</span> of stale tea, coffee, and cake, is not
+  permissible, and may do untold harm. Pastries and desserts of all kinds
+  should be excluded. In the later weeks of pregnancy, because of the large
+  size of the womb, the diet should be cut down as the stomach is
+  interfered with in the process of digestion. Should the patient at any
+  time during pregnancy experience a loss of appetite, or an actual disgust
+  for food as sometimes occurs, it is preferable to suggest a change of
+  scene and surroundings rather than the use of medicine. A short vacation,
+  a change of table, new scenery, will promptly effect a cure. This
+  condition is mental rather than physical; the patient allows herself to
+  become introspective; the daily routine becomes monotonous and stale;
+  hence a change of a few days will be all that is necessary. If it is not
+  possible for the patient to obtain a change of scene, a complete change
+  of diet for a few days will often tide over the difficulty. We have known
+  patients to take kindly to an exclusive diet of kumyss, or matzoon, or
+  predigested foods, with stale toast or zwieback, to which can be added
+  stewed fruits. Alcoholic drinks should be left out entirely.</p>
+
+  <p><b>The Mental State of the Pregnant Woman.</b>&mdash;The coming baby
+  should be the text of many interesting, spontaneous talks between the
+  young couple from the time when it is first known that a new member of
+  the family is on its way. The husband should feel that he is a party to
+  the successful consummation of the little one's journey. He can
+  contribute enormously to this end. It should be his duty, born of a
+  sincere affection and love, to formulate the programme of events which
+  has for its main object the wife's entire mental environment. He should
+  encourage her to live up to the physician's instructions, and arrange
+  details so that she will obtain the proper exercise daily. He should read
+  to her in the evening, and arrange his own business affairs so that he
+  will be with her as much as is possible. In many little ways he can
+  impress upon her the fact that they both owe something to the unborn babe
+  and that each must sacrifice self in its behalf. His principal aim, of
+  course, will be that she will not worry or have cause to worry. He will
+  so direct her mental attitude that she will dwell <!-- Page 79 --><span
+  class="pagenum"><a name="page79"></a>[79]</span> only upon the bright
+  side of the picture; she will thus strive to realize the hope that the
+  baby will be strong and healthy, and she will, prompted by his
+  encouragement and devotion, try to do her duty faithfully. Working
+  together in this way, much can be done that means far more than we know
+  of, and in the end the little one comes into the world a welcome baby,
+  created in love and born into the joy of a happy, harmonious, contented
+  home.</p>
+
+  <p><b>The Social Side of Pregnancy.</b>&mdash;The social side of the
+  question should not be overlooked or neglected at this time. Here again
+  the imperative necessity arises to warn the young wife against certain
+  individuals who seem to have a predilection toward recounting all the
+  terrible experiences they have heard regarding confinements. It is
+  astonishing to learn how diversified a knowledge some women burden
+  themselves with in this connection. They can recount case after case,
+  with the harrowing details of a well-told tale, and seem to delight in so
+  doing. Every physician has met these women. The young wife must not
+  permit or encourage any reference to her condition. Simply refusing to
+  discuss the question is the only sure method of preventing its
+  discussion. She will find among her friends a few who have her best
+  interests at heart, and these few will strive sincerely to be of real
+  usefulness to her. If she will keep in mind that the most important
+  element in the success of the whole period, and consequently the degree
+  of her own health, happiness, and comfort, as well as that of her unborn
+  baby, is the character of her own thoughts from day to day, and month to
+  month, she will be complete master of the situation. By constantly
+  dwelling on happy thoughts, reading encouraging and inspiring books,
+  admiring and studying good pictures, working with cheerful colors in
+  sunny rooms, exercising, dieting, and sleeping in a well-aired room, she
+  will have no cause to regret her share in the task before her, or the
+  kind of baby she will bring into the world.</p>
+
+  <p><b>Minor Ailments of Pregnancy.</b>&mdash;There are certain minor
+  ailments which it would be well to be familiar with lest a little worry
+  should creep into the picture.</p>
+
+  <p>Maternity is not only a natural physiological function, <!-- Page 80
+  --><span class="pagenum"><a name="page80"></a>[80]</span> but it is a
+  desirable experience for every woman to go through. The parts which
+  participate in this duty have been for years preparing themselves for it.
+  Each month a train of congestive symptoms have taxed their working
+  strength; pregnancy is therefore a period of rest and
+  recuperation,&mdash;a physiological episode in the life history of these
+  parts. If any ailment arises during pregnancy it is a consequence of
+  neglect, or injury, for which the woman herself is responsible,&mdash;it
+  is not a natural accompaniment of, or a physiological sequence to
+  pregnancy. Find out, therefore, wherein you are at fault, rectify it, and
+  it will promptly disappear.</p>
+
+  <p><b>Morning Nausea or Sickness.</b>&mdash;So-called morning nausea or
+  sickness is very frequently an annoying symptom. It is present as a rule
+  during the first two or three months of pregnancy. How is it produced and
+  how can it be remedied?</p>
+
+  <p>It is produced most frequently by errors in diet. It may be caused by
+  an unnatural position of the womb or uterus, by nervousness,
+  constipation, or by too much exercise or too little exercise. The
+  physician should be consulted as soon as it is observed to be a regular
+  occurrence. He will eliminate by examination any anatomical condition
+  which might cause it; or will successfully correct any defect found. When
+  the cause is defined his instructions will help you to avoid any error of
+  diet, constipation, or exercise. Many cases will respond to a simple
+  remedy,&mdash;a cup of coffee, without milk, taken in bed as soon as
+  awake will often cure the nausea. The coffee must be taken while still
+  lying down,&mdash;before you sit up in bed. If coffee is not agreeable
+  any hot liquid, tea, beef tea, clam bouillon, or chicken broth, or hot
+  water may answer the purpose, though black coffee, made fresh, seems to
+  be the most successful. Ten drops of adrenalin three times daily is a
+  very certain remedy in some cases, though this should be taken with your
+  physician's permission only. If the nausea occurs during the day and is
+  accompanied with a feeling of faintness, take twenty drops of aromatic
+  spirits of ammonia in a half glass of plain water or Vichy water.
+  Sometimes the nausea is caused by the gradual increase of the womb <!--
+  Page 81 --><span class="pagenum"><a name="page81"></a>[81]</span> itself.
+  This is not usually of a persistent character and disappears as soon as
+  the womb rises in the abdominal cavity at the end of the second
+  month.</p>
+
+  <p>Nausea frequently does not occur until toward the end of pregnancy. In
+  these cases the cause is quite different. Because of the size of the womb
+  at this time the element of compression becomes an important
+  consideration. The function of the kidneys, bowels, bladder, and
+  respiration may be more or less interfered with, and it may be desirable
+  to use a properly constructed abdominal support, or maternity corset.
+  These devices support and distribute the weight, and prevent the womb
+  from resting on or compressing, and hence interfering with, the function
+  of any one organ. If the womb sags to one side, thereby retarding the
+  return circulation of the blood in the veins from the leg, it may cause
+  cramps in the leg, especially at night, or it may cause varicose veins,
+  or a temporary dropsy. The correct support will prevent these troublesome
+  annoyances; a properly constructed maternity corset is often quite
+  effective. The diet should receive some special attention when these
+  conditions exist. Any article of diet which favors fermentation
+  (collection of gas) in the stomach or bowel should be excluded. These
+  articles are the sugars, starches, and fats. It can readily be understood
+  that if the bowels should be more or less filled with gas, or if they
+  should be constipated, it will cause, not only great distress, but actual
+  pain. Regulation of the diet, therefore, and exercise (walking best of
+  all) will contribute greatly to the avoidance of these unnecessary
+  sequelae.</p>
+
+  <p>It must be kept in mind that the entire apparatus of the body is
+  accommodating a changed condition, and though that condition is a natural
+  one, it requires perfect health for its successful accomplishment. This
+  means a perfect physical and mental condition,&mdash;a condition that is
+  dependent upon good digestion, good muscles, healthy nerves, clean
+  bowels, and so on. The slightest deviation from absolute health tends to
+  change the character of the body excretions, the quality of the blood,
+  etc. If the excretions are not properly eliminated, the blood becomes
+  impure, and so we sometimes get itching of the body <!-- Page 82 --><span
+  class="pagenum"><a name="page82"></a>[82]</span> surfaces, especially of
+  the abdomen and genitals; neuralgias, especially of the exposed nerves of
+  the face and head; insomnia and nervousness. These are all amenable to
+  cure, which again means, as a rule, correct diet and proper exercise as
+  the principal remedial agencies.</p>
+
+  <p><b>Undue Nervousness During Pregnancy.</b>&mdash;This is very largely
+  a matter of will power. Some women simply will not exert any effort in
+  their own behalf. They are perverse, obstinate, and unreasonable. The
+  measures which ordinarily effect a cure, they refuse to employ. It is
+  useless to argue with them; drugs should never be employed; censure and
+  affection are apparently wasted on them; they cannot even be shamed into
+  obedience. The maternal duty they owe to the unborn child does not seem
+  to appeal to them. We do not know of any way to handle these women and to
+  our mind they are wholly unfit to bring children into the world.
+  Fortunately these women are few in number. The maternal instinct will,
+  and does, guide most women into making sincere efforts to restrain any
+  undue nervous tendency, and to be obedient and willing to follow
+  instructions. There is nothing so beneficial in these cases as an
+  absolutely regulated, congenial, daily routine, so diversified as to
+  occupy their whole time and thought to the exclusion of any introspective
+  possibility. Frequent short changes to the country or seashore to break
+  the monotony, give good results in most of these cases. The domestic
+  atmosphere must also be congenial and the husband should appreciate his
+  responsibility in this respect.</p>
+
+  <p>Women of this type should have their attention drawn to the following
+  facts in this connection: While the most recent investigations of
+  heredity prove that a woman cannot affect the potential possibilities of
+  her child, she can seriously affect its physical vitality. The following
+  illustration may render our meaning clear: suppose your child had the
+  inborn qualities necessary to attain a 100 per cent. record of
+  achievement in the struggle of life; anything you may or may not do
+  cannot affect these qualities&mdash;the child will still have the ability
+  to achieve 100 per cent. Inasmuch, however, as a mother can affect the
+  health or physical qualities of her <!-- Page 83 --><span
+  class="pagenum"><a name="page83"></a>[83]</span> child she is directly
+  responsible, through her conduct, as to whether her child will ever
+  attain the 100 per cent. record, or if it does, she is responsible for
+  the character of its comfort, its health, its enjoyment, all through its
+  life's struggle toward the 100 per cent. achievement record. She may so
+  compromise its physical efficiency that it will succumb to disease as a
+  consequence of the ill health with which its mother unjustly endowed it,
+  even though it possess the ability to attain the 100 per cent. if it
+  lived.</p>
+
+  <p>We often see brilliant children who are nervous and physically unfit,
+  and we see others of more ordinary mental achievement who are healthy and
+  robust animals. The one is the offspring of parents possessing unusual
+  mental qualities but who are physically unable or unwilling to render
+  justice to their progeny; the other parents may be less gifted mentally,
+  but they are healthy and they are willing to give their best in conduct
+  and in blood to their babies. Many of these brilliant children never
+  achieve their potential greatness because they fall by the wayside owing
+  to physical inability, while the healthy little animals achieve a greater
+  degree of success because of the physical vitality which carries them
+  through. To achieve a moderate success and enjoy good health is a better
+  eugenic ideal than the promise of a possible genius never attained
+  because of continuous physical inefficiency.</p>
+
+  <p>The nervous and willful mother should therefore consider how much
+  depends upon her conduct. It cannot be too frequently reiterated and
+  emphasized that every mother should do her utmost to guard and retain her
+  good health. Good health means blood of the best quality and this is
+  essential to the nourishment of the child. To keep in good health does
+  not mean to obey in one respect and fail in other essentials. It means
+  that you must obey every rule laid down by your physician, willingly and
+  freely in your own interest and in the interest of your unborn babe. In
+  no other way may you hope to creditably carry out the eugenic ideal that
+  "the fit only shall be born."</p>
+
+  <p><b>Headache.</b>&mdash;This is a symptom of great importance. <!--
+  Page 84 --><span class="pagenum"><a name="page84"></a>[84]</span> If it
+  occurs frequently, without apparent cause, the physician should be
+  consulted at once, as it may indicate a diseased condition of the
+  kidneys, and necessitate immediate treatment. Headaches may, of course,
+  be caused in many ways and most frequently they do not have any serious
+  significance, but they must always be brought to the attention of the
+  physician. As a rule they are caused by errors of diet,&mdash;too much
+  sugar, candy, for instance, late and indigestible suppers, indiscriminate
+  eating of rich edibles, etc.,&mdash;or they may be products of nervous
+  excitement (too little rest), as shopping expeditions, strenuous social
+  engagements, late hours, etc.</p>
+
+  <p><b>Acidity of the Stomach, and So-Called Heartburn.</b>&mdash;These
+  are sometimes in the early months of pregnancy annoying troubles. The
+  following simple means will relieve temporarily: A half-teaspoonful of
+  bicarbonate of soda or baking soda in a glass of water or Vichy water; or
+  a half teaspoonful of aromatic spirits of ammonia in Vichy, or plain
+  water; or a tablespoonful of pure glycerine. The best remedy is one
+  tablespoonful of Philip's Milk of Magnesia taken every night for some
+  time just before retiring.</p>
+
+  <p>Heartburn is the result of eating improper food, or a failure to
+  digest the food taken. Starchy foods should be avoided. Meats and fats
+  should be taken sparingly. Avoid also the et ceteras of the table, as
+  pickles, sauces, relishes, gravies, mustard, vinegar, etc. Good results
+  follow dry meals,&mdash;meals taken without liquids of any kind. Live on
+  a simple, easily digested, properly cooked diet. Chew the food
+  thoroughly, take plenty of time and be cheerful.</p>
+
+  <p><b>Constipation During Pregnancy.</b>&mdash;Most women are as a rule
+  more or less constipated during pregnancy. It is caused by failure to
+  take the proper amount of outdoor exercise, to take enough water daily,
+  to live on the proper diet, to live hygienically, or because of wrong
+  methods of dress. It is most important that the bowels should move
+  thoroughly every day. Pregnancy no doubt aggravates constipation by
+  diminishing intestinal activity. Consequently there is a greater need for
+  activity on the part of the woman, and open air exercise is the best way
+  <!-- Page 85 --><span class="pagenum"><a name="page85"></a>[85]</span> to
+  accomplish this. She should eat fruits, fresh vegetables, brown or Graham
+  bread, or bran muffins, figs, stewed prunes, and any article of diet
+  which she knows from experience works upon her bowel. She should drink
+  water freely; a glass of hot water sipped slowly on arising every morning
+  or one-half hour before meals, is good. Mineral waters, Pluto, Apenta,
+  Hunyadi, or one teaspoonful of sodium phosphate, or the same quantity of
+  imported Carlsbad salts in a glass of hot water one-half hour before
+  breakfast, answers admirably. If the salts cannot be taken a three- or
+  five-grain, chocolate-coated, cascara sagrada tablet, may be taken before
+  retiring, but other cathartics should not be taken unless the physician
+  prescribes them. Rectal injections should be avoided as a cure of
+  constipation during pregnancy. They are very apt to irritate the womb and
+  if taken at a time when the child is active, they may annoy it enough to
+  cause violent movement on its part, and these movements may cause a
+  miscarriage. See article on "Constipation in Women."</p>
+
+  <p><b>Varicose Veins, Cramps, and Neuralgia of the Limbs.</b>&mdash;When
+  cramps or painful neuralgia occur repeatedly in one or both legs, some
+  remedial measures should be tried. Inasmuch as the cause of this
+  condition is a mechanical one, it would suggest a mechanical remedy. The
+  baby habitually seeks for the most comfortable position, and having found
+  it stays there until conditions render it uncomfortable. He does not
+  consult you in the matter, but he may be subjecting you to untold misery
+  and pain. The child may rest on the mother's nerves or blood-vessels as
+  they enter her body from her lower limbs. If the pressure is sufficient,
+  it can interfere quite seriously with the return blood supply, because
+  veins which carry back to the heart the venous or used blood, are vessels
+  with thin, soft, compressible walls, while arteries which carry blood
+  away from the heart cannot be compressed easily, because their walls are
+  hard and tense. The condition therefore is that more blood is being sent
+  into the limb than is being allowed to return; in this way are produced
+  varicose veins. If these varicose veins burst or rupture we have ulcers,
+  which <!-- Page 86 --><span class="pagenum"><a
+  name="page86"></a>[86]</span> may quickly heal, or they may refuse to
+  heal, and become chronic. A dropsical condition of the leg may follow,
+  and because of interference with the circulation of the blood we get
+  cramps and neuralgias. How can we remedy this painful condition?</p>
+
+  <p>Sometimes we don't succeed, but at least we can try. So long as the
+  cause exists, it is self-evident that rubbing the limb with any external
+  application, will not give any permanent relief, though it is well to
+  try. When rubbing, to relieve cramps at night, always rub upward. It is
+  not a condition that calls for medicine of any kind, while hot baths and
+  hot applications will only make the trouble worse. The remedy that
+  promises the quickest and longest relief is for the patient to assume the
+  knee-chest position for fifteen minutes, three times a day, till relief
+  is permanently established. The patient rests on her knees in bed, and
+  bends forward until her chest rests on the bed also. The incline of the
+  body in this position is reversed; hips are highest, the head lowest. The
+  baby will seek a more comfortable position and this new position may
+  relieve the pressure and cure the condition. Doing this three times daily
+  for fifteen minutes gives relief to the leg by reestablishing a normal
+  blood circulation, and very soon the baby finds a new position that does
+  not interfere with its mother's blood supply, and the cramps, and
+  neuralgia and dropsy, and maybe the varicose veins will soon show
+  improvement. Wearing the proper kind of abdominal support may help, as
+  explained on page <a href="#page77">77</a>. If the varicose veins are
+  bad, it is desirable to wear silk rubber stockings or to bandage the
+  limbs.</p>
+
+  <p><b>Insomnia During Pregnancy.</b>&mdash;Insomnia or sleeplessness is
+  sometimes a vexatious complication during pregnancy. It seldom if ever
+  becomes of sufficient importance or seriousness to interfere with the
+  pregnancy or the health of the patient. Nevertheless, a period of
+  sleeplessness lasting for two or three weeks is not a pleasant experience
+  to a pregnant woman. It is most often met with during the latter half of
+  pregnancy.</p>
+
+  <p>There can be no question that every case of insomnia has definite
+  cause, and can be relieved if we can find the <!-- Page 87 --><span
+  class="pagenum"><a name="page87"></a>[87]</span> cause. The only way to
+  find it is to systematically take up the consideration of each case, and
+  this is best done by the physician. He must have patience and tact; you
+  must answer each question truthfully and fully. Your diet, personal
+  conduct, exercise, condition of bowels, mental environment, domestic
+  atmosphere, everything, in fact, which has any relation to you or your
+  nerves, must be inspected with a magnifying glass. Some little
+  circumstance, easily overlooked, of seemingly no importance, may be the
+  cause of the trouble. You may need more outdoor exercise, or you may need
+  less outdoor exercise. You may need more diversion, more variety, or you
+  may need less. You may need a sincere, honest, tactful, patient confidant
+  and friend, or you may need to be saved from your friends. You may be
+  exhausting your vitality and fraying your nerves by social
+  exigencies,&mdash;those empty occupations which fill the lives of so many
+  fussy, loquacious females,&mdash;echoless, wasted, babbling moments, of
+  supreme important to the social bubbles who ceaselessly chase them but of
+  no more interest to humanity than the wasted evening zephyrs that play
+  tag with the sand eddies on the surface of the dead and silent desert.
+  You may have wandered from the narrow limitations of the diet allowable
+  in pregnancy, or you may be the victim of an objectionably sincere
+  relation who pesters you with solicitous inquiries of a needless
+  character. Whatever it is, rectify it. A good plan to follow on general
+  principles is to take a brisk evening walk with your husband just before
+  bedtime, and at least two hours after the evening meal. Follow this with
+  a sitz bath as soon as you return from the walk.</p>
+
+  <p>A sitz bath is a bath taken in the sitting position with the water
+  reaching to the waist line. It should last about fifteen minutes and the
+  water should be comfortably hot. It is sometimes found that this form of
+  bath creates too much activity on the part of the child and defeats the
+  purpose in view. This is apt to be the case in very thin women when the
+  abdomen is not covered by a sufficient layer of fatty tissue. These women
+  will find it advisable to take, in place of the sitz bath, a sponge bath
+  in a warm room, using the water rather cool than hot but in <!-- Page 88
+  --><span class="pagenum"><a name="page88"></a>[88]</span> a warm room.
+  Rub your skin briskly but waste no time in getting into bed. A glass of
+  hot milk, before going to bed, or when wakeful during the night, may
+  serve as a preventive. When these measures fail the physician should be
+  called upon to advise and prescribe.</p>
+
+  <p><b>Ptyalism, or an Excessive Flow of Saliva.</b>&mdash;This is a
+  common condition in pregnancy, but cannot be prevented. It is of no
+  importance other than that it is a temporary annoyance.</p>
+
+  <p>Itching of the abdomen can usually be allayed by a warm alcohol rub,
+  followed by gently kneading the surface of the abdomen with warm melted
+  cocoa butter, just before retiring.</p>
+
+  <p><b>A Vaginal Discharge.</b>&mdash;Soon after pregnancy has taken place
+  the woman may notice a discharge. It may be very slight or it may be
+  quite profuse. In some cases it does not exist at all during the entire
+  period. As a rule the discharge is more frequent and more profuse toward
+  the end of pregnancy.</p>
+
+  <p>If the discharge exists at any time,&mdash;and it is no cause for
+  worry or alarm if it does exist,&mdash;inform your physician. He will
+  advise you what to do, because it is not wise for you to begin taking
+  vaginal douches or injections without his knowledge, and at a time when
+  they may do you serious harm. Should itching occur as a result of any
+  vaginal discharge the following remedial measures may be employed:</p>
+
+  <p>A solution of one teaspoonful of baking soda to a douche bag of tepid
+  water may be allowed to flow over the parts, or cloths saturated with
+  this mixture may be laid on the itching part. A solution of carbolic acid
+  in hot water (one teaspoonful to one pint of hot water), is also useful,
+  or a wash followed by smearing carbolic vaseline over the itching parts.
+  If your physician should suggest a mild douche for itching of the vagina
+  as the result of a discharge, it may be promptly relieved by using
+  Borolyptol in the water. Buy a bottle and follow directions on the
+  label.</p>
+
+  <p><b>Testing Urine In Pregnancy&mdash;Importance of.</b>&mdash;One of
+  the most important duties, if not the most important, of both the
+  physician and the patient is to have the <!-- Page 89 --><span
+  class="pagenum"><a name="page89"></a>[89]</span> urine of the pregnant
+  woman examined every month during the first seven months and every two
+  weeks during the last two months. The urine examined during the first
+  seven months should be the first urine passed on the day it is sent for
+  examination. During the last two months of pregnancy the <ins
+  class="correction" title="'pateint' in original">patient</ins> should
+  pass all her water into a chamber for an entire day, and take about three
+  ounces of this mixed water for examination. She should measure the total
+  quantity passed during these days and mark it with her name on the label
+  of the bottle. The physician will thus have an absolute record and guide
+  of just how the kidneys are acting, and as they are the most important
+  organs to watch carefully during every pregnancy, the greatest care
+  should be taken to see that failure to note the first symptom of trouble
+  does not take place.</p>
+
+  <p><b>Attention to Nipples and Breast.</b>&mdash;The physician should
+  inspect the breasts and nipples of every pregnant woman when she first
+  visits his office. Frequently the nipples are found to have been
+  neglected, probably subjected to pressure by badly fitting corsets or too
+  tight clothing. Instructions gently to pull depressed nipples out once
+  daily, if begun early, will result in marked improvement by the end of
+  pregnancy. During the latter part of pregnancy the breasts should be
+  carefully and thoroughly bathed daily in addition to the daily bath. This
+  special bath should be with a solution of boric acid (one teaspoonful to
+  one pint of water). After the bath apply a thin coating of white vaseline
+  to the nipples. It may be necessary to resort to the following mixture to
+  harden the nipples and to make them stand out so that the child can get
+  them in its mouth: Alcohol and water, equal parts into which put a pinch
+  of powdered alum; this mixture should be put in a saucer and the nipples
+  gently massaged with it twice daily. A depressed nipple may also be drawn
+  out by means of a breast pump. If the nipples are not pulled out the
+  child will be unable to nurse. It may then be necessary to put the child
+  on the bottle and when the nipples are ready he may not take them after
+  being used to the rubber nipple. The breasts may become caked and as a
+  caked breast is a very painful <!-- Page 90 --><span class="pagenum"><a
+  name="page90"></a>[90]</span> and serious ailment it is wise to attend to
+  this matter in time.</p>
+
+  <p><b>The Vagaries of Pregnancy.</b>&mdash;Certain foolish, old-fashioned
+  ideas, have crept into the minds of impressionable people regarding
+  pregnancy, which are aptly termed vagaries. It is believed by some that
+  if the pregnant woman is the victim of fright, or is badly scared, or
+  witnesses a terrifying or tragic sight, her child will be, in some way,
+  affected by it. If the incident is not of sufficient gravity to cause an
+  abortion or a miscarriage it will not, in any way mark, or affect the
+  shape of the child in the womb.</p>
+
+  <p>It is believed by some that a child can be marked by reason of some
+  event occurring to the mother while carrying it. This is not so; a child
+  cannot be marked by any experience or mental impression of the mother.
+  Some believe that the actual character of a child can be changed by
+  influences surrounding the mother while carrying it. The character of a
+  child cannot be changed one particle after conception takes place, no
+  matter how the mother spends her time in the interim.</p>
+
+  <p>It should be carefully understood that the character of the baby is
+  entirely different from the physical characteristics of the baby. Were
+  this not so it would be futile on the part of the mother to discipline or
+  sacrifice herself in the interest of her baby. The baby's character will
+  reflect the qualities of the combined union of mother and father. The
+  baby's physical characteristics will largely depend upon the treatment
+  accorded it by the mother during its intro-uterine life. Hence we lay
+  down rules of conduct, diet and exercise in order to produce a good,
+  sturdy animal, while the character or mind of the animal is a part of the
+  fundamental species already created. In other words, no matter how much
+  care you bestow upon a rose bush, its flower will still be a
+  rose,&mdash;it may be a better rose, a stronger, sturdier rose, a better
+  smelling and a more beautiful rose, but it is still a rose.</p>
+
+  <p><b>Contact With Infectious Diseases.</b>&mdash;The pregnant woman
+  should be warned against the danger of coming in contact with any person
+  suffering from any infectious or contagious diseases. To become the
+  victim of one <!-- Page 91 --><span class="pagenum"><a
+  name="page91"></a>[91]</span> of these diseases near the time of labor
+  would be a dangerous complication not only to the mother, but to the
+  child. A woman is more liable to catch one of these diseases during the
+  last month of pregnancy than at any other time. The most dangerous
+  diseases at this period are Scarlet Fever, Diphtheria, Erysipelas, and
+  all diseased conditions where pus is present.</p>
+
+  <p><b>Avoidance of Drugs.</b>&mdash;It is a safe rule during pregnancy to
+  avoid absolutely the taking of all medicines unless prescribed by a
+  physician.</p>
+
+  <p><b>The Danger Signals of Pregnancy.</b>&mdash;The following conditions
+  may be of very great importance and may be the danger signals of serious
+  coming trouble. They must not therefore be neglected or lightly
+  considered. When any of them make their appearance send for the physician
+  who has charge of your case, at once, and follow his advice whatever it
+  may be.</p>
+
+<blockquote class="b1">
+
+  <p>1. Any escape of blood from the vagina, whether in the form of a
+  sudden hemorrhage or a constant leaking, like a menstrual period.</p>
+
+  <p>2. Headache, constant and severe.</p>
+
+  <p>3. Severe pain in the stomach.</p>
+
+  <p>4. Vertigo or dizziness.</p>
+
+  <p>5. Severe sudden nausea and vomiting.</p>
+
+  <p>6. A fever, with or without a chill.</p>
+
+</blockquote>
+
+  <br clear="all" />
+<hr class="full" />
+
+<p><!-- Page 93 --><span class="pagenum"><a name="page93"></a>[93]</span></p>
+
+<h3>CHAPTER VIII</h3>
+
+<h3>THE MANAGEMENT OF LABOR</h3>
+
+<blockquote class="b1">
+
+  <p><b>When to Send for the Physician in Confinement Cases&mdash;The
+  Preparation of the Patient&mdash;The Beginning of Labor&mdash;The First
+  Pains&mdash;The Meaning of the Term "Labor"&mdash;Length of the First
+  Stage of Labor&mdash;What the First Stage of Labor Means&mdash;What the
+  Second Stage of Labor Means&mdash;Length of the Second
+  Stage&mdash;Duration of the First Confinement&mdash;Duration of
+  Subsequent Confinements&mdash;Conduct of Patient During Second Stage of
+  Labor&mdash;What a Labor Pain Means&mdash;How a Willful Woman Can Prolong
+  Labor&mdash;Management of Actual Birth of Child&mdash;Position of Woman
+  During Birth of Child&mdash;Duty of Nurse Immediately Following Birth of
+  Child&mdash;Expulsion of After-birth&mdash;How to Expel
+  After-birth&mdash;Cutting the Cord&mdash;Washing the Baby's Eyes
+  Immediately After Birth&mdash;What to Do with Baby Immediately After
+  Birth&mdash;Conduct Immediately After Labor&mdash;After Pains&mdash;Rest
+  and Quiet After Labor&mdash;Position of Patient After Labor&mdash;The
+  Lochia&mdash;The Events of the Following Day&mdash;The First Breakfast
+  After Confinement&mdash;The Importance of Emptying the Bladder After
+  Labor&mdash;How to Effect a Movement of the Bowels After
+  Labor&mdash;Instructing the Nurse in Details&mdash;Douching After
+  Labor&mdash;How to Give a Douche&mdash;"Colostrum," Its Uses&mdash;<ins
+  class="correction" title="'Adantages' in original">Advantages</ins> of
+  Putting Baby to Breast Early After Labor&mdash;The First Lunch&mdash;The
+  First Dinner&mdash;Diet After Third Day.</b></p>
+
+</blockquote>
+
+  <p><b>When to Send for the Physician in Confinement Cases.</b>&mdash;The
+  physician should be notified just as soon as it is known that labor has
+  begun. The adoption of this course is necessary for a number of reasons.
+  It is only just that he should have an opportunity to arrange his work so
+  that he may be at liberty to give his whole time to your case when he is
+  wanted. He may not be at home at the moment, but can be notified, and can
+  arrange to be on hand when your case progresses far enough to need his
+  personal attention. It will relieve your mind to be assured that he will
+  be with you in plenty of time. <!-- Page 94 --><span class="pagenum"><a
+  name="page94"></a>[94]</span></p>
+
+  <p>Don't worry unnecessarily if he does not come immediately when you
+  notify him, provided you notify him at the beginning of labor. There is
+  plenty of time. You have a lot of work to do before he can be of any
+  help. Many women entertain the idea that a physician can immediately
+  perform some kind of miracle to relieve them of all pains at any stage in
+  labor. This is a mistaken idea. No physician can hasten, or would if he
+  could, a natural confinement. He waits until nature accomplishes her
+  work, and he simply watches to see that nature is not being interfered
+  with. If something goes wrong, as it does now and again; or if the pains
+  become too weak, or if the proper progress is not being made, he may help
+  nature or take the case out of her hands and complete the confinement. If
+  it is thought best to do this, there will be plenty of time.</p>
+
+  <p><b>The Preparation of the Patient and the Conduct of Actual
+  Labor.</b>&mdash;It is assumed that the patient has adhered to the
+  instructions of the physician given during the early days of her
+  pregnancy. These instructions included directions as to exercise, diet,
+  bathing, etc.</p>
+
+  <p>Having calculated the probable date of the confinement, it is the
+  better wisdom to curtail all out-of-door visiting, shopping, social
+  engagements, etc.,&mdash;everything in fact out-of-doors except actual
+  exercise, for two weeks previous to the confinement date. The usual walk
+  in the open air should be continued up to the actual confinement day. The
+  daily bath may be taken, and it is desirable that it should be taken, up
+  to and on the confinement day.</p>
+
+  <p><b>The Meaning of the Term "Labor."</b>&mdash;By labor is meant, the
+  task or work involved in the progress by means of which a woman expels
+  from her womb the matured ovum or child. After the child has been carried
+  in the womb for a certain time (estimated to be 280 days) it is ripe, or
+  fully matured, and is ready to be born. The womb itself becomes irritable
+  because it has reached the limit of its growth and is becoming
+  overstretched. Any slight jar, or physical effort on the part of the
+  patient, or the taking of a cathartic, is apt to set up, or begin the
+  contractions which nature has devised as the process of "labor" by which
+  the womb empties itself. <!-- Page 95 --><span class="pagenum"><a
+  name="page95"></a>[95]</span></p>
+
+  <p><b>The Beginning of Labor.</b>&mdash;When the first so-called pains of
+  actual labor begin they are not always recognized as such. The
+  explanation of this seeming paradox is that the "pains" are not always
+  painful. A woman will experience certain undefined sensations in her
+  abdomen; to some, the feeling is as if gas were rumbling around in their
+  bowels; to others, the feeling is as if they were having an attack of not
+  very painful abdominal colic; while others complain of actual pain. The
+  fact that these sensations continue, and that they grow a little worse;
+  and that the day of the confinement is due, or actually here, impresses
+  them that something unusual is taking place; then, and not till then,
+  does the knowledge that labor is really approaching dawn upon them.</p>
+
+  <p>In due time one of these new sensations, which constitute the first
+  stage of labor, will be more emphatic; there will be a little actual pain
+  so that she will feel like standing still, holding her breath and bearing
+  down. That is the first real labor pain and marks the beginning of the
+  second stage of labor, and may be the first absolute sign that will leave
+  no doubt in her mind that labor has begun.</p>
+
+  <p>The nurse will now inquire into the condition of the patient's bowels.
+  If they have not already moved freely that day, she will give the patient
+  a rectal injection of one pint of warm soap suds into which one
+  teaspoonful of turpentine is put. After the bowels have been thoroughly
+  cleansed, the patient will be made ready for the confinement. The
+  clothing necessary consists of dressing gown, night gown, stockings and
+  slippers. These are worn as long as the patient is out of bed, when all
+  but the night gown will be discarded. The entire body of the patient,
+  from the waist line to the knees, should be thoroughly cleansed, paying
+  particular attention to the private parts; first with warm water and
+  castile soap, and then rendered aseptic by washing with four quarts warm
+  boiled water into which has been put one teaspoonful of Pearson's
+  Creolin. A soft napkin is then wrung out of water that has been boiled
+  and cooled to a suitable temperature, and laid over the genital region,
+  and held <!-- Page 96 --><span class="pagenum"><a
+  name="page96"></a>[96]</span> in place by a dry clean napkin, and allowed
+  to remain there until the physician takes personal charge of the
+  case.</p>
+
+  <p><b>Length of the First Stage of Labor.</b>&mdash;There is no definite
+  or even approximate length of time for the first stage of
+  labor,&mdash;that, you may recall, was the more or less painless stage,
+  or as it has been termed, the "getting-ready" stage. Inasmuch as it is an
+  unimportant and practically painless stage, most patients do not mind it.
+  They continue to be up and around and work as usual.</p>
+
+  <p>The first stage of labor is utilized by nature in opening the mouth of
+  the womb.</p>
+
+  <p>The second stage of labor is utilized by nature in expelling the child
+  into the outer world.</p>
+
+  <p><b>Length of the Second Stage of Labor.</b>&mdash;After the second
+  stage has begun, the length of time necessary to end the labor, assuming
+  everything is normal, depends upon the strength and frequency of the
+  pains. The stronger and more frequent the pains, the quicker it will be
+  over. First confinements necessarily take longer, because the parts take
+  more time to open up, or dilate, to a degree sufficient to allow the
+  child to be born. In subsequent confinements, these parts having once
+  been dilated yield much easier, thus shortening the time and the pains of
+  this, the most painful, stage of labor. The average duration of labor is
+  eighteen hours in the case of the first child, and about twelve hours
+  with women who have already borne children. The time, however, is subject
+  to considerable variation, in individual cases, as has been pointed
+  out.</p>
+
+  <p><b>Conduct of the Patient During the Second Stage of
+  Labor.</b>&mdash;She should remain up, out of bed, as long as she
+  possibly can. The object of this is because experience shows that the
+  labor pains are stronger, and more frequent, when in the upright
+  position. Even though this procedure would seem to invite more constant
+  suffering, it must be remember that labor is a physiological, natural
+  process, that there is nothing to fear or dread; and if the patient is in
+  good health, it is to her advantage to have it over soon, rather than to
+  encourage a long drawn out, exhausting labor. When the pains come <!--
+  Page 97 --><span class="pagenum"><a name="page97"></a>[97]</span> she
+  should be told to hold on to something, to hold her breath as long as
+  possible, and to bear down. A good plan is to roll up a sheet lengthwise,
+  and throw it over the top of an open door and let her grasp both ends
+  tightly and bear down; or she can put her arms over the shoulders of the
+  nurse and bear down. Instruct her to hold her breath as long as she can,
+  bearing down all the time, and when she can't hold it any longer, tell
+  her to let up, and then take a quick deep breath and bear down again,
+  repeating this programme until the pain ceases. Tell her specifically to
+  be sure to keep bearing down till the end of the pain, because the most
+  important time, and the few seconds during which each pain does most of
+  its work during the second stage of labor, is at the very end of each
+  pain. When a woman understands that these instructions are for her good,
+  and that they are given with the one purpose of saving her pain, and
+  shortening the length of labor, she will try to obey. Each pain is
+  intended by nature to do a certain amount of work, and each pain will
+  accomplish that work if the woman does not prevent it; and if she does
+  prevent it, she is only fooling herself, because the next pain will have
+  to do what she would not allow the former to do, and so on according to
+  how she acts.</p>
+
+<h4>THE CARRIERS OF HERITAGE</h4>
+
+  <div class="figcenter" style="width:50%;">
+      <a href="images/v1fig003.jpg"><img width="100%" src="images/v1fig003.jpg"
+      alt="The Carriers of Heritage" /></a>
+    <p>Here is the actual bridge from this generation to the next.</p>
+
+    <p>Into these two little bodies&mdash;the larger not over
+    one-twenty-fifth of an inch in diameter&mdash;is condensed the
+    multitude of characteristics transmitted from one generation to
+    another.</p>
+
+    <p>The vital part of the <i>Ovum</i> is the <i>Nucleus</i>, which
+    contains the actual bodies that carry heritage&mdash;the little grains
+    that are the mother's characteristics&mdash;<i>Chromosomes</i>. This
+    nucleus is nourished by oils, salts and other inclusions, known as
+    <i>Cytoplasm</i>. Floating in the cytoplasm may be found a tiny body
+    known as the <i>Centrosome</i>, which acts as a magnet in certain
+    phases of cell development. Around this whole mass is a <i>Cell
+    Wall</i>, more or less resisting and protective.</p>
+
+    <p>The <i>Spermatozoan</i> is structurally much different from the
+    ovum, but it also has its nucleus and chromosomes, which carry to the
+    child the transmittable characteristics of the father.</p>
+
+    <p>The ovum is usually comparatively large and stationary, and whatever
+    motion is therefore necessary to bring it into contact with the male
+    cell devolves upon the latter, which possesses what is known as a
+    <i>locomotor tail</i>. In addition there are usually many sperms to one
+    ovum, so that the chances are that at least one male cell will reach
+    the egg and effect fertilization, and the beginning of a new life.</p>
+
+    <p>The diagrams on the opposite page show the actual steps by which the
+    spermatozoan unites with the ovum. It is the very first stage of the
+    process of cell multiplication that results in the offspring.</p>
+  </div>
+<h4>THE FORMATION OF A NEW LIFE</h4>
+
+  <div class="figcenter" style="width:66%;">
+      <a href="images/v1fig015.jpg"><img width="100%" src="images/v1fig015.jpg"
+      alt="The Formation of a New Life" /></a>
+    <i>Reproduced by permission from "Genetics," Walters, The Macmillan
+    Co.</i>
+  </div>
+  <p><b>How a Willful Woman Can Prolong Labor.</b>&mdash;For a certain
+  time, during the second stage of labor, a willful, unreasonable woman,
+  can work against nature and save herself a little pain by prolonging the
+  issue; but there will come a time when, the head having reached a certain
+  position, the expulsive pains will be so great that she won't be able to
+  control them and nature then seems to take her revenge. So if a woman
+  holds back, and begins to cry, and scream, when she feels a pain coming,
+  she renders the pain to a large degree negative, she prolongs her labor,
+  adds to the total number of pains, exhausts herself, and endangers the
+  life of her child. It must, however, be remembered in all justice that
+  this is a time when it is much easier to preach than to practice.</p>
+
+  <p>Every confinement is a new experience; no matter how many a physician
+  may have seen, there are no two <!-- Page 98 --><span class="pagenum"><a
+  name="page98"></a>[98]</span> alike. It is one of the interesting
+  psychological problems in medicine to observe the conduct of women during
+  their first confinement.</p>
+
+  <p>Some are calm, exhibiting a degree of self-control that is admirable.
+  They are willing to be instructed, and they recognize that the advice is
+  given for their benefit. They conscientiously try to obey suggestions,
+  and they make praiseworthy efforts to keep themselves under control. They
+  are stoics.</p>
+
+  <p>Others collapse at once; they go to pieces under the slightest excuse,
+  and frequently without as much as an excuse. As soon as the pain begins,
+  they willfully ignore all the instructions given and desperately and
+  foolishly try to escape what they cannot escape. In this unreasonable
+  selfishness they resent advice, and at the same time they implore you to
+  "do something" for them. There is absolutely no excuse for this kind of
+  conduct; and any prospective mother who, because of a willful trait in
+  her disposition, refuses to profit by the kindly professional advice of
+  her physician or nurse, should at least have some consideration for her
+  unborn babe. It may seem unkind to criticise the conduct of any woman at
+  such a time. It is not prompted by a lack of patience or justice however.
+  These women permit, in spite of every assurance to the contrary, an
+  unreasonable fear to overwhelm them; and because of this fear they refuse
+  to be guided into a path of conduct that will save them suffering and
+  shorten the pains which they complain of. It is our conviction that if a
+  woman would try to follow the advice of the physician at this time, at
+  least half of all the seeming suffering would be avoided. We are glad to
+  be able to truthfully state that this type of woman is vastly in the
+  minority.</p>
+
+  <p>When the second stage has advanced far enough, the patient will decide
+  to go to bed. It may be necessary to put her in bed earlier, if her pains
+  are very strong, as there is always a possibility of suddenly expelling
+  the child under the influence of a strong pain. She will, as previously
+  stated, discard all clothing, except her night gown, which can be folded
+  up to her waist line and let down as far as necessary after the
+  confinement is over. The obvious advantage of this arrangement is <!--
+  Page 99 --><span class="pagenum"><a name="page99"></a>[99]</span> that
+  the gown remains unsoiled, and saves what would be needless trouble if it
+  proved necessary to change the night gown at a time when the tired-out
+  patient needs rest. Much aid may be afforded the woman at this stage by
+  twisting an ordinary bed sheet and putting it around one of the posts or
+  bars of the foot of the bed. The patient may then pull on the ends during
+  the pain; she may also find much comfort and aid by bracing her feet on
+  the foot of the bed while pulling. It is desirable to instruct the nurse
+  to press on the small of the back during these pains. Some women
+  appreciate a hot water bottle in this region. If the pains are hard the
+  patient may perspire freely; it is always refreshing occasionally to wipe
+  the face and brow off with a cloth wrung out of cold water. Cramps of the
+  limbs may be relieved by forcibly stretching the leg and pulling the foot
+  up toward the knee. From this time until the child and after-birth are
+  born the physician will take active charge of the case.</p>
+
+  <p><b>The Management of the Actual Birth of the Child.</b>&mdash;Near the
+  end of the second stage of labor it will be observed that the pains have
+  grown strong, expulsive, and more frequent. Very soon the advancing head
+  will begin to push outward the space between the front and back passage;
+  the rectum is pushed outward and the lips of the vagina open. If an
+  anesthetic is to be used these are the pains that call for it. A few
+  drops may be dropped singly on a small clean handkerchief held up by the
+  middle over the nose, its ends falling over the face. A few drops will
+  just take the edge off the pains, and render them quite bearable. As soon
+  as the pain is over the patient should rest, relax completely, and not
+  fret and exhaust herself worrying about the pains to come. It is
+  astonishing how much actual rest a woman can get between pains if she
+  will only try; and it is astonishing how much concentrated mischief a
+  willful, unreasonable woman can do in the same time. She will not try to
+  rest, but cries and moans and pleads for chloroform, until she succeeds
+  in giving everyone except the physician and nurse the impression that she
+  is suffering unnecessarily. Her husband or her mother, <!-- Page 100
+  --><span class="pagenum"><a name="page100"></a>[100]</span> whichever is
+  present, gets nervous; they begin to wonder if the physician is really
+  trying to help; assume a long, sad, serious face! forget their promise to
+  look cheerful, and mayhap offer sympathy to the woman. It is a trying
+  moment and needs infinite patience and tact. The physician attends
+  strictly to his duty, which will now be to guard the woman against
+  exerting too great a force during the last few pains. About this time, or
+  before it in many instances, the "waters will break." This means simply
+  that the bag or membrane in the contents of which the child floated burst
+  because of the pressure of a pain. This is a perfectly natural procedure
+  and should not cause any worry: simply ignore it as if it had no bearing
+  on the labor in any way. As soon as the oncoming head has dilated the
+  passage sufficiently, so that the edges of the entrance to the vagina
+  will slip over the head without tearing, the physician allows the head to
+  be born. It takes some time to do this, and he must hold the head back
+  until just the right moment. It is best not to let the head slip through
+  at the height of a pain, or rupture is sure to occur. Wait till it will
+  slip through as a pain is dying out, and if you have waited long enough
+  and handled the head skillfully, the conditions will be just right at a
+  certain moment to permit this without tearing the parts. There are some
+  cases where a tear, and a good tear, is impossible to guard against. It
+  is not a question of patience, or tact, or skill; it is a combination of
+  conditions which patience, tact, and skill are powerless against.</p>
+
+  <p><b>Position of Woman During Birth of Child.</b>&mdash;The position of
+  the woman is a matter of choice and is not contributory to the results at
+  all. She can lie on her back, which is the ordinary way, or on her side,
+  as the physician or the patient prefer. As soon as the head is born the
+  physician should see that the cord is not round the child's neck; if it
+  is, release it. The shoulders will most likely be born with the next or
+  succeeding pain. The physician will permit the lower shoulder to slip
+  over the soft parts first; this is done by retarding the upper shoulder
+  by pushing it gently behind the pubic bone of the mother. When the
+  shoulders are through, the <!-- Page 101 --><span class="pagenum"><a
+  name="page101"></a>[101]</span> rest of the body of the child slips out
+  without effort.</p>
+
+  <p><b>Duty of Nurse Immediately Following Birth of Child.</b>&mdash;As
+  soon as the child is born the nurse should sit by the side of the mother
+  and hold the womb until the after-birth is expelled. The womb can be
+  easily felt in the lower part of the woman's abdomen as a hard mass. It
+  feels about the size of an extra large orange. The object of holding it
+  is to prevent the possibility of an internal hemorrhage. It can be
+  readily appreciated that the interior of a womb, immediately after a
+  child is born, is simply a large bleeding wound. So long as the womb
+  remains firmly contracted there is very little chance for an extensive
+  bleeding to take place. As a rule the womb remains sufficiently
+  contracted to preclude a hemorrhage until the after-birth is out. After
+  the after-birth is expelled, the womb usually closes down firmly and the
+  liability to bleed is very much reduced. Because there is a distinct
+  chance or tendency for the womb to bleed freely during the time the
+  after-birth remains in, it is customary, as stated above, to watch it
+  closely and to hold it securely. It is best held with the right hand. The
+  fingers should surround the top of the womb and exert a slight downward
+  pressure. Should it show any tendency to dilate or fill with blood, get
+  it between the fingers and the thumb and squeeze it, pushing downward at
+  the same time.</p>
+
+  <p><b>Expulsion of After-Birth.</b>&mdash;The after-birth is usually
+  expelled in about twenty minutes after the child is born. Great care
+  should be experienced in its expulsion. It should not be pulled at any
+  stage of its expulsion. If it does not come easily give it a longer
+  time,&mdash;it takes time for the womb to detach itself from the
+  after-birth; and some after-births are very firmly attached. Eventually
+  it will come out with a little encouragement in the way of frictional
+  massage of the womb through the abdominal walls. If the membranes remain
+  in the womb after the body of the after-birth is out, do not pull on
+  them. Take the after-birth up in the palm of your hand and turn or twist
+  it around, and keep turning it around gently, thereby loosening the
+  membranes from the womb instead of pulling them, which would surely break
+  them, leaving <!-- Page 102 --><span class="pagenum"><a
+  name="page102"></a>[102]</span> the broken ends in the womb, and, as a
+  result, the chance of developing serious trouble.</p>
+
+  <p>The patient should now be given one teaspoonful of the fluid extract
+  of ergot, which should be repeated in an hour. Should there be an
+  excessive flow of blood after this period it may be again repeated at the
+  third hour.</p>
+
+  <p><b>Cutting the Cord.</b>&mdash;As soon as the child is born, and of
+  course long before the after-birth is expelled, the physician will tie
+  the cord. This is best done at two places, one about two inches from the
+  child, and the other two or three inches nearer the mother. Cut the cord
+  about one-half inch beyond the first ligature, which will be between the
+  two ligatures. The cord should be tied with sterile tape made for the
+  purpose, or heavy twisted ligature silk, or a narrow, ordinary, strong
+  tape, previously boiled. It should be tied firmly and inspected a number
+  of times within one hour of its birth. It is possible for a baby to lose
+  enough blood from a cord badly tied to cause its death. A very good way
+  to ensure against such an accident is to cut the cord one inch from the
+  ligature nearest the baby, then turn this inch backward and retie with
+  the same ligature, thus making a double tie at the same spot. Cut the
+  cord with scissors that have been boiled and reserved for this
+  purpose.</p>
+
+  <p><b>Washing Baby's Eyes and Mouth Immediately After Birth.</b>&mdash;As
+  soon after birth as is practicable, wash the baby's eyes with a saturated
+  solution of boracic acid.</p>
+
+  <p>Immediately after the eyes have been washed the physician will drop
+  into them a solution of silver nitrate, three drops of a two per cent.
