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Given By 

U. S. S upt. -Doc w vn£ Y\ ts 







Bureau Publication No. 3 









AN ACT To establish in the Department of Commerce and Labor a bureau to 
be known as the Children's Bureau. 

[62d Cong., 2d seBSion. S. 252. Public, No. 116.] 

Be it enacted hy the Senate and House of Representatives of the 
Vmted States of America in Congress assembled^ That there shall be 
established in the Department of Commerce and Labor a bureau to 
be known as the Children's Bureau.^ 

Sec. 2. That the said bureau shall be under the direction of a 
chief, to be appointed by the President, by and with the advice and 
consent of the Senate, and who shall receive an annual compensation 
of five thousand dollars. The said bureau shall investigate and 
report to said department upon all matters pertaining to the welfare 
of children and child life among all classes of our people, and shall 
especially investig/it^ the/i^fuejstioris . of; infant n;ortality, the birth 
rate, orphanage, juvecHe/QoliftSj^-de<sertioii;**daE'g>erous occupations, 
accidents and diseases of children, employment^ legislation affecting 
children in the several States; and Territories. But no official, or 
agent, or representative of said bureau shall, over the objection of 
the head of the fanvty-'eiiter a ay house used "exclusively as a family 
residence. The cki^f of said bur'^au Qwy 'frdrrt time to time publish 
the results of these investigations in such manner and to such extent 
as may be prescribed by the Secretary of Commerce and Labor. 

Sec. 3. That there shall be in said bureau, until otherwise pro- 
vided for by law, an assistant chief, to be appointed by the Secretary 
of Commerce and Labor, who shall receive an annual compensation 
of two thousand four hundred dollars; one private secretary to the 
chief of the bureau, who shall receive an annual compensation of one 
thousand five hundred dollars; one statistical expert, at two thou- 
sand dollars ; two clerks of class four ; two clerks of class three ; one 
clerk of class two; one clerk of class one; one clerk, at one thousand 
dollars; one copyist, at nine hundred dollars; one special agent, at 
one thousand four hundred dollars; one special agent, at one thou- 
sand two hundred dollars, and one messenger at eight hundred and 
forty dollars. 

Sec. 4. That the Secretary of Commerce and Labor is hereby 
directed to furnish sufficient quarters for the work of this bureau at 
an annual rental not to exceed two thousand dollars. 

Sec. 5. That this Act shall take effect and be in force from and 
after its passage. 

Approved, April 9, 1912. 

1 Transferred from Department of Commerce and Labor to Department of Labor, upon 
the creation of the latter by act approved March 4, 1913, 



Letter of transmittal 5 

Scope of the bulletin 7 

City health officials' work in reducing death rate 7 

Lack of adequate funds for carrying on work 9 

Cooperation of health boards with benevolent agencies 11 

Complete and prompt birth registration as a basis for effective work 13 

Morbidity and mortality charts 14 

Inspection of milk supply 15 

Methods in different cities 15 

Recognized grades of milk 18 

Milk stations 20 

Recent increase in number 20 

Not a means of encouraging bottle feeding 22 

Instruction of mothers a necessary feature 22 

Equipment and management 23 

Baby clinics 24 

Operation in certain cities 26 

Little Mother Leagues 30 

Visiting nurses 32 

Value of service in prenatal and postnatal work 32 

Work in different cities 34 

Prenatal work 38 

Effect of housing conditions on infant mortality 41 

Fight against flies, garbage accumulation, dust, etc 42 

Stables and stable flies 42 

Fresh-air camps and hospitals 43 

Educational work through the distribution of circulars, pamphlets, etc 44 

Conclusion 45 

Appendix 47 

How to Save the Babies (circular issued by the New York State Depart- 
ment of Health) 47 

Ten Reasons Why a Mother Should Nurse Her Baby (leaflet issued by the 

New York City Department of Health) 54 

Save the Babies (circular issued by the Pennsylvania Department of 

English 55 

Italian 58 

German 62 

Polish 65 

Yiddish 69 

Slovak 71 

General Directions for Feeding Young Children (circular issued by the 

Providence, R. I., Health Department) 74 



Appendix — ContiBued. Page. 

How to Take Care of Babies (published in French by the Providence, B. I., 

Health Department) 76 

Summer Care of Babies (circular issued by the Bridgeport, Conn., Depart- 
ment of Health) : 

English 79 

Yiddish 81 

Slavish 83 

Hungarian 85 

Italian 87 

Advice to Those About to Become Mothers (leaflet issued by the Provi- 
dence, R. I., Health Department) 90 

To Expectant Mothers (leaflet issued by the Oregon State Department of 
Health) 91 


U. S. Department of Labor, 

Children's Bureau, 
Washington, D. C, June 16, 1913. 
Sir : As a preliminary to more careful study of the work now car- 
ried on in various cities for the prevention of infant mortality, the 
following letter was sent to the mayors of the 109 cities of the United 
States having a population of 50,000 or more each : 

Dear Sie : We are much interested iu ascertaining the prospects of baby- 
saving campaigns for the summer of 1913 in the principal cities of the country. 
May we ask you to give us information as to the organization of your depart- 
ment of health as especially related to the care of infants iu summer? We 
should like esiJecially to have any recent reports that you have made as to 
this service, and to know whether there is to be any enlargement of the service 
over last year; also what special features of your system you would recom- 
mend for general adoption. 

In making this inquiry it was only anticipated that it would secure 
needed information for the office of this Bureau. The replies have 
shown that work of the utmost significance is going on in certain 
cities, while little or nothing is being done in others. In various 
instances city officials have shown much interest in such work and 
have made inquiries as to the best methods of initiating it. 

In view of the interest shown and of the practical value of many of 
the replies received, the Bureau has summed up the information 
contained in them in the following statement as to the summer care 
of babies in certain American cities. The effort has been not to pre- 
sent in any respect an exhaustive report, but to show what is being 
done in various localities and the ways to go about such work. The 
appendix contains examples of circulars in various languages avail- 
able for reproduction. It is intended to follow this preliminary 
statement by fuller bulletins, issued from time to time, showing the 
most advanced methods employed by various communities to safe- 
guard the health of children, with especial reference to the growing 
work of rural health officers and rural nursing. 

Special acknowledgment is made of the services of Mr. Ethelbert 
Stewart, statistical expert of this Bureau, in the preparation of the 
present pamphlet. 

Very respectfully, 

Julia C. Lathrop, Chief. 

Hon. William B. Wilson, 

Secretary of Labor. 



What the American cities are doing and can do toward preventing 
infant mortality and the too common high death rate of children 
under 5 years of age is to be the subject of an annual bulletin by 
the Children's Bureau. The present issue does not claim to be com- 
plete either as to the cities which are giving attention to such work 
or to the scope of their activities ; it is merely a preliminary outline, 
introductory of 'what the Bureau hopes to accomplish in the way of 
acquainting cities with one another, when all cities have come habit- 
ually to report all such activities or lack of them to this Bureau. 

Summer campaigns for babies' lives have been waged with such 
marvelously good effect in some cities, both in this and foreign 
countries, that it seems important to enlist the energies of as many 
cities in this work as possible. To this end it is most important that 
each city should know, in somewhat of detail, just what the other 
cities are doing. Information which represents a large expenditure 
of labor and which is invaluable as demonstrating comparative 
methods in different cities is tied up in reports of local health 
officials which have little or no circulation. To present, for the 
information and perhaps encouragement of all, the results of inves- 
tigation as to the little or much that is being done by the various 
cities, whether directly or through municipal activity in conjunc- 
tion or cooperation with private philanthropies, will be the purpose 
of this annual bulletin on summer campaigns for babies to be issued 
hereafter by this Bureau. 



The Special Public Health Commission of the State of New York, 
which was appointed by Gov. William Sulzer to collect facts, receive 
suggestions, and make recommendations as to changes in the public 
health laws and their administration, in its report to the governor, 
under date of February 19, 1913, makes clear the influence of city 
health officers in reducing the general death rate of cities within the 
last 10 years. It shows the mortality rate per 100,000 in cities of 



the State, including villages of over 8,000 inhabitants, and th© corre- 
sponding rate in rural districts and villages of fewer than 8,000 
inhabitants. " It will be noted," says the report in discussing a 
chart in which the conditions are graphically shown, " that the urban 
death rate, beginning at 1,771 in 1902, falls to 1,466 in 1912. The 
rural and village death rate, beginning at 1,404 in 1902, has slowly 
risen, beginning to exceed the urban death rate in 1909, and since 
that date the divergence between the two in favor of the urban death 
rate has steadily increased." ^Vhile, as Prof. Walter F. Willcox, of 
Cornell University, states, the somewhat more " complete registration 
of rural deaths in later years and the preponderance of population 
of the middle ages in cities, owing to immigration " may account for 
some of the sharpness of the contrast, nevertheless these consider- 
ations leave practically unaffected the general fact indicated by the 
figures, that the urban death rate is falling more rapidly than the 
rural and village death rate. That the- attention given to such mat- 
ters by local health officers, by private charitable societies, and by 
both in cooperation, has reduced the general death rate of cities 
below that of rural districts and villages is certainly a tribute to 
such efforts. It indicates clearly what can be done even with faulty 
organization and meager cooperation and emphasizes the importance 
of more extended and better organized means and method. 

Discussing the reduction of death rates, the report referred to, 
after detailing the work against tuberculosis, says : ^ 

Next largest in the groups of deaths which are to a large extent preventable 
by known and practical methods, is infant mortality. The number of deaths 
from diarrhea and enteritis among those under 2 years of age in 1912 was 

Measures are being taken in a number of cities for reducing infant mortality. 
The first step in a comprehensive plan for the State as a whole is an adequate 
birth registration law, efficiently and uniformly enforced throughout the State. 
The enactment of such a law and the initial steps in its enforcement rest upon 
the State. With knowledge of the number of infants born and the localities 
and the causes of deaths, each village and city of considerable size should, 
when necessary, secure through its health department (a) the instruction of 
mothers during the prenatal period, (ft) competent attendance at childbirth, 
(c) the encouragement of breast feeding, (d) medical supervision of the child 
at stated intervals, whether breast or bottle fed, and (e) pure, clean milk for 
infants for whom maternal nursing is impossible. 

Each city with a population in excess of 10,000 and having an industrial 
population should have one infant-welfare station and larger cities with an 
industrial population should have one such station for approximately each 
20,000 inhabitants. 

There is no doubt that through effective action by the State in securing birth 
registration and in encouraging localities to undertake and effectively to prose- 
cute such infant-welfare work, the number of deaths of children under 2 years 
could be enormously reduced in the immediate future. 

iGov. Sulzer'R Message on Public Health with Report of Special Health Commission, 
transmitted to the legislature Feb. 19, 1913. 


Among the specific recommendations made by the commission and 
approved by the governor in his message to the legislature are: 

Each city, county, village, and town should be given specific authority to 
employ one or more trained nurses to act as infant-welfare nurses, school 
nurses, tuberculosis nurses, and generally at the request of physicians or health 
officers, to visit the sick who are unable otherwise to secure adequate care and 
to instruct other members of the households in the care of the sick. The State 
Public Health Council should establish qualifications of eligibility and condi- 
tions of appointment for such public-health nurses. In larger communities, 
when several nurses are employed, some would doubtless be assigned to one or 
the other of these duties, but in smaller localities all of them may be performed 
by one trained nurse. The advent of trained nursing marks not only a new 
era in the treatment of the sick, but a new era in public-health administration. 

In the city of New York thei*e are in the service of the department of health 
over 300 trained nurses in addition to those employed in hospitals for con- 
tagious diseases. Trained nurses are also employed by health authorities in 
some of the other cities of the State. Three counties and a considerable num- 
ber of cities, villages, and voluntary committees employ tuberculosis nurses. 
An exceptionally interesting account was given to this commission of the 
work of district visiting nurses in the rural communities and villages of north- 
ern Westchester County. These nurses are in the employ of a benevolent cor- 
poration and are supported by private contributions, but in our judgment such 
nurses might equally well be employed elsewhere by local authorities. We 
strongly urge, therefore, that specific authority be given to each city, county, 
village, and town to employ one or more trained nurses for all the public- 
health purposes for which trained nursing has now been found to be practi- 


The principal impediment to efficient work in the health depart- 
ment of most cities is the lack of adequate funds either to pay a suit- 
able salary to the health officer or to provide means for carrying on 
preventive measures intelligently. The New York commission rec- 
ommended minimum salaries to health officers of towns and villages, 
equivalent to at least 15 cents per inhabitant of the village or town. 
This in addition to expense of carrying on the work. 

As a general rule the most effective health service is not accom- 
plished when the annual resources of the department, including 
salary of health officer, falls much below $1 per capita of population. 
In cities of over 100,000, or when a great deal of work is done and the 
expense met by benevolent societies working in cooperation with the 
health department, this per capita is sometimes reduced without crip- 
pling the efficiency of the office. 

That it is worth while to make some effort to arouse such an inter- 
est in saving infant lives as shall force appropriations in some degree 
commensurate with the work to be done is made evident by the fol- 
lowing illustrations of the situation in two States, New York and 
Illinois — States in which certainly the poverty of the taxing bodies 
can not be pleaded in excuse for parsimony. 


Dr. George Thomas Palmer, of Springfield, 111., has collected 
reports from Illinois cities which show that in 44 cities and towns in 
Illinois having a population of 3,000 or over, and averaging about 
16,500 for all, the average salary paid to health officers is $300'. 
Twelve cities, including one with a population of 30,000, another of 
22,000, and one of 21,500, pay nothing. Twenty-one of the 44 cities 
and towns make no appropriation for expense beyond that covering 
the nominal salary of the health officer, if any. 

His report is contained in a paper written by him, entitled " The 
Shortcomings of Municipal Public Health Administration," pub- 
lished in the American City for August, 1911. Some of the strongest 
paragraphs of the report are as follows : 

* * * I have ascertained the facts in 44 Illinois cities of 3,000 population 
or over. * * * of the 44 Illinois cities, we find that 6 have medical com- 
missioners personally responsible for the work of their departments, and 15 
have boards of health with medical officers. That is, 21 of the 44 cities have 
forms of health organization which may reasonably be presumed to afford effi- 
cient service. Of the others, 4 have headless boards of physicians in which no 
one is especially responsible; 1 has a board of physicians with layman health 
officer ; 7 have boards of physicians and laymen with no health officer ; 1 has a 
mixed board with layman health officer; 6 have boards of laymen with no 
medical guidance; and 3 intrust their health affairs to lay health officers with- 
out boards of any kind. One city of 26,000 employs merely a layman health 
officer, while a city of 22,000 has a board of laymen, the police matron acting 
as health officer when she is not otherwise engaged. While 15 of these cities 
exceed 20,000 in population and 3 are over 50,000, not one pays sufficient salary 
to warrant a competent man in devoting all of his time to the health department. 
One city of 59,000 pays $1,500 per year, the highest salary paid to any munici- 
pal health officer in Illinois outside Chicago ; a city of 70,000 pays $1,200, and 
one of 51,000 pays $1,000. Three of the 44 cities pay $900 per annum, 1 pays 
$800 per annum, 5 pay $600, 2 pay $400, 2 pay $300, 7 pay $200, 1 pays $150, 1 
pays $100, 1 pays $75, 4 pay $60, 2 pay $25, and 12 pay nothing at all for public- 
health supervision. The average population of the 44 cities is about 16,500; 
the average salaiy paid to health officers is $300. The 12 cities paying nothing, 
including one of 30,000, one of 22,000, and one of 21,500, should expect nothing 
in the way of protection of the lives and health of their people. A city of 
30,000 which pays $400 per year for its health officer could not expect to receive 
the services of a competent man for more than one-sixth of his time, while a 
city of 25,000 paying $200 per year could not ask a well-qualified officer to de- 
vote a full hour a day to its public-health affairs. I make this estimate on the 
assumption that a competent health officer could be secured to devote all his 
time to the office for $2,400 per year, and it was this assumption I had in mind 
■when I stated that, iu my opinion, every growing city of 20,000 or over should 
employ a competent man constantly in its protective and constructive public- 
health work. 

* * * It may be noted that 36 of the 44 Illinois cities pay less than un- 
skilled workman's wages to their health officers. Applying our third standard 
of preparedness and efficiency — specific appropriation for public-health pur- 
poses — we find that 21 of the 44 Illinois cities have no appropriation, or only 
that for the payment of the nominal salaries of board members and health 


officer. In some of the appropriations given the cost of garbage disposal Is 
incliuletl, making the showing, so far as public-health purposes are concerned, 
far too high. We note, however, that two cities of over 20,000 propose to give 
adequate public-health protection at a cost of $300 per year, while one city has 
no appropriation. 

* * * Of the 44 cities, 29 employ no inspectors; among these one of over 
20,000 pays nothing for its health officer, and another of 10,000 pays its health 
officer $25 per annum. 

The New York situation is described by the Special Health Com- 
mission thus :^ 

There is the widest diversity as to the compensation of town and village 
health officers, except that in nearly every case it is inadequate and in many 
cases ridiculous. In some cases there is a salary, in other cases fees, in some 
cases both, and in a few cases no compensation at all. The average annual com- 
pensation including fees and salaries of health officers of the 771 towns and vil- 
lages represented by the 652 health officers replying to our letter of inquiry 
(652 of a total of 1,032) was $(50.84. The amounts received range from $3 to 
$1,400. Their average amiual compensation (some serving more than one town 
or village) is $71.96. 

There is no reason to believe that New York and Illinois are different 
from other States in this regard. A letter from the clerk of the 
board of health in a city of 687,029 population to this Bureau, dated 
February 20, 1913, says: "I have to advise that the health depart- 
ment has no funds available for organizing a division for the care 
of infants." Another health officer of a city of over 168,000, replying 
to the Bureau's letter asking what plans were being considered for a 
summer campaign against infant mortality, said : " We have been 
unable to get an appropriation from the city council for carrying on 
a campaign of this kind." 

^^-lien the truth of the motto of the New York City Health Depart- 
ment — " Public health is purchasable ; within natural limitations a 
community can detennine its own death rate " — is generally recog- 
nized, it is certain that civic appropriations will become adequate. 


In view of this wide-spread, if not general, lack of appropriation 
to enable health boards to deal with the situation, direct cooperation 
with private benevolent societies has suggested itself and has been 
acted upon with excellent results in many places. Dr. Selskar M. 
Gunn, when health officer of Orange, N. J., said: 

The campaigns against infant mortality in the past have been conducted for 
the most part in large cities, and this is quite natural, as in the large city the 
necessity for worli in this direction is more evident than in the smaller com- 
munity, but I venture to state that in some of our smaller cities the coudi- 

' Gov. Sulzer's Message on Public Health, with Report of Special Public Health Com- 
mission, transmitted to the legislature Feb. 19, 1913. 


tions are almost as serious as in the larger places. * * * The methods of 
approaching and attacking these problems are varied and many. One of the 
first things to be done is for the board of health to establish, if it has neglected 
to do so, good relationships with the various civic organizations that are present 
in the community. I refer particularly to the bureau of associated charities, 
day nurseries, diet kitchens, visiting nursing settlements, and organizations of 
similar character that are working for the good of the community. This is 
very essential in small cities where the board of health does not receive adequate 
financial support from the city fathers, a condition usually to be met. These 
societies can be of very material help in supplying the necessary weapons for 
the attack. Such cooperation will be found particularly useful in all branches 
of public-health work. * * * Many of these organizations are not doing the 
effective work they are capable of because they are not in a position to discover 
the cases which they really should be assisting. They have oftentimes to take 
the cases as they come, irrespective of the real need, and so many who most 
need help are never reached. All of this emphasizes the important fact that in 
small cities the health department should cooperate in every way possible with 
all the private social agencies that are at work in the city. These agencies are 
not infrequently doing work which probably should be done by the health 
department, but which, through the parsimony or false economy of the city 
fathers, can not be undertaken at the present time. * * * Milk deix)ts are 
examples of this.^ 

'\^'Tien, as is sometimes the case, no private agencies exist with which 
to cooperate, the health officer often resorts to agitation to bring them 
into existence. This is done by using the local press to call attention 
to the infant mortality of the place, emphasizing the number of pre- 
ventable deaths each week from causes so largely social in their 
nature that the individual parents can not be considered whollj'^ to 
blame. In thus showing the need of private philanthnopies, directed 
toward the causes of preventable infant mortality, the health officer 
has recourse to his wall charts. In Utica, N. Y., a fusillade of news- 
paper paragraphs calling attention to the fact that the infant death 
rate of that city exceeded that of any other city of its size in the 
State except two, one of which was exceptional because of its hospital 
population, finally brought into existence the Utica Babies' Pure 
Milk and Health Station Association, which most effectively entered 
the campaign against preventable infant mortality in 1912. 

The health officer can, more effectively than anyone else, call 
public attention to the fact that : " The reduction of infant mortality 
is a public-health problem. The basis of responsibility lies with the 
public which must voice its decision through its mouthpiece, the gov- 
ernment."^ In the event of local government neglecting or refus- 
ing, private philanthropies must step in. 

Wlien cooperation is offered with a view to directing and thus 
minimizing wasted effort, it is usually accepted in good spirit. The 

1 Dr. Selskar M. Gunn, Modem Methods of Health Boards in Small Cities, Journal of 
American Public Health Association, May, 1911. 

2 "The Principles of the Reduction of Infant Mortality," by Josephine Bakei, M. D., 
New York Medical Journal of Nov. 25, 1911. 


excellent work being done in Atlanta, Ga., with the exception of 
milk inspection, is private work with municipal cooperation; this is 
also true in Baltimore, Md. ; Columbus, Ohio; Erie, Pa.; Indianap- 
olis, Ind. ; Jacksonville, Fla. ; Newark, N. J.; Washington, D. C. ; 
and many other cities. Probably the most conspicuous examples of 
successful cooperation are those of the New York City Health De- 
partment with the New York Milk Committee and Cleveland, Ohio, 
with the Babies' Dispensary and Hospital. In the report of the 
latter institution for the year ending September 13, 1912, Dr. H. J. 
Gerstenberger writes: 

The success in the reduction of infant mortality in any community depends 
principally upon the following factors : First, the full recognition of the various 
causes of infant mortality and their relative importance ; second, the Ivuowledge 
of the means to remedy these causes and, better still, to prevent them, and the 
application of these means; third, the education of the future pai'ents, physi- 
cians, and nurses ; and fourth, the degree of unity in plans for action existing 
among the various private philanthropies and departments of the municipality 
and State that are more or less directly interested in this subject. 

The outcome of successful private work through the cooperation 
of city health officers is usually to cause the city councils to appro- 
priate sufficient funds to allow the municipality to take over this 
work, gradually sometimes, but eventually completely. This has 
been the experience, for instance, in Bridgeport, Conn., where a pri- 
vate visiting nurses' association established a milk station, demon- 
strating its value to the city, which established two in 1912, providing 
a nurse in connection with them. The Milwaukee division of child 
welfare in the Municipal Health Department is an outgrowth of a 
child-welfare campaign conducted by a commission. This extension 
of municipal control of preventive work through cooperation with 
private associations is being experienced in Reading, Pa; Holyoke, 
Mass. ; Indianapolis, Ind. ; Philadelphia, Pa. ; Boston, Mass. ; Rich- 
mond, Va. ; Jacksonville, Fla.; and many other places. The health 
officer of Jacksonville, Fla., writes : 

We have organized an Infant Welfare Association and are at the present 
time preparing to employ a nurse who shall devote her whole time to that 
worli. She will be under the direction of the welfare association and in con- 
stant touch with this department, from which she will probably receive the 
largest ix>rtion of her calls. 



The plan adopted in some cities toward a summer campaign is to 
arrange for a complete and quick registration of births; to get the 
baby under observation as quickly as possible.^ Even where State 


laws permit much longer time in which to report births, some city 
health officers have made arrangements with physicians and mid- 
wives to give immediate notification of births during the summer 
months. Lists of all physicians and mid wives are presumably kept 
complete at all times, and calling these groups together — separately 
of course — and having frequent conferences wdth them is suggested 
as a great aid in securing speedy notification of births. Sending 
each mother immediately a card or letter stating that the health office 
has been apprised of the birth of her child, as is done in Kansas City 
and other places, has been found to be an effectual means of securing 
the interest of the mother and of spreading sentiment in favor of 
complete registration. Upon receipt of a card or letter the mother 
will comment upon it to other mothers. The mother who has not re- 
ceived such a letter will at once want to know of her physician or 
midwife why her baby was not registered and why she did not get a 
notice of it. Inclosed with this card or letter to the mother many 
cities send a folder containing advice to mothers on the care of babies. 
The health bureau thus gets in with its advice ahead of the neighbors. 
The folders carry, of course, a strong apj^eal for breast feeding and 
give instructions for the care of the breasts and for feeding in case 
breast feeding is impossible. 


The health officer should be the guiding hand in these private activ- 
ities; he has but to call attention to his morbidity and mortality 
charts upon which, with various colored pins, he shows exactly where 
the high death rate is coming from and the causes producing it. 
These wall charts are city ward maps upon which blocks and, if pos- 
sible, lots and buildings are indicated. A colored pin is stuck into 
the map at the proper place for each reported death and for each 
reportable disease return. By means of these pins of various colors 
the relative health conditions of the different localities can be shown 
and the health officer can point out the high death-rate districts, and 
can show the causes which have produced this death rate. As Mr. 
Sherman C. Kingsley. when superintendent of the United Charities 
of Chicago, said : " Where the white hearse goes most often there 
you will find the weakest place in your municipal housekeeping." 
The health officer, from the pins upon his wall chart, can follow the 
route of the bad-milk man and can prophesy very accurately where 

1 Tlie work in Detroit, Mich., is thus described by the health officer : " As to some spe- 
cial features in connection with this work would say that we are looking after the mid- 
wives, boarding out of babies, maternity homes, watching the birth certificates very 
closely, seeing about getting proper registration of births, keeping close watch of the 
death rates, making maps showing where the babies die, in order to direct our work to 
these locations this coming summer." 


the white hearse will go. Summer diarrhea and enteritis in children 
under 2 years is, wherever possible, made a reportable disease during 
the hot months, and reported morbidity from this cause is indicated 
on the wall map. A separate map is frequently used for children's 
diseases. Better results in locating bad-milk routes are obtained 
from studying these morbidity returns than from merely following 
mortality returns. 

Cooperation with private benevolent societies makes itself most felt 
and is most effective when such societies have immediate notification 
of births and of morbidity returns. The best results have been ob- 
tained where there is no waiting for the official formalities; when 
birth notifications, reports of sick babies, and infant death returns are 
immediately' telephoned to the private society. 


A rigid inspection of the milk supply is strictly the province of the 
municipality, and usually the summer campaign against infant mor- 
tality begins, as in Atlanta, Ga., with a " more rigid inspection of the 
milk and dairies during the summer." 

Lists of every milk producer furnishing milk to the city and every 
dealer in the city, whether from wagon or from store, usually kept 
complete at all times, is made subject to vigorous revision, even where 
license is not necessary, and frequent samples from all dealers are 
thoroughly tested, not only for fat but for dirt and bacteria. A num- 
ber of cities that get no further in the way of summer baby saving 
make a complete inspection of dairies and the milk supply during the 
hot months. The importance of milk control in summer months can 
not be overestimated. Health officers are practically as one in the 
opinion that unclean milk, or the improper preparation and care of 
milk in the home, is responsible for a large share of the increase in 
infant death rate that comes with the heated season. It is the city's 
duty to see that the people can buy clean milk ; it is the parent's duty 
to see that the milk is kept clean. The wall charts above referred 
to enable the health officer to locate the bad districts — to get a geog- 
raphy, as it were, of the death rate. 


That the example of Atlanta, Ga., in beginning the summer with 
more rigid inspection of the milk and dairies is followed by many 
cities, the following extracts from letters to this Bureau will attest : 

New Haven, Conn. — We give more close attention to dairy and farm inspec- 
tions and malve a larger number of examinations of milk. 

Salt Lake City, Utah. — We have a vei'y good milk ordinance which is rigidly 
enforced and has a tendency to reduce infant mortality. 


Springfield, 111. — The Department of Health has done nothing toward the 
prevention of infant mortality, except very careful inspection and reinspection 
of dairies for an area (ft 15 miles about the city. 

Seattle, Wash. — In all our milk vrork WQ have endeavored to raise the 
standard of milk production along lines somewhat original. We have first 
sought to make the business profitable by endeavoring, so far as possible, to 
educate the dairyman how to produce the best stock, how to feed the same, 
and in general make the occupation of dairying profitable. We have done this 
primarily so that we might have steady shippers. There is no branch of 
milk production comparable with this in my judgment. A city must strive to 
maintain a shipment of milk from dairymen who are Avell acquainted with the 
laws and ordinances, who on account of experience can produce milk under the 
terms of our ordinances. If a city has a number of dairymen changing from 
one vocation to another, such a milk supply can never be first class. 

Schenectady, N. Y. — During the past year we have made radical changes in 
our milk-inspection work. July 1, 1912, we adopted a new set of rules govern- 
ing the production, sale, and care of milk in the city of Schenectady, after 
having studied the milk question thoroughly. At present we are contemplat- 
ing several further changes, and we hope to get an ordinance which will pro- 
hibit milk being dipped on the streets and of enforcing the sale of bottled milk 
only. In fact, we are trying to get our milk-inspection system as near the ideal 
as possible. When all is said, perhaps the most important factor of a baby- 
saving campaign is pure milk. 

To trace the cases of intestinal diseases from the cow or the dairy 
farm to the nursing bottle of the infected child, just as was done in 
ikio, case of diphtheria in the towns of Dorchester, Milton, and Hyde 
Park, Mass., is a very effective and conclusive method of securing 
ordinances which permit either the establishment of municipal milk 
supply or complete control of private sources.^ 

Cartoons descriptive of well-known local conditions are always 
good to emphasize local needs. The Chicago Health Department 
very effectively illustrates the superiority of breast feeding by a 
cartoon which it calls " The Long and Short Haul," which is repro- 
duced on the opposite page. Local illustrations along similar lines 
have been made very effective elsewhere. 

The larger cities, such as New York, Chicago, Boston, Philadel- 
phia, and particularly Washington, D. C, have made every effort 
to control the milk supply from its source. 

The following quotation from "The Milk Question," by M. J. 
Rosenau, gives some idea of the problem involved in a survey of the 
milk supply for large cities : 

The extent to which this separation of consumer and producer has taken 
place in the milk industry is patent when we recall that Boston gets most 
of its milk supply outside of a 50-mile circle, and some milk starts 243 miles 
from the city. New York receives practically no milk within 50 miles, and 

1 See Monthly Bulletin of the State Board of Health, Mass., May, 1907, Vol. II, No. 5, 
p. 117 ; also Bulletin 56 of the Hygienic Laboratory, U. S. Public Health Service, entitled 
" Milk and its Relation to the Public Health," p. 36. 









The Long 


The Short Haul 

70 percent of city babies get their 
food through a tube 60 miles long. 

It takes about 36 hours — often 
42 hours — for the milk to run from 
the cow end of the tube to the 
baby end of the tube. 

This tube is open in many places 
and baby's food is frequently pol- 
luted. It is often wrongly kept b 
overheated places. 

Then there may be a diseased 
cow at the country end of the tube. 

And Yet Some People Wonder Why 
So Many Babies Die ! 

On the other hand the mother- 
fed baby gets its milk fresh, pure 
and healthful — no germs can get 
into it 

To Lessen Baby Deaths Let Us Have 
More Mother-Fed Babies. 

You can't improve on God's plan. 
For Your Baby's Sake— Nurse It! 




w M ^^ 



Chicago Health Department Educational Poster No. 72. Designed by Dr. C. St. Clair Drake. 
94219°— 13 2 


some of its supply comes from points as far away as 400 miles. New York 
City uses about 1,600,000 quarts of milk a day, derived from 40,000 dairy 

Most of the milk supply of Chicago is produced within 60 miles of the city. 
A 100-mile circle about the city would include nearly all the dairies producing 
its supply. In times of exceptional scarcity in summer sweet cream is shipped 
200 miles. The production of Chicago's milk within such a short distance 
of the city is in marked contrast with conditions in Boston and New York. 
Chicago uses about 1,000,000 quarts of milk a day. The health commissioner 
estimates that, in 1910, 120,0(JO milch cows were necessary to furnish the city 
supply, making an average production of 6.3 quarts per day per cow. 

The District of Columbia consumes about 76,000 quarts of milk a day, or 
about 0.4 of a pint per capita. TTiis milk is produced on 1,091 dairy farms 
from 17,688 cows. About one-third is brought in by wagons and two-thirds by 
steam and electric railroads. The cream is largely received from Pliiladelphia 
and New York. 

