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Training of Expectant Mothers and the

Care of Infants
L. H. HUFFMAN, M.D., Hobart, Oklahoma.

Life today is demanding more than ever in the history of the world. In every occupation and in every profession and department of business there is a greater strife for supremacy, and in keeping with the times demands a closer proximity to perfection. Business organizations demand master minds and a system as complete as a perfect machine. Antiquated methods and ideas are lost in our present manner of living and scheme of things. This struggle for supremacy in all lines of business, with the strife to be at the top of the ladder, demands from each individual the qualifications necessary to meet these requirements. He who enters this life handicapped by the lack of proper training, education and environment must of necessity fall far behind in the race and fail of success.

A healthy mind, a necessity for a wholesome citizenship, cannot be built on a defective body, therefore in the interest of public health and for the raising of the standard of our citizens of tomorrow, a continuous co-operation of physicians, teachers and public health departments is required to overcome the physical defects of infants and children.

The care of expectant mothers determines the strength of the child, whether it be a healthy, normal child or the reverse. Now, the essential points in the care of expectant mothers are four in number—to eliminate disease, debility, improper food and overwork. It would require a readjustment of our social and economic conditions to gain these points. Not only does the present system exert its influence during the nine months previous to birth, but also unfits the mother for nursing and caring for the child after birth.

The better baby contests, as a new movement, have for their supreme purpose the placing of such information before parents as will teach them how to preserve the child's energies and by so doing bring about as nearly as possible perfect human beings. Few parents now, with the ordinary social custonis, have proper time to devote to their home, necessarily neglecting the training of the children. The well-to-cio are in search of pleasure, while the poorer classes are compelled to spend the most of their time in mills or factories. Reduction of the working hours to women who are compelled to

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earn their living and the passage of child labor laws have done much toward reducing infant mortality. Through the boards of health and medical meetings, to which the public is invited, much valuable information is given out as to correct methods of living and sanitation.

The health of the infant is greatly influenced by the health of its parents, particularly the health of the mother. One-third of all infants dying in the first year of life die the first month, and onefourth of these die the first week. The deaths may be due to conditions that develop after birth, but are in a large measure due to absence of proper hygienic living of the mother previous to giving birth and not to lack of care of the child after delivery.

It must be remembered that the mother is the only source of food and nourishment for the child for nine months. From her blood the child must be formed. Then if her blood is diseased or if she is overworked, or worried, or underfed, the blood supply of her offspring is impoverished, and the result is a diseased or deformed and debilitated child. As an example of this dentists now claim that the decay of children's teeth is due to the lack of lime salts in the mother's blood previous to birth.

In the same manner all the other organs of the body are influenced in regard to the proper development, depending upon the composition of the blood of the mother. Diseases affecting the offspring most are mental diseases, insanity, epilepsy, and lastly the one most dreaded of all-syphilis. All chronic diseases of the mother, whatever they may be, are productive of a lowered vitality and a weakened condition of the child.

For the nine months during pregnancy great strength and energy are required, and as each mother has but a certain amount of this it is quite necessary that they be conserved during this period. The mother carrying the child has a constant drain on her system, and if she is using her strength in other directions the child is robbed. In all cases where the care of the mother has been systematic we find no miscarriages, no still births or difficult labors, but instead we have a healthy baby free from disease and up to the standard in weight and vitality.

The subject of greatest importance for the infant is that of feeding during the first year of life. There is but little doubt that there are fewer mothers now nursing their children than in the past. While there has been an immense improvement in the physical and social life of people in all countries during the last century, the high rate of infant mortality leads us to but one conclusion and places the blame on one cause-artificial food. No matter how carefully or scientifically we may modify the food, there is but one which is natural and will produce the best developed child, and that is the “natural mother's milk.” Whether or not the mothers have a supply of breast food, it is a fact that artificial food is more frequently

used than previously. Our drug stores are filled with patent and proprietary foods on which there is placed too high a valuation.

Many mothers could and would nurse their children had they been properly instructed in regard to the importance of nursing the baby and the ill effects which result from artificial foods. We find the greatest number of artificially fed babies, first, among the women employed in the factories, and, second, among those who play society, likewise the highest infant mortality. Let us consider the future life of the child and what adverse conditions it must contend with, unfitted for the struggle before it when improperly nourished by artificial foods.

Passing from the infant, a few points on the general care of the child. Good, simple, pure food, including milk and fruit, are the requirements for the child. Teach them to masticate well and for the same reason, to have proper mastication and a well nourished child. The teeth should be given proper attention. Exercise, plenty of fresh air and sleeping in the open will act properly to stimulate and develop the child both physically and mentally. Strong, sturdy and active children are those who are brought up under good hygienic conditions and environment. The backward, dull children are descendants of parents lacking in physical and mental strength. Crowding children either in a physical or mental way beyond their natural ability will produce physical weakness or mental dullness, and for this reason we see at once the great importance of having a school physician who should concern himself with those who are mentally backward and co-operate with the teachers in guiding them in the amount of work they are to do and assist in the mental and physical development of the children.