+  solution in each eye, or argyrol, three drops 20 per cent. solution. This
+  precaution is taken against possible infection during labor and, as
+  explained elsewhere, it is a preventive against certain diseased
+  conditions which, if present, would result in blindness.</p>
+
+  <p>The physician should then wind a little sterile cotton round his
+  moistened little finger, dip it in the boracic solution, and holding the
+  baby up by the feet head down, insert this finger into the throat, thus
+  clearing it of mucus. The tongue and mouth may be gently washed with the
+  same solution. <!-- Page 103 --><span class="pagenum"><a
+  name="page103"></a>[103]</span></p>
+
+  <p>After the baby has cried lustily as an evidence of life and strength,
+  he should be wrapped up in a warm blanket quickly, and immediately put in
+  a cozy basket in a warm place, and left there undisturbed, with his eyes
+  shaded from the light until the nurse is ready to attend to him. The baby
+  should be laid on his right side.</p>
+
+  <p><b>Conduct Immediately Following Labor.</b>&mdash;As soon as the
+  physician is satisfied that the patient is well enough to be left in care
+  of the nurse or attendant, every effort should be made to favor a long,
+  refreshing sleep. Nothing will contribute to the patient's well-being so
+  much as a quiet, restful sleep after labor. The nurse will therefore take
+  the baby into another room, fix the mother comfortably, and give her a
+  glass of warm milk,&mdash;draw the shades or lower the light and tell the
+  tired-out mother to go to sleep. As a rule she will sleep easily, as she
+  is sore and exhausted.</p>
+
+  <p><b>After-Pains.</b>&mdash;In women who have had children the womb does
+  not as a rule contract down as firmly as after the first confinement.
+  This condition permits of slight relaxation of the muscular wall, at
+  which times there is a slight oozing of blood. This blood collects and
+  forms clots in the uterine cavity which acts as irritants, exciting
+  contractions in the effort to expel them. These contractions cause what
+  are commonly known as "after-pains." These pains last until the womb is
+  free from blood-clots. They may be severe the first twenty-four hours and
+  then gradually die out during the following two or three days. Ordinarily
+  in uncomplicated confinements they rarely annoy the patient longer than a
+  few hours. It is a rare exception to observe them after the first
+  confinement.</p>
+
+  <p><b>Rest and Quiet After Labor.</b>&mdash;Sometimes the birth chamber
+  is the rendezvous for all the inquisitive ladies in the neighborhood. No
+  one should be permitted in the lying-in chamber until the patient is
+  sitting up, except the husband and the mother. This should be made an
+  absolute rule in every confinement. This is a period that demands the
+  maximum of uninterrupted rest and repose. The world and all its concerns
+  should remain a blank to a woman during the whole period of her
+  confinement. This is the only successful means of <!-- Page 104 --><span
+  class="pagenum"><a name="page104"></a>[104]</span> obtaining mental rest.
+  The husband and mother should be instructed to present themselves just
+  often enough to demonstrate their interest in the welfare of the patient
+  and the baby.</p>
+
+  <p><b>Position of the Patient After Labor.</b>&mdash;After delivery a
+  woman should be instructed to lie on her back, without a pillow, for the
+  first night. On the following morning she may have a pillow, but she must
+  remain on her back for the first week. Sometimes an exception may be made
+  to this rule by letting the patient move around on the side, with a
+  pillow supporting the back, on the fourth day. These exceptional cases
+  are those whose womb has contracted firmly, as shown by the quick change
+  in the amount and color of the lochia. Women should be told why they must
+  remain on their backs as explained in the chapter: "How long should a
+  woman remain in bed?"</p>
+
+  <p><b>The Lochia.</b>&mdash;The discharge which occurs after every labor
+  is called the lochia. Its color is red for the first four or five days;
+  for the succeeding two or three days it is yellow; for the remainder of
+  its existence it is of a whitish color. It lasts from ten days to three
+  weeks.</p>
+
+  <p>The odor of the lochia is at first that of fresh blood; later it has
+  the odor peculiar to these parts. If at any time the odor should become
+  foul or putrid it is a danger signal to which the nurse should
+  immediately draw the physician's attention.</p>
+
+  <p>If the amount of the lochia should be excessive it should be
+  investigated.</p>
+
+  <p><b>The Events of the Day Following Labor.</b>&mdash;We will assume
+  that the patient enjoyed a long sleep and wakes up refreshed, and with a
+  thankful feeling that all is over and that baby is safely here. She will
+  want to see and caress baby, of course. Lay the baby down in bed beside
+  her and let her love and mother it. Tell her not to lift it, for the
+  strain might injure her, then quietly steal away for ten or fifteen
+  minutes, for these are precious, sacred moments. Motherhood&mdash;that
+  angel spirit, whose influence every human heart has felt&mdash;that
+  guards and guides the world in its sheltering arms&mdash;is born in its
+  divine sense, into the heart of every woman for the <!-- Page 105
+  --><span class="pagenum"><a name="page105"></a>[105]</span> first time,
+  as she gazes in ecstasy and wonder at her first-born. She feels that she
+  has begotten a trust,&mdash;a trust direct from her Creator, and she
+  makes a silent resolve, as she gently and timidly feels the softness of
+  baby's cheek, that she will watch over it, and guide it, and do all a
+  mother can for it, with God's help. It is good for the race that mothers
+  do feel this way: and it is good for all concerned that they be given the
+  opportunity to be so inspired.</p>
+
+  <p>Just as gently take the baby away at the expiration of the allotted
+  time. Take it with a cheerful, smiling word, and do not comment upon
+  mother's happy, thoughtful face, she will quickly collect herself and
+  enter into the spirit of quiet congratulation that should now permeate
+  the home.</p>
+
+  <p><b>The First Breakfast After Labor.</b>&mdash;If the patient has
+  passed a comfortable night, feels well, and is free from temperature, and
+  has a normal pulse, breakfast will consist of a cup of warm milk, or a
+  cup of cocoa made with milk, a piece of toasted bread, and a light boiled
+  egg; or if preferred a cereal with milk and toasted bread. This will be
+  the breakfast for the two following days also. The milk, or the cocoa
+  (whichever is taken), must be sipped, while the attendant supports the
+  patient's head. The cereal, or the egg (whichever is taken), must be fed
+  to the patient out of a spoon. The patient must not make any physical
+  effort to help herself; she must remain relaxed. Even when she sips her
+  milk, or cocoa, she must not make any effort to raise her head; the nurse
+  must support its entire weight. This will be the absolute routine of
+  every meal until the physician gives permission to change the procedure.
+  It is a waste of time to formulate rules only to disobey them.</p>
+
+  <p>Shortly after breakfast the patient's toilet should be attended to.
+  She should have her hair combed, and her face and hands washed. The hair
+  on the right half of her head should be combed while the head rests on
+  the left side, and vice versa. The water used for washing the hands and
+  face should be slightly warmed. It is best to keep the hair braided and
+  to consult the wishes of the patient as to the frequency of combing it.
+  <!-- Page 106 --><span class="pagenum"><a
+  name="page106"></a>[106]</span></p>
+
+  <p><b>The Importance of Emptying the Bladder After Labor.</b>&mdash;An
+  effort should be made now to have the patient urinate. This is very
+  important at this time, as it is not an uncommon experience to find that
+  the abdominal muscles are so worn out and overstrained with the fatigue
+  of labor that they refuse to act when an effort is made to urinate. As a
+  consequence the bladder becomes distended and may have to be emptied by
+  other means. This condition is a temporary and a painless one, and will
+  rectify itself in a day or two; meantime, if this accident has occurred,
+  it is essential that the bladder should be emptied from time to time
+  until the patient can do it herself. To test this function place the
+  patient on the bed pan into which a pint of hot water has been put, and
+  give her a reasonable time to make the effort to pass her water. Should
+  she fail, take an ordinary small bath towel and wring it out of very hot
+  water, just as hot as she can tolerate, and spread it over the region of
+  the bladder and genitals: if there is running water in the room, turn it
+  on full and let it run while the towel is in position as above. If the
+  bladder is full, there is a peculiar, irresistible desire to urinate when
+  one hears running water. If this effort fails, report the fact to the
+  physician when he makes his daily call; he will draw the urine and it
+  will be part of his daily duty to give specific instructions regarding
+  this function until nature reëstablishes it.</p>
+
+  <p>No particular attention need be paid to the bowels for the first two
+  days. On the morning of the third day, if they have not acted of their
+  own accord, the physician will give the necessary instructions to move
+  them. The means necessary to accomplish the first movement after a
+  confinement is a matter of choice. The old-time idea was to use castor
+  oil, and while other remedies are now more or less fashionable, castor
+  oil is still an excellent agent. Enemas are frequently used, but their
+  use is questionable in this instance, inasmuch as a movement has not
+  taken place for three days, the object is to clean out the whole length
+  of the intestinal tract, and an enema is limited to part of the large
+  intestine only,&mdash;according to how it is given. If the small <!--
+  Page 107 --><span class="pagenum"><a name="page107"></a>[107]</span>
+  intestines are not thoroughly emptied, particles of food may remain
+  there, and if so, they will putrify and the patient runs the risk of
+  developing gas,&mdash;sometimes to an enormous extent. This affliction is
+  painful, and dangerous, and nearly always unnecessary. It is always,
+  therefore, more safe, and more desirable, to use some agent by the mouth,
+  and we know of no better one than castor oil; and as castor oil can be so
+  masked as to be practically tasteless at any drug-store soda fountain
+  there can be small objection to it. My custom is to send the nurse or
+  husband with an empty glass to the drug store to have the mixture made
+  there and brought back ready for use. We have frequently obtained it in
+  this way and given it to the patient without her knowing what it was. The
+  best time to give castor oil is two hours after a meal, and two hours
+  before the next meal&mdash;i.e., on an empty stomach. It works quicker
+  and does not nauseate when the stomach is empty.</p>
+
+  <p><b>Instructing the Nurse in Details.</b>&mdash;The nurse will attend
+  to the patient's discharges by changing the napkins frequently. The
+  bruised parts should be washed twice daily, for the first three or four
+  days. If the nurse is a trained graduate nurse a few directions will
+  suffice. If she is not a trained nurse the physician should be explicit
+  in his instructions. It would be better if he actually showed her just
+  how he wanted this work done. The best way to cleanse the vulvæ or
+  privates is to take an ordinary douche bag at the proper height (about
+  three feet) and allow the solution (1 to 2,000 bichlorid) to run over the
+  parts into the douche pan, but do not touch any part of the patient with
+  the nozzle of the douche bag. While she is directing the water with the
+  left hand she should have a piece of sterile cotton in the right hand
+  with which she will gently mop the parts. This method ensures disengaging
+  any clotted blood and is aseptic. Dry the parts afterwards with a soft
+  sterile piece of gauze and apply a clean sterile napkin.</p>
+
+  <p><b>Douching After Labor.</b>&mdash;A nurse should never give a vaginal
+  douche without instructions from the physician. Douches are not necessary
+  in the convalescence of ordinary uncomplicated confinement cases. When it
+  is <!-- Page 108 --><span class="pagenum"><a
+  name="page108"></a>[108]</span> necessary to give vaginal douches after a
+  confinement, there are good reasons why they should be given, and it is
+  therefore absolutely essential that they should be given properly, and
+  with the highest degree of aseptic precautions. If these rules are not
+  observed, the danger of causing serious trouble is very great, and as the
+  physician is directly responsible for the conduct of the case, he should
+  in justice to himself and his patient, do the douching himself.</p>
+
+  <p><b>How to Give a Douche.</b>&mdash;The proper way to give a vaginal
+  douche after a confinement, when the parts are bruised and lacerated, and
+  when, as a consequence, the possibility of infection is very great, is as
+  follows:</p>
+
+  <p>Instruct the nurse to boil and cool about two quarts of water and have
+  another kettle of water boiling. Boil the douche bag and its rubber
+  tubing and the glass douche tube (do not use the hard rubber nozzle that
+  comes with the ordinary douche bag). Drain off the water after it has
+  boiled for ten minutes, but instruct the nurse not to touch the bag or
+  tube, to leave them in the pan, covered, till the physician uses them.
+  When the physician calls, place the patient on a clean warm douche pan
+  while he is sterilizing his hands and making the solution ready. While he
+  is douching the patient the nurse will hold the bag. The bag should not
+  be held higher than two feet above the level of the patient.</p>
+
+  <p><b>Advantages of Putting Baby to the Breast Early After
+  Birth.</b>&mdash;The patient can now take, and will likely be ready for,
+  an hour's nap. After the rest it is desirable to put the baby to the
+  nipple, first carefully cleaning the nipple with a soft piece of sterile
+  gauze dipped in a saturated solution of boracic acid. The reasons for
+  this are as follows:</p>
+
+  <p>1st. There is in the breasts of every woman after confinement a
+  secretion known as "colostrum" which has the property of acting as a
+  laxative to the child, in addition to being a food.</p>
+
+  <p>2nd. It is advisable that the child's bowels should move during the
+  first twenty-four hours and the colostrum was put there partly for that
+  purpose.</p>
+
+  <p>3rd. The act of suckling has a well-known influence <!-- Page 109
+  --><span class="pagenum"><a name="page109"></a>[109]</span> on the womb,
+  in that it distinctly aids in contracting it, and thereby expelling
+  blood-clots and small shreds of the after-birth which might cause trouble
+  if left in.</p>
+
+  <p>4th. By nursing the colostrum out of the breasts, it will favor and
+  hasten the secretion of milk.</p>
+
+  <p>5th. It is frequently easier for the baby to get the nipple before the
+  breast is full of milk, and having once had the nipple it will be easier
+  to induce him to take it again when it is more difficult to get.</p>
+
+  <p><b>The First Lunch After Labor.</b>&mdash;Lunch will be next in order,
+  and that should consist of a clear soup,&mdash;chicken broth, mutton
+  broth, beef broth with a few Graham wafers or biscuits, and a cup of
+  custard or rice pudding. This will be the lunch for the two following
+  days also. The same precautions are to be observed in giving this as were
+  observed with breakfast and as will be observed with all other meals as
+  clearly stated before, and repeated again, so that no mistake may be
+  made. In the middle of the afternoon the patient can take a cup of beef
+  tea or a cup of warm milk.</p>
+
+  <p><b>The First Dinner After Labor.</b>&mdash;Dinner will consist of more
+  broth, or a plate of clear consomme with a dropped egg, or a cereal, a
+  little boiled rice with milk, and stewed prunes, or a baked apple.</p>
+
+  <p>After the bowels have moved, on the third day, and provided the
+  temperature and pulse have been normal since the confinement, the patient
+  can be put on an ordinary mixed diet, particulars regarding which are
+  given on page <a href="#page121">121</a> under the heading "Diet for the
+  nursing mother."</p>
+
+  <br clear="all" />
+<hr class="full" />
+
+<p><!-- Page 111 --><span class="pagenum"><a name="page111"></a>[111]</span></p>
+
+<h3>CHAPTER IX</h3>
+
+<h3>CONFINEMENT INCIDENTS</h3>
+
+<blockquote class="b1">
+
+  <p><b>Regarding the Dread and Fear of Childbirth&mdash;The Woman Who
+  Dreads Childbirth&mdash;Regarding the Use of Anesthetics in
+  Confinements&mdash;The Presence of Friends and Relatives in the
+  Confinement Chamber&mdash;How Long Should a Woman Stay in Bed After a
+  Confinement?&mdash;Why Do Physicians Permit Women to Get Out of Bed
+  Before the Womb Is Back in Its Proper Place?&mdash;Lacerations, Their
+  Meaning and Their Significance&mdash;The Advantage of an Examination Six
+  Weeks After the Confinement&mdash;The Physician Who Does Not Tell All of
+  the Truth</b></p>
+
+</blockquote>
+
+  <p><b>Regarding the More or Less Prevalent Dread or Fear of
+  Childbirth.</b>&mdash;Much has been written, and much more could be
+  written upon this subject. Inasmuch as this book is largely intended for
+  prospective mothers to read and profit thereby, and is not for physicians
+  and nurses whose actual acquaintance with confinement work would render
+  such comments superfluous, it will not be out of place to consider this
+  phase of the subject briefly, from a medical standpoint. When one
+  considers that "a child is born every minute" as the saying goes, and
+  which is approximately true, and at the same time remembers that
+  statistics prove, as near as can be estimated, that there is only one
+  death of a mother in twenty thousand confinements, it would really seem
+  as though we were "looking for trouble" to even regard the subject as
+  worthy of the smallest consideration. It is much more dangerous to ride
+  five miles on a railroad, or on a street car, or even take a two-mile
+  walk,&mdash;the percentage possibility of accident is decidedly in your
+  favor to stay at home and have a baby. Almost any disease you can mention
+  has a higher, a much higher fatality percentage than the risks run by a
+  pregnant <!-- Page 112 --><span class="pagenum"><a
+  name="page112"></a>[112]</span> woman. The real justification for actual
+  fear of serious trouble is so small that it barely exists. These are
+  facts that cannot be argued away by any specious if or and. Why,
+  therefore, should there be any real fear?</p>
+
+  <p>Did you ever hear of the remarks made by a famous philosopher who was
+  given a dinner by his friends in celebration of his 85th birthday? In
+  replying to the eulogisms of his friends he said in part:</p>
+
+  <p>"As I look back into those blessed years that have faded away, I can
+  recall a lot of troubles and many worries as well as much happiness and
+  pleasure, and thinking of it all this evening I can truthfully say my
+  worst troubles and worries never happened."</p>
+
+  <p>So it is with the woman who for weeks or months has made her own life
+  wretched, and possibly the life of her husband and friends, the same in
+  imagining all kinds of dreadful things that never take place. It is
+  undoubtedly an exhibition of weakness, an evidence of failure in the
+  development of self-control. Childbirth is a natural process,&mdash;there
+  is nothing mysterious about it. If you do your part you have no cause to
+  fear,&mdash;the very fact, however, that you entertain a dread of it,
+  shows that you are not doing your part. One of the saddest parts of life,
+  one of the real tragedies of living, is the fact that most of us have to
+  live so long before we really begin to profit by our experiences. Could
+  we only be taught to learn the lesson of experience earlier, when life is
+  younger and hope stronger, we would have so much more to live for and so
+  many more satisfied moments to profit by. One of the most valuable
+  lessons experience can teach any human being is not to worry and fret
+  about the future. You can plant ahead of yourself a path of roses and be
+  cheerful, or you can plant a bed of thorns and reap a thorny reward.
+  Cultivate the spirit of contentment, devote all your energy to making the
+  actual present comfortable. Don't fret about what is going to bother you
+  next week, because, as the philosopher said, most of the troubles we
+  anticipate and worry about never occur, but the worry kills.</p>
+
+  <p><b>Regarding the Use of Anesthetics in
+  Confinements.</b>&mdash;Anesthetics are as a rule given in all <!-- Page
+  113 --><span class="pagenum"><a name="page113"></a>[113]</span>
+  confinements that are not normal. To make this statement more plain it
+  may be said, that, when it is necessary to use instruments, or to perform
+  any operation of a painful character, it is the invariable rule to give
+  anesthetics. As to the wisdom of giving an anesthetic when labor is
+  progressing in a normal and satisfactory manner, there is a difference of
+  opinion. Much depends upon the disposition of the patient and the
+  viewpoint of the physician in charge of the case. It is a fact that a
+  large number of confinements are easy and are admitted to be so, by the
+  patients themselves, and in which it would be medically wrong to give an
+  anesthetic. In a normal confinement, however, when the pains are
+  particularly severe and the progress slow, there is no medical reason why
+  an anesthetic could not be given to ease the pain. In these cases it is
+  not necessary to render the patient completely unconscious. Sufficient
+  anesthetic to dull each pain is all that is necessary, and as this can be
+  accomplished with absolute safety by the use of an anesthetic mixture of
+  alcohol, ether and chloroform, there can be no possible objection to it.
+  The use of an anesthetic, however, is a matter that must be left entirely
+  to the judgment of the physician as there are frequently good reasons why
+  it should not be given under any circumstances.</p>
+
+  <p><b>The Presence of Friends and Relatives in the Confinement
+  Chamber.</b>&mdash;It is a safe rule to exclude every one from the
+  confinement room during the later stages of labor. Sometimes it is
+  desirable to make an exception to this rule in the interest of the
+  patient, by permitting the mother or husband to remain. If this exception
+  is made, however, they must be told to conduct themselves in a way that
+  will tend to keep the patient in cheerful spirits. They must not
+  sympathize, or go around with solemn, gloomy faces. Cheerfulness and an
+  encouraging word will tide over a trying moment when the reverse might
+  prove disastrous.</p>
+
+  <p>Practically the same rule applies to the entire period of
+  convalescence during which time the patient is confined to bed. This is a
+  very important episode in a woman's life and the consequences may be
+  serious if it is misused in any way. Friends and relatives do not
+  appreciate the <!-- Page 114 --><span class="pagenum"><a
+  name="page114"></a>[114]</span> absolute necessity of guarding the
+  patient from small talk and gossip, and an unwitting remark may cause
+  grave mental distress, which may retard the patient's convalescence and
+  disastrously affect the quality and quantity of her milk, thereby
+  injuring the child.</p>
+
+  <p><b>How Long Should a Woman Stay in Bed After a
+  Confinement?</b>&mdash;To answer this question by stating a specific
+  number of days would be wrong, because, few women understand the need for
+  staying in bed after they feel well enough to get up. If any answer was
+  given, it should be at least fourteen days, and it would be nearer the
+  truth medically to double that time. Let us consider what is going on at
+  this period. The natural size of the unimpregnated womb is three by one
+  and three-quarter inches, and its weight is one to two ounces. The
+  average size of the pregnant womb just previous to labor is twenty by
+  fourteen inches, and its weight about sixteen ounces. We have, therefore,
+  an increase of about 600% to be got rid of before it assumes again its
+  normal condition. This decrease cannot be accomplished quickly by any
+  known medical miracle. Nature takes time and she will not be hurried: she
+  will do it in an orderly, perfect manner if she is allowed to. The womb
+  will again find its proper location and will resume its work, in a
+  painless, natural way, in due time, if all goes well. The uterus or womb
+  is held in its place by two bands or ligaments, one on either side, and
+  is supported in front and back by the structures next to it. These bands
+  keep the womb in place in much the same way as a clothes pin sits on a
+  clothes line, and it will retain its proper place provided everything is
+  just right. After labor, it is large and top heavy. If you put a weight
+  on the top of a clothes pin as it sits on a clothes line, what will take
+  place? It will tilt one way or the other, and if the weight is heavy, it
+  will turn completely over. So long as the woman lies in bed the womb will
+  gradually shrink back to its proper size and place; if she sits up or
+  gets out of bed too soon, the weight of the womb, being top heavy, will
+  cause it to tilt and sag out of its true position. As soon as it does
+  this the weight of the bowels and other structures above will push and
+  crowd it further <!-- Page 115 --><span class="pagenum"><a
+  name="page115"></a>[115]</span> out of place. This crowding and tilting
+  interferes with the circulation in the womb and its proper contraction is
+  interfered with, and thus is laid the foundation for the multitude of
+  womb troubles that exist.</p>
+
+  <p>It is a mechanical as well as a medical problem. Being partly
+  mechanical, it is subject to the rules that govern mechanical problems.
+  The importance of this dual process will be appreciated by considering
+  the following fact. Many medical conditions tend to cure or rectify
+  themselves because nature is always working in our behalf if we give her
+  a chance. Take for example an ordinary cold. You can have a very severe
+  cold and you can neglect it, and in spite of your neglect you will get
+  well. It is not wise to neglect colds, nevertheless, it is true that
+  nature will cure, unaided, a great many diseased conditions, if she has
+  half a chance. This, to a very large extent, is the secret of Christian
+  Science, yet the principle is known to everyone. A mechanical condition,
+  on the other hand, has absolutely no tendency to get well of its own
+  accord, or without mechanical aid. This is why Christian Science cannot
+  cure a broken leg. It is this principle that makes diseases of the womb
+  so persistent, and so stubborn of cure. When a womb once becomes slightly
+  displaced, the tendency always is for it to grow worse and never to cure
+  itself. The longer it lasts the worse it gets. Its cure depends upon
+  mechanically putting it back in place and holding it long enough there to
+  permit nature to reëstablish its circulation, and by toning and
+  strengthening it so that when the mechanical support is taken away it
+  will retain its position. There is no other possible way of doing it. Now
+  since it has been proved that nature takes many days to contract a
+  pregnant womb, a woman is taking a risk, and inviting trouble by getting
+  out of bed before that time.</p>
+
+  <p><b>Why Do Physicians Permit Women to Get Up Before the Womb is Back in
+  its Proper Place?</b>&mdash;Without offering the excuse that a woman will
+  not stay in bed as long as a physician knows she should, there is,
+  however, a large degree of truth in this excuse. And we are of the
+  opinion that, if a physician made it a rule to keep all his confinement
+  cases in bed for one month, <!-- Page 116 --><span class="pagenum"><a
+  name="page116"></a>[116]</span> he would very soon find himself without
+  these patients.</p>
+
+  <p>Experience has taught us, however, that it is safe, under proper
+  restrictions, and in uncomplicated confinements, to allow patients to sit
+  up in bed on the 12th and in certain cases on the 10th day, and to get
+  out of bed on the 12th or 14th day. When the patient is allowed to sit
+  up, out of bed, it should not be for longer than one or two hours, and
+  during that time she should sit in a comfortable rocking or Morris chair,
+  which should be placed by the side of the bed. Each day the time can be
+  lengthened, and the distance of the chair from the bed increased. This
+  procedure gives her the opportunity to walk a little further each day,
+  thereby to test her strength and ability to use her limbs. On the fourth
+  day, if all has gone well, she may stay up all day and she may walk more
+  freely about the room. She should be just to herself, however. As soon as
+  she is fatigued she should not make any effort to try to "work it off."
+  When a feeling of fatigue appears she should rest completely. If she has
+  any pain or distress she should acquaint the physician with it at once.
+  She should not try to hide anything on the mistaken idea that "it isn't
+  much." She does not know, and she is not supposed to know what the pain
+  may mean; it may be exceedingly significant. Many women have saved
+  themselves needless suffering, and their husbands unnecessary expenditure
+  of money, by calling the physician's attention to conditions, which in
+  time would have been serious, and would have necessitated long, expensive
+  treatment.</p>
+
+  <p><b>Lacerations During Confinement, Their Meaning and Their
+  Significance.</b>&mdash;The only interest a laceration or a tear has to a
+  physician, is whether the laceration or tear is of sufficient importance
+  to need surgical interference. The laceration can take place at the mouth
+  of the womb, or on the outside, between the vagina and rectum.</p>
+
+  <p>Those of the mouth of the womb always take place, in every
+  confinement, to some degree. They are never given any attention at the
+  time of the confinement, unless under extraordinary circumstances, such
+  as a more or less complete rupture of the womb, and this is such a <!--
+  Page 117 --><span class="pagenum"><a name="page117"></a>[117]</span> rare
+  accident that most physicians practice a lifetime and never see or hear
+  of one single case. Those on the outside are always attended to
+  immediately after labor, or should be, unless they are very extensive and
+  the patient is not in condition to permit of any immediate operative
+  work. In such a case it is best to leave it alone until the patient is in
+  condition to have it operated on at a later date.</p>
+
+  <p>It is distinctly preferable to have it attended to immediately after
+  labor when it is possible, and it is possible in a very large percentage
+  of the cases. The explanation of this is because it is practically
+  painless then, owing to the parts having been so stretched and bruised
+  that they have little or no feeling. If it is left for a day or two and
+  then repaired, it will be more painful, because the parts will have
+  regained their sensitiveness. Another good reason in favor of immediate
+  repair is that a much better and quicker union will take place than if
+  postponed.</p>
+
+  <p>When a patient is torn, but not to the degree necessary to stitch, it
+  is to her advantage to be told to lie on her back and keep her knees
+  together for twelve hours, thus keeping the torn edges together and at
+  rest, thereby favoring quick and healthy repair of the tear. Some
+  physicians go as far as to bind the patient's knees together so she
+  cannot separate them during sleep.</p>
+
+  <p>It is the custom of every conscientious physician to request every
+  woman he confines to report at his office six or eight weeks after labor.
+  The reason for this is to find out by examination the character and
+  extent of the lacerations of the mouth of the womb. No physician can tell
+  at the time of labor just how much damage has been done, because the
+  mouth of the womb, at the time of labor, is so stretched and thinned out,
+  that it is impossible to tell. After the womb has contracted to about its
+  normal size, it is a very simple matter for any physician to tell exactly
+  the character and extent of the lacerations. Most of these tears need
+  absolutely no attention; there are a few however that do. This is a very
+  important matter for two very good reasons.</p>
+
+  <p>1st. Every woman should know, and is entitled to <!-- Page 118
+  --><span class="pagenum"><a name="page118"></a>[118]</span> know, just
+  what condition she is in, because if she has been torn to an extent that
+  needs attention, and is left in ignorance of it, her physical health may
+  be slowly and seriously undermined and the cause of it may not be
+  understood or even guessed at. A woman who becomes nervous and irritable,
+  loses vim and vitality, has headaches, backaches and anemia, and no
+  symptoms, or few, that point to disease of the womb, will suffer a long
+  time before she seeks relief of the right kind, and will be astonished
+  and outraged when she is told that it all results from a bad tear of her
+  womb that she knew nothing about.</p>
+
+  <p>2nd. A physician should in justice to himself insist on this late
+  examination, because if a woman is told, at some subsequent time, by
+  another physician that she is badly torn, and she was not told of it by
+  the physician who confined her, she is very apt to form an unjust opinion
+  of his work and to entertain an unfriendly feeling toward him as a
+  man.</p>
+
+  <p>Some physicians also, to their discredit, are not slow in permitting
+  an unjust opinion of a colleague to be spread around, by preserving a
+  silence, when an explanation would result in an entirely different
+  opinion by the patient. They permit it to be inferred that the physician
+  was responsible for the tear, when such is not the case. No physician on
+  earth can prevent a tear of the mouth of the womb and this should be
+  explained to the patient. Where the physician is at fault is in the
+  failure to examine his patients when it is possible to tell that a tear
+  of any consequence exists. If such an examination is made, he is in a
+  position to state that a tear exists of sufficient extent to justify
+  careful attention. Immediate operation is seldom necessary, and if the
+  patient is comparatively young, it may not be wise to operate, because if
+  pregnancy takes place within a reasonable time the womb will again tear.
+  She should be told, however, that should she not become pregnant during
+  the next three years she should be examined from time to time, and if the
+  condition of her womb, or her health suggest it, she should have the tear
+  attended to. If after this explanation she neglects herself she must
+  blame <!-- Page 119 --><span class="pagenum"><a
+  name="page119"></a>[119]</span> herself, she will at least have no cause
+  to harbor any resentment against her physician who has done all any
+  physician is called upon to do under the circumstances. Another important
+  reason for finding out the character of the laceration is because these
+  lacerations of the mouth of the womb frequently cause sterility.</p>
+
+  <br clear="all" />
+<hr class="full" />
+
+<p><!-- Page 121 --><span class="pagenum"><a name="page121"></a>[121]</span></p>
+
+<h3>CHAPTER X</h3>
+
+<h3>NURSING MOTHERS</h3>
+
+<blockquote class="b1">
+
+  <p><b>The Diet of Nursing Mothers&mdash;Care of the Nipples&mdash;Cracked
+  Nipples&mdash;Tender Nipples&mdash;Mastitis in Nursing
+  Mothers&mdash;Inflammation of the Breasts&mdash;When Should a Child Be
+  Weaned?&mdash;Method of Weaning&mdash;Nursing While
+  Menstruating&mdash;Care of Breasts While Weaning Child&mdash;Nervous
+  Nursing Mothers&mdash;Birth Marks&mdash;Qualifications of a Nursery
+  Maid.</b></p>
+
+</blockquote>
+
+  <p><b>The Diet of Nursing Mothers.</b>&mdash;A nursing mother should eat
+  exactly the same diet as she has always been accustomed to before she
+  became pregnant. If any article of diet disagrees with her she should
+  give up that particular article. She should not experiment; simply adhere
+  to what she knows agreed with her in the past. More, rather than less,
+  should be taken, especially more liquids as they favor milk-making. It is
+  sometimes advisable to drink an extra glass of milk in the mid-afternoon
+  and before retiring. If milk disagrees, or is not liked, she may take
+  clear soup or beef tea in place of it. In a general way milk in
+  quantities not over one quart daily, eggs, meat, fish, poultry, cereals,
+  green vegetables, and stewed fruit constitute a varied and ample dietary
+  to select from.</p>
+
+  <p>Every nursing mother should have one daily movement of the bowels; she
+  should get three or four hours' exercise in the open air every day; and
+  she should nurse her child regularly.</p>
+
+  <p>The diet of the nursing mother during the period immediately after
+  confinement is given elsewhere.</p>
+
+  <p>Alcohol, of all kinds, should be absolutely avoided during the entire
+  period of nursing.</p>
+
+  <p>Drugs of every variety, or for any purpose, should never be taken
+  unless by special permission of her physician.</p>
+
+  <p><b>Care of the Nipples.</b>&mdash;As soon as the mother has had a good
+  sleep after the confinement the nipples should be <!-- Page 122 --><span
+  class="pagenum"><a name="page122"></a>[122]</span> washed with a
+  saturated solution of boracic acid, and the child allowed to nurse. The
+  milk does not come into the breast for two or three days, but the child
+  should nurse every four hours during that time. There is secreted at this
+  time a substance called colostrum. This is a laxative agent which nature
+  intends the child should have as it tends to move the bowels and at the
+  same time it appeases the hunger of the infant. It also accustoms the
+  child to nursing and gradually prepares the nipples for the work ahead of
+  them.</p>
+
+  <p>After each nursing the nipples should be carefully washed with the
+  same solution and thoroughly dried.</p>
+
+  <p><b>Cracked Nipples.</b>&mdash;Cracked nipples often result from lack
+  of care and cleanliness. If they are not cared for as described above
+  they are very apt during the first few days to crack. They should never
+  be left moist. They should be washed and dried after every feeding. If
+  the breasts are full enough to leak they should be covered with a pad of
+  sterile absorbent gauze.</p>
+
+  <p>Nursing mothers should guard against cracked nipples, as they are
+  exceedingly painful; frequently necessitating a discontinuance of
+  nursing; and may produce abscess of the breast.</p>
+
+  <p><b>Treatment of Cracked Nipples.</b>&mdash;In addition to washing the
+  nipples, drying them thoroughly, and placing a pad of dry gauze over them
+  after each feeding, they should be painted with an 8 per cent. solution
+  of nitrate of silver twice daily. Before the next feeding, after the
+  silver has been used, they should be washed with cooled boiled water. If
+  the cracks are very bad it may be necessary to use a nipple-shield over
+  them while nursing for a few days.</p>
+
+  <p><b>Tender Nipples.</b>&mdash;Many women complain of the pain caused by
+  the baby when it is first put to the breast. These nipples are not
+  cracked, they are simple hypersensitive. They should be thoroughly
+  cleansed and dried as above and painted with the compound tincture of
+  benzoin. They should be washed off with the boracic acid solution before
+  each feeding. After a few days under this treatment the tenderness will
+  leave them.</p>
+
+  <p><b>Mastitis in Nursing Mothers.</b>&mdash;When inflammation of <!--
+  Page 123 --><span class="pagenum"><a name="page123"></a>[123]</span> the
+  breast takes place in a nursing mother it is the result of exposure to
+  cold, or it may result from injury. If infection occurs and an abscess
+  develops, it results from the entrance, through the nipples, or cracks,
+  or fissures in the nipple, of bacteria into the breast. There is fever,
+  with chills and prostration, and very soon it is impossible to nurse the
+  child because of the pain. Nursing should be immediately discontinued,
+  the breast supported by a bandage and the milk drawn, with a breast pump,
+  at the regular nursing intervals. An ice-bag should be constantly applied
+  to the painful area and the bowels kept freely open with a saline
+  laxative. When the fever and the pain subside nursing may be resumed.</p>
+
+  <p>If the gland suppurates in spite of treatment it must be freely opened
+  and freely drained.</p>
+
+<h4>WEANING</h4>
+
+  <p><b>When to Wean the Baby.</b>&mdash;Medically there is no exact time
+  at which the baby should be weaned. Certain conditions indicate when it
+  should be undertaken. It is desirable to wean the baby between the tenth
+  and twelfth months. A month or two one way or another will not make much
+  difference if the mother and child are in good condition. It should be
+  weaned between the periods of dentition rather than when it is actively
+  teething. The time of year is important. It would be better to wean it
+  before the hot weather if it is strong and has been accustomed to taking
+  other food than the breast milk. On the other hand it would be decidedly
+  better to defer the weaning until the fall, rather than risk weaning at
+  the tenth or twelfth months if these fall during the height of the hot
+  weather.</p>
+
+  <p><b>Methods of Weaning.</b>&mdash;The best way to wean is to do it
+  gradually. It is not desirable to take the mother's milk away suddenly
+  unless there is a very good reason for it. The child should be fed small
+  portions of suitable other food at the beginning of the tenth month. By
+  the end of the tenth month he should be taking a feeding two or three
+  times a day of food other than the breast milk. This feeding may be given
+  in a bottle. In some cases <!-- Page 124 --><span class="pagenum"><a
+  name="page124"></a>[124]</span> the mother may be able to feed the child
+  with a spoon instead of the bottle. The substitute feedings allowable at
+  this age are given in another chapter.</p>
+
+  <p><b>Times When Rapid Weaning is Necessary.</b>&mdash;There are times
+  when the child must be weaned suddenly, as, for example, at the death of
+  the mother, serious sickness of the mother, or in cases where for any
+  cause the mother suddenly loses her milk. In these cases it is best to
+  wean at once. If an infant refuses to take the bottle under such
+  circumstances, the best plan to adopt, and the wisest one in the long
+  run, is to starve the child into submission. If he gets absolutely
+  nothing but the bottle he will shortly take it without protest. If a
+  meddling individual attempts to feed the child some other food and tries
+  to coax it to take the bottle in the meantime, much harm may result; it
+  is safe only to fight it out for a day or two and win than to half starve
+  the child and lose in the end.</p>
+
+  <p>The child should be weaned if it is not gaining in weight. This may
+  indicate a deficient quality of the mother's milk, or it may indicate a
+  lack of proportion between the child and mother. If a robust child is
+  depending upon the nourishment furnished by a mother who is not in good
+  physical condition the milk may not be adequate in quality and quantity.
+  The child will not therefore develop normally and it may be necessary to
+  wean it.</p>
+
+  <p>If the mother becomes pregnant it will be necessary to wean, because
+  pregnancy invariably affects the quality of the milk. It is a very good
+  habit to accustom the child to take its daily supply of water from a
+  bottle from a very early age. This procedure will make it easier to wean
+  at any time.</p>
+
+  <p>Menstruation is not an indication for weaning as has been explained.
+  If, however, the return of menstruation affects the milk so that it
+  disagrees with, or fails to satisfactorily nourish the child, it may be
+  necessary to wean, but not unless.</p>
+
+  <p>The best reason for weaning a child at the twelfth month is that a
+  mother's milk after that time is not adequate in quality for a child of
+  that age. A child at one year of age has grown beyond the capability of
+  its <!-- Page 125 --><span class="pagenum"><a
+  name="page125"></a>[125]</span> mother to nurse it: nature demands a
+  stronger and a more substantial food than any mother can supply. A mother
+  who nurses her child beyond that period is not only injuring herself, but
+  she is cheating her child. The exception to this rule is, as has been
+  explained, the second summer.</p>
+
+  <p>The child will evidence its dissatisfaction with the breast supply if
+  it is not enough; it will not gain in weight, it will be irritable and
+  fretful, it will tug long and tenaciously at the nipple, it will be
+  unwilling to cease nursing after it should have finished, and it will
+  drop the nipple frequently with a dissatisfied cry. These are all signs
+  of insufficient nourishment, and to the observant mother they will at
+  once indicate that the child must be weaned and fed upon a mixed
+  diet.</p>
+
+  <p><b>Care of Breasts While Weaning Child.</b>&mdash;The process of
+  weaning should cause little or no discomfort. If the weaning is gradual
+  it is necessary to press out enough milk to relieve the tension from time
+  to time. It usually takes three or four days.</p>
+
+  <p>If it is necessary to wean abruptly, as it is occasionally, there may
+  be considerable distress. In these cases it is necessary to massage the
+  breasts completely,&mdash;until all the milk is out, or as much as it is
+  possible to get out,&mdash;then rub the breasts with warm camphorated
+  oil, and bind them firmly. When the breasts are massaged for any reason,
+  the rubbing should be toward the nipple and it should be done gently. If
+  there are any hard lumps, or caked milk, in the breasts, they must be
+  massaged until soft, and the binding renewed. It may be necessary to
+  repeat this process for a number of days. In binding the breasts use a
+  large wad of absorbent cotton at the sides, under the arms, to support
+  the breasts, and another wad between the breasts. This renders the
+  binding more effective; permits the binder to be put on tighter; and
+  prevents it from cutting into the skin. When weaning has to be done
+  quickly the patient should absolutely abstain from all liquids. A large
+  dose of any saline, Pluto, Apenta, or Hunyadi Water, or Rochelle salts,
+  or Magnesium Citrate, should be given every morning for four or five
+  days. <!-- Page 126 --><span class="pagenum"><a
+  name="page126"></a>[126]</span></p>
+
+  <p>If the weaning is gradually undertaken the child should be allowed to
+  nurse less frequently. One less nursing every second day until two
+  nursings daily are given. Keep the two daily nursings up for one week and
+  then discontinue them, after which the above measures may be adopted. To
+  dry the milk up, the breasts may be anointed with the following mixture:
+  Ext. Belladonna, 2 drams; Glycerine, 2 ounces; Oil of Wintergreen, 10
+  drops.</p>
+
+  <p><b>Nervous Nursing Mothers.</b>&mdash;Nervousness, considered not as
+  the product of a diseased condition, but as a temperamental quality, is
+  an unfortunate affliction in some nursing mothers. Let us illustrate just
+  how this characteristic is detrimental to the helpless baby. A mother was
+  instructed to give her baby a half teaspoonful of medicine one-half hour
+  after each feeding. She was told how to give it, and how to hold the baby
+  when giving it. She was also told that the baby would not like it, and
+  would try to eject it from its mouth rather than swallow it, and that
+  when it did swallow it, it would make a little choking noise in its
+  throat, but not to mind these, to go ahead and give it, as the baby could
+  not strangle or choke. It was essential to give the baby this medicine,
+  and hence the physician explicitly instructed her in these details. What
+  was the result? On the following day when the physician called, and found
+  the baby much worse, the mother said: "Oh, doctor! I couldn't give the
+  medicine, the baby wouldn't take it, she nearly strangled to death when I
+  tried to give it." The physician asked for the medicine and placing the
+  baby over his knee, gave it without the slightest trouble, much to the
+  mother's amazement. The servant girl who was a hard-headed, cool, Scotch
+  girl, was instructed and shown how to give the medicine, which she did
+  successfully. The mother was temperamentally nervous, was easily excited
+  and became helpless the moment the baby objected, though she was a
+  strong, robust, healthy woman.</p>
+
+  <p>Another mother was carefully instructed to drop into the eye of her
+  baby two drops of medicine every four hours. She was told and apparently
+  appreciated the <!-- Page 127 --><span class="pagenum"><a
+  name="page127"></a>[127]</span> urgent necessity of the medication as her
+  baby's eye was badly infected. She was further told that if she did
+  exactly as shown, the eye would be better in two or three days, and if
+  she did not, the other eye would become infected, and blindness might
+  result. She undertook to carry out the directions faithfully. She
+  absolutely failed, however, to carry out the instructions. Her husband
+  informed the physician on the following day that she became so nervous
+  and excited that she utterly failed to treat the eye once, and when he
+  and a sister offered their assistance she became so unreasonable in her
+  fear that "they might hurt the baby" that it was impossible to do
+  anything with her. Her sister was finally shown how to do it and carried
+  the case through quite successfully.</p>
+
+  <p>Inasmuch as this book is intended to convey helpful instruction to
+  every mother, the author would suggest to those of this type the
+  necessity of resisting this tendency. It is a matter of will power, just
+  make up your mind not to be silly and if you find that you cannot trust
+  yourself to follow instructions, let someone else do it. When the
+  physician tells you a certain thing must be done, and that no harm can
+  result, do it, and don't imagine all kinds of impossible happenings.</p>
+
+  <p>So much anguish and <ins class="correction" title="'anoyance' in original"
+  >annoyance</ins> is caused in this world by imagining and anticipating
+  trouble, that half the pleasure of life is denied us. You cannot do your
+  whole duty by a helpless baby if you do not reason and act upon sound
+  judgment. Many babies are lost by mothers being afraid to do what should
+  be done, and what they know should be done. It is not what the doctor
+  does that brings a baby through a dangerous sickness; it is the
+  faithfulness of the nurse in carrying out his instructions that is
+  responsible for the outcome. A timid, halting, doubting nurse can quickly
+  undo all a physician hopes to accomplish; while a prompt, faithful nurse,
+  with initiative, and good judgment, can save a little life in a crisis,
+  even in the absence of the physician. Follow instructions implicitly,
+  even though the carrying out of the instructions seem to cause the baby
+  pain and suffering,&mdash;it is for the baby's best interest.</p>
+
+<p><!-- Page 128 --><span class="pagenum"><a name="page128"></a>[128]</span></p>
+
+  <p><b>Birth Marks.</b>&mdash;Much has been written on this subject which
+  a later study of biology and eugenics have shown to be utterly false. Let
+  us consider the actual facts. The baby is already a baby, floating in a
+  fluid of its own manufacture. It has absolutely no connection with its
+  mother except by means of its umbilical cord,&mdash;which is composed of
+  blood vessels. The blood in these vessels is the child's blood and never
+  at any time does it even mix with the blood of the mother. It is sent
+  along these vessels into the placenta, or after-birth, in which it
+  circulates in small thin vessels, so close to the mother's blood that
+  their contents can be interchanged. Yet the two streams never actually
+  mix. The carbonic acid and waste products, in the child's blood, are
+  taken up by the mother's blood, and given in exchange oxygen and food,
+  which is returned to nourish the child. There is absolutely no nervous
+  connection between the mother and the child. How then is it possible for
+  the mother to affect her child in any way except insofar as the quality
+  of its nourishment is concerned? Nor can a mother affect her child in any
+  other sense. If the intermingling of blood could affect a child's
+  education we would frequently resort to surgery. In the article on
+  Eugenics, under the heading, "Education and Eugenics," it is explained
+  that the child is "created" at the moment of conception; that absolutely
+  nothing can affect it after it is created; that no influence of the
+  mother or father can in any way affect it for better or worse. A mother
+  cannot create in her child any quality which she may desire no matter how
+  she conducts herself. It was formerly thought that a mother could for
+  example create a musical genius by devoting all her time to the study of
+  music while she carried the unborn child; or that she could make a
+  historian of it if she studied history; or an artist if she studied
+  paintings. We now know this to be wholly wrong and for very excellent
+  reasons.</p>
+
+  <p>The mother must realize that the only aid she can bestow upon her
+  unborn child is to give it the best possible nourishment. She must
+  provide good blood because the quality of the maternal blood stream
+  bespeaks a healthy or unhealthy, a fit or unfit, child. Whatever the <!--
+  Page 129 --><span class="pagenum"><a name="page129"></a>[129]</span>
+  child is to be is already fixed, its innate characteristics art part of
+  itself. Whether it will have the vitality to develop its inherent
+  possibilities depends, to a great degree, upon its intra-uterine
+  environment,&mdash;and its intra-uterine environment depends upon the
+  health of its mother and the quality of the blood she is feeding it upon.