Smaller cities or cities situated in the center of rural districts do 
not, of course, have a problem so serious as this. Nevertheless, the 
survey and control of the milk supply is not the province of private 
philanthropies and should not be expected of them.^ 


Beyond milk inspection and survey of the milk supply, the next 
step is the establishment of milk depots to furnish pure milk for 
babies who for any reason can not be breast fed. The health depart- 
ment usually examines and certifies the character of the milk. The 
milk is usually graded in three classes: (1) Certified milk, (2) in- 
spected milk, and (3) pasteurized milk, and these classifications are 
embodied in the laws or the regulations and enforced by public-health 

The following definitions or specifications for the grades of milk 
named are taken from a paper on " The Classification of Market 
Milk," by Dr. A. D. Melvin, chief of the Bureau of Animal Industry, 
United States Department of Agriculture, published in Hygienic 

1 There are, of course, numerous private publications on methods of dairy and milk 
inspection. Health officers will, however, find most concise and helpful " Twenty Dairy 
Suggestions with Special Reference to Sanitation," a stable placard obtainable from the 
Bureau of Animal Industry, United States Department of Agriculture. In " Municipal 
Ordinances, Rules, and Regulations Pertaining to Public Hygiene," reprint from Public 
Health Reports, No. 70, of the U. S. Public Health Service, Washington, 1912, will be 
found ordinances and regulations from a large number of cities (pp. 70-150), from which 
a satisfactory ordinance could be selected or drafted to suit any locality. The city ordi- 
nance of Berkeley, Cal., contains a score card used in grading dairies. Other reports pub- 
lished by the U. S. Public Health Service which health officers will find extremely useful 
are " Milk and Its Relation to Public Health," issued as Hygienic Laboratory Bulletin 
No. 56, second edition, 1912, and " Methods and Standards for the Production and Distri- 
bution of ' Certified Milk,' " reprint from Public Health Reports, No. 85, 1912. The 
Bureau of Animal Industry is sometimes able to help raise the standard of local condi- 
tions, by sending, upon request of a city or State health officer, an expert to assist in 
making a survey of the milk and milk supply. 


Laboratory Bull. No. 56, second edition, 1912, entitled " Milk and Its 
Eelation to the Public Health," pp. 608-610 : 

Class i: Certified milk. — The use of this term Should be limited to milk 
produced at dairies subjected to periodic inspection and the products of which 
are subjected to frequent analyses. The cows producing such milk must be 
properly fed and watered, free from tuberculosis, as shown by the tuberculin 
test and physical examination by a qualified veterinarian, and free from all 
other communicable diseases, and from all diseases and conditions whatsoever 
likely to deteriorate the milk. They must be housed in clean and properly 
ventilated stables of sanitary construction and must be kept clean. All persons 
who come in contact with the milk must exercise scrupulous cleanliness and 
must not harbor the germs of tyi)hoid fever, tuberculosis, diphtheria, or other 
infections liable to be conveyed by the milk. Milk must be drawn under all pre- 
cautions necessary to avoid infection and be immediately strained and cooled, 
packed in sterilized bottles, and kept at a temperature not exceeding 50° F. 
until delivered to the consumer. Pure water, as determined by chemical and 
bacteriological examination, is to be provided for use throughout the dairy farm 
and dairy. Certified milk should not contain more than 10,000 bacteria per 
cubic centimeter, and shwild not be more than 12 hours old when delivered. 
Such milk should be certified by public health oflScers or by some other prop- 
erly constituted authority. 

Class 2: Inspected milk. — This term should be limited to clean raw milk 
from healthy cows, as determined by the tuberculin test and physical examina- 
tion by a qualified veterinarian. The cows are to be fed, watered, housed, and 
milked under good conditions, but not necessarily equal to the conditions pi*e- 
scribed for class 1. All persons who come in contact with the milk must exer- 
cise scrupulous cleanliness and must not harbor the germs of tn^hoid fever, 
tuberculosis, diphtheria, or other infections liable to be conveyed by the milk. 
This milk is to be delivered in sterilized containers and is to be kept at a 
temperature not exceeding 50° F. until it reaches the consumer. It should con- 
tain not more than 100,000 bacteria per cubic centimeter. 

Class 3: Pasteurized milk. — Milk from dairies which do not comply with the 
requirements specified for classes 1 and 2 should be pasteurized before being 
sold, and should be sold under the designation " pasteurized milk." Milk for 
pasteurization should be kept at all times at a temperature not exceeding 60° F. 
while in transit from the dairy farm to the pasteurizing plant, and milk after 
pasteurization should be placed in sterilized containers and delivered to the 
consumer at a temperature not exceeding 50° F. 

All milk of unknown origin should be placed In class 3 and subjected to 
clarification and pasteurization. No cow in any way unfit for the production 
of milk for use by man, as determined upon physical examination by an author- 
ized veterinarian, and no cow suffering from a communicable disease should 
be permitted to remain on any dairy farm on which milk of class 3 is pro- 
duced, except that cows which upon physical examination do not show physical 
signs of tuberculosis may be included in dairy herds supplying milk of this 

This milk is to be clarified and pasteurized at central pasteurizing plants, 
which should be under the personal supervision of an oflicer or officers of the 
health department. These pasteurizing plants may be provided either by private 
enterprise or by the municipality, and should be located within the city. 

By the term " pasteurization," as used herein, is meant the heating of milk 
to a temperature of 150° F. or 65° C. for 20 minutes, or 160° F. or 70° C. for 10 


minutes, as soon as practicable after milking, in inclosed vessels preferably 
the final containers, and after such heating immediate cooling to a temperature 
not exceeding 50° F. or 10° C. 

Other conditions. — No milk should be regarded as pure and wholesome which, 
after standing for two hours or less, reveals a visible sediment at the bottom of 
the bottle. 

No dairy farm should be permitted to supply milk of a higher class than that 
for which its permit has been issued, and each dairy farm supplying milk of a 
specified class should be separate and distinct from any dairy farm of a differ- 
ent class. The same owner, however, may supply different classes of milk, pro- 
viding the dairy farms are separate and distinct. 

The term " milk " as herein used includes cream. 

The New York City Board of Health adopted the following reso- 
lutions in regard to the sale of " loose " or " dipped " milk, on 
September 17, 1912, effective on June 1, 1913 : 

Whereas the interest of the public health requires that milk should be 
protected from contamination by human agencies and by dust, dirt, and flies; 

Whereas many of the premises in the city of New York where milk is sold 
by dipping from cans are grocery stores in which foods and food products and 
other commodities not in sealed packages are sold in a manner which causes 
much dust; and, 

Whereas the facilities for proper icing, the proper cleansing of utensils, 
and the proper protection from flies are often inadequate in such stores, many 
of which are so arranged that the living rooms open directly into the store: 
Therefore be it 

Resolved, That after June 1, 1913, the sale of milk dipped from cans will be 
permitted only in milk stores approved by this department, and for which a 
permit has been issued, or in places in which foodstuffs, other than milk prod- 
ucts, are sold in original packages only. 


A constantly increasing number of cities of all sizes are establish- 
ing milk stations and dispensing milk, whether pure whole milk, 
certified, modified, pasteurized, or sterilized milk, to mothers of 
babies that must be bottle fed. The U. S. Public Health Service, 
published a compilation ^ from schedules received by that Service 
from certain cities in which such work is being carried on. The re- 
port covers 43 institutions located in 30 cities of over 50,000. These 
cities are Albany, Baltimore, Boston, Buffalo, Chicago, Dayton, De- 
troit, Hartford, Honolulu, Indianapolis, Kansas City, Mo., Lawrence, 
Louisville, Lowell, Milwaukee, Newark, New Bedford, New Haven, 
New York City, Peoria, Pittsburgh, Providence, Rochester, St. Louis., 
Springfield, Ohio, Washington, D. C, Waterbury, Wilkes-Barre, 
Worcester, Yonkers. 

1 " Data Regarding the OpciJition of the Infants' Milk Depots in the United States." 
Reprints from Public Health Reports No. 64, U. S. Public Health Service. 


Twenty-nine of the institutions are maintained by private benevo- 
lence; 11 did not report on this point; while one was reported as 
maintained partly by private means and partly by public appro- 

Forty-three of the institutions mentioned distribute milk, 23 of 
them to infants only, and 20 to both infants and adults. At some 
depots the milk supplied is for expectant or nursing mothers, thus 
contributing indirectly to the welfare of the children. 

Of the 36 institutions furnishing information as to the average 
age of the children fed, in the majority the children are under 1 year 
of age, and in practically all they are under 3 years. 

At 30 of the institutions reporting, literature on infant hygiene 
is distributed with the milk; one of the circulars is issued in seven 
languages. Twelve institutions distribute no literature, and one insti- 
tution distributes practically none. 

Every institution which reported except one takes special measures 
for the education of mothers in infant hygiene. These instructions 
are given by physicians and nurses or by means of literature or by 
both. In 2 cases the educational work was carried on in the homes; 
in 2 only at central stations; in 38 both in the homes and at central 

The letters received by the Children's Bureau indicate a number of 
cities of the class named having milk stations in 1912, or intending 
to establish them in 1913, not in this tabulation. Salem, Mass., for 
instance, has conducted a certified milk station for four summers and 
continues it for 1913. During the 60 days of 1912 in which it was 
operated, 35,863 feedings were dispensed to an average of 66 cases 
per day. Of course, a large number of cities under 50,000, and many, 
like Montclair, N. J., under the 25,000 class, have excellent milk sta- 
tions and are doing splendid work along many child-saving lines. It 
is the intention of this Bureau to obtain, so far as possible, complete 
returns from all cities and towns having more than 15,000 inhabitants 
and to present the result of the investigation in tabular form in next 
year's bulletin. 

The magnitude of the movement in New York City is shown in the 
report on " Milk Stations " issued by the Clean Milk Association. In 
nothing is the importance of cooperation between the municipal 
health office and private philanthropies and civic associations so ap- 
parent as in this matter of summer milk supply. "Wliere municipal 
milk stations and municipal milk supply are impossible it is never- 
theless usually possible to organize a local charity that will supply 
the needed funds for a sufficient number of pure-milk stations. The 
experience of Utica, N. Y., previously referred to in this report, could 
no doubt be duplicated in scores of cities from which reports have 
not yet been received. The frequent and persistent publication of the 


local infant death rate and its relation to the nature of the milk 
supply will sooner or later arouse sufficient public interest in any 
locality to insure to the health office sufficient funds and cooperation 
to apj^ly the remedy. 


Usually the first step taken toward a summer campaign for saving 
babies' lives, whether by a municipal health department or by private 
benevolence, is to establish a pure-milk station. Since the largest 
part of the summer infant mortality comes from bottle-fed babies 
and is traceable to dirty milk, the pure-milk station suggests itself as 
the most obvious and direct remedy. From a number of sources, how- 
ever, comes a warning that the pure-milk station as a separate institu- 
tion must not be too much accentuated. The danger comes from the 
fact that it deals only with bottle-fed babies. Since a bottle-fed baby 
has only one-tenth the chance to live that a breast-fed baby has, it is 
perfectly natural that preventive efforts should first be directed to- 
ward the most potent causes of high death rate, but there may be and 
in some places there have been certain attending dangers where the 
furnishing of milk has been the only thing attempted. On this ac- 
count in many, if not most, milk stations positive proof is required 
that the mother either can not or ought not to nurse her baby be- 
fore she can get the pure milk, and this precaution has been found 
necessary in order to prevent an increase in bottle feeding in the com- 
munity as a result of the feeling of greater safety which the pure- 
milk station gives to mothers who, while perfectly able to nurse 
their children, would prefer, for insufficient reasons, not to do so. It 
is never intended that there should be less insistence upon the duty of 
breast feeding because of the milk station, for while the death rate 
{imong the bottle fed is reduced by pure milk, the death rate among 
the bottle fed from the purest milk possible is still much higher than 
the death rate among the breast fed, and if there is any perceptible in- 
crease in bottle feeding as against breast feeding because of the milk 
station the latter might thus become an agency to increase rather 
than decrease infant mortality. 


It has been the experience of practically all milk dispensaries that 
it is useless to send pure, clean milk into a dirty home to be handled 
by an ignorant, dirty mother or older child. It is necessary to reach 
the mothers, and not only to teach them how to care for the baby's 
milk, but to convince them of the necessity of cleanliness where the 
baby's food is concerned — convince them of the deadliness of dirt, 
especially of dirty milk. 


In many cities it is believed that the principal good to be derived 
from milk stations consists in the opportunity given for those in 
charge to. come in contact with the mothers and with the home sur- 
roundings of the babies in the high death-rate districts. The nurse 
and the physician in consultation with the mother thus become a 
necessary adjunct of the milk station. No milk, however pure or 
clean, agrees at all times with all babies, and the distribution of 
modified milk become necessary almost immediately in a number of 
cases. To modify the milk to serve the needs of a given child that 
child's case must be studied ; hence the child clinic, which almost at 
once grows out of the necessities of the milk station. 


A milk station is simply a room from which pure milk is given out 
for the use of babies that can not be breast fed. The best location is 
in or as near as possible to the congested part of the city. It is only 
necessary that the room shall be sufficiently large to accommodate the 
patrons and the equipment and that it be light and clean. In the case 
of Utica, N. Y., for instance, the first milk station was opened in a 
schoolhouse, and it would seem that schoolrooms, thoroughly scrubbed 
and cleaned, might more generally be turned into this use during the 
summer vacation. The equipment is simple: A good ice box, large, 
and kept clean, a desk, some chairs, and a table. The walls and wood- 
work are usually painted white, and the floor is covered with linoleum, 
which makes easier the task of keeping it clean. 

Signs in large letters and in all needed languages are usually put 
up, stating that pure milk is furnished at the lowest possible price 
(sometimes free to the poor), for the use of babies only. Most cities 
find it better to sell the milk at practically the ordinary price at 
which milk is sold in the city. This avoids conflict with the dairy 
interests, and allays the suspicions of the ignorant, that the pure- 
milk station is but a scheme to get higher prices. The following 
from the report for 1910 of the Babies' Milk Fund Association, of 
Louisville, Ky., is illustrative of the practices and experiences of all : 

At each of the seven stations certified milk was sold below cost for tbe chil- 
dren of the poor. The regular retail price of certified milk, 12^ cents a quart, 
being prohibitive in our station neighborhoods, we made our price at first 8 
cents a quart, meeting exactly the price of the ordinary market milk our pa- 
trons had been accustomed to buy, and raising our price to 9 cents later, when 
market milk was advanced to that price by the retail dealers throughout 
the city. 

We paid 10 cents a quart for this certified milk, and so we lost at first 2 
cents, later 1 cent, on every quart sold. 

The modified milk, which costs the association about 17 cents a day for each 
baby, was sold for 10 cents a day. 


While payment of our low charges was exacted of all families able to pay, 
the milk was furnished entirely free of cost to those unable to pay, and to some 
others at half price, when the applicants were recommended after careful in- 
Aestigation by the Associated Charities or the Federation of Jewish Charities. 


It has been found generally advisable to put the milk station in 
charge of a competent nurse, who is on duty at the station during 
stated hours of the day to distribute the milk. In many cases she 
finds it imperative to give mothers instructions in the care of the 
milk in the home — for pure milk will not stay pure in a dirty home if 
it is exposed — and as well to teach them how to take care of their 
babies. Thus, the milk station unavoidably and inevitably becomes 
a " consultation," like the French institution of the same type. A 
consulting nurse is the first feature ; later, in most cases, " modified 
milk " is added to the pure milk supply ; with modified milk comes 
the frequent necessity of bringing certain babies to the station to 
be examined by a physician for the purpose of determining just how 
the milk should be modified to meet the case. And thus begins the 
" baby clinic," all as the inevitable outgrowth of the milk station. At 
first, milk modifications proceed along the line of a few formulae, 
and graded by numbers this milk is furnished according to the 
age or apparent condition of the child. The tendency here, of 
course, is to diagnose the child to fit the milk, as Dr. Newmayer 
says : " Modified-milk stations with set formulae Nos. 1, 2, 3, try to 
make the baby fit the milk modifications instead of the milk to fit 
the baby." But this does not usually last long and seldom becomes 
serious. The baby clinic soon becomes a recognized necessity of the 
modified-milk dispensary, and out of this grows the visiting-nurse 
S3^stem, since the nurse must go to the mother's house and teach her 
how to modify the milk for her particular baby according to tlie pre- 
scription given by the physician at the clinic. 

Although the methods employed in the conduct of infants' milk 
depots have varied somewhat both in this country and abroad, their 
objects have been the same. It is recognized that all milk dispensed 
should be produced and transported under conditions insuring a 
product of the highest purity, that it should be prepared and modi- 
fied in the depot under medical supervision, and that strict bac- 
teriological precautions should be taken in every step of the process. 

In addition to the care exercised in the depot, the milk is packed 
in a manner to guard against contamination in the home. Each 
bottle contains but one feeding, and is so designed that it will not 
stand on end, and therefore can not be left standing open. 


The milk is modified in accordance with standard fonnulae in use 
at the various depots, and. in addition, special modifications are made 
upon the prescriptions of physicians. 

The following are formulae now in use at the Straus milk depots 
in New York: 

Formulw for viodified milks. 

Formula No. 1 (Dr. Arthur R. (ireen) : Ounces. 

Milk 96 

Cane sugar 2.5 

Salt . 083 

Oat water 32 

Formula No. 2 (Dr. Rowland G. Freeman) : 

Milk 64 

Limewater 4 

Milk sugar 6 

Filtered water 60 

Formula No. 3 (Dr. A. Jacobi) : 

Milk 64 

Barley water 64 

Cane sugar 4 

Table salt *30 

Formula No. 4 (Dr. Rowland G. Freeman) : 

Cream (16 per cent) lOf 

Milk 21i 

Milk sugar 6^ 

Limewater 4 

Filtered water 92 

Formula No. 5 (Dr. Arthur R. Green) : 

Cream (16 per cent) 4 

Milk 16 

Limewater 6 

Milk sugar 6 

Filtered water 102 

The three former mixtures are placed in 6-ounce bottles, the two 
latter in 3-ounce bottles and pasteurized by exposure of 20 minutes 
to 157° F. Whole milk is also pasteurized in 8 and 16 ounce bottles. 

Practically all infants' milk depots in the United States are under 
general medical supervision, and, in addition, many depots are in 
direct charge of grajduate nurses who prepare the milk and give 
instructions to mothers in the care of infants. In some instances, 
visiting nurses also enter the homes of the children for the purpose 
of imparting instruction. 

It frequently happens that several physicians will volunteer to 
give a few hours each week to the baby clinics, and when this is 
done the clinics are held at the milk station, at stated hours, either 
daily or on certain days, the hours being made to conform to the 
proffered services of physicians. Tlie baby clinic necessarily develops 
into a mothers' " consultation " and these usually lead to the public 

1 Grains. 


lectures to mothers which, although held in connection with the gen- 
eral organization controlling the milk stations, are themselves given 
in a church or a schoolroom. The natural growth of the work and 
methods is perhaps best seen by the following description of develop- 
ments in the case of a few typical cities, such as Indianapolis, New 
York, and Philadelphia : 


Campaign in Indianapolis. — An interesting letter, accompanied by 
a report on the work of the stations comes from Indianapolis. Dr. 
H. G. Morgan, health officer, writes : " The Indianapolis City Board 
of Health is working in conjunction with the Children's Aid Associa- 
tion in the care of infants in summer. If there is any one feature 
of the work I would especially recommend, it would be an increase 
in the number* of nurses." The report of the association follows: 

The pure-milk stations of tlie Children's Aid Association were open and in 
operation daily during the year 1912. The most important feature of this 
department is the educational work of trained, graduate nurses. In the early 
part of the year we had two such nurses, in May tliere were three, through the 
summer there were five, and then in the fall the number began to be decreased 
until in December we had only one. These nurses made during the year 4,929 
professional visits to the homes of babies, besides attending clinics and helping 
many babies in other ways outside of their homes. 

Where special modifications were prescribed by the physicians, either private 
or as members of the medical staff, the nurses visited the homes and showed the 
mothers how to prepare the milk according to directions. More complex modi- 
fications for very sick babies were made by the nurse at the central station 
and distributed through the regular distributing stations. 

Nursing or prospective mothers were registered in some cases, to the number 
of 63, and received the same personal attention of the nurse, if required, as 
did the babies. 

Most of the clinics of the year were held at the central station in the Bald- 
win Block. Some, however, were held at the branch distributing stations as 
occasion required. During the lighter seasons of woiic two clinics a week were 
held, but in the summer clinics were held daily except Sundays and holidays. 
These clinics were in charge of physicians, one or two being present each day. 
In all 210 clinics were held and 882 children examined. 

The milk for children who required special feeding was distributed through 
milk stations, of which during the summer there were five. Two others were 
open for a short period, but were discontiuued on account of the expense in 
reaching them in proportion to the number of children obtaining milk there. 
At each of these stations a woman was employed at a small monthly fee to 
distribute milk, check up the return of bottles, a plan which was found to be 
more economical than in using salaried nurses for this purijose. In this* way 
the larger stations near the center of the city can be maintained economically, 
but small stations, and at a distance from the center of the city where con- 
siderable time is required daily to haul the milk, are too exi>ensive. To be con- 
ducted economically some way of distribution through a retail distributing 
milk company is necessary to make it possible to reach the babies scattered 
over the city who need the help of the milk stations. 


The milk used in this worlc was obtained principally from . Both of 

these herds consist of high-gi*ade cattle, tuberculin tested, properly housed, grain 
fed; and the milk was handled with such care, being bottled at the dairy in 
bottles furnished by the association and shipped in ice, that the tests for 
cleanliness were uniformly excellent. During the year approximately 46,000 
quarts of this milk were used. 

Six public educational meetings for mothers were held in the summer, one at 
the Jewish Federation, South Meridian Street, two at Mayor Chapel, Norwood 
and West Streets, one at Christamore Settlement, and one at the Church of the 
Assumption, Blaine Avenue, West Indianapolis. These meetings were addressed 
by physicians on subjects of practical interest to mothers on the care of small 
babies. The aggregate attendance at the meetings was 117, which indicates 
a fair beginning. 

The total expense for the year amounted to $8,317.56, of which the greater 
part was used for milk and for personal service of trained nurses. This ex- 
pense was covered in part by a city appropriation, through the department of 
health, of $4,000 ; by receipts from sales of milk amounting to $1,827.07 ; by 
specific contributions from churches, lodges, Sunday school classes, and in- 
dividuals aggregating $900 for certain stations or certain babies ; the balance 
being provided through the general contributions to the Children's Aid Associa- 
tion. Voluntary services of many kinds, professional and otherwise, and useful 
materials have been generously donated. For all these kindnesses and to all 
those who have assisted, the association is deeply grateful. 

Milk Commission Statistics, January 11 to December 31, 1912. 


Number of babies helped — 

Feeding cases 468 

Nonfeeding cases 568 

Total 1, 036 

Visits of trained nurses to the homes of children 4,928 

Number of clinics held, doctor and nurse attending 210 

Number of children examined at clinics 882 

Special treatment given by nurses 895 

Special day cases (sick babies cared for during the day by nurses) 245 

Special modifications made by nurses 950 

Quarts of milk distributed to feeding cases 45,912 

Deaths among feeding cases 14 

Nursing mothers registered 63 

Mothers' meetings held 16 

Attendance 117 


Milk account $5, 640. 91 

Salaries 2. 178. 00 

Car fare 155. 00 

Printing and stationery 71.00 

Feeding supplies 15. 00 

Miscellaneous 87. 85 

Total 8, 317. 56 


Campaign in New York City in 191 1.' — The 27 stations founded by the 
milk committee were situated in the most congested parts of the city. The 
object of the committee's campaign was to malie a demonstration of the value 
of millv stations in reducing infant mortality, to show that these stations 
should be situated in the most densely populated districts of the city, and that 
the ordinaiy store was suited for a milk station. 

The plan of campaign was as follows: Each station was in charge of a 
graduate nurse, especially chosen for her knowledge of infant hygiene, for 
her interest in the problem, and her willingness to give herself as well as her 
time to the work. She was assisted by a matron. In certain districts where 
the population was almost entirely foreign and where English was spoken and 
understood as rarely as in Italy or Russia, a matron was selected, when pos- 
sible, who was able to talk the language of the district. When two or more 
languages must be spoken an inteii^reter was provided in addition. 

Each nurse canvassed her district from house to house, looking for babies, 
leaving the folder of the station with the mother, and offering to help her keep 
her baby well. That was the great thing the stations tried to teach — to pre- 
vent sickness. The windows of each station were adorned with placards in 
various languages inviting mothers to make use of it. The outside of each 
station was painted a light, bright blue, and the "blue fronts" became a regular 
expression of the district, being incorporated into many foreign languages. 

The milk-committee stations tried first and foremost to encourage maternal 
nursing. Mothers were told how necessary it was and how it would save the 
baby many of the dangers of the hot weather. Not only were they urged to 
nurse their babies, but they were taught to care for themselves so that they 
could nurse them. They were told what to eat and, more important, what 
not to eat and drink. When breast milk seemed to be failing they were pro- 
vided with milk and, if necessary, nourishing food, to try to increase the 
ability to nurse. When nursing was impossible, artificial feeding was ordered 
by the doctor in attendance at the station. Each baby was treated as an 
individual and the food ordered according to its individual needs. 

Let us trace a baby through its whole progi'ess at the station. The doctor 
was in attendance at definite hours twice or three times a week. If a new 
baby was brought to the clinic it was seen by the physician and its food 
ordered by him. If brought in at another time, after a preliminary talk from 
the nurse in which the whole system was explained, the mother was asked if 
she wanted to enroll her baby. If so, it was stripped and weighed by the 
nurse and the weight recorded on the individual chart. The nurse's record 
and the history card were then filled out and the nurse ordered a temporary 
feeding for the child, according to instructions very carefully prepared by the 
supervising physician and indorsed by the medical council. If the baby was 
sick it was sent to a station where a doctor was in attendance that day, or the 
station doctor was communicated with and arranged to see the baby. 

Its milk having been ordered, the mother procured her supply of milk 
bottles, barley flour, etc., and returned to her home, whither the nurse 
speedily followed her. At this visit she was taught how to prepare the food 
and in her own home given a lesson in general hygiene. The formulfe ordered 
for the babies were of the simplest kind possible. Whole-milk mixtures were 
used almost exclusively. She was then told to bring the baby back to the 
station on the next clinic day and to come every morning for her supply of 
milk. She was also urged, at the first sign of illness, however slight, to report 

1 " Infant Mortality and Milk Stations,' Special Report of the Committee for the Reduc- 
tion of Infant Mortality, New York Milk Committee, 1912. 


at once to the station. On clinic days every baby was stripperl, weighed, and 
examined by the station physician, its progress discussed with the mother, any 
necessary changes ordered, and the nurse instructed what to do. Very sick 
babies were referred to hospitals or to private physicians. 

If the mother was unable to buy milk, through an arrangement with the 
Charity Organization Society, the Association for Improving the Condition of 
the Poor, and. the United Hebrew Charities, such cases were immediately 
repbi'ted to them, and were at once investigated. * * * As the nurse went 
about from house to house, from family to family, s»he found many expectant 
mothers. Part of the campaign was to get in touch with these women and 
to try to advise and teach them so that they might pass successfully through 
their pregnancy and be in physical condition to nurse their babies. * * * 
The milk u.sed came from tuberculin-tested herds and was of the highest 
standard. It was sold for 7 cents a quart. The contract for this milk was 
awarded after bids had been asked for from the chief milk dealers of this 
city. A constant watch was kept on the quality of this milk. Bacterial counts 
were made daily from samples taken from various stations. * * * in order 
to estimate the mortality among the babies in the areas under the influence 
of the milk stations, the following method was adopted : A map was made and 
plotted out showing the location of the station and the number of babies enrolled 
in each block surrounding the station. In this way the actual sphere of 
influence of the station was determined. A few babies came from longer dis- 
tances and therefore from outside the district. In order to determine the mor- 
tality in the district thus established, a search of the records at the health 
department and a tabulation of all deaths occurring in the months of June to 
November were made for the years 1910-11. In order to determine the infant 
mortality it was necessary to tabulate the births by blocks in the same 
area. * * * 

The following conclusions seem to be warranted: 

First. That milk stations did have a distinct influence in diminishing the 
mortality among the babies in the districts in which they were situated. 

Second. That the milk stations did not indirectly encourage artiflcial feed- 
ing — 32.4 per cent of all babies under 1 year of age were entirely breast fed ; 
60.6 were partly breast fed. 

Third. That home modification, even among the very poor and ignorant, is 

Fourth. That the results, as shown by the mortality and by the condition of 
the surviving babies at the end of the period of demonstration, prove that as 
good results can be obtained as when already modified milk is distributed. 

Campaign in Philadelphia.' — A conference was held early in the summer 
(1909) at which plans were considered for reducing infant mortality. As a 
result, the Modified Milk Society, various settlements, and a number of women's 
clubs conducted work along independent lines. The health department placed 
its medical in&ijectors in the most congested parts of the city to canvas for sick 
babies and to instruct mothers in their care. Milk dealers were provided with 
bags upon which were printed simple directions as to the care of the milk and 
the feeding of the baby. 

In 1910 a conference was called by the mayor. This was attended by repre- 
sentatives of some 200 agencies, the object being to bring about a better working 
relation between the various organizations engaged in summer work for 
mothers and children. As a result of this conference a bureau of registration 

1 " Infant Mortality and Milk Stations," Special Report of the Committee for the Reduc- 
tion of Infant Mortality, New York Milk Committee, 1912, p. 90. 


and information was establistied at the city hall. A directory was published 
and distributed giving the names of the agencies and the kind of service each 
was prepared to render. 

The Modified Milli Society established 10 distributing stations and later 
opened 8 more. The city council appropriated funds to maintain a corps of 
eight nurses, and by utilizing the medical inspectors and district physicians, a 
temporary division of child hygiene was established. This division began inten- 
sive work in June in four of the most congested wards. Other organizations 
assisted by furnishing nurses, who reported daily to the health department and 
worked with their nurses. 

Previous to the closing of the schools in the four wards selected, demonstra- 
tions were given to girls in the grammar schools in the care of babies. This 
work was done by medical inspectors and school nurses through the coopera- 
tion of the school authorities. A house-to-house canvass was carried on in 
the district by the health department nurses to instruct mothers in their 

At the central office a careful system of record keeping for each case was in- 
stalled. Day and night telephone service was established for receiving requests 
for aid in emergency cases. The police and fire departments cooperated by in- 
structing all police stations and fire houses to forward by telephone any request 
for medical or nursing aid. A lai'ge number of bulletins, posters, and circulars 
were distributed, chiefly through the police department. 

Free ice was distributed, midwives were brought under inspection, and several 
baby farms were closed. 

There was a reduction of 40 per cent in the deaths of children under 2 years 
in the four wards where the work was concentrated. In the city itself, during 
the three summer months, there was an increase of 132 deaths over those in 
1909, though the proportion of the total deaths which occurred under 1 year 
fell 0.5 per cent. 

In 1911 a still more vigorous campaign was waged. A " milk show " was 
held, which was attended by 110.681 people. 

The city council voted $5,000 for the summer work and the nursing staff was 
Increased. The work was carried on in four wards. The mayor appointed a 
strong commission to investigate and report upon the whole subject of milk 
supply. The refrigeration of milk in transit was required for the first time. 
In the four wards where the nurses were working there was a reduction of 11.3 
per cent in all deaths under 1 year from the 1910 figures and of 34.6 per cent 
in diarrheal deaths under 2 years. 


" Little Mother Leagues " and " Little Mother Classes " in the pub-" 
lie schools represent efforts made in New York, N. Y., Kansas City, 
Mo., Cleveland, Ohio, and Milwaukee, Wis., to carry instruction into 
the home from another angle. " Little Mothers " are the school girls 
who have to help care for babies or for younger children at home. 
Of course the schools of every city have many such, and as they live 
in all parts of the town and come from every class, it follows that to 
reach them is to influence an ever-widening circle of mothers and 
homes where instruction is most needed. The policy in New York 
City was to organize these school girls who were caretakers of little 


children into groups and teach them the care of babies. These groups 
were called " leagues " and the whole organization was " The Little 
Mothers' League." Dr. Josephine Baker, of the New York division 
of child hygiene, in a paper before the International Congress of 
Hygiene and Demography, in September, 1912, says : 

The aid of ovei* 20,000 girls fi'om 12 to 14 years of age was enlisted and 
made of practical value by the formation of " Little Mothers' Leagues." These 
are still one of the most important branches of our work. The girls are taught 
all practical methods of baby hygiene and feeding. The potential value of 
training young girls for intelligent motherhood is not only of immense im- 
portance, but the immediate results have been striking in the improved care 
that is given to the babies who are directly under the care of these young girls. 
As true prevention work, it ranks of first importance in the prevention of infant 
mortality in this and the next generation. In all, 239 of these leagues were 
found in 1911, and practically an equal number have been organized this year 
(1912). Weekly meetings are held for instruction. Each league is under the 
supervision of a doctor and a nurse from the division of child hygiene. 
Each weekly lesson takes up some particular phase of baby care. The doctor 
gives a short, simple talk; then, with the nurse, demonstrates his sub.iect. Our 
outline embraces the importance of breast feeding, hygiene of the home, clean- 
liness, ventilation, etc.. hygiene of the infant, including bathing, dressing, and 
value of fresh air, infant feeding, with methods of milk modification. The 
lessons are simple and practical, and the children are required to carry out each 
part of the work. Babies are not lacking for demonstration purposes, for nearly 
every little mother brings her own charge to the meetings, and often the rivalry 
is great to have " my baby " chosen as an object lesson of health and right 
living. The members write and act little plays, the play always hinging upon 
some newly discovered way to keep the baby well. The real iniquity of loUy- 
pops and dill pickles as baby food is being uncovered, and these and kindred 
baby pacifiers of former days are being relegated to oblivion. 

