LIBRARY OF CONGRESS. | 
 
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 Slielf_ % Ks>_£^ 
 
 UNITED STATES OF AMERICA. 
 
 
 

A HANDBOOK 
 
 OF 
 
 Obstetrical Nursing, 
 
 FOR 
 
 NURSES, STUDENTS AND MOTHERS. 
 
 COMPRISING THE COURSE OF INSTRUCTION IN OBSTETRICAL 
 
 NURSING GIVEN TO THE PUPILS OF THE TRAINING 
 
 SCHOOL FOR NURSES CONNECTED WITH THE 
 
 WOMAN'S HOSPITAL OF PHILADELPHIA. 
 
 ANNA M. FULLERTON, M. D., 
 
 DEMONSTRATOR OF OBSTETRICS IN THE WOMAN'S MEDICAL COLLEGE OF 
 PENNSYLVANIA ; PHYSICIAN-IN-CHARGE AND OBSTETRICIAN AND GYNAE- 
 COLOGIST TO THE WOMAN'S HOSPITAL OF PHILADELPHIA, AND 
 SUPERINTENDENT OF THE NURSE TRAINING SCHOOL OF 
 THE WOMAN'S HOSPITAL OF PHILADELPHIA. 
 
 SECOND EDITION— REVISED. 
 
 PHILADELPHIA : 
 
 BLAKISTON, SON 
 
 IOI2 WALNUT STREET. 
 189I. 
 
 & 
 
 F °°^/> A 
 BRIGHT * 
 
 SEP 4- 1891 
 CO., 
 
 
w<1 . 
 
 Copyright, 189 1, by Anna M. Fullerton. 
 
 ( Hv, 
 
 PRESS OF WM. F. FELL & CO., 
 
 1220-24 SANSOM STREET, 
 
 PHILADELPHIA. 
 

 TO 
 Dr. ANNA E. BROOMALL, 
 
 PROFESSOR OF OBSTETRICS IN THE WOMAN'S MEDICAL COLLEGE 
 OF PENNSYLVANIA, 
 
 ATTENDING OBSTETRICIAN AND GYNAECOLOGIST, 
 
 AND FORMER PHYSICIAN-IN-CHARGE, 
 
 OF THE 
 
 WOMAN'S HOSPITAL OF PHILADELPHIA, 
 
 THIS VOLUME 
 IS AFFECTIONATELY DEDICATED. 
 
PREFACE TO SECOND EDITION. 
 
 In this second edition of my book, the main 
 revisions have been made in the chapter on the 
 care of the new-born infant, in which I have 
 endeavored to bring the subject up to the present 
 standard of our knowledge. I would acknowledge 
 in this connection the valuable aid afforded me by 
 the articles of Dr. T. M. Rotch on the subject and 
 the analytical work of Dr. H. Leffmann. I trust 
 that these additions may serve to make life healthier 
 and happier for infancy. 
 
 ANNA M. FULLERTON. 
 August, i8gi. 
 
PREFACE. 
 
 The teachings embodied in this little book are 
 chiefly the substance of a series of lectures deliv- 
 ered, yearly, by Dr. Anna E. Broomall to the nurse- 
 pupils of the Woman's Hospital of Philadelphia. 
 
 The methods advocated by Dr. Broomall are 
 strictly observed in the practical work of the 
 Maternity connected with the Woman's Hospital 
 — a building mainly planned by Dr. Broomall and 
 built during her administration as Physician-in- 
 Charge of the Woman's Hospital. 
 
 The excellent results attained by an adherence 
 to these methods prove the value of cleanliness, 
 antisepsis and eternal vigilance on the part of the 
 nurse, in averting the dangers of childbirth and 
 reducing the mortality of early infancy. 
 
 The great importance of a thorough understand- 
 ing of the many little details of scientific nursing 
 on the part of the physician leads me to trust that 
 this little book may be of value to physician as 
 
 vii 
 
Vlll PREFACE. 
 
 well as nurse; and since both of these must have 
 the entire support, sympathy and assistance of the 
 patient in their efforts for her well-being, the direc- 
 tions herein given as to preparations to be made, 
 and rules of action to be observed, will, it is hoped, 
 enable the patient to work in harmony with those 
 who are working for her good. 
 