+  After birth its health, its success, its efficiency, depends upon the
+  care it gets and the quality of its mother's milk. A mother therefore
+  must be in good physical and mental health if she hopes to do her full
+  duty as a mother.</p>
+
+  <p><b>Qualifications of a Nursery Maid.</b>&mdash;When a helper, or maid,
+  is employed to aid in caring for the baby, much precaution should be
+  exercised in selecting her. The association of the nursery maid and the
+  child, is necessarity an intimate one, and she should be willing to
+  submit to a medical examination to prove her physical fitness. Her lungs
+  should be examined thoroughly, so also should the condition of her mouth,
+  throat and nose be known. An observant and tactful mother will also find
+  out if there are any other objectionable conditions existing, which would
+  render her unfit for the position. A nursery maid should be naturally
+  fond of children, she should be industrious, and sensible; of quiet
+  tastes and good disposition. Her work should be a pleasure not a
+  task.</p>
+
+  <br clear="all" />
+<hr class="full" />
+
+<p><!-- Page 131 --><span class="pagenum"><a name="page131"></a>[131]</span></p>
+
+<h3>CHAPTER XI</h3>
+
+<h3>CONVALESCING AFTER CONFINEMENT</h3>
+
+<blockquote class="b1">
+
+  <p><b>The Second Critical Period in the Young Wife's Life&mdash;The
+  Domestic Problem Following the First Confinement.</b></p>
+
+</blockquote>
+
+  <p>The first three or four months following the first confinement is the
+  second important period in the young wife's life. In one sense it is the
+  most critical period. The first important period you will remember we
+  stated to be the first few months after marriage. During these months the
+  young wife passed through the period of adaptation. She found out that
+  matrimony was not all sunshine and happiness. She learned that her
+  husband was not the paragon she had idealized. She discovered his human
+  side. She met daily trials and annoyances incident to domestic life. She
+  found her level, and, in finding it, she discovered herself. She is not
+  very safely anchored yet but she is trying to succeed and the future
+  promises well. Some day she awakes to the knowledge that she is pregnant
+  and a multitude of new speculations enter into the situation. She finds
+  she must go on striving and hoping and praying that she may have the
+  strength and courage to do her part. Time passes, and if she is an
+  ordinary woman she scarcely does justice to herself. Her duties are
+  exacting, and her physical condition is not given the study and care
+  which she ought to give it. She does not understand the importance of the
+  hygiene of pregnancy, and the day of the confinement finds her more or
+  less exhausted, and worn out. She passes through the crisis of maternity,
+  however, and spends the customary ten days in bed. At the end of that
+  period the nurse and physician leave her to face the most important
+  problem of life alone. She is a mother, and has in her exclusive charge a
+  human life.</p>
+
+  <p>Let us exactly understand what the real situation is. It would not
+  further the object of this book or help in the solution of the problem
+  the author has in mind to depict <!-- Page 132 --><span
+  class="pagenum"><a name="page132"></a>[132]</span> a false situation. We
+  must concede the following facts to be true, if we understand the
+  subject:</p>
+
+  <p>1. That the mothers of the human race are, in the vast majority, the
+  poor.</p>
+
+  <p>2. That they are uneducated in the sense that they are not versed in
+  the science of hygiene and sanitation, and consequently health
+  preservation.</p>
+
+  <p>3. That even the fairly well educated are innocently ignorant of the
+  science of heredity, environment, hygiene, sanitation and health
+  preservation.</p>
+
+  <p>4. That to benefit the majority we must depict conditions as they
+  exist among the poor, and reason from that standard.</p>
+
+  <p>Such books as have been written on this subject have based their facts
+  upon too high a plane. Their remedies are beyond the means and the
+  understanding of the average poor mother. Their analogies are based upon
+  conditions that exist among the better class. The average poor housewife
+  gets no practical assistance or help from their deductions, because her
+  environment precludes any utilization of the data furnished; the data is
+  not practical in her particular case.</p>
+
+  <p>Our young mother is in all probability a physically and mentally
+  immature girl. She most likely entered the marriage relationship without
+  a real understanding of its true meaning, or even a serious thought
+  regarding its duties or its responsibilities. She was not taught the true
+  meaning of motherhood before actual maternity was thrust upon her. She
+  has probably innocently acquired habits which are detrimental to her
+  health and her morals; and she has no conception of the fundamental
+  duties of a homemaker. Yet into the keeping of this woman a human life
+  has been given.</p>
+
+  <p>Her home surroundings are not such as to inspire confidence or from
+  which to elicit encouragement. It has been a struggle to make ends meet;
+  to keep the peace; to be hopeful and cheerful. If she has succeeded in
+  keeping her home neat and clean and comfortable, it has been at the
+  expense of her not too robust constitution. If she has made efforts to
+  observe the amenities of life, to be true as wife, companion and
+  confidant, it <!-- Page 133 --><span class="pagenum"><a
+  name="page133"></a>[133]</span> has taxed her nerves, her courage and her
+  vitality. She has frequently been at the breaking point but she has kept
+  up because she felt it was her duty, and because there was nothing else
+  to do.</p>
+
+  <p>As she rests from her weary labor during the first long days after
+  getting out of bed, the loneliness of it all crushes her. She is weak,
+  nervous, and discouraged, and her white, wan face, with its tired,
+  appealing eyes, bespeaks her anemic and hopeless condition. She is only a
+  child herself, yet fate has crowned her with the holy diadem of
+  motherhood. There are thousands of such mothers and yet posterity need
+  not despair. This is just the beginning, and from such beginnings have
+  sprung the heroes of the race. If the reader has carefully read the
+  chapter on Heredity she will understand that the temporary condition of
+  this mother is not important so far as the destiny of the child is
+  concerned. The really important question is, How will this mother
+  develop? The environment of the child depends upon the conditions with
+  which its mother surrounds it. If she is a failure, the child's
+  environmental influences will be unfavorable; if she proves worthy of her
+  trust, if she progresses and masters her difficulties; if she is a good
+  mother and a good homemaker the child's surroundings and influences will
+  be favorable to the full development of its hereditary endowment. But it
+  must be remembered that even an unfavorable environment need not prevent
+  the hereditary promise from dominating the life of the individual.</p>
+
+  <p>To return to our girl mother, upon whose slender shoulders the weight
+  of a great responsibility rests,&mdash;we wish to concede that her burden
+  is great. Her home duties are rendered more onerous because of her
+  physical weakness and disability. The strain of nursing her fretful child
+  is taxing her vitality and her nerves to the limit. Her disposition is
+  imposed upon by the exactions of an uncomprehending husband. She is
+  inclined to fretfulness and melancholia by the seeming uncharitableness
+  of fate and fortune. Her moments of introspection are almost bitter. It
+  is a critical period,&mdash;she has reached the breaking point. <!-- Page
+  134 --><span class="pagenum"><a name="page134"></a>[134]</span></p>
+
+  <p>Such moments are apt to be epochal. The turning of the wheel of
+  fortune will decide the destiny of a human soul.</p>
+
+  <p>It may be a friend who will supply the needed inspiration that will
+  revitalize hope, and courage, and the determination to succeed. Or it may
+  be a prayer, breathed in the silence of despair that will inspire the
+  courage to fight on, and change the complexion of life.</p>
+
+  <p>Once again we would advise such a young wife to calmly think matters
+  over; to find out "what she is working for"; to assemble her ideals and
+  to "know what she wants." There is nothing organically wrong. It is a
+  condition, not a disease. She is discouraged, despondent, nervous and
+  weak. The discouragement, despondency, and nervousness is a result of
+  reduced physical vitality and lack of system. She is not efficient
+  because she is not a trained worker. She is easily discouraged because
+  anemia or bloodlessness fails to supply the oxygen necessary to a fight.
+  There is no period in a woman's life when she is more apt to fall into a
+  rut than at this time. Every element, spiritual and physical, which is
+  necessary to stagnation and indifference is present, and it will take a
+  bold and brave effort to resist the temptation to failure which has
+  encompassed her.</p>
+
+  <p>How can we suggest a remedy? She must first regain her health. She has
+  simply a condition to combat, not a disease, and a definite system, a
+  well laid out plan strictly adhered to will effect the result. She must
+  regain her health, because, without health, she cannot hope to be
+  efficient in work or agreeable in disposition, and she owes both to
+  herself, to her husband and to her child. She must get out of doors. She
+  must walk in the open air. There is absolutely nothing in life that will
+  effect so miraculous a transformation in a discouraged, tired, weary and
+  sick woman, as systematic daily walks in the open air. She must walk
+  briskly, however, and she must desire to get well. We cannot get well if
+  we do not wish to get well. One who walks with a purpose will walk erect,
+  firmly and briskly; she will hold her chest up, and will breathe deeply,
+  and she will drink in hope, and health, and happiness. It takes time to
+  regain strength after <!-- Page 135 --><span class="pagenum"><a
+  name="page135"></a>[135]</span> the strain of pregnancy and labor. Many
+  women complain that they feel weak and do not regain strength quickly,
+  but they make no effort. They must make a beginning. Sitting around
+  waiting for it to come will not bring it. If they cannot walk a mile,
+  they must walk half that distance to begin with; the five mile walk will
+  follow in time. Many young mothers get into the habit of taking baby out
+  in his carriage for an airing, and regard this as exercise for
+  themselves. They join the baby brigade and parade up and down the block,
+  or select a sunny spot where there are others on a like quest, and sit
+  around exchanging confidences. These outings usually degenerate into
+  gossiping parties and are a dangerous and questionable practice. They are
+  no doubt good for the baby, but they are morally and physically bad for
+  the young mother. This daily habit is called exercise, but it is in no
+  sense physical exercise. The young mother should select a certain time
+  each day, immediately after a nursing when baby is likely to sleep, and
+  devote this period to walking. One hour each day will accomplish much in
+  regaining and establishing health and strength, and appetite for the
+  mother. No indoor work can take the place of a walk out of doors. It is a
+  duty on the part of the nursing mother to do this. It will enable her to
+  supply better milk; it will banish her tendency to nervousness; it will
+  ensure a good appetite, good spirits, and sound sleep. It will make her a
+  better mother and a better wife. Many young wives sow the first seeds of
+  discontent, and ultimate failure during the natural depression that
+  follows maternity.</p>
+
+  <p>She must adopt system in the performance of her household duties. A
+  good plan is to set aside a certain definite time for meals, when to
+  begin cooking and when to end washing the dishes. Then arrange regarding
+  the general household duties. Make a schedule for a week devoting each
+  day to a certain task so that at the end of the week all the essential
+  work will have been completed. By systematizing work in this way a great
+  deal of ground can be covered and as time passes it will become easier,
+  as many helpful ways will suggest themselves whereby time will be
+  economized. <!-- Page 136 --><span class="pagenum"><a
+  name="page136"></a>[136]</span></p>
+
+  <p>Adopt a system with the baby. Many mothers are worn-out, nervous
+  wrecks for no other reason than a lack of system in the management of the
+  daily life of their offspring. If system is not adopted in feeding and
+  caring for an infant it becomes irritable. To a sick, tired, weary mother
+  an irritable child is an unspeakable torture. Begin right. Give it
+  adequate, but no unnecessary attention. Nurse it every two hours, and at
+  no other time. Wake it to nurse at its regular time. It will in a few
+  days acquire the habit of feeding regularly and will sleep between
+  feedings. Do not overfeed it. Remember babies never die from starvation,
+  but many do by overkindness, and overfeeding is the most prolific cause
+  of infant mortality known. Read the article on "How long should a baby
+  nurse?" Keep the baby clean, comfortable and happy and you will not have
+  a fretful child, but one that will be a constant inspiration and
+  incentive to you.</p>
+
+  <p>Find time to rest, take a mid-day nap. Get off occasionally to the
+  country or the sea shore for a day or two. Keep up your interest in your
+  personal appearance, be neat and clean, and invite the attention of your
+  husband during the evening hour. Don't let him grow away from you. Be
+  cheerful, encourage him to tell of his hopes and plans, and show an
+  interest in his health and in his work. Do not forget the dominating
+  influence on your efficiency, and on your happiness which the study habit
+  possesses. Interest yourself in some art, cultivate your mind, and soon,
+  sooner than you think, you will have forgotten your troubles and you will
+  have regained your health.</p>
+
+  <p>There is no other way to do it. There is no royal way in which it can
+  be done which is not open to the poorest mother.</p>
+
+  <p>An ocean voyage, a trip to Europe, a society Doctor, a professional
+  masseur, beauty experts and miracle workers cannot accomplish more than
+  you can in your poor apartment, if you "go about it in the right way and
+  in the right spirit." Keep in mind always, that: "failure exists only in
+  acknowledging it." Every task that is worth while is won by
+  self-sacrifice, by self-abnegation, by patient, persistent, enthusiastic
+  effort, and in no other way. The joy of consummation is reward enough for
+  all human sacrifice.</p>
+
+
+
+
+
+
+
+
+<pre>
+
+
+
+
+
+End of the Project Gutenberg EBook of The Eugenic Marriage, Volume I. (of
+IV.), by W. Grant Hague, M.D.
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+</body>
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+The Project Gutenberg EBook of The Eugenic Marriage, Volume I. (of IV.), by
+W. Grant Hague, M.D.
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: The Eugenic Marriage, Volume I. (of IV.)
+       A Personal Guide to the New Science of Better Living and Better Babies
+
+Author: W. Grant Hague, M.D.
+
+Release Date: October 21, 2006 [EBook #19594]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK EUGENIC MARRIAGE ***
+
+
+
+
+Produced by K.D. Thornton, Jason Isbell, Keith Edkins and
+the Online Distributed Proofreading Team at
+http://www.pgdp.net
+
+
+
+
+
+Transcriber's note: A few typographical errors have been corrected: they
+are listed at the end of the text.
+
+[Illustration: Eugenics Hath Its Own Reward]
+
+The Eugenic Marriage
+
+A Personal Guide to the
+New Science of Better
+Living and Better Babies
+
+By W. GRANT HAGUE, M.D.
+
+College of Physicians and Surgeons (Columbia University), New York; Member
+of County Medical Society, and of the American Medical Association
+
+In Four Volumes
+
+VOLUME I
+
+New York
+
+THE REVIEW OF REVIEWS COMPANY
+
+1916
+
+Copyright, 1913, by W. GRANT HAGUE
+
+Copyright, 1914, by W. GRANT HAGUE
+
+       *       *       *       *       *
+
+
+                                                                        [i]
+INDEX OF THE FOUR VOLUMES
+
+NOTE--The Roman numerals I, II, III and IV indicate the volume; the Arabic
+figures 1, 2, 3, etc., indicate the page number.
+
+Accidents and emergencies, IV, 629.
+
+Accouchement Beds, how to prepare, I, 65.
+
+Acne, IV, 576.
+
+Adenoids, IV, 519; how to tell when child has, IV, 520; treatment of, IV,
+521.
+
+Adentitis, acute, IV, 558; causes of, IV, 558; symptoms of, IV, 558;
+treatment of, IV, 558.
+
+Advice to young wives, III, 357.
+
+After-birth, expulsion of, I, 101.
+
+After-pains, I, 103.
+
+Age at which to marry, III, 331.
+
+Albumen water, II, 245.
+
+Alcohol, in patent medicines, III, 455.
+
+Alcoholic drunkenness, I, 44; Dr. Branthwaite on, I, 45; Dr. Sullivan on,
+I, 44.
+
+Amenorrhea, causes, II, 192; absence of menstruation, II, 191; treatment
+of, II, 192.
+
+Anemia, severe, IV, 567; simple, IV, 565; treatment of various forms, IV,
+567.
+
+Anesthetics, new, IV, 654; use of in confinements, I, 112.
+
+Angina, IV, 508.
+
+Anti-meningitis, serum, IV, 656.
+
+Aperient waters, abuse of in constipation, III, 326.
+
+Appendicitis, IV, 546; treatment of, IV, 546.
+
+Appetite, loss of, II, 287; poor, II, 286; treatment for loss of, II, 288.
+
+Arrest of hemorrhage, IV, 635.
+
+Artificial Food, II, 249; formulae for, II, 253; mistakes in preparing, II,
+267.
+
+Aseptic surgery, IV, 653.
+
+Baby, amusing the, II, 217; bathing the, II, 213; care of eyes, II, 215;
+care of genital organs, II, 216; care of mouth and teeth, II, 215; care of
+newly-born, II, 210; care of skin, II, 216; clothing of, II, 214;
+constipation in bottle-fed, II, 309; food for first year, II, 261; fresh
+air for, II, 232; how it gets nourishment in womb, II, 183; how long it
+should sleep, II, 236; how to weigh, II, 220; hygiene and development of,
+II, 209; intervals of feeding, II, 225; night-clothes of, II, 215;
+overfeeding the, II, 224; proper way to lay in bed, II, 235; what to
+prepare for the coming, II, 209; why it cries, II, 237.
+
+Baby's comforter, II, 241.
+
+Bacteria, what happens if we inhale, III, 410.
+
+Barley gruel, II, 244.
+
+Barley water, II, 244, 256.
+
+                                                                       [ii]
+Bath, bran, IV, 591; cold, for reducing fever, IV, 590; cold sponge or
+shower, IV, 592; during pregnancy, I, 76; hot air or vapor, IV, 591; hot,
+IV, 591; mustard, IV, 590; tepid, IV, 592; various kinds of, IV, 590.
+
+Bathing, the baby, II, 213.
+
+Bed, proper way to lay baby in, II, 235.
+
+Bed-wetting, IV, 580.
+
+Beef juice, II, 262.
+
+Beef or meat pulp, II, 244.
+
+Bichloride of mercury solution, IV, 627.
+
+Binder, how to apply, I, 66.
+
+Birth, management of, I, 99.
+
+Birth-chamber, the, I, 61.
+
+Birth marks, I, 128.
+
+Bites, dog, IV, 638.
+
+Blackheads, IV, 576.
+
+Blood, children suffering from poor, IV, 566; poor, IV, 565.
+
+Boils, IV, 559.
+
+Boracic Acid, solution of, IV, 626.
+
+Bottle-feeding, method of, II, 256; what a mother should know about, II,
+264.
+
+Bowels, daily movement necessary, II, 307; how to wash out, IV, 586;
+importance of clean, II, 306.
+
+Boy, building of, II, 139; chancre, the, II, 145; gonorrhea or "clap," II,
+142; sex-hygiene for, II, 139; social evil, II, 141; sources of immorality,
+II, 141; syphilis or "pox," II, 144.
+
+Brain, complications of in syphilis, II, 146.
+
+Bran, as a food, II, 292; bath, IV, 591; muffins, recipe for, II, 311.
+
+Branthwaite, Dr., on alcoholic drunkenness, I, 45.
+
+Bread, II, 273.
+
+Breasts, care of when weaning, I, 125; colostrum in, I, 108; how long
+should baby stay at, II, 225; putting baby to after labor, I, 108.
+
+Bronchitis, IV, 511; chronic, IV, 515; diet for, IV, 513; drugs in, IV,
+514; external applications for, IV, 514; inhalations for, IV, 513; in older
+children, IV, 512; symptoms of in infants, IV, 512; treatment of IV, 512.
+
+Broncho-Pneumonia, acute, IV, 516; symptoms of, IV, 516; how to tell when
+child has, IV, 517; treatment of child with, IV, 517.
+
+Bruise, or contusion, IV, 633.
+
+Burbank, Luther, on education, I, 24.
+
+Burning Clothing, how to extinguish, IV, 641.
+
+Burns, and scalds, IV, 641.
+
+Calomel, II, 297; how to take, II, 297.
+
+Cancer, in women, III, 442; what every woman should know about, III, 442.
+
+Carron oil, solution of, IV, 627.
+
+Castor oil, II, 295; how to give dose of, II, 296.
+
+Catarrh, acute nasal, IV, 500; symptoms of, IV, 500.
+
+Catarrh powders, III, 458.
+
+Cathartics, calomel, II, 295; castor oil, II, 295; citrate of magnesia, II,
+298; how to give children, II, 295.
+
+Cereals, II, 273.
+
+Chancre, the, II, 145.
+
+Change of life, conduct during, III, 446; the menopause, III, 443; symptoms
+of, III, 444.
+
+Cheerful wife and mother, III, 400.
+
+Chicken broth, II, 244.
+
+                                                                      [iii]
+Chicken-pox, IV, 606; symptoms of, IV, 607.
+
+Child, the delicate, II, 281; diet of sick, II, 279; most helpless living
+thing, II, 279; rate of growth of, II, 221; sick, should be in bed, II,
+277; washing mouth and eyes after birth, I, 102.
+
+Child-Birth, I, 61; fear of, I, 111.
+
+Children, acute intestinal diseases of, IV, 529; constipation in, II, 303;
+hysterical, II, 293; rheumatism in, IV, 569; temperature in, II, 217; with
+whom milk does not agree, IV, 535.
+
+Cholera infantum, IV, 540.
+
+Chlorosis, IV, 566; symptoms of, IV, 566.
+
+Chronic Nasal catarrh, IV, 503; treatment of, IV, 504.
+
+Circumcision, should it be advised, II, 169.
+
+Citrate of magnesia, II, 295; how to take, II, 298.
+
+Clap, or gonorrhea, II, 142.
+
+Clothing, baby's, II, 214.
+
+Coddled egg, II, 245.
+
+Cold-pack, IV, 589.
+
+Colds, catching, IV, 497.
+
+Colic, IV, 544; symptoms of, IV, 545; treatment of, IV, 545.
+
+Colitis, chronic, IV, 538.
+
+Colon, irrigation of, IV, 587.
+
+Colostrum, uses of, I, 108.
+
+Condensed milk feeding, II, 227; objections to, II, 257.
+
+Confinement, choice of physician, I, 69; convalescing after, I, 131;
+domestic problem following first, I, 131; how to calculate date of, I, 66;
+how to prepare bed for, I, 65; lacerations during, I, 116; how long woman
+should stay in bed after, I, 114; position and arrangement of bed for, I,
+64; preparations for, I, 61; selection of a nurse, I, 70; use of
+anesthetics in, I, 112; what to provide for, I, 62.
+
+Confinement chamber, presence of friends in, I, 113; presence of relatives
+in, I, 113.
+
+Constipation, II, 315; abuse of cathartics and aperient waters, II, 326;
+always harmful, II, 321; chief cause of, II, 315; cost of, II, 317;
+diseases of women and, II, 320; during pregnancy, I, 84; in bottle-fed
+infants, II, 309; in breast-fed infants, II, 308; in girls between 16 and
+20, II, 321; in children over two years old, II, 309; in infants and
+children, II, 303; lack of bulk in food, II, 326; lack of exercise and, II,
+325; lack of water, II, 325; negligence of, II, 324; pregnancy and, II,
+321; significance of, II, 305; social exigencies and, II, 319; treatment
+of, II, 323; treatment of obstinate, II, 311.
+
+Consumption cure, III, 461.
+
+Consumptives, information for and those living with, III, 421.
+
+Contagious diseases, IV, 599; conduct and dress of nurse for, IV, 600;
+convalescence after, IV, 603; rules to be observed in treatment, IV, 599;
+what isolation means, IV, 600.
+
+Contusion, or bruise, IV, 633.
+
+Convulsions, IV, 577; treatment of child with, IV, 579.
+
+Cord, cutting, the, I, 102; dressing the, II, 210.
+
+Cough, treatment of, IV, 505; nervous or persistent, IV, 504.
+
+                                                                       [iv]
+Cream, for constipation in infants, II, 309.
+
+Croup, false, IV, 506; treatment of false, IV, 507; spasmodic, IV, 507;
+treatment of spasmodic, IV, 507.
+
+Deaf and dumb, I, 37.
+
+Detention, symptoms of, II, 219; treatment of, II, 219.
+
+Desserts, II, 273.
+
+Diarrhoea, inflammatory, IV, 535; summer, IV, 539; symptoms of summer, IV,
+540; treatment of inflammatory, IV, 537; treatment of summer, IV, 541.
+
+Diet, of nursing mother, I, 121; of the pregnant woman, I, 77; of sick
+child, II, 279; for constipated child, II, 310; older children, II, 271.
+
+Dinner, the first after labor, I, 109.
+
+Diphtheria, IV, 610; symptoms of, IV, 611; treatment of, IV, 613.
+
+Disease, how we catch, III, 409; tendency to, III, 416; vice and, I, 4; of
+womb, ovaries or fallopian tubes, II, 199.
+
+Disinfecting, Clothing and linen, IV, 601; mouth and nose, IV, 602; sick
+chamber, IV, 604.
+
+Dislocations, IV, 640.
+
+Dog-bites, IV, 638.
+
+Douche, how to give after labor, I, 108; the use of when pregnant, I, 76.
+
+Draw-sheet, the, I, 65.
+
+Dried bread, II, 245.
+
+Dusting and cleaning, II, 391.
+
+Dysentery, cause of, IV, 535; symptoms of, IV, 536.
+
+Dysmenorrhea, II, 193.
+
+Ear, foreign bodies in, IV, 631; inflammation of, IV, 556; method of
+removing foreign bodies, IV, 632; treatment of inflammation, IV, 556.
+
+Earache, IV, 555.
+
+Ears, do not box, IV, 554; do not pick, IV, 554; let them alone, IV, 554.
+
+Eczema, IV, 562; of the face, IV, 563; rubrum, IV, 563.
+
+Education, and the educator, I, 29; eugenics and, I, 4; Dr. C. W. Saleeby
+on, I, 22; Dr. Helen C. Putnam on, I, 27; Havelock Ellis on, I, 33; Herbert
+Spencer on, I, 35; Luther Burbank on, I, 24; Wm. D. Lewis on, I, 25; true
+province of, I, 35; what place sex hygiene will find in, II, 162; Ella
+Wheeler Wilcox on, I, 22.
+
+Educational systems, difficulty in devising, I, 27; inadequate, I, 22.
+
+Efficiency, requisites of, III, 346.
+
+Egg, coddled, II, 245; white of, II, 262.
+
+Ellis, Havelock, on Education, I, 33.
+
+Emergencies and accidents, IV, 629.
+
+Enema, High, IV, 588; hot, 586.
+
+Enteritis, cause of, IV, 535; symptoms of, IV, 536.
+
+Entero-colitis, IV, 535.
+
+Enuresis, IV, 580.
+
+Environment, I, 3.
+
+Eruptions of the skin, II, 145.
+
+Establishing toilet habits, II, 240.
+
+Eugenic clubs, mother's, I, 54.
+
+Eugenic idea, the, I, 9.
+
+Eugenic principle, I, 10.
+
+Eugenics, I, 12; definition of, I, 12; education and, I, 21; and history,
+I, 5; husband and, I, 19; marriage and, I, 11; motherhood and, I, 16;   [v]
+parenthood and, I, 15; the unfit and, I, 37; what every mother should know
+about, I, 47.
+
+Exercise enough for husband, III, 347; lack of and constipation, III, 347.
+
+Eye, foreign bodies in, IV, 630; method of removing foreign bodies from,
+IV, 631.
+
+Fake medical treatment, for venereal diseases, II, 167.
+
+Father and the boy, II, 163.
+
+Fault-finding, III, 350.
+
+Feeble-minded, the, I, 37; Dr. John Punton on, I, 42; Dr. Max Schlapp on,
+I, 39; segregation and treatment of, I, 42.
+
+Feeding, artificial, II, 249; artificial from birth to twelfth month, II,
+254; the delicate child condition which will justify artificial, II, 266;
+during second year formulae for artificial, II, 253; how to prepare milk
+mixtures, II, 259; intervals of, II, 225; overfeeding, II, 223; regularity
+of, II, 227; what a mother should know about, II, 264; why regularity is
+important, II, 228.
+
+Felon, run-around, or whitlow, IV, 640; treatment of, IV, 641.
+
+Female, beginning of, disease, III, 434; chief cause of diseases, III, 436;
+diseases are avoidable, III, 439; generative organs, II, 178; weakness
+cures, III, 470; what woman with disease should do, III, 441.
+
+Fermentation, of the stomach, II, 304.
+
+Fertility, conditions which affect women, II, 196.
+
+Fever, cold packs for, IV, 589; cold sponging for reducing, IV, 589; ice
+cap for reducing, IV, 589; methods of reducing, IV, 589.
+
+Finger, biting the nails, IV, 585.
+
+Fit, the, only shall be born, I, 10.
+
+Fits, IV, 577.
+
+Fly, dangerous house, IV, 645; to kill, IV, 648.
+
+Fomentations, hot, IV, 593.
+
+Food, allowable during first year, II, 261; bran as a, II, 292; formulae for
+baby, II, 243.
+
+Foodstuffs, IV, 647.
+
+Foreign bodies, in nose, IV, 632; in throat, IV, 633.
+
+Formative period, the, III, 339.
+
+Fraudulent testimonials, III, 467.
+
+Friends, choosing your, III, 367; your husband's, III, 363.
+
+Fruits, II, 273.
+
+Garbage, IV, 647.
+
+Gastric indigestion, acute, IV, 527; treatment of, IV, 527.
+
+Gastro duodenitis, IV, 547.
+
+Generative organs, female, II, 178.
+
+Genital organs, care of, II, 26.
+
+Girl, what a mother should tell her little, II, 173.
+
+Glands, swollen, IV, 558; treatment of swollen, IV, 558.
+
+Gleet, II, 143
+
+Gonorrhea, symptoms of in a man, II, 142; wife infected with, II, 147.
+
+Good health, requirements of, II, 316.
+
+Government investigation of patent medicines, IV, 486.
+
+                                                                       [vi]
+Habits, of delicate child, II, 285.
+
+Hair, falls out in syphilis, II, 146.
+
+Headache, IV, 585; during pregnancy, I, 83; remedies, III, 457; treatment
+of, IV, 585.
+
+Heartburn, during pregnancy, I, 84.
+
+Hemorrhage, arrest of, IV, 635; nasal, IV, 522.
+
+Heredity, I, 3; and eugenics, I, 16; function of education, I, 32.
+
+Hiccough, IV, 523.
+
+High School, system fallacious, I, 29.
+
+Hives, IV, 559; cause of, IV, 559; treatment of, IV, 559.
+
+Home, good housekeeper, III, 389; owning a, III, 400; the ideal, III, 393;
+what makes the, III, 394.
+
+Honeymoon, the, III, 335; marital relations during, III, 336.
+
+Hot pack, IV, 589.
+
+Housefly, dangerous, IV, 645.
+
+Housekeeper, what constitutes an efficient, III, 390.
+
+Husband, and home, III, 404; is he to blame, II, 151; the, and eugenics, I,
+19.
+
+Hysterics, and children, II, 293; treatment of, II, 294.
+
+Ice-cap, for reducing fever, IV, 589.
+
+Ileo-colitis, chronic, IV, 538; treatment of, IV, 539.
+
+Imperial Granum, II, 245.
+
+Incontinence, IV, 580.
+
+Indigestion, acute gastric, IV, 527; acute intestinal, IV, 532; symptoms of
+acute intestinal, IV, 532; treatment of acute gastric, IV, 527; treatment
+of acute intestinal, IV, 533.
+
+Infants, constipation in bottle-fed, II, 309; jaundice in, IV, 547;
+mortality of, I, 2; records of, II, 222.
+
+Infection, direct, IV, 499.
+
+Infectious diseases, IV, 599.
+
+Inflammatory diarrhea, IV, 535.
+
+Influenza, IV, 608; symptoms of, IV, 608; treatment of, IV, 609.
+
+Injections, oil, II, 312.
+
+Insane, care of, I, 43.
+
+Insomnia, during pregnancy, I, 86.
+
+Interior organs, complications of in syphilis, II, 146.
+
+Intermittent fever, IV, 571.
+
+Intestinal diseases of children, IV, 529.
+
+Intestinal Indigestion, acute, IV, 532; symptoms of acute, IV, 532;
+treatment of, IV, 533.
+
+Intestinal worms, IV, 548.
+
+Jaundice, catarrhal, IV, 547; in infants, IV, 546; in older children, IV,
+547.
+
+Junket, II, 244.
+
+Kelly pad, the, I, 65.
+
+Knowledge, two ways of gaining, III, 377.
+
+Labor, after-pains, I, 103; beginning of, I, 95; clothing during, I, 95;
+conduct during second stage of, I, 96; conduct immediately following, I,
+103; douching after, I, 107; first breakfast after, I, 105; first dinner
+after, I, 109; first lunch after, I, 109; first stage of, I, 96; importance
+of emptying bladder after, I, 106; the Lochia, or discharge after, I, 104;
+management of, I, 93; putting baby to breast after, I, 108; second stage
+of, I, 96.
+
+Lacerations during confinement, I, 116.
+
+                                                                      [vii]
+La Grippe, IV, 608; treatment of, IV, 609.
+
+Laryngitis, acute catarrhal, IV, 506; treatment of, IV, 507.
+
+Leucorrhea, cause of sterility, II, 201; in girls, II, 190.
+
+Lewis, Wm. D., on education, I, 25.
+
+Life and insurance, III, 400.
+
+Lithia water, III, 458.
+
+Lochia, or discharge after labor, I, 104.
+
+Lunch, the first after labor, I, 109.
+
+Malaria, intermittent fever, IV, 571; serum for, IV, 656; treatment of, IV,
+571.
+
+Malformation, II, 201.
+
+Man, building a, II, 151.
+
+Marital relations, when they are painful, III, 337; when they should be
+suspended, III, 337.
+
+Marriage, and motherhood, I, 2; best age for, III, 331; certificate and
+vice, I, 15; certificate, utility of, I, 13; evils of early, III, 333;
+failures in, I, 2.
+
+Mastitis, in infancy, IV, 553; in young girls, IV, 554.
+
+Masturbation, or self-abuse, II, 157.
+
+Meats, medical essentials of good, III, 393; preparation and selection of,
+III, 390.
+
+Measles, IV, 616; complications in, IV, 618; Koplik's spots in, IV, 617;
+rules of department of health, IV, 619; symptoms of, IV, 616; treatment of,
+IV, 618.
+
+Medical, letter brokers, III, 482; reliable advice, III, 486.
+
+Medicine chest, contents of family, IV, 629.
+
+Medicine concern run by women, III, 475.
+
+Menstruation, II, 187; irregular, II, 187; painful, II, 193; should not be
+accompanied with pain, II, 189; symptoms of, II, 189; treatment for
+painful, II, 194; why it occurs every 28 days, II, 180.
+
+Milk, children with whom it does not agree, IV, 535; difference between
+human and cows, II, 252; mixture, how to prepare, II, 259; peptonized, II,
+262.
+
+Mind, training the, III, 360.
+
+Miscarriage, II, 202; after treatment of, II, 205; causes of, II, 203;
+course and symptoms of, II, 204; what to do when threatened with, II, 204;
+tendency to, II, 206; womb displacement in, II, 198.
+
+Mosquitoes, regarding, IV, 572; rules of Department of Health, IV, 574.
+
+Mother, the cheerful, III, 400; education of the, II, 277; existence of the
+average, III, 437; what she should know about eugenics, I, 47; what she
+should tell her little girl, II, 173; what she should tell her daughter,
+II, 173.
+
+Motherhood, eugenics and, I, 16; function of, I, 17; preparing for, II,
+187.
+
+Mothers, eugenic clubs, I, 54; girls must not become, II, 184.
+
+Moths, IV, 648.
+
+Mouth, how to disinfect, IV, 601; sore, IV, 523; treatment for ulcers in,
+IV, 525; treatment of sore, IV, 524.
+
+Mucous patches, and ulcers, II, 145.
+
+Mumps, IV, 605; symptoms of, IV, 605.
+
+Mustard bath, IV, 590.
+
+Mustard paste, how to make, IV, 593.
+
+                                                                     [viii]
+Mustard pack, how to prepare and use, IV, 594.
+
+Mutton Broth, II, 244.
+
+Napkins, sanitary, I, 66.
+
+Nasal discharge, chronic, IV, 502.
+
+Nausea, during pregnancy, I, 80.
+
+Nettle-rash, IV, 559; cause of, IV, 559; treatment of, IV, 559.
+
+Night losses, or "wet dreams," II, 158.
+
+Nightmare or night terrors, IV, 583; treatment of, IV, 581.
+
+Nipples, care of, I, 121; cracked, I, 122; tender, I, 122; treatment of
+cracked, I, 122; what mother should know about bottle and, II, 264.
+
+Normal salt, solution of, IV, 627.
+
+Nose, chronic discharge of, IV, 503; complications of in syphilis, II, 146;
+foreign bodies in, IV, 632.
+
+Nose-bleeds, IV, 522.
+
+Nosophobia, or the dread of disease, III, 380.
+
+Nursery maid, qualifications of, I, 129.
+
+Nursing mothers, I, 121; diet of, I, 121; mastitis in, I, 122; nervous, I,
+126.
+
+Oatmeal water, for constipation in infants, II, 309.
+
+Oat-water, II, 244.
+
+Obstetrical outfits, ready to purchase, I, 63.
+
+Oil injections, II, 312.
+
+Oiled silk, IV, 594; what it is and why it is used, IV, 594.
+
+Orange juice, II, 262; for constipation in infants, II, 309.
+
+Organs, transplanting from dead to living, IV, 655.
+
+Otitis, acute, IV, 556.
+
+Ovaries, disease of, II, 199; function of, II, 179.
+
+Overeating, II, 289; III, 327; symptoms of, II, 290.
+
+Overfeeding the baby, II, 223.
+
+Parents, and the Boy, II, 153; a word to, II, 161; eugenics and, I, 15.
+
+Parotitis, epidemic, IV, 605.
+
+Patent Medicines, and education, III, 493; and eugenics, III, 494; and the
+newspaper, III, 484; conspiracy against freedom of press, III, 483; dangers
+of, III, 489; fraudulent testimonials, III, 467; intoxicating effects of,
+III, 453; government investigation of, III, 486; pure food and drug act,
+III, 452, 490.
+
+Patent Medicine Evil, III, 451, 489; and the duty of mothers III, 489; what
+mothers should know about the, III, 451.
+
+People, two kinds of, III, 363.
+
+Peptonized milk, II, 262.
+
+Physicians, what they are doing, IV, 649.
+
+Pimples, IV, 576.
+
+Pneumonia, IV, 516.
+
+Poultices, IV, 593.
+
+Pox, or syphilis, II, 144.
+
+Precautions to be observed, IV, 647.
+
+Pregnancy, avoidance of drugs during, I, 90; clothing during, I, 77;
+constipation during, I, 84; headache during, I, 83; heartburn during, I,
+84; hygiene of, I, 75; insomnia during, I, 86; minor ailments of, I, 76;
+morning nausea, I, 80; sexual intercourse during, I, 76; social side of, I,
+79; undue nervousness during, I, 82; vagaries of, I, 90; vaginal discharge,
+I, 88; varicose veins, cramps and neuralgia during, I, 85.
+
+                                                                       [ix]
+Pregnant, few ailing women become, III, 435; conduct of woman, I, 75; diet
+of woman, I, 77; mental state of woman, I, 78; when woman should first call
+upon physician, I, 68.
+
+Prickly Heat, IV, 560; treatment of, IV, 560.
+
+Principle, differences of, III, 344.
+
+Privy Vaults, IV, 647.
+
+Procreative Function, abuse of, II, 153; III, 440.
+
+Procreative Power, period of, II, 155.
+
+Puberty, age of, II, 179; period of in the female, II, 178.
+
+Pulse, rate in children and adults, II, 221.
+
+Punton, Dr. John, on feeble-minded, I, 42.
+
+Pure Food and Drug Act, III, 452, 490.
+
+Putnam, Dr. Helen C., on education, I, 27.
+
+Quacks, how they dispose of confidential letters, III, 481.
+
+Quarrel, the first, III, 349.
+
+Quinsy, IV, 523.
+
+Race Culture, I, II.
+
+Radium, IV, 652.
+
+Rashes, of childhood, IV, 574; other, IV, 575; treatment of, IV, 576.
+
+Records, Infant, II, 222.
+
+Rectal Irrigations, to reduce fever, IV, 590.
+
+Reproductive Organs, changes in, II, 178; function of the, II, 179.
+
+Resolves, making, III, 371.
+
+Rest and recreation, III, 398.
+
+Rest and sleep, III, 347.
+
+Rheumatism, in children, IV, 569; treatment of acute attack, IV, 570;
+treatment of tendency to, IV, 570.
+
+Rhinitis, chronic, IV, 503.
+
+Rice water, II, 244.
+
+Ringworm, of the scalp, IV, 561.
+
+Rubbers, practice of wearing needs consideration, IV, 498.
+
+Run-around, or felon, IV, 640; treatment of, IV, 641.
+
+Rupture, IV, 551.
+
+Saleeby, Dr. C.W., on education, I, 22.
+
+Sanitary napkins, how to prepare, I, 66.
+
+Santonin, for worms, IV, 549.
+
+Scalds and burns, IV, 641.
+
+Scalp, ringworm of, IV, 561; wounds of, IV, 640.
+
+Scarlet Fever, IV, 620; complications in, IV, 621; eruptions, IV, 621;
+measures to prevent spread of, IV, 621; treatment of, IV, 622.
+
+Scarlatina, IV, 620.
+
+Scientific Dressing, III, 427.
+
+Schlapp, Dr. Max, on the feeble-minded, I, 39.
+
+Self-abuse or Masturbation, II, 155.
+
+Self-culture, young wife's incentive to, III, 379.
+
+Serum, Anti-meningitis, IV, 656; for malaria, IV, 656.
+
+Sexual excesses, II, 159; treatment of, II, 160.
+
+Sexual intercourse, during pregnancy, I, 76.
+
+Shock, the condition of, IV, 637.
+
+Sitz bath, during pregnancy, I, 87.
+
+"606," IV, 655.
+
+Skin, care of, II, 216; care of in contagious diseases, IV, 602; eruptions
+of, II, 145.
+
+Sleeplessness, causes of, IV, 583; treatment of, IV, 583.
+
+Social Evil, what parents should know about, II, 161.
+
+Solutions, normal salt, IV, 627; various, IV, 626.
+
+Soothing syrup, III, 458.
+
+Sore Mouth, IV, 523; treatment of, IV, 524.
+
+                                                                        [x]
+Sore throat, IV, 508.
+
+Sowing wild oats, II, 167.
+
+Spasms, IV, 577.
+
+Spencer, Herbert, on education, I, 35.
+
+Spermatozoa, functions of the, II, 181; the male, or papa egg, II, 181.
+
+Sprains, IV, 639.
+
+Sprue, IV, 525; treatment of, IV, 525.
+
+Stables, IV, 646.
+
+Sterility, II, 195; causes of, in women, II, 198.
+
+Sterilizing, food for day's feeding, II, 260.
+
+Stomach, diseases of, IV, 527; fermentation of, II, 304; function of the,
+II, 304.
+
+Stomach bitters, alcohol in, III, 455.
+
+Stomatitis, IV, 523.
+
+Story, Dr. Thomas A., on education, I, 26.
+
+Study habit, the, III, 374.
+
+Sullivan, Dr., on alcoholic drunkenness, I, 44.
+
+Success, attainment of, III, 345; formula of, III, 373.
+
+Summer Diarrhea, IV, 539; symptoms of, IV, 540; treatment of, IV, 541.
+
+Summer diseases of intestines, IV, 529.
+
+Surgery, aseptic, IV, 653.
+
+Syphilis, or the "pox," II, 144.
+
+Tape worms, IV, 551.
+
+Teeth, care of the, II, 219; how they come, II, 218.
+
+Temperature, in children, II, 217.
+
+Thiersch's solution, IV, 627.
+
+Thought, bad habits of, III, 360; what is a, III, 359.
+
+Thread worm, IV, 549.
+
+Throat, foreign bodies in, IV, 633; sore, IV, 508.
+
+Thrush, IV, 525; treatment of, IV, 525.
+
+Thumb-sucking, IV, 585.
+
+Tonsilitis: Angina, "sore throat," IV, 508; treatment of acute, IV, 510.
+
+Transplanting organs of dead to living, IV, 655.
+
+Tuberculosis, best treatment for, III, 418; facts about, III, 414.
+
+Turpentine stupe, the, IV, 594.
+
+Typhoid, how to keep from spreading, IV, 625; how to prevent getting, IV,
+624; symptoms of, IV, 623; vaccine in, IV, 654.
+
+Ulcers, in mouth, IV, 525; mucous patches and, II, 144.
+
+Vacant lots, IV, 647.
+
+Vaccination, method of, II, 299; symptoms of successful, II, 299; time for,
+II, 299; treatment, II, 300.
+
+Vaccine in typhoid fever, IV, 654.
+
+Vapor bath, IV, 591.
+
+Varicella, IV, 606.
+
+Varicose veins, during pregnancy, I, 85.
+
+Vegetables, II, 272.
+
+Venereal Diseases, fake medical treatment for, II, 167; ten million victims
+of, I, 11.
+
+Vomiting, of children between feedings, II, 226; significance of after
+feeding, II, 230.
+
+Washing dishes, III, 391.
+
+Water, drink plenty of, III, 429.
+
+Weaning, I, 123; care of breasts when, I, 125; menstruation and, I, 124;
+methods of, I, 123; rapid, when it is necessary, I, 124; when to start, I,
+124.
+
+Wedding night, its medical aspect, III, 334.
+
+What to eat and wear in hot weather, III, 426.
+
+When delays are dangerous, III, 423.
+
+Whey, II, 244.
+
+Whitlow, or felon, IV, 640.
+
+                                                                       [xi]
+Whooping Cough, IV, 613; symptoms of, IV, 614; treatment of, IV, 615.
+
+Wife, her part, III, 353; the cheerful, III, 400; the indifferent, III,
+401; what she owes to herself, III, 357.
+
+Wifehood, first weeks and months of, III, 336.
+
+Wilcox, Ella Wheeler, on education, I, 23.
+
+Womb, function of, II, 180; how baby gets nourishment in, II, 183; how held
+in place, II, 189.
+
+Women, ailing, are inefficient, III, 434; diseases of, III, 433; who don't
+want children, III, 439; medicine concern run by, III, 475; most popular,
+III, 365; use of patent medicines in diseases, III, 473.
+
+Work, must be interesting, III, 351.
+
+Working for something, III, 395.
+
+Worms, intestinal, IV, 548; round, IV, 548; symptoms of tape, IV, 551;
+symptoms of thread, IV, 549; tape, IV, 551; thread, IV, 549; treatment of
+round, IV, 549.
+
+Worry, freedom from, III, 348.
+
+Wound, cleaning a, IV, 637; closing and dressing a, IV, 637; removal of
+foreign bodies from, IV, 636.
+
+Wounds, IV, 634; of the scalp, IV, 640.
+
+X-Ray, treatment and diagnosis, IV, 652.
+
+       *       *       *       *       *
+
+
+VOLUME I
+
+       *       *       *       *       *
+
+
+                                                                       [xv]
+TABLE OF CONTENTS
+
+EUGENICS. RACE CULTURE
+
+CHAPTER I
+
+CONDITIONS WHICH HAVE EVOLVED THE SCIENCE OF EUGENICS
+
+Infant mortality--Marriage and
+motherhood--Heredity--Environment--Education--Disease and
+vice--History--Summary ... PAGE 1
+
+CHAPTER II
+
+THE EUGENIC IDEA
+
+The value of human life--The eugenic principle--"The fit only shall
+live"--Eugenics and marriage--The venereal diseases--The utility of
+marriage certificates--The marriage certificates and vice--Eugenics and
+parenthood--The principle of heredity--Eugenics and motherhood--Eugenics
+and the husband ... PAGE 9
+
+CHAPTER III
+
+EUGENICS AND EDUCATION
+
+The present educational system is inadequate--Opinions of Dr. C.W. Saleeby,
+Ella Wheeler Wilcox, Luther Burbank, William D. Lewis, Elizabeth Atwood,
+Dr. Thomas A. Story, William C. White, Dr. Helen C. Putnam--Difficulty in
+devising a satisfactory educational system--Education an important
+function--The function of the high school--The high school system
+fallacious--The true function of education ... PAGE 21
+
+CHAPTER IV
+
+EUGENICS AND THE UNFIT
+
+The deaf and dumb--The feeble-minded--A New York magistrate's
+report--Report of the Children's Society--The segregation and treatment of
+the feeble-minded--What the care of the insane costs--The
+alcoholic--Drunkenness ... PAGE 37
+
+CHAPTER V
+
+WHAT EVERY MOTHER SHOULD KNOW ABOUT EUGENICS
+
+PAGE 47
+
+                                                                      [xvi]
+CHILD-BIRTH
+
+CHAPTER VI
+
+PREPARATIONS FOR THE CONFINEMENT
+
+The birth chamber--What to provide for a confinement--Ready to purchase
+obstetrical outfits--Position and arrangement of the bed--How to properly
+prepare the accouchement bed--The Kelly pad--The advantages of the Kelly
+pad--Should a binder be used--Sanitary napkins--How to calculate the
+probable date of the confinement--Obstetrical table--When should a pregnant
+woman first call upon her physician--Regarding the choice of a
+physician--How to know the right kind of a physician for a confinement--The
+selection of a nurse--The difference between a trained and a maternity
+nurse--Duties of a confinement nurse--The requisites of a good confinement
+nurse--The personal rights of a confinement nurse--Criticizing and
+gossiping about physicians ... PAGE 61
+
+CHAPTER VII
+
+THE HYGIENE OF PREGNANCY
+
+Daily conduct of the pregnant woman--Instructions regarding household
+work--Instructions regarding washing and sweeping--Instructions regarding
+exercise--Instructions regarding passive exercise--Instructions regarding
+toilet privileges--Instructions regarding bathing--Instructions regarding
+sexual intercourse--Clothing during pregnancy--Diet of pregnant
+women--Alcoholic drinks during pregnancy--The mental state of the pregnant
+woman--The social side of pregnancy--Minor ailments of pregnancy--Morning
+nausea, or sickness--Treatment of morning nausea, or sickness--Nausea
+occurring at the end of pregnancy--Undue nervousness during pregnancy--The
+100% baby--Headache--Acidity of the stomach, or
+heartburn--Constipation--Varicose veins, cramps,
+neuralgias--Insomnia--Treatment of insomnia--Ptyalism, or excessive flow of
+saliva--Vaginal discharge, or leucorrhea--Importance of testing urine
+during pregnancy--Attention to nipples and breasts--The vagaries of
+pregnancy--Contact with infectious diseases--Avoidance of drugs--The danger
+signals of pregnancy ... PAGE 75
+
+CHAPTER VIII
+
+THE MANAGEMENT OF LABOR
+
+When to send for the physician in confinement cases--The preparation of the
+patient--The beginning of labor--The first pains--The meaning of the term
+"labor"--Length of the first stage of labor--What the first stage of [xvii]
+labor means--What the second stage of labor means--Length of the second
+stage--Duration of the first confinement--Duration of subsequent
+confinements--Conduct of patient during second stage of labor--What a labor
+pain means--How a willful woman can prolong labor--Management of actual
+birth of child--Position of woman during birth of child--Duty of nurse
+immediately following birth of child--Expulsion of after-birth--How to
+expel after-birth--Cutting the cord--Washing the baby's eyes immediately
+after birth--What to do with baby immediately after birth--Conduct
+immediately after labor--After pains--Rest and quiet after labor--Position
+of patient after labor--The Lochia--The events of the following day--The
+first breakfast after confinement--The importance of emptying the bladder
+after labor--How to effect a movement of the bowels after
+labor--Instructing the nurse in details--Douching after labor--How to give
+a douche--"Colostrum," its uses--Advantages of putting baby to breast early
+after labor--The first lunch--The first dinner--Diet after third day ...