In Kansas City and in Milwaukee all girls desiring to enter these 
classes are enrolled, whether or not they are caretakers of babies at 
home. The health department undertakes to teach baby hygiene 
through the public schools to all girls who care to avail themselves of 
the opportunity by joining the classes — a step, in short, toward the 
movement in French and German schools in education for mother- 

In Cleveland, Ohio, instruction is given to girls in the seventh and 
eighth grades by the introduction of an infant hygiene division in 
the domestic science department of the schools. On June 9, 1913, 
there were 48 classes a week, with 884 girls taking the work. The 
course consists of six lessons, as follows : 

Lesson I. — How to keep baby w^ell. Causes and prevention of high 
death rate. 

1 At the last International Congress of School Hygiene, at Paris, on the proposition of 
Dr. Pinard, a resolution was passed that in schools for girls the care of Infants should 
form an integral part of obligatory instruction in all the primary schools, and examina- 
tions should be passed in these subjects. — American Journal of Sociology, January, 1912. 


Lesson II. — Growth and development of normal baby. 

Lesson III. — Pattern demonstration. Each pupil cutting patterns 
for baby's outfit. 

Lesson IV. — Feeding: Maternal nursing, artificial feeding, dan- 
gers of patent foods. (Charts for five l&ssons.) 

Lesson V. — Bath: Things necessary, preparation, how much good 
it does baby. 

Lesson VI. — Common illness among babies. First home treatment 
ill beginning of intestinal disturbances. 



The warning note against placing too much dependence upon the 
simple pure-milk station which comes up from so many cities is 
struck with more certain sound from a number of cities which place 
practically all of the emphasis upon visiting nurses and the instruc- 
tion of the mothers in the homes. 

In an address before the International Congress of Hygiene and 
Demography, held in Washington in September. 1912, Dr. Josephine 
Baker, director of child hygiene, department of health, city of New 
York, on the reduction of infant mortality in New York City 

The evolution of the infants' milk station is essential. Pure milk, however 
desirable, will never alone solve the infant-mortality problem. Under our 
system of home visiting to instruct mothers in the care of babies we have 
demonstrated that babies may be kept under continuous supervision at the cost 
of 60 cents per month per baby, and the death rate among babies so cared for 
by us has been 1.4 per cent. The death rate among babies under the care of 
the milk stationsi has been 2.5 per cent, and the cost $2 per month per baby. 
Without overlooking the value of pure milk, I believe this problem must pri- 
marily be solved by educational measures. In other words, the solution of the 
problem of infant mortality is 20 per cent pure milk and 80 per cent training 
of the mothers. Tlie infants' milk stations will serve their wider usefulness 
when they become educational centers for prenatal instruction and the encour- 
agement of breast feeding and teaching better hygiene, with the mother in- 
structed to buy the proper grade of milk at a place most convenient to her home. 

The value of pure milk where babies can not be breast fed, how- 
ever, must not be underestimated. No amount of cleanliness or care 
on the part of the mother can entirely offset the dangers that come 
through polluted milk from dirty dairies. The city health officers, 
placing most stress upon nurses and instrucion, do not go so far 
as to recommend that the milk problem be allowed to take care of 


" The Work of the Public Welfare Committee of Essex County 
for the Eeduction of Infant Mortality in Newark," written by Dr. 
Julius Levy, says: 

Our survey of the infant-mortality problem in Newark revealed tlie following 
facts : 

During the past decade there were more deaths of infants under 1 year of age 
than from tuberculosis in all forms and at all ages. That is why the section on 
health of the public-welfare committee felt called upon to devote itself to the 

While it was found that the greater part of these deaths occurred in about 
four districts, the clinics and hospitals were often not in the center of these dis- 
tricts and therefore not where they could do the greatest amount of good. 

It was found, further, that the doctors and nurses usually could not speak the 
language of the mothers; and so at best could have very little effect in eliminat- 
ing what I believe is the greatest single factor in this problem — ignorance made 
hidebound by prejudice. 

It was further found that though modified milk could be obtained at a milk 
depot, relatively very few mothers could avail themselves of it on account of the 
distance, and though certified milk has been sold here for more than 15 years, 
practically all of the mothers in districts of highest mortality were buying 
very filthy store or bottle milk. The one fact, however, that was most astound- 
ing of all, was that while there has been a reduction of infant mortality in 
Newark during the past 10 years and though certified milk has been introduced 
and a milk depot oioerated, the infant mortality from diarrheal diseases showed 
a veiy marked increase in the first half of the past decade and was actually- 
higher at the end of the decade than at the beginning. The reduction of infant 
mortality has been due to factors not directly influenced by milk supply and 

As a result of these and other studies and observations, we were convinced 
that milk is not the greatest single factor in the infant-mortality problem and 
that the distribution of modified milk is not the way to solve this complex 
problem. Indeed, I have long felt that the milk depot, in the first place, in- 
creases the number of artificially fed, and, secondly, does not reach the infants 
that require it most — those with the most ignorant and indifferent mothers — 
nor, indeed, when the mortality among infants is highest, before the third 
month of life. 

Our plan found its basis in the common knowledge, obtained both empirically 
and biologically, that mothers' milk is the only proper food for infants; that 
mothers can nurse their infants successfully in greater numbers and for longer 
periods than obtains to-day — that the failure to nurse wholly or partly is due, 
in large part, to ignorance, inherited prejudices and superstitious beliefs that 
are fostered by anxious grandmothers, ignorant midwives, and I am soriy to 
admit, indifferent doctors ; in a lesser degree to the equally preventable social 
and economic conditions of overwork, undernourishment, tuberculosis and other 
debilitating diseases. Our plan is nothing more than to try to induce mothers 
to accept our knowledge of the importance of maternal nursing and its rationale, 
of the hygiene of infancy, of the imj^rtance of obtaining a clean tuberculin- 
tested milk and then taking proper care of it in the home. Our method has for 
its fundamental thought that mothers can only be convinced of these somewhat 
lecently emphasized facts by doctors and nurses who see the mothers fre- 
quently, know their customs, habits, and prejudices, speak their language — ^yes, 

94219°— 13 3 


and even their dialect. Our ultimate purpose is to conduct our work in such 
a manner that the public and tlie authorities will be convinced that infant- 
welfare work is of such value and importance to the entire community that it 
shall become a part of the municipal activity for the conservation of public 


Boston is one of the cities where special attention has been given to 
the question of nurses and in a letter to this bureau, dated February 
25, 1913, the health department says : 

At present we have 10 nurses in the division of child hygiene doing pre- 
natal and iK)stnatal work. The work consists in instructing and advising ex- 
pectant mothers and mothers of young infants, and in visiting regularly such 
mothers to see that proper care and attention is given to the child. This con- 
tinues during the first year of infancy. Special attention is given to bottle-fed 
infants, as the mortality among these has been high, as you will note by the 
reports I am sending. The recent law passed by the Massachusetts Legislature 
compelling physicians to report births within 48 hours after birth has been a 
great aid in this work. 

The board of health is at this time making estimates as to the cost of pro- 
viding milk stations in this city, as in New York, and believes that this will 
help greatly during the summer months in saving the lives of infants. 

During the summer months it is recommended that mothers take their in- 
fants on the Floating Hospital, which is a large steamer supported by public 
contributions. The steamer leaves the wharf daily at 9 a. m. cruising about 
the harbor and at times anchoring in the lower bay and returning about 5 p. m. 
Physicians and nurses are in attendance on this steamer to take care of on an 
average 200 per day. This is shown to be very beneficial and a great aid in 
the campaign to save the lives of babies. 

The instructions to the Boston nurses are thus condensed in the re- 
port of the department: 

These nurses will be expected to have accurate information concerning every 
baby in the district assigned to them. 

Breast-fed babies will cause little or no anxiety. The nurse will visit these 
cases to make sure that breast feeding is maintained ; to advise the mother on 
the care of the breasts, and on general hygienic rules for the preservation of 
her milk and the care of the baby. 

Bottle babies who are under the care of the family physician will be visited 
by the nurse to make sure that such care is continuous; the services of the 
nurse will be offered to the tired-out mother in assisting in preparing the baby's 
food and in carrying out the directions of the family jihysician. It is exi>ected 
that the bulk of the work will be among the bottle babies of those who are 
unable to employ a physician. Recommendations will be made to these mothers 
to place their babies under the care of the nearest pediatric clinic at once be- 
fore they show any signs of illness. Every assistance will be rendered these 
mothers by the nurses in carrying out the advice and instructions given at the 
clinic, and unceasing attention will be given by the nurses to the sick babies of 
this class, particularly during the summer months. 

The division of child hygiene is entitled only to a portion of the money ap- 
propriated for the maintenance of the board of health. The erection of tents 
at the seashore, the employment of additional nurses in such touts to assist in 


the care of sick babies, the maintenance of milk stations have been considered, 
but the amoimt of money available for this division prohibits the undertaking 
of such projects this year. 

In Bridgeport, Conn., a nurse visits all the families where a new- 
born baby has arrived, and where her services are likely to be an 
advantage, and gives advice and instruction in the care of the baby. 
Leaflets containing such information printed in the mother's own 
language are left with the mother. "\^Tiere breast feeding is im]DOs- 
sible the nurse urges the mother to send daily to the milk station for 
the baby's milk supply. 

Fall River, Mass., reports : 

Since last July a visiting nurse has been employed who is continually visit- 
ing the homes of newly born infants whose addresses are furnished her daily. 
She supplements the verbal instructions to the mother by explaining and dem- 
onstrating the proper care of infants, urging breast feeding, modification of 
milk, etc. Since the nurse's employment the mortality among infants has been 
very materially reduced, and we hope during the coming year, by an appropria- 
tion asked for. to be able to employ an additional nurse. 

In Jacksonville, Fla., the city health department directs nurses em- 
ployed by private organizations. Jersey City, N. J., Cambridge, Mass., 
Duluth, Minn., Evansville, Ind., Fort Worth, Tex., Grand Rapids, 
Mich., Memphis, Tenn., Rochester, N. Y., and other cities resort pri- 
marily to the nurse system. The health officer at Grand Rapids 
saj^s : " I will recommend a special feature that we have used in our 
citj^ for the past two years for general adoption, as follows: The 
visitation by trained nurses within 24 hours to everj^ household re- 
porting a birth." 

Some cities do not attempt to visit the homes of all newly born 
infants but have various methods of selecting by districts or other- 
wise ; for instance, the Los Angeles, Cal., authorities report that : 

During the school vacation the municipal nurses make home calls on all 
maternity cases, in the house courts and in the congested districts, reporting to 
the milk station all cases where breast feeding is impossible, obtaining modified 
uiilk for infants, or assistance where mothers need such. 

The report from Richmond, Va., states that: 

We believe the instructive end of the work to be all important, and we have 
nurses for this purpose (five in number) at the present time. Babies are 
selected by assuming that all babies in some districts should be under super- 
vision and that all twins and illegitimate babies are proper subjects wherever 
found. This information is obtained from our certificates of births, while 
babies in special districts are located both by birth certificates and by house- 
to-house canvass. * * * j have been for some time convinced of the infec- 
tious origin of a very considerable part of infantile diarrhea. For this reason 
our nurses are now told to give special instructions regarding the disinfection 
of diapers. The other points covered by them are, of course, seeing that the 
baby gets proper food and clothing — both as regards warmth of clothing in 
winter and as little clothing as possible in summer. 


The health department of Kansas City, Mo., writes this Bureau, 
under date of March 17, 1913, as follows: 

I would say that we were among the first of the western cities to talie \ip the 
worli of prevention of the number of infant deaths during the hot summer 
months, and we have established stations over the city, with nurses and phy- 
sicians attending, where the poor can go to receive medical advice and exami- 
nation of the baby, and, if placed on artificial feeding, to get pure milk at cost. 
We also give milk to those mothers who are unable to purchase the same, and 
instructions are given by the nurse at the dispensary how to prepare milk for 

We intend to employ six nurses and utilize six of the medical school inspec- 
tors this summer at our stations to care for those babies who become ill. It 
is my opinion that, in order to cut down the death rate among infants under 
one year old, prenatal instructions should be given at all dispensaries, and 
that a follow-up system should be employed among parents where births are 
registered in certain districts which have a high death rate. They should be 
visited by nurses and carefully looked after, with instructions how to raise the 
baby intelligently and not to remove the child from breast feeding unless there 
is good reason for doing so. I think a false security has been given out over 
the United States with regard to milk stations saving babies, and this false 
idea should be corrected in the minds of many who have expected to accomplish 
the object sought. I can not help but emphasize that prenatal instruction, 
with advice from competent authority regarding the sanitation of the home, 
will in time bring about the desired results, rather than a dependence upon the 
milk depots. 

Johnstown, Pa., begins this year with a visiting nurse under the 
control of the Civic Club. Smaller cities make a beginning by em- 
ploying a nurse, Avhereas a more elaborate plan of campaign would 
not be possible. Montclair, N. J., reports for 1912 : 

Prevention of infant mortality. — Nurse gave part of her time to the instruc- 
tion of mothers in the proper modification of milk for infant feedings. A clinic 
was maintained and milk sugar and other supplies were furnished when needed. 
The total clinic attendance was 286, and the number of feedings taught was 414. 

Dr. Charles V. Chapin, health officer of Providence, R. I., says, 
" We attempted for two years to distribute clean milk to the babies 
of the poor, but we decided the money could be better spent on 
trained nurses." Writing to this Bureau, under dates of February 
19, and May 5, 1913, Dr. Chapin says : 

I would say that most of the baby-saving work in this city is carried on by 
the Providence District Nursing Association. They employ five nurses for this 
purpose all the year around, and are likely to put on another during the sum- 
mer. A very large number of babies are referred to the nurses by the doctors, 
and are cared for under the direction of the latter. Some of the most effective 
work is in connection with babies attended by midwives, amounting to about 
25 per cent of all. The midwives report each birth immediately, and a nurse 
employed by this department at once visits each case and refers all that need 
them to the district nurses. 


There are two consultations maintained by tlie Congress of Mothers and the 
district nurses, and another is projected for the coming summer. 

Three very efficient dispensaries are maintained by different agencies. 

There is no very pressing need for millc stations in this city, but the estab- 
lishment of one or two on a small scale is being considered. * * * 

Milk inspection in Providence is not a function of the health department. 
The milk inspector is an independent officer elected by the board of aldermen. 
Our inspector is a very efficient officer, and has done much to improve our 
milk supply. Unfortunately more and more of our milk is railroad milk, 
coming chiefly from Connecticut, but a large amount is still brought in by the 
producers themselves or their neighbors. The milk inspector has done much by 
personal visits to the farms and insistence on essentials: (1)~ sterile utensils, 
(2) ice, (3) clean barns. A "call down" when " bacteria ^'im up" is his 

The midwives are required to report all births immediately on iX)Stal cards. 
They report very well, as a rule. About 25 per cent of all births are by mid- 
wives. The baby nurse of the health department promptly visits all babies, 
and turns over to the district nurses all cases needing attention. The District 
Nursing Association has five baby nurses. They not only supervise all mid- 
wives' babies under my general supervision, but they look after a large number 
who are referred by physicians. 

All these nurses apply treatment for ophthalmia, but call in the health de- 
partment oculist whenever it is at all necessary, or get the child to the hospital. 

Dr. Chapin has issued, for 1913, from the health department a 
"List of Milk Dealers AVho Produce the Milk Which They -Sell." 
It is issued for the convenience of physicians and nurses, and gives 
the name of each local dealer, the analysis of the milk he handles, 
both as to fats and total solids, and the bacteria count per cubic 
centimeter, giving the lowest, highest, and average for his product. 
It thus serves as a guide in the selection of milk for bottle-fed babies 
wherever found in the town. 

Montclair, N. J., in its annual rei^ort gives a somewhat similar sur- 
vey of the milk, as does Erie, Pa. 

The Nashville, Tenn., city health department reports : 

In connection with the operation of the milk dispensaries, the district nurs- 
ing feature with home modification, distribution of literature, organizing of 
clubs, instructions given by lectures and personal work of the nurses, we also 
furnished gowns, napkins, and other articles of clothing where needed. In con- 
nection with this we also looked after expectant mothers, referring them to 
hospitals for confinement, or where this was Impractical we furnished phys- 
ician, nurse, or sterile sheets and all accessories to insure against infection in 
their homes. For the year 1913 we have increased our nursing force to four, 
we will operate four milk stations, and in the future will use these stations as 
a basis of operation in our baby-saving work. You also asketl, " What special 
feature of your system would you recommend for general adoption?" I be- 
lieve the making of milk dispensaries the basis of operation to be the best way 
to handle this work. We have furnished from stations modified milk free, and 
this work is strictly a part of the operation of the health department, and has 
no connection further than cooperation with private charity. 



When it is realized that practically 38 per cent of deaths under 1 
year of age are due to causes mainly dependent upon the health and 
condition of the mother during her pregnancy and confinement; 
that within the registration area of the United States, of 154,373 
infants under 1 year of age, who died in the year 1910, 14,946, or 
nearly 10 per cent, lived less than one day; that 36,351, or practically 
23.5 per cent, lived less than one week, it will be seen that the infant 
mortality problem can not be solved adequately by any measures 
which leave out of their scope some attention to the care of expectant 
mothers. Since the above sentence was written " Mortality statistics " 
for 1911 has been issued by the Bureau of the Census, showing a more 
distressing situation than was revealed by the figures for 1910. With 
an increased death registration area (now covering 63 per cent of the 
total population) there was a decrease in deaths of children under 
1 year to 149,322 as against 154,373 in 1910. But those who lived less 
than one day increased not only relatively but absolutely, i. e., from 
14,946, or not quite 10 per cent, in 1910 to 18,074, or 12.1 per cent; 
those living less than one week increased from 36,351, or 23.5 per 
cent, in 1910 to 40,883, or 27.4 per cent, in 1911. These figures show 
that the efforts made to save babies through pure milk and more 
intelligent care have produced residts, while the lack of organized 
effort to reach prenatal conditions for a very considerable period or 
over any extended area has further emphasized its need. This has 
been realized by a number of cities, as is shown by the folloAving list, 
which is not, however, claimed or assumed to be in any way complete : 

New York, N. Y. — ^The department of health is working in coop- 
eration with the New York Milk Committee in a system of prenatal 
work among mothers, and the department intends to take up this 
work first in connection with the Infants' Milk Stations and later 
with a special force of nurses. 

The New York Association for Improving the Condition of the 
Poor, the pediatric department of the New York Medical Clinic, and 
the NeAv York Diet Kitchen include prenatal instruction in their 

The Sixth Annual Report of the New York Milk Committee, 1912, 
contains the following statement on prenatal prevention of infant 
mortality : 

During the summer of 1911, as part of the milk-station work, an experiment 
was tried looking to the reduction of the deaths of babies under 1 month of 
age. Appalling as is the fact that from 1 in every 10 to 1 in eveiy 6 babies 
die during the first year of life, even more terrible is it that nearly 1 in 3 
of all these deaths occurs during the first month of life. The baby does not 
even have the chance of a good start. This is generally admitted to depend 
largely on conditions acting before and during the birth of the baby, and it 


is exactly during this time that tlie least systematic eCfort has been made to 
improve conditions. 

This preliminary attempt to meet this condition, which was carried on by 
two special nurses, promised such excellent results that it was decided to make 
this our chief worli during 1912. * * * 

The attempt is being made to reach expectant mothers as early as possible 
during their pregnancy. The nurse comes in touch with these women through 
cooperation with the city milk stations, relief organizations, settlements, 
churches, charity organizations, etc. Each woman is visited in her home by 
the nurse, who explains the purpose of her visit and gains her confidence by 
showing interest and a desire to help. Thus the nurse is able to appreciate the 
actual conditions of life and to give advice which can be followed under 
existing conditions. 

The expectant mother is told how important it is for her to put herself in 
as good physical condition as possible, both for her own sake and for that of 
her unborn child. She is taught how to keep herself in this condition, what 
to eat, what not to eat, what kind of work she should avoid, and all the details 
which a woman in better financial circumstances would be told by her phy- 
sician. She is encouraged to begin early to provide for the arrival of her 
baby. She is told what clothes it will need, and she is shown how to make 
them. The subject of her confinement is discussed. She is advised as to 
what arrangements she should make and encouraged to make them well in 
j'dvance. The greatest stress is laid upon the value of nursing, both for the 
mother's sake and that of the baby. All the instruction that is given is of a 
practical character and the reason for doing certain things is always explained 
carefully by the nurse. 

With each expectant mother is left a post card addressed to the nurse and 
filled out by her, to be sent to her headquarters if she is needed at any time. 
Visits are made every 10 to 12 days — oftener if needed. Examination of the 
urine is made at each visit, and if any abnormalities are found it is imme- 
diately reported to the office. The physician then visits the case, if necessary, 
or advises the nurse what to do under the circumstances. 

The object of this campaign is to show that, under existing conditions, the 
mortality during the first month of life can be greatly reduced; also that 
the number of stillbirths and premature births can be reduced. With this 
idea in mind any woman is accepted as a patient, regardless of whether she 
is to be confined by a physician, in a hospital, or by a midwife. Whenever 
advice can be given on this subject a physician or a hospital is urged. Every 
effort is made to persuade the woman to put herself under the care of whoever 
is to have charge of her confinement at an early date. An effort is made to 
utilize the facilities already at hand, and whenever minor ailments or diffi- 
culties arise during the pregnancy the case is referred to a dispensary or to the 
physician, and the nurse's duty is not done until she sees that this advice is 
carried out. It is only in exceptional cases that the committee's physician 
cares for these women. * * * 

Up to December 31, 1912, 1.375 women had been watched, helped, and cared 
for through their pregnancies and for a month after the baby was born. * * * 

Results among supervised cases, as compared with the borough of Man- 
hattan, show reduction of 32 per cent in deaths under 1 month and of 28 
per cent in stillbirths among 1,398 babies, with two deaths among 1,375 
mothers. * * * 

Also it is encouraging to see that over 92 per cent of the babies living at the 
end of one month were being nursed entirely ; that only 3.7 per cent were alto- 
gether deprived of the breast. 


Kansas City, Mo. — The health department contemplates the estab- 
lishment of several stations in those districts where mortality was 
highest last year, where expectant mothers can receive advice from 
the doctors and nurses in attendance. 

Indianapolis, Ind. — On a small scale; the funds allowed are not 
sufficient to carry on the work in any extensive way. The expectant 
mothers in the poor quarters of the city are instructed at different 
times during their pregnancy, the majority from the third month on 
to term, others varying from the sixth to the eighth month and just 
before delivery. They are instructed as to proper care of themselves 
in regard to exercise, need of rest, freedom from worry. They are 
also instructed as to the care of the baby, its feeding, and the need 
of general hygienic precautions. In some cases the expectant mother 
is taken to the country or to the summer mission for rest. 

Providence, R. I. — Health department issues a leaflet containing 
advice to women who are about to become mothers. 

Baltimore, Md. — The Maryland Association for the Study and 
Prevention of Infant Mortality visits and instructs all expectant 
mothers registered in four leading hospitals. 

Chicago, 111. — The Mary Crane Day Nursery carries on prenatal 
work for the women of the Hull House Neighborhood. The Visiting 
Nurse Association gives some instruction. 

St. Louis, Mo. — The Visiting Nurse Association carries on pre- 
natal work as a part of their daily routine. The social service depart- 
ment of Washington University sends a nurse to visit all women 
who register in the obstetrical clinic. 

Detroit, Mich. — Pregnancy clinics are in operation in connection 
with the stations of the Babies' Milk Fund. 

Richmond, Va. — To a limited extent the health department carries 
on prenatal w^ork. The nurses visit expectant mothers and give 
advice covering the usual well-known points. 

Louisville, Ky. — The Babies' Milk Fund Association does a certain 
amount of prenatal work in connection with other educational effort. 

Milwaukee, Wis. — The Milwaukee Child Welfare Division pur- 
poses sending out a folder containing instructions to expectant 
mothers, and has opened classes for mothers at three of its stations. 
The Milwaukee Maternity Hospital and Free Dispensary Associa- 
tion is also active in this work. 

Nashville, Tenn. — In connection with the operation of the milk 
dispensaries the health department looks after expectant mothers, 
referring them to hospitals for confinement, or where this is imprac- 
ticable, furnishes physician, nurse, sterile sheets, and all accessories 
to insure against infection in their homes. 


Cincinnati, Ohio. — -Extensive work toward caring for and educat- 
mg expectant mothers is carried on by private organizations. 

Fall River, Mass. — The District Nursing Association does excellent 
work in caring for expectant mothers. 

Buffalo, N. Y. — The Visiting Nurse Association carries on prenatal 
work as part of the regidar routine. 

Boston, Mass. — The Boston Board of Health has a prenatal and 
postnatal subdivision of its division of child hygiene. S3'stematic 
and extensive work is carried on by the committee on infant social 
service in the Women's Municipal League, by the pregnancy clinic 
of the Boston Lying-in Hospital, and by South End House, one of 
the social settlements. 

Inasmuch as this feature in the work of the prevention of infant 
mortality is comparatively new, the methods and instruction required 
under it are difficult of access. We here reproduce ^ the prenatal 
bulletin of the city of Providence, R. I., issued in 1910, and also the 
circular of the Oregon State Board of Health, very recently issued, 
believing that these will be especially acceptable to health officers in 
the smaller cities. 


In organizing a baby-saving campaign the first and main point of 
attack is usually the milk supply. There seems to be general agree- 
ment that this emphasis is justified, but there are also warnings from 
health experts against classing milk as the sole factor which brings 
about the high death rate among babies. A large number of disease- 
producing conditions are covered by the term " bad housing condi- 
tions." In a broad sense the remedy lies in having better building 
regulations, more supervision of tenement construction, more serious 
study of the congestion question in the large cities, and the field is 
so large that it is not possible to accomplish much in a quick cam- 
paign, beyond what good may result from giving the question pub- 
licity. But many of the accompanying evils, such as bad ventilation 
and lack of cleanliness, are being attacked through the influence of 
the visiting nurses, through instructions to " little mothers " and 
through educational printed matter, and doubtless the effort has an 
effect in lowering the death rate from " bad-air " diseases, such as 
pneumonia and bronchitis, which make up approximately 15 per 
cent of the total causes of infant mortality. 

^ See Appendix, pp. 90 and 91. 




While it is quite generally agreed that the germ of cholera in- 
fantum originates with the cow excreta, and that dirty milk is the 
principal carrier of the infection, it is by no means admitted that 
it is the only carrier — the house fly, as a death distributor, is only 
recently receiving the attention it deserves. Flies carry the infec- 
tion not only to exposed milk but directly to the baby's mouth 
or to the nipple of its bottle. To limit the breeding of flies is the 
essential thing, and this can be done most effectually by giving the 
health office of the city power to enforce the collection of garbage 
and regulation of the city dumps. Insistence upon screens for the 
baby's rooms and for the baby's bed is a part of the campaign against 
infant mortality. Not only the flies, but dust, as is now well known, is 
a carrier of enteritis germs and through this the breast-fed child no 
less than the bottle-fed is exposed to the dangers of this summer terror. 
When it is understood that this gei:m when developed can and does 
use dust particles as a vehicle upon which to ride from pastures to the 
dusty streets and thence into homes, however carefully guarded and 
protected its little ones may be, the importance of permitting the 
health department to have supervisory control over street sprinkling 
in poor residence districts during June, July, August, and September 
becomes very apparent. The need for this precaution will be more 
readily understood when it is realized that the infant death rate in 
the hot weeks almost invariably falls for a few days after a general 
dust-settling rain. 


Upon the opening of summer a thorough listing of all horse stables 
and livery barns, whether public or private, is made by cities like 
Seattle and Indianapolis, and complete measures for the control of 
the fly-breeding places instituted. Whether or not the stable fly is 
the only carrier of infantile paralysis it is certainly one, probably 
the principal carrier. Certain cities have issued circulars with mag- 
nified cuts of the stable fly to show the distinction between that and 
the common house fly. This distinction is not generally known and 
is not readily ascertainable by the eye. In fair weather the stable 
fly rarely enters the house ; just before a rain or a storm it does enter 
the house and the common saying that " just before a storm the flies 
bite " is indicative of this. The house fly does not " bite " ; it is always 
the stable fly that bites and it is its bite which is so often fatal to 
small children. 



Below is the form of stable score card used in Seattle, Wash., in 
its inspection service to eradicate the breeding places of flies and 
control stable flies : 


Stable score card. 

Owner or lessee of stable . 

Number of horses Number of cows 

board or private 

Date of inspection ,191. 


Cliaracter of building 

If of first class construction of frame or masonry 10 

If poorly constructed 5 

If dilapidated 2 

Floors, cem nt with proper gutters and catch basin, and sewer or cesspool 


Cement, badly laid 5 

Cement, broken 2 

Wood, tightly laid, as per ordinance 8 

Wood, open cracks 

Manure box, strictly fly proof, with vent 

Manure box, with any part open 5 

Manure box, tight without vent 40 

Surroundings, perfectly clean 

If there is water on lot 10 

If there is manure scattered about 3 

If premises are disorderly 5 

If any manure be on premises, exposed to flies, score will be limited to 49. 
If floors are not properly cleaned, deduct 5 from total. 
Filthy catch basins, deduct 5 from total. 


Fresh-air camps have been operated during the summer months 
with good results in many cities. These are usually private philan- 

Although prevention is the chief end and aim of all work in behalf 
of children, nevertheless there must be hospital accommodations for 
those cases of illness which can not be properly cared for at home. 
As a city grows a hospital of some sort sooner or later becomes a 
necessity. However small such a hospital, it may contain from the 
first beds for children. As an example of what is possible on a large 
scale, Cleveland, Ohio, has a finely equipped Babies' Hospital, devoted 
entirely to the care of infants and young children. In almost any 
hospital it is possible to turn over to the exclusive use of children 
some of the beds and facilities, so that in case of emergency there 
will be some place where sick children may be taken care of. 



The volume of printed instructions annually issued, as well as the 
character of the material, improves each year. State boards of health 
have issued exceedingly valuable pamphlets appealing alike to city 
authorities to bestir themselves and to parents to instruct themselves 
in the care of babies. These two audiences have not always been kept 
distinct, as much material directed at both is sometimes contained 
in the same pamphlets. 

The North Carolina State Board of Health issued in 1912, as 
Special Bulletin No. 10, a pamphlet on " The Baby," using most 
effectively a cartoon of a mother gazing into the empty cradle. A 
part of the legend is " In future men will stop locking the stable 
door after the horse is stolen. They will not be content with spend- 
ing on a funeral the money that would have saved the child; they 
will not tolerate the thought that a poor mother must bear 10 chil- 
dren to raise 5." " Save the Baby " articles are prepared by a nmn- 
ber of the State boards, and furnished to the papers throughout the 
State. In North Carolina these are included from time to time in 
the State Board of Health's " Daily Press Service " publications. 
In other States as Iowa, Idaho, etc., where the general scheme is 
adopted the articles are prepared only on special occasions. A 
bibliography of these State and city publications would be valuable 
and may form a part of this report next year, but can not be at- 
tempted now. 

Some cities, notably Chicago and 'Seattle, issue weekly or monthly 
bulletins which in addition to statistical matter contain much that 
is instructive as to the care of babies' food. 

The health officer of Washington, D. C, issues instructive pam- 
phlets on such subjects as the care of milk, the fly menace, methods 
of destroying flies, etc. 

Lectures to mothers and moving-picture films, illustrative of the 
principles of baby hygiene, are also among the educational features 
which some cities have successfully adopted. 

Of prime importance are the folders addressed to mothers and 
dealing directly with the care and feeding of the child. These are 
mailed immediately upon receipt of notice of birth of a child, or are 
delivered by the nurse Avho calls as the result of such birth notifica- 
tion. Such folders are issued in all of the principal languages spoken 
in the locality, as, for instance: Bridgeport, Conn., prints in four 
languages; Providence, R. I., in five; the State Board of Health of 
Pennsylvania publishes such circulars of instructions in five or six 
languages, and furnishes these to the various cities of the State. 