 My thanks are due to Dr. Broomall for her 
 kindly advice and encouragement in the comple- 
 tion of this handbook, and to Dr. Louise L. Wylie 
 for valuable assistance given in the preparation of 
 the illustrations. 
 
 ANNA M. FULLERTON. 
 
 Woman's Hospital of Philadelphia, 
 December, 1889. 
 
CONTENTS 
 
 CHAPTER I. 
 Signs of Pregnancy, 17 
 
 CHAPTER II. 
 Management of Pregnancy, 22 
 
 CHAPTER III. 
 Accidents of Pregnancy, 41 
 
 CHAPTER IV. 
 Preparations for the Labor, 47 
 
 CHAPTER V. 
 
 Signs of Approaching Labor and the Process of 
 Labor, 59 
 
 CHAPTER VI. 
 Duties of the Nurse during Labor, 65 
 
 CHAPTER VII. 
 Accidents and Emergencies of Labor, 83 
 
 CHAPTER VIII. 
 
 Care of the New-born Infant, 101 
 
 ix 
 
X CONTENTS. 
 
 CHAPTER IX 
 
 PAGE 
 
 Management of the Lying-in 136 
 
 CHAPTER X. 
 
 Characteristics of Infancy in Health and Dis- 
 ease, 176 
 
 CHAPTER XI. 
 The Ailments of Early Infancy, 184 
 
 Index, 217 
 
LIST OF ILLUSTRATIONS. 
 
 FIG. PAGE 
 
 1. Abdominal Belt, 25 
 
 2. Spiral Reverse Bandage of Lower Extremity, 29 
 
 3. Nipple Protector, 33 
 
 4. Chemilette, . 34 
 
 5. Divided Skirt, . . . 34 
 
 6. Union Undergarment, 35 
 
 7. Leglette, 35 
 
 8. Equipoise Waist, 37 
 
 9. Garrigues' Occlusion Dressing, 49 
 
 10. Nightingale Wrap, 5 1 
 
 11. Sylvester Method of Artificial Respiration 1st movement, . 87 
 
 12. " " " " " 2d " . 88 
 
 13. Schultze's " " " " 1st " . 90 
 
 14. " " " " " 2d . " . 91 
 
 15. Position of Patient in Hemorrhage After Labor, 97 
 
 16. Home-made Bath Tub and Crib, no 
 
 17. Lactometer, 116 
 
 18. Sterilizer (Starr's), 129 
 
 19. Feeding-bottle (graduated), Starr, 132 
 
 20. Rubber Nipple, 134 
 
 21. Nipple Shield, 149 
 
 22. Variously Shaped Nipples, 151 
 
 23. Figure-of-8 of one Breast, 152 
 
 24. Figure-of-8 of both Breasts, 153 
 
 25. Garrigues' Breast Bandage, 154 
 
 26. Breast Pump, -. 155 
 
 27. Handkerchief Bandage of Breast, 156 
 
 28. Double Y Bandage of Breast, . 158 
 
 29. Obstetrical Breast Support, 159 
 
 30. Tarnier's Couveuse, 186 
 
 31. Auvard's " (interior), 190 
 
 32. " " (exterior), 191 
 
 33. Swaddled Baby, 192 
 
 34. Single-bulb Syringe, 200 
 
 xi 
 
" He shall gather the lambs with his arm, and carry them in his 
 bosom, and shall gently lead those that are with young." 
 
 — Isaiah, Chap, xl, v. u. 
 
OBSTETRICAL NURSING. 
 
 CHAPTER I. 
 SIGNS OF PREGNANCY. 
 
 The signs of pregnancy may be divided into signs of 
 
 . pregnancy. 
 
 three classes : the suspicious, the probable, and the 
 certain. 
 
 Under the head of suspicious signs maybe classed Suspicious 
 
 . 1 signs. 
 
 the many nervous sensations which are apt to ac- 
 company early pregnancy ; as general discomfort, 
 sudden changes of temperature, headache, tooth- 
 ache, giddiness, faintness, changes in disposition. 
 