+PAGE 93
+
+CHAPTER IX
+
+CONFINEMENT INCIDENTS
+
+Regarding the dread and fear of childbirth--The woman who dreads
+childbirth--Regarding the use of anesthetics in confinements--The presence
+of friends and relatives in the confinement chamber--How long should a
+woman stay in bed after confinement--Why do physicians permit women to get
+out of bed before the womb is back in its proper place?--Lacerations, their
+meaning, and their significance--The advantage of an examination six weeks
+after the confinement--The physician who does not tell all of the truth ...
+PAGE 111
+
+CHAPTER X
+
+NURSING MOTHERS
+
+The diet of nursing mothers--Care of the nipples--Cracked nipples--Tender
+nipples--Mastitis in nursing mothers--Inflammation of the breasts--When
+should a child be weaned?--Method of weaning--Nursing while
+menstruating--Care of breasts while weaning child--Nervous nursing
+mothers--Birthmarks--Qualifications of a nursery maid ... PAGE 121
+
+CHAPTER XI
+
+CONVALESCING AFTER CONFINEMENT
+
+The second critical period in the young wife's life--The domestic problem
+following the first confinement ... PAGE 131
+
+       *       *       *       *       *
+
+
+                                                                      [xix]
+INTRODUCTION
+
+Despite the fact that much has been written during the past two or three
+years with reference to Eugenics, it is quite evident to any one interested
+in the subject that the average intelligent individual knows very little
+about it so far as its scope and intent are concerned. This is not to be
+wondered at, for the subject has not been presented to the ordinary reader
+in a form that would tend to encourage inquiry or honest investigation. The
+critic and the wit have deliberately misinterpreted its principles, and
+have almost succeeded in masking its supreme function in the garb of folly.
+
+The writer has yet to meet a conscientious mother who fails to evince a
+reasonable degree of enthusiastic interest in eugenics when properly
+informed of its fundamental principles.
+
+The eugenic ideal is a worthy race--a race of men and women physically and
+mentally capable of self-support. The eugenist, therefore, demands that
+every child born shall be a worthy child--a child born of healthy, selected
+parents.
+
+No one can successfully assail the ethics of this appeal. It is morally a
+just contention to strive for a healthy race. It is also an economic
+necessity as we shall see.
+
+The history of the world informs us that there have been many civilizations
+which, in some respects, equalled our own. These races of people have all
+achieved a certain success, and have then passed entirely out of existence.
+Why? _And are we destined to extinction in the same way?_ We know that the
+cause of the decline and ultimate extinction of all past civilizations was
+due primarily to the moral decadence of their people. Disease and vice
+gradually sapped their vitality, and their continuance was impossible. [xx]
+It would seem to be the destiny of a race to achieve material prosperity at
+the expense of its morality. When conditions render possible the fulfilment
+of every human desire, the race exhausts its vitality in a surfeitment of
+caprice. The animal instincts predominate, and the potential vigor of the
+people is exhausted in contributing to its own amusement. Each succeeding
+civilization has reached this epochal period, and has fallen, victim of the
+rapacity of stronger and younger invading antagonists, _themselves to
+succumb to the same insidious process_.
+
+The present civilization has reached this epochal--this transition--period.
+In one hundred years from now we shall either have accomplished what no
+previous civilization accomplished, or we shall have ceased to exist as a
+race. Our success depends on the response of the people to the eugenic
+appeal. Few appreciate the responsibility involved.
+
+It is not necessary, however, to combat or deplore the evils of the past.
+Civilization has failed in the task of race-maintenance; it failed,
+however, in ignorance. We cannot plead the same excuse. We are face to face
+with conditions that we must solve quickly or our destiny will be decreed
+before we apply the remedy.
+
+A function of the eugenist is to gather and attest statistics, and to
+establish conclusions based on these statistics. It has been conclusively
+demonstrated that, if the race continues to progress as it exists now--that
+is, if conditions remain the same, and our standard of enlightenment, so
+far as racial evolution is concerned, does not prompt us to adopt new
+constructive measures--_every second child born in this country, in fifty
+years, will be unfit; and, in one hundred years, the American race will
+have ceased to exist_. We mean by this that every second child born will be
+born to die in infancy, or, if it lives, will be incapable of self-support
+during its life, because either of mental degeneracy or physical
+inefficiency. This appalling situation immediately becomes a problem of
+civilization. No state can exist under these conditions. If these
+statistics are reliable--and we know they are true and capable of
+verification by any individual who will go to the trouble of          [xxi]
+investigating them--it is self-evident that a radical change must
+immediately be instituted to obviate the logical consequences that must
+follow as a sequence. The eugenic demand, that "every child born shall be a
+worthy child," is, therefore, the solution of the problem.
+
+This does not imply, however, that the eugenist must solve the elementary
+problem of how the state will ensure its own salvation by guaranteeing
+worthy children. Worthy children can come only from fit and worthy (clean
+and healthy) parents. It becomes the imperative function of the state--the
+function on which the very life of the state depends--to see that every
+applicant for marriage is possessed of the qualities that will ensure
+healthy, worthy children. We must, therefore, sooner or later devise a
+system of scientific regulation of marriage, and it is at this point we
+stumble against the problem that has prompted the ebullitions of the wit
+and the sarcasm of the critic. A casual reference to the science
+immediately suggests to the layman an impossible or quixotic system of
+marriage by force. Even the word "eugenics" is associated in the minds of
+many otherwise estimable old ladies, and others who should know better,
+with a species of malodorous free love, and their hands go up in holy
+horror at the intimation of a scientific regulation of this ancient
+function.
+
+Unfortunately, the popular mind has received the impression that this
+incident constitutes the sum total of the eugenic idea, while the truth is
+that the eugenist is only slightly concerned with its modus operandi. This
+feature has been so magnified by widely published disingenuous discussion
+that it has assumed the aspect of a test problem, a judgment on which shall
+decide the utility of the science itself. Should this decision be
+unfavorable, it would seem, according to its exponents, that it would not
+be worth while promulgating the doctrines of the science beyond this point.
+It is as though we were asked to deny ourselves the inspiration and
+pleasure of a trip abroad because the morning of the day on which the ship
+sailed happened to be cloudy.
+
+It is certainly no part of the function of the eugenist to uproot    [xxii]
+instinct, or to trample into the dust age-long rights, though the instinct
+is simply the product of an established habit, based on an erroneous
+hypothesis, and the so-called rights simply acquired privileges, because
+the intelligence that would have builded differently was not awakened.
+Eugenic necessity will render imperative the state's solution of this
+fundamental problem, for the reason that civilization will be driven to
+demand its just inheritance--the right to exist. The eugenist will not be
+compelled to open the door; it will be opened for him. We can afford,
+therefore, to wait with supreme confidence, because the good sense of the
+people will not always submit to the tactics of the jester when it needs a
+saviour.
+
+The eugenist does not seek to interfere with the liberties of the rising
+generation: a boy may choose whom he will; the girl may select the one who
+appeals to her most, and they may enjoy all the vested rights and romance
+that custom has decreed the lover; but, when they resolve to marry, _the
+state must decide their qualifications for parenthood_. This must be the
+crucial test of the future. The life of the state depends on it. The
+continuance of the race must be the supreme object of all future
+constructive legislation. We must recognize that "life is the only wealth,"
+and that every other criterion of an advanced civilization must measure its
+success according to its wealth in worthy parenthood.
+
+The eugenist does not even dictate what the test for parenthood shall be.
+Common sense, however, suggests that it will assume some form that will
+eliminate those physically or mentally diseased. He believes that, when the
+people are sufficiently educated to appreciate the object in view, they
+will devise a system that will meet with universal approval.
+
+Eugenics concerns itself with problems on which the destiny of the race
+depends. It must not, therefore, be limited to questions relative to mating
+and breeding. Every factor that contributes to the well-being and uplifting
+of the race, every subject that bespeaks physical or mental regeneration,
+that aids moral and social righteousness and salvation, and promises a
+greater social happiness and contentment, has a eugenic             [xxiii]
+significance. So long as there exists an unsupported mother or a suffering
+child; so long as we rely on hospitals and prisons, penitentiaries and the
+police, to minister to the correction and regeneration of the unfit and
+degenerate; so long as we tolerate grafting politicians and deprive the
+poor of breathing spaces, sanitary appliances, and a hygienic environment;
+so long as war and pestilence deprive posterity of the best of the race for
+parenthood; so long as we emphasize rescue rather than prevention, so long
+must the eugenist strive unceasingly to preach his propaganda of race
+regeneration.
+
+The scope of eugenics is too far-reaching in its beneficent purpose to be
+fettered by the querulous triflings of the ancient or intellectual prude;
+nor should it be belittled by the superficial insight of the habitual
+scoffer. It is not a fantasy nor an idle dream. It is not even an
+inspiration. The destiny of the race has brought us face to face with
+conditions unparalleled in the history of this civilization, and the very
+existence of the race itself may be wholly dependent on the foresight of
+the minds that have made the science of eugenics possible.
+
+A brief consideration of the conditions that actually exist, with which we
+are face to face, and which certainly justify the existence of a science
+whose function it should be to demand serious investigation of methods of
+race regeneration, may help the reader to an intelligent and practical
+understanding of the tremendous importance of the subject.
+
+It has been already remarked that, at the present rate of decrease, the
+birth-rate will be reduced to zero within a century. If the birth-rates in
+England, Germany, and France should continue to decrease as they have since
+1880, there would be no children born, one hundred years hence, in these
+countries. While we do not assert, and probably none of us believes that
+either or all of these nations will actually be out of existence in a
+hundred years--unquestionably because we feel, at least we hope, that our
+methods will be so changed in that time that the necessary modification
+will ensure a continuance of the race, nevertheless, the fact remains that
+_the inevitable result of continuing along present lines will be     [xxiv]
+that, within the period of one hundred years, these peoples will cease to
+perpetuate themselves_.
+
+It is not necessary to enquire closely into the various causes for this
+unparalleled situation. The falling birth-rate in itself is not the prime
+cause. Even admitting that there are enough babies born, too many of them
+are born only to die in infancy. We need no further proof of the urgent
+need for conscientious inquiry, call it by what name you please. The
+science of common sense is all-sufficient. The seemingly intelligent
+individual who can only find material for ribaldry in this connection is a
+more serious buffoon than he imagines. It is apparent that our methods are
+wrong. Any constructive effort to correct them is commendable. When it is
+stated that 20 per cent. of the American women are unable to bear children,
+and that 25 per cent. of all the others are unwilling to assume the burden
+and responsibility of motherhood, we partly realize the gravity of the
+case.
+
+On the other hand, statistics show that the majority of men have acquired
+disease before they marry, and that a very large percentage of these men
+convey contagion to their wives. This condition, to a very large extent,
+accounts for the inefficiency of women as mothers. It is responsible for at
+least 75 per cent. of the sterility that exists. The effect of this
+deplorable condition is directly responsible, also, for the ill health that
+afflicts women and that renders necessary the daily operations of a serious
+nature that are conducted in every hospital in every city in the civilized
+world. As a result of the dissemination of this poison, children are born
+blind, or are born to die, or, if they live, they are compelled to carry
+all through their helpless lives the stigma of disease and degeneration. It
+would surely seem that the individual to whom God has given intelligence
+and a conscience cannot think of these, the saddest facts in human
+experience, without resentment and humility. _Surely the time has arrived
+when every boy should know, from his earliest youth, that there is here on
+earth an actual punishment for vicious living as frightful as any that the
+mind of man can conceive._ [Page xxv]
+
+When we inquire into the cause of this trend toward race degeneracy, we
+find that poverty and the inability of the workingman to support large
+families, luxurious living, and the life of ease and amusement on the part
+of the women of wealth; the fact that an increasingly large number of women
+have entered professions that prevent motherhood, and that the number of
+apartment-houses where children are not wanted are on the increase, all
+play their part. In this age of intense living, it is not to be wondered at
+that many shrink from the responsibility of rearing children, and the same
+conditions that contribute to this decadent ideal intensifies sex-hunger,
+and it is this dominating passion that tolerates and makes possible the
+most frightful crime of the age--infanticide. Greece and Rome paved the way
+for their ultimate annihilation when their beautiful women ceased to bear
+children and their men sought the companionship of courtesans.
+
+Baby contests have demonstrated that only one child in ten was found to be
+good enough to justify a second examination. In a test examination in the
+public schools, only eight in five thousand were competent to qualify in
+all the tests. One of these eight was a Chinese boy and another an
+American-born son of a native Greek. Of the twenty million school-children
+in the United States, not less than 75 per cent. need immediate attention
+for physical defects.
+
+While man has been assiduously improving everything else, he has neglected
+to better his own condition. Every animal that man has taken from its
+native haunts and domesticated, he has efficiently improved. He has even
+produced more marvelous results by the application of the same principles
+to the vegetable kingdom. In his haste to civilize himself, however, he has
+failed to apply the principles that are essential to self-preservation. It
+is regrettable, also, to know that, while the government has spent many
+thousands of dollars in sending out literature to the farmers, instructing
+them how to raise profitable crops and to breed prize horses and pigs,
+absolutely none of the public money has been used in instructing American
+mothers how to raise healthy children. [Page xxvi]
+
+A distinguished insurance expert has proved that there was an increase of
+nearly 100 per cent. in the mortality from degenerative diseases in the
+United States between 1880 and 1909. The growing prevalence of these
+diseases indicates a falling-off in the vitality of the race. It means that
+the diseases of old age are invading the younger ranks.
+
+The Life Extension Institute, of New York City, in its recent report,
+states that "forty of every hundred men and women employed in the Wall
+Street district require medical attention; twenty of the forty need it
+immediately, and ten of the forty must have it to avert serious results."
+
+There are from one-quarter to three-quarters of a million of preventable
+deaths every years in this country. That number of individuals could have
+been saved with proper care and attention to health in the early stages of
+disease, or before it gained a start. Practically all the diseases that
+carry business men off prematurely are curable in the early stages.
+
+Of the percentage of Wall Street men who need medical attention
+immediately, most have kidney or heart disease. The others are victims of
+typical unhygienic habits, such as fast, gluttonous eating, neglect of
+exercise, too much tobacco and liquor, and bad posturing in the office. The
+business man considers these trifles, but they count heavily.
+
+Business efficiency is greatly increased, first, by selecting men
+physically fit for work, and, second, by keeping them in that condition.
+There is a tremendous waste from inefficiency constantly going on, due to
+impaired health. Wall Street has an astonishing corps of neurasthenics.
+
+We need a broader interpretation of the term Eugenics, so that we may gain
+a more sympathetic and tolerant audience. The remedy does not lie in an
+academic discussion of these problems; to continue the debate behind closed
+doors will not lead anywhere: the public must be educated to a just
+appreciation of existing conditions and the remedy must be the product of
+effort on its part.
+
+Any condition that fundamentally means race deterioration must be   [xxvii]
+rendered intolerable. The prevalant dancing craze is an anti-eugenic
+institution, as is the popularity of the delicatessen store. No sane person
+can regard with complacency the vicious environment in which the future
+mothers of the race "tango" their time, their morals, and their vitality
+away. We do not assume to pass judgment on the merits of the dance; we do,
+however, emphatically condemn the surroundings.
+
+The moving-picture shows, vaudeville entertainments, dancing carnivals, the
+ease of travel, the laxity of laws, the opportunities for promiscuous
+interviews, all tend to give youth a false impression of the reality of
+life and to make the path of the degenerate easy and attractive.
+
+The history of civilization is, curiously enough, the story of masculine
+brutality, self-indulgence, and vice. The history of the world also proves
+that woman's sphere has been to submit patiently and silently to injustice
+and imposition. _Practical eugenics is the first worthy effort in the
+history of all time to hold men and women responsible for their mode of
+living._ It is a mighty problem. There is no greater nor more difficult one
+to be solved. It has taken eons to bring men to the point of questioning
+their right to do as they please; it will take time to compel them to
+realize their disgrace and acknowledge their duty. When we consider that
+there are eighty thousand women condemned to professional moral degradation
+in the City of London, and that every so-called civilized city on the globe
+contributes its pro rata share to this army of potential mothers, we begin
+to appreciate the vastness of the task.
+
+Eugenics has already accomplished what no other movement has ever
+accomplished: it has created the spirit that gave birth to the thought of
+men's responsibility, and it has taught us that the female of the race has
+rights. We can now speak without fear; the light is no longer hidden.
+
+Women must realize, however, that they have contributed, and continue to
+contribute, to race degeneracy. We hear and read much about the double
+standard of morals. As long as woman are willing to marry their daughters
+to reformed rakes, providing they have money and social position,  [xxviii]
+so long shall we have a double standard. So long as young society women go
+into hysterics over pedigreed dogs and horses and then marry men reeking in
+filthy unfitness for parenthood, mothers cannot expect any other standard
+of morals. So long as one marriage in twelve ends in divorce, the ethics of
+the female need enlightenment. We shall not get another standard of morals
+until women themselves demand it and insist on it. If they lend themselves
+to breaking down the conspiracy of silence, the women may solve the
+marriage problem by refusing to marry rakes.
+
+We need a more liberal construction of the intent of eugenics in order to
+clarify the obtuse minds so that its propaganda of education may be easily
+and justly comprehended.
+
+There is no field for speculation in the analysis of right living. It
+conforms to the law of cause and effect. It is positively concrete in
+substance. A recital of the life history of Jonathan Edwards, in comparison
+with that of the celebrated "Jukes" family, emphasises this assumption with
+a degree of positiveness that is tragic in its significance.
+
+Jonathan Edwards was born in England in Queen Elizabeth's time. He was a
+clergyman and he lived an upright life. So did his wife. His son came to
+the United States, to Hartford, Connecticut, and became an honorable
+merchant. His son, in turn, also became a merchant, upright and honored.
+His son, again, became a minister, and so honored was he that Harvard
+University conferred two degrees on him on the same day; one in the morning
+and one in the afternoon. This learned man again had a son, and he became a
+minister. Jonathan Edwards was his name.
+
+Now let us see, in 1900, what this one family, started by a man in England
+who lived an upright life and gave that heritage to his children, produced:
+1,394 descendants of this man have been traced and identified; 295 were
+college graduates; 13 were college presidents; 65 were professors; 60 were
+physicians; 108 were clergymen; 101 were lawyers; 30 were judges; 1 was
+Vice-President of the United States; 75 were Army and Navy officers; [xxix]
+60 were prominent authors; 16 were railroad and steamship presidents; and
+in the entire record not one has been convicted of a crime.
+
+Twelve hundred descendants have been traced from the one man who founded
+the "Jukes" family. This record covers a period of seventy-five years; out
+of these, 310 were professional paupers, who spent an aggregate of two
+thousand three hundred years in poorhouses; 50 were evil women; 7 were
+murderers; 60 were habitual thieves; and 130 were common criminals.
+
+It has been estimated that this one family was an economic loss to the
+state, measured in terms of potential usefulness wasted; costs of
+prosecution; expenses of maintenance in jails, hospitals and asylums; and
+of private loss through thefts, and robberies, of $1,300,000 in
+seventy-five years, or more than $1,000 for each member of the family.
+
+_It would seem to be worth while to be well born, after all._
+
+In order to succeed in the regeneration of the race, we must believe that
+race regeneration is possible, and, that it is worth while. We must preach
+its principles as we would a religion. The power of knowledge is a mighty
+lever. We are living in a period of transition, but we are nearer the
+future than the past.
+
+We are told by the average individual that it will be impossible to arouse
+the public to an intelligent appreciation of the scope of race
+regeneration. When the writer conceived the happy phrase, "Better Babies,"
+a few years ago, he builded better than he knew. It has become the slogan
+of splendid achievement already, and there are a multitude of signs and
+tokens that the propaganda is established on a sure foundation.
+
+If the annihilation of all past civilizations was due to the refusal of its
+members to breed for posterity, may we not reasonably assume that we have,
+according to our statistics, reached the same crisis? If this is logical
+reasoning, and every factor warrants this conclusion, have we not reached
+the time when the perpetuation of the race is the most serious question of
+our times? Is it not a problem for the enthusiastic and immediate     [xxx]
+support of every statesman, politician, teacher, and preacher alike? Can
+any question be of more importance? What will our marvelous material
+splendor avail if the race is destined to immediate extinction?
+
+We need the assistance of every intelligent citizen, we need most, the
+awakening impulse of the mothers of the race. We who are alive are
+responsible for environment and nurture, and we must believe that the
+purpose to be achieved is of supreme importance. Every mother, through the
+power of knowledge, may become a practical eugenist. It is to aid her in an
+intelligent appreciation of the practical intent of the science that this
+work is presented.
+
+  W. GRANT HAGUE, M.D.
+
+  New York City.
+
+       *       *       *       *       *
+
+
+                                                                        [1]
+THE EUGENIC MARRIAGE
+
+CHAPTER I
+
+    "Nations are gathered out of nurseries."
+
+    CHARLES KINGSLEY.
+
+    "To be a good animal is the first requisite to success in life, and to
+    be a nation of good animals is the first condition of national
+    prosperity."
+
+    HERBERT SPENCER.
+
+CONDITIONS WHICH HAVE EVOLVED THE SCIENCE OF EUGENICS
+
+    INFANT MORTALITY--MARRIAGE AND
+    MOTHERHOOD--HEREDITY--ENVIRONMENT--EDUCATION--DISEASE AND
+    VICE--HISTORY--SUMMARY.
+
+There has been evinced during recent years a desire to know something more
+definite about the science of eugenics.
+
+Eugenics, simply defined, means "better babies." It is the art of being
+well born. It implies consideration of everything that has to do with the
+well-being of the race: motherhood, marriage, heredity, environment,
+disease, hygiene, sanitation, vice, education, culture,--in short,
+everything upon which the health of the people depends. If we contribute
+the maximum of health to those living, it is reasonable to assume that the
+future generation will profit thereby, and "better babies" will be a direct
+consequence.
+
+We are frequently told that we must take the world as we find it. This has
+been aptly termed, "the motto of the impotent and cowardly." "Life is what
+we make it," is the more satisfying assertion of the optimist, and most [2]
+of us seem to be trying to make existence more tolerable and more happy. It
+is encouraging to know that intelligent men and women to-day seek an
+opportunity to devote serious consideration to the betterment of the race,
+while yet the pursuit of wealth and pleasure are enticing and strenuous
+occupations.
+
+It would be superfluous in a book of this character to enter into any
+lengthy explanation as to how the science of eugenics proposes to work out
+its problems. We hope only to excite the interest of mothers in the
+subject, and to instruct them in its rudiments and principles.
+
+It will be of distinct advantage, however, first to briefly consider the
+conditions,--which are known to all of us,--which have led up to the
+present status of the subject.
+
+INFANT MORTALITY.--No elaborate argument is necessary to prove that the
+present infant mortality, in every civilized country, is too high. It is
+conceded by every authority interested in the subject, no matter what
+explanation he offers, or what system he advances as a solution of the
+problem.
+
+MARRIAGE AND MOTHERHOOD.--Every intelligent person knows that most young
+girls enter into the marriage relationship without a real understanding of
+its true meaning, or even a serious thought regarding its duties or its
+responsibilities. We know that their home training in domestic science is
+generally not adequate, and that their educational equipment is
+inefficient. We also know that economic necessity has deprived them of the
+tutelage essential to social progress and physical health, and has endowed
+them with temperamental characteristics undesirable in the mothers of the
+race. Maternity is thrust upon these physically and mentally immature young
+wives, and they assume the principal role in a relationship that is onerous
+and exacting. We know that the duties of wife and mother require an
+intelligence which is rendered efficient only by maturity and experience.
+We know that many, if not most, young wives acquire habits which undermine
+their health and their morals unwittingly, and we also know that the
+product of this inefficiency results in the decadence and the           [3]
+degeneration of the race.
+
+HEREDITY.--Much remains inexplicable at the present time regarding this
+intensely interesting department of science. We do know, however, that its
+truths are being investigated and tabulated. Our present knowledge of its
+principles has demonstrated the existence of laws from which we can
+ethically deduce explanations of conditions which were, in the past, not
+amenable to any classification. These relate to individual and racial
+characteristics. We are beginning to learn that we can modify these
+characteristics by proper selection, by environment, and by education. This
+process will, to an eminent degree, redound to the permanent advantage of
+mankind. We may reasonably aspire to a system of race-culture which will
+eliminate the undesirable or unfit, and conserve all effort in the
+propagation of the desirable or fit. This is a consummation to be desired,
+and if by any system of eugenics the promise of the future is realized it
+is deserving of the intelligent interest and the active cooeperation of
+every aspiring mother.
+
+ENVIRONMENT.--By environment we mean the provision of suitable surroundings
+in its largest sense. A child to be fit and efficient must be born of
+selected parentage, the home surroundings must be desirable, the
+educational possibilities must be advantageous, the sanitary and hygienic
+conditions must be suitable, opportunities for physical and spiritual
+culture must be provided, and the State must ensure justice and the right
+to achieve success. We know that--generally speaking--these conditions do
+not exist. We know that the dregs of the human species--the blind, the
+deaf-mute, the degenerate, the imbecile, the epileptic, the criminal
+even,--are better protected by organized charity and by the State than are
+the deserving fit and healthy. We know that in the slums thousands of
+desirable children waste their vitality in the battle for existence, and we
+know that, though philanthropy and governmental supervision and protection
+are afforded the deaf, the dumb, the blind and degenerate child, no helping
+hand is held out to save the healthy and efficient child, who must pay in
+disease and inefficiency the price of his normality in degrading toil,  [4]
+in factory and pit, where child labor is tolerated. We need the awakening
+which is the promise of the eugenist, that these wrongs will be righted,
+not by the statesmanship which believes that empires are founded and
+maintained by the power of material might, but by a process which will
+ennoble selected motherhood and give to every child born its due and its
+right.
+
+EDUCATION.--The present system of education is one of the great reflections
+on the intelligence of the human race. One of the greatest of contemporary
+writers has characterized it as "a curse to modern childhood and a menace
+to the future." Even the humblest of us--who would willingly believe the
+system efficient, who have no desire to invite criticism as to our
+opinion--are forced to acknowledge that there is something wrong with the
+educational system now in vogue. The writer is disposed to believe,
+however, that the fault is not wholly one of art. The conditions with which
+education has to contend are essentially hypothetical. It may be that the
+laws of heredity and psychology, when fixed, will evolve, at least, a more
+rational and a more ethical hypothesis. So far as eugenics is concerned
+with education, its limitation is defined and fixed. If the innate ability
+is not possessed by the child, no system of instruction, and no art of
+pedagogy, will ever draw it out. When the proper material is supplied by an
+adequate system of race culture, science may probably supply the requisite
+complementary data which will ensure an educational system that will really
+educate.
+
+DISEASE AND VICE.--The eugenic idea is more directly concerned with disease
+which tends to deteriorate the racial type. The average parent has no means
+of adequately estimating the significance of this type of disease. It has
+been estimated that one-half of the total effort of one-third of the race
+is expended in combating conditions against which no successful effort is
+possible. Think what this means. The struggle of life is a real struggle,
+even with success as an incentive and as a possible reward. It becomes a
+tragedy when we think of the wasted years, the hopeless prayers and the
+anguish of those who fight the battle which is predestined to end in    [5]
+apparent failure. We are disposed to doubt the justice of the Omnipotent
+Mind who created us and left us seemingly alone--derelicts in the eddies of
+eternity.
+
+This is but a finite fault, however. The truth is that the scheme of the
+universe is unalterable, we are but part of the whole and must share in the
+evolution of the process. An apparent failure is not necessarily a
+discreditable one. Most lives are failures, if appraised by human estimate.
+Take for example the life of a young wife who marries a man with disease in
+his blood. She begins her wedded life with certain commendable ideals. She
+is young, enthusiastic, ambitious, strong, and she inherently possesses the
+right to aspire to become an efficient home-maker and a good mother. She
+gives birth to a child, conceived in love, and during her travail she
+beseeches her Creator to help her and to help her baby, as all women do at
+such a time. Her baby is born blind and it is a weak and puny mite. The
+mother recovers slowly, but she is never the same vigorous and ambitious
+woman. Later her strength fades away, her enthusiasm falters, the home is
+blighted and seems a desecrated spot. The baby is a constant worry, it is
+always sick, it needs expensive care and it exhausts the physical remnant
+of its mother's health. It finally dies and is laid away, not forgotten,
+but a sad, sad memory. The ailing and dispirited mother is informed that
+she must submit to an operation if she desires to regain her health, if not
+to save her life. She returns from the hospital--not a woman--a blighted
+thing, an unsexed substitute for what once was a happy, sunny, healthy,
+innocent girl.
+
+This is not an overdrawn tale,--it is a true story, a common, every-day
+story. Who was to blame? Why were her prayers not heard? Why, indeed? One
+might as well ask why seemingly splendid civilizations decayed into
+forgotten dust, or why empires rotted away. The answer is the same.
+
+HISTORY.--From the eugenists' standpoint history is prolific only in
+negation. A correct interpretation of its pages teaches us that it has not
+taught the lesson of the "survival of the fittest," but rather the survival
+of the strongest. That the strongest is not always the "fittest" needs  [6]
+no commentary. That the fit should survive is the genetic law of nature,
+and it has been strictly obeyed by biology and humanity when these sciences
+have adhered to, and have been under the jurisdiction of the natural law.
+
+When religious schisms swayed the world, the stronger party, in material
+strength or in actual numbers, massacred the weaker, which was frequently
+the fitter from the standpoint of desirability as progenitors of the race.
+Thus posterity was deprived of what probably was the representative,
+potential strength of generations.
+
+At a later date religious schism changed her _modus operandi_ but
+accomplished the same pernicious purpose, as the following shows:
+
+"Whenever a man or woman was possessed of a gentle nature that fitted him
+or her to deeds of charity, to meditation, to literature or to art, the
+social condition of the time was such that they had no refuge elsewhere
+than in the bosom of the Church. But the Church chose to preach and exact
+celibacy, and the consequence was that these gentle natures had no
+continuance, and thus, by a policy, was brutalized the breed of our
+forefathers."
+
+When religion was not the dominating power, mankind was ruled by militant
+tyrants. The non-elect were slaves,--uneducated, uncivilized, debased and
+diseased. The elect were licentious and indolent. Neither class practised
+any domestic virtues, or respected the institution of motherhood. The
+process of the selection of the fittest for survival for the purpose of
+parentage, and for the consummation of the evolutionary gradation, through
+which the human race is apparently destined to pass, was again in abeyance
+for a series of generations.
+
+In our own times, the fate of nations and the destiny of their people would
+seem to depend upon the size of the fighting force and the efficiency of
+the ships we build; our ability to dicker and barter, to gain a
+questionable commercial supremacy, and the loquaciousness of our
+politicians. This, at least, is the criterion upon which the modern
+statesman estimates the quality of present-day civilization. He is not  [7]
+apparently interested in the story of the ages. The progress of God's
+supernal scheme through aeons of bigotry and darkness neither suggests nor
+inspires in him a loftier constructive analysis. He is content to leave the
+destiny of nations to tons of material, tons of men and tons of talk.
+
+Nowhere do we find any reference to the quality of the blood-stream of the
+people. Nor does it seem to have been discovered by those who wield
+authority, that the glory of a nation depends upon its brains, not its
+bulk; nor do they apprehend that the greatness of a people is not in its
+past history, but in its ever-existing motherhood; and that its battles, in
+the future, must be fought, not on battlefields, but in its nurseries. When
+we judge our national worth and wealth by the quality of our maternal
+material, and estimate our greatness and our glory by the record of our
+infant mortality, we will have carved an enduring niche in the celestial
+scheme that will be unchangeable and for all time.
+
+There are in Britain to-day over a million and a quarter females of
+marriageable age in excess of the number of marriageable males. A war
+between Britain and Germany would unquestionably be the bloodiest war in
+all history, and it probably would be the last one, because it would only
+end in the dominance of one power over all the others. If we concern
+ourselves only with Britain--from the eugenic standpoint--who would dare
+compute the ratio of marriageable females over the males after the war was
+over? The consequence of such a war on posterity would be tragic. It would
+mean the annihilation of the fittest for fatherhood for generations. Only
+the unfit would be left from which to begin a new breed.
+
+The multitude of females who would necessarily be left unable to
+participate in the highest function of womanhood would have to be
+self-supporting. The economic problem would, therefore, have a far-reaching
+influence and even if solved adequately as an economic problem, it could
+never be solved satisfactorily as a sociological, or as a problem in
+eugenics.
+
+Infant mortality is too high. Apart from the statistical proof which    [8]
+shows it, we may rightly construe as further proof of it, the widespread
+effort being made in every civilized country in the world to ameliorate the
+condition.
+
+The laws and ethics of marriage are inadequate. Its true purpose is
+frustrated and racial and individual injustice and imperfection are the
+products of existing conditions.
+
+Motherhood, in its every aspect is not, and has not in the past, been
+elevated to the plane which a true estimate of its supreme importance to
+the race justifies.
+
+Heredity as a scientific principle is undeveloped, and because of
+maladministration in past generations, the present generation is
+endeavoring to do the work, the fruits of which it should be enjoying.
+
+Environment in its highest sense is impossible because of inadequate laws,
+imperfect hygienic and sanitary knowledge, incomplete education, vice and
+disease.
+
+If there was not some supremely important, cardinal error somewhere, it is
+reasonable to suppose that in one or other of the departments of human
+effort we would have reached the summit of idealism. The State, as an
+institution, would have evolved a perfection which would enable it to exist
+as an independent mechanism, complete and ideal in all its ramifications.
+We have had no such state, however. The highest type of empire has been
+ludicrously dependent upon the minor exigencies of individual human
+existence.
+
+Science would have evolved the superman, but history, as we have seen, has
+persistently deprived science of the material wherewith to contribute him.
+
+The institution of marriage would have been a fixed and an inviolable
+guarantee of the happiness of the home, but human wisdom has erred and the
+solution is as yet apparently undiscovered.
+
+Investigation into every field of human effort shows that the ultimate aim
+in view, if any, was something other than the welfare of the race, as a
+race or as individuals.
+
+       *       *       *       *       *
+
+
+                                                                        [9]
+CHAPTER II
+
+    "The public health is the foundation on which reposes the happiness of
+    the people and the power of a country. The care of the public health is
+    the first duty of a statesman."
+
+    LORD BEACONSFIELD.
+
+THE EUGENIC IDEA
+
+    THE VALUE OF HUMAN LIFE--THE EUGENIC PRINCIPLE--"THE FIT ONLY SHALL
+    LIVE"--EUGENICS AND MARRIAGE--THE VENEREAL DISEASES--THE UTILITY OF
+    MARRIAGE CERTIFICATES--THE MARRIAGE CERTIFICATES AND VICE--EUGENICS AND
+    PARENTHOOD--THE PRINCIPLE OF HEREDITY--EUGENICS AND
+    MOTHERHOOD--EUGENICS AND THE HUSBAND.
+
+The eugenist believes the cardinal error of the past has been a failure to
+recognize the worth or value of human life. In the past human lives have
+counted for absolutely nothing. As we have seen, each generation has
+practically deprived posterity of the best of its breed, and we shall see,
+when we consider the facts which affect the present vitality of the race,
+that the same preposterous conditions still exist.
+
+It is not necessary to waste the reader's time in an effort to prove,
+simply from an argumentative standpoint, the logic of the eugenic idea.
+There is no existing economic problem that has established itself so firmly
+in the hearts of the people who understand it, as has the study of race
+culture. It is not the subject, but its scope of application, that is new.
+Biologically, we see the manifestations of eugenics on every side. In the
+flower garden we breed for beauty, in the orchard for quality. In the
+poultry yard and on the stock farm the same process weeds out the unfit and
+cultivates the desirable. The value of the eugenic idea is most strikingly
+illustrated in the cultivation, or breeding, of the horse from a primitive
+creature into the splendid animals which represent the various types of
+equine present-day perfection. It has taken generations of the most    [10]
+painstaking intelligence to understand the traits which had to be evolved
+in scientific mating to reach the present standard. If the same rules, or
+lack of rules, applied to the mating of horses as applied to ourselves,
+there would be few, if any, "thoroughbreds" among them. The principle which
+we must recognize is that "Life is the only wealth."
+
+Progress and efficiency will be ensured and of an enduring character, when
+all human effort is consecrated to this fundamental principle as a basic
+law, and not till then.
+
+To cultivate the human race on prescribed scientific principles will be the
+supreme science of all the future, the object and the final goal of all
+honest governmental jurisprudence, and the ultimate judge of all true
+constructive legislation.
+
+THE EUGENIC PRINCIPLE
+
+The eugenic principle is, that "the fit only shall live." This does not
+mean that the unfit must die, but that only the fit shall be born.
+Occasionally, as a product of bad environment, or faulty training, or
+eccentricity, a horse gives evidence of vicious traits, but the scientific
+breeder never mates him. He is allowed to die out. If he were permitted to
+father a race, his progeny would develop murderous characteristics that
+would retard the type for generations.
+
+THE FIT ONLY SHALL BE BORN.--This implies the exclusion of those, as
+parents, who are incapable of creating fit children. Fit children are
+children who are physically and mentally healthy. Parents who are unfit to
+create physically and mentally healthy children are those diseased in body
+or mind, especially if the disease is of the type which science has proved
+to be transmissible, or which directly affects the vitality of the child.
+In such a category we place those who are deaf, dumb, blind, epileptic,
+feeble-minded, insane, criminal, consumptive, cancerous, haemophilic,
+syphilitic, or drunkards, and those known to be victims of disease of  [11]
+any other special type.
+
+It must not be inferred that the above classification is made arbitrarily.
+There are many arguments which may be advanced limiting the eugenic
+applicability of certain of these diseased conditions. These, however, do
+not directly come within the province of the mother. They may be safely
+left to special state regulation. We simply make the assertion that no
+mother would willingly, or designedly, ally her offspring with any member
+of society afflicted with any of the diseases enumerated.
+
+EUGENICS AND MARRIAGE.--The eugenic idea, practically applied to the
+institution of marriage, means that no unfit person will be allowed to
+marry. It will be necessary for each applicant to pass a medical
+examination as to his, or her, physical and mental fitness. This is
+eminently a just decree. It will not only be a competent safeguard against
+marriage with those obviously diseased and incompetent, but it will render
+impossible marriage with those afflicted with undetected or secret disease.
+Inasmuch as the latter type of disease is the foundation for most of the
+failures in marriage, and for most of the ills and tragedies in the lives
+of women, it is essential to devote special consideration to it in the
+interest of the mothers of the race.
+
+It is estimated that there are more than ten million victims of venereal
+disease in the United States to-day. In New York City alone there are two
+million men and women--not including boys and girls from six to twelve
+years of age--actively suffering from gonorrhea and syphilis. Eight out of
+every ten young men, between seventeen and thirty years of age, are
+suffering directly or indirectly from the effects of these diseases, and a
+very large percentage of these cases will be conveyed to wife and children
+and will wreck their lives. No one but a physician can have the faintest
+conception of the far-reaching consequences of infection of this character.
+The great White Plague is merely an incident compared to it. These diseases
+are largely responsible for our blind children, for the feeble-minded, for
+the degenerate and criminal, the incompetent and the insane. No other  [12]
+disease can approximate syphilis in its hideous influence upon parenthood
+and the future. The women of the race, and particularly the mothers, should
+fully appreciate the real significance of the situation as it applies to
+them individually. That they do not appreciate it is well known to every
+physician and surgeon.
+
+It is first necessary to state certain medical facts regarding these
+diseases. They exist for years after all symptoms have disappeared; no
+evidences exist even to suggest to the patient that he, or she, is not
+entirely cured. After the germs have been in the patient for some time they
+lose a certain degree of their virility, and a condition of immunity is
+established. In other words the tissue ceases to be a favorable medium for
+the development, or activity, of the germs. If these germs, however, are
+conveyed to another person, who has never had the disease, or whose tissue
+is not immune, they will immediately resume their full activity and
+virulence, and will establish the disease, frequently in its most violent
+form, in the person so infected. The startling deduction which we must draw
+from these facts is, that a man may infect his wife, and may thereby be the
+direct cause of wrecking her entire life, and may, in addition, as a
+consequence of the infection, cause a child to be born blind, without even
+remotely suspecting that he is in any way responsible for it. In the light
+of this knowledge, what is the percentage risk a young girl takes when she
+selects a husband, remembering that eight out of every ten husbands bring
+these germs to the marriage bed? Reread the true story of the young woman
+on page five, accept my assurance that there are thousands and thousands of
+such cases, and ask yourself, who is to blame? We may certainly assure
+ourselves that no man living would wilfully desecrate his bride. He did not
+know,--did not even suspect that the disease he had years ago was still in
+his system. Society is to blame--you and I--the laxity of the law is the
+culprit. Had he been compelled to pass a physical examination before
+marriage he would have been told the truth.
+
+It is a notorious fact, that in every civilized city in the world, the
+number of operations that are daily performed on women, is increasing  [13]
+appallingly. Every surgeon knows that nine-tenths of these operations are
+caused, directly or indirectly, by these diseases, and in almost every case
+in married women, they are obtained innocently from their own husbands. It
+is rare to find a married woman who is not suffering from some ovarian or
+uterine trouble, or some obscure nervous condition, which is not amenable
+to the ordinary remedies, and a very large percentage of these cases are
+primarily caused by infection obtained in the same way.
+
+When a girl marries she does not know what fate has in store for her, nor
+is there any possible way of knowing under the present marriage system. If
+she begets a sickly, puny child,--assuming she herself has providentially
+escaped immediate disease,--she devotes all her mother love and devotion to
+it, but she is fighting a hopeless fight, as I previously explained when I
+stated that one-half of the total effort of one-third of the race is
+expended in combating conditions against which no successful effort is
+possible. Even her prayers are futile, because the wrong is implanted in
+the constitution of the child, and the remedy is elsewhere. These are the
+tragedies of life, which no words can adequately describe, and compared to
+which the incidental troubles of the world are as nothing.
+
+So long as these conditions exist need we not tremble for the future of the
+race? Is not this future welfare a personal issue, or can we trust the
+future of our daughters to the same indiscriminate fate that has written
+the pages of history in the past?
+
+This problem has been debated from every possible angle without our
+reaching any seemingly practical solution. The promise of emancipation,
+however, came with the dawn of eugenics. It is the only solution that gives
+promise of immediate and reasonable success. For that reason alone it
+should receive the active support of every good mother in all lands.
+
+THE UTILITY OF MARRIAGE CERTIFICATES.--There would seem to be no question
+as to the utility of marriage certificates. We must remember, however, that
+there is a distinction between marriage and parenthood, and that       [14]
+eugenics is concerned only with parenthood. It is interested in the
+institution of marriage to the extent only that it may, by some system of
+regulation, be a positive and fixed factor in the production of exclusively
+healthy children. The eugenist demands fit children. If society can ensure
+fit children, as a consequence of any marriage system which may or may not
+include medical certification, the eugenic aim is fully met. At the present
+time the giving of a marriage certificate, which is really a permit to
+marry, would seem to be the most practical way promptly to accomplish the
+eugenic purpose. We should promptly question the honor of any prospective
+husband disposed to evade the examination simply because he was not
+compelled to obey by a legislative enactment.
+
+We believe that when the public is educated to the truth and intent of
+eugenics, there need be no compulsory examination. Men and women will, of
+their own accord, desire to know if their marriage will jeopardize the
+race. There will be questions of heredity to elucidate, questions of
+inherited insanity, poison taints, of blindness and deafness, or it may be
+of drunkenness.
+
+Further, marriage certificates, or permits, must be considered in regard to
+the future conduct of those to whom we refuse permits to marry. A refusal
+of the permission to marry will not change the desire to marry. Many, of
+course, to whom a permit is refused, will accept the situation, will be
+thankful to be possessed of the knowledge of their incompetency in order
+that they may seek medical aid. These individuals will remain under medical
+supervision until their ailments are cured and their competency
+established. In this way the eugenic aim is materially furthered. Others
+may not abide by the decree which forbids marriage. It would wholly defeat
+the eugenic idea if the unfit children were to continue to be born
+illegitimately. These individuals will comprise the few--probably the
+present unfit members of society--and the final solution of the matter must
+remain a question of education and evolution. When public opinion is
+educated to the degree necessary to establish a system of eugenic
+self-protection, we shall be provided with a race of children whose    [15]
+culture will achieve the ideal of parenthood by a process of education
+rather than legislation.
+
+THE MARRIAGE CERTIFICATE AND VICE.--If a prenuptial examination were made
+compulsory there is no doubt of the very prompt and salutory effect it
+would have on present-day vice. It has often been said that "You cannot
+legislate virtue or sobriety into a people." We are familiar too with the
+maxim that "You can lead a horse to the well, but you cannot make him
+drink." You can lead a horse to the well, however, and lo! he drinks. If
+you lead him at the right time he will always drink. If we legislate at the
+psychological moment we can legislate virtue and sobriety into a people.
+
+A very large percentage of existing vice is the immediate product of
+ignorance, and the larger percentage of the remainder is the result of
+propinquity and the idea that it will never be found out. Very little of it
+is the outcome of innate degeneracy. It is an acquired degeneracy we must
+guard against, and that is the special educational motive of eugenics.
+Young men will be taught the truth about vice, and if they have been
+victims in the past, they will willingly submit themselves to a _competent_
+investigation of their fitness for marriage. If they are still pure, the
+desire to remain so, in order to be eligible for parenthood, will guard
+them against the risk of contamination. This will not only result in a
+distinct improvement of the moral tone, but the potential possibilities to
+posterity will be incalculable. Legislation might therefore be the vehicle
+through which eugenic education could enlighten and evolve a fit race.
+
+EUGENICS AND PARENTHOOD
+
+If the supreme end is a better race we must recognize that the great need
+for society to-day is to educate for parenthood. History teaches that a
+civilization that dissipates its virility in profligacy or spends its
+energy in political and commercial trickery, and gives no thought to the
+character of the men and women it produces, is destined to total failure.
+Parenthood and birth--in these we have the eugenic instruments of the  [16]
+future. The only permanent way to cure the ills of the world is to prevent
+the multiplication of people below a certain standard. The elevation and
+the actual preservation of the race depends upon rendering it impossible
+for the unfit coming into existence at all. In other words the unfit or
+unworthy must be rejected, not necessarily as individuals, but as parents.
+
+Eugenics is allied to the principle of heredity,--the principle that
+enables us to modify conditions so as to ensure the right children being
+born. The propaganda against infant mortality is directed only toward the
+provision of a good environment,--so that children, when born, may survive
+and attain the maximum of their hereditary promise. The two campaigns are
+essentially complementary. The one applies only before birth, the other
+after birth. The statistics of infant mortality unfortunately show that it
+is not a process that extinguishes the unfit only. The healthy succumb to
+unfavorable environment and it was to amend this condition that the
+campaign against infant mortality was undertaken. The two campaigns appeal
+to the same creed: that parenthood is the supreme function of the race,
+that it must not be indifferently undertaken; that it demands the most
+careful preparation; that it is a duty which can only be carried out
+eugenically by the highest attainable health of body and mind and emotions.
