the discharges to touch its face. Then the attendant will tie the cord twice, once at a distance of 2 inches from the child's navel, once 2 inches nearer the mother, using pieces of the sterilized bobbin or other string that has been boiled. The cord is then cut with the scissors, between the two ligatures. There will be a single spurt of blood, but bleeding will immediately cease if the ligatures are tight. If bleeding from the baby's navel should not stop altogether another ligature should be made nearer the navel without disturbing the first. The baby should then be covered with something warm but soft and removed to a place of safety while the mother is being taken care of. The separation of the afterbirth takes place within 10 to 30 minutes in most cases. Sometimes the interval is as long as two hours, but the process must not be hurried, save under the doctor's direction. Sometimes the mother can help the matter by straining as she did to bring the child, but unless the doctor or nurse has arrived it is better to be patient and wait for the natural removal of the contents of the uterus. All the soiled pads and dressings and the mass of tissue expelled must be saved for the doctor's inspection. After the soiled pads have been removed the region around the vagina is carefully washed with the bichlorid solution, using pieces of the sterile gauze or some of the cotton pledgets for this purpose. An abdominal binder and one of the sanitary pads are then put on. the soiled dressings are removed and the pad beneath the mother renewed. If after all is over the mother suffers from a nervous chill. as often happens, she need not be alarmed. A hot-water bag at her feet, a glass of hot milk, and a blanket will soon warm her and she will usually be ready to fall asleep to rest after the fatigue of the labor.

AL

There is always a considerable discharge of blood at first; but if for any reason there is an excessive amount of bleeding and the doctor has not come, an attempt must be made to stop it without delay. The attendant, sitting on the bed, facing the foot of the bed. with the hands on the abdomen, will feel for the womb, which wil be a rather large soft mass just under the navel, and will massage it gently, passing the thumb over the front of the organ, while the fingers surround it. These manipulations will cause the fibers of the muscles to contract and will help to stop the bleeding. Cracked ice, wrapped in a towel, may be laid over the uterus to help in the contractions, and sometimes putting the baby to breast will serve the same purpose.

When the doctor comes, he will repair any laceration that may have occurred.

CARE OF THE BABY.

Immediately after the head is born, before the delivery of the body, the baby's eyes should be carefully wiped free from mucus or blood, with bits of clean absorbent cotton or soft old household linen which has been sterilized by boiling, dipped in boiled water, or in saturated solution of boric acid. A separate piece of cotton should be used for each eye and should be discarded as soon as it has been used once. Wipe from the nose outward without opening the lid. At this time also the lips and nose should be wiped clean and the nurse's or doctor's little finger, wrapped with a piece of moist cotton, should be passed into the child's mouth and any accumulated mucus removed by an outward sweep of the finger. As soon after the birth as possible the eyelids should be again wiped clean of mucus, and two drops of an antiseptic solution, which the doctor or nurse will provide, should be put into each of the baby's eyes, gently opening the lids so that the medicine will get inside the eye. This care is necessary because a baby's eyes may become infected during the passage through the birth canal and this infection sometimes leads to opthalmia neonatorum, as it is called, which may cause blindness. It is a perfectly simple, harmless treatment, and is practically sure to preserve the sight. It is a wise precaution, therefore, to take in all cases. If, however, this is not done and symptoms of the disease appear, namely, redness, swelling of the lids, and a discharge from beneath them, the mother should not lose an hour in placing the baby in the hands of the most competent physician she can find. The eyes may be saved by a few hours' care at this time; neglect may doom the baby to lifelong blindness or at best to impaired vision.

In bathing the eyes always use different pieces of cotton or gauze for each eye, and in case of any infection use the greatest care not to infect one eye from the other. This infection may be carried by the fingers, the towels, or the cotton used in treating an infected eye, and is extremely contagious.

The newborn baby's skin is covered with a cheeselike substance, which is the more readily removed if it is first covered with albolene or vaseline. The baby may then be wrapped warmly and put in a safe place until the mother has been attended to, after which the baby may be bathed. The water should be of a temperature that feels comfortable to the bare elbow of the nurse. After the skin is thoroughly but very gently washed, using Castile soap and taking every care not to get soap into the eyes, it should be patted dry with warm and very soft old towels. The navel dressing is made by covering it with a pad of sterile gauze, which has a hole for the cord, holding it in place with the flannel binder already prepared. Unless

this dressing becomes wet or soiled it is not necessary to change it for a few days. The stump of the cord will usually shrivel and fall off within a week. After this happens the navel will be dressed in the same manner until it is entirely healed.

Within 6 to 12 hours after delivery the mother will be sufficiently rested to give the baby the breast. If in the meantime the baby is restless, it may be given a few drops of warm water from a medicine dropper. The water should contain neither sugar nor any sort of medicine. At this period four nursings in 24 hours will be enough. An infant should sleep 20 out of the 24 hours until it is about 2 months old.

The second bulletin of this series, Infant Care, now ready for distribution, gives directions for the care of the baby to the end of the second year.

LYING-IN PERIOD.