Likewise the Department of Health of New York issues a pam- 
phlet on " How to Save the Babies," which is distributed through the 
city health bureaus. Selected copies of these circulars in various 
languages will be found in the appendix. The importance of having 
these instructions in many languages will be apparent. It very often 
happens that the mother does not understand the language either of 
the visiting nurse or of the physician, and is hence thrown back, as 
soon as they leave the house, upon her own resources, or left to the 
mercy of advisory neighbors as ignorant as herself. It may fre- 
quently happen, also, that where health officers have no means or 
opportunity of doing anything more they can have such circulars 
distributed among mothers, or have the material printed in the local 
papers. Experience has shown that the editor, for instance, of the 
Italian paper is glad to print this material if the copy is furnished 
to him in Italian; the publisher of the Yiddish paper is entirely 
willing to publish it if it can be furnished to him in Yiddish, etc. 
It should be noted that these " Care of the Baby " and " Save the 
Baby " circulars frequently contain some information as to the care 
of the mother immediately before the birth of the child. 


It is evident that no universal program for civic baby-saving work 
can be laid down, because each community must begin at the point 
which is practicable or most urgent as shown by local conditions, but 
the following summary is offered as universally applicable : 

(1) A continuous graphic statement of the births and deaths of 
babies, kept by means of different-colored pins to be placed day by 
day on a city ward map or, preferably, a block map showing each 
dwelling, is a simple means of keeping informed as to the points of 

(2) Complete registration of births is necessary in order that the 
baby may be brought under observation as soon after birth as 

(3) The appeal to mothers to nurse their babies can not be made 
too strong, since it is estimated that bottle-fed babies have only one- 
tenth the chance to live that breast-fed babies have. 

(4) A clean milk supply is a fundamental need. The ideal is: 
Nothing short of clean milk for everybody. This calls for intelli- 
gent and effective inspection of farms, the means of transportation, 
and the shops where milk is sold. 

Milk stations for distributing clean milk to babies, maintained liy 
private philanthropy, are a useful beginning. 

1 See page 14. 


(5) The organization of " Little Mother Leagues " or similar classes 
in the public schools, through which girls from 12 to 14 years of age 
are taught all practical methods of home making, including baby 
hygiene and feeding, ranks as important work in the prevention of 
infant mortality in this and in the next generation. 

(6) All efforts for civic cleanliness serve the babies no less than 
the rest of the population. 

In conclusion, as summing up the significance of the work de- 
scribed in this publication it seems fitting to recall the statement of 
a great sanitary authority that the infant death rate is the truest 
index of the welfare of any community. 



[Suggestions to Mothers from the New York State Department of Health, Eugene H. 
Porter, A. M., M. D., t-ommissioner. Written by H. L. K. Shaw, M. D., consulting pedia- 
trician, and issued by the division of publicity and education of the State department 
of health, Albany.] 


This booklet is prepared and placed at the free disposal of the 
mothers of the State of New York to assist them in the care of them- 
selves during pregnancy and in the care of the baby after it is born. 
Copies can be obtained through the local health officer or the registrar 
or direct from the State Department of Health, Albany, N. Y. 

At present it is published only in English; as the need is demon- 
strated it will be issued in other languages. It is by no means in- 
tended to take the place of the physician, whose advice should be 
frequently sought and followed. 

It is the desire of the commissioner of health that a copy of these 
suggestions be placed in the hands of every expectant mother, or 
that it reach her as soon as possible after the birth of her child. 
The local registrar or health officer will cooperate in seeing that 
this wish is fulfilled. 


Do you know that out of every five deaths in New York State 
one is that of a baby less than a year old? A large percentage of 
these are due to causes which could and should be prevented. 

An epidemic of smallpox gives rise to startling headlines in the 
newspapers and the entire community is aroused and alarmed. Pub- 
lic opinion demands prompt and vigorous action on the part of the 
health officers. Yet the number of deaths in this disease is exceed- 
ingly small in comparison with the number of preventable deaths 
among infants. 

The New^ York State Department of Health is endeavoring to 
" save the baby " and enlists your support. 

A large number of deaths among infants indicates the existence 
of insanitary conditions or of ignorance that will affect not alone 
the little children but the entire community. 

The most important factor in the solution of this problem is the 
mother. She is the natural caretaker of her baby. A lower death 



rate among the babies can only be accomplished through intelligent 
motherhood, maternal nursing, cleanliness and fresh air, and pure 
and properly prepared milk for the babies who have to be artificially 

The following suggestions are made in order that the mother can 
intelligently prepare and care for her baby. 


Health of mother. — A poorly fed or sickly mother can not give 
birth to a vigorous, healthy infant and successfully nurse it. Such 
a mother rarely carries her baby for the full 280 days. A woman 
who has had repeated miscarriages or whose labors have come on 
before time should, early in pregnancy, consult her physician in order 
that the underlying cause can be cured or alleviated. During preg- 
nancy, and especially in the latter months, the expectant mother must 
have abundant rest and spare herself as much as possible. An extra 
amount of sleep is required by the pregnant woman, and a daytime 
rest for an hour or two is desirable. Select and consult your physi- 
cian early in pregnancy. Keep yourself in good health. Hard house- 
hold labor or factory work during the latter months of pregnancy 
tend to bring about miscarriages or the birth of puny and undersized 

Exercise. — Exercise in the open air in the form of walks should 
be taken throughout the entire course of pregnancy. Violent exercise 
in any form should be prohibited, and unnecessary stair climbing must 
be avoided in the latter months. The sewing machine must not be 
used toward the end of pregnancy. 

When labor is threatened before the proper time the mother should 
go at once to bed and remain perfectly quiet until the danger is well 

Care of nipples. — Small, flattened, or depressed nipples should be 
drawn out with the forefinger and thumb and held for five minutes 
night and morning during the two months preceding labor. The 
nipples should be carefully anointed each night with white vaseline 
and washed each morning with castile soap and w^arm water. This 
will soften and remove the milk which is secreted in the latter part of 
pregnancy, and which if not removed would form hard crusts and 
ulcerate the soft tissue beneath. Proper attention to the care of the 
nipples during pregnancy will make the act of nursing one of 
pleasure and satisfaction instead of one of pain and discomfort. 

Diet. — The diet should be carefully regulated. A full, whole- 
some, and liberal diet is essential. This depends on the woman's tastes 
and habits, as food which agrees with one will not agree with another. 
Highly seasoned or veiy rich food should be avoided as well as fatty 
foods and coarse vegetables. 

The following dietary is recommended during pregnancy and 
nursing : 

Soup. — Any kind. 

Fish. — Fresh fish of any kind, boiled or broiled. Raw oysters and 
raw clams. 

Meats. — Chicken, beef, ham or bacon, veal, lamb, tender lean mut- 
ton. Eed meat should be allowed in moderation and only once a day. 


Cereals. — Hominy, oatmeal, farina, cream of wheat, rice mush, 
shredded wheat biscuits, etc. 

Breads. — Stale bread, corn bread, Graham bread, rye bread, brown 
bread, toast, crackers. 

Vegetables. — Potatoes, onions, spinach, cauliflower, asparagus, 
green corn, green peas, beans, lettuce, or other salads with oil. 

Desserts. — Plain puddings, custard, junket, ripe raw fruits, stewed 
fruits, ice cream. No pastry. 

Drinks. — Tea and coffee very sparingly, never more than one cup 
a day. No alcoholic beverages, beer, etc. At least two quarts of 
water a da3^ Milk, buttermilk, cocoa, malted milk. 

At least one satisfactory movement of the bowels should take place 
daily ; if there is any difficulty about this consult a doctor. 


Send for the doctor. — Send for the doctor when the labor pains 
begin. He j)refers being called too early than too late. A sudden 
gush of water signifies that the membranes have ruptured, and the 
mother should go to bed at once. 

The bed should be prepared as follows: Place a rubber sheet or 
three thicknesses of newspapers next to the mattress and over this 
a clean sheet. Next place three thicknesses of newspapers over the 
middle and edge of the side of the bed and cover with a folded sheet, 
and then cover with a clean sheet. This top layer of papers and 
sheets can be easily removed after the labor and the mother lies on a 
clean dry sheet. 

Everything should be in readiness for the reception and care of the 
baby. A warmed flannel blanket in which to place the baby after 
birth, and hot-water bottles to surround it, if the room is cold, are 
desirable. The baby should be exposed as little as possible during 
the bath, and the clothes and diapers should be warmed. Every- 
thing that comes in contact with the baby should be scrupulously 

Save the baby's eyesight. — The mother should insist that a drop 
of silver solution, as provided free of charge by the New York State 
department of health, be placed in the baby's eyes. This will pre- 
vent blindness. If the baby weighs less than four pounds it can best 
be taken care of in incubators, which are to be found in any well- 
equipped hospital. Your physician is required to make a prompt 
report of the birth to the registrar or local board of health. This is 
a matter of great importance, and don't let him forget it. The 
mother should remain in bed for at least two weeks after confinement. 
The womb does not return to its normal state for five or six weeks, 
and no hard work or active exercise should be taken during this 


Nurse your baby. — If you love your baby, nurse it. Mothers' 
milk is nature's food, and no other food is as good. The chances of 
your baby living are nine times greater on breast milk than cow's 
milk or any other kind of food. Even though you have but little 

94219°— 13 4 


milk at first, do not get discouraged. Be patient and try, try again. 
There are very, very few motliers whose breasts will not give suffi- 
cient milk if they will but encourage the baby to suck. This keeps 
the milk flowing and increases its flow. Even though you feel weak 
you can nurse your baby without danger to yourself. Only a few 
serious diseases forbid nursing. If you are in doubt consult your 
doctor. His advice is better than that of your neighbors. 

Nurse your' hahy until the tenth month. — If you really can not 
nurse him as long, give him your milk as long as you can, for every 
drop he gets adds to his strength for his hard fight in life as no 
other food does or ever will. Keep your boAvels regidar. Constipa- 
tion in the mother often causes colic in the baby. Follow the dietary 
shown on a preceding page and eat three plain, well-cooked meals a 
day at regular intervals. Drink plenty of water., but avoid tea, 
coffee, and beer. So long as the mother keeps well the baby will be 

Nurse the hahy regularly. — Feed him by the clock. From birth to 
three months feed every two and a half hours during the day with 
only one nursing between 10.30 p. m. and 6 a. m. After the third 
month feed him every three hours and do not nurse during the night. 
Do not let the baby remain at the breast more than 20 minutes. 
Never allow the baby to sleep at the breast at night. Wlien the baby 
cries between feedings give him pure, warmed water without any- 
thing in it. Then let him alone. The mother should wash the nipple 
with plain, cold water before each nursing. 

Wean gradually by substituting bottle feedings for breast meals — 
one each day during the first week of weaning, two each day during 
the second week, and so on until all are bottle feedings. If possible 
do not wean during the hot summer. 


Substitute for mother's milk. — Cow's milk is the only good substi- 
tute for mother's milk. 

It should come from healthy, consumption-free, and clean-kept 
cows and be promptly cooled. It should be milked in a clean stable 
by clean milkmen and bottled in clean bottles. It must be kept con- 
tinually^ on ice until used for the baby. Common store or milkman's 
milk is not safe food for the baby, even though it tastes and looks 
^ood. The patent baby foods, condensed milk, etc., harm the babies 
m most cases and should not be used. They often make the baby fat, 
but not strong. If you can not afford the best milk get the best you 
can from a milkman whom you know to be clean. Place in a clean 
dish and boil the milk from 5 to 10 minutes. Cool as quickly as 
possible by placing the dish in another filled with ice water. 

As soon as the milk is cooled prepare the food as directed by 
the doctor, using only clean dishes. The food is then poured in the 
nursing bottles and clean cotton batting is used for stoppers. These 
bottles are kept on ice if possible. 

Homemade ice box. — A cheap ice box can be made as follows: 
Get a box about 18 inches square from your grocer and put 3 inches 
of sawdust in the box. Place two pails in the sawdust, one inside the 
other, and fill the space between the outer pail and the box with saw- 


dust. The nursing bottles filled with milk are placed in the inner 
pail and the pail is surrounded with cracked ice. The inner pail 
should have a tin cover. Nail several thicknesses of newspapers on 
the under surface of the cover of the box. This ice box should be 
kept covered and in a shady, cool place. 

Care of nursing bottles. — The bottles should be cleaned immedi- 
ately after feeding by first rinsing with clear water and then soak- 
ing in soda, borax, or soap water. Then clean well with a clean 
brush and rinse with boiled water. They should be filled with boiled 
water until ready for use. 

Use only nipples which are slipped over the neck of the bottle. 
Nij^ples with tubes are convenient for a lazy mother, but they can 
not be cleansed thoroughly and may mean death to the baby. After 
each feeding cleanse the nipple thoroughly inside and outside. Boil 
the nipple at least once daily, and keep it dry in a clean covered cup 
or glass. 

Early feeding. — Feed the baby one part milk and two parts water 
during the first month at intervals not less than two and a half hours 
and in amounts not more than four ounces (eight tablespoons). 

During the second and third months use one part milk and one part 
water at three-hour intervals and five ounces (10 tablespoons) in 

After the fourth month give two parts milk and one part water at 
three-hour intervals and six ounces (12 tablespoons) in amount, in- 
creasing one ounce at each meal during each succeeding month. Bar- 
ley water or oatmeal water can be used to dilute the milk. One level 
teaspoon of granulated sugar should be added to every three ounces 
(six tablespoons) of diluting solution (water, barley, or oatmeal 
water) . 

Warm the bottle to about body heat before giving it to the child, 
by placing the bottle in a dish of hot water. If the milk is not sweet 
do not give it to the baby. Wash your hands before touching the 
nipple. Shake the bottle before using. Never put the nipple in your 
own mouth to find out whether the milk is warmed enough. Try it 
on your wrist. Hold the baby in your arms while feeding it, and do 
not allow the baby to drink from the bottle longer than 20 minutes. 
If he does not take the whole feeding throw it out and do not save 
for the next time. 

Don't overfeed. — Never coax the baby to take more food than he 
Avants. Too much food and too frequent feedings overtax the diges- 
tion and lead to stomach and intestinal disturbances. This is what 
makes the baby cry. He cries because he has indigestion from too 
much food, not because he is hungry. Boil a pint of water every 
morning and put in clean bottle. Keep in cool place. Warm it be- 
fore giving to the baby. Give as much as he will take between 

After the eleventh month. — A well cooked cereal (farina, cream 
of wheat, strained oatmeal, etc., cook three hours) can be given once 
a day after the eleventh month in place of the noonday feeding. 
Beef juice with stale bread crumbs, broths, or a soft-boiled egg can 
be given in addition to the cereal after the twelfth month. A well- 
baked potato, boiled rice, rare roast beef, custard, corn starch, rice 
pudding, baked apple, apple sauce, stewed prunes, and bread and 
butter can be given after the fifteenth month. 


Ham, bacon, or pork, cabbage, pickles, tea, coffee, or beer, bananas, 
berries, cake, candy, or ice cream, should not be given to babies or 
little children. 

Teething. — Teething rarely causes serious illness. If the child 
seems to be ill, do not put it down to teething^ but consult the doctor. 

Diarrhea. — As soon as the baby has diarrhea or vomiting, stop all 
food at once and give only boiled water or clear barley water until 
the doctor sees the baby. 

Fresh air. — Give the baby pure fresh air day and night and keep 
the windows open but screened to exclude flies and mosquitoes. Keep 
the baby in the open air when possible, but avoid the sun during hot 
weather. Select the shady side of the street. 

Avoid infection. — Keep the rooms free from soiled clothes and 
rubbish. Do not encourage the baby to play with cats or dogs; they 
often have disease germs in their fur. Do not let the child crawl 
around on a dirty floor or dusty carpet. Do not let it put playthings 
into its mouth. 

Bath. — Every child should have one tub bath daily. On very 
warm days the 10-minute spongings with cool soda water (one tea- 
spoonful of bicarbonate of soda to a pint of water) will add greatly 
to the baby's comfort. 

Clothes. — Do not put too many clothes on the baby. A band, 
shirt, petticoat, and dress are all that are needed in the house. Dur- 
ing very hot days a napkin, band, and a thin muslin slip are all that 
the baby needs. 

Sleep, — Be sure the baby gets two naps a day and at least twelve 
hours of sleep at night. Do not let him sleep on a feather pillow. 
The baby should sleep in a bed or crib by itself — never in bed with 
its mother. Do not rock or jomice the baby and remember that con- 
stant handling is harmful. Keep the baby and bedclothes clean. 
Diapers should be carefully washed as soon as they become soiled 
and then dried in the open air. Do not use a diaper a second time 
before washing it. 

Soothing sirups. — Under no circumstances should soothing sirups 
be given to the baby. They contain opium and are dangerous. 

Good habits. — Train the baby into good habits. Do not get the 
child into the habit of expecting to be carried about if it cries. Train 
the baby to go to sleep Idv itself in the dark, A well-trained baby 
makes a well-behaved child, 


Barley water. — This is often used instead of water to dilute the 
milk and tends to make the curds of the milk more digestible. One 
heaping tablespoonful of barley flour and a pinch of salt are mixed 
w^ith a little water into a thin paste and added to 1 quart of boiling 
water. Stir well and boil for 20 minutes. Add enough water to 
make 1 quart. Pearl barley requires more cooking. It should be 
boiled for at least 3 hours and must be strained before using. Make 
fresh daily. 

Oatmeal water. — This is used in the same way as barley water, 
but it has a laxative effect. Stir two tablespoonfuls of oatmeal and a 
pinch of salt in a quart of boiling water and let it simmer for three 


hours. Replace the water that evaporates so that there will be a 
quart when clone. Strain. Make fresh daily. 

Egg water. — To be used when the baby can not digest milk. Stir 
the white of one egg into 1 pint of boiled water, add a pinch of salt, 
shake thoroughly, and strain. This should be kept in the ice box or 
other cool place. 

Beef juice. — Take rare broiled beef and cut into small pieces and 
press out the blood. This can be diluted with plain boiled water or 
barley water. 

Broths. — Take 1 pound of meat, free from fat, and cook for 3 
hours in 1 quart of water. Add water from time to time so that there 
will be 1 quart of broth. Cool, remove fat, strain, and add a little 

Whey. — Warm one pint of milk to blood heat and add one tea- 
spoonful essence of pepsin or junket tablet. Let it stand until it 
jellies and then break up the curds with a fork. Strain through a 
cloth. What goes through is called whey and is used when babies 
can not digest cow's milk. 

[Leaflet issued by New York City Department of Health.] 



1. One death out of every five which occur at all ages is that of a 
baby under 1 year of age. 

2. In the city of New York during 1910, 4,794 babies under 1 
year of age died from bowel trouble, and 9 out of every 10 of these 
babies were bottle fed. 

3. Out of the 16,213 babies under 1 year of age who died from all 
causes in New York city during 1910, one-third died before they were 
1 month old. 

4. A large proportion of these babies would have lived if they had 
been nursed by their mothers. 

5. Mother's milk is the only safe food for a baby during the first 
six months of its life. If the weather is warm the baby should not 
be weaned until it is at least 9 months old. Cow's milk or prepared 
food can never equal breast milk as the proper food for the baby. 

6. Breast-fed babies rarely have bowel trouble. Bottle-fed babies 
rarely escape having it, particularly during warm weather. 

7. Babies fed on breast milk shoAv the best development; the teeth 
will appear at the proper time, the muscles and bones will be stronger, 
and walking will not be delayed. 

8. A breast-fed baby is not so likely to have bronchitis or croup, 
and if attacked by any disease has a much better chance of living 
than a bottle-fed baby. 

9. Pneumonia in babies is fatal more often in bottle-fed babies 
than in breast-fed babies. 

10. Your baby will have the best chance of living that you can 
give it if it is breast fed. 

Surely these facts are worth considering before deciding not to 
nurse your baby. 

Issued by order of the board of health. 


[Circular issupd by the Pennsylvania Department of Health.] 
Form 20. 



The hot weather of this season of the j^ear is extremely dangerous 
to the lives of infants and young children, not only because of the 
depressing effects of high atmospheric temperature in general, but 
more especially because of the effect of hot weather upon all perish- 
able articles of food, among which cow's milk holds the first place. 

It is therefore highly important that cow's milk to be used for 
infant's food should be the purest and freshest that you can afford to 
buy. During the hot weather ice is absolutely necessary for the 
preservation of milk, and all milk used for food should be cooled by 
ice as soon as it comes from the cow and should be kept next to the 
ice until ready to be used. A little money spent for ice may prevent 
illness and its much greater expense for medicine, nursing, and medi- 
cal attendance. As water is often a carrier of disease it is safest to 
use only boiled water for drinking or the preparation of a baby's food. 

The following rules will aid you in keeping your baby well during 
the hot weather: 

Breast feeding. — Every mother should endeavor to nurse her baby. 
Breast milk is the natural food of the newborn baby. There is no 
other food that can compare with it. A breast-fed baby has a much 
greater chance of living than a bottle-fed baby. 

Immediately after birth do not give any kind of artificial food to 
the baby, while waiting for the breast milk to come. Put the baby 
to the breast every four hours, and give nothing else but water that 
has been boiled. The baby needs nothing else, and will not starve. 

After the milk comes into the breast nurse the baby every two 
hours during the day and two or three times at night. 

Don't nurse the baby whenever he cries ; a moderate amount of cry- 
ing helps to develop the lungs. Babies who are nursed irregularly, 
or whenever they cry, are likely to get indigestion and then cry the 
harder from pain. Nurse regularly and the baby will soon learn to 
expect its nursing only at the proper intervals. Give the baby a little 
boiled water several times a day. 

After the baby is 2 months old lengthen the time between feeding 
to 2^ or 3 hours, with only one or two feedings at night. 

Do not wean the baby as long as he is gaining and never do so ex- 
cept by advice of your doctor. Do not follow the advice of friends 
or neighbors about weaning. If the baby remains well but after a 
time stops gaining in weight, do not think that your milk is of no 
value, but consult your doctor about adding one or two bottles to help 
you out. 



Bottle feeding. — If it becomes necessary to feed the baby either 
entirely or only in part upon the bottle, remember that the greatest 
cleanliness is necessary in all details of the feeding. As soon as a 
bottle is finished, it should be thoroughly washed with cold water, 
then cleansed with hot wat-er and borax (1 teaspoonful to a pint of 
water) and put aside for further cleansing, before being used again. 
If you have only a few bottles and it becomes necessary to use the 
same bottle for the next feeding, boil it for a few minutes before 
putting fresh food into it. Never let the baby nurse from the re- 
mains of a bottle which he has not finished at once. Take it away 
from the crib, pour out the milk, and cleanse at once. Stale milk 
curds sticking to the inside of a bottle after a few hours become 
poisonous and may contaminate fresh milk coming in contact with 
them. It is better to have as many bottles as the number of the 
baby's daily feedings, so that all the bottles can be boiled together be- 
fore the food is prepared in the morning. 

Nipples. — Tiie simpler the nipple the safer for the baby. Do not 
use complicated nipples, and under no circumstances buy a bottle 
with a long rubber tube attached to the nipple. It can not be kept 
clean and will certainly cause bowel trouble. After the bottle is fin- 
ished the nipple should be removed at once, turned inside out over the 
finger and scrubbed with cold water and a brush kept only for this 
purpose. After use, always boil the brush. 

The cleansed nipple should be kept in fresh borax water (1 tea- 
spoonful of borax to a pint of water) in a covered glass. Rinse the 
nimble in boiling water before using it. 

Do not put the nipple into your own mouth to find out whether the 
milk is warmed enough. Let a few drops of the milk fall on your 
wrist; if it feels too hot to your wrist it is too hot for the baby's 

No general instructions can be given about the preparation of a 
milk mixture for your baby. Each baby needs a combination suited 
to his digestion. The mixture upon which some other baby is thriv- 
ing may be too strong or too weak for your baby. Let the doctor 
tell you how to mix the food. If it is necessary to use cream in the 
mixture do not buy cream — it is likely to be stale — but get it by 
pouring off half a pint from the top of a quart bottle of milk, after 
cleansing the lip of the bottle. 

Do not be guilty of constantly changing food for the baby as 
mothers are apt to do through the advice of " good " neighbors. Fol- 
low the instructions of your doctor. 

During the summer the baby's food should be brought to a scald 
after it is prepared. It should then be poured into the clean bottles, 
corked with baked clean cotton wool and kept next the ice until 
needed. Do not heat a bottle when you go to bed and keep it in 
bed until nursing time, because you do not want to go to the ice 
box for it and heat it when the baby needs it. This is a certain way 
to make the baby sick. 

Bowel movement. — A bottle-fed baby should have at least one 
and not more than two or three bowel movements a day. If the 
milk is clean to start with and has been kept cold, and all the feed- 
ing utensils cleaned as you have just been told, the baby's move- 
ments should be yellow in color, and not too hard to be passed 


easily. If the movements become greenish in color, but not more 
frequent than two or three a day, give one or two teaspoonsfiil of 
castor oil. If the color does not improve after the oil has worked 
off, consult your doctor. At this time he will be able to prevent 
the serious bowel trouble with which the baby is threatened. If 
the movements remain green in color and increase in number to 
five or six or more in the 24 hours, your baby is beginning to have 
bowel trouble, or summer diarrhea. Stop milk at once, give pure 
boiled water instead and call the doctor. It may not be too late. 

Do not begin milk feeding again until the doctor orders it. You 
will not starve your baby by stopping the milk; every drop of milk 
that goes into his mouth after this warning simply adds to the poison 
already there. You will cause serious or fatal illness by keeping up 
milk food after the bowels become loose and the movements green in 

Vomiting. — A bottle-fed baby should not vomit if its food is pure 
and properly adjusted to its needs. If vomitings occur it is usually 
a sign of approaching illness, either of one of the serious diseases of 
childhood, or more commonly in hot weather, of summer diarrhea. 
Vomiting due to this cause may be the first sign of trouble and the 
bowels may not become loose until several days later. If vomiting 
is repeated, stop milk feeding, give boiled water, cool or of the tem- 
jDcrature at which the milk is given, and consult your doctor at once. 

Clothing. — Do not put too much clothing on the baby in summer. 
During the hottest weather, remove most of the clothes ; a thin loose 
shirt and a diaper are sufficient during the day and on very hot, 
close nights. 

Xever use clothing made with tight waistbands. Petticoats and 
skirts should be supported by straps over the shoulders. 

Bathing. — Bathe the baby every day. In hot weather a quick 
sponging all over later in the day will give comfort and make him 
sleep better. Wash the baby each time the diaper is changed and 
dry the parts thoroughly before using powder. Wash all soiled 
diapers and boil them. Never use a dried wet diaper without first 
washing it. 

Flies. — Be careful to exclude flies from the baby's bottle and food 
and do not allow them to light on the baby's lips while sleeping. 
Flies carry disease to thousands of infants every summer. 

Fresh air. — Fresh air is as important for the baby's health as 
fresh food. During the summer, keep the baby out of doors as much 
as possible. Keep the baby out of the kitchen ; he may get a " sun- 
stroke " from too much heat indoors. 

Eruptions of the skin. — If the baby has an eruption or breaking 
out of the skin, consult a doctor. Do not think that every rash is 
prickly heat ; it may be some serious disease like scarlet fever, measles, 
smallpox, or chickenpox. 

If a baby is worth having it's worth saving. Half of the babies 
that die in Pennsylvania each summer could be saved by following 
the advice given in this circular. 

Issued May 15, 1909. 

[Circular issued by Pennsylvania Department of Health.] 
Form 20B. — Italian. 




II caldo della stagione estiva e assai pericoloso per la vita dei bam- 
bina di tenera eta, specialmente per i neonati, non tanto per le con- 
seguenze dell' alta temperatiira in generale, quanto, ed in modo spe- 
eiale. per TetFetto ehe il caldo puo avere su tiitti qiiei cibi che possono 
andare soggetti a decomposizione. Fra questi, il latte di vacca occupa 
il primo posto. 

E, di conseguenza, d'importanza massima che il latte di vacca che 
voi destinate all' allattamento dei bambini sia il piii puro ed il piu 
fresco che i vostri mezzi vi permattano di comprare. Durante la 
stagione calda, il ghiaccio e assolutamente necessario per mantenere 
fresco il latte. Qnesto, quando viene usato come cibo, deve essere 
raffreddato col ghiaccio non appena munto clalla vacca e deve essere 
tenuto in ghiaccio fino al momento in cui © usato. Pochi soldi spesi 
per un po' di ghiaccio possono tener lontane le malattie e qualunque 
spesa per visite mediche, medicinali o altro da esse derivanti. Sic- 
come I'acqua, spesso e volentieri, e veicolo d'infezione e, quindi di 
malattie, si deve usare soltanto acqua bollita, quando deve essere 
bevuta, oppure una qualunque altro preparazione speciale per 

I seguenti consigli e suggerimenti vi aiuteranno a mantenere i 
vostri bambini in buone condizioni di salute durante il caldo dell' 
estate : 

Allattamento. — Ogni madre deve fare il possibile di allattare da 
se il proprio bambino. II latte materno e il cibo naturale del neonate 
e non vi e alcun altro cibo che puo reggere al paragone. Un bambino 
che ha succhiato il latte dal seno materno ha molte piu possibilita 
di vita di qualunque altro bambino allattato col biberon. Al bambino 
appena nato non date mai cibo artificiale. Avvicinatelo alia mam- 
mella ogni quattro ore e non dategli altro che acqua che sia stata ben 
bollita. II neonato non ha bisogno di piu' e siate pur sicuri che esso 
Jion morra certamente per mancanza di nutrimento. Non appena la 
mammella a colma di latte, allattate il neonato ogni due ore, durante 
il giorno, e due o tre volte durante la notte. 

Non allattate il neonato ogniqualvolta esso piange o grida.— 
II piangere moderato e una delle funzioni che, nel neonato, contri- 
buisce ad accrescere lo sviluppo dei suoi polmoni. Quel bambini ai 
quali il latte non vien dato regolarmente oppure ad ogni minimo ac- 
cenno di pianto, possono spesso andar soggetti ad indigestione ed alle 
sue conseguenze. Allattate il bambino regolarmente e vedrete ch'esso 



imparera do se stesso a chiederlo a tempo debito. Dategli pure spesso 
11 n poco d'acqiia durante il giorno ed abbiate cura ch'essa sia stata 
prima ben bollita. 

Lo svezzamento del bambino non deve assolutamente avvenire du- 
rante il sno sviluppo e se non prima non si e. consultato in proposito 
un medico. Xon state ad ascoltare i consigli e gli avvertnnenti di 
amiche e di vicine, quando si tratta di svezzare il bambino. Se esso 
gode buona salute puranco non aumentando affatto di peso, non state 
a credere che la potenza benefica del vostro latte sia venuta meno. 
Consigliatevi invece con im medico e domandategli se una o due bot- 
tiglie di latte possono aiutarvi ad assolvere il compito materno. 

Allattamento col biberon. — Qualora sia realmente necessario alla- 
tare il bambino, interamente o in parte, col biberon, tenete ben pre- 
sente che la pulizia e cosa prima ed indispensabile in tutti i processi 
dell' allattamento. Non appena il biberon e vuoto, deve essere ben 
lavato con acqua fredda e poscia accuratamente pulito con acqua 
calda e borace (un cucchiaino sciolto in una pinta d'acqua). Piii 
tardi, al momento in cui e necessario usarlo nuovamente, il biberon 
deve essere di nuovo lavato e pulito. Nel caso che voi abbiate poche 
bottiglie soltanto, e che sia indispensabile usare la stessa bottiglia, 
tenetela in un recipiente d'acqua bollente per qualche minuto, prima 
di mettervi dentro altro latte. Abbiate bene cura di non dare mai 
al bambino il rimenente di un biberon vuotato solo in parte. Togliete 
questo biberon dalla culla, vuotatelo del contenuto e piilitelo im- 
mediatamente. I filament! del latte stantio o acido che rimangono 
attaccati al vetro divengono ricettacolo d'infezione e possono, di 
conseguenza, contaminare il latte fresco che ad essi va ad aggiungersi. 
E quindi consigliabile avere tante bottiglie per quante volte, durante 
il giorno, voi devete allattare il bambino. In questa guisa voi le 
potreste lavare e pulire insieme in acqua bollente ogni mattina. 

Capezzoli di gemma. — Piii semplice e questo capezzolo, tanto piii 
consigliabile esso e per la salute del bambino. Xon usate altri capez- 
zoli e per nes suna ragione al mondo comprate biberons che abbiano 
tubi di gomma attaccati al capezzolo. Essi non possono essere mai 
tenuti abbastanza puliti e possono quindi causare disturb! visceral!. 
Esaurito il contenuto di un biberon, liberatelo immediatamente del 
capezzolo. Cio fatto, col dito rovesciate questo capezzolo, come 
fareste con un guanto e pulitelo bene, in acqua fredda, con uno 
spazzolino che avrete cura di conservare esclusivamente per questo 
uso. E necessaria pulire lo spazzolino con acqua bollente ogni volta 
che lo si usa. 