 Of the probable signs, one of the earliest and Probable 
 most constant is the stoppage of the monthly flow Cessation of 
 in a person who has been regular. This may be, ation. 
 however, caused by other conditions than preg- 
 nancy. Thus, change in one's mode of living, a 
 new climate, or general ill-health may produce the 
 same result. In the early months of marriage we 
 may also have an irregularity in menstruation 
 where there is n& pregnancy. On the other hand, 
 
 2 17 
 
i8 
 
 OBSTETRICAL NURSING. 
 
 Deepened 
 color of 
 vagina. 
 
 Develop- 
 ment of 
 breasts. 
 
 Enlarge- 
 ment of 
 abdomen. 
 
 in rare instances, we may have the monthly flow 
 persisting for some months or throughout the entire 
 pregnancy. It is then generally scanty and short 
 in duration. 
 
 A deepening in the color of the vagina and vulva, 
 by which they take on a purplish hue, is another 
 sign, and is caused by the enlargement of the blood 
 vessels and a stoppage of the circulation, due to 
 pressure from the enlargement of the uterus. The 
 coloration may be caused to some extent by tumors. 
 
 Increase in the size of the breasts occurs in the 
 early months of pregnancy with a deposit of color- 
 ing matter in the areola, or ring, which surrounds 
 the nipple. Some of this coloring matter seems 
 to extend irregularly over the outer margin of 
 the ring, and is called the " secondary areola " or 
 " areola of Montgomery." With this distention 
 of the breasts there is also a secretion found in 
 them — a watery fluid, sometimes yellowish in 
 color, known as " colostrum." 
 
 Temporary distention of the breasts, with the 
 accumulation of this secretion, may occur in a 
 slighter degree as an accompaniment of menstrua- 
 tion, or it may persist for a long time after a woman 
 has stopped nursing her infant. 
 
 Enlargement of her abdomen, which begins about 
 the third month of pregnancy, is another important 
 sign. Yet this may also be caused by tumors, or 
 
SIGNS OF PREGNANCY. 1 9 
 
 by flatulence, or the deposit of fat in the abdominal 
 walls. 
 
 Marks upon the abdomen, due to the rapid " striae." 
 stretching of the skin, sometimes occur in great 
 numbers, and are called " striae," owing to the fact 
 of their resemblance to the marks left by whip- 
 lashes. These marks sometimes extend down 
 upon the thighs. This, too, may be caused by 
 tumors. The " brown line " of pregnancy is the Brown-iine 
 deposit of pigment in the median line of the ab- of pre^ ask 
 domen. This may exist when there is no preg- nancy * 
 nancy, as also may the peculiar browning of 
 the skin found in irregular patches over the face, 
 particularly on the forehead, and called the " mask 
 of pregnancy." 
 
 " Morning sickness," another sign, begins early in Morning 
 
 siclcncss 
 
 the second month or at the time of the first missed 
 period. It is generally confined to the first three 
 months and is largely a nervous symptom. It 
 varies much, however, in degree and time of occur- 
 rence. Sometimes it is simply a slight feeling of 
 sickness at the stomach occurring early in the morn- 
 ing ; again, it may persist throughout the entire day, 
 or it may occur one day and not again for several 
 days. Sometimes it continues throughout the 
 entire pregnancy, and is then dangerous because of 
 the constant loss of food. Sometimes it occurs 
 early in the pregnancy, then disappears to reappear 
 
20 OBSTETRICAL NURSING. 
 
 in the last month, when there is direct pressure 
 upon the stomach. 
 
 "Quicken- " Quickening" — or the appreciation of the move- 
 ments of the child by the mother — is another prob- 
 able sign, and is first experienced about the middle 
 of pregnancy. A woman who has previously borne 
 children feels this sensation about two weeks earlier 
 than one pregnant for the first time. 
 
 other prob- There are other probable signs of pregnancy 
 which would come only under the observation of 
 the physician. As they require considerable knowl- 
 edge of obstetrics and skill in the conducting of an 
 examination for the discovery of pregnancy, we 
 will not do more than refer to them here. 
 
 Positive The positive signs of pregnancy as agreed upon 
 
 by most obstetricians are but two : the direct 
 appreciation of the parts of the child by touch, and 
 the "foetal pulse," or heart sounds, of the child. 
 The " foetal pulse " is, as a rule, twice as fast as the 
 pulse of the mother. It is hardly strong enough to be 
 heard, even by experienced ears, much before the 
 5 th month — or end of the 20th week — rarely heard 
 well before the 24th week. 
 