No branch of hygiene, perhaps, has met with so little progress as the prevention of the infectious diseases of childhood. This is partly due to the inability on the part of the laity to comprehend the loss of life from these diseases. Measles, whooping cough, diphtheria and scarlet fever are the four diseases which recent investigation has shown to be the most fatal, and they are all preventable diseases. Epidemics of these infectious diseases which cause death and distress in different cities every year should be prevented by a quarantine rigidly observed and enforced.

Let me say that every doctor in our country should employ his every energy and every known method towards the prevention of these diseases, and the greatest progress can only be made after the public has been educated at public health meetings, when they, too, can lend a helping hand toward their prevention.

Human lives are at stake, therefore educating the public is a necessity and can be accomplished by public meetings to properly instruct them along the line of preventable, infectious diseases. We cannot place too much stress upon the importance of every professional man and good citizen lending a hand in this cause. Journai Oklahoma Medical Association.

Rural School Conditions in the United States

One of the most important committees appointed by the Council on Health and Public Instruction of the American Medical Association is that on co-operation with the National Educational Association. This committee, appointed two years ago, has been working with a similar committee appointed by the National Education Association on the subject of school hygiene. The first year of the committee's existence was devoted largely to a survey of the field and a consideration of what activities should be first undertaken.. After careful discussion the committee decided that the rural school was more in need of attention and assistance than the city school. Then the question arose as to the amount of available information con. cerning rural schools and school houses. Surprising as it may seem, it was found that little was known of the actual conditions of rural schools in the different states. A preliminary survey was accordingly undertaken with a view to remedying this defect. Through the United States Bureau of Education, Professor Dresslar of Nashville, Tenn., made a careful study of a large number of country school districts in the South. Special surveys in Connecticut, Vermont and New York, as well as general investigations which gathered statistics from every state in the Union, and special studies of rural conditions in Idaho, Massachusetts, Pennsylvania, New Jersey and Virginia, resulted in the accumulation of a large mass of information which is now being digested and drawn up in the form of a report. Professor Dresslar's work will be made public through a special report issued by the United States Bureau of Education. While the work of the committee is only begun, enough has been learned to show that the sanitary condition of rural schools is not by any means so satisfactory as was generally supposed. In the New York Times, March 8, appeared a lengthy article based on a statement by Dr. T. D. Wood of Columbia University, chairman of the education committee.

After describing the organization of the committee and the work which it has undertaken, Dr. Wood said: “We grew up with the notion that the school children in the country were bound to be much healthier than the children of the cities. Our parents always credited the little red school house for their excellent constitutions. Of late years, however, there has been a good deal of suspicion cast on that same little red school house. We have begun in this day of sanitation and medical inspection to have our doubts about those un

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Dr. Wood then gives a few specific instances in proof of the general proposition that the country school child is from 15 to 20 per cent more defective than the city child. In Pennsylvania a study of 1,831 rural school districts was contrasted with the health of the school children in Harrisburg, Pittsburgh and Altoona. The percentage of defective children in Altoona was 69 per cent, in Pittsburgh 72.2 per cent, while in the rural districts studied the aggregate of defective children amounted to 75 per cent. This means that three-fourths of the 294,427 country school children in Pennsylvania are in need of special care and treatment, while even in New York City only 72 per cent of the children are at all defective.

The investigation of specific defects gives the same results. For instance, a comparison of the school children of Orange County, Virginia, with those of New York City shows that with all of the surroundings and disadvantages of city life, the number of New York school children with lung trouble amounts to only a fraction of i per cent, while 3.7 of all the school children in Orange County, Virginia, suffer from some affection of the lungs. When the nutrition of rural school children was considered, it was supposed that here, of course, the country child would greatly surpass the child in the city, yet the average of malnutrition ainong the school children of New York City is 23.3 per cent, while that of rural school children in the districts investigated is 31.2 per cent. The same startling result is found when the figures for mental defectives are compared. Statistics from twenty-five cities and from rural districts in Pennsylvania, Massachusetts, New Jersey, Idaho and Virginia were compared, showing that the average of mental defects among city children was 0.2 per cent, while the average among rural school children was 0.8 per cent. Heart disease is twice as prevalent among country children as among city school children. City school children have only 0.13 per cent of curvature of the spine, while rural school children have 3.5 per cent. Ear troubles are five times and eye troubles are four times as frequent among country children. Adenoids are found in city school children in 8.5 per cent, but in the country the percentage is 21.5. The children in twenty-five cities showed an average percentage of enlarged tonsils of 8.8, while a similar number of country children showed over 30 per cent, and in Idaho the percentage ran up to 43.9.

Discussing the causes for these amazing and startling conditions, Dr. Wood finds that even in the slums, where the pinch of poverty is the sharpest, the food is better prepared than it is in the country, while the distance from, dentists, oculists and clinical advantages accounts for the large number of defects of sight, hearing and teeth. Country houses are often drafty and overheated. The chances for house infection are greater and children are more exposed to cold, heat and dampness. The school houses are often old and carelessly built and have insufficient equipment. In seven states

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