II capezzolo, una volta pulito, deve essere costantemente tenuto in 
una soluzione d' acqua e di borace (un cucchiaino di borace in una 
pinta d'acqua) in un recipiente di vetro ben chiuso. Quindi, prima 
di essere nuovamente usato, e. necessario sciacquarlo in acqua bollente. 

Non mettete mai in bocca il capezzolo artificiale per accertarvi se 
il latte e caldo abbastanza. — All' uopo bastera che lasciate cadere 
qualche goccia sul vostro polso. Se e troppo calda vuol dire ne che e 
troppo calda per la bocca del neonato. 

Non e possibile dare, in generale, consigli e suggerimenti circa il 
modo in cui deve essere fatta una preparazione di latte per il vostro 
bambino. Ogni bambino ha una costituzione fisica speciale ed 
abbisogna di una speciale preparazione adatta alle sue tacolta di- 


gestive. Una preparazione che puo essere biiona ^Der questo o quel 
bambino puo essere troppo pesante o troppo leggera per il vostro. 
Lasciate che il medico vi consigli a questo proposito. Se e indispen- 
sabile usare della crema, non comprate mai della crema bell'e fatta — 
puo benissimo essere stantia o acida. Prendetela invece dalla parte 
superiore della bottiglia del latte (quelle da un quarto) e soltanto 
dopo aver bene puliti gli orli del recipiente. 

Durante I'estate, il latte destinato ai bambini deve essere alquanto 
riscaldato dojDO la sua preparazione. Cio fatto, esso deve essere 
versato in un recipiente ben pulito ed accuratamente chiuso da 
turaccioli di cotone sterilizzato, recipiente che deve essere costante- 
mente mantenuto nel ghiaccio fino a quando il suo contenuto non 
viene usato. Non riscaldate mai la bottiglia allatto di andare a letto, 
ne' tenetela mai con voi fino al momento opportuno, affine di ris- 
parmiarvi I'incomodo di andarla a togliere dal ghiaccio e riscaldarla. 
Ricordatevi che questa trascuratezza e negligenza, spesso e volentieri, 
sono cause prime delle malattie dei figli vostri. 

Funzione dei visceri. — Un bambino allattato artificialmente, cioe 
col biberon, dovrebbe, in condizioni normali, evacuare almeno una 
volta al giorno ma non piii di due. Se, a buon conto, il latte e. buono 
ed e stato mantenuto in fresco e se tutti gli altri ingredienti per 
I'allattamento sono stati anch'essi mantenuti nel modo dovuto, gli 
escrementi del bambino dovrebbero essere di color gialliccio e non 
troppo duri, in giiisa tale da renderne difficile I'uscitta. Se gli 
escrementi diventano di color verdiccio ma I'evacuazione non avviene 
piu di due o tre volte al giorno, sara bene somministrare al bambino 
un cucchiaino d'olio di ricino. Se, con totto I'olio, il colore degli 
escrementi non tende a migliorare, consultate subito il vostro medico. 
Se lo farete immediatamente il medico sara in grado di poter 
scongiurare a tempo quella serie complicazioni e malattie viscerali 
che minacciano di solito i bambini. Se gli escrementi rimarranno 
di color verdiccio e le evacuazioni aumenteranno si da raggiungere 
il numero di cinque o sei nel periodo di ventiquattro ore, il vostro 
bambino soifre di visceri o e affetto da diarrea estiva. In questo caso 
non date piii latte al bambino, ma soltanto acqua ben bollita fino a 
quando non arrivera il medico. Non sara mai troppo tardi. 

Non incominciate di nuovo I'allattamento fino a quando il medico 
non ve lo avra permesso. State pur sicuri che il vostro bambino non 
morira d'inedia se avrete sospeso I'allattamento e ricordate invece 
che ogni goccia di latte che date al bambino, in queste contingenze, 
non fa altro che peggiorare il suo stato. In queste condizioni, con- 
tinuando I'allattamento voi causerete serii e gravi danni al bambino. 

Vornito. — Un bambino allattato artificialmente, cioe col biberon, 
non vomita se il latte e puro e nella quantita adattata al suo fisico. 
II vomito, di solito, e. il primo indizio di una malattia, sia essa una 
della pill pericolose oppure, se nell' estate, una diarrea estiva. II 
vomito che avviene in queste condizioni puo essere il primo indizio 
d'indisposizione e puo far si che i visceri non riprendano la loro 
funzione normale se non dopo parecchi giorni. Se il vomito si ripete, 
sospendete I'allattamento e date al bambino acqua soltanto, ma che 
sia stata prima bollita, tanto fresca quanto della temperatura solita 
del latte e consultate immediamente il vostro medico. 


Vestiti. — Non vestite di troppi panni il vostro bambino durante 
Testate. Nei giorni di temperature torrida, liberatelo di gran parte 
dei panni die I'avvolgono ; una leggera camiciola aperta ed un panno- 
lino sono pivi che sufficienti durante giornate e nottate afose. Non 
usate mai vestitini stretti alia vita. Sottanine e camiciole devono 
essere a spalla. 

Bagni. — Fate fare al bambino un bagno al giorno. Nelle giornate 
calde passategli sollecitamente su tutto il corpo una spugna bagnata. 
II bambino ne risentirii subito il benefico effetto e dormira meglio. 
Ogni volta che il pannolino e bagnato d'urina bisogna cambiarlo, 
dopo aver lavate bene ed accuratamente asciugate con cipria le parti 
basse del bambino. Lavate sempre in acqua bollente tutti i pannolini 
sporclii e non usate mai pannolini che sono stati bagnati d'urina e 
che sono asciutti senza essere stati lavati. 

Le mosche. — Abbiate cura di tener le mosche lontano dalle bot- 
tiglie del latte e da qualunque altro cibo destinato ai bambini. Scacci- 
atele quando le vedete posare sul volto dei vostri piccoli e ricordatevi 
che le mosche, ogni anno, sono causa di molte malattie a migliaia di 

Aria fresca. — L'aria fresca e un cosi importante fattore nelle 
l)uone condizioni di salute del bambino quanto lo e il latte fresco. 
Durante Testate, cercate per quanto piii vi e possibile di tenerli 
all' aperto. Teneteli sempre lontano dalla cucina, II troppo calore, 
in luoglii chiusi puo essere spesso causa di malesseri. 

Eruzioni cutanee. (Sfogo della ])elle.) Se vedete dello sfogo sulla 
faccia e sul corpo del bambino, chiamate il medico. Non tutte le 
eruzioni cutanee sono causate dal calore. Lo sfogo potrebbe benissimo 
essere indizio di malattie gi'avi, quali la febbre scarlattina, il morbillo, 
il vaiuolo, la varicella. 

Se desiderate con tanta ansia avere un bambino, perche non alle- 
varlo e mantenerlo come si deve? La meta dei casi di mortalita di 
neonati nella Pennsylvania potrebbero essere evitati se si seguissero 
i consigli ed i suggerimenti contenuti in questa circolare. 

Issued May 15, 1909. 

Translated May 20, 1912. 

[Circular issued by Pennsylvania Department of Health.] 
Form 20 A— German. 

^r^ttltet bie ^ttuglingc! 

Dicgeltt, tticl^e Bet bcr ^flcgc itnb Se^anblunfj ton Hcineii ^inbcvn 
toa^rcttb be§ 6ommer§ Bcfolgt tocrbcn fottten. 

®a§ t)ei§c SBetter biefer iga^reSjeit ift ciii^erft gefci^rlid^ fitr baS Scben bon 
(Sciugfingcn unb fleincn ^inbern, nic^t nur hjegen ber iiicberbrurfeiiben SSirhtng 
f)of)er atniofpf)anf(^er SEemperatur im Qtlgemeinen, fonbern mef)r inobefonbere ivegen 
ber SBirhmg ber f)ei§en SBitterung aitf nlle Uid)t Derberbenben 9^al)nmg§mittcl, 
unter benen S?nfimtl(| ben erften ^la| eutnimmt. 

6§ ift be§^alb iiberauS tuirfitig, ba§ ^'ut)milc^, iueld^e gitr SfJa^rung bou Heinen 
^inberu gebrouc^t tuirb, jo rein unb frifd^ ift, h)ie man fie nur faiifen Jonn. 
2Bat)renb be§ t)ei^en SBetter§ ift @i§ obfotut notbrtjenbig ^nv ©rtjaltitng t)on 
9KiI(i), unb aHe SJJild^, h)el(f)e §ur 9^at)rung bertDenbet unrb, fotlte bnrd) @i§ ab- 
gefii^It tuerben, fobalb fie tton ber ^u^ fommt, unb in ber 9Ja^e bon @i§ geljatten 
tuerben, bi§ fie gcbraui^t trirb. ©in inenig @etb ha^i fiir (£i§ berauSgabt n)irb, 
mag ^ran!I)eit ber^iiten unb i^re t)ie( gro^eren Soften fiir SJJebigin, ^ftege unb 
orjtIid)e S3e^onbIung. S)o SBoffer oft ein ^'ran!f)eit§trager ift, fo berfii^rt man 
am fic^erften, nur gefo(f)teS SBaffer §um Xrinfen ober gur ^wt'ci^eitung bon 9^a{)= 
rung fiir ben ©angling gu gebrouc^en. 

S)ie fotgenben fRegeIn hjerben baju l^elfen, bie ©duglinge tna^renb be§ {)ei^en 
SSetterg gu erl)atten: 

Stillcn an ber ©ruft. — ^ebe SIKutter fottte fic^ beftreBen, i^r ^inb ju fdugen. 
SDfuttermilc^ ift bie natiirlid^e 91at)rung fiir ba§ neugeborene ^inb. ^'eine onbere 
^JJatjrnng Vd'^t fid^ bamit bergleic^en. @in ^inb, iia^ an ber 9)hitterbruft aufge= 
jogen tnirb, l^at eine bebeutenb Beffere 2(u§fi(^t, ju leben, aU ein .^'inb, h)el(^e§ on 
ber ?5^lafc^e anfgegogen ift. 

Wan gebe bem Slinbe unmittetbar nai^ ber (SJefiurt !eine fiinftlic^e 9?af)rung, 
mat)renb man onf bo§ ^'ommen ber 9Jluttermil(^ Ujartet. Sege ha^ Jft'tnb aUe 
bier ©tunben on bie 93rnft imb gib i^m toeiter nidjtS aU obgefoc^tc§ Saffer. 
®a§ ^'inb braudjt nid)t§ 5(nbere§ unb mirb fcinen |)unger leiben. SSenn bie 
Wil^ in ber 93rnft !ommt, fduge bo§ l^inb oUe gmei ©tunben lnat)renb be§ XageS 
unb jftjei bi§ brei 'SRal miil)renb ber Slac^t. 

©title ta§ ^inb nid)t jebeSmat toenn e§ fc^reit, md^ige§ ©d^reien fijrbert bie 
©nttnidlung ber Sungen. ^inber, bie imregelmd|ig geftiUt luerben, obcr jebe§ 
Wal tuenn fie fdjveien, merben f)6d)\t h)al)rfd)einli(^ Unberbaulid)tcit befommcn 
unb fd)reien bann nur no(^ I)eftiger infotge bon ©djinerjcn. ©titte ba§ Sl1nb 
rcgelmd^ig, unb e§ tnirb fid) batb baron geJui3f)nen, bie ^JJof)rung nur in ben rec^ten 
3inifd)enrdumen gu erlborten. ®ib bem ^inbe meljrere 9JiaIc be§ XogeS ein 
tbenig abgefod)te§ SBoffer. 

(Sntlnot)ne ba§ St'inb nid)t, fo longe e§ gunimmt, unb t^ne e§ nidjt, ouf3cr ouf 
dr,^tli(^en 9tat^. Scfotge in biefer ^e,^ie^nng nid)t ben 9iat^ bon greunben obcr 
$Kad)barn. S3Ieibt ba§ Slinb gefnnb, I)iJrt e§ ober nod) einer gciuiffen 3ttt onf, on 
@einid)t jugunetimen, fo gtaube nid^t, ba§ bie 2}iil(^ tt)ertt)lo§ ift, fonbern gie^e 



cineii 9lrst gu 9^otf)e unb Befrage i{)n, ob e§ ft)ei§ttd^ ift, eine ober gtoet glafc^en 
5ur %t§t)ulfe tjingujufugen. 

Slii[\icl)cii ail &cr gla[d)c. — 2Birbe§nott)njenbig,bQ§ SI inb gong unb gar ober 
t^eilmcife an ber ^laidjt aitJ5it,^ieI)en, jo ben!e baran, bo^ bie gro^te 9teinU(^!eit 
in nUcn ©injeUjeiten ber @rnd{)nmg notliiuenbig ift. ©obalb bie Slofcfie leer ift, 
follte fie griinblid^ mil faltem S5>affer geluafc^en nub bann mil f)et§em SBaffer unb 
93ora5 (1 St)eeI6ffel fiir eine ^Mnte SSnffer) gereinigt tnerben, e{)e fie tuieber ge* 
liraiid)t niirb. SBenn man nnr ein |)aar j^!ald)en ^at unb biefelbe ?5laf^e ba§ 
uiic^fte Wai gebroud}en nntf], fo fod)e man bicfelbe etlic^e 9JJinuten an§, e^e mon 
nene 9taf)ntng in biefelbe I)ineintt}nt. 9)fan laffe bo§ &inb nie bie iiberrefte aii^ 
einer S'lnfrfje trinfen, Uieid)e e§ ba§ erfte Wal nid)t gteid) geleert t)at. 9Jimm bie 
fflafdje tiom ^inberbett f)inrt)cg, gief3e bie Wild) axi^ unb nimm fogleid) bie "Sid- 
niflitng bor. 3(bgeftanbcne MM) gerinnt, fe|t fic^ im ignnern ber j^lafc^e feft, 
mirb nad) etlidien (gtnnben giftig unb bernnreinigt frifd)e 2Ri(d), luetc^e in $8eriit)* 
rung mil berfelben fommt. @y ift beffcr, fo f iele f^lafdjeu gu f)aben, aU bie 5rn= 
^al)i ber Mafjljeiten be§ ftinbcS bctrdgt, fo ha'^ aUt glafdjen jufammen ou§gefod^t 
loerben tonnen, e!)e man bie 9cabrung be§ 9)Jorgen§ gubereitet. 

<Saiigl)iitdKn (Nipples).— ^e einfad)er ba§ ©ougbiitdjen, urn fo fid^erer fiir 
ha^ .^inb. S8raud)e feine fomplisirten ©ang()iitd)en nub taufe unter feinen Umftcin* 
ben eine {^lafdje mit einem langen ©ummifdjlauc^, meldier on bem ©augbiitdjen be- 
fcftigt ift. ©erfelbe !ann nid)t rein ge^alteu njerben unb toirb fidjertid) ©tbrimg 
in ben ©ebdrinen Ijernorrufen. ©obalb ba§ tinb mit ber glafc^e fertig ift, follte 
ba§ ©augbutd}en abgenommen, bnS Snncre mit bem 3^iuger uac^ au^cn geluanbt 
unb mit tattem Staffer abgebiirftet tuerben; fiir biefen Qw^id fottte man eine be= 
fonberc 33nrft f)alten. diad) bem ©ebrand) !od)e man bie $8urft an§. 

5Da§ gereinigte ©ongbiitdjcn fottte in frifd)e§ S3oraj:maffer (1 'Jljeeloffel Sorof 
anf eine ^^inte Staffer ), in ein gugebedte^ @la§ getegt merben. $Sor bem ©ebrauc^ 
fpiile man ba§ ©angbiitd)en in todjenbem Staffer ouS. 

9Jimm ba§ @aug^iitd)en uidjt in beinen eigenen SShmb, urn au§,^nfinben ob bie 
Tlxid) Warm genug ift. Sa^ etlid)e Xropfen bon ber Wild) onf bein |)anbgelen! 
fallen; menu e§ gu l^ei^ fiir bein ^anbgelen! fiit)It, fo ift e§ and) §u f)ei§ fiir ben 
9)htnb be§ SiinbeS. 

i^uv bie 3itbereitung einer 9J?iId)mifd)ung fiir ba§ ^iub laffeu fid) feine attge* 
meiuen ^nftruftionen geben. ;^ebe§ ^ inb brauc^t eine ©ombination, meldie feiner 
^erbanung angcpa^t ift. SDie SDtifdjung, tnelc^e fiir ein onbere§ Slinb gutrdglic^ 
ift, mag fiir bein Slinb ju ftart ober ju fd)mac^ fein. t^rage ben SDoftor, mie bie 
9?atirung gu mifd)en ift. 2Benn e§ uotbloenbig ift, hd ber 9}hfc^ung 9?a^m §u 
berliienben, fo taufe feinen 9\at)m — berfelbe ift mbglic^ermeife abgeftanben — 
fonbern berfc^affe bir benfelben, inbem bit uac^ SJeiuigung be§ glafd^enranbe^ eine 
f)olbe ^inte toon ber Oberfldc^e einer Cuartflafc^e SOlild^ abgie^eft. 

2Bed)fete uii^t beftdnbig mit ber 9?a{)rnug fiir ba§ ^inb, tuogu SUJiitter auf ben 
$Ratf) „guter" 9Jad)boru Ieid)t geneigt finb. Sefolge bie Stntueifungen beine§ 

2Bdf)renb be§ ©ommerS fottte bie S^a^rung fiir ba§ ^'inb, nac^ ibrer 3"berei= 
tung, Quf ben ©iebe|}nntt gebro^t toerben. ©obann fottte fie in reiue j^lafc^en 
gegoffen, mit reiner SBatte berfdjloffen unb bi§ gum diebraud) in ber 9M^e be§ 
6ife§ gcljalten toerben. 9Jlad)e bie S^oft^c "ii^lt ^^^^> c^e bn bic^ ,^ur 9tul)e tegft, 
unb be^olte fie uid)t im SBett, bi§ bie 3t'it 3um ©titten be§ ^inbe§ fommt, tneil bu 
nic^t sum @i§fd)rauf gel}en mittft, luenn ba§ ^'inb biefetbe braud)t. ®ie§ ift ein 
fidjerer 28eg, ba§ ^'inb franf §u madjen. 

© t u I) I g a ]\ g . —(gin ^ inb, metd)e§ an ber glafdie aufgejogen ift, fottte menigftenS 
einmat unb nid)t met)r al§ sluei- bi§ breimal tdglid) (Stut)(gang baben. SSenn 
bie Mild) beim 5(nfang rein ift nub fiil)( gebalteu mirb unb aUc j^iitterungSnten* 
filien gereinigt finb, mie foeben angegeben, fottte ber ©tufitgang be§ ftinbe§ eine 


gelbtirfie ^ax'bz f^aUn unb nicE)t gu f)Qrt jetit, fo baf3 bcrfelbe teirf)t a6gefuf)rt icer= 
ben faim. SBcnn bcr ©tiiljlgang einc grunlid)e garbc annimmt, aber ni(f)t ^aufi= 
ger aU ^Wti- big brcinml be§ Xagc§ eintritt, fo gib einen bi§ §lt)ei 2;^ee(bffel 
9ticimt§b(. SBenn fid) bie f^arbe nic^t beffert, noc^bem ba§ Del gelt)irft l^Qt, jo 
gie^e ben ©oftor gu 'Matl^t. Qu biejer 3eit lt)irb er im ©tonbe jein, bie erften 
S)arnibcj'(f)lt)erben ,^u Oer^iiten, ftou benen ba§ Sinb bebro^t ift. 2Benn ber @tiif)t= 
gang eine griine g-arbe beljatt xmb bi§ auf fiinf ober jed}§ ober mcf)r 9J?at in 24 
©timben fteigt, fiingt ba§ ^inb an ©ormftorimgen ober @ommer=jDiarrf)i)e ^u be- 
fommen. |)bre fogleic^ mit 9JUIc^ auf, gib anftatt bcffen reined ge!od)te§ SBaffer 
imb gietje ben ®oftor gu 9iot{)e. @§ ntag nid)t 511 fpdt fein. 

gauge uid)t loieber an, bcm ^iube 9JHld) ju gebeu, bi§ ber ®o!tor e§ berorb^ 
net. SDa§ ^inb toirb feiueu ^uuger leibeu, Ipeun umu aufl)i)rt, bemfelben 9JiiId) 
3U gebeu; jeber STro^feu Wiii^, tueldjer nod) biefer SBaruung in feiueu Wuni 
gef)t, t)ermef)rt ba§ ©ift, lne(d)e§ bereitS bo ift. ^'jt ber ©tufjlgoug log unb griin 
in ?^orbe, fo mirb man burd) SSerabreic^ung toon nte^r 2JliIc^-9Jot)rung eine erufte 
ober OcrtjdnguifiooIIc ^rant^eit {)eroorrufeu, 

(^ r b r c d) c n . — ©in ^ inb, toeldjCy an ber f^Iafd^e anfgegogen loirb, f oUte ft(^ nid)t 
brcd)en, lueuu bie Siobrung rein unb feiueu SSebiirfniffen in ber rcc^teu SSeife on* 
QZpa^t ift. SBeuu @rbred)eu eintritt, fo ift bieg gelubl}nli(^ cin ^cid^en einer f)eroU' 
nof)euben gefdl}rlid)en ^'iuber!rnn!t)eit, obex Oon ©ommer=^iarrbbe, Joie e§ hd 
I)ei|em SBetter me{)r oUgemein ber ^a(I ift. ©rbred)eu, tocldjcg biefer Urfodjc ,^u 
©runbe liegt, mag ba§ erfte 3e^<ijei^ ^ou (Stbruug fein unb @tuf)lgang uiog nici^t 
bi§ etlidje Xoge f:pdter eintreten. SBenn fid) bo§ S3red)eu toiebcr^olt, ftette bie 
giitteruug utit 9[Rild) eiu, gib abgefod)tc§ SBoffer, fittjl ober in ber Xentperatur, 
toie bie Tlild) gegebeu ift, nub ,^iel)e fogteid) einen Wr^t gu 'lRat^^. 

Sx 1 c i b u ng . — Qidji bcm Sliube im ©ommer uic^t gu oiete Ift leiber an. ©ntfente 
Jod()reub be§ I)ei|3efteu SBettcrg bie mciften I'kiber; eiu biinne§ Iofe§ |)emb unb 
eine SSinbel genitgen lud^reub be§ Xage§ unb in fel)r t)ei^en, fc^toiilen 9uic^teu. 

(^ebroud)e nie ^teiber mit engen Seibd)en. Unterrbde unb ^embeu fottten 
bnrc^ 2;rdger liber bie ©c^uttern gefjotten merben. 

S5 a b c n . — S3abe ba§ Si iub jeben 2;ag. S3ei I)ei|em SBetter tierfc^afft eiu fdjuette§ 
5(blr)afd)en mit bem (Sd^luamm footer om 2;age Siubernug uub fbrbcrt ben ©c^Iof. 
SSflfd^e ba§ Jil inb jcbe^ dJtal menu bie SSiubetn ge)ued)felt merbeu, uub trodue bie 
Xtjcite t)or bem ©cbroud) bou ^ulocr griiublic^ ai. SBofc^e oUe befc^mu^ten 
SBiubelu unb fod)e fie au§. ©ebrou^e nie eine getroduetc uoffe SBinbcI, oljue fie 
erft 5u mofdjeu. 

glicgcn. — (Sei t)orfid)tig, ba^ !eine l^liegeu in bie B^tafc^e uub 9'?of)rung be§ 
^inbe§ getongen, and-) laffe man biefelben nid)t auf ben Si)3lpen bc§ SliubcS fi^en, 
locuu e§ fdjltift. ?^liegen finb bie Uebertrdger jotjftofer Slroufbeiten. 

^rif d)c ^ lift.— grifc^e Snft ift ebenfo loidjtig fiir bie (JJcfnubl^eit be§ tiube§, 
mie frifd)e 32at)rung. §atte ha§> ^inb ludt)renb be§ ©ommcrg fo t)iel al§ mijglid) in 
ber frifd)en Suft. ^olte bo§ S^inb an§ ber HHic^e — e§ mbd;te bieUcit^t einen 
(Sonucuftic^ iufolge gn biet |)i^e im |)onfe befommen. 

S;> a u t a u & f d) lag. — 2Bcun ba§ Sliub einen 9lu§fd)lag ober 9lu§bru^ ber ^ant be- 
fommt, fo gielje eiueu Strgt gu 9iot{)e. ©loube nidjt, bo^ jeber |)outau§fd}tog 
^iplofcn (prickly heat) ftub; e§ mag eine gefd{)rlic^e ^rou!()eit fein, ioie @d)or= 
lodjficber, SKofcru, SSIattern ober ^iif)uerpoden. 

^mn e§ fid) tol)nt, eiu finb ju l)abeu, fo Io()nt e§ fic^ and) boffelbe ^u er^t= 
ten. SDie §dlftc bcr liuber, bie jebcu ©ommer in ^^ennft)IOouicu fterben, tbunteu 
burd) SBefotguug ber 9htl)fct)ldge, lueldie in biefem ^irtular ertl)eilt luerbeu, ge= 
rettet locrbeu. 

ertoffcu am 15. Wai 1909. 

Ueberfe^t om 1. ^uni 1912, 

[Circular issued by Pennsylvania Department of Health.] 
Form 20 C. — Polish. 



Gor^ce powietrze w tej porze roku jest najbardziej niebezpiecznem 
(11a zycia niemowli|t i matych dzieci, nie tylko z przyczyny oci^zatej 
i wysokiej atmosferycznej temperatury w ogolnosci, lecz wi§cej z 
wplywu jakie gorq,ce powietrze wywiera na wszystkie pokarmy, ktore 
latwo poddajq^ si§ zepsuciu a mi^dzy ktoremi krowie mleko zajmuje 
pierwsze miejsce. 

Dlatego tez jest bardzo wazne, azeby krowie mleko, ktore ma bye 
uzyte za pokarm dla niemowl^t, byto najczystsze i najswiezsze na 
jakie nas tylko stac. 

Podczas iipalu lod jest koniecznie potrzebny do zakonserwowania 
mleka, a mleko przeznaczone na pokarm, ma bye lodem wystudzone 
zaraz po odebraniu od krowy i utrzymane zimno az do przyrzQdzenia. 

Mala suma pieni^dzy wydana na lod moze zapobiec, wi§kszemu 
wydatkowi na lekarstwa, opiek^ i lekarza (lekarska opieka). 

Z powodu iz woda jest cz^sto roznosicielkq, chorob, jest bezpieczniej 
uzywac tylko gotowanej wody do picia lub tez przyrzadzonego po- 
karm ii do picia dla dziecka. 

Nast^pujace regiily pomoga do iitrzymania zdrowia dzieci podczas 

Karmienie piersia. — Kazda matka powinna si§ starac aby karmic 
dziecko piersia. 

Pokarm z piersi jest naturalnym dla nowonarodzonego dziecka. 

Niema innego pokarmu ktoryby mogl bye porownywany, 

Dziecko karmione piersia ma wi§ksze szanse do zycia. 

Natychmiast po urodzeniu nie dac dziecku zadnego sztucznego 
pokarmu, nim nadejdzie pokarm piersi. 

Przyktadac dziecko do piersi co cztery godziny, a poic niczem 
innym tylko wodfj, przegotowanq. 

Dziecku nie potrzeba nie wi§cej i ono z glodu nie umrze. 

Gdy nadejdzie pokarm do piersi karmic dziecko co dwie godziny 
podczas dnia, a dwa lub trzy razy w nocy. 

Nie karmic dziecka kiedy tylko zaplacze, umiarkowany placz 
pomaga do rozszerzania pluc. 

Dzieci karmione nieregularnie i kiedy tylko zaplacz^, podpadajs|, 
niestrawnosci, a wtedy placz% z bolu. 

Karmic regularnie, a dziecko nauczy si§ spodziewac pokarmu tylko 
w oznaczonym czasie. 

Dac dziecku pic troch§ gotowanej wody kilka razy na dzieii. 

94219°— 13 B 65 


Gdy dziecko dojdzie do dwoch miesi^cy, przedtuzyc czas kar- 
mienia od 2^ do 3-ch godzin dziennie a tylko raz lub dwa razy na 

Nie odl^czac dziecka od piersi gdy dziecko zyskuje a w kazdym. 
razie uczynic to za porada lekarza. 

Nie sluchaj porady s^siadow lub przyjaciol w odl^czeniu od piersi 

Jezeli dziecko pozotaje zdrowe, ale po pewnym czasie nie zy- 
skuje na wadze nie sadz iz pokarm twoj nie jest pozytecznym ale 
poradiz si§ lekarza, co do dodania jednej lub dwuch flaszeczek mleka 
celem wzmocnienia. 

Karmienie flaszka. — Jezeli koniecznie potrzeba dziecko karmic 
calkowicie lub cz^sciowo flaska, pami§tac nalezy aby zachowac, jak 
najwi^ksza czystosc we wszystkich szczegolach. 

Gdy tylko flaszka jest prozna, trzeba ja starannie wyplukac zimnq, 
wod^, a potem wymyc gor^cq, z buraksem (lyzeczk^ boraksu do pol 
kwarty wody) i odlozyc na bok do dalszego czyszczenia zanim b^dzie 
znowu uzyta. 

Jezeli ma si§ tylko par^ flaszek i potrzeba uzyc te same flaszki 
do nast^pnego karmienia, trzeba jq, przez kilka minut wygotowac 
zanim si§ do niej swiezy pokarm naleje. 

Nigdy nie powawac dziecku ostatko-v* pokarmu w flaszce jezeli 
go przedtem nie spozylo. 

Wziasc natychmiast flaszk§ z kolyski, wylac mleko i wyczyscic 
odrazu flaszk?. 

Zwietrzate mleko zsiada si§ i lepi na wn^trzu flaszki a po uplywie 
kilku godzin staje si§ trujg,cem i moze zanieczyscic swieze mleko. 

Najlepiej miec tyle flaszek ile si§ razy dziecko karmi dziennie, a 
wtedy mozna wszystkie razem wygotowac zanim si§ przygotuje 
pokarm z rana. 

Smoczki gumowe. — Czem prostszy smoczek tem bezpieczniejszy 
dla dziecka. 

Nie uzywac zkomplikowanych smoczkow a pod zadnym warunkiem. 
nie kupowac flaszki z dluga gumow^ rurka przyczepiona do smoczka. 

Takowa nie moze bye wyczyszczon^ i napewno sprowadzi zaburz- 
enie zolqdka. 

Gdy flaszka wyprozniona smoczek ma bye natychmiast zdj^ty 
odwrocony na palcu i wyczyszczony w zimnej wodzie szczotkjj, tylko 
do tego przeznaczona. 

Po wyczyszeceniu potrzeba szczotk§ zawsze gotowac. 

Oczyszczony smoczek umiescic w swiezej boraksowej wodzie 
(lyzeczk boraksu do pol kwarty wody) w zakrytej szklance. 

Wyplukac smoczek w goracej wodzie przed uzyciem. 

Nie wkladaj nigdy smoczka do swycn ust aby si§ przekonac czy 
mleko jest dose cieple. 

Spusc kilka kropel mleka na r§k§, jezeli mleko parzy wtedy jest 
za gorace dla dziecka. 

Nie mozna podac szczegolowych przepisow dla przyrz^dzenia 
pokarmu dla r'2ieci. 

Kazde dziecko potrzebuje odmiany stosownej do jego strawnosci. 

Mieszanina na ktorej jedno dziecko chowa si§ dobrze, moze bye 
za mocne lub tez za slabe dla drugiego. 


Niech lekarz os^dzi jak przjTzadzic pokarm. 

Gdy smietana jest potrzebna w przyrzadzaniu, nie nalezy tejze 
kupowac, gdyz moze by starjj, najlepiej zlac pol kwaterki z kwar- 
towej biitelki mleka po oczyszczeniu nakrywki z flaszki. 

Nie zmieniac ciagle pokarmu dla dziecka jawo matki zwykle 
czyni^, przez porad§ dobrych s^siadow. 

Trzymac si§ przepisow lekarza. 

Podczas lata pokarm dziecka powinien bye przegotowany po 

Wlany w czyste flaszki, zakorkowany czyst^ pazon{|. bawelna i 
trzymany przy lodzie az do iizycia. 

Nie grzac flaszki gdy si§ odchodzi spac i nie trzymac w lozku 
aby nie w^'stygta, gdy si? nie dice isc do lodowni i zagrzewac, gdy 
dziecko pokarmu potrzebuje, bo w ten sposob najpewniej mozna 
przyproAvadzic chorob? dzieckn. 