This is the name given to the time immediately following childbirth, which is occupied with the establishment of maternal nursing and the restoration of the special organs to the condition they were in before pregnancy. The involution of the uterus is the most important of these changes. By this process the uterus dwindles in weight from about 2 pounds to about 2 ounces and sinks down in the pelvic cavity until it resumes its original position. The length of time required for these changes to take place is shorter with nursing than with nonnursing mothers, but the process of complete involution commonly . takes five or six weeks. If lacerations or other accidents of childbirth have occurred, the time may be longer. It is plain, then, that the mother, no matter how well she may feel, needs a certain time of rest before she is capable of taking up her ordinary occupations and pleasures, which, if indulged in too early, may result in retarding or stopping altogether the natural restorative processes. Most women are able to sit up in a chair for an hour on the tenth day; they may be walking about the room usually after two weeks and by the end of a month be able to go up and down stairs, but in all cases it is well for the mother to refrain from full activity for six weeks. At the end of this period the doctor should make a final examination to be sure that all is as it should be, and direct the proper treatment in case anything is amiss.

The lochia, as the characteristic vaginal discharge of this period is called, is at first pure blood, but later becomes quite brown in color. The discharge will last for some time after the birth of the child, and is apt to increase somewhat as the mother gets about. This is an additional reason for prolonging the period of quiet and rest after childbirth. While women do not usually menstruate during lactation, hospital records show that this occurs in about one-third of the nursing mothers within two months. If this happens, it will be a wise precaution to rest in bed when the times comes for the

next period. This may retard the reappearance of the flow and protect against another conception. If pregnancy should, however, recur, the baby will have to be weaned.

NURSING THE BABY.

To nurse her baby is the first duty of every mother.

Mother's milk is composed of 87 parts of water and 13 parts of solids, these latter being fats, sugar, proteids, and salts. The cream of the milk contains its fat; the lactose is its sugar; and the proteid is the curd of the milk. All these are essential to the proper nourishment of the child. The fat is needed to build up the fatty tissues of the body and to produce body heat and energy; the sugar serves similar purposes; the proteids are of very great importance, their use being to build up the cells which compose the blood, the muscles, and all the tissues of the body; the salts are needed chiefly for the bones and the blood; while the water holds the food in a condition of solution or minute subdivision so that it may be digested and assimilated and helps the work of the excretory organs. Now, although it is quite possible to modify cow's milk in such a way that the proportions of fat, sugar, proteid, and water are not widely different from those in human milk, the latter has other qualities which can not be reproduced by any imitation, no matter how cunningly devised. No one knows just in what state the milk goes from the breast of the mother into the stomach of the babe, but such milk is perfectly adapted to the purpose which it serves. Mother's milk is the one perfect infant food.

It behooves all mothers who desire healthy and happy babies to nurse them. Not only does the mother's milk give the baby the help he must have in the complicated and difficult task of growing, but it renders him to a considerable extent immune to illnesses of many sorts and greatly increases his chances for life itself. Besides it is easier to nurse the baby than to feed him otherwise. To make bottle feeding safe requires scrupulous and constant care. To secure a supply of pure milk; to keep it at the proper temperature; to have it properly prepared for the baby's use; to change the composition of the milk in accordance with the baby's changing needs; to keep all the utensils used in the care and preparation of the baby's feedings absc'utely clean; to have the bottles and nipples scrubbed and sterilized constantly entails upon the mother unremitting attention-attention which is sometimes intrusted to the responsibility of ignorant and careless nursemaids-even when the baby is thriving. But when, as is often the case, the baby does not thrive, the difficulties of artificial feeding are greatly multiplied. Too often do we see babies whose first six or twelve months have been passed in a series of unfortunate feeding experiments, with the result that the growth of

organs, the functions, and general development have been appreciably retarded.

It is true, no doubt, that not all mothers can nurse their babies, even when they would gladly do so. But the cases in which maternal nursing is really impossible are very rare. It is the manifest duty of every doctor, nurse, or other attendant upon a mother in confinement to insist that the mother shall exercise this function; to do everything possible to establish lactation; to promote it and even to bring it back, if for any reason the breasts have ceased to secrete.

From 48 to 60 hours elapse after the birth of the child before the mother's milk "comes." During this period the baby needs no food, but it may be given a few drops of slightly warmed water, now and then, and should be put to breast every six hours, beginning some hours after birth, when the mother has somewhat recovered from the fatigue of labor. The first secretion of the breasts, called the colostrum, serves some useful purpose to the baby, but the principal value of this early nursing is in the training it gives both mother and babe in the habit of nursing. After the milk comes there may be an excessive supply for a few days, until the relation between supply and demand is established. If an overdistention of the breasts occurs, the excess milk may be removed by the use of a breast pump, if it seems absolutely necessary, or by gentle massage of the breast, using warm oil on the hands. But since all manipulation of the breast only stimulates the gland to greater activity, it is better to try to relieve the discomfort in other ways. A bandage, properly made, is valuable, but requires professional skill for its successful use. Hot or cold applications, according to the weather and the patient's preference, may help. Only the gentlest methods can be employed, and usually nature will soon take care of the excess of milk.

The greatest care must be exercised to keep the nipples in good condition. They should be washed with boric acid or clean water after each nursing, thoroughly dried, and, in general, should be kept as clean and dry as possible. They may crack as a result of the efforts of the baby to nurse, and if this happens a nipple shield, either rubber or glass, should be used until the abrasions are healed, for if the baby's mouth comes into contact with the sore nipple, infection may result which may lead to a breast abscess-a very painful affliction, and one which often requires surgical treatment. Cracked nipples are caused also by allowing the baby to nurse too long at a time or at irregular intervals, so that the nipples are wet and irritated much of the time.

From the first nursing an effort must be made to secure regularity in the nursing of the baby. Before the milk comes, as has been said, the baby may have the breast about once in six hours; after that the