+
+EUGENICS AND MOTHERHOOD.--Any plan or scheme which has for its object race
+regeneration must concern itself with the health, the education, and the
+psychology of woman; the environment which shall surround her period of
+motherhood, and her selection of the fathers of the future. Society must
+safeguard her in all her relations. The race to-morrow are the babies of
+to-day. The wealth of a nation therefore is the type of baby that will
+constitute its civilization from generation to generation, and absolutely
+nothing else counts. We hear much about race suicide, but is it not
+monstrous to cry for more babies when we do not know how to keep alive
+those we have? It is a fact that everywhere the birth rate of the Caucasian
+people is on the decline. Our birth rate as a whole, however, is ample;[17]
+it is the death rate that is significant and appalling. When we remember
+that one-third of all the babies born die before they reach the age of five
+years; and that the deaths of babies under one year of age comprise about
+one-fourth of the total death-roll; and that fully one-half of all these
+deaths are needless and unnecessary, wherein is the wisdom of working for a
+higher birth rate if it is merely that more may die?
+
+The majority of babies are born physically healthy, but because of our
+destructive process, we proceed to annihilate hundreds of thousands of them
+yearly, and because of defective environment and education we render
+thousands of others, including the fit and unfit, inefficient and
+incompetent as propagating factors. It is to remove this disastrous stigma
+on our intelligence that we have been forced to study the conditions which
+the eugenic idea represents. When these principles are understood and
+believed, and when they are acted upon, infant mortality will cease to
+exist.
+
+It was the design of the Creator that human motherhood should be an exalted
+occupation. He placed in her care to nurture and to love, the most helpless
+living thing. Few have regarded a baby from this viewpoint and fewer still
+understand its supreme significance. That it is the most utterly helpless
+thing possessing life is a self-evident fact, and that it should be
+destined to be King of all mammalian tribes as well as Lord of all the
+earth is a superlative paradox. Because of its utter inability to care for
+itself it is more in need of care than any other representative of the
+animal world. It is not only in need of immediate care, but it demands care
+longer than the young of any other species.
+
+It stands to reason, therefore, that the function of motherhood must be
+reckoned with in any scheme of race regeneration; that it must be provided
+with the most favorable environment; and that it must be relieved of any
+condition which would materially retard the meeting of the obligation to
+its fullest possible extent. In an ideal eugenic sense the state must
+ensure sustenance to those deprived of ample food and raiment, and     [18]
+science must continue to solve the problem of a fitter sanitary and
+hygienic environment for the congested and densely populated zones of
+habitation. Philanthropy must not continue to be wholly misdirected, it
+must extend its aid to the deserving healthy and fit, as well as to be
+exclusively the protecting agency of the diseased and unfit. If life is the
+only wealth, and the preservation of childhood the highest duty of society
+and the state,--which it would seem to be, since the continuance and
+preservation of the race is obviously essential to the continuance of the
+state itself,--the life of every child must be considered an economic as
+well as a moral trust. If, therefore, every child is sacred, every mother
+is equally sacred. If every child is to be cared for, every mother must be
+cared for. If the state cannot afford to provide for what is imperatively
+essential to its own continuance, it might as well go out of existence, as
+it inevitably will in the end on any other basis, and as all preceding
+states have done.
+
+Mothers must not be dependent upon their children's labor for their
+maintenance, because if children are compelled to work, they will not be
+able to work in the future,--and adult efficiency is necessary to the
+well-being of the individual, the race, and the state.
+
+No mother should work, because in the care of her children she is already
+doing the supreme work. The proper care of children is so continuous and
+exacting a task, and of such importance to posterity, that it must be
+regarded as the highest and foremost work--and adequate in itself--and its
+efficiency must not be hampered by mothers having to do anything else.
+
+Motherhood must not be financially insecure, because this would defeat its
+eugenic purpose. Society, therefore, as a matter of self-preservation, must
+ensure to woman her mental and economic security. Civilization's margin is
+large enough to provide this. We spend large amounts on luxuries and evils
+which are contrary to the genesis of self-preservation, while motherhood is
+its basic necessity. When public opinion is educated in the essentials of
+eugenics much of this can be, and will be diverted to a nobler purpose. The
+total cost necessary to ensure the adequate care of dependent          [19]
+motherhood would be a mere fraction of the national expenditure, and not a
+tithe of what we spend in pension allowances yearly. The latter is regarded
+as an honorable debt and is at best the direct product of a decadent ideal,
+while motherhood constitutes the very germ of the only altruistic idealism
+for all the future.
+
+We concede, therefore, that the children and the mothers must be provided
+for, not only as a product of the true construction of the ethics of
+sociology, but in obedience to the fundamental law of a moral system of
+eugenics. We must go further and assert that children must be cared for
+through the mother. It has been the practice to divorce the improvident
+mother from her dependent children. This has been demonstrated to be not
+only an altruistic fallacy. It has proved to be an economic blunder.
+
+There is another type of evil which largely menaces the eugenic ideal of
+motherhood. It is those cases where married women who have children are
+compelled to be the bread winners of the family as well as its mothers. No
+woman can earn support for herself and children outside of her home and
+competently assume the responsibilities of motherhood at the same time.
+Whatever aid a mother renders to the state, as a result of effort in
+factory or shop, is of infinitely less value, from an economic standpoint,
+than her contribution as mother in caring for her own children in her own
+home. A careful study of infant mortality, and the conditions of child
+life, so far as survival value is concerned, condemns in the strongest and
+most vital sense this whole practice. The preservation of the race is the
+essential requisite, and it is the vital industry of any people. Any
+seeming economic necessity which destroys that industry is one that will
+contribute largely to the downfall of the people as a race.
+
+EUGENICS AND THE HUSBAND.--The question of the husband's moral and parental
+obligation, as dictated by the marriage institution and constitution, may
+be left out of this discussion. We may assert, however, that we do not
+believe the eugenic principle intends, in devising ways and means for  [20]
+the adequate protection, in its completest sense, of motherhood, to relieve
+the father of any of his moral or parental obligations. These obligations
+will be justly defined, and as previously stated, will be the subject of
+special state legislation. No legislation of an economic character can
+detract from the performance of a moral obligation, and by no process of
+sophistication can modern statesmanship accomplish the dethronement of
+motherhood. The duty of the father is to support his children and the
+mother of his children, and the duty of the state is to see that this is
+done. The fundamental law of the eugenist must be to recognize that
+fatherhood is a deliberate and responsible act, for which a fixed
+accountability must be maintained. Whatever legislation is undertaken in
+this connection must be with the object in view of strengthening the
+efforts of the right kind of father and husband, and of rendering more
+difficult the path of the irresponsible father and husband. If the supreme
+duty of a state is the maintenance of justice, its whole effort in the
+future will be to legislate in harmony with the eugenic principle.
+
+       *       *       *       *       *
+
+
+                                                                       [21]
+CHAPTER III
+
+    "I hope to live to see the time when the increased efficiency in the
+    public health service--Federal, State and municipal--will show itself
+    in a greatly reduced death rate. The Federal Government can give a
+    powerful impulse to this end by creating a model public health
+    service."
+
+    EX-PRESIDENT TAFT.
+
+EUGENICS AND EDUCATION
+
+    THE PRESENT EDUCATIONAL SYSTEM IS INADEQUATE--OPINIONS OF DR. C. W.
+    SALEEBY, ELLA WHEELER WILCOX, LUTHER BURBANK, WILLIAM D. LEWIS,
+    ELIZABETH ATWOOD, DR. THOMAS A. STORY, WILLIAM C. WHITE, DR. HELEN C.
+    PUTNAM--DIFFICULTY IN DEVISING A SATISFACTORY EDUCATIONAL
+    SYSTEM--EDUCATION AN IMPORTANT FUNCTION--THE FUNCTION OF THE HIGH
+    SCHOOL--THE HIGH SCHOOL SYSTEM FALLACIOUS--THE TRUE FUNCTION OF
+    EDUCATION.
+
+The fundamental law of eugenics demands that all education be exerted for
+parenthood. We have proved that the child is not only essential to the life
+of the state, but is the state. Consequently any function other than
+parenthood is a non-essential so far as organic existence is dependent upon
+it. Education can, therefore, have no higher or more righteous motive than
+as a contributory agency in the perpetuation of the function upon which all
+existence depends. If the only function of education is to make one a
+worthy citizen, or to make him, or her, self-supporting, or able to bear
+arms in defense of his country, rather than a perfect link in the complete
+chain of enduring life, its purpose is being perverted. It is not
+sufficient to provide a girl, for instance, with an exclusive environment
+which regards her simply as a muscular entity, as is the tendency in some
+of the "best" girls' schools to-day; nor to fit her as a domestic or
+society ornament; nor must she be regarded simply as an intellectual
+machine, as is done under the system styled "the higher education of
+women." Any one of these is an example of misdirected excess and is    [22]
+only part of the whole. None of these systems strives to develop the
+emotional side of the complex female character, and any educational system
+which ignores the emotions is not only inadequate but reprehensible in the
+highest degree. The ideal which will strive for education for ultimate
+parenthood will more completely solve the question of complete (eugenic)
+living.
+
+THE PRESENT EDUCATIONAL SYSTEM IS INADEQUATE.--There is no question that
+education, as conducted at the present time, is one of the most disastrous
+institutional fallacies of modern civilization. In support of this
+contention, we are prompted to quote at length from various authorities
+bearing on this subject.
+
+Dr. C. W. Saleeby, an international authority on education, writes as
+follows:
+
+"A simple analogy will show the disastrous character of the present
+process, which may be briefly described as 'education' by cram and emetic.
+It is as if you filled a child's stomach to repletion with marbles, pieces
+of coal and similar material incapable of digestion--the more worthless the
+material the more accurate the analogy--then applied an emetic and
+estimated your success by the completeness with which everything was
+returned, more especially if it was returned 'unchanged,' as the doctors
+say. Just so do we cram the child's mental stomach, its memory, with a
+selection of dead facts of history and the like (at least when they are not
+fictions) and then apply a violent emetic called an examination (which like
+most other emetics causes much depression) and estimate our success by the
+number of statements which the child vomits onto the examination paper--if
+the reader will excuse me. Further, if we are what we usually are, we
+prefer that the statements shall come back 'unchanged'--showing no sign of
+mental digestion. We call this 'training the memory.' The present type of
+education is a curse to modern childhood and a menace to the future. The
+teacher who cannot tell whether a child is doing well without formally
+examining it, should be heaving bricks, but such a teacher does not exist.
+In Berlin they are now learning that the depression caused by these    [23]
+emetics (examinations) often lead to child suicide--a steadily increasing
+phenomenon mainly due to educational overpressure and worry about
+examinations.
+
+"Short of such appalling disasters, however, we have to reckon with the
+existence of this enormous amount of stupidity, which those who fortunately
+escaped such education in childhood have to drag along with them in the
+long struggle towards the stars. This dead weight of inertia lamentably
+retards progress.
+
+"If you have been treated with marbles and emetics long enough, you may
+begin to question whether there is such a thing as nourishing food; if you
+have been crammed with dead facts, and then compelled to disgorge them, you
+may well question whether there are such things as nourishing facts or
+ideas."
+
+The gifted writer, Ella Wheeler Wilcox, in an editorial in the _New York
+American_, expressed herself recently in the following terms:
+
+"A wave of dissatisfaction is sweeping over the country regarding our
+school system. And eventually this will cause a change to be made. The
+larger understanding of mothers regarding education will result in the
+personal element entering into the training of children.
+
+"When women have a voice in the affairs of the nation there will be more
+teachers, larger salaries, fewer pupils in each department, and more
+attention will be given to the temperaments and varying dispositions of
+children by their instructors.
+
+"Instead of regarding the little ones who enter public schools as machines
+which must be taught to go according to one rule, each child will be
+studied as a threefold being, and his mind, body and spirit will be cared
+for and developed according to his own peculiar needs. All this will come
+slowly, but it will come.
+
+"Before children enter the public schools there should be a great sifting
+process under the direction of a national board of scientific men. The
+brain equipment of each child, the tendencies given it at birth, should be
+tested; then the nervous, hysterical and erratic minds ought to be     [24]
+placed in a school by themselves, under the care of men and women who know
+the law of mental suggestion.
+
+"Quiet, loving, wholesome rules, followed day after day and month after
+month, would bring these children out into the light of self-control and
+concentration. The hurried, crowding, exciting methods of the public
+schools are disastrous to fully half of the unformed minds sent into the
+intellectual maelstrom which America provides under the name of Public
+Schools.
+
+"For the well-born, normal-minded, healthy-bodied child, who has wise and
+careful guardians or parents to assist in his mental guidance, the public
+school forms a good basis on which to build an education. For the average
+American child of excitable nerves and precocious tendencies, it is like
+deep surf swimming for the inexperienced and adventurous bather.
+
+"The great foundation of education--character--is not taught in the public
+schools. There is no systematized process of developing a child's power of
+concentration; there is not time for this in the cramming process now in
+vogue and with the enormous pressure placed on teachers. No teacher can do
+justice to more than fifteen children through the school hours. In many of
+our public schools there are fifty and sixty children under one instructor.
+This is fatal to the nervous system of the teacher and deprives the pupils
+of that personal sympathy which is of such vital importance."
+
+Luther Burbank, the famous California horticulturist, declares that the
+great object and aim of his life is to apply to the training of children
+those scientific ideas which he has so successfully employed in working
+transformation in plant life.
+
+In an editorial, entitled, "Teaching Health," the _New York Globe_ states,
+"Anatomy and physiology are reasonably exact sciences, and nine-tenths of
+the hygienic abuses against which the doctors are preaching would be
+prevented if the laity had an elementary knowledge of physiology. Such an
+educational reform could be carried out without causing any clash whatever
+between the warring medical sects." [Page 25]
+
+William D. Lewis, Principal of the William Penn School, Philadelphia, in an
+article entitled: "The High School and the Girl," in a recent issue of the
+_Saturday Evening Post_, wrote in part as follows:
+
+... "The first thing that society wants of our girl is good health. This is
+the first essential for her efficient service and personal happiness in
+shop, office, store, school or home. The future of the race so far as she
+represents it, depends upon her health. What is the high school doing to
+improve the girl's health? In the overwhelming majority of cases absolutely
+nothing. On the other hand, it is subjecting her to a regimen planned for
+boys, without the slightest consideration of the physical and functional
+differences between the sexes.
+
+"It pays no attention to the curvature of the spine developed by the
+exclusively sit-at-a-desk-and-study-a-book type of education bequeathed to
+the girlhood of the nation by the medieval monastery: It ignores the
+chorea, otherwise known as St. Vitus' dance developed by overstudy and
+underexercise; it disregards the malnutrition of hasty breakfasts, and
+lunches of pickles, fudge, cream-puffs and other kickshaws, not to mention
+the catch penny trash too often provided by the janitor or concessionaire
+of the school luncheon, who isn't doing business for his health or for
+anybody else's; it neglects eye-strain, unhygienic dress, uncleanly habits,
+anemia, periodic headaches, nervousness, adenoids, and wrong habits of
+posture and movements.... If you believe that the high school is a social
+institution with a mission of public service, regardless of the relation of
+that service to Latin or Algebra, then you must agree that it should look
+after what everyone recognizes as the foremost need of the adolescent girl.
+
+"One fact that every educator in both camps knows is that the home is not
+attending to the health of the adolescent girl. This problem is pressing
+upon us now largely because of the revolutions in living conditions that
+has come within the last quarter of a century."
+
+In a report of a recent Conference on the Conservation of School       [26]
+Children held at Lehigh University by the American Academy of Medicine, the
+following items appear.
+
+Four great reasons why medical inspection in schools is needed were brought
+out by Dr. Thomas A. Story of New York, who spoke from the educator's
+standpoint:
+
+"The first reason is concerned with communicable diseases, and the second
+with remediable incapacitating physical defects. It was reported in 1906
+that over twenty per cent. of the children in the schools of New York City
+had defective vision, and over fifty per cent. had defective teeth. These
+defective conditions are amenable to treatment whereby the functional
+efficiency of the pupil is improved. He is capable of better work and the
+school efficiency is advanced.
+
+"The third reason is concerned with irremediable physical defects. The
+cripples, the deformed and the delinquents whose incapacitating defects are
+permanent should be found and classified. This enables special instruction
+and opens up educational possibilities otherwise unattainable, besides
+removing retarding factors in the progress of the normal pupil.
+
+"The fourth reason is concerned with the development of hygienic habits in
+the school child, and through the child, of the community. Medical
+inspection which influences the health habits of the masses is a matter of
+supreme importance. The teacher will have pupils of cleaner habits and
+healthier, with fewer interruptions and disturbances from absences.
+
+"To make medical inspection successful physical examinations should uncover
+the anatomic, physiologic, and hygienic conditions. Every piece of advice
+given to a pupil that can be followed up should be followed up and the
+result recorded. No system of medical inspection in schools can be complete
+and permanently successful which does not eventually educate the parent and
+child to a sympathetic and cooeperative relationship with the system.
+Medical inspection is a force working for a better general education in
+personal hygiene and should cooerdinate with the class room instruction.
+Hence it must be a system in sympathetic relationship with the general [27]
+management of the school, and should be under the same responsible control.
+Since it is an educational influence and so directly related to the success
+of the school, it ought to be a part of the school organization."
+
+A paper was read by Dr. Helen C. Putnam of Providence, R. I., on "The
+Teaching of Hygiene for Better Parentage." She said:
+
+"Life is a trust from fathers and mothers beginning before history; to be
+guarded and bettered in one's turn, and passed along to children's
+children. A definite conception of this trust is essential to right living.
+Educators are finding that well directed correlation of human life, with
+phenomena of growing things in school gardens and nature studies, develops
+a wholesome mental attitude. Since tens of millions of our population have
+only fractions of primary schooling, there is where the teaching must
+begin. These primary years are the time to lay foundations before a wrong
+bias is established.
+
+"Education for parenthood cannot be completed at this early age. The
+strategic years for making it most effective are from sixteen to
+twenty-four, when home-making instincts are waking and strongest. We have
+15,000,000 young people of these ages in no schools, and eligible for such
+instruction. All state boards of education were recently petitioned by the
+American Association for Study and Prevention of Infant Mortality to urge
+the appointment of commissions on continuation schools of home-making, to
+investigate conditions and needs in their respective states and to report
+plans for meeting them effectively through such continuation schools or
+classes."
+
+DIFFICULTY IN DEVISING A SATISFACTORY EDUCATIONAL SYSTEM.--It will be
+observed that each of these authoritative writers criticises the system of
+education now in vogue. The criticism is not, nor could it justly be,
+specialized. It is simply an expression, from different viewpoints, of the
+feeling that we are not doing ourselves justice as yet, we are groping
+after something better. It may be, as I have previously stated, that no[28]
+satisfactory system of education will be evolved until the laws of kindred
+sciences, which have organic relationship to what we understand as
+education, are fixed and better understood. We are just beginning to
+appreciate the true meaning of environment. We know little about heredity,
+but enough to appreciate its vital importance. Psychology is a realm of
+much hope, but we have only tasted of its surface promise and know little
+of the mysteries it may unfold. Eugenics, the infant giant of science,
+promises to establish the race on an enduring foundation. These sciences
+have laws which we do not yet understand; they relate to that part of human
+evolution which mind dominates. The quality of the mind's dominion depends
+upon the mind's education and environment, and since the laws of these
+sciences, upon which a perfect system of education depends, have not been
+revealed, it is quite evident that all past systems of education have been
+more or less deficient. It is further evident that evolution has suffered
+as a result of the mind's imperfect education,--a condition that is
+manifest all around us.
+
+It must be appreciated, however, that we are discussing a large subject. If
+we understood all there is to know about environment; if we knew the laws
+of heredity, and psychology, and eugenics, and then could apply them, and
+educate the product of this combination of forces, we would be very near to
+the super-man. One must have a sober mental horizon to evolve the picture
+which would be the product of the above solution and then to estimate its
+meaning on human happiness and progress. We are approaching the ethics of
+right living,--of justice and truth,--the divine in man. At no time in the
+history of man has civilization been so near a solution of life's supreme
+problem as at the present moment.
+
+Education is an important function in life's scheme, and while we may
+regret that it is not possible to formulate a system that would be perfect
+and capable of immediate application, we can continue to work patiently and
+hopefully, with assurance that in the near future the problem will be
+satisfactorily solved. When heredity, psychology, and eugenics combine [29]
+to dictate the system, we shall doubtless find, that, in the beginning, it
+will be a system of individualization. In the interest of health and of
+justice, and consequently of efficiency, this would seem to be the natural
+and the logical lead.
+
+So long as human nature is as it is, we must meet conditions as they exist.
+We know as parents, and some of us know as physicians, that a task easily
+performed by one individual, without any apparent harmful results, will tax
+the capacity of another individual to the very utmost. Any educational
+system which does not recognize this law, is vicious. Yet such is the
+system in vogue to-day in America. We must adapt the burden to the
+endurance of the pupil. The administration of an educational machinery must
+solve this problem from the individual standpoint.
+
+In the departmental work in our public schools there seems to be no system.
+Each teacher prescribes home work without any knowledge of what others of
+the same grade do, and without any apparent consideration in favor of the
+individual pupil. The result is that the total amount for each night is
+absurdly in excess of the capacity of the ordinary, or for that matter the
+extraordinary, pupil. This engenders nervousness and irritability, and is
+contrary to the ethics of education,--the fundamental law of which should
+be the preservation of good health. We must have regard for the physical
+and mental health of each pupil, and as the capacity of each pupil is
+different, the system is committing an egregious wrong by sacrificing the
+weaker instead of adapting the burden according to the strength and
+endurance of the bearer.
+
+THE HIGH SCHOOL SYSTEM FALLACIOUS.--Even the high schools do not seem to be
+wisely availing themselves of their opportunity from the eugenic or
+economic standpoint. According to the report of the Commissioner of
+Education of the United States the percentage of pupils studying some of
+the more important subjects in the year 1909-1910 is stated as follows:[30]
+
+Latin, French and German         83 per cent.
+Algebra and Geometry             88  "    "
+English Literature               57  "    "
+Rhetoric                         57  "    "
+History                          55  "    "
+Domestic Economy,--including
+  sewing, cooking and household
+  economies                       4  "    "
+If only barely four per cent. of the girls in our high schools are studying
+subjects which directly contribute to their efficiency as home-makers, what
+are the prospects for worthy parenthood in the light of the fact that
+seventy-five per cent. of all women between the ages of twenty and
+twenty-four are married?
+
+The function of the high school, so far as girls are concerned, is to
+conserve health, to train for domestic efficiency and motherhood, and if
+necessary for economic independence. It must also furnish the stimulus for
+mental culture and direct a proper aspiration for social enlightenment. The
+curriculum should include biology, hygiene, psychology, home beautifying,
+the story-telling side of literature, music and a few other studies tending
+to make woman more like woman than she is to-day. When we have this,
+teaching for mothercraft will be more nearly realized.
+
+From the eugenic standpoint the present system of education is not
+satisfactory. To attain our end it is essential to devise other means of
+education. It must be remembered, however, that no system of education
+alone can ever enable us to achieve our end, no matter how perfect the
+system may be. Education can only draw out what is in the child; it cannot
+draw out what is not there. What the child is, depends upon its heredity.
+The pedagogic ability of the school-master will never make a genius.
+
+A child's mind may be likened to a block puzzle, each block representing a
+part of a picture, which can only be completed when they are all arranged
+in their correct places. Each block is an ancestral legacy,--the child's
+heritage--and to find its proper place in order to complete the        [31]
+character picture--to solve the riddle of the jumbled blocks,--is the duty
+of the educator. He can only manipulate what is there, and the test of his
+system will depend upon his ability to solve the puzzle of the ancestral
+blocks. We must divorce ourselves from the idea that a child's mind, at the
+beginning, is an empty space, to be filled in with knowledge according to
+the ability of the teacher; or that it is like a sheet of paper, to be
+written upon. Education, and the educator, is absolutely limited to
+"drawing out" what heredity put there. Education frequently is given credit
+which rightly belongs to nature. A child cannot do certain things until
+nature intends that it should. A baby cannot possibly walk until the
+nervous mechanism which controls the function of walking is developed. Many
+children walk at the first attempt, simply because they did not make the
+first attempt until after nature had perfected the mechanism and the innate
+ability to walk was already there. Suppose we tried to teach that baby to
+walk a month before nature was ready; each day we patiently coax it to
+"step out," we guide it from support to support, and we protect it from
+stumbling. Some day it walks, and we congratulate ourselves on the victory,
+when as a matter of fact, we not only had nothing to do with it but were
+impertinent meddlers, not instructors. Nature was the teacher and she was
+quite capable of completing the task without our aid. It is reasonable also
+to assume that any effort to force a natural function is quite likely to do
+much harm. We have found this to be so in various departments of education
+when the system was wrongly conceived. In physical culture this principle
+has been demonstrated over and over again.
+
+If our ancestral legacy is a good one, our picture blocks will be numerous
+and it will be possible for the proper system of education, aided by a
+suitable environment, to arrange them into many designs. If, on the other
+hand, our heredity did not endow us abundantly the number of our picture
+blocks may be limited to three or four, and they will be easily arranged so
+as to form a simple picture. The one represents a child whom heredity has
+richly endowed, the other one whom it has meagerly supplied with innate[32]
+possibilities. Heredity therefore dictates the function of education; and
+the school-master can only fashion the picture put there. If the ancestral
+blocks are not there with which to make an elaborate picture he must
+content himself with what is there,--he or his art cannot create others.
+When he congratulates himself on achieving a wonderful result in graduating
+a particularly brilliant student, he is taking to himself unmerited honors.
+If his individual ability is responsible in one instance, why not apply the
+same system to all pupils? If this system is responsible for the brilliancy
+of one pupil, why does not the same system make all brilliant? The reader
+knows the answer,--because heredity did not endow them equally. Men are not
+born equal, despite the Declaration of Independence.
+
+The school-master is not responsible for the apt and the inapt pupil. He is
+responsible for his system which dictates how he will differentiate between
+the apt and the inapt pupil, in order to achieve the best results without
+injustice to either.
+
+The inefficient teacher is a dangerous equation in the school system. I
+mean by inefficiency, the quality of being temperamentally unsuited to the
+profession. There are a large number of anemic, hysterical young women
+teaching in the public schools of our cities who should not be there. They
+should not be there in justice to themselves, nor should they be there in
+justice to their pupils. A strict, yearly medical examination should be
+made of the teachers to decide their physical and psychical fitness to fill
+their positions adequately. One teacher, physically or psychically
+inefficient, can do an inconceivable amount of harm in one school term. We
+cannot afford to experiment along this line. It means too much, and even at
+the price of one unhappy child it is too much to pay. The teacher who feels
+that she is not suited to the work; who has constantly to hold herself and
+her temper under control; whose nerves are such that she cannot do justice
+to herself, whose sense of justice is capable of perversion on purely
+sentimental grounds; or who has lost--or never possessed--the gift of
+maintaining discipline, should promptly find another position. She is  [33]
+earning her salary under false pretenses, and that alone condemns her. I
+believe, that a large percentage of the inefficiency of the New York
+Schools is due, not to the academic or scholastic inability of the average
+teacher, but to the average female teacher's physical, and especially her
+psychical unfitness to teach. We must concede, however, that in many
+instances the teacher's unfitness is a direct product of the pernicious
+system itself.
+
+[Illustration: _From "The Village of a Thousand Souls," Gesell, American
+Magazine_
+
+Evidence of a Feeble Mind
+
+A dirty shack in a mud hole in the country is merely another reflection of
+the same condition that causes the slums of the city. In our glowing spirit
+of humanity we cry out to raise up "the submerged tenth." Rather, should we
+not stamp them out of existence--treat them as a menace, and not as a thing
+of pity?
+
+Men, in general, rise; their minds are subjectively or objectively educated
+to their mental limit. They cannot go beyond it. "The submerged tenth"
+exists because its mental limit is low--often close to the upper margins of
+feeble-mindedness--and because it is mentally incapable of rising to
+anything else.]
+
+[Illustration: _From "The Village of a Thousand Souls," Gesell, American
+Magazine_
+
+Evidence of a Vigorous Mind
+
+The family that is vigorous, healthy in mind and body, "up and coming,"
+reflects itself in a hundred different ways. Small matter whether or not it
+is "an old family," has wealth, social position, a college education. A
+daughter's or a son's happiness, the real, deep-down-inside happiness that
+is worth while, may be more certainly insured by marrying with an eye to
+mentality and stock than by a marriage into a so-called "first family."
+
+Eugenics hath its reward.]
+
+Under an ideal system of education the child would be left absolutely free
+until the age of seven. We do not believe that the physical apparatus of
+the mind is prepared for educational interference before that age, and we
+know that the growth of the brain, physiologically and anatomically, is not
+complete until after the seventh year.
+
+The greater portion of a child's education necessarily depends upon its
+environment. Heredity and environment, therefore, are the two factors which
+determine the characters of any living thing. Heredity gives to the child
+its potential greatness,--its promise of greatness. Whether these potential
+qualities ever become real depends upon environment. A child may have the
+hereditary (innate) ability to become a Shakespeare, but if his environment
+is not suitable to the development of this potential greatness, he will
+never realize his hereditary promise. In other words, the innate qualities
+which he has, and which will make of him a Shakespeare are never "drawn
+out" or educated. Hence he can never become great until environment
+furnishes the means to him.
+
+Environment, including education, does not add to the potential qualities
+of inheritance. Education can only educate what heredity gives; it can give
+or add nothing itself; it simply educates what is there already. There is
+plenty of material, but it is not the right material. What educators want
+is the right kind of material--the material which the eugenists will
+eventually supply. Or as Mr. Havelock Ellis has expressed it:
+
+"Education has been put at the beginning, when it ought to have been put at
+the end. It matters comparatively little what sort of education we give[34]
+children; the primary matter is what sort of children we have to educate.
+That is the most fundamental of questions. It lies deeper even than the
+great question of Socialism versus Individualism, and indeed touches a
+foundation that is common to both. The best organized social system is only
+a house of cards if it cannot be constructed with sound individuals; and no
+individualism worth the name is possible unless a sound social organization
+permits the breeding of individuals who count. On this plane Socialism and
+Individualism move in the same circle."
+
+Education, then, as an exclusive factor, cannot achieve our ideal of
+race-culture. In order that education may achieve a large measure of
+success, it must have the proper material, and the right material can only
+come as a result of the working out of the eugenic principle. Then--in the
+aftertime--our educational efforts will not be wasted and misdirected, as
+they are almost wholly to-day.
+
+If we could transmit our acquired characteristics, education would have a
+relatively smaller, and a much more fixed function in the "general scheme,"
+but we cannot. We can only transmit what was inherent in us when created.
+This simply means that, at the moment of conception, the child is
+created,--it is a completed whole,--what it is to be is fixed at that
+moment, its inherent capacities are formed. Nothing can affect it, in this
+sense, after that moment. No act of either parent can have any influence on
+it. Whatever ability the father or mother possessed of an innate character
+is transmitted to the child at the instant of conception and that innate
+legacy constitutes the working instrument of the child for all time. It
+cannot be added to by education, or by environment, but both of these may
+have a large influence in deciding whether it will be developed to its
+highest possible limit of attainment.
+
+Education, mental, moral and physical, is limited by this inability to
+transmit acquired character to the persons educated. Each generation must,
+therefore, begin, not where their parents left off, but at the point   [35]
+where they began. The same difficulties and the same problems must be met
+at the beginning of each generation.
+
+THE TRUE PROVINCE OF EDUCATION.--Education may justly be the instrument,
+however, which will educate public opinion to a true appreciation of the
+function of race culture. In this way the cause of the eugenist will
+greatly prosper, and the race will profit through the effort which will
+further the conservation of the best and most fit specimens for parenthood.
+So also may education, through the molding of public opinion, create sound
+opinion,--when each individual will be a center of eugenic enthusiasm.
+Especially does this responsibility fall upon parents and those who are in
+charge of childhood. The young must be taught the supreme sanctity of
+parenthood. They must be instructed in eugenic principles in a way that
+will impart to them the definite knowledge that it is the highest and
+holiest science. The eugenic education of children is the real beginning at
+the beginning, the indispensable necessity, if race culture is to assume
+its transcendent role in modern civilization. It is urgently necessary for
+both sexes but more especially for girls. "Urgently necessary," because,
+though Herbert Spencer wrote the following criticism nearly fifty years
+ago, the conditions are much the same to-day:--
+
+... "But though some care is taken to fit youth of both sexes for society
+and citizenship, no care whatever is taken to fit them for the position of
+parents. While it is seen that, for the purpose of gaining a livelihood, an
+elaborate preparation is needed, it appears to be thought that for the
+bringing up of children, no preparation whatever is needed. While many
+years are spent by a boy in gaining knowledge of which the chief value is
+that it constitutes 'the education of a gentleman'; and while many years
+are spent by a girl in those decorative acquirements which fit her for
+evening parties; not an hour is spent by either in preparation for that
+gravest of all responsibilities--the management of a family. Is it that
+this responsibility is but a remote contingency? On the contrary, it is
+sure to develop on nine out of ten. Is it that the discharge of it is easy?
+Certainly not. Of all functions which the adult has to fulfill, this is the
+most difficult. Is it that each may be trusted by self-instruction to  [36]
+fit himself, or herself, for the office of parent? No; not only is the need
+for such self-instruction unrecognized, but the complexity of the subject
+renders it the one of all others in which self-instruction is least likely
+to succeed."
+
+It must be our highest educational aim to cultivate or create the eugenic
+sense. In this way, and in this way only, may we feel satisfied that the
+foundation, upon which shall be erected the generations that are yet to
+come, will be of an enduring character.
+
+       *       *       *       *       *
+
+
+                                                                       [37]
+CHAPTER IV
+
+    "It is only because we are accustomed to this waste of life and are
+    prone to think it is one of the dispensations of Providence that we go
+    on about our business, little thinking of the preventive measures that
+    are possible."
+
+    CHARLES E. HUGHES.
+
+EUGENICS AND THE UNFIT
+
+    THE DEAF AND DUMB--THE FEEBLE-MINDED--A NEW YORK MAGISTRATE'S
+    REPORT--REPORT OF THE CHILDREN'S SOCIETY--THE SEGREGATION AND TREATMENT
+    OF THE FEEBLE-MINDED--WHAT THE CARE OF THE INSANE COSTS--THE
+    ALCOHOLIC--DRUNKENNESS.
+
+In order to achieve success in eugenics we must strive to encourage the
+parenthood of the worthy or fit, and to discourage the parenthood of the
+unworthy or unfit. The unfit are those, as previously explained, who,
+because of mental or physical disability, are unable to create fit or
+healthy children.
+
+THE DEAF AND DUMB.--The condition known as deaf-mutism is due to innate
+defect in about half of all cases. Deaf children have one or two deaf
+parents or grandparents. There may be two or three such children in a
+family. That the deaf should not marry is generally conceded by those who
+work amongst them. It should be our aim to discourage the intimate
+association of the adolescent deaf and dumb in institutions. It has been
+found that such intimate association frequently results in marriage. They
+should be educated and instructed in the knowledge that they cannot marry.
+When they understand the eugenic principle upon which this social law is
+constructed they will be amenable to reason. No process of suasion will be
+necessary, however, if their intimate association is prevented.
+
+THE FEEBLE-MINDED.--This includes the criminal, the imbecile, the insane,
+and the epileptic. The feeble-minded, technically speaking, belong to the
+degenerate class. They enter life mentally deficient, not necessarily  [38]
+diseased. They should, therefore, be regarded as fit subjects for
+educational modification rather than for penal correction or punishment. It
+is conservatively estimated that there are five million feeble-minded
+people in the United States to-day and not one-eighth of them are receiving
+adequate treatment or education. Recent statistics, from various countries,
+show that the percentage of deficient or feeble-minded children is
+decidedly on the increase. According to a bulletin issued by the United
+States Bureau of Education (August, 1912) there are 15,000,000 school
+children suffering from physical defects which need immediate attention and
+which are prejudicial to health. It would seem as though the time had
+passed for anything other than radical measures in the interest of the
+race.
+
+Apart from the eugenic fact that these feeble-minded children are not fit
+subjects for parenthood, they are a constantly contaminating influence on
+society morally, and are a detriment and a hindrance to social and economic
+advancement. One illustration of this contaminating process, which is of
+serious eugenic import, is the presence of these deficient children in our
+public schools. By reason of their lack of attention and concentration,
+their mental or psychic insufficiency, their moral delinquency, and
+uncontrollable instincts and impulses, they are a menace to the well-being
+and to the progress of the normal or fit pupils; they retard and undermine
+the discipline of the schoolroom, and they affect the efficiency of the
+teachers. They are allowed to stay in school because of the indifference of
+the authorities, or because of the influence and social standing, or
+political "pull" of the parents, despite the recognition of the injustice
+done. Many of the parents of these children seek medical advice but,
+because of absurdly inadequate civic or state provision for such cases, the
+physician is practically helpless. Most of these irresponsible children are
+allowed to wander through the years unrestrained and unprotected. They
+easily become the victims of vice and crime, and eventually they become
+degenerates and end their lives in insane institutions. Because of the
+stigma of degeneration these feeble-minded individuals fall into the   [39]
+hands of the law and are thereby robbed of the medical assistance which
+society should afford them in the early years when improvement is yet
+possible.
+
+The following report which recently appeared in one of the daily papers is
+interesting and suggestive in this connection. One of the New York City
+Magistrates, in his annual report, said: "There is growing up in this city
+a menacing army of boys and young men who are the most troublesome element
+we have to deal with.... From the ranks of these rowdies that are organized
+in bands, or bound up with chums or pals, come most of the crop of
+burglars, truck thieves, holdup men, gun-bearers, so-called 'bad men' and
+other criminals and dangerous characters. Without reverence for anything,
+subject to no parental control, cynical, viciously wise beyond their years,
+utterly regardless of the rights of others, firmly determined not to work
+for a living, terrorizing the occupants of public vehicles and disturbing
+the peace of the neighborhoods, they have no regard for common decency."
+
+But it is to the records of the Children's Society that one must go for
+reliable statistics of the potential criminal, as there the only systematic
+study of their conditions is made and recorded by one of the greatest
+neurologists in the country, Dr. Max Schlapp, of New York. As a specialist
+in nervous diseases he has been connected with the Children's Society and
+the Children's Court, where he has had wide opportunities for observing the
+relation between delinquence and mental defectiveness. In cases of
+viciousness or feeble-mindedness exhaustive studies have been made by Dr.
+Schlapp. And the extent to which society is daily at the mercy of
+uncontrolled potential criminality is alarming.
+
+"Feeble-minded children and feeble-minded men," says Dr. Schlapp, "are
+roaming about the streets of New York to-day as free agents. Parents are
+not compelled by law to put a feeble-minded child in custody. Yet that
+feeble-minded child unsuspected as such, amiable and care-free as he
+usually is, is potentially a criminal, and at any moment may commit a
+crime. That child is permitted to grow up without restraint, except    [40]
+such as the parents exercise, and this has no effect whatever in these
+cases. The child is allowed to marry and bring forth children of his own
+kind, more feeble-minded and more dangerous. There is no system designed to
+pick out from the community persons so afflicted, and no law whatever to
+prevent their untrammelled movements.
+
+"The city street is a recruiting ground for the gangster because it is full
+of defective children, mental and moral, who are potential criminals. This
+question has never been seriously considered. When brought under corrective
+restraint it has hitherto long been the custom to herd all the cases
+together while serving time. But in 1894 the German Government woke up to
+the fact that 3 to 7 per cent. of city children and those of isolated rural
+communities contain the 'moron,' or intellectually defective type, together
+with the moral imbecile."
+
+Investigation showed recently that in a reformatory near Berlin 63 per
+cent. of the inmates were abnormal, while over 50 per cent. were seriously
+defective or menaces to society. This has since been shown to exist in all
+the leading nations--England, France, Italy, where, by the way, the
+Camorrist type is the equivalent for our New York gangster. In the Elmira
+Reformatory 38 per cent. are, as a rule, feeble-minded and consist of types
+that repeat their offense against society or commit some other crime.
+
+There is only one way to prevent these types from becoming a menace.
+Restrain them while they are still developing; keep them from becoming free
+agents in the community they menace. Types continually come up in the
+Children's Society and the Children's Court. They are carefully studied.
+From the actions of the child, from his parents and family history, from
+the frequency with which he repeats some offense particularly pleasing to
+him, and by virtue of psychological tests and careful medical examinations
+the examiners are able to pick out children who should receive scientific
+care and treatment.
+
+"The characteristics of the feeble-minded are usually deceiving. One
+expects to find them with low brows and furtive looks and more or less
+vicious in appearance after they develop criminal tendencies. One would[41]
+expect them to show stupidity at a glance. On the contrary, they are
+sometimes bright on the surface, amiable, good-tempered under trying
+conditions, and almost likeable for their external social side. This is
+particularly true of the high grade defectives. The lower order may be
+taciturn, gloomy and retiring, and these traits may be noticed almost from
+infancy. But as they grow up their social nature may be developed, and they
+too may give the appearance of amiableness. One notable thing about them is
+their pose of frank innocence. In this they are engaging, and almost
+convincing.
+
+"The street type that makes a gangster is practically the same if cruder in
+development. These children usually exhibit absolutely no sign of affection
+for their parents, no sympathy, and are notably cruel toward animals. One
+boy we had in the Children's Society persistently killed all the dogs and
+cats his family kept. Finally, when they ceased keeping the animals he got
+at the canary cage and killed the bird by pulling the feathers out singly.
+He had no compunction about lying, and looked you right in the eye when he
+lied. Otherwise he was charming and natural."
+
+While moral insanity is hereditary, yet it can be produced in one
+generation. An alcoholic man with clean antecedents may leave tainted
+descendants. The only way to combat these conditions in the city is to have
+strict registration of all feeble-minded and insane. The state should
+discover them, examine them through public officials, and segregate them.
+Not only physicians, but school teachers and officials in public
+institutions should detect them. There should be in each state an
+institution for feeble-minded delinquents.
+
+The history of the average "gangster" shows a taint of alcoholism. This is
+further aggravated by living under immoral surroundings, where petty crimes
+like stealing and lying are considered "smart." This is the starting point
+of the New York "gangster." He is handicapped, and under ancestral
+disabilities and the disadvantages of environment that is pernicious, he
+cannot get very far. A boy usually qualifies with a gang on his own    [42]
+personality and tastes. He will often wander from one gang to another until
+he has found his particular atmosphere. The best will never find any one
+gang congenial enough to hold him, and he finally emerges a decent citizen.
+It is all a process of finding himself. The aim of the police should be to
+discount as much as possible any swaggering and false hero worship.
+
+The time has come when this great nation should take national cognizance of
+this problem. There should be a national institution on some isolated
+island. Civilization is coming to recognize such a necessity. With a close
+eye on the tide of immigration and a careful segregation of these defective
+types, we should soon rid ourselves of what is now growing to be a serious
+menace to the home and the nation.
+
+THE SEGREGATION AND TREATMENT OF THE FEEBLE-MINDED.--Dr. John Punton, of
+Kansas City, Mo., in an able and exhaustive article on "The Segregation and
+Treatment of the Feeble-Minded," writes as follows:
+
+"Your attention is directed to a recent report issued by Wentworth E.
+Griffin, Chief of Police of Kansas City, Mo., in which he claims that
+recently within six months' time no less than 2,480 juveniles were arrested
+charged with crimes ranging from vagrancy to murder and that the majority
+of these boys and girls were not normal children, but degenerates who
+required medical rather than penal treatment. 'Boys and girls,' says he,
+'should not receive correction in the city jails, the work house or
+reformatories. These should be the last resort. To correct a boy you must
+have an idea of his mental processes. It is natural that the parents
+understand something of the child and use that knowledge to make a good boy
+out of him. Certainly it cannot be done in the reformatories, for although
+the authorities there are competent, they are hardly medical psychologists.
+In my opinion, if any progress is to be made it is the parent and the
+doctor that must do the work, not the police and the courts.'
+
+"That our Chief of Police deserves credit for not only publishing this
+report, but also for the advanced position he takes in recognizing the
+appropriate care and treatment of the juvenile offender, is certain,   [43]
+for he understands the fact that the parents are often the chief culprits
+in the child's delinquency and that medical rather than penal treatment is
+more often indicated than is at present allowed or practiced.
+
+"When we come to inquire into the cause of feeble-mindedness, alcoholic
+heredity, syphilitic heredity, and consanguineous marriages are found to be
+the chief etiological factors. Bourneville claims that 48 per cent. of the
+idiots and imbeciles are the offspring of alcoholic parents.... Acute and
+chronic diseases in the parents, fright, shock, injuries, parental neglect,
+faulty education, poverty, malnutrition, social dissipation and lack of
+proper control are all well-known factors in the production of
+feeble-mindedness.
+
+"Segregation of the feeble-minded is advocated by medical authority the
+world over, and when this is done they can be made under appropriate
+medico-pedagogic treatment to become largely self-supporting.
+
+"As an economical as well as a humane measure, the various States can well
+afford to make such provision, more especially for the large body of
+feeble-minded who are now without any medical care whatever. Moreover,
+where it is possible, laws prohibiting the marriage of such as well as all
+other defectives should be passed and enforced."
+
+WHAT THE CARE OF THE INSANE COSTS.--The total cost of the care of the
+insane, in this country, has been estimated to be $165,000,000 a year. In
+estimating the cost of the insane we must take into account the value or
+worth of each adult to the State. This value has been computed to be $700 a
+year. If, upon this basis, we count the adult membership of the insane
+class between the ages of eighteen and forty-five, we find that their worth
+is roughly about $132,000,000.
+
+The cost of maintenance in the various insane institutions is about
+thirty-three millions of dollars a year. It would be quite possible to
+justly increase this total by estimating the worth of the help whose whole
+time is devoted to the care of the insane. If these individuals worked at
+some other trade or profession, their time would. be of value to the   [44]
+state in general--not to a class who should be non-existent. The cost to
+the state of the potential criminal is not included in this estimate.
+
+From the above figures it may be observed that it costs more to simply
+maintain the insane each year than it costs to work the Panama Canal; or to
+pay for the total cost of the Executive, Legislative and Judicial
+departments of our government. The total cost is more than the entire value
+of the wheat, corn, tobacco, and dairy and beef products exported each year
+from this country.
+
+ALCOHOLIC DRUNKENNESS.--Alcoholism is a sign and a symptom of degeneracy
+and is a distinct indication of unfitness for parenthood. The only cure for
+alcoholism is to prohibit parenthood. It has been proved that alcohol taken
+into the stomach can be demonstrated in the testicle or ovary within a few
+minutes, and, like any other poison, may injure the sperm or the germ
+element therein contained. As a result of this intoxication of the primary
+elements, children may be conceived and born who become idiots, epileptics
+or feeble-minded. It is asserted that 48 per cent. of all the idiots and
+imbeciles are the offspring of alcoholic parents.
+
+Recent experiments show that parental alcoholism alone can determine
+degeneration. Mr. Galton quoted the case of a man who, "after begetting
+several normal children became a drunkard and had imbecile offspring"; and
+another case has been recorded of a healthy woman who, when married to a
+drunkard, had five sickly children, dying in infancy, but in a later union
+with a healthy man bore normal and vigorous children.
+
+Dr. Sullivan found on inquiry that:
+
+.... "Of 600 children born of 120 drunken mothers 335 died in infancy or
+were still-born, and that several of the survivors were mentally defective,
+and as many as 4.1 per cent. were epileptic. Many of these women had female
+relatives, sisters or daughters, of sober habits and married to sober
+husbands. On comparing the death rate amongst the children of the sober
+mothers with that amongst the children of the drunken women of the same
+stock, the former was found to be 23.9 per cent., the latter 55.2 per
+cent., or nearly two and a half times as much. It was further observed [45]
+that in the drunken families there was a progressive rise in the death rate
+from the earlier to the later born children."
+
+Dr. Sullivan cites as a typical alcoholic family one in which the first
+three children were healthy, the fourth was of defective intelligence, the
+fifth was an epileptic idiot, the sixth was dead born, and finally the
+productive career ended with an abortion.
+
+The nervous systems of many children of alcoholic parents are wrecked for
+life; many die in convulsions as infants. Many, however, who do not die,
+live as epileptics. This action of alcohol on the health and vitality of
+the race is the most serious of the evils that intemperance brings on the
+community. The tendency of all children of alcoholics is toward nervous
+disorders of a grave type.
+
+Statistics show a very high rate of still-births and abortions among the
+children of drunken mothers, show that drunken women must not be permitted
+to become mothers.
+
+Dr. Branthwaite in a lecture stated: "In my judgment, habitual drunkenness,
+so far as women are concerned, has materially increased, during the last
+twenty-five years, which I have spent entirely amongst drunkards and
+drunkenness. These people are not in the least affected by orthodox
+temperance efforts; they continue to propagate drunkenness, and thereby
+nullify the good results of temperance energy. Their children, born of
+defective parents, and educated by their surroundings grow up without a
+chance of decent life, and constitute the reserve from which the strength
+of our present army of habitual drunkards is maintained. Truly we have
+neglected in the past, and are still neglecting, the main source of
+drunkard supply--the drunkard himself; crippled that and we should soon see
+some good results from our work."
+
+Dr. Fleck, another authority, says: "It is my strong conviction that a
+large percentage of our mentally defective children, including idiots,
+imbeciles and epileptics, are the descendants of drunkards."
+
+Therefore the chronic inebriate must not become a parent.