 Methods of The ordinary method of reckoning the probable 
 
 reckoning 
 
 termination date of confinement is as follows : Learn on what 
 
 of preg- 
 nancy, day the last monthly flow began, then count three 
 
 months backward (or nine months forward) and 
 
 add seven days. For example, say that a woman 
 
SIGNS OK PREGNANCY. 21 
 
 was unwell last on f March 115th, counting three 
 months back, gives December 15th; add seven 
 days, and we have December 22d as the probable 
 date of her confinement. When, for any reason 
 it is impossible to make the calculation by this 
 method, it may be computed by adding four and a 
 half months to the date of quickening in the case 
 of a woman pregnant for the first time, and five 
 months in the case of one who has previously 
 borne children. 
 
 The third method, that of adding forty weeks, or 
 ten lunar months, to the date of conception is too 
 uncertain to be of much practical use. Examina- 
 tion of the patient by an intelligent physician who 
 knows and appreciates the distinctive signs of the 
 several months offers a fourth method of comput- 
 ing the date of pregnancy. 
 
CHAPTER II. 
 
 MANAGEMENT OF PREGNANCY. 
 
 Attention to 
 laws of 
 health. 
 
 Constipa- 
 tion. 
 
 The management of pregnancy consists, for the 
 most part, in greater attention to the laws of health. 
 The increased activity of all the organs of the body, 
 together with the disturbances caused by pressure, 
 necessitates this. 
 
 Constipation is an almost invariable accompani- 
 ment of pregnancy. In the early months it is a 
 sympathetic condition ; later, the effect of direct 
 pressure upon the bowels. It is also, undoubtedly, 
 in part due to the want of exercise. 
 
 The treatment of constipation is the same as in 
 other conditions, except that only mild laxatives are 
 used. Regularity in attention to the bowels, a glass 
 of cold water at night and again in .the morning, 
 liquids (either milk or water), not taken with the 
 meals, but in the intervals, a teaspoonful of common 
 salt in the water occasionally, the use of uncooked 
 fruit and coarse bread, the avoidance of starches and 
 fine flour — all these are helpful in overcoming this 
 condition. There is an objection to the use of 
 sugared fruits, as confections of fruit, senna leaves, 
 etc., because of their liability to disturb the stomach. 
 
 22 
 
MANAGEMENT OF PREGNANCY. 23 
 
 Prunes are, perhaps, the least objectionable ; licor- 
 ice powder, because of the senna which it contains, 
 is apt to cause griping pains. Rhubarb is, perhaps, 
 the best of the mild laxatives. A small piece of 
 rhubarb root, the size of a pea, may be taken at 
 night, followed by a glass of water. If there is an 
 objection to its taste, it may be taken in pill form. 
 
 Cream of tartar, a half a teaspoonful being taken 
 at night in a cup of cold water, is often efficient. 
 In some cases it may be necessary to repeat the 
 dose in the morning. 
 
 Massage of the abdomen, so efficient in the man- 
 agement of constipation, should never be resorted 
 to in the pregnant state, as it is apt to excite uterine 
 contractions, and may lead to a miscarriage. There 
 is an objection to the too frequent use of enemata on 
 the same ground ; also, the habit is thus acquired of 
 depending upon this stimulus, and over-distention 
 of the bowels is the result. It may be necessary, 
 however, occasionally to alternate an enema with a 
 laxative, especially when the patient suffers from 
 piles. 
 