Rozwolnienie zoladka. — Dziecko karmione flaskg powinno miec 
stolec przynajmniej raz na dzieii a nie wi^cej jak dwa albo trzy. 

Jezeli mleko jest czyste i utrzymane czysto i zimno a wszystkie 
naczynia czyszczone w sposob przedtem podany. 

Dziecka stolec powinien bye austryackiego koloru i nie za twardy. 

Jezeli stolec zmienia si§ na (ajryski) kolor lecz nie powtarza si? 
wi?cej jak dwa lub trzy razy dziennie, dac jednq, lub dwie lyzeezki 
ryeynowego oleju. 

Gdy kolor si§ nie zmieni po uzyeiu oleju poradz si? lekarza. 

W tjm. czasie on b?dzie zdolny zapobiec powaznej chorobie kiszek 
zagrazajacej dziecku. 

Jezeli stolec pozostaje zielonego koloru i cz?sciej si? powtarza, 
pi?c lub szesc razy dziennie (na 24 godzin), twoje dziecko dostaje 
choroby letniej. 

Zatrzymac mleko natychmiast a dac gotowan^ wod? i zawolac 
doktora, a moze nie b?dzie za pozno. 

Nie dac pokarmu mlecznego az doktor pozwoli. 

Dziecko si? nie zaglodzi przez wstrzymanie mleka, a kazda kropla 
mleka podana do ust dziecka po tym ostrzezeniu tylko dodawalaby 
trucizn?, juz tam si? znajdujacej. 

Bylaby to przyczyna powaznej lub fatalnej choroby przez danie 

Przyczynilabys si? do powaznej a moze i fatalnej choroby dajac 
dziecku mleko, za pokarm, moze nastapic rozwolnienie zolqdka, a 
stolec bylby zielony. 

Wymioty. — Dziecko karmione butelka nie powinno wymiotowac. 
jezeli pokaiTn jest czysty i nalezj^^cie przyrzadzony do potrzeb dziecka, 

Jezeli wymioty si? zdarzq, to jest czysty objaw zblizajacej si? 
choroby, moze bye, albo jedna z powaznych chorob dziecinnych, lub 
tez wi?cej rozpowszechnionej w czasach goraczki letniej (diarrhea). 

Wymioty z tej przyczyny moga bye pierwsza oznaka zaburzenia, 
rozwolnienie moze nastapic w kilka dni pozniej. 

Jezeli wymioty si? powtorza, przestac karmic mlekiem, dac go- 
towana wod? studzona, lub tej samej temperatury co podawane mleko 
i poradzic si? natychmiast doktora. 

Ubranie. — Nie wkladac za wiele ubrania na dziecko podczas let- 
nich miesi?cy. 


Podczas najwi^kszej goraczki, zdjac jak najwiecej sukieniek. a 
takze tylko cienka i luzna kosziilka i pieliiszka zupelnie wystarczy 
podczas dnia, a takze w bardzo gorqce i duszne noce. 

Nigdy nie iizywac ciasnego ubrania, spodniczki i sukienki powinne 
si§ zwieszac z ramion. 

Kapiel. — Kapac dziecko codziennie. 

Podczas wielkich upalow szybkie wycieranie calego ciala przy 
koncu dnia orzezwi dziecko i pomoze mu spokojnie spac. 

Umyc dziecko po zmianie kazdej pieluchy, wytrzec starannie 
przed iizyciem proszku. 

Prac zwalane pieluchy i wygotowac je. 

Nigdy nie zakladac suszonej pieluchy, wpierw potrzeba ja wyprac, 

Muchy. — Zachowac najwieksz^j, ostroznosc aby muchy nie siadaly 
]ia flaszce i pokarmie dziecka i nie pozwolic im usi^sc na ustach 
dziecka podczas snii. 

Muchy niosj} zaraz? tysi^com niemowlat co lato. 

^wieze powietrze. — Swieze powietrze jest tak potrzebne ku 
zdrowiu dziecka jak zdrowj?^ pokarm. 

Podczas lata umiescic dziecko o ile moznosci na dworze. 

Nie trzymac dziecka w kuchni, ono moze takze dostac udaru 
slonecznego z bytniego gor^ca w domu. 

Wyrzuty skorne. — Jezeli dziecko ma wysepk§ lub p§kniecie skory, 
porad si§ lekarza. 

Nie mysl, iz kazdy wyrzut jest wysepk^ lub krosta z gor^jca, moze 
to bye powazna choroba, jako szkarlatyna, odra lub ospa. 

Jezeli warto miec dziecko, warto je tez odpowiednio wychowac, 

Polowa dzieci, ktore umierajg, w Pennsylwanii kazdego lata, moz- 
naby ocalic przez zachowanie powyzszych rad podanych w tym 

Wydane 15-go Maja 1909. 

Przejrzane 1-go Czerwca 1912. 

(Circular Issued by Pennsylvania Department of Health.) 

ly^ijsnya jik jyayj i^f jjidds^ 'itx ^11 jyiyii ts^nyjas jyno ya^yii lyfjyjyn 
.jyoi^j^D -lyon n pK -\]}iyp 

-ysoyts lyB'nyiJDKDds ip"oy;i'?N lyn pu opysjj; ]yijypm oyn inn 113 ta'3 ,iyij>p pjn pw 

DJinnyJ ynayaiyuB' j?^n ej'in nyuyn jjjD^'n pjs j^ipn'n ii?t Tin inj?D n^ej ]n>n:^T iitsKT 

.}'n'?5 ytsB'nj? DKT Doy:nys •j'j'O D'mp ij?n ya'jyn ji-B-ms jy^a^o 

.jyfi'ip IX jycytyiya iia ^t Djyp ys^'ii ytoDcns pN j?t3D:'n n pn Sx: nynj'p jib jjnnsa 
;iyt3Ss<mxB'iN t:o iS'O n mx t"N i^a^'n u j'tD'u injjt oy t'x ji'tDKjyo VD'^n n iin 
JIB tsaip 't m H'JB' '"« V'H ff|'ix iyij?n lyo'jNnyj "jk; j^nnw dSn C3'",i2j,u csnyn ya^jrn iS'O 
lyD'n^M ^iK ]j'p t»'N qnx ]yn:,uDiix ta^'n i.tx Dys^'ii 1%'^ ^>do x .iv^n-iap nix to mp lyn 
.J3i'in:xnj?3 i^-jpxT px Di'DTU /jyj'snyo tb DyD:j?3cpj; p.a ini^o "]N3 jix iirB"np:K"ip pB 
iw lya'nayji iv lyiys'T oy T'x /]yi:"np3xnp ps v^xtiix n lyoxn T'X SnxQ ySyt 'n 'nx 
.]y'7tD<o DJ:nnxi D'^ii^a lyn ps jaiu'nya-ntB Di:i lyix jvpano mv nj'Dxii y:j?tD.sTyj 
pB rjM^iyB px ninyj 'a»3 "iy»x jyaSxn is p't ;!»B^'nj?a T»x lySyn ly^yjyi yn:3;;!^yB 

: li'uyn ij,'D«n ayn 
rx nS'O Dona ja^a irrx ]j?:)'n lyayjt is ]i'.TDya T? 'jxt lymo yny .jjnnx: eona 
Sxt yaSyn jannxa ynyijx ]''^p ^sto': t'x oy .'S'la yiyn^tayj-'o -lyT i»b jannij: ya»^TBX> n 
-D'lx inyo Dxn oona lyn inn cnnyiiy uiyn •i}3by^^ »a"a x .isxt jyiyn iy3'^;iyj!i2i ipyp 

.•byufiia X inn unny:ny aiyn Dxn ^:»p x ohn jyay'? is jyM't 
nn»x njyinyn /'a^a nyn jyayj Jiinnx: ^yccunx y:"p *in'x u'iixT u-nayj lyT ^xj n'rxa 
Dy tDU ]ix lynaitsB' 4, y'^x taona ly^x is is ij'p dxt tajy^ -lyoip ^xi iS'o taona n tx taixii 
.iy'iyji:imyc t:u uyii px ikt y■^y^Jx p'p uania 'a^a n .lyoxn y:yjxtyj »ii ixr yiyijx p'p 

2 11X i^o nyn inn lyn^itaty 2 y^x iy;i»u is 'a>'a lyn tau taona lyn px taaip "|'?to n m oynaxa 

.taaxj lyT ^nn ^nxo 3 nyix 
ly^p'iitajy is tas^yn jya^n H'D'ax .taa'ni oy ]yii Snxo yhn ]yj'u is »a''a lyi ta'j 'tau 
-aix ]y2»t iyj"n "T jyii d'jxoxt lynx -tanny:iy jiDyD^y;iy-i ta'a lyiyn ya'7yn D"a^n .p;j3iS n 
pc jyj"ii nnyo lynaxj ]ynD px (jain'myB tau) jycDDytrn'ni'x \vvip is jyB-i^mya 
Dxn jyuixmy is jy:-iy'?D'ix I't tayn la^a n px j'oyo'^y.iyT tyj'i: is lynj'p n tau .pyoB' 
.jxta px bnxa ya'Vjy lyoxn yjyta^ryj Syo^ax 'a^a nyn du .n"S lyj'taan lyi ]tx in jyj'iT 

3 lynx 2>^ y^x jyj'it is iu oy tau /U^x nuxjxo 3 lynx 2 rx '2"a n 'ii nyi im 

.uaxa lyT -;in Snxo 2 m ]ix — jyn:iut!' 
i^tBya Snxo ]"p oy mnu /is taoy: na'p dxt lyii b"S lyn j'x ^a'^a n u'a uanyncay 
-taay lyi jyjyn caac "lynx yna'ns ps naxn nyn d'j Diyn .nxtap^ji ly^'x c^o I't ntaxiya in'x 
px jyainyj is ^imx oy taiyn ja"s yo'iiyj x n^j lyax laityj taa'i^a 'a"a n a'lx .^aianyn 
D^xT in'X a'lN n^Dp^T lyx ta^o tt ntaxnya .inyo ta'3 :i»ia n'i»a lyx tx d'j tapayn ,t3amyj 

.]yE'?yn is omx "i»ix mx oSyta^fa "iis lynx ]"x ;ysyt is 
lyiM jysaxji px 'a^a lyn lyj'it jyayj is jnaynnu'o t'x oy a>ix .oSytaya Tin iyjnt 
PB taa'Ti'H iyny» j'X j'la'u t'x r3"pa''?a'n yc:yij n dxt Dpaynyji /"bycya x "pin fii^'inu 
!a>o lyiyn iyB'xiiy;iD>ix eii;i oy but iscu'ey;) T^t taxn H'taxa x m ^yats* 'iitx oannxa nyn 
ca'X£3 X IS ^yBy*? yyna 1) Dpxi)<a ]ix lyoxii yD'>n ta'D taa'^pyj lynaxa px lyoxii "yti'i'xp 
-yj Sn^ox 1X3 ciyn oy ixBya jynyii is Bia'^pyjD'ix lyta'ni nix pynx oy uSytac px (lyoxn 
1XB ^yta^a yr^yt dxt lya'iiayj taeixi irrx px D^yaxa y^&^y lu taxn in'x a»ix .laa^na 
-I'^'o ytt^ns n i>nx tama in»x *u<Eya taia'o ya^'boy jynyt cy tatx^ /jannxj lyaopya lyT 
n DX11 i^'O ^yo'a x |y2y»'?ay;nya'x t'x oy ^ya^yii ]'X ^yra^a x jib lyj'it ta»a hnnti p'p tatxS 
Dxn taixE^tt taa'Sp ]ix i'j'o n D'ix taou /pynx oy tar^ya /ixcya ]ib taca'Eyj tao taxn <a«ta 
-aitaiy ix^re k ]'x px ^ytacxa cyn pB T'oa'x n is taey'^pyj is tanyii i^'o ytrnB ta'3 n .^y^ya 
lyoxjyi ]''nH lynaxi tsiyn oxii iS'D ytr-nB ybiv^ Tix taaxo iix T'^nytr Dy taiyn anx jyn 
'2i'a n '?nxo "^ya »ii D'7yD!<a ^ya vtx ]yaxn is lyoya tanxT t»x oy -^yta^ta iya*7yt nyn px 
33nnx3 n inyaya jyiyn jy^i^^y^ ]V^VP lyoxtis ybn ]y^xt "t dix 3^'ta oyi ^nn 3annx3 ta^np 

.jyjn^a ]yny» ta'njy^is tanyn 
pa B^mjiryj nyi *ixb lyiyan y^^ oy t'X jya"t o'i'yBu n lyaxaa^'x dxii .D^ys'j 
DU *in^x ta^xt lyjaujnya i'2^>p *iyta:ix px /D'?y5'3 ya'jyp'inya ]"p ta'i taa^nayj .ca^n n 
tau |yp Dy .'jye^: ois &"b lyaaxn lyjax^ x tasytyjis t'X Dy jya^yn "a "bytaxa \^>p jye'ip 
ta-iyii ^yo^a dxt »ii nynaxs .3xt3"ii "pia lyaxtiixnya lyan tayn oy px ^^^^ jyiyn |ya?«ny3 
-"•iD'iHDy px jyinypiya'x oy^'jxt jyo ,iy^3y3 pyns taixciKt ^ys'a nyn jyo ^xt tajnySyJD'ix 
*iynaK3 px /]y"iyit taa^nayj pyns jytyn tb 113 ^xt ya'jyn ipxna x ta»o lyDxn yn^xp ta'O jya 

,]y-iyii lynxiyj trxia n "^xt 
-^3 ^yay^ yynto 1) nyoxn Dpxixa cna ]'x lyiyn lyta^xny^ ^xt ^yB'3 ytas'Spyj dxt 
"Ufaya lyoxn yoixn px ^yB'3 dxt tapayiw Mtbi ytaasoiya x px (nyoxn taj'xs x is opsn 

.jya'nayj nyn 



Mo D"3'>i nyn ikb en 
-«o lyiSKTis ]iD JiaitD'nyaiNB lyn inb jyiyn )yayjyj3N tD»3 jyp oBnciKB y:"oyj^K i"p 
n jyDNEis Tt ^xt y3'?yn )yB">3>aoKp yo'nyj n tss'na 'u'ta viy» .^atn nyK *i'B i^'D jib JiaiBf 
IS lyji'SD'nx I'T lyp »3"3 lyiynas p'K *ikb bu j"t 'jnt ya^yn iitftsDp'o n Oiin'myB pn 
.jjnnxi n lye^Q is »nN ni lyjKt i^top^T lyn t'k Skt .'2"2 ly'K ikb ^Kilts' is lyiN pnNBB* 
j"T ]yp Dy '?"ii Dnp j>ip t2"'3 toD'ip mu'tDDpo lyn j^x d ' i p jy^'nayj is :i'D'13 t'n oy 2'ik 
Ml ny^3KJ -n'?'o 'jya^ea K pe jyKjB'iya'iK cyT pe ta:'N9 jya^xn k lyujiix t:oy3 .yiyan^niys 

.tD:''?py;i onx au Syt^^a dnt taxn 
.t:yD>ny2*iNB uiyn oy 'ii nynsxj lyiyn aa^pyj Jiannw d''2"3 ivt 'jnt lyoit nyn iin 
-l^ta^p pn U'a ]yiyii tosNonye tsu px ,D^yt2?<3 y:'n n ]'« lyiyn }yDx;!yji"iK ]xt ^xt oy 
D1S tanyj in^x lyeya "bytaxn x j^ a'j taaynxii .lyanisyj ms tu t"x jy^p jyu^xnyj px "jn^n 
TEXT 113 /'2''3 lyn ]y3yj is oy taenia in'x |yii t)"S lyT is lo taya px u'j oy u'^xn ]ix oya 
iyp DXT .Dy aa'iia u'O »n jyii jyoixinyn oy pK Dpsa t"N ms ]ynyj t:o id'j'ii *in>x "^'m 

.pjxip »3"a n lyaxo lya't 
3 lyix 2 »ii *inyo id'j Sxt ^ya^a k n*in tsinyany jDi.yii ya'byn i3"3 h .]'»t is lycjj 
-nx3 y'jx J1X tsSxp jyixnyj lyta'jxnyj t'x ]ix pn rx nS"o n anx .pn jyex jxd x 'jnxta 
j'n JiJNJD'TiK D''r"3 lyT ^xt /]ynxin':i tajxryj piB' yn t'x Dy 'ii t3:''7py:i |y"in'tj'y;i D::n 
-in:i JDiyn jjxjD'nx lyn a'lx .;i2xjD»nx ms taa"*? px Dixn is ]'n t2'3 ^xt px /I'Sxp px a'jyj 
.'ii'y iXDDxp ^yBy^yyna 3 lynx 2 tau 'Jxd n Snxra 3 nynx 2 'ii nnya d'j nyax /i^^^tp px yh 
yt rm^iya /^ijipi'ii I'n torxoy;i tsxn S'^jiyi mi oynaxi ;U'i-pT uiyoyaiys I'^^'p dxt a'lx 
px D'byxixnts yaoa^inyEyJi n ]yT»oiyB |yjyp iy tsyn tD'^s lytyn is .ixtapyn lyx ts'D 
T» tnyDynJiys px *i^S(<p px pij t2a"'72 ;ijx;idmix lyT anx .-inxcyj PK rx 'a^a n ya'iiyn 
'^yaixitD I'la ]yaxn is \\} ^r'o lyx ojaxB /injitac 24 px Snxa inyo lyax 6 ,5 ps ^nxs ytt 
K tasn ]ix <*iyDKii yayoyiyj yj'n tsu jix -jS^o ]yay;i tsnxcxT taeytD .]ya'Miax -lyoir lynx 

.taysB' IS t2'3 rx oy tx "i'7jyo t'x oy /ixcp^eT 
-yjiinoMK to'j nyii in^x .n^^x tDD^n ixtspj*! lyn ra ^nxo x nxa jyaio is jx u'i tsJiixB 
px ]>nx tanyj Dxn ^^'o lysxiD "lyiy .■i'?'0 n jvQxbd tayn in'x dnii k'cxt ii'o -ly^x ]yi 
-lys tsyii in^x .taixT pic "in uj'cyji ya'jyn taeu n tsnyDyiJiiyB jjuixn lytyn nxj ^mq pn 
Ml nyiaxj ^'?'D lyayj nyjD'Mi toyn in'x anx iya"np:xip ya'^inycyj i^nx yjiDjny lyaxtnix 

.n^Sxp px pi,i px vib taiyii j3{<JDmx lyn 
;i3iinx3nanx jyayia B'i uyn ^yuxa x Tin tD*iny:iy 'ta-yii ya'?yii '3'i3 x -lyayia 
tx ]ya"s K Dy rx lyayia ixb iDOip Dy anx .yD'JEinya n is tcoxeyjis j'toan px ]''^^ rx 
rx Dxn /iy-ix .u'lmjip ]ib iyD'inp:xip yt3D:iy n lis y:"x *iynx ,yi tonytD:ny3"iyn ta»'np3Xip 
lytyn inn ixb taoip Dya'^yn lyayna dxt .;ya»ni2j< lyon -lytsyii iyD'»n px T'?inyiiyji inyo 
px ra ri^ ta»3 ixsnyT taiyn j:x;idm-ik lyn p.x /"^yantita pB lya^s nytstriy lyn rx yaxnix 
yuaxpyji uu /n':»'0 ]yayj tasxtsD /"ij<b ^nxo x "ixi taiaip lyayia dxt anx .lyDysB' Jiyo ya''i»tDy 
px /jyay^yj aiyii ya'byii i^'d n ni mtDxiyBoytD yaSyt n lyaxn 'i'XTDy nynx y'7n'p -lyoxii 

.*ii<up5<T *iy"x ts'O t3i^cj<T "in nuxiya 
lyiycyii yD'vi n px -nyon px »3"a lyn rinx lyT'Sp Syc is si'nx u'i a-iy*? .Jin"'?? 
jxts piya'x juya rx lyB'xi x px ^yioyn tm^ pT x ; ')yt^'>bp »n ]ib ytaoa^D n pynx taoya 

.iaax3 yo'in *inyt x ]'X px 
px Dmxp'cyB -Dnaya tsD"ii yj3y ts'O iyni»Sp ]^''p lyaniayj ta'a irrx ta'i'XT Sixd ]"p 

•ly^opx n "lya'x DsyitiD tD^o lyu^xnyjiytajix pn ]ySxt DDinpo 
ji'tyTni^SD ySyitf dh'X tau nyiayii |yD"n px .:xb jyny 'a^'a n uynxa .]ynxa 
]ycx^tr lyaxa ]ix ]yB'nc-iy 'a"3 "lyi Dy tayn jxq ]'ain lyiayBc -lysiyp ]ysaxj piya'x 
yoxa n b«< taaypnta px lyB'ttn oyn damayj inix ]yii ^nxa oyny 'a^a n tacxn .lyoya 
^^a^^p px Dnys'xn ytpy'^cyj y^x ta^'xii .lynixB oyi taaniayj in'x "Hfcya lyeiyp ]ib |yS"nta 
.D'lx cH'x tacyii in'x ixcya lys'yn lyoaypnuy-ionx x lyaniayj lau in>x ta^xt ^nxa ]"p ."t 
layinyii .t^bb' ^ne mi nanya D''a'»a lyn ixd a^Dani m:x t'x taei'? ytyns .taciS yr'iB 
P> P Dy .lytra'p ]'x »a'»a n ta»a ta'bxn •T'jjyD ^ys mi nn cyi lyoMX ^a^a n uSxn lyon nyn 

.D1N11 yjn"D3'x '^yc IS PB "TtatrayaxT,, x lyanp 
in ntaxiya /lann lyn einx jx'^b'Dmx |x laxn »a"a n anx .taMn *iyi ps yay'^troMX 
la^npa^ip ytaoaiy ]h ]«i ]yp oy ; pta^n ps rx aySe-Dnx lyiy tx tao tapayi .nxtapj<T x ta'O 

.Dp!<B lyp'ts-D lynx DpxB "iittoD /^y'bTio /lya^B tay^"i«<pD mi 
"ly 11X ,r»BB' px '^yia^a D'^a^a lyn ps lyay^B ly-i^oisonx a^taamyB ta'n .^yay'^s 
lysy'i'B'nyB jyay^'jB .taBs^tf Dy layinyii ]yB»^ D''2"3 lyn P|iin lynytau' lySxT "t ta'3 »n taa'i^ 

.lyon lyny lyna^p lynayrnta is iyt2"npa»ip 
pB a^xn .lytayi is ya^'t Dxn nuiyn Dy t^x ,'2"a x yaxn is niaiyii rx Dy anx 
^xi ]yD 2MX lynyn taytaynyj taaypyj jya^xii x'a'Mi^'DayB px ^yaixtair ya'jyii '^v'^yp 't 
.i8^ipi»s lytyn ytt jyayjyj laiyii lya^yii nuyi oyn iya^»<B 

.nya^'tr'D^tp ce"m:nyi .1012 ^icn ;yal lyn 


[Circular issued by Pennsylvania Department of Health. 1 
Form 20 D. — Slovak. 

zachrAnte deti. 


Horiice pocasie tohoto obdobia je vel'mi nebezpecne zivotu ne- 
mluv^nat a mal^'ch dietok, a to nielen nasledkom stiesnujiicich licinkov 
vysokej vzdusnej temperatiiry vo vseobecnosti, ale zvlast pre ucinok, 
aky ma horiice pocasie na vsetky zahube podliehajiice clank}^ po- 
travne medzi ktorymi na prvom mieste stoji kravske mlieko. 

Je preto najvj's dolezite, aby kravske mlieko, ktore ma sliizit' za 
potravu nemluvnatam, bolo to najcistejsie a najcerstvejsie, ake vobec 
mozno kupit'. Pocas horiiceho pocasia I'ad je nezbqtue potrebn}' k 
zachovaniu mlieka a vsetko mlieko, ktore ma sliizit' za pokrm, ma 
byt' najprv I'adom vychladene, akonahle vynde z kravy a pri Fade 
ma byt drzane do tych cias, kym ho nedame k pouzitiu. 

Tych malo penazf, co stoji I'ad, moze zabranit' nemoci, a o mnoho 
viae stoja lieky, osetrovanie a opatera lekarska. A pretoze voda je 
casto nosicom nemoci, je najbezpecnejsie iizivat' vodii len v stave pre- 
vareaom tak na pitie, ako i pri ijripravovani detskeho pokrmu. 

Nasledovne pravidla pomozu Vam udrzat' Vase dietky v zdravi 
po^^'as horueoho pocasia : 

Kojenie. — Kazda matka ma kojit' svoje nemlmiia mliekom svojim. 
Prsne mlieko je prirodzenou potravou novonarodeneho decka. 2iaden 
inv" pokrm nevyrovna sa tejto. Prsy zivene diet'a ma o mnoho vacsiu 
moznost', ze ostane na zive, ako diet'a chovane flaskou. 

Po narodeni, kym cakate na prichod prsneho mlieka, nedavajte 
dietku ziadnej umelej potravy. Vezmite si dietko k prsiam kazd^ 
stj^ri hodiny a nedavajte mu nie ineho ako vodu, ktora bola prv 
prevarena. Nemluvna nepotrebnje nic ineho a nezahynie hladom. 
Ked pride mlieko do prs, dajte nemluvnatu cicat' bazde dve hodiny 
cez defi a v noci dva lebo tri razy. 

Nekojte dieta zavse, ked' krici. — Mierne mnoztvo kriku napomaha 
vyvoj pl'iic. Xemluvfiata, kojene nepravidelne, alebo zavse, akonahle 
sa dajii do kriku, obycajne trpia na nezazivnost a potom nasledkom 
b^l'ov kricia este vacsmi. Kojte pravidelne vzdy v riadnych prestav- 
kach. Davajte dietku trocha prevarenej vody niekol'ko j-azy cez deii. 

Ked nemluviia je dvamesacne predlzte cas medzi kojenim na 2 i pol 
lebo tri hodiny cez deii a v noci dajte mu prse len raz lebo dva razy. 

Neodstavujte diet'a, kym toto pribera na sebe a necinte tak nikdy 
prv, kym sa nejDoradite so svojim lekarom. Nenasledujte radu 
priatel'ov alebo susedov straniva odstavenia, Ak dieta zostava 
zdrave, ale po istom case prestane priberat' na vahe, nehl'adajte 



pricinu toho, akoby mlieko Vase nebolo viae dobre ale porad'te sa s 
lekarom, ci nemate si pribrat' jednu lebo dve flasky na vypomoc. 

Zivenie flaskou. — Ak sa stane potrebnym, krmit' nemluviia uplne 
lebo ciastocne flaskou, pamiitajte, ze pri takomto ziveni je potrebna 
cistota vo vsetkych podrobnostiach. Akonahle sa flaska vyprazdni, 
vyplachnite ju studenou vodou, za tym vymyte ju horiicou vodou a 
boraxom (1 cajova lyzka do 1 pajntky vody) a odlozte ju k d'al- 
siemu vymytiu. Ak mate len malo flasiek a stane sa potrebnym 
pouzit' tu istu flasku k nasledujucemu kojeniu, dajte ju na niekol'ko 
mintit do vriacej vody a len potom naplnte ju cerstvou. Nikdy 
nedajte diet'at'u pozivat' pozostatky z flasky, ktorii ono nevyprazdnilo 
naraz. Vezmite flasku z kolisky, vylejte z nej pozostale mlieko a 
vycistite ju bezodkladne. Tvarozky zo stareho mlieka, nalepene na 
vniitornych steniich flasky stanu sa po niekol'ko hodinach jedovatymi 
a mozu zanecistit' cerstve mlieko, akonahle s tymto pridu do styku. 
Je lepsie mat' tol'ko flasiek, kol'ko razy davame diet'at'u denne 
potravu. Takze vsetke flasky mozu byt' kazde rano pred pripravenim 
potravy spolu vyvarene. 

Cmulky. — Cim jednoduchsi je cmiilok, tym bezpecnejsi je pre 
nemluviia. Neuzivajte komplikovanych cmulkov a za ziadnych 
okolnosti nekupujte flasku s dlhou ku cmulku pripojenou gummovou 
rurkou. Taka flaska nemoze byt udrzovana v cistote a iste zapricini 
bnisne nesnadze. Akonahle je flaska vyprazdnena, cmulok ma byt' 
ihned' odstraneny, obrat'te ho rubom na palci, osuchajte kefkou 
namocenou v studenej vode. Kefka tato ma byt drzana jedine k 
tomuto ucelu. Po pouziti vyvarte kefku v horucej vode. 

Vycisteny cmulok ma byt drzany v cerstvej boraxovej vode (1 
cajova lyzka boraxu do 1 pajntky vody) v zakrytom pohari. 
Vyplachnite cmulok vo vriacej vode pred kazdym pouzitim. 

Neberte cmulok do svojich list za ucelom, aby ste sa presvedcili, 
ci je mlieko dost' teple. Nechajte padnut' niekol'ko kvapok mlieka 
na svoje zapastie, ako pocitite, ze je vel'mi horiice na zapasti, je vel'mi 
horiice pre ilstocka decka. 

Pre pripravu mliecnej miesaniny pre diet'a neplatia ziadne vseo- 
becne pravidla. Kazde diet'a potrebuje slozku primeranu jeho 
zazivnosti. Slozka, ktora je dobra pre druhe dieta, moze byt prisilnou 
lebo prislabou pre Vase decko. Porad'te sa preto lekara, ako mate 
pripravit.' pokrm. Ak je potrebna smotanka, nekupujte tuto— bude 
pravdepodobne stara — ale ziskajte si ju tak, ze slejete asi polpajntky 
s vrchu kvartovej flasky mlieka, ale prv ocistite okraj flasky. 

Neprehreste sa stalym menenim potravy pre decko, ako to zvycajne 
matky rady robievajii na radu " dobrych " susedov. Nasledujte 
upravy svojeho lekara. 

V lete pokrm pre nemluvfia po jeho pripraveni ma byt' prineseny 
do stavu oparenia. Potom nech sa vleje do cistych flasiek, tieto 
zapchaju sa suchoii bavlnou a drzia sa pri I'ade az do casu pouzitia. 

Nesohrievajte flasku, ked idete do postele, a ne-drzte ju v posteli, 
kym nepride cas kojenia, pretoze sa Vam nechce ist' po fiu do skrine 
s I'adom a sohrievat' ju, kedy nemluviia ju potrebuje. Toto je isty 
sposob urobit' diet'a chorym. 

Stolica. — Flaskou krmene diet'a ma mat' raz a nie viae ako dva lebo 
trirazy denne stolicu. Ak mlieko je ciste pri zaciatku, drzane bolo 
V chlade a vstke nadoby sii ciste, jako Vam o tom hore bolo pove- 


dane, stolica diet'at'a ma byt' zltej barvy, nie vel'mi tvrda, aby snadno 
vysla. Ak stolica stane sa zelenkavou, ale nie castejsou, ako dva lebo 
tri razy denne, dajte deckii jednu lebo dve cajove lizky kastoroveho 
oleja. Ak barva stolice po tomto sa nezlepsi, poradte sa s lekarom. 

V tomto case lekar bude este v stave zabranit' vaznejsej brusnej 
nemoci, ktora diet'at'u hrozi. Ak barva stoli zostava i d'alej zeleixou 
a diet'a ide na stolicu castejsie, pat', sest' lebo i viae razy v behu 24 
hodin, diet'a Vase dostava brusnii nesnadz, alebo letnii nemoc. 
Zastavte mlieko doraz a miesto neho davajte diet'at'u prevarenii cistu 
vodu a povolajte lekara. Mozno, nebude este neskoro. 

Xezacnite krmit' s mlekom prv, kym Vam tak nenariddi lekar. 
Zastavenim mlieka neublizite diet'at'u: kazda kvapka mlieka, ktora 
sa po tejto vystrahe dostane do list nemluvnat'a meni sa na jed a 
zhorsuje stav diet'at'a. Zapricinite vaznu ba aj osudnu nemoc, ak i 
d'alej budete davat' decku mlieko potom, ked creva stanii sa vol'nymi 
a stolica barvy zelenej. 

Davenie. — Flaskou krmene nemluviia nemalo by davit', ak potrava 
jeho je cista a primerane pripravena k jeho protrebam. Ak nastane 
davenie, je to dl'a vstkeho predzvest' bliziacej sa chorobv, lebo jednej 
z tych vaznejsich detskych nemoci, lebo nemoci takzvanej letnej, ktora 

V horiicom obdobi je castou. Davenie z tejto priciny moze byt' 
prvym znakom nesnadze a creva nestanii sa vol'nejsimi len po 
niekol'ko dilov. Ak davenie sa opakuje, zastavte davat' diet'at'u 
mlieko, davajte mu prevarenii vodu, studenii alebo takej temperatiiry, 

V akej my bolo davane mlieko a porad'te sa bezodkladne s lekarom. 
Odev. — Nediivajte mnoho siat na nemluviia v lete. Pocas 

najhoriicejsej povetrnosti, odstraiite s neho vacsinu satociek; tenka 
vol'na kosielka a plienka postaci vo vel'mi horiicich diioch a vel'mi 
honicich nociach. 