+
+       *       *       *       *       *
+
+
+                                                                       [47]
+CHAPTER V
+
+    "The real undermining of health is not seen. It is done in an insidious
+    way. It has to be carefully ferreted out."
+
+    DR. HARVEY W. WILEY.
+
+WHAT EVERY MOTHER SHOULD KNOW ABOUT EUGENICS
+
+In the preceding pages we have written about eugenics as a science; it is
+our intention now to point out briefly in just what way eugenics directly
+concerns the mothers of to-day. In the first place let us try to appreciate
+what it will mean to the race if "the fit only are born." "Fit" children,
+it will be recalled, means children born healthy of healthy, selected
+parents, parents with a good ancestral history, conveying to their
+offspring a reasonably adequate legacy. If the "fit only are born" we start
+with a healthy stock. What a significant and tremendous advantage this is.
+At once we rid the world of the potential inefficients--the feeble-minded,
+the insane, the criminal, the deaf-mute, the drunkard. If we are correct in
+assuming that the reason why all former civilizations have failed and
+passed away, was because they bred a race of people physically and mentally
+unfit to survive, the demand of the eugenist that only "fit children shall
+be born" will strike at the very root of this evil. If we uproot the cause
+of racial degeneration we begin the building of a race that should not
+degenerate. If we establish a race that will not degenerate, it must gain
+strength and virility with each generation.
+
+This assumption is logically correct, but we must do more than breed "fit"
+children. We must take care of them after they are born. We must furnish
+them with a good environment (see page 3). Heredity without favorable
+environment counts for very little,--we must never forget that. Heredity
+and environment are the two important determining factors in the life of
+every child born. If eugenics furnishes the heredity by ensuring the   [48]
+birth of the "fit" only, it depends upon the mothers of the race to provide
+the environment. Every mother must know how to take the best care of
+herself and of her child. This book is devoted to instructing her in the
+details of this duty.
+
+We cannot hope, however, to reach this high altruistic plane by simply
+taking the first step in the right direction. We who are alive to-day must
+begin the work, and leave it to posterity to carry forward. We must do our
+part. Every mother must become an enthusiastic eugenist. If she begins to
+teach, and preach, and practise its principles now, she will contribute to
+the heredity of unborn generations. To those of us who are alive to-day,
+environment is the vastly more important consideration, for our heredity is
+fixed and beyond the power of control. The question of eugenics for the
+present generation, therefore, is a question of environment.
+
+All our efforts must be directly in developing what heredity gives our
+children. We are wholly responsible for that. We must feed and clothe them
+properly; we must provide air spaces and playgrounds for exercise; we must
+educate them, and protect them from disease; and we must safeguard the
+birth of future generations by keeping our race stream pure. This is no
+small task, and the only way it will ever be satisfactorily accomplished is
+for each mother to realize her individual trust. The average individual
+does not realize the actual conditions that prevail. When recently the
+question of the public health was investigated by competent authorities,
+and the report furnished to the United States Senate, it caused a
+tremendous sensation. If that is possible in a body composed of men who are
+supposed to be intelligent and wide-awake to existing conditions, how much
+more significant and appalling it should be to the average mother whose
+interest is centered in her own home.
+
+According to the statistics and statements given in that document the
+annual financial loss from needless deaths and accidents alone amounted to
+$3,000,000,000. [Page 49]
+
+Acute diseases are held responsible for a large part of the loss. Chronic
+diseases are responsible for the greatest part of the waste of life, and
+they are believed to be increasing in their ravages. Minor ailments,
+believed to be nine-tenths preventable, are now costing the nation many
+dollars through incapacitation of persons and through leading to serious
+illness. Industrial accidents, largely preventable, are also exacting a
+heavy toll annually.
+
+That this great waste of life and health and the national economic loss
+that results can be modified by national action is asserted. Here are to be
+found the reasons advanced for a great national department of health. The
+work of this department would be varied. It would include direct work in
+promoting health on the part of the government, such as administering the
+food and drug act; aiding the healing and educational agencies, both city
+and State; obtaining information concerning the cause and prevention of
+diseases, and disseminating scientifically proved information on all health
+subjects.
+
+It is maintained that the movement for the conservation of health is the
+most momentous of the conservation movements in this country, and that of
+all the national wastes which are to be condemned, this waste of health is
+the gravest.
+
+Many startling statements are set forth in the document. Dr. Charles
+Wardell Stiles, of the United States Public Health and Marine Hospital
+Services, declares that "The United States is seven times dirtier than
+Germany and ten times as unclean as Switzerland." He declares that: "Lack
+of interest in preventive measures against diseases is slaughtering the
+human race." He takes the position that the real trouble is not so much
+race suicide as race slaughter, and that it is rather that too many
+children are allowed to die than that not enough children are born.
+
+It is estimated that tuberculosis, a preventable disease, costs the nations
+$1,000,000,000 annually. Typhoid fever is estimated by Dr. George M. Kober,
+dean of the medical department of Georgetown University, to cost over
+$300,000,000 annually. [Page 50]
+
+In connection with acute diseases this statement is made: "The loss from
+tuberculosis has been reduced to half of what it was thirty years ago.
+Nevertheless, of the 90,000,000 people now living in the United States at
+least 5,000,000 will be lost through this disease because adequate effort
+is not made to prevent it. Besides the economic waste through deaths from
+any disease, the waste through sickness from the same disease is also
+colossal."
+
+Great as are the reductions in the rates of infant mortality by improved
+milk and water supplies and by educational campaigns, the present rate is
+still enormous.
+
+"If some witch or wizard could conjure up the unnecessary babies' funerals
+annually occurring in this country it would be found that the little
+hearses would reach from New York to Chicago. If we should add the mourning
+mothers and friends, it would make a cortege extending across the
+continent."
+
+While the death rates from acute diseases have been greatly reduced, the
+rates from chronic diseases have been steadily increasing. Cancer is one of
+the chronic diseases apparently on the increase.
+
+That the annual death toll and the 3,000,000 constant sick beds could be
+reduced from one-fourth to one-half by proper measures is asserted. In
+other words, there might be saved every day, as many lives as perished on
+the _Titanic_, with the consequent enormous economic saving.
+
+These are surely impressive statements. It would seem as though it should
+be a simple task to pass a Public Health Bill, establishing a bureau in
+Washington, with a representative in the cabinet, whose sole duty it would
+be to preserve the public health. It has proved rather the reverse,
+however. We have been able to inaugurate various species of
+conservation,--of lands, of forests, of water,--but the conservation of
+human life is not important enough. Even though states and empires depend
+upon their people for their very existence, our statesmen feel that human
+life is too cheap, too common, to take immediate steps in this direction.
+
+If women--especially mothers--would devote themselves to the eugenic   [51]
+end of legislation, men would soon obey. The application of eugenics to the
+human species, coming, almost in the spirit of an inspiration, at the time
+when women are about to be enfranchised, is significant. It may be that
+destiny has decreed that the one shall be the complement of the other; it
+is certainly beyond contradiction that in eugenics the women of the earth
+have a divine weapon with which to wage a righteous and an awaking
+propaganda of truth.
+
+A mother should be interested in every phase of the subject. Her daughter's
+success in marriage should intimately concern her. Her health and her
+happiness in that sphere should elicit her deepest maternal consideration.
+She may rightly hope to be proud of her daughter's offspring, and to find
+pleasure in the society of her grandchildren. She should, therefore, devote
+all her efforts to ascertain the truth, with reference to the physical and
+mental equipment of her future son-in-law; his ability adequately to
+support a family; his sobriety, his disposition, associates, etc., should
+all be carefully considered and pondered over. This is not going far
+enough, however; we must know positively that he is not diseased,--that he
+is not a victim of gonorrhoea or syphilis.
+
+When parents weigh in the balance the possibility of a wrecked life, of
+destroying the right to have children, or of bringing them into the world
+blind or diseased; of permanently destroying the hope of happiness, peace,
+and success, no combination of advantages in a son-in-law is deserving of
+the slightest consideration. We are treating of the sacred things of
+life--of life itself. If parents combine to crucify and betray their
+daughters--to sell them body and soul into bondage for social or other
+advantages; if they preserve silence when they should speak and thereby
+take all the sunshine, for all eternity, out of one existence; then, if on
+their death-beds these daughters should accuse them, the guilty knowledge
+that they were responsible will be the sting that will blast their hope of
+peace and forgiveness here and in the worlds to come.
+
+When mothers realize that, every day, in every large hospital in every city
+in the civilized world some woman (a daughter of some mother) is being [52]
+unsexed because of these unjustly obtained diseases, surely their voices
+shall speak in no uncertain way.
+
+Another eugenic suggestion that should deeply concern every good mother is,
+that the mother's milk is the private property of the babe, and whoever
+deprives the babe of this, the sole right it possesses, is not only a thief
+but a scoundrel. A curious and significant fact was discovered by
+investigators when studying the question of infant mortality a few years
+ago. It was found from a mass of statistics that there were two recent
+instances when the death rate of infants decreased suddenly and quite
+decidedly. The first instance was when the Civil War in this country caused
+a cotton famine in England. As a result of the famine the factories of
+Lancashire were all closed and the employees being then without work
+remained at home. As a large percentage of the workers were married women
+with children they had the time and the opportunity to nurse their children
+regularly. Despite the fact that these women were starved and badly clad
+and deprived of the comforts of home, the death rate of the infants dropped
+steadily to an unprecedently low mark.
+
+A number of years later, when the German army surrounded Paris during the
+Franco-Prussian War the besieged inhabitants of the capital suffered from
+hunger and disease. The death rate of the adult population increased
+enormously while the death rate of the infants dropped markedly.
+
+The explanation of this curious phenomenon was simply that while times were
+normal the women labored outside of their homes and as a consequence the
+babies were not fed regularly and when fed were not fed mothers' milk. It
+demonstrated a truth that we are apt to lose sight of, that mothers' milk,
+even the milk from badly-nourished, poverty-stricken mothers is infinitely
+better than an abundant supply of artificial food combined with neglect. In
+view of the fact that there is a distinct tendency to evade this maternal
+duty these facts should be suggestive and important. It is the duty of the
+mother with any eugenic sense to preach and to practise this gospel.   [53]
+Paris learned the lesson of the siege because though she has the smallest
+birth-rate to-day, she nevertheless has the smallest infant death-rate of
+any large city in Europe.
+
+The writer believes that in eugenics the women of the race have the
+instrument wherewith to save the world. He is assured that it is the
+supreme potential agency for the betterment of the race, and that mankind
+will never be inspired with a holier cause. He believes that through all
+the ages the human race has been growing better, coming nearer the truth,
+and that as a result of this patient progress, there has been evolved the
+eugenic idea that is to solve the problems of the human family. If the "fit
+only are born" think of the possibilities of education and of environment.
+Each child is born with a great potential promise, and endowed with a
+reasonably good heredity, the whole effort of that child will be toward a
+higher moral attainment. If the effort of the individuals of the race is to
+achieve a high moral success, the quality of the civilization of future
+generations will be far superior to the type with which we are familiar.
+
+Eugenics gives to women the supreme civilizing instrument of the future. It
+places the burden of the morality of the home and of the race on their
+shoulders. If we deny the writing on the wall it does not render the
+warning negative. The signs of the times are epochal. The great political
+parties are realizing, for the first time in history, that new and
+important issues concerning the family, the home, and the children, in
+other words the nation's manhood and womanhood, must be considered and
+included in their platforms. They know that the time has gone when
+statesmen will exclusively decide what shall be done with the sons and
+daughters which women bring into the world. They know that the mothers of
+the race must have a voice in deciding for peace or war since they create
+every soldier that will lie dead when war is over. Women will help decide
+the question of taxation by government and by trusts, because they know
+that it comes out of their incomes and they need it all for their children.
+Women know that their cause is the cause of freedom, and freedom is the[54]
+cause of the eugenist. They know that the function of government should be
+justice and no code of justice can have higher ethics than the ethics of
+eugenism.
+
+MOTHERS' EUGENIC CLUBS.--There should be established in every community a
+mothers' eugenic club. The object of the club should be to further the
+eugenic idea. Papers should be prepared, read, and discussed on subjects
+having a eugenic interest.
+
+One of the main aims of these clubs should be to interest the local
+Congressman and the member of the State Legislature in eugenics. In all
+probability they will know nothing specific about race-culture--unless they
+are exceptional men--in which case it will be the duty of the members of
+the club to educate them. The object of such education of course would be
+to ensure that they will act intelligently when any legislative proposal is
+made having a eugenic interest. Find out what they know about the public
+health as contained in the report on page 48, and if they will vote in
+favor of a Public Health Bureau. You should know how your representatives
+stand on the Pure Food and Drugs Act; if they really appreciate the
+significance of the measure; if they would be in favor of pensioning
+mothers and widows who have children depending upon them; what their views
+are regarding compulsory marriage licenses; the reporting of venereal
+diseases to the local health authorities; if they would favor the
+segregation of the feeble-minded and their maintenance and treatment by the
+state; if they endorse the eugenic principle that "the fit only shall be
+born," and if they really understand just what that means.
+
+If the mothers in every community would take this step, they could control
+the legislation affecting such subjects in a comparatively short time. If
+the various States concede to women the right to vote--as they will sooner
+or later--such mothers' clubs would have a large and intelligent share in
+educating the women's votes on questions which directly concern their own
+immediate and remote welfare.
+
+The question of education would concern these clubs and much could be done
+by mothers to direct the authorities as to just what is needed to educate
+for [Page 55] parenthood, along the lines suggested elsewhere in this book.
+
+A mothers' eugenic club would rightly become an instrument for good in all
+local sociological interests. It could maintain a trained nurse to care for
+the sick and helpless, to teach the people how to live, and how to care for
+their homes and their children. The members themselves could visit the
+poor, the needy, and the sick.
+
+There are so many people in the world who are near the brink of
+failure,--so many who need a little hope infused into their lives,--and so
+many who are really deserving of help and sympathy and inspiration. The
+women who do this work for the work's sake are amply repaid by the good
+they find to do. The doing of such work is a consecration and an education.
+Life means more, and the whole temperament reflects a truer sympathy and a
+stronger purpose.
+
+There are many mothers, for example, who are willing to do what is
+essential in the interest of their children, but they do not know what
+should be done. These people cannot afford a physician or a nurse to teach
+them, nor do they even know that their methods are wrong or that they need
+any instruction. We must carry the information and the explanation to them.
+We must show them the need for a change of methods. This is the work for
+those charitably disposed women who desire some worthy purpose in life, who
+really wish to do some genuine good. All the equipment they need is good
+common sense. They will explain why it is essential to pasteurize the milk
+before feeding it to the baby because most of the milk used by the poor is
+unfit for use as a baby food. They will show how to keep the nipples and
+the bottles clean, and they will give them lessons on how to prepare the
+food to the best advantage. They will instruct them how to dress the baby
+in hot weather, and they will explain why it is necessary to provide the
+baby with all the fresh air possible. They will gain the confidence of
+these mothers and they will tell them all they know, in tactful and
+diplomatic and common-sense language so that they may appreciate the
+eugenic reasons for everything they do regarding the care and well-being of
+the baby. In every city in the country this work is needed and is      [56]
+waiting for the missionaries who will volunteer. To teach mothers the need
+for boiled water as a necessary drink for baby and older children is alone
+a worthy avocation. To impress upon one of these willing but ignorant
+mothers the absolute necessity for washing her hands before preparing
+baby's food, that she must keep a covered vessel in which the soiled
+napkins are placed until washed, that she should frequently sponge her baby
+in hot weather,--and explain thoroughly why these are important
+details,--is a work of true religious charity. They should be taught to rid
+their houses of flies, and especially to keep them from the baby and from
+its food, bottles, and nipples. They should be instructed to discontinue
+milk at the first sign of intestinal trouble, to give a suitable dose of
+castor oil, and to put the child on barley water as a food until the danger
+is passed. They should be taught to know the serious significance of a
+green watery stool, that it is the one danger signal in the summer time
+that no mother can ignore without wilfully risking the life of her baby.
+They should be shown how to prepare special articles of diet when they are
+needed. If every mother were educated to the extent as indicated in the
+above outline the appalling infant mortality would fall into
+insignificance. It is not a difficult task, nor would it take a long time
+to carry out; it is the work for willing women who have time and who
+perhaps spend that time in less desirable but more dramatic ways. It is
+education that is needed, and it is education that is willingly received,
+as all mothers are ready to devote their time in the acquirement of
+knowledge that will help them save their offspring. This is the eugenic
+opportunity and it is an opportunity that should devolve upon the women of
+the race.
+
+Such a mothers' club would receive the willing financial support of the men
+of the community. It should be placed upon a sound financial basis because,
+to be successful, it would have to bestow much material aid. I know of
+clubs that are self-supporting, however. Each club needs a leader to begin
+it; will the reader be that one in her Community?
+
+A Mothers' Eugenic Club would of course discuss the practical side of  [57]
+the eugenic question: the proper feeding and clothing of children; hygiene,
+sanitation, housekeeping and homemaking, and the efficiency and health of
+each member of the home, and all other topics of interest to every wife and
+mother. The writer believes that in the very near future we shall have a
+Mothers' Eugenic Club in every community in the United States; that these
+clubs will be guided by, and be an instrument of, a National Eugenic
+Bureau, composed of women, that will cooeperate and harmonize the work as a
+whole, so that the conservation of human life will be effected to its
+maximum extent; that the excessive infant mortality will be overcome,
+because ignorant and incompetent mothers--the greatest cause of infant
+mortality--will be educated and instructed in the rudiments of eugenics and
+will consequently, to a large extent, cease to be ignorant and incompetent;
+that the desecration of young wives will stop, and stop forever, because
+vice and disease will be branded and exposed; that the feeble-minded, the
+deaf-mute, the imbecile, and the insane, will no longer be allowed to
+propagate their kind, to the permanent detriment of the race.
+
+When such clubs are established, and when all mothers do their individual
+duty in the interest of the race, we shall begin to see the dawn of a
+promise that will achieve its supreme success in the generations that will
+people the earth in the eugenic aftertime.
+
+       *       *       *       *       *
+
+
+                                                                       [61]
+CHILD-BIRTH
+
+CHAPTER VI
+
+    "Solicitude for children is one of the signs of a growing civilization.
+    To cure is the voice of the past; to prevent, the divine whisper of
+    to-day."
+
+    KATE DOUGLAS WIGGIN.
+
+PREPARATIONS FOR THE CONFINEMENT
+
+    THE BIRTH CHAMBER--WHAT TO PROVIDE FOR A CONFINEMENT--READY TO PURCHASE
+    OBSTETRICAL OUTFITS--POSITION AND ARRANGEMENT OF THE BED--HOW TO
+    PROPERLY PREPARE THE ACCOUCHMENT BED--THE KELLY PAD--THE ADVANTAGES OF
+    THE KELLY PAD--SHOULD A BINDER BE USED?--SANITARY NAPKINS--HOW TO
+    CALCULATE THE PROBABLE DATE OF THE CONFINEMENT--OBSTETRICAL TABLE--WHEN
+    SHOULD A PREGNANT WOMAN FIRST CALL UPON HER PHYSICIAN--REGARDING THE
+    CHOICE OF A PHYSICIAN--HOW TO KNOW THE RIGHT KIND OF A PHYSICIAN FOR A
+    CONFINEMENT--THE SELECTION OF A NURSE--THE DIFFERENCE BETWEEN A TRAINED
+    AND A MATERNITY NURSE--DUTIES OF A CONFINEMENT NURSE--THE REQUISITES OF
+    A GOOD CONFINEMENT NURSE--THE PERSONAL RIGHTS OF A CONFINEMENT
+    NURSE--CRITICIZING AND GOSSIPING ABOUT PHYSICIANS.
+
+THE BIRTH CHAMBER
+
+The room in which the confinement is to take place should be selected with
+care. In many cases there will be no choice for the reason that there will
+be only one suitable bedroom available. Where practicable however a room
+having the following accessories, or as many of them as is possible, should
+be given the preference.
+
+    1.--Good light, and a southern exposure.
+
+    2.--Capable of being well ventilated and well heated if necessary.
+
+    3.--Running water if plumbing is modern.
+
+    4.--Fairly large size (not a hallroom).
+
+    5.--A quiet room, free from street noises.
+
+If the house is a private one the room should be on the second floor. If
+the home is in an apartment house the confinement chamber should be as [62]
+far removed from the living-room as circumstances will permit,--especially
+if there are other children who will make more or less continuous noise.
+
+All unnecessary furniture, pictures and draperies should be taken out of
+the room a few days before the confinement is due; the room itself, and
+everything left in it, should be thoroughly cleaned and aired. A small
+table for holding instruments, sterilizing basins, etc., should be provided
+and in readiness.
+
+WHAT TO PROVIDE FOR A CONFINEMENT.--The following articles should be in
+readiness at all confinements:--
+
+    1.--Douche pan.
+
+    2.--Bed pan.
+
+    3.--Douche bag (fountain syringe) with glass douche tube.
+
+    4.--One rubber sheet 11/2 yards square.
+
+    5.--Two bed pads, one yard square, made of absorbent cotton or old
+    clean cloths, covered with washed cheese cloth and stitched here and
+    there to hold in place.
+
+    6.--One dozen clean towels.
+
+    7.--One-half dozen clean sheets.
+
+    8.--A hot water bottle.
+
+    9.--One pound absorbent cotton (good quality).
+
+    10.--Five yards sterile gauze.
+
+    11.--Four quarts of hot, and as much cold water, that has been boiled.
+
+    12.--One-half dozen papers assorted safety pins.
+
+    13.--One box sanitary pads.
+
+    14.--Four pieces of unbleached cotton or muslin, one and one-quarter
+    yards long.
+
+    15.--Four ounces powdered boracic acid.
+
+    16.--Four ounces of brandy or whisky.
+
+    17.--One jar of white vaseline (unopened).
+
+    18.--One cake of castile soap.
+
+    19.--Two or three agate or china hand basins.
+
+    20.--One slop jar.
+
+    21.--One pan under bed for after birth.
+
+The physician will direct that certain additional articles be provided
+according to his individual taste and custom. These will include an    [63]
+antiseptic and ergot; any other requisite found necessary can be sent for,
+or the physician can supply it, as he invariably has in his bag whatever
+may be required in complicated cases or in an emergency. All the items
+enumerated in the above list are absolutely essential, they may not all be
+used but it would not be safe to undertake a confinement without providing
+the essential requisites. Many maternity outfits are prepared ready for use
+and can be obtained at the larger drug stores, costing from $10 to $25. The
+articles in the above list can be bought for about $6, not including those
+articles which the patient is assumed to have. The following are samples of
+the ready-to-purchase outfits:
+
+READY-TO-PURCHASE OBSTETRICAL OUTFITS
+
+          OUTFIT NO. 1
+  1 Sterilized Bed Pad (30 inches square).
+  2 dozen Sterilized Vulva Pads.
+  2 Sterilized Mull Binders (18 inches wide).
+  5 yards Sterilized Gauze.
+  1 pound Sterilized Absorbent Cotton (1/2 pound).
+  Rubber Sheet, 11/2 yards by 2 yards, Sterilized.
+  Douche Pan, Sterilized.
+  1 Tube K-Y Lubricating Jelly.
+  Sterilized Nail Brush.
+  Boric Acid, Powdered.
+  Tinct. Green Soap.
+  Bichloride Tablets.
+  Lysol.
+  Tube Sterilized Tape.
+          PRICE $10.00.
+
+          OUTFIT NO. 2.
+  2 Sterilized Bed Pads (30 inches square).
+  2 dozen Sterilized Vulva Pads.
+  2 Sterilized Mull Binders (18 inches wide).
+  6 Sterilized Towels.
+  10 yards Sterilized Gauze.
+  [Page 64]
+  1 pound Sterilized Absorbent Cotton (1/2 pound).
+  Rubber Sheet, 1 yard by 11/2 yards, Sterilized.
+  Rubber Sheet, 11/2 yards by 2 yards, Sterilized.
+  4 quart Sterilized Douche Bag with glass nozzle.
+  Douche Pan, Sterilized.
+  Sterilized Nail Brush.
+  2 Agate Basins, Sterilized.
+  Safety Pins.
+  2 Tubes Sterilized Petrolatum.
+  1 Tube K-Y Lubricating Jelly.
+  Boric Acid, Powdered.
+  100 grms. Chloroform (Squibb's).
+  Fl. Ext. Ergot.
+  Tinct. Green Soap.
+  Bichloride Tablets.
+  Lysol.
+  Tube Sterilized Tape.
+  Sterilized Soft Rubber Catheter.
+  Sterilized Glass Catheter.
+  Stocking Drawers, Sterilized.
+  Talcum Powder.
+  Bath Thermometer.
+          PRICE $19.50.
+
+These materials, being cleansed and sterilized, are ready for use at any
+time.
+
+These complete outfits are packed in neat boxes, thus enabling the contents
+to be kept intact until needed.
+
+THE POSITION AND ARRANGEMENT OF THE BED.--The bed should be a substantial
+single bed. If a double one is used, prepare the side for the confinement
+which will permit the physician to use his right hand,--that will be the
+right side of the patient as she lies in bed. One objection to a double bed
+is its tendency to sag. This tendency can be obviated however by placing an
+ironing board under the spring from side to side, or by using shelves from
+a book case. This expedient will support the mattress, thereby rendering
+the bed firm and free from any sagging tendency. The position of the bed in
+the room should be such that the patient will not directly face the window
+light, nor be in a direct draught between the window and the door. It  [65]
+should be so arranged that the nurse can get easily to either side,
+consequently it must not be pushed against the wall.
+
+HOW TO PREPARE THE ACCOUCHMENT BED.--Over the mattress place the rubber
+sheet so that its center will be exactly under the hips of the patient. Pin
+with large safety pins each corner of the rubber sheet to the mattress; now
+put the sheet on exactly as you do when making an ordinary bed. On top of
+the sheet, and in the middle of the bed (again where the patient's hips
+will rest), place a draw sheet. A draw sheet is a sheet folded once, placed
+across the bed, and pinned tightly with large safety pins to the mattress
+at each side. The advantage of this sheet is, that it can be removed when
+necessary, leaving the original clean sheet on the bed, without disturbing
+the patient. Be particular not to have the top of the draw sheet higher
+than the middle of the patient's back. Place the pad,--previously prepared
+for the purpose,--on the draw sheet and level with the top of the draw
+sheet.
+
+Most physicians carry with them to all confinements a _Kelly pad_. A Kelly
+pad is a rubber pad with inflated sides, which is put under the patient's
+hips, and which retains all the discharges incident to a confinement so
+that when it is removed the bed is clean and fresh. The advantage of the
+Kelly pad is twofold; first, it ensures a clean, compact, systematic
+confinement; second, its use subjects the patient to the least necessary
+movement at a time when movement is distressing, painful, and frequently
+dangerous. If a Kelly pad is not used, it is desirable to place under the
+pad (between the pad and the draw sheet) a piece of oil cloth or rubber
+sheeting, or a number of newspapers will do. This will prevent, to a
+considerable degree, the discharges from soaking through the pad on to the
+draw sheet and sheet and mattress below.
+
+After the confinement is over and the patient is clean, remove the Kelly
+pad, and the pad below if necessary, or the pad and newspapers if these are
+used,--place a clean pad under the patient and you are ready to place the
+binder on if a binder is to be used. [Page 66]
+
+SHOULD A BINDER BE USED?--Medically a binder is not necessary, neither is
+it objectionable from a medical standpoint. It is supposed to hold the
+flaccid, empty womb in place. This it does not do and we are of the
+opinion, that it, in many instances, according to how it is put on,
+compresses the womb out of place. The binder is certainly appreciated by
+most patients because of its snug, comfortable feeling; and in cases when
+the abdominal wall is fat and the muscles soft, it holds them together in a
+way that is impossible by the use of any other device. To claim that the
+binder prevents hemorrhages is absurd. Our personal rule is to put one on
+if the patient wants one, or if she has previously had one. To be
+effective, in any sense, the binder should extend from the waist line down
+to halfway between the hips and knees and should be snugly, but not too
+tightly pinned.
+
+SANITARY NAPKINS.--These can be purchased already prepared in most drug
+stores, or they can be made in the following manner: Take an ordinary grade
+of cheese cloth, wash it, and when dry, cut it into half yard squares. In
+the center of each square place a strip, six or eight inches long, of
+absorbent cotton and fold the gauze lengthwise over it so as to make a pad.
+These can be used as napkins, and after they are soiled can be burned. It
+is absolutely wrong to use rags or any old cloths for napkins, as the
+patient can be infected and made seriously sick by this procedure.
+
+HOW TO CALCULATE THE PROBABLE DATE OF THE CONFINEMENT.--The duration of
+pregnancy extends for 280 days from the end of the last menstruation. Add
+seven days to the date of the last menstruation, and from that date count
+ahead nine months, or backward three months and you may have the probable
+date of the confinement. Should you pass this time you will probably go on
+for two additional weeks. The reason for this is that the most susceptible
+time for conception to occur is either during the week following
+menstruation or a few days before menstruation. If, therefore, you pass the
+above probable date which was calculated from the end of the last
+menstruation, it shows that conception did not take place during the   [67]
+week following that menstruation; and the assumption will be that it took
+place a few days before the next menstruation, which will be about two
+weeks later than the date as calculated above.
+
+If, for example, a pregnant woman was last sick from January 1st to 5th we
+add seven days to the 5th, which is the 12th, to which we add nine months,
+which will give us, as the probable date of confinement, October 12th.
+Should she go a few days over the 12th, the probability is that the
+confinement will take place on October 26th.
+
+  TABLE FOR CALCULATING THE DATE OF CONFINEMENT
+  -----------------------------------------------------------------
+  JAN.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  OCT.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
+  -----------------------------------------------------------------
+  JAN.  21 22 23 24 25 26 27 28 29 30 31
+  OCT.  28 29 30 31  1  2  3  4  5  6  7   NOV.
+  -----------------------------------------------------------------
+  FEB.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  NOV.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
+  -----------------------------------------------------------------
+  FEB.  21 22 23 24 25 26 27 28
+  NOV.  28 29 30  1  2  3  4  5            DEC.
+  -----------------------------------------------------------------
+  MAR.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  DEC.   6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
+  -----------------------------------------------------------------
+  MAR.  21 22 23 24 25 26 27 28 29 30 31
+  DEC.  26 27 28 29 30 31  1  2  3  4  5   JAN.
+  -----------------------------------------------------------------
+  APR.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  JAN.   6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
+  -----------------------------------------------------------------
+  APR.  21 22 23 24 25 26 27 28 29 30
+  JAN.  26 27 28 29 30 31  1  2  3  4      FEB.
+  -----------------------------------------------------------------
+  MAY.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  FEB.   5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
+  -----------------------------------------------------------------
+  MAY.  21 22 23 24 25 26 27 28 29 30 31
+  FEB.  25 26 27 28  1  2  3  4  5  6  7   MAR.
+  -----------------------------------------------------------------
+  JUNE   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  MAR.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
+  -----------------------------------------------------------------
+  JUNE  21 22 23 24 25 26 27 28 29 30
+  MAR.  28 29 30 31  1  2  3  4  5  6      APR.
+  -----------------------------------------------------------------
+  JULY   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  APR.   7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
+  -----------------------------------------------------------------
+  JULY  21 22 23 24 25 26 27 28 29 30 31
+  APR.  27 28 29 30  1  2  3  4  5  6  7   MAY
+  -----------------------------------------------------------------
+  AUG.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  MAY    8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
+  -----------------------------------------------------------------
+  AUG.  21 22 23 24 25 26 27 28 29 30 31
+  MAY   28 29 30 31  1  2  3  4  5  6  7   JUNE
+  -----------------------------------------------------------------
+  SEPT.  1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  JUNE   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
+  -----------------------------------------------------------------
+  SEPT. 21 22 23 24 25 26 27 28 29 30
+  JUNE  28 29 30  1  2  3  4  5  6  7      JULY
+  -----------------------------------------------------------------
+  OCT.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  JULY   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
+  -----------------------------------------------------------------
+  OCT.  21 22 23 24 25 26 27 28 29 30 31
+  JULY  28 29 30 31  1  2  3  4  5  6  7   AUG.
+  -----------------------------------------------------------------
+  NOV.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  AUG.   8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
+  -----------------------------------------------------------------
+  NOV.  21 22 23 24 25 26 27 28 29 30
+  AUG.  28 29 30 31  1  2  3  4  5  6     SEPT.
+  -----------------------------------------------------------------
+  DEC.   1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20
+  SEPT.  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
+  -----------------------------------------------------------------
+  DEC.  21 22 23 24 25 26 27 28 29 30 31
+  SEPT. 27 28 29 30  1  2  3  4  5  6  7   OCT.
+  -----------------------------------------------------------------
+
+                                                                       [68]
+The foregoing table affords us a handy means of finding the probable date
+of confinement at a glance.
+
+Find the date of the last day of the last menstrual period in the upper
+row; the date immediately below it is the probable date of confinement.
+
+For example if the last menstrual period was from Jan. 1st to 5th, we find
+January 5th and below it we note October 12th as the probable date of
+confinement.
+
+WHEN SHOULD A PREGNANT WOMAN FIRST CALL UPON HER PHYSICIAN?--The earliest
+indication of pregnancy is the interruption of menstruation. When
+menstruation fails to appear at its regular time in a young married woman
+whose past menstrual history is good,--i.e., she has been sick every month
+regularly and without pain since she began menstruating as a girl,--the
+assumption would naturally be that she was pregnant. Menstruation may
+however "miss" one month for other reasons than pregnancy just at this
+time, as is explained elsewhere, so it is wise to defer a positive
+assumption on such an important matter. When the second menstruation does
+not appear, and there are no specific reasons for its failure to appear, it
+may be safely assumed that pregnancy has taken place. A visit to the family
+physician one week after the second menstruation should have appeared, or
+at least long enough to feel absolutely certain that the sickness is not
+coming around, is not only necessary, but is the essential and correct step
+to take for a number of very good reasons. If a woman for example has not
+had a baby, how does she know she can have one? It is quite possible to
+become pregnant and yet it may be wholly impossible to give birth to a
+child. It is necessary to be constructed normally, or as near what is
+regarded as normal as is possible, in order safely to assume the
+responsibility of carrying a pregnancy to a successful completion. No one
+but a physician, who is skilled and familiar in the knowledge of what
+constitutes the proper size, and shape, and quality, and relations, one
+with another, of your bones, and ligaments, and muscles, can tell      [69]
+whether you can safely be permitted to carry a pregnancy to term or not. If
+the anatomical conditions are not just right; if circumstances from a
+medical standpoint are not favorable; if your personal risk is too
+hazardous; if, in other words, medical science should decide that you are
+one of the very few women who cannot have a baby, is it not of very great
+importance that you should know this as soon as possible? Does not that
+fact alone render your early call upon your physician imperative? A
+physician can bring out facts, relating to the personal and family history,
+and habits, of the prospective mother, which will enable him to formulate
+advice which will prove of the highest value from the very beginning of
+pregnancy. Instructions carried into effect at this early date, as to
+personal conduct, exercise, diet, etc., will have a distinctly beneficial
+influence, not only on the patient's health and the character of her
+confinement, but on the physical vitality of the coming baby.
+
+REGARDING THE CHOICE OF A PHYSICIAN.--This is a matter that should receive
+the most careful consideration. While it is just to admit that every
+physician is capable of successfully conducting maternity cases, there are
+certain characteristics in the individual temperament that would seem to
+indicate that some physicians are better adapted to this special work.
+
+Trustworthiness is an imperative essential in a physician who assumes the
+responsibility of confinement engagements. He must be clean in his personal
+habits as well as morally. He should possess the virtue of patience and be
+tactful, and above all he should be made to feel that he has your implicit
+confidence. If you will analyze these qualifications you will understand
+just what they imply. The physician who has the reputation of having the
+largest practice is not necessarily the man you want, nor does it imply
+that he is the best fitted to conduct your case to your satisfaction. The
+fact that he is a very busy man may be distinctly detrimental to your best
+interests. If the physician has the reputation of being an excellent
+doctor, but, "You can't always depend on him,--he may be out of town, or he
+may send his assistant, or substitute," you don't want him; it is too  [70]
+important an event to you to take a chance with. Rely rather upon the man
+who, though his charge may be a little higher, is known to be trustworthy;
+who will take a personal interest in you, and is known to be patient and
+capable.
+
+THE SELECTION OF A NURSE.--A choice must be made between having a trained
+nurse and what is known as a maternity, or monthly, nurse. The choice may
+be dictated by the financial means of the patient. A trained nurse is paid
+from $25 to $30 per week, while a maternity nurse usually gets $15 per
+week.
+
+A trained nurse is a graduate from a hospital where she has successfully
+completed a course of training. She is to be preferred, if she can be
+afforded, for the reason that she has been trained to obey absolutely the
+orders of a physician, and because she has the requisite knowledge to
+detect emergencies, and the necessary skill and experience to enable her to
+act intelligently of her own initiative in any emergency.
+
+The maternity nurse, on the other hand, has not had an adequate training
+and is absolutely helpless, so far as medical knowledge is concerned, in a
+real emergency. Her experience is limited to what she has picked up in the
+various cases she has had. She, as a rule, has chosen this means of
+obtaining a living as a result of some domestic financial affliction. She
+does not understand the laws of sterilization and has not been trained to
+obey, without question, the instructions of a physician. The maternity
+nurse follows a routine which she is incapable of modifying to suit the
+particular case. She has old-fashioned ideas and notions which she carries
+out as a matter of course, and she overestimates the great importance of
+her experience to the extent of wholly disregarding the advice of the
+physician. She assumes the care of the patient and baby, and regards this
+as her right, and as a result she is frequently responsible for much injury
+to the mother and child. Despite these objections we have worked with many
+of these nurses who were to be preferred to trained nurses. It is the
+individual after all that counts, and if a maternity nurse, though
+technically untrained, is adaptable, tactful, and will consent to be   [71]
+instructed to the extent of obeying without argument, she can become
+invaluable, and her skill and experience will carry her creditably over
+many trying incidents. The objection of the medical profession to an
+untrained nurse is based, not so much on her lack of ability, as upon her
+propensity to indiscriminate and indiscreet talk,--they have not been
+trained to know the value of professional silence, nor have they had the
+necessary education which would have enabled them to acquire through their
+experience the knowledge that "silence is golden" at all times. A trained
+nurse possesses the requisite knowledge, but may have an objectionable
+individuality. An untrained nurse may have sufficient knowledge, and what
+she lacks she may make up for in being congenial and adaptable. While the
+trained nurse strictly attends exclusively to the mother and the baby, a
+maternity nurse as a rule attends to the household duties in addition. She
+cooks the meals of the entire family, and dresses and cares for the other
+children if there is no one else to do it. The duties of a maternity nurse
+can be specified and agreed upon, and the terms arranged when she is
+engaged. The duties of a trained nurse are fixed by nursing laws and
+medical rules and cannot be changed or modified by private agreement. These
+laws and rules, however, are not sufficiently arbitrary to make it
+impossible for the nurse to be obliging, courteous, and
+sincere,--qualifications which every patient has a right to expect, and a
+right to insist upon from every graduate nurse.
+
+The selection of a nurse should receive careful consideration. She should
+be known to be honest, honorable, competent, healthy, and personally clean
+in habits and dress, and she should be tactful, obliging, and she should
+attend to her own affairs strictly. She should not be a gossip; she should
+not shirk her work or pry into family affairs that do not concern her; and
+she should not drag into the conversation her own personal or family
+secrets.
+
+The nurse has certain rights which the patient should willingly recognize.
+She is entitled to a comfortable bed, sufficient sleep, good food, and
+exercise in the open air every day. These are essential in order that  [72]
+she maintain her own health, as well as keep at the highest point of
+efficiency.
+
+When you select your physician consult with him regarding your nurse. If
+you know personally a capable nurse, there is no objection to selecting
+her, and no physician will oppose this procedure if you assume the
+responsibility of her capability.
+
+There are many advantages, however, in permitting the physician to provide
+a nurse. He assumes the responsibility of the nurse's capability, and it is
+safe to assume he will not recommend one whom he knows to be personally
+objectionable, or professionally incapable. Every physician acquires
+certain individual methods in the conduct of maternity cases, which
+experience has taught him to be successful. A competent knowledge of these
+methods by the nurse greatly facilitates the details and ensures a
+harmonious conduct of the entire case,--facts which accrue to the comfort
+and the well-being of the patient.
+
+It is not out of place here to warn a young wife against being advised by a
+neighbor or a busybody, as to whom she should select as physician or nurse.
+You must not depend upon the gossip of the neighborhood. The physician or
+nurse whom you are told by one of these irresponsible individuals not to
+take, may be the one above all others whom you should take. When you hear a
+gossiping woman decry a physician, depend upon it, she owes him
+something,--most often it is a bill, but it may only be a grudge. There is
+no class of men in any community who are maligned and abused so much as are
+physicians. They seem to be the choice victims of the enmity and spite of
+every malicious feminine tongue. A woman should think twice before she
+utters a criticism regarding the work of a physician. She would, if she but
+knew how quickly she brands and advertises herself as irresponsible and
+lacking in ordinary courtesy and good breeding, as she is not qualified to
+criticise the professional capability of a physician, nor is she qualified
+to estimate the extent of the wrong she perpetrates. There is no class of
+men who do more conscientious work, day after day, than do physicians, [73]
+and there is no class of men who are more deserving of the commendation of
+the entire community than the thousands of self-sacrificing, underpaid
+members of the medical profession. Be suspicious therefore when you hear a
+criticism, and be very, very sure before you utter one,--rather give him
+the benefit of the doubt and you will do no wrong, and it may be at some
+future date you will be thankful you did not criticise.
+
+       *       *       *       *       *
+
+
+                                                                       [75]
+CHAPTER VII
+
+THE HYGIENE OF PREGNANCY.
+
+    DAILY CONDUCT OF THE PREGNANT WOMAN--INSTRUCTIONS REGARDING HOUSEHOLD
+    WORK--INSTRUCTIONS REGARDING WASHING AND SWEEPING--INSTRUCTIONS
+    REGARDING EXERCISE--INSTRUCTIONS REGARDING PASSIVE
+    EXERCISE--INSTRUCTIONS REGARDING TOILET PRIVILEGES---INSTRUCTIONS
+    REGARDING BATHING--INSTRUCTIONS REGARDING SEXUAL INTERCOURSE--CLOTHING
+    DURING PREGNANCY--DIET OF PREGNANT WOMEN--ALCOHOLIC DRINKS DURING
+    PREGNANCY--THE MENTAL STATE OF THE PREGNANT WOMAN--THE SOCIAL SIDE OF
+    PREGNANCY--MINOR AILMENTS OF PREGNANCY--MORNING NAUSEA, OR
+    SICKNESS--TREATMENT OF MORNING NAUSEA, OR SICKNESS--NAUSEA OCCURRING AT
+    THE END OF PREGNANCY--UNDUE NERVOUSNESS DURING PREGNANCY--THE 100 PER
+    CENT. BABY--HEADACHE--ACIDITY OF THE STOMACH, OR
+    HEARTBURN--CONSTIPATION--VARICOSE VEINS, CRAMPS,
+    NEURALGIAS--INSOMNIA--TREATMENT OF INSOMNIA--PTYALISM, OR EXCESSIVE
+    FLOW OF SALIVA--VAGINAL DISCHARGE, OR LEUCORRHEA--IMPORTANCE OF TESTING
+    URINE DURING PREGNANCY--ATTENTION TO NIPPLES AND BREASTS--THE VAGARIES
+    OF PREGNANCY--CONTACT WITH INFECTIOUS DISEASES--AVOIDANCE OF DRUGS--THE
+    DANGER SIGNALS OF PREGNANCY.
+
+CONDUCT OF THE PREGNANT WOMAN
+
+The young wife will arrange her daily routine according to the physician's
+instructions, which, by the way, she should faithfully carry out. If you
+are one of the fortunate many who enjoy reasonably good health, you have
+doubtless been told to follow a plan very similar to the one we shall now
+briefly outline.
+
+For the first six months she can safely continue to do her household work.
+It is to her advantage to do so for many reasons, but especially because it
+helps to keep her physically in good condition, and because it keeps her
+mind engaged, thus avoiding a tendency to nervous worry. After the sixth
+month it is desirable to give up the heavier part of the work. Washing and
+sweeping should be absolutely prohibited. Moving furniture or heavy trunks
+must not be done by the prospective mother, but all light work can and [76]
+should be indulged in to the very end. Find time to spend at least one hour
+and a half in the open air every day. Unless there is a medical reason
+against active exercise there is nothing so beneficial to the pregnant
+woman as walking, nor is there any substitute for it. A drive or motor ride
+into the country, or a car ride around town, is an excellent device against
+ennui and is highly desirable during this time, but not as a substitute for
+the daily long walk. A pregnant woman must keep her muscles strong and in
+good tone if she hopes to do her share toward having a short and easy
+confinement. She must keep active to ensure perfect action of all her
+organs--the stomach must digest; the bowels and kidneys must act perfectly;
+the heart, and lungs, and nerves must be supplied with good blood and fresh
+air; the appetite must be keen, and the sleep sound. Walking in the open
+air will do all this and nothing else can, to the same satisfactory degree.
+
+Light passive exercise at home is desirable to those very few who cannot
+walk in the open air, but at best it is a poor substitute. It is necessary
+to avoid any exercise or any labor of the following character from the very
+beginning of pregnancy: stretching, lifting, jarring, jumping, the use of
+the sewing machine, bicycling, riding, and dancing.
+
+She should continue to employ the same toilet privileges she has been
+accustomed to except the use of the vaginal douche, which must be stopped
+from the date of the first missed menstrual period. This is the only safe
+rule to follow and no exception should be made to it except upon the advice
+of a physician.
+
+Bathing during the entire course of pregnancy is a highly necessary duty.
+It is particularly advantageous during the later months because it relieves
+the kidneys at a time when they are called upon to perform an excess of
+work. The temperature of the bath should be warm and rapidly cooled at the
+finish. Brisk rubbing with a course towel will ensure the proper reaction.
+
+Sexual intercourse must be restricted during pregnancy; and it should be
+wholly abstained from during what would have been the regular menstrual
+periods, if pregnancy had not occurred, for the reason that abortion is[77]
+apt to take place. It is most harmful during the early and late months of
+pregnancy. Sexual intercourse is distasteful to most and harmful to every
+pregnant woman.
+
+CLOTHING DURING PREGNANCY.--The clothing should be so constructed as to
+relieve any undue pressure on the breasts or abdomen. For this reason it
+should be suspended from the shoulder. When it is appreciated that clothing
+supported by the waist crowds the growing womb, and exerts pressure upon
+the kidneys, and is responsible for many of the kidney complications that
+occur during pregnancy, no further reason need be given for discarding all
+clothing, except very light garments, that are not held by some device
+whose support is from the shoulders. A specially constructed linen waist is
+made and sold for this purpose. It is fashioned so that all the lower
+garments and the garters can be fastened to, and supported by it. Corsets
+should be absolutely discarded from the very first day of pregnancy.
+
+In a large woman with a lax abdomen, a properly made abdominal support will
+not only be a great comfort but of real advantage. It should exert a
+support upward by lifting the abdomen, not by constricting it. It should
+therefore be obtained from a reliable dealer and be made and applied to
+effect the above object,--otherwise it may do more harm than good.
+
+DIET OF PREGNANT WOMEN.--Some degree of digestive disturbance and loss of
+appetite is the rule early in pregnancy. By the fourth month these
+conditions invariably cease, and the appetite and the ability to digest
+will greatly improve. The diet from the very beginning of pregnancy should
+be plain and easily digested. It is not possible to formulate an absolute
+table of what or what not to eat, as the same foods do not agree equally
+well with all patients. The individual taste should be catered to within,
+reason, and the meals should be taken at regular intervals. Articles of
+diet that experience shows do not agree with the patient should be rigidly
+excluded from the menu. A varied diet of nutritious character is essential
+during pregnancy in order to ensure good blood, health, and strength. A
+monotonous diet, or a diet composed largely of stale tea, coffee, and  [78]
+cake, is not permissible, and may do untold harm. Pastries and desserts of
+all kinds should be excluded. In the later weeks of pregnancy, because of
+the large size of the womb, the diet should be cut down as the stomach is
+interfered with in the process of digestion. Should the patient at any time
+during pregnancy experience a loss of appetite, or an actual disgust for
+food as sometimes occurs, it is preferable to suggest a change of scene and
+surroundings rather than the use of medicine. A short vacation, a change of
+table, new scenery, will promptly effect a cure. This condition is mental
+rather than physical; the patient allows herself to become introspective;
+the daily routine becomes monotonous and stale; hence a change of a few
+days will be all that is necessary. If it is not possible for the patient
+to obtain a change of scene, a complete change of diet for a few days will
+often tide over the difficulty. We have known patients to take kindly to an
+exclusive diet of kumyss, or matzoon, or predigested foods, with stale
+toast or zwieback, to which can be added stewed fruits. Alcoholic drinks
+should be left out entirely.
+
+THE MENTAL STATE OF THE PREGNANT WOMAN.--The coming baby should be the text
+of many interesting, spontaneous talks between the young couple from the
+time when it is first known that a new member of the family is on its way.