 Diarrhoea is rather a rare disturbance of preg- Diarrhc 
 nancy, but it sometimes occurs as a direct result 
 of constipation — small, hardened masses forming in 
 the bowel, known as " scybala," which produce an 
 irritation of the mucous lining. The use of rhubarb 
 night and morning, in the manner described above, 
 
24 OBSTETRICAL NURSING. 
 
 until all the masses are removed from the bowels, 
 will serve to check the diarrhoea. 
 The urinary Changes in the urinary organs are mainly due to 
 
 organs. ° J ° J 
 
 direct pressure. In the first three months of preg- 
 nancy there is direct pressure on the bladder, hence 
 of r the bility g rea t irritation, due to interference with the disten- 
 biadder. t j on Q f foe bladder, producing a constant desire to 
 pass water. For this the recumbent position is the 
 only help. The uterus rises in the abdomen at the 
 end of the third month, and the bladder being thus 
 relieved from pressure, this symptom passes away. 
 Retention of The tendency from the fourth to the ninth month 
 
 urine. . . . 
 
 is to the accumulation of urine, because there is 
 less than the proper irritability of the bladder, the 
 organ being flattened between the uterus and the 
 abdominal wall, and its walls thereby suffering a 
 partial paralysis, 
 inconti- I n the last month there is incontinence of urine, 
 
 nence of 
 
 urine. because the pressure is so great that there is no 
 
 room for the accumulation of urine. 
 Retention of During labor there is pressure upon the neck of 
 
 urine in last ° - - . . ^-. . 
 
 month of the bladder and urethra, leading to retention. This 
 
 pregnancy. ° 
 
 may exist for the last two weeks of pregnancy. 
 Necessity for the use of the catheter is confined, as 
 a rule, to this period. The distention of the blad- 
 der may impede labor. With the drawing up of 
 the uterus the bladder is drawn up and the urethra 
 elongated, hence the use of the long rubber catheter, 
 
MANAGEMENT OF PREGNANCY. 2$ 
 
 known as the English catheter, will be necessary. 
 Nos. 8 and 9 are those ordinarily used. 
 
 Sometimes irritability of the bladder is due to Excessive 
 excessive acidity of the urine. A physician will urine. y ° 
 generally prescribe some alkali to overcome this 
 condition, as a drop of liquor potassa in a table- 
 spoonful of milk once in three or four hours, or the 
 use of mucilaginous drinks, as flaxseed tea, barley 
 water, milk, etc., may relieve the distress. 
 
 Fig. 1. 
 
 Abdominal Belt. 
 
 When the abdominal walls are much stretched use of 
 and the uterus falls upon the bladder, this may be 
 remedied by the use of the binder or an abdominal 
 supporter. 
 
 Incontinence of urine leads to the excoriation Excoriation 
 and reddening of the parts about the vulva. Fre- 
 quent washing with warm water and borax or pure 
 castile soap relieves the irritation. Diachylon or 
 zinc ointment is best when an ointment is needed. 
 
26 OBSTETRICAL NURSING. 
 
 Over-dis- Incontinence is sometimes the result of over- 
 
 tention of 
 
 bladder, distention of the bladder. Here the use of the 
 catheter is indicated. 
 
 Use of A nurse, unless thoroughly experienced, should 
 
 never attempt passing the catheter in the case of a 
 pregnant woman, as serious injury may be done to 
 the soft parts in a bungling attempt. In all cases, 
 she should have the sanction of the physician before 
 so doing. 
 
 kidL s ^he kidneys are especially subjected to pressure 
 
 from the seventh to the ninth month of pregnancy. 
 A passive congestion is thus produced, which may 
 
 Albumin- i eac [ ^0 the occurrence of albuminuria, or albumin 
 
 una. y 
 
 in the urine. This is an evidence of a drain upon 
 
 the blood which the physician needs to watch very 
 
 carefully. It is customary, therefore, for physi- 
 
 Examina- c i an s to examine the urine of patients whom they 
 
 tion oi urine. L J 
 
 expect to attend, at least once a week, from the 
 seventh month on to the termination of pregnancy. 
 A specimen obtained by the use of the catheter is 
 the best for the purpose, if the patient be troubled 
 by a discharge from the vagina, 
 increase in There is a natural increase in the amount of urine 
 
 amount of 
 
 passed by a pregnant woman, but the increase is 
 mainly in the water. Therefore, the urine will be 
 lighter colored than usual. The reaction of the 
 urine should be acid. 
 
 Should the reaction be alkaline, or the quantity 
 
 urine. 
 
MANAGEMENT OF PREGNANCY. 2J 
 
 of urine diminished rather than increased in amount, 
 the fact should be reported to the patient's physician. 
 