Nikdy neuzivajte siat s lizkymi pasy. Kosielky a suknicky so 
strapcami na ramemich sa odponicajii. 

Kupanie. — Kiipajte dieta kazdy deil. V horiicom pocasi v tielko 
nemluviiat'a s mokrou spongiou. To ho obscerstvi a bude lepsie spat'. 
Umyte diet'a za kazdym, ked' mu davate druhii plienku a ususte 
najprv dobre ciastku tela, ktoni posypete prachom. Vyperte zane- 
cistene plienky. Nikdy neuzivajte ususenii zanecistenii plienku, kym 
ju prv nevyperiete. 

Muchy. — Davajte pozor, aby muchy nesadaly na flasku die'tat'a a 
jeho potravu, tiez aby nesadaly na rty nemluviiat'a, ked' toto spi. 
Muchy prinasajii tisicim a tisicim nemluvnatam nemoc kazde leto. 

Cerstve povetrie. — Cerstve povetrie je prave tak dolezitym pre 
zdravie nemluviiat'a. ako cerstva potrava. V lete drzte diet'a nakol'ko 
mozno vonka. Nezdrzujte sa s deckom v kuchyni — moze dostat' 
" slnecn5" lipal' " od vel'kej horiicosti dnuka. 

Kozne vyrazky. — Ak diet'a ma vyrazku alebo pukliny kozne, 
porad'te sa s lekarom. Nemyslite si, ze kazda cervena skvma je nicim 
inym, ako vypretinou, moze to byt' priznakom vaznej nemoci, jako 
sarlach, zaskrt, kiahne male alebo ovcie. 

Ak hodne je mat' diet'a, je hodno ho zachranit'. Polovica deti, 
ktore zomrii v Pennsylvanii kazde leto, mohla by byt' zachranena 
nasledovanim rad v tomto obezniku. 

Vydany 15. maja, 1909. 

Opraveny 1. jiina, 1912. 

* [Issued by Providence (R. I.) Health Department.] 


[These directions are not intended to talce the place of the family physician. Always 
consult your doctor in regard to the feeding of your child.] 

From 12 to 15 months. — Accustom the child to drink from cup 
and take food from a spoon. Five meals should be given in 24 hours. 

Breakfast. — Cup of cow's milk, a saucer of oatmeal or barley-flour 
jelly, with milk, or cream of wheat with milk. The oatmeal jelly is 
made by putting two-thirds of a cup of rolled oats and 1 teaspoonful 
of salt into 3 cups of boiling water. Let it boil 2 minutes, then cook 
over hot water for 1 hours. Strain. "VVliat goes through is oatmeal 
jelly, and may be kept in a cool place. Make a fresh supply every 
day. Milk may be warmed to suit taste; it should not be iced. 

Forenoon lunch. — Cup of cow's milk. 

Dinner. — Broth or beef juice, bread a day old crumbed in milk. 

Afternoon lunch. — Cup of milk. 

Supper. — Bread crumbed in milk. 

If possible, give two to four tablespoons of orange juice or other 
fruit juice in season before morning lunch. Be sure the fruit is sound 
and ripe. Do not give fruit juice at same time as milk. 

Water may be given as desired, but sparingly at meals. 

From 15 to 18 months — Breakfast. — Cup of cow's milk, saucer 
of oatmeal jelly with milk, or flour or Indian meal gruel, with milk, 
small piece of bread a day old with butter. 

Forenoon lunch. — Cup of milk, small piece of bread and butter. 

Dinner. — Broth or beef juice with boiled rice or barley, and a small 
piece of bread and butter. 

Afternoon lunch. — Cup of milk. 

Supper. — Cup of milk, bread a day old and butter, a little apple 
sauce or pulp of stewed primes or baked apples with skin and seeds 

Water may be given as desired, but sparingly at meals. 

From 18 months to 2 years. — Breakfast. — Cereal and milk. Cup 
of milk. Bread a day old and butter. 

Lunch. — Cup of milk with bread and butter or simple crackers, or 
Indian-meal johnny cakes and milk, or corn bread and milk. 

Dinner.— V>v€)i\\ with boiled rice or barley, or eggs, soft boiled or 
poached, baked or mashed potatoes with butter and salt, bread and 

Afternoon lunch. — Piece of bread and butter. 

Supper. — Milk, bread and butter, or milk toast, pulp of baked 
apple, apple sauce, stewed prunes or ripe fruit according to season. 

Water may be given as desired, but sparingly at meals. 



From 2 to 3 years. — Additions to the diet must be gradually made 
by selecting articles from the list below, always giving small portions 
at first, and never trying two new articles at one meal. AH food 
must be finely cut or mashed, and well chewed. 

Select from the following articles : Milk, eggs, soft boiled, poached 
or scrambled, or mutton or lamb chops, baked or mashed potatoes, 
young peas or beans, scraped beef, white meat of chicken, boiled fish, 
oatmeal, hominy, wheat-germ, cream of wheat (all these cereals being 
thoroughly cooked); broths and soups; white and graham bread a 
day old, toast, zwiebach, plain crackers, milk toast, junket, plain cus- 
tard, corn-starch pudding, bread pudding, blanc mange, ice cream, 
rice pudding ; oranges, baked apples, apple sauce, stewed prunes, and 
pulp of peaches and pears if ripe and sound. 

From 3 to 6 years. — From 3 to 6 years select in addition from 
the following articles : Beef steak, roast lamb, stew of mutton or beef, 
hash of mutton, beef or fish; bacon, mutton or lamb chop, corned 
beef; baked beans, string beans, spinach, asparagus, summer or 
winter squash, beets, tapioca pudding, molasses ginger bread, sugar 
or molasses cookies, grapes (with seeds and skin removed), ripe 
bananas (not more than 1 in one day), melons. 

During the 3 to 6 years four meals should be given at regular in- 
tervals, as 7 a. m., 10.30 a. m. (a smaller meal than the other three), 
1.30 p. m. and 5. p. m. 

The following is suitable for a child of 4 years : 

Breakfast. — Half an orange, two tablespoonfuls of cereal with milk 
and sugar or salt, glass of milk, bread and butter. 

Forenoon lunch. — Glass of milk or cup of broth, bread and butter 
or crackers. 

Dinner. — Two tablespoonfuls of stewed meat finely cut, tablespoon- 
ful of baked potato with butter and salt, a tablespoonful of green peas 
well mashed, bread and butter, a cup custard. 

Slipper. — Milk, bread and butter, cooked fruit. 

Do not give articles on the following list till the child is 4 years 
or older: 

Fried meats and vegetables, tomatoes, carrots, turnips, egg plant, or 
green corn, hot bread or hot rolls, buckwheat or other griddle cakes, 
fruit cakes, candy, and nuts. 

Never give children wine, beer, or cider. 

Do not give celery, cucumbers, lettuce, radishes, cabbage, onions, or 
pies, tarts, doughnuts, tea, or coffee until the child is 7 years old. 
Tea and coffee should even then be weak. 

When children are constipated, do not dose them with medicines 
but consult a physician. If children over 2 years of age are con- 
stipated give them more vegetables, ripe fruit, stewed prunes, oat- 
meal, molasses gingerbread, rye mush and molasses, rye bread and 
graham bread. Avoid wheat bread and crackers. 

Providence, May, 1911. 

[How to take care of babies. — French. Circular issued by Providence (R. I.) Health 




1. Donnez a I'enfant de Pair pur et le jour et la nuit. 

2. Ne lui donnez d'autre aliment que le lait de sa nourrice, le 
biberon ou autre nourriture d'apres ordonnance du medecin, 

3. S'il pleure, s'il est agite ou nerveux, ne lui offrez que de I'eau, 

4. Donnez-lui suffisamment de sommeil, qu'il dorme au moins deux 
fois par jour. 

5. Ne le surchargez pas trop d'habits. 

6. Baignez-le tous les jours. 

7. Laissez-le seul et tranquille. 


Pour prevenir la diarrhee, la maladie, la mort, le Bureau de Sante 
prescrit les regies suivantes : 

Air. — Que I'enfant dorme ou non. il a besoin d'air pur et le jour 
et la nuit. Ne permettez pas au bebe de stationner dans une chambre 
fermee, ni dans un appartement ou se fait cuisine ou lavage. Faites 
le sortir a une heure matinale, evitez que le soleil lui donne dans les 
yeux. Gardez-le dehors durant les nuits tres chaudes. 

Veillez a la proprete et au bon air de la maison. En temps chaud 
ouvrez portes et fenetres tant la nuit que le jour. Ayez toujours 
une fenetre ouverte dans la chambre. 

Nourriture et eau — Exces de nourriture: Diarrhee. — Autant que 
f aire se petit, chaque mere doit allaiter son enfant ; la meilleure nour- 
riture pour un enfant au-dessous d'un an est le lait de sa mere. 

Une des principales causes de maladie chez les jeunes enfants pro- 
vient de I'exces de nourriture, ce qui tres souvent occasionne la 
diarrhee, les maladies de langueur et parfois la mort. La diarrhee ne 
provient pas de la dentition mais plutot de I'exces de nourriture, de 
nourriture trop frequente, du manque d'eau a boire, du manque de 
sommeil, ou de ce que I'enfant soit manie trop souvent. 

Heures pour allaiter. — Le moyen d'eviter la diarrhee et la maladie 
est de nourrir I'enfant a la mamelle et de le nourrir tres reguliere- 

Regies pour nourrir Venfant suivant Vdge. — Depuis la naissance 
et pendant les deux ou trois mois consecutifs, allaiter I'enfant toutes 
les deux heures. A partir de deux mois et demi jusqu'a cinq, I'allaiter 
toutes les deux heures et demie. A dater de six mois jusqu'a douze, 
toutes les trois heures seulement. Ces regies doivent etre observees 
pendant la journee, depuis six heures du matin jusqu'a six heures du 



soir, L'enfant ne doit pas etre allaite plus de deux fois pendant la 
nuit. Eveillez l'enfant regulierement pour le nourrir durant le jour, 
mais non pas entre dix heures du soir et six heures du matin. 

Quand l'enfant est eleve a la mamelle laissez-le se satisfaire, quand 
il en a pris suffisamment faites-le attendre jusqu'a I'heure reglemen- 
taire pour I'allaitement suivant. Sil pleure ou s'il est nerveux, impa- 
tient, donnez-lui de I'eau froide, bieii pure, sans melange ni addition 
de Sucre ou d'autre chose. 

Sewage. — Ne sevrez jamais un enfant au commencement de Fete. 
En le sevrant donnez-lui du lait de vache dilue, une fois le jour 
d'abord, puis d'avantage jusqu'a sevrage complet. 

Enfants Sieves au hiheron. — Le meilleure nourriture pour un 
enfant eleve au biberon est le lait de vache, frais et non ecreme, 
prepare d'apres prescriptions du medecin. Ce lait ne doit jamais etre 
servi a un enfant tres jeune sans etre melange d'une certaine quantite 
d'eau. Ne donnez jamais a l'enfant de lait condense, ni pain, viande, 
pommes de terre, bonbons ou autre chose analogue sans I'avis du 

Conservation du lait. — ^Le lait destine aux enfants ne doit pas 
subir le contact de I'air, mettez-le dans un endroit frais, autrement il 
s'aigrirait et rend l'enfant malade. En ete munissez-vous de glace, 
si faire se peu, et autant que possible maintenez-y le lait, ou a prox- 
imite. A defa\it de glace entourez I'ustensile contenant le lait dim 
linge bien imbibe d'eau froide. Les enfants au biberon devront etre 
nourris aussi regulierement que ceux a la mamelle. 

Nettoyage des hiherons. — Servez-vous d'une brosse pour nettoyer 
les biberons, rinsez-les d'abord a I'eau froide, ensuite a I'eau chaude 
contenant clu soda, rinsez-les plusieurs fois, ensuite emplissez les 
biberons d'eau en y ajoutant encore une pincee de soda, laissez-y I'eau 
jusqu'au moment de se servir du biberon. Ne laissez jamais le lait y 
sejourner, ne vous servez pas de biberon a long tube. 

Tetines. — Ayez au moinsdeux nipples. Quand l'enfant a etenourri 
et que le biberon est lave, retournez le nipple, lavez-le dans de I'eau 
chaude, maintenez-le ensuite dans un bol d'eau de soda jusqu'a nouvel 
usage. Veillez a ce que l'enfant ne prenne pas sa nourriture trop vite, 
des vomissements poun'aient se produire. 

Sommeil — Lit.—'^e faites jamais servir a l'enfant un oreiller de 
plumes, ne le couchez pas non plus sur un lit reconvert de caoutchouc 
ou de toile ciree; un tel lit echauffe le dos et la tete de l'enfant et le 
rend susceptible de prendre froid quand il se leve. 

Le meilleur lit pour un enfant est celui d'excelsior reconvert de 
mousseline (cheese cloth). Cet excelsior se vend dans tout magasin a 
quelques cents le sac et le prix de la mousseline est de trois ou quatre 
cents la verge. Ce genre de lit est toujours propre, frais et confor- 
table, il contribue a fortifier l'enfant et le presei'ver de la toux et des 
refroidissements. Vu son prix peu dispendieux, si ce lit se trouve 
sali ou tache, matelas et excelsior se renouvelle a peu de frais. Ce 
mode de lit est specialement recommande en ete pour des enfants 

Ne hercez "pas Venfant. — Habituez de bonne heure l'enfant a 
s'endormir sans etre berce. Veillez a ce qu'il sommeille dans la 
matinee et I'apres-midi et cela sans lui faire prendre la mamelle ou 
le biberon. 


Pleurs. — Tres souvent les enfants pleiirent quand on les couche; 
laissez-les tranquilles sans leur parler, ni les manier, leurs pleurs 
cesseront pour faire place au sommeil. Laissez I'enfant crier un peu, 
ses poumons s'en trouvent mieux et ces cris ne nuisent nullement a 

Laissez Venfant seul et tranquille. — Quand I'enfant est eveille ne 
le tenez pas toujours dans vos bras ou sur les genoux ; le faire passer 
d'un bras dans un autre et d'une personne a une autre, le rend de 
mauvaise humeur, nerveux et malade. L'enfant aime a jouer seul, 
par consequent laissez-le livrer a lui-meme, que quelqu'un I'observe 
et le surveille mais ne le manie pas incessamment. 

Vetements. — Ne surchargez pas I'enfant de vetements pendant les 
chaleurs surtout, il ne doit porter ni bandes, ni ceinture piquee. Ex- 
cepte le cas ou I'enfant serait tres delicat, son habillement doit con- 
sister en une chemise, un jupon, une robe en coton et une serviette ou 
couche. Les serviettes soient en " diaper cloth " ou coton flanelle et 
non en laine ou caoutchouc. Les serviettes devront etre changees 
aussitot mouillees et immediatement lavees a Feau chaude. Apres 
chaque selle, I'enfant devra etre bien lave; il arrive assez souvent 
qu'il soit ecorche, et cela, soit parce qu'il n'est pas bien lave, soit parce 
que la poudre est appliquee avant entiere proprete, soit encore parce 
que les couches ne sont pas lavees mais seulement sechees et usagees 
de nouveau. 

Bain. — Le bebe doit etre baigne a heure fixe tons les matins, la 
temperature de I'eau sera de deux degres plus elevee que celle de 
I'enfant. Faites I'essai de cette eau sur votre figure afin de vous 
convaincre qu'elle n'est pas trop chaude. Servez-vous du savon 
" Ivory " ou "' Castile." 

Regies pour enfants malades. — Si I'enfant est indispose pendant 
les chaleurs, deshabillez-le a I'exception de la serviette et revetez-le 
d'une robe de nuit. S'il est fievreux et brulant, appliquez-lui plusieurs 
compresses d'eau froide, laissant I'eau s'evaporer, ce qui diminuera sa 
temperature. Faites lui boire de Teau froide si possible. S'il vomit, 
ce qui arrive souvent, ne lui faites prendre ni nourriture, ni remede; 
donnez-lui une cuilleree a the d'eau de chaux toutes les heures jusqu'a 
I'arrive du medecin. S'il souffre de convulsions, donnez-lui un bain 
chaud, faites couler de I'eau froide sur sa tete, administrez-lui ensuite 
une injection de savon et d'eau. 

N'arretez pas les vomissements en lui faisant prendre aucun the ou 
cordial; vomissements et diarrhee sont les suites d'une indigestion, 
il faut qu'il s'en debarrasse. 

[Issued by Bridgeport, Conn., Department of Health, 1911.] 


The proper food for babies is mother's milk. 

Nurse your baby, if possible. — Ten bottle-fed babies die to one 
that is breast-fed. 

Nurse the baby regularly at certain hours, and not every time it 
cries. Once in two or three hours is often enough to nurse it until 
it is 4 or 5 weeks old ; after that not so often. Nurse the baby until it 
is 8 or 9 months old. Do not wean your baby during the hot weather. 

Many infants are killed every year by bringing them to the table 
wnth the family and giving them food for which the little stomachs 
are not fitted. While you nurse your baby do not give it a morsel of 
solid food or give it either tea, coffee, or beer. Wait until the baby 
gets teeth before giving food which needs to be chewed. 

If breast milk fails, feed your baby cow's milk from a clean bottle. 

Bottle-fed babies must be given only good milk, which is kept con- 
stantly covered and on ice. If the milk can not be kept properly 
covered, it should be boiled as soon as received. 

To keep milk sM^eet for your baby, put the milk which the baby 
will need during the next 24 hours in a bottle with tight cork or a 
glass jar having tight cover. The bottle or jar and the cover must 
be boiled before the milk is poured in. Set a pan of cold water on 
the stove. Put in vessel, with top loosely screwed on, containing 
baby's milk. 'NATien water boils take out the vessel with baby's milk, 
open, add a little less than one-half teaspoonful of baking soda to one 
quart of milk. Put back the cover of the vessel. Do not allow any- 
one to touch the milk unless using it for the baby. 

Don't overfeed the baby. — A newborn baby's stomach will hold 
from two to three tablespoonsful, and not more than this amount; 
rather less should be given at a time during the first week or so of a 
bottle-fed baby's life. As the baby grows the quantity should be 
gradually increased, so that at the end of the first month it may be 
taking about four tablespoonsful at a meal. Some children will 
require more, and others Avill not stand so much, but there is more 
danger of giving too much at a time than too little. 

Weigh the baby each week. — A healthy baby should gain a pound 
a week at this period of life. If your baby does not gain this, con- 
sult your doctor about the food to be given and be guided by his 

If the baby cries, remember that if it has been fed regularly it is 
not crying from hunger. 

It may be thirsty. 

It may have colic. 

See that its hands and feet are warm. 

That it is not too hot (sweating). 

That its diaper is soft, clean, and dry. 

That no pins are wounding it. 



To prepare milk for baby's meal. — To each cup of milk add two 
cups of water and white sugar (sometimes sugar of milk is better), 
enough to make it as sweet as breast milk. Pour it into bottle. Heat 
this milk until it is as warm as breast milk. Put rubber nipple on 

Don't feed a baby under 6 months of age with a spoon. — Suck- 
ing is the natural way by which a baby takes its food. It needs the 
sucking action of the lips and mouth and tongue to mix its foods 
with the fluids of the mouth and for the proper development of the 
mouth and teeth. 

Don't use a tube on the bottle. — Use a nipple. 

Don't forget to wash bottle and nipple after using. — Babies often 
get " sore mouth," " wind colic," and " summer complaint " from a 
want of care of the nursing bottle. 

Cleanse the bottle immediately after feeding. 

Cleanse the nipple thoroughly outside and inside. Nipples with 
tubes are convenient for a lazy mother, but mean death to the baby. 

To prepare barley water for the baby. — When the baby is 4 or 
5 weeks old, barley water should be used in the place of plain 
water. Put two tablespoonsful of pearl barley into four cups of cold 
water ; boil an hour or more until the amount of water is reduced to 
two cups ; then strain through a clean cloth ; add a pinch of salt and 
sweeten to breast-milk taste. Add this to a cup of scalded cow's milk, 
as before described, and begin feeding this strength. Use more cow's 
milk gradually and less barley water until at about 6 months of age 
the child is getting two-thirds milk and one-third barley water. This 
will make as good food as the baby can get during teething and wean- 
ing. After this time then one can use pure milk, scalded as before; 
bread and milk; rice and milk; baked potatoes and milk; oatmeal 
porridge (w^ell cooked) and milk (the milk always to be scalded, not 
boiled). No other foods are necessary, except those mentioned above. 

Bathing. — Keep the baby clean and it will stand the heat better. 
It should have at least one full bath every day, and oftener during 
extreme heat. Never bathe the baby within an hour after feeding it. 
^.%he first; feed afterwards. 

Clothing and fresh air, — Dress as lightly as possible in hot weather. 
Keep the baby in the open air out of the hot sun. At night keep the 
windows open, but have them screened, and keep out the flies. When 
the weather turns suddenly cool care must be taken to avoid chilling. 
A thin, soft, flannel binder wound two or three times around the body 
should be worn. This binder should be only wide enough to cover 
the belly, and should be wound smooth and free from creases or 
folds and fitted with a few stitches of soft darning cotton; no pins. 

Do not let the baby sleep in the same bed with any other per- 
son. — If there is no crib, the mother should put a couple of chairs 
at her bedside, with a soft covering on them, and let the baby sleep 
there. It will be more comfortable on a summer night than lying 
against the hot body of its mother and will not be so apt to disturb 
others or to be disturbed. The backs of the chairs will keep the baby 
from falling, and the mother can readily reach over to care for it 
when necessary. 

If the baby vomits, has a diarrhea, or seems sick, stop all milk and 
give nothing but warm water in the nursing bottle, and send for the 

(Issued by Department of Health, Bridgeport, Conn., 1911.) 

lyoyn;! ^tjo inys t«n D'">p3>t>2iyciB' n ,t^jj;d ti« oy nn« »a'»2 lyx tDjnr 

oy ]yn "byo oyny ta'3 jik ,iyniit3tr yomyjj 1»n .3»Dy»'7yjyT u'o n Dinyjiy' 
;>« Dy p£ iy:iMT ]y3y;i is juyj t»« lynjioty im I'k nynK »ms i»h "btja i"« .ta'na' 
nynjj ass i'« oy to o'U n u^ni .m« «t toij Dynsijj ;t2^« lysNii sij's lynK lyjB 
.lynyuyu yDi'n n i'n o^u lym d'J tajnyiway .u7« lyawjja j»o 
tD»D tyiQ 01S "T Djjyna lyo dnit D'onyT tayDMtayj T'7-iny' lyiyu "lynj'p y'rya 
.DjyjKO yi"*?? yiyi "I's tao Tt toDxe D»n ,t"BB' in tau jyo ]in y^'ONB lyn 
,T"BB' yTOND i)}pv'^:i VP lysy^J uo nn»N nn'« a^tjt O'u lyK ajn? inix njynnyn 
,TiiBB' DiTWEiu iiTW iyT'« lyjiT'S tDKH o»o H TO tanNU .lyo "lynij ysxp ,yvn^ 

.lyiyn uypis no ys^yn 
.•byaNs yj'n « jib i'7'a-mp qid »3"a iy"N tannyiiy ,tD'7nyfl "^^'o Bona jyn 
upynyjiu lyu'^Nnyj iniy\:>v^ vt< \}2i)j\-\ ,n^»D ytau ]):-2):^ lyo tia D'a'o ^ytaNi 
K)s«py;i Dy tid ,Dpynyjis tau lyiyii jyu'TKnyj u'j jyp I'b'o n a»iN ,t"« einK ]i« 

.Dy ta^wmy jyo m n^Ka lyiyn 
»a"s n y3'?yii ,i^»o n pnK taou ,o"a lyN tb dw ^'7'D n jyu7Nn is dik 
l'« lyitj /lyBNis ])}»)! ]H tj'D 'pyuKi k i'k ,|ynjitDtr 24 yuDsya n i'n lysixn tayn 
7ypyT lyT p« ':y:jnp lyn lyntj ^yaija n .^ypyn iyj:y jk id'd "ijyj'np Dyanyty*::? ;{ 
e lyiTiN I'snN iMiK o'jytaB' ,^'?1D n i^ns bdu lyo nyT'K lyiyn B2i<pyj n» 
T'T Di'sy; oy )}2by'i'i p« ,TB'yj dnt ]ytanNT poN u^yuB* .nyoNn ya'i'Np ta'o yj^ytan 
DNT D'TiN taoyj ,t2:Np nyoKn dnt ]yii ^uBMityyjJK tm^ ^VPVi Q^T t^'D n'^'O 't 
yi'i'Nn « 111 lyj'jyn "iiyDON pn« mnta ,:inN taaysy n'?'o D'n'uiyT ts'D iitryj 
nyT «in« "bypyT oyn pms ei'nK tasyT .n^'O taijjmp ]"« is «ni<D-pK3 y'bysy'? yyna 
Tfl lysMiayji Dy ^m lyo jyn ]yT'D ,^7'a n lyinmsjN u'j oyji'p can^iy .iitry;! 

lyoyaiye ]yp lyjKO d'o'u DyjyiNiyr"3 k .Jinntja *7y»sis tao n"3 lyn nu 
•jNDt? IXB lyjoyn ]ynyj lya 'bxt lycya pnyo b'j "lyax ny^ysy^-yynu im 10 'ms ]ib 
DpiKii nyi ta'o .lyny"? D'o'>n-'7yDN2 nyn jis tjNn yuB>ny n •inyBy;):iN lyiN njyinyii 
lyutrny oyn yn:y dnt «t ,iynyn unyDyij-iyfl T'm:ysiuB' dno n tinxn n'u lyn ps 
,nny» lysiNT lyna^p y;miiK .'tnok "inb iy'?ysy'7-yynD -lys lyoy: Dy ])}p dnjnd 
*7y»flis lyayji is lys'^nnysyji t'K Dy lya^ ,'7y'B nttj lyjNmnyB uo jyjyp )}'\)i'\:H 

.j':yii IS ni 
pN -]H^^ K taaiB « lyonyiis siint n^n ynjiryj) x .n^n yny u"3 n tajyn 
iNtspNT ny'i« ujy-iB ,'7y'B nT« is tao taonya »3"3 nym nnw ,ta"SDayDy^ ij, m-j 

.T'K aD"n iy in mna px jjuhnj n lyjyii 
Dy tainty ta"iny:iy j'oyo^yjyi »in Dy nnt* dnt apjynyjj jUinty 'a'la n nnx 

.lyjiin pfl QO 
.j'tatrin pN ly T»^jyD 
.pt'i'Np laKH iy Ti'bjyo 
.DyiNii lyji'r D'B ]in liyn yj^n dnt ranyr 
.(qi3 BsniB' ny dni) d^h is do tin Dn'« dkt 
.]ypnu ii« pn ,Tm t'n lys'n lyn dAt 
.DiTN ]y:yt3B> oa'B ):y^p dnt 
n'^itt ysNp lyiy is is t3';i — .q'is'^no D'':i"n k ins 1*710 lyta'nynNs is '"n 
lysKD IS din :i-\iv:i ("lypisn^'O lyoyi t'n tasN) nypis yD'Mi pN lyoNii oya^ep nils 
."jytaNa oyn rioN ^yso you n ^iinN c'?yaB' .n^'O uona m D't "^^'O n 
iy.3nT J?)}S):'? n u»o ta'^N taNiNO Dpyr »ii nyiioyii tin dnii n'o n D»a unnyjiy 
cNHu n q-iNiyi Dy .jannNO raonyj ia"3 n lys'ryn fjnN ,;yii 'iy2»^-iiDNa lyi t'n 
n B'o Ti'Bty pu iytr»oisrin din j:is oyn ]in ^no oyn ,iys'^ n laio lyspNOtr ps 
.lyjiT's n ]iN 'i'no oyn ly'^pinuay is din inN pN ,'7no oyi ]id ja'iip;!'D''7B 
.•bys': N asniayj) ."byuNn Dyn ^inN ^ny") ]^^p tan taamayj 
lyoipya D'l^n .n^nayj oyn inj ^yso oyn ]in "^ytaNn n ]ytrNii is tao uoyjiys 
iy;i'Dy'7rNjiyB pB "lyunnpaNip lyoiT,, pN "Dp'^Np Dani„ /"rno lypaNip,, k tasN 

.^yt3N3-jnT n 
.lyoy iy3y:iyji na^p D^J^ ta^n lyo M) nyns^ji in'7:» D^ytaNa n ia;io»n 

94219°— 13— —6 81 


jn'u n TB ■)yDNir"7nN3 tayainyniNB |j;o m 
toNUB'JN lyDNir^'i'nNn lysmayj ])}K) eiixn ij?3Nir«io'B '^)nH ij?'fl ]ib 'a^u n -hb 
p'yoNii yta'bNp Dj?SNp ij;'S I'n ''"biNi ^nys i:;^yBj;'?-yj;nu 'ms ]inx tatB' .lyDKii irjn^a 
tai'T ]NT ."lyDKn dVbnp 'nn nu tai^'^n oy to "injro i^riN yijma' n lyjNp dj? utn*? 

,lj;3ntyya ijranN m ,'q'7»o mp ytannnyj ysNp n is is dj? q'j .i'j^o taona jib pNotryj 
]iN i^'tt mp "inyo ta^innp T'm3i;BiQB> .u'lp-iKBty lyryn "a lynnyjij? jn taan'n \Mi 
'ms iyDipj?3 njip dnt "tnt cn^nq opyr is inysyjiix dnt nt ,nyDNTr"'?iKn iy;!'jyii 
jannxj ynu ntn ij?2nodm« tayn Dj?Tyn ."lyoNn "^ini '^yom piN pN i^»o ^j;u)-n 
INj .lyjnynajj? mu p« nyjiT's n tarND oy n:j;-inyii lyoipya ii: ]j;p o'o n m 
;i'7'a pN am2 ; d:!«tj?j jyanN mi ,l'7'0 yiannayj j?j'n ly^mnyj jyo jyp ta^s nyryn 
ii« (taaNpyjiDnN tau) Bit ^'oanN ;i'^'» pN "bysKmNp yjyiaNinp ;i'i"i3 px t'n 
lyDMN yTi'Btr yipJN y:i'p .(ta^Npyj too jiNtonnnyj pn jnjyna' ti» n^'o n) n'b'D 

iy .Y^in n iy;!N-ita-iyfl ]yayp lyoya tayii iy px pn n'u n aS^n .] y t n 3 
t2yi«^ .lyscD'H yoinj n in DiytDsy px ,jNa jynyi 1x2 p'N DiycDjsoyn ]]}2m siitjT 
.cnnyity nxJiyT tin lynnB taynxa ,;!JnnK3 n i^ij ynjitatr n mi "lynnB uo bm p'p 

iyD"n N PX -[ibvjKl Ml BD"^ MTN O'O H t3y*T"'rp .UBI^ ytt'OB ]1N JJnn'^p 

lyraoayB n tarKj'o utn'7 .pT i'smn u'J lyaK ,iiBi'i' lynB j'smn o'o n ta^xn .lytayn 
1J?T lJ?n .iyj''^5 n fyiJ^taiMiiy is Dinpo' ta'O ly^ytatyiye "t tatia in'« "iyiN ,'iyBK 
eiiNT "ly .;iJita'i'ypiyB lyii^onyB is jyoNSBMN jyo no ,t3^Np ;i:''bsi'7B taiyn nytayii 
DyT DiiN ^No im •^y^N »mis tanynyjonx lyioo Dy:y^yjN'?B ti);:n lyr'm « iy:iNita 
eiiNT ]iN ,T>n DyT lypyiya is din ji:yj ta'nn ]'n inj eiiNT lyiio lyryn ."lyB-iyp 
P"P ;^yiiN3 y:»Mi d'o taynypitac'yjjyaNTis ,iytyta"3i3 jntj dn^ji u'7ypMiy;ioi'iN ]"t 

p'p Nia»3 T'N Dy DMN ]i« .tayi p« jys'O'N ta'a lysN'i'B' '3"n lyT tao qtn^ 
7NT !i« tayayjiyraiiN tmi ly^itatr ikb « aya "in>N is ]y^yutris *)ytaio n ^nt 'y'byjMi 
tyj'^ IS Ml tasNJ "lyaiT « px lyoyi'ipya jyaiByj Tt uyii iy .lyBx^a* siniNT n'n n 
iyiytaB> is yiyiJN taj^iyji p»T tao tayii iy jin ,-iyuitt lyn jib lysiyp ]yD>in Dyi 113 
tao O'n "lyi ly'i'yii ly'jitatr n ]ib lyta'n-iyoain n .iin is uiytae^y; jh^n -lyiN 
O'U'13 TIN Dy lyii Dn'N is lyoipis ])}iyp tas'i*? tayii lytaira n px ,]v'^k5 lyTN*? 
ta«;i pK n'i"tt n 3N la^Nn ,p:Nip pM is ta3i»tt> lyiN tai'DpN'? ,Q3yi3 o'o n nnx 

♦i^up^T nyn tasn p'« '7yta«3"jnT lyi I'N lyosii ;?ayiyii m DiyiJ« tao an^K 

[Summer Care of Babies — Slavish. Issued by Bridgeport, Conn., Department of Health.] 