+The husband should feel that he is a party to the successful consummation
+of the little one's journey. He can contribute enormously to this end. It
+should be his duty, born of a sincere affection and love, to formulate the
+programme of events which has for its main object the wife's entire mental
+environment. He should encourage her to live up to the physician's
+instructions, and arrange details so that she will obtain the proper
+exercise daily. He should read to her in the evening, and arrange his own
+business affairs so that he will be with her as much as is possible. In
+many little ways he can impress upon her the fact that they both owe
+something to the unborn babe and that each must sacrifice self in its
+behalf. His principal aim, of course, will be that she will not worry or
+have cause to worry. He will so direct her mental attitude that she will
+dwell only upon the bright side of the picture; she will thus strive to[79]
+realize the hope that the baby will be strong and healthy, and she will,
+prompted by his encouragement and devotion, try to do her duty faithfully.
+Working together in this way, much can be done that means far more than we
+know of, and in the end the little one comes into the world a welcome baby,
+created in love and born into the joy of a happy, harmonious, contented
+home.
+
+THE SOCIAL SIDE OF PREGNANCY.--The social side of the question should not
+be overlooked or neglected at this time. Here again the imperative
+necessity arises to warn the young wife against certain individuals who
+seem to have a predilection toward recounting all the terrible experiences
+they have heard regarding confinements. It is astonishing to learn how
+diversified a knowledge some women burden themselves with in this
+connection. They can recount case after case, with the harrowing details of
+a well-told tale, and seem to delight in so doing. Every physician has met
+these women. The young wife must not permit or encourage any reference to
+her condition. Simply refusing to discuss the question is the only sure
+method of preventing its discussion. She will find among her friends a few
+who have her best interests at heart, and these few will strive sincerely
+to be of real usefulness to her. If she will keep in mind that the most
+important element in the success of the whole period, and consequently the
+degree of her own health, happiness, and comfort, as well as that of her
+unborn baby, is the character of her own thoughts from day to day, and
+month to month, she will be complete master of the situation. By constantly
+dwelling on happy thoughts, reading encouraging and inspiring books,
+admiring and studying good pictures, working with cheerful colors in sunny
+rooms, exercising, dieting, and sleeping in a well-aired room, she will
+have no cause to regret her share in the task before her, or the kind of
+baby she will bring into the world.
+
+MINOR AILMENTS OF PREGNANCY.--There are certain minor ailments which it
+would be well to be familiar with lest a little worry should creep into the
+picture.
+
+Maternity is not only a natural physiological function, but it is a    [80]
+desirable experience for every woman to go through. The parts which
+participate in this duty have been for years preparing themselves for it.
+Each month a train of congestive symptoms have taxed their working
+strength; pregnancy is therefore a period of rest and recuperation,--a
+physiological episode in the life history of these parts. If any ailment
+arises during pregnancy it is a consequence of neglect, or injury, for
+which the woman herself is responsible,--it is not a natural accompaniment
+of, or a physiological sequence to pregnancy. Find out, therefore, wherein
+you are at fault, rectify it, and it will promptly disappear.
+
+MORNING NAUSEA OR SICKNESS.--So-called morning nausea or sickness is very
+frequently an annoying symptom. It is present as a rule during the first
+two or three months of pregnancy. How is it produced and how can it be
+remedied?
+
+It is produced most frequently by errors in diet. It may be caused by an
+unnatural position of the womb or uterus, by nervousness, constipation, or
+by too much exercise or too little exercise. The physician should be
+consulted as soon as it is observed to be a regular occurrence. He will
+eliminate by examination any anatomical condition which might cause it; or
+will successfully correct any defect found. When the cause is defined his
+instructions will help you to avoid any error of diet, constipation, or
+exercise. Many cases will respond to a simple remedy,--a cup of coffee,
+without milk, taken in bed as soon as awake will often cure the nausea. The
+coffee must be taken while still lying down,--before you sit up in bed. If
+coffee is not agreeable any hot liquid, tea, beef tea, clam bouillon, or
+chicken broth, or hot water may answer the purpose, though black coffee,
+made fresh, seems to be the most successful. Ten drops of adrenalin three
+times daily is a very certain remedy in some cases, though this should be
+taken with your physician's permission only. If the nausea occurs during
+the day and is accompanied with a feeling of faintness, take twenty drops
+of aromatic spirits of ammonia in a half glass of plain water or Vichy
+water. Sometimes the nausea is caused by the gradual increase of the   [81]
+womb itself. This is not usually of a persistent character and disappears
+as soon as the womb rises in the abdominal cavity at the end of the second
+month.
+
+Nausea frequently does not occur until toward the end of pregnancy. In
+these cases the cause is quite different. Because of the size of the womb
+at this time the element of compression becomes an important consideration.
+The function of the kidneys, bowels, bladder, and respiration may be more
+or less interfered with, and it may be desirable to use a properly
+constructed abdominal support, or maternity corset. These devices support
+and distribute the weight, and prevent the womb from resting on or
+compressing, and hence interfering with, the function of any one organ. If
+the womb sags to one side, thereby retarding the return circulation of the
+blood in the veins from the leg, it may cause cramps in the leg, especially
+at night, or it may cause varicose veins, or a temporary dropsy. The
+correct support will prevent these troublesome annoyances; a properly
+constructed maternity corset is often quite effective. The diet should
+receive some special attention when these conditions exist. Any article of
+diet which favors fermentation (collection of gas) in the stomach or bowel
+should be excluded. These articles are the sugars, starches, and fats. It
+can readily be understood that if the bowels should be more or less filled
+with gas, or if they should be constipated, it will cause, not only great
+distress, but actual pain. Regulation of the diet, therefore, and exercise
+(walking best of all) will contribute greatly to the avoidance of these
+unnecessary sequelae.
+
+It must be kept in mind that the entire apparatus of the body is
+accommodating a changed condition, and though that condition is a natural
+one, it requires perfect health for its successful accomplishment. This
+means a perfect physical and mental condition,--a condition that is
+dependent upon good digestion, good muscles, healthy nerves, clean bowels,
+and so on. The slightest deviation from absolute health tends to change the
+character of the body excretions, the quality of the blood, etc. If the
+excretions are not properly eliminated, the blood becomes impure, and so we
+sometimes get itching of the body surfaces, especially of the abdomen  [82]
+and genitals; neuralgias, especially of the exposed nerves of the face and
+head; insomnia and nervousness. These are all amenable to cure, which again
+means, as a rule, correct diet and proper exercise as the principal
+remedial agencies.
+
+UNDUE NERVOUSNESS DURING PREGNANCY.--This is very largely a matter of will
+power. Some women simply will not exert any effort in their own behalf.
+They are perverse, obstinate, and unreasonable. The measures which
+ordinarily effect a cure, they refuse to employ. It is useless to argue
+with them; drugs should never be employed; censure and affection are
+apparently wasted on them; they cannot even be shamed into obedience. The
+maternal duty they owe to the unborn child does not seem to appeal to them.
+We do not know of any way to handle these women and to our mind they are
+wholly unfit to bring children into the world. Fortunately these women are
+few in number. The maternal instinct will, and does, guide most women into
+making sincere efforts to restrain any undue nervous tendency, and to be
+obedient and willing to follow instructions. There is nothing so beneficial
+in these cases as an absolutely regulated, congenial, daily routine, so
+diversified as to occupy their whole time and thought to the exclusion of
+any introspective possibility. Frequent short changes to the country or
+seashore to break the monotony, give good results in most of these cases.
+The domestic atmosphere must also be congenial and the husband should
+appreciate his responsibility in this respect.
+
+Women of this type should have their attention drawn to the following facts
+in this connection: While the most recent investigations of heredity prove
+that a woman cannot affect the potential possibilities of her child, she
+can seriously affect its physical vitality. The following illustration may
+render our meaning clear: suppose your child had the inborn qualities
+necessary to attain a 100 per cent. record of achievement in the struggle
+of life; anything you may or may not do cannot affect these qualities--the
+child will still have the ability to achieve 100 per cent. Inasmuch,
+however, as a mother can affect the health or physical qualities of her[83]
+child she is directly responsible, through her conduct, as to whether her
+child will ever attain the 100 per cent. record, or if it does, she is
+responsible for the character of its comfort, its health, its enjoyment,
+all through its life's struggle toward the 100 per cent. achievement
+record. She may so compromise its physical efficiency that it will succumb
+to disease as a consequence of the ill health with which its mother
+unjustly endowed it, even though it possess the ability to attain the 100
+per cent. if it lived.
+
+We often see brilliant children who are nervous and physically unfit, and
+we see others of more ordinary mental achievement who are healthy and
+robust animals. The one is the offspring of parents possessing unusual
+mental qualities but who are physically unable or unwilling to render
+justice to their progeny; the other parents may be less gifted mentally,
+but they are healthy and they are willing to give their best in conduct and
+in blood to their babies. Many of these brilliant children never achieve
+their potential greatness because they fall by the wayside owing to
+physical inability, while the healthy little animals achieve a greater
+degree of success because of the physical vitality which carries them
+through. To achieve a moderate success and enjoy good health is a better
+eugenic ideal than the promise of a possible genius never attained because
+of continuous physical inefficiency.
+
+The nervous and willful mother should therefore consider how much depends
+upon her conduct. It cannot be too frequently reiterated and emphasized
+that every mother should do her utmost to guard and retain her good health.
+Good health means blood of the best quality and this is essential to the
+nourishment of the child. To keep in good health does not mean to obey in
+one respect and fail in other essentials. It means that you must obey every
+rule laid down by your physician, willingly and freely in your own interest
+and in the interest of your unborn babe. In no other way may you hope to
+creditably carry out the eugenic ideal that "the fit only shall be born."
+
+HEADACHE.--This is a symptom of great importance. If it occurs         [84]
+frequently, without apparent cause, the physician should be consulted at
+once, as it may indicate a diseased condition of the kidneys, and
+necessitate immediate treatment. Headaches may, of course, be caused in
+many ways and most frequently they do not have any serious significance,
+but they must always be brought to the attention of the physician. As a
+rule they are caused by errors of diet,--too much sugar, candy, for
+instance, late and indigestible suppers, indiscriminate eating of rich
+edibles, etc.,--or they may be products of nervous excitement (too little
+rest), as shopping expeditions, strenuous social engagements, late hours,
+etc.
+
+ACIDITY OF THE STOMACH, AND SO-CALLED HEARTBURN.--These are sometimes in
+the early months of pregnancy annoying troubles. The following simple means
+will relieve temporarily: A half-teaspoonful of bicarbonate of soda or
+baking soda in a glass of water or Vichy water; or a half teaspoonful of
+aromatic spirits of ammonia in Vichy, or plain water; or a tablespoonful of
+pure glycerine. The best remedy is one tablespoonful of Philip's Milk of
+Magnesia taken every night for some time just before retiring.
+
+Heartburn is the result of eating improper food, or a failure to digest the
+food taken. Starchy foods should be avoided. Meats and fats should be taken
+sparingly. Avoid also the et ceteras of the table, as pickles, sauces,
+relishes, gravies, mustard, vinegar, etc. Good results follow dry
+meals,--meals taken without liquids of any kind. Live on a simple, easily
+digested, properly cooked diet. Chew the food thoroughly, take plenty of
+time and be cheerful.
+
+CONSTIPATION DURING PREGNANCY.--Most women are as a rule more or less
+constipated during pregnancy. It is caused by failure to take the proper
+amount of outdoor exercise, to take enough water daily, to live on the
+proper diet, to live hygienically, or because of wrong methods of dress. It
+is most important that the bowels should move thoroughly every day.
+Pregnancy no doubt aggravates constipation by diminishing intestinal
+activity. Consequently there is a greater need for activity on the part of
+the woman, and open air exercise is the best way to accomplish this.   [85]
+She should eat fruits, fresh vegetables, brown or Graham bread, or bran
+muffins, figs, stewed prunes, and any article of diet which she knows from
+experience works upon her bowel. She should drink water freely; a glass of
+hot water sipped slowly on arising every morning or one-half hour before
+meals, is good. Mineral waters, Pluto, Apenta, Hunyadi, or one teaspoonful
+of sodium phosphate, or the same quantity of imported Carlsbad salts in a
+glass of hot water one-half hour before breakfast, answers admirably. If
+the salts cannot be taken a three- or five-grain, chocolate-coated, cascara
+sagrada tablet, may be taken before retiring, but other cathartics should
+not be taken unless the physician prescribes them. Rectal injections should
+be avoided as a cure of constipation during pregnancy. They are very apt to
+irritate the womb and if taken at a time when the child is active, they may
+annoy it enough to cause violent movement on its part, and these movements
+may cause a miscarriage. See article on "Constipation in Women."
+
+VARICOSE VEINS, CRAMPS, AND NEURALGIA OF THE LIMBS.--When cramps or painful
+neuralgia occur repeatedly in one or both legs, some remedial measures
+should be tried. Inasmuch as the cause of this condition is a mechanical
+one, it would suggest a mechanical remedy. The baby habitually seeks for
+the most comfortable position, and having found it stays there until
+conditions render it uncomfortable. He does not consult you in the matter,
+but he may be subjecting you to untold misery and pain. The child may rest
+on the mother's nerves or blood-vessels as they enter her body from her
+lower limbs. If the pressure is sufficient, it can interfere quite
+seriously with the return blood supply, because veins which carry back to
+the heart the venous or used blood, are vessels with thin, soft,
+compressible walls, while arteries which carry blood away from the heart
+cannot be compressed easily, because their walls are hard and tense. The
+condition therefore is that more blood is being sent into the limb than is
+being allowed to return; in this way are produced varicose veins. If these
+varicose veins burst or rupture we have ulcers, which may quickly heal,[86]
+or they may refuse to heal, and become chronic. A dropsical condition of
+the leg may follow, and because of interference with the circulation of the
+blood we get cramps and neuralgias. How can we remedy this painful
+condition?
+
+Sometimes we don't succeed, but at least we can try. So long as the cause
+exists, it is self-evident that rubbing the limb with any external
+application, will not give any permanent relief, though it is well to try.
+When rubbing, to relieve cramps at night, always rub upward. It is not a
+condition that calls for medicine of any kind, while hot baths and hot
+applications will only make the trouble worse. The remedy that promises the
+quickest and longest relief is for the patient to assume the knee-chest
+position for fifteen minutes, three times a day, till relief is permanently
+established. The patient rests on her knees in bed, and bends forward until
+her chest rests on the bed also. The incline of the body in this position
+is reversed; hips are highest, the head lowest. The baby will seek a more
+comfortable position and this new position may relieve the pressure and
+cure the condition. Doing this three times daily for fifteen minutes gives
+relief to the leg by reestablishing a normal blood circulation, and very
+soon the baby finds a new position that does not interfere with its
+mother's blood supply, and the cramps, and neuralgia and dropsy, and maybe
+the varicose veins will soon show improvement. Wearing the proper kind of
+abdominal support may help, as explained on page 77. If the varicose veins
+are bad, it is desirable to wear silk rubber stockings or to bandage the
+limbs.
+
+INSOMNIA DURING PREGNANCY.--Insomnia or sleeplessness is sometimes a
+vexatious complication during pregnancy. It seldom if ever becomes of
+sufficient importance or seriousness to interfere with the pregnancy or the
+health of the patient. Nevertheless, a period of sleeplessness lasting for
+two or three weeks is not a pleasant experience to a pregnant woman. It is
+most often met with during the latter half of pregnancy.
+
+There can be no question that every case of insomnia has definite cause,
+and can be relieved if we can find the cause. The only way to find it  [87]
+is to systematically take up the consideration of each case, and this is
+best done by the physician. He must have patience and tact; you must answer
+each question truthfully and fully. Your diet, personal conduct, exercise,
+condition of bowels, mental environment, domestic atmosphere, everything,
+in fact, which has any relation to you or your nerves, must be inspected
+with a magnifying glass. Some little circumstance, easily overlooked, of
+seemingly no importance, may be the cause of the trouble. You may need more
+outdoor exercise, or you may need less outdoor exercise. You may need more
+diversion, more variety, or you may need less. You may need a sincere,
+honest, tactful, patient confidant and friend, or you may need to be saved
+from your friends. You may be exhausting your vitality and fraying your
+nerves by social exigencies,--those empty occupations which fill the lives
+of so many fussy, loquacious females,--echoless, wasted, babbling moments,
+of supreme important to the social bubbles who ceaselessly chase them but
+of no more interest to humanity than the wasted evening zephyrs that play
+tag with the sand eddies on the surface of the dead and silent desert. You
+may have wandered from the narrow limitations of the diet allowable in
+pregnancy, or you may be the victim of an objectionably sincere relation
+who pesters you with solicitous inquiries of a needless character. Whatever
+it is, rectify it. A good plan to follow on general principles is to take a
+brisk evening walk with your husband just before bedtime, and at least two
+hours after the evening meal. Follow this with a sitz bath as soon as you
+return from the walk.
+
+A sitz bath is a bath taken in the sitting position with the water reaching
+to the waist line. It should last about fifteen minutes and the water
+should be comfortably hot. It is sometimes found that this form of bath
+creates too much activity on the part of the child and defeats the purpose
+in view. This is apt to be the case in very thin women when the abdomen is
+not covered by a sufficient layer of fatty tissue. These women will find it
+advisable to take, in place of the sitz bath, a sponge bath in a warm room,
+using the water rather cool than hot but in a warm room. Rub your skin [88]
+briskly but waste no time in getting into bed. A glass of hot milk, before
+going to bed, or when wakeful during the night, may serve as a preventive.
+When these measures fail the physician should be called upon to advise and
+prescribe.
+
+PTYALISM, OR AN EXCESSIVE FLOW OF SALIVA.--This is a common condition in
+pregnancy, but cannot be prevented. It is of no importance other than that
+it is a temporary annoyance.
+
+Itching of the abdomen can usually be allayed by a warm alcohol rub,
+followed by gently kneading the surface of the abdomen with warm melted
+cocoa butter, just before retiring.
+
+A VAGINAL DISCHARGE.--Soon after pregnancy has taken place the woman may
+notice a discharge. It may be very slight or it may be quite profuse. In
+some cases it does not exist at all during the entire period. As a rule the
+discharge is more frequent and more profuse toward the end of pregnancy.
+
+If the discharge exists at any time,--and it is no cause for worry or alarm
+if it does exist,--inform your physician. He will advise you what to do,
+because it is not wise for you to begin taking vaginal douches or
+injections without his knowledge, and at a time when they may do you
+serious harm. Should itching occur as a result of any vaginal discharge the
+following remedial measures may be employed:
+
+A solution of one teaspoonful of baking soda to a douche bag of tepid water
+may be allowed to flow over the parts, or cloths saturated with this
+mixture may be laid on the itching part. A solution of carbolic acid in hot
+water (one teaspoonful to one pint of hot water), is also useful, or a wash
+followed by smearing carbolic vaseline over the itching parts. If your
+physician should suggest a mild douche for itching of the vagina as the
+result of a discharge, it may be promptly relieved by using Borolyptol in
+the water. Buy a bottle and follow directions on the label.
+
+TESTING URINE IN PREGNANCY--IMPORTANCE OF.--One of the most important
+duties, if not the most important, of both the physician and the patient is
+to have the urine of the pregnant woman examined every month during the[89]
+first seven months and every two weeks during the last two months. The
+urine examined during the first seven months should be the first urine
+passed on the day it is sent for examination. During the last two months of
+pregnancy the patient should pass all her water into a chamber for an
+entire day, and take about three ounces of this mixed water for
+examination. She should measure the total quantity passed during these days
+and mark it with her name on the label of the bottle. The physician will
+thus have an absolute record and guide of just how the kidneys are acting,
+and as they are the most important organs to watch carefully during every
+pregnancy, the greatest care should be taken to see that failure to note
+the first symptom of trouble does not take place.
+
+ATTENTION TO NIPPLES AND BREAST.--The physician should inspect the breasts
+and nipples of every pregnant woman when she first visits his office.
+Frequently the nipples are found to have been neglected, probably subjected
+to pressure by badly fitting corsets or too tight clothing. Instructions
+gently to pull depressed nipples out once daily, if begun early, will
+result in marked improvement by the end of pregnancy. During the latter
+part of pregnancy the breasts should be carefully and thoroughly bathed
+daily in addition to the daily bath. This special bath should be with a
+solution of boric acid (one teaspoonful to one pint of water). After the
+bath apply a thin coating of white vaseline to the nipples. It may be
+necessary to resort to the following mixture to harden the nipples and to
+make them stand out so that the child can get them in its mouth: Alcohol
+and water, equal parts into which put a pinch of powdered alum; this
+mixture should be put in a saucer and the nipples gently massaged with it
+twice daily. A depressed nipple may also be drawn out by means of a breast
+pump. If the nipples are not pulled out the child will be unable to nurse.
+It may then be necessary to put the child on the bottle and when the
+nipples are ready he may not take them after being used to the rubber
+nipple. The breasts may become caked and as a caked breast is a very
+painful and serious ailment it is wise to attend to this matter in     [90]
+time.
+
+THE VAGARIES OF PREGNANCY.--Certain foolish, old-fashioned ideas, have
+crept into the minds of impressionable people regarding pregnancy, which
+are aptly termed vagaries. It is believed by some that if the pregnant
+woman is the victim of fright, or is badly scared, or witnesses a
+terrifying or tragic sight, her child will be, in some way, affected by it.
+If the incident is not of sufficient gravity to cause an abortion or a
+miscarriage it will not, in any way mark, or affect the shape of the child
+in the womb.
+
+It is believed by some that a child can be marked by reason of some event
+occurring to the mother while carrying it. This is not so; a child cannot
+be marked by any experience or mental impression of the mother. Some
+believe that the actual character of a child can be changed by influences
+surrounding the mother while carrying it. The character of a child cannot
+be changed one particle after conception takes place, no matter how the
+mother spends her time in the interim.
+
+It should be carefully understood that the character of the baby is
+entirely different from the physical characteristics of the baby. Were this
+not so it would be futile on the part of the mother to discipline or
+sacrifice herself in the interest of her baby. The baby's character will
+reflect the qualities of the combined union of mother and father. The
+baby's physical characteristics will largely depend upon the treatment
+accorded it by the mother during its intro-uterine life. Hence we lay down
+rules of conduct, diet and exercise in order to produce a good, sturdy
+animal, while the character or mind of the animal is a part of the
+fundamental species already created. In other words, no matter how much
+care you bestow upon a rose bush, its flower will still be a rose,--it may
+be a better rose, a stronger, sturdier rose, a better smelling and a more
+beautiful rose, but it is still a rose.
+
+CONTACT WITH INFECTIOUS DISEASES.--The pregnant woman should be warned
+against the danger of coming in contact with any person suffering from any
+infectious or contagious diseases. To become the victim of one of these[91]
+diseases near the time of labor would be a dangerous complication not only
+to the mother, but to the child. A woman is more liable to catch one of
+these diseases during the last month of pregnancy than at any other time.
+The most dangerous diseases at this period are Scarlet Fever, Diphtheria,
+Erysipelas, and all diseased conditions where pus is present.
+
+AVOIDANCE OF DRUGS.--It is a safe rule during pregnancy to avoid absolutely
+the taking of all medicines unless prescribed by a physician.
+
+THE DANGER SIGNALS OF PREGNANCY.--The following conditions may be of very
+great importance and may be the danger signals of serious coming trouble.
+They must not therefore be neglected or lightly considered. When any of
+them make their appearance send for the physician who has charge of your
+case, at once, and follow his advice whatever it may be.
+
+    1. Any escape of blood from the vagina, whether in the form of a sudden
+    hemorrhage or a constant leaking, like a menstrual period.
+
+    2. Headache, constant and severe.
+
+    3. Severe pain in the stomach.
+
+    4. Vertigo or dizziness.
+
+    5. Severe sudden nausea and vomiting.
+
+    6. A fever, with or without a chill.
+
+       *       *       *       *       *
+
+
+                                                                       [93]
+CHAPTER VIII
+
+THE MANAGEMENT OF LABOR
+
+    WHEN TO SEND FOR THE PHYSICIAN IN CONFINEMENT CASES--THE PREPARATION OF
+    THE PATIENT--THE BEGINNING OF LABOR--THE FIRST PAINS--THE MEANING OF
+    THE TERM "LABOR"--LENGTH OF THE FIRST STAGE OF LABOR--WHAT THE FIRST
+    STAGE OF LABOR MEANS--WHAT THE SECOND STAGE OF LABOR MEANS--LENGTH OF
+    THE SECOND STAGE--DURATION OF THE FIRST CONFINEMENT--DURATION OF
+    SUBSEQUENT CONFINEMENTS--CONDUCT OF PATIENT DURING SECOND STAGE OF
+    LABOR--WHAT A LABOR PAIN MEANS--HOW A WILLFUL WOMAN CAN PROLONG
+    LABOR--MANAGEMENT OF ACTUAL BIRTH OF CHILD--POSITION OF WOMAN DURING
+    BIRTH OF CHILD--DUTY OF NURSE IMMEDIATELY FOLLOWING BIRTH OF
+    CHILD--EXPULSION OF AFTER-BIRTH--HOW TO EXPEL AFTER-BIRTH--CUTTING THE
+    CORD--WASHING THE BABY'S EYES IMMEDIATELY AFTER BIRTH--WHAT TO DO WITH
+    BABY IMMEDIATELY AFTER BIRTH--CONDUCT IMMEDIATELY AFTER LABOR--AFTER
+    PAINS--REST AND QUIET AFTER LABOR--POSITION OF PATIENT AFTER LABOR--THE
+    LOCHIA--THE EVENTS OF THE FOLLOWING DAY--THE FIRST BREAKFAST AFTER
+    CONFINEMENT--THE IMPORTANCE OF EMPTYING THE BLADDER AFTER LABOR--HOW TO
+    EFFECT A MOVEMENT OF THE BOWELS AFTER LABOR--INSTRUCTING THE NURSE IN
+    DETAILS--DOUCHING AFTER LABOR--HOW TO GIVE A DOUCHE--"COLOSTRUM," ITS
+    USES--ADVANTAGES OF PUTTING BABY TO BREAST EARLY AFTER LABOR--THE FIRST
+    LUNCH--THE FIRST DINNER--DIET AFTER THIRD DAY.
+
+WHEN TO SEND FOR THE PHYSICIAN IN CONFINEMENT CASES.--The physician should
+be notified just as soon as it is known that labor has begun. The adoption
+of this course is necessary for a number of reasons. It is only just that
+he should have an opportunity to arrange his work so that he may be at
+liberty to give his whole time to your case when he is wanted. He may not
+be at home at the moment, but can be notified, and can arrange to be on
+hand when your case progresses far enough to need his personal attention.
+It will relieve your mind to be assured that he will be with you in plenty
+of time. [Page 94]
+
+Don't worry unnecessarily if he does not come immediately when you notify
+him, provided you notify him at the beginning of labor. There is plenty of
+time. You have a lot of work to do before he can be of any help. Many women
+entertain the idea that a physician can immediately perform some kind of
+miracle to relieve them of all pains at any stage in labor. This is a
+mistaken idea. No physician can hasten, or would if he could, a natural
+confinement. He waits until nature accomplishes her work, and he simply
+watches to see that nature is not being interfered with. If something goes
+wrong, as it does now and again; or if the pains become too weak, or if the
+proper progress is not being made, he may help nature or take the case out
+of her hands and complete the confinement. If it is thought best to do
+this, there will be plenty of time.
+
+THE PREPARATION OF THE PATIENT AND THE CONDUCT OF ACTUAL LABOR.--It is
+assumed that the patient has adhered to the instructions of the physician
+given during the early days of her pregnancy. These instructions included
+directions as to exercise, diet, bathing, etc.
+
+Having calculated the probable date of the confinement, it is the better
+wisdom to curtail all out-of-door visiting, shopping, social engagements,
+etc.,--everything in fact out-of-doors except actual exercise, for two
+weeks previous to the confinement date. The usual walk in the open air
+should be continued up to the actual confinement day. The daily bath may be
+taken, and it is desirable that it should be taken, up to and on the
+confinement day.
+
+THE MEANING OF THE TERM "LABOR."--By labor is meant, the task or work
+involved in the progress by means of which a woman expels from her womb the
+matured ovum or child. After the child has been carried in the womb for a
+certain time (estimated to be 280 days) it is ripe, or fully matured, and
+is ready to be born. The womb itself becomes irritable because it has
+reached the limit of its growth and is becoming overstretched. Any slight
+jar, or physical effort on the part of the patient, or the taking of a
+cathartic, is apt to set up, or begin the contractions which nature has
+devised as the process of "labor" by which the womb empties itself.    [95]
+
+THE BEGINNING OF LABOR.--When the first so-called pains of actual labor
+begin they are not always recognized as such. The explanation of this
+seeming paradox is that the "pains" are not always painful. A woman will
+experience certain undefined sensations in her abdomen; to some, the
+feeling is as if gas were rumbling around in their bowels; to others, the
+feeling is as if they were having an attack of not very painful abdominal
+colic; while others complain of actual pain. The fact that these sensations
+continue, and that they grow a little worse; and that the day of the
+confinement is due, or actually here, impresses them that something unusual
+is taking place; then, and not till then, does the knowledge that labor is
+really approaching dawn upon them.
+
+In due time one of these new sensations, which constitute the first stage
+of labor, will be more emphatic; there will be a little actual pain so that
+she will feel like standing still, holding her breath and bearing down.
+That is the first real labor pain and marks the beginning of the second
+stage of labor, and may be the first absolute sign that will leave no doubt
+in her mind that labor has begun.
+
+The nurse will now inquire into the condition of the patient's bowels. If
+they have not already moved freely that day, she will give the patient a
+rectal injection of one pint of warm soap suds into which one teaspoonful
+of turpentine is put. After the bowels have been thoroughly cleansed, the
+patient will be made ready for the confinement. The clothing necessary
+consists of dressing gown, night gown, stockings and slippers. These are
+worn as long as the patient is out of bed, when all but the night gown will
+be discarded. The entire body of the patient, from the waist line to the
+knees, should be thoroughly cleansed, paying particular attention to the
+private parts; first with warm water and castile soap, and then rendered
+aseptic by washing with four quarts warm boiled water into which has been
+put one teaspoonful of Pearson's Creolin. A soft napkin is then wrung out
+of water that has been boiled and cooled to a suitable temperature, and
+laid over the genital region, and held in place by a dry clean napkin, [96]
+and allowed to remain there until the physician takes personal charge of
+the case.
+
+LENGTH OF THE FIRST STAGE OF LABOR.--There is no definite or even
+approximate length of time for the first stage of labor,--that, you may
+recall, was the more or less painless stage, or as it has been termed, the
+"getting-ready" stage. Inasmuch as it is an unimportant and practically
+painless stage, most patients do not mind it. They continue to be up and
+around and work as usual.
+
+The first stage of labor is utilized by nature in opening the mouth of the
+womb.
+
+The second stage of labor is utilized by nature in expelling the child into
+the outer world.
+
+LENGTH OF THE SECOND STAGE OF LABOR.--After the second stage has begun, the
+length of time necessary to end the labor, assuming everything is normal,
+depends upon the strength and frequency of the pains. The stronger and more
+frequent the pains, the quicker it will be over. First confinements
+necessarily take longer, because the parts take more time to open up, or
+dilate, to a degree sufficient to allow the child to be born. In subsequent
+confinements, these parts having once been dilated yield much easier, thus
+shortening the time and the pains of this, the most painful, stage of
+labor. The average duration of labor is eighteen hours in the case of the
+first child, and about twelve hours with women who have already borne
+children. The time, however, is subject to considerable variation, in
+individual cases, as has been pointed out.
+
+CONDUCT OF THE PATIENT DURING THE SECOND STAGE OF LABOR.--She should remain
+up, out of bed, as long as she possibly can. The object of this is because
+experience shows that the labor pains are stronger, and more frequent, when
+in the upright position. Even though this procedure would seem to invite
+more constant suffering, it must be remember that labor is a physiological,
+natural process, that there is nothing to fear or dread; and if the patient
+is in good health, it is to her advantage to have it over soon, rather than
+to encourage a long drawn out, exhausting labor. When the pains come   [97]
+she should be told to hold on to something, to hold her breath as long as
+possible, and to bear down. A good plan is to roll up a sheet lengthwise,
+and throw it over the top of an open door and let her grasp both ends
+tightly and bear down; or she can put her arms over the shoulders of the
+nurse and bear down. Instruct her to hold her breath as long as she can,
+bearing down all the time, and when she can't hold it any longer, tell her
+to let up, and then take a quick deep breath and bear down again, repeating
+this programme until the pain ceases. Tell her specifically to be sure to
+keep bearing down till the end of the pain, because the most important
+time, and the few seconds during which each pain does most of its work
+during the second stage of labor, is at the very end of each pain. When a
+woman understands that these instructions are for her good, and that they
+are given with the one purpose of saving her pain, and shortening the
+length of labor, she will try to obey. Each pain is intended by nature to
+do a certain amount of work, and each pain will accomplish that work if the
+woman does not prevent it; and if she does prevent it, she is only fooling
+herself, because the next pain will have to do what she would not allow the
+former to do, and so on according to how she acts.
+
+THE CARRIERS OF HERITAGE
+
+[Illustration: Here is the actual bridge from this generation to the next.
+
+Into these two little bodies--the larger not over one-twenty-fifth of an
+inch in diameter--is condensed the multitude of characteristics transmitted
+from one generation to another.
+
+The vital part of the _Ovum_ is the _Nucleus_, which contains the actual
+bodies that carry heritage--the little grains that are the mother's
+characteristics--_Chromosomes_. This nucleus is nourished by oils, salts
+and other inclusions, known as _Cytoplasm_. Floating in the cytoplasm may
+be found a tiny body known as the _Centrosome_, which acts as a magnet in
+certain phases of cell development. Around this whole mass is a _Cell
+Wall_, more or less resisting and protective.
+
+The _Spermatozoan_ is structurally much different from the ovum, but it
+also has its nucleus and chromosomes, which carry to the child the
+transmittable characteristics of the father.
+
+The ovum is usually comparatively large and stationary, and whatever motion
+is therefore necessary to bring it into contact with the male cell devolves
+upon the latter, which possesses what is known as a _locomotor tail_. In
+addition there are usually many sperms to one ovum, so that the chances are
+that at least one male cell will reach the egg and effect fertilization,
+and the beginning of a new life.
+
+The diagrams on the opposite page show the actual steps by which the
+spermatozoan unites with the ovum. It is the very first stage of the
+process of cell multiplication that results in the offspring.]
+
+THE FORMATION OF A NEW LIFE
+
+[Illustration: _Reproduced by permission from "Genetics," Walters, The
+Macmillan Co._]
+
+HOW A WILLFUL WOMAN CAN PROLONG LABOR.--For a certain time, during the
+second stage of labor, a willful, unreasonable woman, can work against
+nature and save herself a little pain by prolonging the issue; but there
+will come a time when, the head having reached a certain position, the
+expulsive pains will be so great that she won't be able to control them and
+nature then seems to take her revenge. So if a woman holds back, and begins
+to cry, and scream, when she feels a pain coming, she renders the pain to a
+large degree negative, she prolongs her labor, adds to the total number of
+pains, exhausts herself, and endangers the life of her child. It must,
+however, be remembered in all justice that this is a time when it is much
+easier to preach than to practice.
+
+Every confinement is a new experience; no matter how many a physician may
+have seen, there are no two alike. It is one of the interesting        [98]
+psychological problems in medicine to observe the conduct of women during
+their first confinement.
+
+Some are calm, exhibiting a degree of self-control that is admirable. They
+are willing to be instructed, and they recognize that the advice is given
+for their benefit. They conscientiously try to obey suggestions, and they
+make praiseworthy efforts to keep themselves under control. They are
+stoics.
+
+Others collapse at once; they go to pieces under the slightest excuse, and
+frequently without as much as an excuse. As soon as the pain begins, they
+willfully ignore all the instructions given and desperately and foolishly
+try to escape what they cannot escape. In this unreasonable selfishness
+they resent advice, and at the same time they implore you to "do something"
+for them. There is absolutely no excuse for this kind of conduct; and any
+prospective mother who, because of a willful trait in her disposition,
+refuses to profit by the kindly professional advice of her physician or
+nurse, should at least have some consideration for her unborn babe. It may
+seem unkind to criticise the conduct of any woman at such a time. It is not
+prompted by a lack of patience or justice however. These women permit, in
+spite of every assurance to the contrary, an unreasonable fear to overwhelm
+them; and because of this fear they refuse to be guided into a path of
+conduct that will save them suffering and shorten the pains which they
+complain of. It is our conviction that if a woman would try to follow the
+advice of the physician at this time, at least half of all the seeming
+suffering would be avoided. We are glad to be able to truthfully state that
+this type of woman is vastly in the minority.
+
+When the second stage has advanced far enough, the patient will decide to
+go to bed. It may be necessary to put her in bed earlier, if her pains are
+very strong, as there is always a possibility of suddenly expelling the
+child under the influence of a strong pain. She will, as previously stated,
+discard all clothing, except her night gown, which can be folded up to her
+waist line and let down as far as necessary after the confinement is over.
+The obvious advantage of this arrangement is that the gown remains     [99]
+unsoiled, and saves what would be needless trouble if it proved necessary
+to change the night gown at a time when the tired-out patient needs rest.
+Much aid may be afforded the woman at this stage by twisting an ordinary
+bed sheet and putting it around one of the posts or bars of the foot of the
+bed. The patient may then pull on the ends during the pain; she may also
+find much comfort and aid by bracing her feet on the foot of the bed while
+pulling. It is desirable to instruct the nurse to press on the small of the
+back during these pains. Some women appreciate a hot water bottle in this
+region. If the pains are hard the patient may perspire freely; it is always
+refreshing occasionally to wipe the face and brow off with a cloth wrung
+out of cold water. Cramps of the limbs may be relieved by forcibly
+stretching the leg and pulling the foot up toward the knee. From this time
+until the child and after-birth are born the physician will take active
+charge of the case.
+
+THE MANAGEMENT OF THE ACTUAL BIRTH OF THE CHILD.--Near the end of the
+second stage of labor it will be observed that the pains have grown strong,
+expulsive, and more frequent. Very soon the advancing head will begin to
+push outward the space between the front and back passage; the rectum is
+pushed outward and the lips of the vagina open. If an anesthetic is to be
+used these are the pains that call for it. A few drops may be dropped
+singly on a small clean handkerchief held up by the middle over the nose,
+its ends falling over the face. A few drops will just take the edge off the
+pains, and render them quite bearable. As soon as the pain is over the
+patient should rest, relax completely, and not fret and exhaust herself
+worrying about the pains to come. It is astonishing how much actual rest a
+woman can get between pains if she will only try; and it is astonishing how
+much concentrated mischief a willful, unreasonable woman can do in the same
+time. She will not try to rest, but cries and moans and pleads for
+chloroform, until she succeeds in giving everyone except the physician and
+nurse the impression that she is suffering unnecessarily. Her husband or
+her mother, whichever is present, gets nervous; they begin to wonder  [100]
+if the physician is really trying to help; assume a long, sad, serious
+face! forget their promise to look cheerful, and mayhap offer sympathy to
+the woman. It is a trying moment and needs infinite patience and tact. The
+physician attends strictly to his duty, which will now be to guard the
+woman against exerting too great a force during the last few pains. About
+this time, or before it in many instances, the "waters will break." This
+means simply that the bag or membrane in the contents of which the child
+floated burst because of the pressure of a pain. This is a perfectly
+natural procedure and should not cause any worry: simply ignore it as if it
+had no bearing on the labor in any way. As soon as the oncoming head has
+dilated the passage sufficiently, so that the edges of the entrance to the
+vagina will slip over the head without tearing, the physician allows the
+head to be born. It takes some time to do this, and he must hold the head
+back until just the right moment. It is best not to let the head slip
+through at the height of a pain, or rupture is sure to occur. Wait till it
+will slip through as a pain is dying out, and if you have waited long
+enough and handled the head skillfully, the conditions will be just right
+at a certain moment to permit this without tearing the parts. There are
+some cases where a tear, and a good tear, is impossible to guard against.
+It is not a question of patience, or tact, or skill; it is a combination of
+conditions which patience, tact, and skill are powerless against.
+
+POSITION OF WOMAN DURING BIRTH OF CHILD.--The position of the woman is a
+matter of choice and is not contributory to the results at all. She can lie
+on her back, which is the ordinary way, or on her side, as the physician or
+the patient prefer. As soon as the head is born the physician should see
+that the cord is not round the child's neck; if it is, release it. The
+shoulders will most likely be born with the next or succeeding pain. The
+physician will permit the lower shoulder to slip over the soft parts first;
+this is done by retarding the upper shoulder by pushing it gently behind
+the pubic bone of the mother. When the shoulders are through, the rest[101]
+of the body of the child slips out without effort.
+
+DUTY OF NURSE IMMEDIATELY FOLLOWING BIRTH OF CHILD.--As soon as the child
+is born the nurse should sit by the side of the mother and hold the womb
+until the after-birth is expelled. The womb can be easily felt in the lower
+part of the woman's abdomen as a hard mass. It feels about the size of an
+extra large orange. The object of holding it is to prevent the possibility
+of an internal hemorrhage. It can be readily appreciated that the interior
+of a womb, immediately after a child is born, is simply a large bleeding
+wound. So long as the womb remains firmly contracted there is very little
+chance for an extensive bleeding to take place. As a rule the womb remains
+sufficiently contracted to preclude a hemorrhage until the after-birth is
+out. After the after-birth is expelled, the womb usually closes down firmly
+and the liability to bleed is very much reduced. Because there is a
+distinct chance or tendency for the womb to bleed freely during the time
+the after-birth remains in, it is customary, as stated above, to watch it
+closely and to hold it securely. It is best held with the right hand. The
+fingers should surround the top of the womb and exert a slight downward
+pressure. Should it show any tendency to dilate or fill with blood, get it
+between the fingers and the thumb and squeeze it, pushing downward at the
+same time.
+
+EXPULSION OF AFTER-BIRTH.--The after-birth is usually expelled in about
+twenty minutes after the child is born. Great care should be experienced in
+its expulsion. It should not be pulled at any stage of its expulsion. If it
+does not come easily give it a longer time,--it takes time for the womb to
+detach itself from the after-birth; and some after-births are very firmly
+attached. Eventually it will come out with a little encouragement in the
+way of frictional massage of the womb through the abdominal walls. If the
+membranes remain in the womb after the body of the after-birth is out, do
+not pull on them. Take the after-birth up in the palm of your hand and turn
+or twist it around, and keep turning it around gently, thereby loosening
+the membranes from the womb instead of pulling them, which would surely
+break them, leaving the broken ends in the womb, and, as a result, the[102]
+chance of developing serious trouble.
+
+The patient should now be given one teaspoonful of the fluid extract of
+ergot, which should be repeated in an hour. Should there be an excessive
+flow of blood after this period it may be again repeated at the third hour.
+
+CUTTING THE CORD.--As soon as the child is born, and of course long before
+the after-birth is expelled, the physician will tie the cord. This is best
+done at two places, one about two inches from the child, and the other two
+or three inches nearer the mother. Cut the cord about one-half inch beyond
+the first ligature, which will be between the two ligatures. The cord
+should be tied with sterile tape made for the purpose, or heavy twisted
+ligature silk, or a narrow, ordinary, strong tape, previously boiled. It
+should be tied firmly and inspected a number of times within one hour of
+its birth. It is possible for a baby to lose enough blood from a cord badly
+tied to cause its death. A very good way to ensure against such an accident
+is to cut the cord one inch from the ligature nearest the baby, then turn
+this inch backward and retie with the same ligature, thus making a double
+tie at the same spot. Cut the cord with scissors that have been boiled and
+reserved for this purpose.
+
+WASHING BABY'S EYES AND MOUTH IMMEDIATELY AFTER BIRTH.--As soon after birth
+as is practicable, wash the baby's eyes with a saturated solution of
+boracic acid.
+
+Immediately after the eyes have been washed the physician will drop into
+them a solution of silver nitrate, three drops of a two per cent. solution
+in each eye, or argyrol, three drops 20 per cent. solution. This precaution
+is taken against possible infection during labor and, as explained
+elsewhere, it is a preventive against certain diseased conditions which, if
+present, would result in blindness.
+
+The physician should then wind a little sterile cotton round his moistened
+little finger, dip it in the boracic solution, and holding the baby up by
+the feet head down, insert this finger into the throat, thus clearing it of
+mucus. The tongue and mouth may be gently washed with the same        [103]
+solution.
+
+After the baby has cried lustily as an evidence of life and strength, he
+should be wrapped up in a warm blanket quickly, and immediately put in a
+cozy basket in a warm place, and left there undisturbed, with his eyes
+shaded from the light until the nurse is ready to attend to him. The baby
+should be laid on his right side.
+
+CONDUCT IMMEDIATELY FOLLOWING LABOR.--As soon as the physician is satisfied
+that the patient is well enough to be left in care of the nurse or
+attendant, every effort should be made to favor a long, refreshing sleep.
+Nothing will contribute to the patient's well-being so much as a quiet,
+restful sleep after labor. The nurse will therefore take the baby into
+another room, fix the mother comfortably, and give her a glass of warm
+milk,--draw the shades or lower the light and tell the tired-out mother to
+go to sleep. As a rule she will sleep easily, as she is sore and exhausted.
+
+AFTER-PAINS.--In women who have had children the womb does not as a rule
+contract down as firmly as after the first confinement. This condition
+permits of slight relaxation of the muscular wall, at which times there is
+a slight oozing of blood. This blood collects and forms clots in the
+uterine cavity which acts as irritants, exciting contractions in the effort
+to expel them. These contractions cause what are commonly known as
+"after-pains." These pains last until the womb is free from blood-clots.
+They may be severe the first twenty-four hours and then gradually die out
+during the following two or three days. Ordinarily in uncomplicated
+confinements they rarely annoy the patient longer than a few hours. It is a
+rare exception to observe them after the first confinement.
+
+REST AND QUIET AFTER LABOR.--Sometimes the birth chamber is the rendezvous
+for all the inquisitive ladies in the neighborhood. No one should be
+permitted in the lying-in chamber until the patient is sitting up, except
+the husband and the mother. This should be made an absolute rule in every
+confinement. This is a period that demands the maximum of uninterrupted
+rest and repose. The world and all its concerns should remain a blank to a
+woman during the whole period of her confinement. This is the only
+successful means of obtaining mental rest. The husband and mother     [104]
+should be instructed to present themselves just often enough to demonstrate
+their interest in the welfare of the patient and the baby.
+
+POSITION OF THE PATIENT AFTER LABOR.--After delivery a woman should be
+instructed to lie on her back, without a pillow, for the first night. On
+the following morning she may have a pillow, but she must remain on her
+back for the first week. Sometimes an exception may be made to this rule by
+letting the patient move around on the side, with a pillow supporting the
+back, on the fourth day. These exceptional cases are those whose womb has
+contracted firmly, as shown by the quick change in the amount and color of
+the lochia. Women should be told why they must remain on their backs as
+explained in the chapter: "How long should a woman remain in bed?"
+
+THE LOCHIA.--The discharge which occurs after every labor is called the
+lochia. Its color is red for the first four or five days; for the
+succeeding two or three days it is yellow; for the remainder of its
+existence it is of a whitish color. It lasts from ten days to three weeks.
+
+The odor of the lochia is at first that of fresh blood; later it has the
+odor peculiar to these parts. If at any time the odor should become foul or
+putrid it is a danger signal to which the nurse should immediately draw the
+physician's attention.
+
+If the amount of the lochia should be excessive it should be investigated.
+
+THE EVENTS OF THE DAY FOLLOWING LABOR.--We will assume that the patient
+enjoyed a long sleep and wakes up refreshed, and with a thankful feeling
+that all is over and that baby is safely here. She will want to see and
+caress baby, of course. Lay the baby down in bed beside her and let her
+love and mother it. Tell her not to lift it, for the strain might injure
+her, then quietly steal away for ten or fifteen minutes, for these are
+precious, sacred moments. Motherhood--that angel spirit, whose influence
+every human heart has felt--that guards and guides the world in its
+sheltering arms--is born in its divine sense, into the heart of every woman
+for the first time, as she gazes in ecstasy and wonder at her         [105]
+first-born. She feels that she has begotten a trust,--a trust direct from
+her Creator, and she makes a silent resolve, as she gently and timidly
+feels the softness of baby's cheek, that she will watch over it, and guide
+it, and do all a mother can for it, with God's help. It is good for the
+race that mothers do feel this way: and it is good for all concerned that
+they be given the opportunity to be so inspired.
+
+Just as gently take the baby away at the expiration of the allotted time.
+Take it with a cheerful, smiling word, and do not comment upon mother's
+happy, thoughtful face, she will quickly collect herself and enter into the
+spirit of quiet congratulation that should now permeate the home.
+
+THE FIRST BREAKFAST AFTER LABOR.--If the patient has passed a comfortable
+night, feels well, and is free from temperature, and has a normal pulse,
+breakfast will consist of a cup of warm milk, or a cup of cocoa made with
+milk, a piece of toasted bread, and a light boiled egg; or if preferred a
+cereal with milk and toasted bread. This will be the breakfast for the two
+following days also. The milk, or the cocoa (whichever is taken), must be
+sipped, while the attendant supports the patient's head. The cereal, or the
+egg (whichever is taken), must be fed to the patient out of a spoon. The
+patient must not make any physical effort to help herself; she must remain
+relaxed. Even when she sips her milk, or cocoa, she must not make any
+effort to raise her head; the nurse must support its entire weight. This
+will be the absolute routine of every meal until the physician gives
+permission to change the procedure. It is a waste of time to formulate
+rules only to disobey them.