 Leucorrhcea, a discharge from the vagina, com- Leucor- 
 monly known as " the whites," is much increased 
 often during pregnancy, and is due to the greater 
 activity in the secretion of all the mucous mem- 
 branes. If a vaginal discharge be of a white, yellow 
 or green color, it indicates inflammation of the 
 vagina itself. The discharge, on reaching the vulva 
 and coming in contact with the air, decompose sand 
 becomes irritating. Cleanliness is important in over- 
 coming the effects of this. The itching induced by 
 it is sometimes very obstinate, and generally worse 
 at night. A solution of borax and water for bath- 
 ing the parts, or carbolic acid, 15 to 20^ to a 
 pint of water, will often give relief. Should vaginal 
 injections be ordered by the physician, they should 
 be given with great caution. A fountain syringe 
 should be used, which produces a continuous stream. 
 The interrupted stream should never be employed. 
 In some conditions of excessive discharge the 
 physician may prescribe tannic acid suppositories to 
 be used nightly in the vagina. After a thorough 
 drying of the parts surrounding the vulva, they may 
 be dusted with a powder consisting of one part 
 powdered camphor to four parts starch. This often 
 gives great relief. Calomel powder may be used in 
 the same way. 
 
28 OBSTETRICAL NURSING. 
 
 rhoicuTor Hemorrhoids, or piles, are often very trouble- 
 piles * some during the latter part of pregnancy. Lying 
 down immediately after a movement of the bowels, 
 and remaining in the recumbent position for ten to 
 fifteen minutes, will tend to relieve them, also care 
 in obtaining a daily evacuation of the bowels, and 
 the use of means to secure as soft a movement as 
 possible. Should the piles come down they should 
 be fomented by cloths wrung out in hot water, to 
 which a little Pond's Extract or fluid extract of 
 hamamelis may be added — one tablespoonful, or 
 two, to one pint of water — and when shrunken, 
 anointed with cold cream or cosmoline and re- 
 turned into the bowel. 
 
 Sometimes the case is so aggravated as to neces- 
 sitate keeping the patient in bed for a time. A 
 physician should of course be consulted about the 
 treatment, 
 swelling of The swelling and pain of the external organs of 
 
 lower limbs. ox o 
 
 generation and of the lower limbs, resulting from 
 pressure and the over-distention of the blood 
 vessels, is best relieved by the recumbent posture. 
 Should the veins of the leg be much enlarged, 
 or the feet swollen, the patient should have com- 
 pression made over them by the application of a 
 bandage (the spiral-reverse of the lower limb), or 
 she should wear an elastic stocking, such as may 
 be obtained of any good instrument maker. For 
 
MANAGEMENT OF PREGNANCY. 
 
 2 9 
 
 the bandage the best material is flannel cut bias, 
 the width being about three inches. The bias 
 
 Fig. 2. 
 
 Spiral Reverse Bandage of Lower Extremity. 
 
 bandage makes more even compression. Great 
 harm may result from the neglect of enlarged 
 
30 OBSTETRICAL NURSING. 
 
 veins, as they sometimes become so distended as 
 to burst. 
 Pain from Pain caused by the stretching of the walls of the 
 
 distention of . 
 
 abdominal abdomen may be relieved by thorough inunction 
 
 walls. J so 
 
 of the skin. Cotton-seed, olive or cocoanut oil 
 may be used for the purpose. 
 
 Pains in Severe pains in the back, neuralgic in character 
 
 and so severe sometimes as to prevent the patient 
 from sleeping, may yield to change of position, 
 relieving pressure. Rubbing with soap liniment, 
 volatile liniment, whiskey, or any liniment not too 
 active, is helpful. Warm hip-baths may sometimes 
 be prescribed by a physician. 
 
 increased The salivary glands are in some cases very active 
 
 activity of . " . 
 
 salivary during pregnancy, inducing so excessive a secre- 
 
 glands. £> f o J> o 
 
 tion of saliva as to cause the patient great annoy- 
 ance. This trouble is generally very intractable, 
 and may refuse to yield to all treatment, ceasing 
 only with parturition. Astringent washes, as of 
 tannic acid, alum, myrrh, etc., may be tried, as also 
 the use of pieces of ice. Physicians sometimes use 
 atropia in small doses. Its use requires careful 
 watching. 
 Bad teeth. B ac j teeth, which occur so often during preg- 
 nancy, are said to be due to acidity of the saliva. 
 A little baking soda or prepared chalk placed in 
 the mouth at night will counteract the effect of this 
 acidity when it exists. The question is often asked 
 