Zvlastno jeclena dietach je materinske mleko. 

Ak len mozno, dajte dietatu prse. — Desat razy telko dietata zomru. 
CO z flasky pijii, ako co prse dostanii. 

Dajte dietatu jest' poradne, v istim case a ne vzdy ked place. 
Jedon raz kazde dve alebo try hodiny je dostatocne, kim je dieta 
stir}^ lebo pet' tizdne staro; zatim ne tak caste. Dajte dietatu prse 
kim je osem lebo devat mesacno. Ne odviknujte dieta v horucim 

Mnoho diety zomru kazdy rok skrz teho ze ich nehaju s rodicam 
ku stolu sednut, a daju im take jedla,prektore maly zaludok je nesucy. 
Kim dieta pri prsach nedajte mu any len kustyk celistveho jedla, any 
kavu, ten cy pivo. Cakajte kim dieta ma zuby na take jedla ktore po- 
trebno zut'. 

Ak nemate mleko v prsach, dajte dietatu mleko z cistej flasky. 

Dieta, ktoro z flasky pije musy lefi dobro mleko dostavat, ktoto je 
vzdy zakryto a na lade. Ked nemozete mleko patricne zakryt, to ma 
byt uvareno, ak skoro ho dostanete. 

Aby mleko slatke zostalo pre dieta, dajte mleko, ktore pre dieta 
potrebno na nasledne 24 hodiny, do tube zapchatej flasky, lebo do 
skleneho krcaha, ktory je tube zakrity. Flaska alebo krcah musy byt 
vyvareny, kim mleko do teho lejete. Dajte hrnec zimnej vody na pec 
a dajte do hrncu flasku s mlekom, otvorte a dajte malou lizickou 
pekacej sody ku jednim kvarte mleka. Zapchajte zasek flasky a nedo- 
\olte nikomu sa dotknut mleka, kim ho pre dieta ne berete. 

Nedajte dietatu pri moc. — Zaludok novorodeneho dietala zdrzy 
dva lebo try lyzicam a ne viae, ako telo. Racej by ste maly mene dat' 
V najprvsich tizdnach novorodeneho dietata, ktoro z flasy pije. Ako 
dieta narastne davka moze byt postupne zvyssena tak ze na koncii 
prvseho mesiaca ak styry lyzican moze dostat kazdy raz. Daktore 
diety \dac poziadaju, druhe any telko ne zdrzia, ale vzdy nebezpecnejsie 
viae dat' na jedon raz, ako menej. 

Vazite dieta kazdy tizden. — Zdravo dieta o jedon funt ma rastnut' 
kazdy tizden v timto casu zivota. Ak nerastne telko, opitajte sa 
Vaseho lekara jako jedana mate mu dat' a srobte ako on vam porady. 

Ked dieta place, pamatajte, ze ked dieta dostane poriadne jest', to 
neplace, z hladu. 

Mozno, ze je smadno. 

Mozno ze ma krce v bruche. 

Pozorujte aby ruky a nohy boly teple. 

Aby nebolo pry horuco [lipoteno]. 

Aby ho spendliky nepichnuly. 

Pripravena mleka pre dieta.— Ku kazdyn hrnceku mleka dajte dva 
hrnceky vody a telo bjeleho cukru [dakedy mlekovy cukor je lepsy], 
aby tako teplo bolo ako mleko prsach, potom dajte ma flasku cuclik. 



Nedajte dietatu pod sest mesiacoch jest' s lyzicou.— Cicana je 
prirodny sposob, ako ma dieta dostat' svoj potrav. Pry cicania pery, 
lista a jazyk zmesaju jedena so slinim ustach a ucinkuju patricne 
rozvinuta ustach a zubach. 

Ne uzivajte rurku na flaske, len cuclik. 

Nezabudnite flasku a cuclik za uzivania umyt. — Diety castne 
dostanii " bolenia ustach," " vetrove krcy ■' a " letnii nemoc " skrz 
teho, ze flaska je nedrzana v patricnom poriadku. 

Vycistte flasku bezodkladne po uzivania. 

Vycistte cuclik uplne z nutra a z vonka. Cucliky s rurkou sii po- 
bodle pre lenivu matkii, ale aj usmrtnu dieta. 

Ako ma byt pripravena jacmenova voda pre dieta. — Ak je dieta 
stiry lebo pet tizdne staro, davajte mu jacmenovu vodu mesto obicaj- 
nej vody. Dajte dva lyzice perloveho jacmena ku stiry hrncykam 
vody, nehajte jednu lebo viae hodiny varit', kim nezostane viae ako dva 
hrncike vody. Potom precedajte cez cistu handricku, vlozte kvapku 
soly a srobte ho tak sladko, ako mleko prsach. Ku timto prilejte 
jedon hrncek mleko kravej, tak obareno ak vysse spisano, a tak za- 
cinajte davat dietatu. Postupne berte viae kraveho mleka a menej 
jacmenovej vody, takom sposobom, ze ked je dieta sest mesiacno dos- 
tane dva tretiny mleka a jednu tretinu jacmenovej vody. To je naj- 
lepsy potrav, co dieta len dostat moze v case kedy mu zuby idu a pri 
odviknutia. Za timto casom uz mozete davat cisto mleko, obareno 
ako vysse spisano ; chleb s mlekom ; ryzu pecene bandurky s mlekom ; 
dobre uvarenu miiku ovosa s mlekom ; mleko vzdy ma byt obareno a 
nie uvareno. Inse jedena ako te vysse spomute su nepotrebne. 

Kupania. — Drzte dieta v cistote a lahkse vydrzy horiicost. Aspon 
jedon raz kazdy den treba dieta okupat, a vica razy vo velmy horucom 
povetre. Nekupajte dieta nikdy prevj ako celu hodinu za jedena. 
Prvej ho kupajte a potom davajte jest. 

Saty a crstvy zduch. — V horucom povetre dajte take lahke saty ak 
len mozno. Drzte dieta na crstvom vzduche a nie na slunkii. V nocy 
nehajte obloky otvorene, ale preci zavojene aby muchy nemohly sa 
dnuka dostat'. Ked povetre na zimme sa obraty, mavajte pozor aby 
so dieta ne prechladlo. Tenka flanelovat pantla dva alebo try razy 
okolo tele okrutena ma byt. Ta pantla nema byt sirsa, len aby bruch 
zakryla a musy byt hldaka bez krce a zahyby, a pripnuta s nekolkim 
nitkam makej cerneji ne uziva jte spendliky. 

Ne nehajte dieta spat s druhym v tej samej postely. — Ak nemate 
postelku to matka nech polozy kelokolvek stolce ku svojej postely, 
nech ich s mekou pokrivkou zakrije a dieta tam polozy. Tak mri tarn 
lepsie bude v letnej nocy, ako kedb pri horucym tele matkej lezalo, a 
nebude vyrusat nikoho a samo tez nebude vyrusano. Zadok stolca 
ochrany dieta aby nespadlo a matka ma ho pri ruke, ak mu daco po- 

Ak dieta vraca, ma behacku alebo nemocnim vyzera nedavajte 
mleka a nie inso len teplu vodu z flaskej z ktorej cicalo a zaslite po 

[Summer Care of Babies — Hungarian. Issued by Bridgeport, Conn., Department of Health,] 


A csecsemo tulajdonkepeni Ttiplaleka az Anyatej. 

Ha scak lehetseges, szoptassa a gyermeket. — Tizszer annyi halale- 
set fordul elo a palackon nevelt gyermek kozot, mint azok kozt, kik 
anyatejjel vannak taplalva. 

Etesse a gyermeket rendesen bizonyos meghatarozott orakban es 
rem mindenkor, ha sir. Ket vagy harom orankint egy szoptatas ele- 
gendo, mig a gyermek ot vagy hat hetes; azuttin nem sziikseges o 
annyit etetni. Szoptassa a gyermeket nyolc vagy kilenc honapos ko- 
raig. Ne szoktassa el a gyermeket forro idoszakban. 

Szamos g}^ermek hal el evente azaltal, hogy a nagj'^okkal egyiitt ill 
asztalhoz es olyan etket kap, a mit kis g^^omra el nem bir. A mig a 
gyermek anyatejet iszik ne adjon neki egy harapasnyi szilard etelt, 
sem pedig teat, kavet vagy sort. Varjon mig megjon a gyerek foga, 
ha olyan etelt akar adni, a mit meg kell ragni. 

Ha nines anyatej, adjon a gyermekenek tehentejet tiszta palackbol. 

Ha a gyermek palackbol iszik, csakis jo tejet kell neki adni es az 
allandoan zarva es jegen tartandc. Ha a tej nincsen kelloen lefedve. 
rogton megfozendo, a mint megkapja. 

Hogy a gyermek teje meg ne romoljek, tegj^e a legkozelebbi 24 
orara sziikseges tejet palackba, mely szorosan bedugaszolando, vagy 
pedig szorosan fedett korsoba. A palack vagy a korso, valamint a 
fedo, kifozendo, mielott beleonti a tejet. Tegj'en fel egy fazek hideg 
vizet a kemenczere, abba helyezze a gj^ermek tejet tartalmazo edenyt, 
lazan elzarva azt. Mikor a viz felfott, veg3'e ki a gyermek tejet tar- 
talmazo edenyt, bontsa ki es adjon egy fel teas kanalnyi szodat 
minden kvart tejhez, Ezutan zarja el megint az edenyt es ne nyiiljon 
senki sem a tejhez, csak mil^or mar a gyermeknek adjak. 

Ne etesse tul a gyermeket. — Az iijsziilott csecemo ket vagy harom 
kanalnyit elbir, tobbet nem. Inkabb kevesebbet kell adni ennel, a 
palackon nevelt gyermeknek az elso hetekben, egy etkezesre. A mint 
a gyermek megno, az adag is nagyobb lehet, ugy hogy az elso honap 
vegen negy evokanalnyit kaphat egy etkezesre. Nemely gyermeknek 
ennel tobb kell, nemely iknek meg kevesebb, de mindig veszelyesebb 
tobbet adni, mint kevesebbet. 

Mazsalja meg a gyermeket minden heten. — Az egeszseges csecse- 
monek minden heten egy fonttal kell gyarapodnia. Ha az On-e 
nem novekszik ilyen aranvban, kerdezze meg az orvost a taplaleka 
felol, es cselekedjek utasitasa szerint. 

Ha a gyermek sir, ne feledje, hogy ha rendesen van taplalva, akkor 
nem sir ehsegtol. 

Lehet, hogy szomjas. 

Lehet, hogy hasgorcse van. 

Tartsa melegen kezet, labat. 

Ne tartsa tiilmelegen (izzadasig). 

Haskotoje puha, tiszta es szaraz legyen. 

Ne sertse valamelyik i\\. 

A tej elkeszitese a gyermek reszere. — Minden pohar tejhez adjon 
ket pohar vizet es annyi feher cukrot (vagy neha jobb a tejcukor) 



hogy olyan edes legyen, mint az anyatej. Ontse egy palaczkba es 
melegitse az anyatej homersekere. Alkalmazzon gummi szopokat a 

Hat honapon alul ne etesse a gyermeket kanallal. — A csecsemo 
termeszetes etmodja a szopas. Az ajkak, a szaj es a nyely szopc moa^ 
diilata sziikseges ahhoz, hogy az etel a szaj nyalkaival keverodjon 
es hogy a szaj es a fogazat kelloen kifejlodjek. 

Ne hasznaljon csovet a palackon. — Hasznaljon szopokat. 

Ne feledje el a palackot es a szopokat hasznalat utan megmosni. — 
A gyermek gyakran kap " szajfajast," " szeleket " vagy " nyari bajt," 
mert a palack nincsen kello rendben tartva. 

Tisztitsa a palackot azonnal hasznalat utan. 

Tisztitsa a szopokat alaposan kiviil es beliil. Csovel ellatott szopo- 
kak igen kenyelmesek a lusta anyara nezve, de a gyermeknek halalt 

Hogyan keszitendo a gyermek reszere arpaviz. — Mikor a gyermek 
negy vagy ot hetes a kozonseges viz helyett arpa-vizet ad junk neki. 
Tegyen negy csesze hideg vizbe ket evokanallal gyongy-arpat, fozze 
egy ora hosszat vagy tovabb, ligy hogy a vizbol csak ket cseszenyi 
marad. Azutan sztirje at tiszta ruhan; vegyen egy csipetnyi sot es 
edesitse meg az anyatej izere. Ehez ontson egy cseszevel a fentebb 
leirt modon melegitett tehen-tejet es evvel kezdje az etetest. Fokoza- 
tosan vegyen tobb tejet es kevesebb arpa-vizet, ugy hogy mikor a 
gyermek mar vagy hat honapos, ket harmad tejet es egy harmad 
arpa-vizet kap majd. Ez a legjobb taplalek a mi csak adhato a gyer- 
meknek fogzas es elszoktatas idjen. Mikor ez az ido elmult tiszta 
tej hasznalhato, az elobb leirt modon felmelegitve, tejes kenyer, tejes 
rizs, siilt burgonya tejjel, jol megfott zabliszt tejjel (a tej mindenkor 
melegitve es nem megfozve). Az emlitetten kiviil mas taplalek nem 

Fiirdes. — Tartsa a gyermeket tisztan es jobban fogja tiirni a hoseget. 
Legalabb egyszer naponta teljesen megfiirdendo, rendkiviili hoseg- 
ben meg gyakrabban. Ne fiirossze a gyermeket eves utan egy oran 
beliil. Eloszor legyen a fiirdes, azutan az eves. 

Ruhazat es szabad levego. — Meleg idoben a ruhazat oly konnyii 
legyen, mint csak lehetseges. Tartsa a gyermeket a szabad levegon, 
de ne legyen a forro napon. Ejjel tartsa az ablakokat nyitva, de 
behalozva, hogy a legyek be ne johessenek. Mikor az idojaras hirte- 
len lehiil, evakodni kell a hiilestol. Hasznaljon vekony, puha kotot, 
mely ketszer vagy haromszor ateti a testet. Az ilyen kotot csak olyan 
szeles legyen, hogy a hast befedje es siman, rancz s csomo nelkiil, 
racsavarando, azutan illessze oda nehany oltessel pamutcernaval, ne 
hasznaljon tiit. 

A gyermek ne aludjek mas valakivel egy agyban. — Ha nines 
gyermekagya, toljon az anya ket szeket az Agya melle, tegyen reajuk 
puha takarot es fektesse oda a gyermeket. Ez egy nyari ejszakan 
sokkal kenyelmesebb lesz, mint mikor az anyja meleg testehez dol, 
azonfeliil pedig sem nem zavar masokat, es nines megzavarva maga 
sem. A szek hata megovja az esestol es az anyja kezenel van, ha 
sziikseges valami. 

Ha a gyermek hany, hasmenese van, vagy betegnek latszik, ne ad- 
jon neki semmifele tejet es semmi mast, mint meleg vizet a szopo 
palackkal s kiildjon az orvosert. 

[Summer care of babies — Italian. Issued by Bridgeport, Conn., Department of Health.] 


II nutrimento adatto pei bambini e il latte della madre. 

Allevate il vostro bambino voi stessa, se cio e possibile. — La mor- 
talita dei bambini e in queste proporzioni : die per ogni uno die ne 
muore, die e stato allattato a petto, ne muoino dieci die sono stati 
allattati con la bottiglia. 

Allattate il bambino regolarmente a ore fisse, e non ogni volta die 
piange. Bisogna allattare il bambino una volta ogni due o tre ore 
iinche egli ha I'eta di quattro o cinque settimane ; dopo di questa eta lo 
si deve allattare non tanto spesso. Si deve dare il latte al bambino 
finclie egli raggiunge gli otto o nove mesi. Non si svezza il bambino 
durante la stagione calda. 

Molti ragazzi muoiono ogni anno pel fatto die essi sono messi a 
tavola con la famiglia, e si da loro del cibo non adatto ai loro piccoli' 
stomachi. Finclie voi allattate il vostro bambino non gli date un 
boccone di cibo solido, ne gli date te, caffe o birra. Aspettate finclie 
egli abbia messo i denti prima di dargli del cibo die ha bisogno di 
esser masticato. 

Se vi manca il latte del petto date al vostro bambino latte di vawa 
con una bottiglia pulita. 

I bambini che sono allevati col latte delle bottiglie debbono avere 
soltanto latte buono, e questo deve esser mantenuto senipre coperto e 
in ghiaccio. Se il latte non puo esser mantenuto coperto come si 
deve, lo si deve bollire appena ricevuto. 

Per mantener dolce il latte pel vostro bambino si metta in una 
bottiglia o in un boccaccio di vetro a coperchio ben stretto, il latte di 
cui il bambino avra bisogno per le prossime 24 ore. Tanto la bot- 
tiglia e il sughero, quanto il boccaccio e il coperchio debbono boUirsi 
prima die vi si versi dentro il latte. Si ponga sulla stufa una 
casseruola con acqua fresca. Vi si ponga dentro il recipiente col 
latte del bambino, col coperchio avvitato lento. Quando I'acqua bolle 
toglietene il recipiente col latte del bambino, apritelo, aggiungetevi 
poco meno di mezzo cucdiiarino di bicarbonato di soda per ogni litro 
di latte, e quindi si ricopra il recipiente. Non permettete a nessuno 
di toccare il latte, altro die quando serve pel bambino. 

Non nutrite troppo il bambino. — Lo stomaco di un neonato puo 
contenerne da due a tre cucchiai da tavola, e non piii di tanto. Du- 
rante la prima settimana, piii o meno, della vita di un bambino che e 
allevato col latte di bottiglia, bisognerebbe dargliene anche meno di 
questo. A misura die il bambino cresce, la quantitita deve crescere 
gradatamente, cosi che alia fine del primo mese il bambino debba tro- 
varsi a prendere circa quattro cucciiiai da tavola per volta. Alcuni 
bambini possono averne bisogno di piu, mentre altri non possono 
sostenerne tanto, ma vi e sempre piii pericolo a darne troppo alia volta 
che poso. 



Pesate il bambino ogni settimana. — Un bambino di buona salute 
dovrebbe guadagnare durante questo periodo, una libbra per setti- 
mana. Se il vostro bambino non cresce tanto consultate il medico pel 
cibo che bisogna dargli, e fatevi guidare dal suo consiglio. 

Se il bambino piange, ricordatevi che se e stato nutrito regolar- 
mente non piange per fame. 

E puo aver sete. 

O puo avere una colica. 

Badate die abbia le mani e piedi caldi. 

Che non stia troppo caldo, da sudare. 

Che la sua biancheria sia morbida, pulita e asciutta. 

Che non vi siano spilli che lo pungano. 

Come si prepara il latte per nutrire il bambino. — x^d ogni tazza di 
latte si aggiungano due tazze di acqua, e del zucchero bianco (qualche 
volta il zucchero di latte e migliore) abbastanza da renderlo dolce 
come il latte di petto. Si versi quindi nella bottiglia e si riscaldi 
questo latte finche esso sia tanto caldo quanto il latte di petto. Si 
metta quindi alia bottiglia il capezzolo di gomma. 

Non si usi il cucchiaio nel nutrire un bambino al di sotto dei sei 
mesi. — II succhiar e il mezzo naturale che un bambino adopera per 
nutrirsi. Perche il nutrimento si mischi coi fluidi della bocca, e per 
1' adeguato sviluppo della bocca e dei denti vi e bisogno dell' atto suc- 
chiativo delle labbra, della bocca e della lingua. 

Non si usi un cannello sulla bottiglia, si usi un capezzolo. 

Non dimenticate di lavare la bottiglia e il capezzolo dopo che ve 
ne siete servita. — Spesso i bambini pigliano " mali alia bocca," 
" coliche flatulenti " e " sciolte estive " per difetto di cura della 
bottiglia da allattamento. 

Si pulisca la bottiglia immediatamente dopo I'allattamento. Si 
pulisca ben bene il capezzolo, di fuori e di dentro. I capezzoli col 
tubo sono comodi per una madre pigra, ma significano la morte del 

Come si prepara I'acqua xii orzo pel bambino. — Quando il bambino 
ha quattro o cinque settimane, invece di acqua semplice si deve usare 
acqua di orzo. Si mettano due cucchiai da tavola di orzo mondato, 
in quattro tazze di acqua fresca, e si faccia bollire per un ora o piu 
finche 1' acqua si restringa a due tazze. Si passi quandi per un panno 
pulito, vi si aggiunga un pizzico di sale, e si addolcisca tanto da avere 
il sapore di latte di petto. Si aggiunga 'questo ad una tazza di latte 
di vacca, riscaldato come si e detto innanzi e s'incominci a nutrire il 
bambino con queste proporzioni. A poco a poco, gradatamente si usi 
piu latte di vacca e meno acqua di orzo finche, quando il bambino ha 
circa sei mesi si abbia la proporzione di due terzi di latte, ed un terzo 
di acqua di orzo. Questo sara un nutrimento abbastanza buono per 
lui durante il periodo della dentizione e dello svezzamento. Passato 
questo periodo gli si potra dare latte puro, riscaldato come si e deto 
innanzi; pane e latte; riso e latte; latte con patate inf ornate; bro- 
detto di oatmeal ben cotto, e latte (il latte sempre riscaldato, non 
bollito). Non vi e necessita di altri cibi salvo quelli di sopra menzio- 

Bagni. — Si mantenga il bambino pulito, ed egli sopportera il caldo 
assai meglio. Egli dovrebbe avere almeno un bagno completo ogni 
giorno, e piu d'uno durante i calori estremi. Non si dia mai il bagno 


al bambino entro I'ora nella quale egli ha avuto il latte. Gli si da 
prima il bagno e poi da succhiare. 

Panni ed aria fresca. — Quando fa caldo si vesta il bambino quanto 
piii leggermente e possible, si tenga il bambino all'aria aperta, ma 
non al sole ardente. La notte si tengano le retine e si evitino le 
mosche. Quando il tempo si raffredda tutto a un tratto bisogna aver 
cura di evitare che il bambino si raffreddi. Bisognerebbe in tal caso 
avvolgerne il corpo due o tre volte con una sottile e morbida fascia di 
flanella. Questa fascia dovrebb'essere abbastanza larga da coprir 
la pancia, e dovrebb'essere avvolta liscia e senza crespe o piegature, 
aggiustata con qualche punto di cotone morbido da rammendare e 
senza spilli. 

Non fate dormire il bambino nello stesso letto, assieme ad altri. — 
Se non si ha una culla, la madre dovrebbe mettere accanto al suo letto 
un paio di sedie con poj^ravi una morbida copertura, e farvi dormire il 
bambino. In una notte estiva stara a miglior agio che non stando 
presso il caldo corpo della madre, e sara pivi difficile che dia fastidio 
agli altri o che ne riceva. Le spalliere delle sedie eviteranno che il 
bambino cada, e la medre e sempre a portata per prenderne cura, 
ove mai fosse necessario. 

Se il bambino vomicasse, avesse diarrea, o sembrasse malaticcio, non 
gli date piu latte, non gli date che acqua tiepida nella bottiglia da 
allattare, e mandate a chiamare il dottore. 

[Leaflet issued by Providence, R. I.. Health Department.] 


Before the birth of her baby, there are some things which may he 
done by the mother to make her more likely to be well herself and to 
have a healthy child. 

Food. — The food of the mother should be abundant, plain, without 
much spice and seasoning, and with not more than one cup of coffee 
or tea at a meal, and none between meals. If she wants more to 
drink, there is nothing better for her than milk. Meat should not be 
eaten oftener than once a day. The more water that is taken the 

Bowels. — It is very .important to have a movement of the bowels 
every day. Strong medicines must not, however, be used to open the 
bowels; costiveness can be avoided by sufficient exercise and suitable 
food, as brown bread, stewed vegetables, fruit, and abundance of 

Work. — The woman may do her usual work, but should not work 
hard enough to get very tired. Work in store and mills is not good, 
and it should be stopped as soon as possible, at least four weeks before 
the expected birth of the baby. She should go out of doors every 
day, but must not run for cars, or jump, or overexert herself in any 

Once in four weeks, at the time when the woman would have been 
unwell if she were not to have a baby, she should be even more careful 
than usual about overexertion, because at these times there is more 
danger of miscarriage. 

Clothing. — All clothing should be loose. As soon as she begins to 
show her condition, the mother should leave off her corsets, and have 
nothing about the waist that is at all tight. A loose corset waist 
should be worn to which side garters should be attached instead of 
wearing circular ones about the legs. 

Baths. — It is important to keep the skin in a healthy condition, 
and this is best done by frequent bathing. Sea bathing is not good, 
however, because it is too violent. 

Nipples. — Nothing should be put on the nipples until the last 
month. Then they should be washed every day with clean soap and 
water and boracic acid solution put on them. Get some boracic acid 
from the drug store and put a heaping tablespoonful in a pint bottle 
and fill with warm water, or better, put in warm water two-thirds 
and alcohol one-third. If they are small or turned in they should 
once every day be gently pulled out, so as to make them ready for 
the baby to nurse. 

Food for baby. — No food is as good for a baby as its mother's 
milk. This is why so many more bottle-fed babies are sick and die 
than breast-fed babies. For this reason the mother ought to try to 
nurse her baby as long as she has any milk at all. One or two feed- 
ings a day from the breast are a great deal better than none at all. 
Keep the body well nourished before the birth of the baby in order 
to secure a good supply of milk. Kegular nursing and corn-meal 
gruel, a pint or more a day, are the best things to make more milk. 

PROVmENCE, 1910. 

[Published by the Oregon State Board of Health.] 


Too frequently the expectant mother receives no advice from a 
physician or anyone else competent, presuming the condition to be a 
perfectly normal one that needs no a&sistance. This is far from 
true. So many little conditions arise that intelligent care and in- 
struction would prevent not only great discomfort but lower the 
mortality rate in these conditions. 

The first and commonest symptom is nausea. This is purely reflex 
and while no specific drug will cure the condition, by proper advice 
in the way of diet and the addition of some simple stomachics or 
some drug furnishing temporary rest to the organs will accomplish 

Next is the obstinate constipation. Any milk laxative, such as the 
compound licorice powder or phenolax wafers not only adds to the 
comfort of the mother but assists in the development of a healthy 

The most serious of all are the kidney complications. These are 
usually brought on by cold drafts; exposure, such as sitting on 
damp ground or being chilled by long rides or drenched with rain. 
The presence of albumin denotes the possibility of convulsions, and 
urine analysis should, from the fourth to the ninth month, be made 
at least every two weeks. * * * 

Next in importance is the care of the nipples. By persistent use 
of alcohol or glycerol of tannin, the skin can be hardened and prevent 
painful fissures that too frequently follow. 

The duration of the normal pregnancy is 280 days. Near the ter- 
mination of that time, the mother should have ready a quiet room 
apart from the rest of the house and other children, if possible, be- 
cause rest is above all things most desirable in the new mother. She 
should have ready rubber sheet to protect the bedding; binders, three 
or more, made of old toweling, to perfectly support the relaxed abdo- 
men and not only derive perfect comfort but also to preserve a more 
comely appearance in after years ; clean basins and pads, that can be 
made from the ordinary cotton covered with newspapers and steri- 
lized afterwards by dry heat in the oven. Also, plenty of clean 
cloths and sterile oil. 

For the baby she should have at least four dozen napkins; four 
soft binders to bind its little abdomen and protect the cord. Shirts 
supported by straps from the shoulders, skirts always made with the 
body and not with a band that must be bound tightly around the ribs 
to hold in place ; soft pillows, soft covers, and knit wrapping blanket. 
These, together with sacks, wrappers, bibs, and caps, complete the 
new wardrobe. 

The baby's basket should be one specifically for its own use. This 
should contain large and small safety pins, talcum powder, a soft 
hairbrush, castile soap, blunt scissors for the nails, old linen for clean- 



ing the mouth, soft towels for the bath, cold cream or cocoa butter, 
and a bath blanket. 

The feeding of the baby then is of the most importance. Unfortu- 
nately, there are two classes of mothers : the one who, either from a 
life of idleness or lack of exercise, secretes insufficient milk for the 
baby's food, and the other, who from overwork, lack of proper diet, 
and lack of sleep confronts the same condition. No milk, no matter 
how carefully prepared, is as good for the baby as mother's milk. 
However, when this is impossible, the next best substitute is coav's 
milk. The milk of a mother is alkaline. The milk of a cow is acid. 
The milk of the cow contains much more casein, so of necessity 
must be modified some. In the city every mother who must raise her 
child on a bottle should use nothing but certified milk. A little in- 
quiry on her part will tell you just what to use. In country districts 
or small towns it is possible for intelligent parents to see to it that the 
milk for their baby comes from cows that are free from tuberculosis 
or any other disease, that the hair is clipped away from the cow's 
udders, that the milking is done in narrow-mouthed buckets covered 
with clean cloth, so that there is no possibility of excretions from the 
cow or dirt from the stable contaminating the milk. It is an unfortu- 
nate fact that the mortality rate in infants is higher in the country 
nearer the center of production of raw cow's milk than it is in cities, 
and this is due only to carelessness. 

If a bottle must be used, keep it scrupulously clean, with a large 
nipple fitting directly over the bottle. Under no condition should 
the old rubber tube be used. At the completion of each feeding the 
bottle and nipple should be boiled and then kept waiting for use in 
an ordinary solution of bicarbonate of soda, which keeps it sweet and 

The capacity of a newborn babe's stomach is, during the first week, 
1| fluid ounces; during the second week, 24 ounces; from the third 
and fourth week about 3 ounces; at the third month, 5 ounces; at 
the ninth month, 12 ounces. A study of this table will easily con- 
vince you that most babies are overfed. The newborn babe should, 
during the first three days of its existence, have no other food save 
that which comes from the mother's breast. The use of cloth filled 
with sugar or a diluted solution of brandy is absolutely criminal. 

Next to dirt, the greatest murderer of newborn babies is the 
house fly. One speck on the baby's nipple may be sufficient to start 
an attack of intestinal trouble that would result fatally. The per- 
nicious habit of too many mothers is the throwing of soiled napkins 
in some corner of the kitchen or back porch, thereby furnishing food 
for flies, and in turn to be transferred to the milk, the baby's nipple, 
or even direct to the baby's face, thereby setting up an infection that 
will assist materially in increasing infant mortality. 

All babies should early become accustomed to an abundance of 
fresh air. Night air will not hurt babies any more than adults, un- 
less it is last night's air shut up in some close room. Accustom them 
to sleeping with all the windows open, or better yet, to taking their 
daily naps on the porch, protected only from drafts. See that no 
single day passes that the infant does not have at least two hours out- 
doors, breathing in all the ozone that the Creator intended it should 


A proper cart or large basket or crib for sleeping is incomparably 
better than the old cradle, as the digestion is more perfect in children, 
as in adults, when they are not constantly throwing their center of 
gravity outside their bodies. 

Whenever possible a graduate nurse should be in charge of the 
mother and babe. AAHiere it is not possible, a person of wide experi- 
ence, who has had it thoroughly impressed upon her mind that clean- 
liness is next if not equal to godliness, is the only one to be safely 

A normal child should weigh at birth 7f pounds; at the end of 
the second week, 9^ pounds; at the end of the third week, 11 pounds; 
at the end of the fourth week, 12^ pounds ; and at the end of one year, 
21 pounds. These are perfectly normal averages, but variations can 
not but occur. 

It is important that the mother, following the birth of her child, 
shall have ample opportunity for rest. She should stay in bed at least 
two weeks. The habit of entertaining friends the following day or 
for several days after can not be too strongly condemned. She should 
have ample opportunity to sleep, for this will bring back color to her 
cheeks more quickly than malt or any other medicines masquerading 
under the name of tonics. 

The diet for the first few days until milk appears in the breast, 
which is usually 48 hours after, should be liquid entirely. After 
this a liberal diet of easily assimilated foods usually solves the prob- 
lem of the milk supply. 

There is no other condition in life where absolute cleanliness is so 
essential as it is in this condition for the welfare of mother as well 
as the babe. 

A quiet life during the period that the mother is nursing the babe 
will not only add to her comfort and happiness but to that of her 
babe as well. 

Late suppers, dances, improper diet, and overwork all tend to de- 
crease the quantity and quality of her milk, as well as to affect the 
digestion and disposition of the child. A prolonged rest will avoid 
many of the displacements with the accompanying discomforts or 
even surgical operations that too frequently follow childbirth. 



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