+
+Shortly after breakfast the patient's toilet should be attended to. She
+should have her hair combed, and her face and hands washed. The hair on the
+right half of her head should be combed while the head rests on the left
+side, and vice versa. The water used for washing the hands and face should
+be slightly warmed. It is best to keep the hair braided and to consult the
+wishes of the patient as to the frequency of combing it. [Page 106]
+
+THE IMPORTANCE OF EMPTYING THE BLADDER AFTER LABOR.--An effort should be
+made now to have the patient urinate. This is very important at this time,
+as it is not an uncommon experience to find that the abdominal muscles are
+so worn out and overstrained with the fatigue of labor that they refuse to
+act when an effort is made to urinate. As a consequence the bladder becomes
+distended and may have to be emptied by other means. This condition is a
+temporary and a painless one, and will rectify itself in a day or two;
+meantime, if this accident has occurred, it is essential that the bladder
+should be emptied from time to time until the patient can do it herself. To
+test this function place the patient on the bed pan into which a pint of
+hot water has been put, and give her a reasonable time to make the effort
+to pass her water. Should she fail, take an ordinary small bath towel and
+wring it out of very hot water, just as hot as she can tolerate, and spread
+it over the region of the bladder and genitals: if there is running water
+in the room, turn it on full and let it run while the towel is in position
+as above. If the bladder is full, there is a peculiar, irresistible desire
+to urinate when one hears running water. If this effort fails, report the
+fact to the physician when he makes his daily call; he will draw the urine
+and it will be part of his daily duty to give specific instructions
+regarding this function until nature reestablishes it.
+
+No particular attention need be paid to the bowels for the first two days.
+On the morning of the third day, if they have not acted of their own
+accord, the physician will give the necessary instructions to move them.
+The means necessary to accomplish the first movement after a confinement is
+a matter of choice. The old-time idea was to use castor oil, and while
+other remedies are now more or less fashionable, castor oil is still an
+excellent agent. Enemas are frequently used, but their use is questionable
+in this instance, inasmuch as a movement has not taken place for three
+days, the object is to clean out the whole length of the intestinal tract,
+and an enema is limited to part of the large intestine only,--according to
+how it is given. If the small intestines are not thoroughly emptied,  [107]
+particles of food may remain there, and if so, they will putrify and the
+patient runs the risk of developing gas,--sometimes to an enormous extent.
+This affliction is painful, and dangerous, and nearly always unnecessary.
+It is always, therefore, more safe, and more desirable, to use some agent
+by the mouth, and we know of no better one than castor oil; and as castor
+oil can be so masked as to be practically tasteless at any drug-store soda
+fountain there can be small objection to it. My custom is to send the nurse
+or husband with an empty glass to the drug store to have the mixture made
+there and brought back ready for use. We have frequently obtained it in
+this way and given it to the patient without her knowing what it was. The
+best time to give castor oil is two hours after a meal, and two hours
+before the next meal--i.e., on an empty stomach. It works quicker and does
+not nauseate when the stomach is empty.
+
+INSTRUCTING THE NURSE IN DETAILS.--The nurse will attend to the patient's
+discharges by changing the napkins frequently. The bruised parts should be
+washed twice daily, for the first three or four days. If the nurse is a
+trained graduate nurse a few directions will suffice. If she is not a
+trained nurse the physician should be explicit in his instructions. It
+would be better if he actually showed her just how he wanted this work
+done. The best way to cleanse the vulvae or privates is to take an ordinary
+douche bag at the proper height (about three feet) and allow the solution
+(1 to 2,000 bichlorid) to run over the parts into the douche pan, but do
+not touch any part of the patient with the nozzle of the douche bag. While
+she is directing the water with the left hand she should have a piece of
+sterile cotton in the right hand with which she will gently mop the parts.
+This method ensures disengaging any clotted blood and is aseptic. Dry the
+parts afterwards with a soft sterile piece of gauze and apply a clean
+sterile napkin.
+
+DOUCHING AFTER LABOR.--A nurse should never give a vaginal douche without
+instructions from the physician. Douches are not necessary in the
+convalescence of ordinary uncomplicated confinement cases. When it is [108]
+necessary to give vaginal douches after a confinement, there are good
+reasons why they should be given, and it is therefore absolutely essential
+that they should be given properly, and with the highest degree of aseptic
+precautions. If these rules are not observed, the danger of causing serious
+trouble is very great, and as the physician is directly responsible for the
+conduct of the case, he should in justice to himself and his patient, do
+the douching himself.
+
+HOW TO GIVE A DOUCHE.--The proper way to give a vaginal douche after a
+confinement, when the parts are bruised and lacerated, and when, as a
+consequence, the possibility of infection is very great, is as follows:
+
+Instruct the nurse to boil and cool about two quarts of water and have
+another kettle of water boiling. Boil the douche bag and its rubber tubing
+and the glass douche tube (do not use the hard rubber nozzle that comes
+with the ordinary douche bag). Drain off the water after it has boiled for
+ten minutes, but instruct the nurse not to touch the bag or tube, to leave
+them in the pan, covered, till the physician uses them. When the physician
+calls, place the patient on a clean warm douche pan while he is sterilizing
+his hands and making the solution ready. While he is douching the patient
+the nurse will hold the bag. The bag should not be held higher than two
+feet above the level of the patient.
+
+ADVANTAGES OF PUTTING BABY TO THE BREAST EARLY AFTER BIRTH.--The patient
+can now take, and will likely be ready for, an hour's nap. After the rest
+it is desirable to put the baby to the nipple, first carefully cleaning the
+nipple with a soft piece of sterile gauze dipped in a saturated solution of
+boracic acid. The reasons for this are as follows:
+
+1st. There is in the breasts of every woman after confinement a secretion
+known as "colostrum" which has the property of acting as a laxative to the
+child, in addition to being a food.
+
+2nd. It is advisable that the child's bowels should move during the first
+twenty-four hours and the colostrum was put there partly for that purpose.
+
+3rd. The act of suckling has a well-known influence on the womb, in   [109]
+that it distinctly aids in contracting it, and thereby expelling
+blood-clots and small shreds of the after-birth which might cause trouble
+if left in.
+
+4th. By nursing the colostrum out of the breasts, it will favor and hasten
+the secretion of milk.
+
+5th. It is frequently easier for the baby to get the nipple before the
+breast is full of milk, and having once had the nipple it will be easier to
+induce him to take it again when it is more difficult to get.
+
+THE FIRST LUNCH AFTER LABOR.--Lunch will be next in order, and that should
+consist of a clear soup,--chicken broth, mutton broth, beef broth with a
+few Graham wafers or biscuits, and a cup of custard or rice pudding. This
+will be the lunch for the two following days also. The same precautions are
+to be observed in giving this as were observed with breakfast and as will
+be observed with all other meals as clearly stated before, and repeated
+again, so that no mistake may be made. In the middle of the afternoon the
+patient can take a cup of beef tea or a cup of warm milk.
+
+THE FIRST DINNER AFTER LABOR.--Dinner will consist of more broth, or a
+plate of clear consomme with a dropped egg, or a cereal, a little boiled
+rice with milk, and stewed prunes, or a baked apple.
+
+After the bowels have moved, on the third day, and provided the temperature
+and pulse have been normal since the confinement, the patient can be put on
+an ordinary mixed diet, particulars regarding which are given on page 121
+under the heading "Diet for the nursing mother."
+
+       *       *       *       *       *
+
+
+                                                                      [111]
+CHAPTER IX
+
+CONFINEMENT INCIDENTS
+
+    REGARDING THE DREAD AND FEAR OF CHILDBIRTH--THE WOMAN WHO DREADS
+    CHILDBIRTH--REGARDING THE USE OF ANESTHETICS IN CONFINEMENTS--THE
+    PRESENCE OF FRIENDS AND RELATIVES IN THE CONFINEMENT CHAMBER--HOW LONG
+    SHOULD A WOMAN STAY IN BED AFTER A CONFINEMENT?--WHY DO PHYSICIANS
+    PERMIT WOMEN TO GET OUT OF BED BEFORE THE WOMB IS BACK IN ITS PROPER
+    PLACE?--LACERATIONS, THEIR MEANING AND THEIR SIGNIFICANCE--THE
+    ADVANTAGE OF AN EXAMINATION SIX WEEKS AFTER THE CONFINEMENT--THE
+    PHYSICIAN WHO DOES NOT TELL ALL OF THE TRUTH
+
+REGARDING THE MORE OR LESS PREVALENT DREAD OR FEAR OF CHILDBIRTH.--Much has
+been written, and much more could be written upon this subject. Inasmuch as
+this book is largely intended for prospective mothers to read and profit
+thereby, and is not for physicians and nurses whose actual acquaintance
+with confinement work would render such comments superfluous, it will not
+be out of place to consider this phase of the subject briefly, from a
+medical standpoint. When one considers that "a child is born every minute"
+as the saying goes, and which is approximately true, and at the same time
+remembers that statistics prove, as near as can be estimated, that there is
+only one death of a mother in twenty thousand confinements, it would really
+seem as though we were "looking for trouble" to even regard the subject as
+worthy of the smallest consideration. It is much more dangerous to ride
+five miles on a railroad, or on a street car, or even take a two-mile
+walk,--the percentage possibility of accident is decidedly in your favor to
+stay at home and have a baby. Almost any disease you can mention has a
+higher, a much higher fatality percentage than the risks run by a     [112]
+pregnant woman. The real justification for actual fear of serious trouble
+is so small that it barely exists. These are facts that cannot be argued
+away by any specious if or and. Why, therefore, should there be any real
+fear?
+
+Did you ever hear of the remarks made by a famous philosopher who was given
+a dinner by his friends in celebration of his 85th birthday? In replying to
+the eulogisms of his friends he said in part:
+
+"As I look back into those blessed years that have faded away, I can recall
+a lot of troubles and many worries as well as much happiness and pleasure,
+and thinking of it all this evening I can truthfully say my worst troubles
+and worries never happened."
+
+So it is with the woman who for weeks or months has made her own life
+wretched, and possibly the life of her husband and friends, the same in
+imagining all kinds of dreadful things that never take place. It is
+undoubtedly an exhibition of weakness, an evidence of failure in the
+development of self-control. Childbirth is a natural process,--there is
+nothing mysterious about it. If you do your part you have no cause to
+fear,--the very fact, however, that you entertain a dread of it, shows that
+you are not doing your part. One of the saddest parts of life, one of the
+real tragedies of living, is the fact that most of us have to live so long
+before we really begin to profit by our experiences. Could we only be
+taught to learn the lesson of experience earlier, when life is younger and
+hope stronger, we would have so much more to live for and so many more
+satisfied moments to profit by. One of the most valuable lessons experience
+can teach any human being is not to worry and fret about the future. You
+can plant ahead of yourself a path of roses and be cheerful, or you can
+plant a bed of thorns and reap a thorny reward. Cultivate the spirit of
+contentment, devote all your energy to making the actual present
+comfortable. Don't fret about what is going to bother you next week,
+because, as the philosopher said, most of the troubles we anticipate and
+worry about never occur, but the worry kills.
+
+REGARDING THE USE OF ANESTHETICS IN CONFINEMENTS.--Anesthetics are as a
+rule given in all confinements that are not normal. To make this      [113]
+statement more plain it may be said, that, when it is necessary to use
+instruments, or to perform any operation of a painful character, it is the
+invariable rule to give anesthetics. As to the wisdom of giving an
+anesthetic when labor is progressing in a normal and satisfactory manner,
+there is a difference of opinion. Much depends upon the disposition of the
+patient and the viewpoint of the physician in charge of the case. It is a
+fact that a large number of confinements are easy and are admitted to be
+so, by the patients themselves, and in which it would be medically wrong to
+give an anesthetic. In a normal confinement, however, when the pains are
+particularly severe and the progress slow, there is no medical reason why
+an anesthetic could not be given to ease the pain. In these cases it is not
+necessary to render the patient completely unconscious. Sufficient
+anesthetic to dull each pain is all that is necessary, and as this can be
+accomplished with absolute safety by the use of an anesthetic mixture of
+alcohol, ether and chloroform, there can be no possible objection to it.
+The use of an anesthetic, however, is a matter that must be left entirely
+to the judgment of the physician as there are frequently good reasons why
+it should not be given under any circumstances.
+
+THE PRESENCE OF FRIENDS AND RELATIVES IN THE CONFINEMENT CHAMBER.--It is a
+safe rule to exclude every one from the confinement room during the later
+stages of labor. Sometimes it is desirable to make an exception to this
+rule in the interest of the patient, by permitting the mother or husband to
+remain. If this exception is made, however, they must be told to conduct
+themselves in a way that will tend to keep the patient in cheerful spirits.
+They must not sympathize, or go around with solemn, gloomy faces.
+Cheerfulness and an encouraging word will tide over a trying moment when
+the reverse might prove disastrous.
+
+Practically the same rule applies to the entire period of convalescence
+during which time the patient is confined to bed. This is a very important
+episode in a woman's life and the consequences may be serious if it is
+misused in any way. Friends and relatives do not appreciate the       [114]
+absolute necessity of guarding the patient from small talk and gossip, and
+an unwitting remark may cause grave mental distress, which may retard the
+patient's convalescence and disastrously affect the quality and quantity of
+her milk, thereby injuring the child.
+
+HOW LONG SHOULD A WOMAN STAY IN BED AFTER A CONFINEMENT?--To answer this
+question by stating a specific number of days would be wrong, because, few
+women understand the need for staying in bed after they feel well enough to
+get up. If any answer was given, it should be at least fourteen days, and
+it would be nearer the truth medically to double that time. Let us consider
+what is going on at this period. The natural size of the unimpregnated womb
+is three by one and three-quarter inches, and its weight is one to two
+ounces. The average size of the pregnant womb just previous to labor is
+twenty by fourteen inches, and its weight about sixteen ounces. We have,
+therefore, an increase of about 600% to be got rid of before it assumes
+again its normal condition. This decrease cannot be accomplished quickly by
+any known medical miracle. Nature takes time and she will not be hurried:
+she will do it in an orderly, perfect manner if she is allowed to. The womb
+will again find its proper location and will resume its work, in a
+painless, natural way, in due time, if all goes well. The uterus or womb is
+held in its place by two bands or ligaments, one on either side, and is
+supported in front and back by the structures next to it. These bands keep
+the womb in place in much the same way as a clothes pin sits on a clothes
+line, and it will retain its proper place provided everything is just
+right. After labor, it is large and top heavy. If you put a weight on the
+top of a clothes pin as it sits on a clothes line, what will take place? It
+will tilt one way or the other, and if the weight is heavy, it will turn
+completely over. So long as the woman lies in bed the womb will gradually
+shrink back to its proper size and place; if she sits up or gets out of bed
+too soon, the weight of the womb, being top heavy, will cause it to tilt
+and sag out of its true position. As soon as it does this the weight of the
+bowels and other structures above will push and crowd it further out  [115]
+of place. This crowding and tilting interferes with the circulation in the
+womb and its proper contraction is interfered with, and thus is laid the
+foundation for the multitude of womb troubles that exist.
+
+It is a mechanical as well as a medical problem. Being partly mechanical,
+it is subject to the rules that govern mechanical problems. The importance
+of this dual process will be appreciated by considering the following fact.
+Many medical conditions tend to cure or rectify themselves because nature
+is always working in our behalf if we give her a chance. Take for example
+an ordinary cold. You can have a very severe cold and you can neglect it,
+and in spite of your neglect you will get well. It is not wise to neglect
+colds, nevertheless, it is true that nature will cure, unaided, a great
+many diseased conditions, if she has half a chance. This, to a very large
+extent, is the secret of Christian Science, yet the principle is known to
+everyone. A mechanical condition, on the other hand, has absolutely no
+tendency to get well of its own accord, or without mechanical aid. This is
+why Christian Science cannot cure a broken leg. It is this principle that
+makes diseases of the womb so persistent, and so stubborn of cure. When a
+womb once becomes slightly displaced, the tendency always is for it to grow
+worse and never to cure itself. The longer it lasts the worse it gets. Its
+cure depends upon mechanically putting it back in place and holding it long
+enough there to permit nature to reestablish its circulation, and by toning
+and strengthening it so that when the mechanical support is taken away it
+will retain its position. There is no other possible way of doing it. Now
+since it has been proved that nature takes many days to contract a pregnant
+womb, a woman is taking a risk, and inviting trouble by getting out of bed
+before that time.
+
+WHY DO PHYSICIANS PERMIT WOMEN TO GET UP BEFORE THE WOMB IS BACK IN ITS
+PROPER PLACE?--Without offering the excuse that a woman will not stay in
+bed as long as a physician knows she should, there is, however, a large
+degree of truth in this excuse. And we are of the opinion that, if a
+physician made it a rule to keep all his confinement cases in bed for one
+month, [Page 116] he would very soon find himself without these patients.
+
+Experience has taught us, however, that it is safe, under proper
+restrictions, and in uncomplicated confinements, to allow patients to sit
+up in bed on the 12th and in certain cases on the 10th day, and to get out
+of bed on the 12th or 14th day. When the patient is allowed to sit up, out
+of bed, it should not be for longer than one or two hours, and during that
+time she should sit in a comfortable rocking or Morris chair, which should
+be placed by the side of the bed. Each day the time can be lengthened, and
+the distance of the chair from the bed increased. This procedure gives her
+the opportunity to walk a little further each day, thereby to test her
+strength and ability to use her limbs. On the fourth day, if all has gone
+well, she may stay up all day and she may walk more freely about the room.
+She should be just to herself, however. As soon as she is fatigued she
+should not make any effort to try to "work it off." When a feeling of
+fatigue appears she should rest completely. If she has any pain or distress
+she should acquaint the physician with it at once. She should not try to
+hide anything on the mistaken idea that "it isn't much." She does not know,
+and she is not supposed to know what the pain may mean; it may be
+exceedingly significant. Many women have saved themselves needless
+suffering, and their husbands unnecessary expenditure of money, by calling
+the physician's attention to conditions, which in time would have been
+serious, and would have necessitated long, expensive treatment.
+
+LACERATIONS DURING CONFINEMENT, THEIR MEANING AND THEIR SIGNIFICANCE.--The
+only interest a laceration or a tear has to a physician, is whether the
+laceration or tear is of sufficient importance to need surgical
+interference. The laceration can take place at the mouth of the womb, or on
+the outside, between the vagina and rectum.
+
+Those of the mouth of the womb always take place, in every confinement, to
+some degree. They are never given any attention at the time of the
+confinement, unless under extraordinary circumstances, such as a more or
+less complete rupture of the womb, and this is such a rare accident   [117]
+that most physicians practice a lifetime and never see or hear of one
+single case. Those on the outside are always attended to immediately after
+labor, or should be, unless they are very extensive and the patient is not
+in condition to permit of any immediate operative work. In such a case it
+is best to leave it alone until the patient is in condition to have it
+operated on at a later date.
+
+It is distinctly preferable to have it attended to immediately after labor
+when it is possible, and it is possible in a very large percentage of the
+cases. The explanation of this is because it is practically painless then,
+owing to the parts having been so stretched and bruised that they have
+little or no feeling. If it is left for a day or two and then repaired, it
+will be more painful, because the parts will have regained their
+sensitiveness. Another good reason in favor of immediate repair is that a
+much better and quicker union will take place than if postponed.
+
+When a patient is torn, but not to the degree necessary to stitch, it is to
+her advantage to be told to lie on her back and keep her knees together for
+twelve hours, thus keeping the torn edges together and at rest, thereby
+favoring quick and healthy repair of the tear. Some physicians go as far as
+to bind the patient's knees together so she cannot separate them during
+sleep.
+
+It is the custom of every conscientious physician to request every woman he
+confines to report at his office six or eight weeks after labor. The reason
+for this is to find out by examination the character and extent of the
+lacerations of the mouth of the womb. No physician can tell at the time of
+labor just how much damage has been done, because the mouth of the womb, at
+the time of labor, is so stretched and thinned out, that it is impossible
+to tell. After the womb has contracted to about its normal size, it is a
+very simple matter for any physician to tell exactly the character and
+extent of the lacerations. Most of these tears need absolutely no
+attention; there are a few however that do. This is a very important matter
+for two very good reasons.
+
+1st. Every woman should know, and is entitled to know, just what      [118]
+condition she is in, because if she has been torn to an extent that needs
+attention, and is left in ignorance of it, her physical health may be
+slowly and seriously undermined and the cause of it may not be understood
+or even guessed at. A woman who becomes nervous and irritable, loses vim
+and vitality, has headaches, backaches and anemia, and no symptoms, or few,
+that point to disease of the womb, will suffer a long time before she seeks
+relief of the right kind, and will be astonished and outraged when she is
+told that it all results from a bad tear of her womb that she knew nothing
+about.
+
+2nd. A physician should in justice to himself insist on this late
+examination, because if a woman is told, at some subsequent time, by
+another physician that she is badly torn, and she was not told of it by the
+physician who confined her, she is very apt to form an unjust opinion of
+his work and to entertain an unfriendly feeling toward him as a man.
+
+Some physicians also, to their discredit, are not slow in permitting an
+unjust opinion of a colleague to be spread around, by preserving a silence,
+when an explanation would result in an entirely different opinion by the
+patient. They permit it to be inferred that the physician was responsible
+for the tear, when such is not the case. No physician on earth can prevent
+a tear of the mouth of the womb and this should be explained to the
+patient. Where the physician is at fault is in the failure to examine his
+patients when it is possible to tell that a tear of any consequence exists.
+If such an examination is made, he is in a position to state that a tear
+exists of sufficient extent to justify careful attention. Immediate
+operation is seldom necessary, and if the patient is comparatively young,
+it may not be wise to operate, because if pregnancy takes place within a
+reasonable time the womb will again tear. She should be told, however, that
+should she not become pregnant during the next three years she should be
+examined from time to time, and if the condition of her womb, or her health
+suggest it, she should have the tear attended to. If after this explanation
+she neglects herself she must blame herself, she will at least have no[119]
+cause to harbor any resentment against her physician who has done all any
+physician is called upon to do under the circumstances. Another important
+reason for finding out the character of the laceration is because these
+lacerations of the mouth of the womb frequently cause sterility.
+
+       *       *       *       *       *
+
+
+                                                                      [121]
+CHAPTER X
+
+NURSING MOTHERS
+
+    THE DIET OF NURSING MOTHERS--CARE OF THE NIPPLES--CRACKED
+    NIPPLES--TENDER NIPPLES--MASTITIS IN NURSING MOTHERS--INFLAMMATION OF
+    THE BREASTS--WHEN SHOULD A CHILD BE WEANED?--METHOD OF WEANING--NURSING
+    WHILE MENSTRUATING--CARE OF BREASTS WHILE WEANING CHILD--NERVOUS
+    NURSING MOTHERS--BIRTH MARKS--QUALIFICATIONS OF A NURSERY MAID.
+
+THE DIET OF NURSING MOTHERS.--A nursing mother should eat exactly the same
+diet as she has always been accustomed to before she became pregnant. If
+any article of diet disagrees with her she should give up that particular
+article. She should not experiment; simply adhere to what she knows agreed
+with her in the past. More, rather than less, should be taken, especially
+more liquids as they favor milk-making. It is sometimes advisable to drink
+an extra glass of milk in the mid-afternoon and before retiring. If milk
+disagrees, or is not liked, she may take clear soup or beef tea in place of
+it. In a general way milk in quantities not over one quart daily, eggs,
+meat, fish, poultry, cereals, green vegetables, and stewed fruit constitute
+a varied and ample dietary to select from.
+
+Every nursing mother should have one daily movement of the bowels; she
+should get three or four hours' exercise in the open air every day; and she
+should nurse her child regularly.
+
+The diet of the nursing mother during the period immediately after
+confinement is given elsewhere.
+
+Alcohol, of all kinds, should be absolutely avoided during the entire
+period of nursing.
+
+Drugs of every variety, or for any purpose, should never be taken unless by
+special permission of her physician.
+
+CARE OF THE NIPPLES.--As soon as the mother has had a good sleep after the
+confinement the nipples should be washed with a saturated solution of [122]
+boracic acid, and the child allowed to nurse. The milk does not come into
+the breast for two or three days, but the child should nurse every four
+hours during that time. There is secreted at this time a substance called
+colostrum. This is a laxative agent which nature intends the child should
+have as it tends to move the bowels and at the same time it appeases the
+hunger of the infant. It also accustoms the child to nursing and gradually
+prepares the nipples for the work ahead of them.
+
+After each nursing the nipples should be carefully washed with the same
+solution and thoroughly dried.
+
+CRACKED NIPPLES.--Cracked nipples often result from lack of care and
+cleanliness. If they are not cared for as described above they are very apt
+during the first few days to crack. They should never be left moist. They
+should be washed and dried after every feeding. If the breasts are full
+enough to leak they should be covered with a pad of sterile absorbent
+gauze.
+
+Nursing mothers should guard against cracked nipples, as they are
+exceedingly painful; frequently necessitating a discontinuance of nursing;
+and may produce abscess of the breast.
+
+TREATMENT OF CRACKED NIPPLES.--In addition to washing the nipples, drying
+them thoroughly, and placing a pad of dry gauze over them after each
+feeding, they should be painted with an 8 per cent. solution of nitrate of
+silver twice daily. Before the next feeding, after the silver has been
+used, they should be washed with cooled boiled water. If the cracks are
+very bad it may be necessary to use a nipple-shield over them while nursing
+for a few days.
+
+TENDER NIPPLES.--Many women complain of the pain caused by the baby when it
+is first put to the breast. These nipples are not cracked, they are simple
+hypersensitive. They should be thoroughly cleansed and dried as above and
+painted with the compound tincture of benzoin. They should be washed off
+with the boracic acid solution before each feeding. After a few days under
+this treatment the tenderness will leave them.
+
+MASTITIS IN NURSING MOTHERS.--When inflammation of the breast takes   [123]
+place in a nursing mother it is the result of exposure to cold, or it may
+result from injury. If infection occurs and an abscess develops, it results
+from the entrance, through the nipples, or cracks, or fissures in the
+nipple, of bacteria into the breast. There is fever, with chills and
+prostration, and very soon it is impossible to nurse the child because of
+the pain. Nursing should be immediately discontinued, the breast supported
+by a bandage and the milk drawn, with a breast pump, at the regular nursing
+intervals. An ice-bag should be constantly applied to the painful area and
+the bowels kept freely open with a saline laxative. When the fever and the
+pain subside nursing may be resumed.
+
+If the gland suppurates in spite of treatment it must be freely opened and
+freely drained.
+
+WEANING
+
+WHEN TO WEAN THE BABY.--Medically there is no exact time at which the baby
+should be weaned. Certain conditions indicate when it should be undertaken.
+It is desirable to wean the baby between the tenth and twelfth months. A
+month or two one way or another will not make much difference if the mother
+and child are in good condition. It should be weaned between the periods of
+dentition rather than when it is actively teething. The time of year is
+important. It would be better to wean it before the hot weather if it is
+strong and has been accustomed to taking other food than the breast milk.
+On the other hand it would be decidedly better to defer the weaning until
+the fall, rather than risk weaning at the tenth or twelfth months if these
+fall during the height of the hot weather.
+
+METHODS OF WEANING.--The best way to wean is to do it gradually. It is not
+desirable to take the mother's milk away suddenly unless there is a very
+good reason for it. The child should be fed small portions of suitable
+other food at the beginning of the tenth month. By the end of the tenth
+month he should be taking a feeding two or three times a day of food other
+than the breast milk. This feeding may be given in a bottle. In some  [124]
+cases the mother may be able to feed the child with a spoon instead of the
+bottle. The substitute feedings allowable at this age are given in another
+chapter.
+
+TIMES WHEN RAPID WEANING IS NECESSARY.--There are times when the child must
+be weaned suddenly, as, for example, at the death of the mother, serious
+sickness of the mother, or in cases where for any cause the mother suddenly
+loses her milk. In these cases it is best to wean at once. If an infant
+refuses to take the bottle under such circumstances, the best plan to
+adopt, and the wisest one in the long run, is to starve the child into
+submission. If he gets absolutely nothing but the bottle he will shortly
+take it without protest. If a meddling individual attempts to feed the
+child some other food and tries to coax it to take the bottle in the
+meantime, much harm may result; it is safe only to fight it out for a day
+or two and win than to half starve the child and lose in the end.
+
+The child should be weaned if it is not gaining in weight. This may
+indicate a deficient quality of the mother's milk, or it may indicate a
+lack of proportion between the child and mother. If a robust child is
+depending upon the nourishment furnished by a mother who is not in good
+physical condition the milk may not be adequate in quality and quantity.
+The child will not therefore develop normally and it may be necessary to
+wean it.
+
+If the mother becomes pregnant it will be necessary to wean, because
+pregnancy invariably affects the quality of the milk. It is a very good
+habit to accustom the child to take its daily supply of water from a bottle
+from a very early age. This procedure will make it easier to wean at any
+time.
+
+Menstruation is not an indication for weaning as has been explained. If,
+however, the return of menstruation affects the milk so that it disagrees
+with, or fails to satisfactorily nourish the child, it may be necessary to
+wean, but not unless.
+
+The best reason for weaning a child at the twelfth month is that a mother's
+milk after that time is not adequate in quality for a child of that age. A
+child at one year of age has grown beyond the capability of its mother[125]
+to nurse it: nature demands a stronger and a more substantial food than any
+mother can supply. A mother who nurses her child beyond that period is not
+only injuring herself, but she is cheating her child. The exception to this
+rule is, as has been explained, the second summer.
+
+The child will evidence its dissatisfaction with the breast supply if it is
+not enough; it will not gain in weight, it will be irritable and fretful,
+it will tug long and tenaciously at the nipple, it will be unwilling to
+cease nursing after it should have finished, and it will drop the nipple
+frequently with a dissatisfied cry. These are all signs of insufficient
+nourishment, and to the observant mother they will at once indicate that
+the child must be weaned and fed upon a mixed diet.
+
+CARE OF BREASTS WHILE WEANING CHILD.--The process of weaning should cause
+little or no discomfort. If the weaning is gradual it is necessary to press
+out enough milk to relieve the tension from time to time. It usually takes
+three or four days.
+
+If it is necessary to wean abruptly, as it is occasionally, there may be
+considerable distress. In these cases it is necessary to massage the
+breasts completely,--until all the milk is out, or as much as it is
+possible to get out,--then rub the breasts with warm camphorated oil, and
+bind them firmly. When the breasts are massaged for any reason, the rubbing
+should be toward the nipple and it should be done gently. If there are any
+hard lumps, or caked milk, in the breasts, they must be massaged until
+soft, and the binding renewed. It may be necessary to repeat this process
+for a number of days. In binding the breasts use a large wad of absorbent
+cotton at the sides, under the arms, to support the breasts, and another
+wad between the breasts. This renders the binding more effective; permits
+the binder to be put on tighter; and prevents it from cutting into the
+skin. When weaning has to be done quickly the patient should absolutely
+abstain from all liquids. A large dose of any saline, Pluto, Apenta, or
+Hunyadi Water, or Rochelle salts, or Magnesium Citrate, should be given
+every morning for four or five days. [Page 126]
+
+If the weaning is gradually undertaken the child should be allowed to nurse
+less frequently. One less nursing every second day until two nursings daily
+are given. Keep the two daily nursings up for one week and then discontinue
+them, after which the above measures may be adopted. To dry the milk up,
+the breasts may be anointed with the following mixture: Ext. Belladonna, 2
+drams; Glycerine, 2 ounces; Oil of Wintergreen, 10 drops.
+
+NERVOUS NURSING MOTHERS.--Nervousness, considered not as the product of a
+diseased condition, but as a temperamental quality, is an unfortunate
+affliction in some nursing mothers. Let us illustrate just how this
+characteristic is detrimental to the helpless baby. A mother was instructed
+to give her baby a half teaspoonful of medicine one-half hour after each
+feeding. She was told how to give it, and how to hold the baby when giving
+it. She was also told that the baby would not like it, and would try to
+eject it from its mouth rather than swallow it, and that when it did
+swallow it, it would make a little choking noise in its throat, but not to
+mind these, to go ahead and give it, as the baby could not strangle or
+choke. It was essential to give the baby this medicine, and hence the
+physician explicitly instructed her in these details. What was the result?
+On the following day when the physician called, and found the baby much
+worse, the mother said: "Oh, doctor! I couldn't give the medicine, the baby
+wouldn't take it, she nearly strangled to death when I tried to give it."
+The physician asked for the medicine and placing the baby over his knee,
+gave it without the slightest trouble, much to the mother's amazement. The
+servant girl who was a hard-headed, cool, Scotch girl, was instructed and
+shown how to give the medicine, which she did successfully. The mother was
+temperamentally nervous, was easily excited and became helpless the moment
+the baby objected, though she was a strong, robust, healthy woman.
+
+Another mother was carefully instructed to drop into the eye of her baby
+two drops of medicine every four hours. She was told and apparently
+appreciated the urgent necessity of the medication as her baby's eye  [127]
+was badly infected. She was further told that if she did exactly as shown,
+the eye would be better in two or three days, and if she did not, the other
+eye would become infected, and blindness might result. She undertook to
+carry out the directions faithfully. She absolutely failed, however, to
+carry out the instructions. Her husband informed the physician on the
+following day that she became so nervous and excited that she utterly
+failed to treat the eye once, and when he and a sister offered their
+assistance she became so unreasonable in her fear that "they might hurt the
+baby" that it was impossible to do anything with her. Her sister was
+finally shown how to do it and carried the case through quite successfully.
+
+Inasmuch as this book is intended to convey helpful instruction to every
+mother, the author would suggest to those of this type the necessity of
+resisting this tendency. It is a matter of will power, just make up your
+mind not to be silly and if you find that you cannot trust yourself to
+follow instructions, let someone else do it. When the physician tells you a
+certain thing must be done, and that no harm can result, do it, and don't
+imagine all kinds of impossible happenings.
+
+So much anguish and annoyance is caused in this world by imagining and
+anticipating trouble, that half the pleasure of life is denied us. You
+cannot do your whole duty by a helpless baby if you do not reason and act
+upon sound judgment. Many babies are lost by mothers being afraid to do
+what should be done, and what they know should be done. It is not what the
+doctor does that brings a baby through a dangerous sickness; it is the
+faithfulness of the nurse in carrying out his instructions that is
+responsible for the outcome. A timid, halting, doubting nurse can quickly
+undo all a physician hopes to accomplish; while a prompt, faithful nurse,
+with initiative, and good judgment, can save a little life in a crisis,
+even in the absence of the physician. Follow instructions implicitly, even
+though the carrying out of the instructions seem to cause the baby pain and
+suffering,--it is for the baby's best interest.
+
+                                                                      [128]
+BIRTH MARKS.--Much has been written on this subject which a later study of
+biology and eugenics have shown to be utterly false. Let us consider the
+actual facts. The baby is already a baby, floating in a fluid of its own
+manufacture. It has absolutely no connection with its mother except by
+means of its umbilical cord,--which is composed of blood vessels. The blood
+in these vessels is the child's blood and never at any time does it even
+mix with the blood of the mother. It is sent along these vessels into the
+placenta, or after-birth, in which it circulates in small thin vessels, so
+close to the mother's blood that their contents can be interchanged. Yet
+the two streams never actually mix. The carbonic acid and waste products,
+in the child's blood, are taken up by the mother's blood, and given in
+exchange oxygen and food, which is returned to nourish the child. There is
+absolutely no nervous connection between the mother and the child. How then
+is it possible for the mother to affect her child in any way except insofar
+as the quality of its nourishment is concerned? Nor can a mother affect her
+child in any other sense. If the intermingling of blood could affect a
+child's education we would frequently resort to surgery. In the article on
+Eugenics, under the heading, "Education and Eugenics," it is explained that
+the child is "created" at the moment of conception; that absolutely nothing
+can affect it after it is created; that no influence of the mother or
+father can in any way affect it for better or worse. A mother cannot create
+in her child any quality which she may desire no matter how she conducts
+herself. It was formerly thought that a mother could for example create a
+musical genius by devoting all her time to the study of music while she
+carried the unborn child; or that she could make a historian of it if she
+studied history; or an artist if she studied paintings. We now know this to
+be wholly wrong and for very excellent reasons.
+
+The mother must realize that the only aid she can bestow upon her unborn
+child is to give it the best possible nourishment. She must provide good
+blood because the quality of the maternal blood stream bespeaks a healthy
+or unhealthy, a fit or unfit, child. Whatever the child is to be is   [129]
+already fixed, its innate characteristics art part of itself. Whether it
+will have the vitality to develop its inherent possibilities depends, to a
+great degree, upon its intra-uterine environment,--and its intra-uterine
+environment depends upon the health of its mother and the quality of the
+blood she is feeding it upon. After birth its health, its success, its
+efficiency, depends upon the care it gets and the quality of its mother's
+milk. A mother therefore must be in good physical and mental health if she
+hopes to do her full duty as a mother.
+
+QUALIFICATIONS OF A NURSERY MAID.--When a helper, or maid, is employed to
+aid in caring for the baby, much precaution should be exercised in
+selecting her. The association of the nursery maid and the child, is
+necessarity an intimate one, and she should be willing to submit to a
+medical examination to prove her physical fitness. Her lungs should be
+examined thoroughly, so also should the condition of her mouth, throat and
+nose be known. An observant and tactful mother will also find out if there
+are any other objectionable conditions existing, which would render her
+unfit for the position. A nursery maid should be naturally fond of
+children, she should be industrious, and sensible; of quiet tastes and good
+disposition. Her work should be a pleasure not a task.
+
+       *       *       *       *       *
+
+
+                                                                      [131]
+CHAPTER XI
+
+CONVALESCING AFTER CONFINEMENT
+
+    THE SECOND CRITICAL PERIOD IN THE YOUNG WIFE'S LIFE--THE DOMESTIC
+    PROBLEM FOLLOWING THE FIRST CONFINEMENT.
+
+The first three or four months following the first confinement is the
+second important period in the young wife's life. In one sense it is the
+most critical period. The first important period you will remember we
+stated to be the first few months after marriage. During these months the
+young wife passed through the period of adaptation. She found out that
+matrimony was not all sunshine and happiness. She learned that her husband
+was not the paragon she had idealized. She discovered his human side. She
+met daily trials and annoyances incident to domestic life. She found her
+level, and, in finding it, she discovered herself. She is not very safely
+anchored yet but she is trying to succeed and the future promises well.
+Some day she awakes to the knowledge that she is pregnant and a multitude
+of new speculations enter into the situation. She finds she must go on
+striving and hoping and praying that she may have the strength and courage
+to do her part. Time passes, and if she is an ordinary woman she scarcely
+does justice to herself. Her duties are exacting, and her physical
+condition is not given the study and care which she ought to give it. She
+does not understand the importance of the hygiene of pregnancy, and the day
+of the confinement finds her more or less exhausted, and worn out. She
+passes through the crisis of maternity, however, and spends the customary
+ten days in bed. At the end of that period the nurse and physician leave
+her to face the most important problem of life alone. She is a mother, and
+has in her exclusive charge a human life.
+
+Let us exactly understand what the real situation is. It would not further
+the object of this book or help in the solution of the problem the author
+has in mind to depict a false situation. We must concede the following[132]
+facts to be true, if we understand the subject:
+
+1. That the mothers of the human race are, in the vast majority, the poor.
+
+2. That they are uneducated in the sense that they are not versed in the
+science of hygiene and sanitation, and consequently health preservation.
+
+3. That even the fairly well educated are innocently ignorant of the
+science of heredity, environment, hygiene, sanitation and health
+preservation.
+
+4. That to benefit the majority we must depict conditions as they exist
+among the poor, and reason from that standard.
+
+Such books as have been written on this subject have based their facts upon
+too high a plane. Their remedies are beyond the means and the understanding
+of the average poor mother. Their analogies are based upon conditions that
+exist among the better class. The average poor housewife gets no practical
+assistance or help from their deductions, because her environment precludes
+any utilization of the data furnished; the data is not practical in her
+particular case.
+
+Our young mother is in all probability a physically and mentally immature
+girl. She most likely entered the marriage relationship without a real
+understanding of its true meaning, or even a serious thought regarding its
+duties or its responsibilities. She was not taught the true meaning of
+motherhood before actual maternity was thrust upon her. She has probably
+innocently acquired habits which are detrimental to her health and her
+morals; and she has no conception of the fundamental duties of a homemaker.
+Yet into the keeping of this woman a human life has been given.
+
+Her home surroundings are not such as to inspire confidence or from which
+to elicit encouragement. It has been a struggle to make ends meet; to keep
+the peace; to be hopeful and cheerful. If she has succeeded in keeping her
+home neat and clean and comfortable, it has been at the expense of her not
+too robust constitution. If she has made efforts to observe the amenities
+of life, to be true as wife, companion and confidant, it has taxed her[133]
+nerves, her courage and her vitality. She has frequently been at the
+breaking point but she has kept up because she felt it was her duty, and
+because there was nothing else to do.
+
+As she rests from her weary labor during the first long days after getting
+out of bed, the loneliness of it all crushes her. She is weak, nervous, and
+discouraged, and her white, wan face, with its tired, appealing eyes,
+bespeaks her anemic and hopeless condition. She is only a child herself,
+yet fate has crowned her with the holy diadem of motherhood. There are
+thousands of such mothers and yet posterity need not despair. This is just
+the beginning, and from such beginnings have sprung the heroes of the race.
+If the reader has carefully read the chapter on Heredity she will
+understand that the temporary condition of this mother is not important so
+far as the destiny of the child is concerned. The really important question
+is, How will this mother develop? The environment of the child depends upon
+the conditions with which its mother surrounds it. If she is a failure, the
+child's environmental influences will be unfavorable; if she proves worthy
+of her trust, if she progresses and masters her difficulties; if she is a
+good mother and a good homemaker the child's surroundings and influences
+will be favorable to the full development of its hereditary endowment. But
+it must be remembered that even an unfavorable environment need not prevent
+the hereditary promise from dominating the life of the individual.
+
+To return to our girl mother, upon whose slender shoulders the weight of a
+great responsibility rests,--we wish to concede that her burden is great.
+Her home duties are rendered more onerous because of her physical weakness
+and disability. The strain of nursing her fretful child is taxing her
+vitality and her nerves to the limit. Her disposition is imposed upon by
+the exactions of an uncomprehending husband. She is inclined to fretfulness
+and melancholia by the seeming uncharitableness of fate and fortune. Her
+moments of introspection are almost bitter. It is a critical period,--she
+has reached the breaking point. [Page 134]
+
+Such moments are apt to be epochal. The turning of the wheel of fortune
+will decide the destiny of a human soul.
+
+It may be a friend who will supply the needed inspiration that will
+revitalize hope, and courage, and the determination to succeed. Or it may
+be a prayer, breathed in the silence of despair that will inspire the
+courage to fight on, and change the complexion of life.
+
+Once again we would advise such a young wife to calmly think matters over;
+to find out "what she is working for"; to assemble her ideals and to "know
+what she wants." There is nothing organically wrong. It is a condition, not
+a disease. She is discouraged, despondent, nervous and weak. The
+discouragement, despondency, and nervousness is a result of reduced
+physical vitality and lack of system. She is not efficient because she is
+not a trained worker. She is easily discouraged because anemia or
+bloodlessness fails to supply the oxygen necessary to a fight. There is no
+period in a woman's life when she is more apt to fall into a rut than at
+this time. Every element, spiritual and physical, which is necessary to
+stagnation and indifference is present, and it will take a bold and brave
+effort to resist the temptation to failure which has encompassed her.
+
+How can we suggest a remedy? She must first regain her health. She has
+simply a condition to combat, not a disease, and a definite system, a well
+laid out plan strictly adhered to will effect the result. She must regain
+her health, because, without health, she cannot hope to be efficient in
+work or agreeable in disposition, and she owes both to herself, to her
+husband and to her child. She must get out of doors. She must walk in the
+open air. There is absolutely nothing in life that will effect so
+miraculous a transformation in a discouraged, tired, weary and sick woman,
+as systematic daily walks in the open air. She must walk briskly, however,
+and she must desire to get well. We cannot get well if we do not wish to
+get well. One who walks with a purpose will walk erect, firmly and briskly;
+she will hold her chest up, and will breathe deeply, and she will drink in
+hope, and health, and happiness. It takes time to regain strength     [135]
+after the strain of pregnancy and labor. Many women complain that they feel
+weak and do not regain strength quickly, but they make no effort. They must
+make a beginning. Sitting around waiting for it to come will not bring it.
+If they cannot walk a mile, they must walk half that distance to begin
+with; the five mile walk will follow in time. Many young mothers get into
+the habit of taking baby out in his carriage for an airing, and regard this
+as exercise for themselves. They join the baby brigade and parade up and
+down the block, or select a sunny spot where there are others on a like
+quest, and sit around exchanging confidences. These outings usually
+degenerate into gossiping parties and are a dangerous and questionable
+practice. They are no doubt good for the baby, but they are morally and
+physically bad for the young mother. This daily habit is called exercise,
+but it is in no sense physical exercise. The young mother should select a
+certain time each day, immediately after a nursing when baby is likely to
+sleep, and devote this period to walking. One hour each day will accomplish
+much in regaining and establishing health and strength, and appetite for
+the mother. No indoor work can take the place of a walk out of doors. It is
+a duty on the part of the nursing mother to do this. It will enable her to
+supply better milk; it will banish her tendency to nervousness; it will
+ensure a good appetite, good spirits, and sound sleep. It will make her a
+better mother and a better wife. Many young wives sow the first seeds of
+discontent, and ultimate failure during the natural depression that follows
+maternity.
+
+She must adopt system in the performance of her household duties. A good
+plan is to set aside a certain definite time for meals, when to begin
+cooking and when to end washing the dishes. Then arrange regarding the
+general household duties. Make a schedule for a week devoting each day to a
+certain task so that at the end of the week all the essential work will
+have been completed. By systematizing work in this way a great deal of
+ground can be covered and as time passes it will become easier, as many
+helpful ways will suggest themselves whereby time will be economized. [136]
+
+Adopt a system with the baby. Many mothers are worn-out, nervous wrecks for
+no other reason than a lack of system in the management of the daily life
+of their offspring. If system is not adopted in feeding and caring for an
+infant it becomes irritable. To a sick, tired, weary mother an irritable
+child is an unspeakable torture. Begin right. Give it adequate, but no
+unnecessary attention. Nurse it every two hours, and at no other time. Wake
+it to nurse at its regular time. It will in a few days acquire the habit of
+feeding regularly and will sleep between feedings. Do not overfeed it.
+Remember babies never die from starvation, but many do by overkindness, and
+overfeeding is the most prolific cause of infant mortality known. Read the
+article on "How long should a baby nurse?" Keep the baby clean, comfortable
+and happy and you will not have a fretful child, but one that will be a
+constant inspiration and incentive to you.
+
+Find time to rest, take a mid-day nap. Get off occasionally to the country
+or the sea shore for a day or two. Keep up your interest in your personal
+appearance, be neat and clean, and invite the attention of your husband
+during the evening hour. Don't let him grow away from you. Be cheerful,
+encourage him to tell of his hopes and plans, and show an interest in his
+health and in his work. Do not forget the dominating influence on your
+efficiency, and on your happiness which the study habit possesses. Interest
+yourself in some art, cultivate your mind, and soon, sooner than you think,
+you will have forgotten your troubles and you will have regained your
+health.
+
+There is no other way to do it. There is no royal way in which it can be
+done which is not open to the poorest mother.
+
+An ocean voyage, a trip to Europe, a society Doctor, a professional
+masseur, beauty experts and miracle workers cannot accomplish more than you
+can in your poor apartment, if you "go about it in the right way and in the
+right spirit." Keep in mind always, that: "failure exists only in
+acknowledging it." Every task that is worth while is won by self-sacrifice,
+by self-abnegation, by patient, persistent, enthusiastic effort, and in no
+other way. The joy of consummation is reward enough for all human
+sacrifice.
+
+       *       *       *       *       *
+
+
+Corrections made to printed original.
+
+Index: Constipation, in breast-fed infants: 'in-infants' (line-break) in
+original
+
+Ibid.: Gleet; Mucous patches; Pox; Vol II: Vol I. in original
+
+Ibid.: Sanitary napkins; I, 66: I, 63 in original
+
+Ibid.: Sexual intercourse; I, 76: I, 78 in original
+
+Page 23: whether there is such a thing: 'think' (hand-corrected) in
+original
+
+Page 40: recruiting ground for the gangster: 'ganster' in original
+
+Page 65: incident to a confinement: 'confiement' in original
+
+Ibid.: The advantage of the Kelly pad: 'paid' in original
+
+Page 89: the patient should pass: 'pateint' in original
+
+Page 93: Advantages of Putting Baby to Breast: 'Adantages' in original
+
+Page 127: anguish and annoyance: 'anoyance' in original
+
+
+
+
+
+
+End of the Project Gutenberg EBook of The Eugenic Marriage, Volume I. (of
+IV.), by W. Grant Hague, M.D.
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