MANAGEMENT OF PREGNANCY. 3 1 
 
 whether there is any danger in having the teeth Fining or 
 rilled or attended to during pregnancy. There is teeth dimng 
 always some danger, because a certain amount of 
 nerve-irritation is the result. If the patient be suf- 
 fering, however, it is better to have them filled by 
 a temporary rubber filling, which causes little pain 
 or irritation, than to lose rest in consequence of 
 toothache. Extraction of the teeth should only be 
 allowed when absolutely essential. If the pain be 
 simply a neuralgic pain, it is better to wait. 
 
 Vomiting is, as has been said in the preceding vomiting of 
 
 - r pregnancy. 
 
 chapter, a most common accompaniment of preg- 
 nancy. It more frequently exists, perhaps, with the 
 first pregnancy than any other. The act is accom- 
 plished, as a rule, without much effort. Diet seems 
 to have but little effect upon it. Various articles 
 have been recommended for it, as rice-water, beef- 
 tea, barley-water, the various gruels, the yolk of a 
 hard-boiled egg, scraped beef in the form of sand- 
 wiches, ice-cream, cracked ice, etc. In some cases 
 one or other of these seems to relieve the irritation. 
 A cup of coffee, weak tea, or milk taken warm early 
 in the morning before the patient raises her head 
 from the pillow, will often act as a preventive. In 
 extreme cases of vomiting rectal feeding must be 
 resorted to. In obstinate vomiting it is important 
 that the physician should examine for the position of 
 the uterus or the existence of ulcerations or erosions. 
 
32 OBSTETRICAL NURSING. 
 
 It must not be forgotten that the constant loss of 
 food may be so great a drain upon the patient's 
 strength as to endanger her life. As this symptom 
 is so largely sympathetic, the proper use of bro- 
 mides or other nerve sedatives prescribed by a 
 physician may be of great use in checking it. 
 Care of the Care of the breasts in a pregnant woman neces- 
 
 breasts. x ° 
 
 sitates careful attention to the prevention of com- 
 pression. Full development should be permitted 
 by the looseness of the clothing. The importance 
 of the proper dressing of growing girls cannot be 
 overestimated in this connection. Did mothers 
 realize the evils — of which the atrophy of the breasts 
 is but one — resulting from tight lacing, there would 
 be fewer unhealthy women and fewer mothers 
 unable to nurse their offspring. The nipples 
 should be prevented from rubbing, and the skin 
 over the nipples should be strengthened by using the 
 
 Nipple bath, nipple-bath — filling a small, wide-mouthed bottle 
 one-third full of cold water and inverting it over 
 the nipples daily, from five to ten minutes at a 
 time. Sometimes a little cologne-water or alcohol 
 
 Use of oil. is added to the nipple-bath. Keeping off scabs and 
 concretions of various kinds from the surface of the 
 nipples by the use of a little oil is also admissible. 
 
 Nipple The use of the nipple-protector, which will be 
 
 protector. l 
 
 referred to more fully in the chapter on the man- 
 agement of the lying-in, is of great importance 
 
MANAGEMENT OF PREGNANCY. 33 
 
 where there is a tendency to flattening of the 
 nipple, to remove the pressure of the clothing. 
 
 The clothing of a pregnant woman should be clothing, 
 worn loose from the very beginning, both because 
 the breasts begin to enlarge early and corsets inter- 
 fere with their development, and because any 
 amount of pressure upon the intestines tends to 
 produce uterine displacements, which are especially 
 dangerous during pregnancy, as they predispose to 
 abortion. The clothing should all be supported 
 from the shoulders. 
 
 Fig. 3. 
 
 Nipple Protector. 
 
 Many new dress-reform systems are now in Hygienic 
 
 1 • r 1 • 1 • 1 i«i dressing. 
 
 vogue, having lor their object the great desideratum 
 of adjusting woman's dress so as to make it both 
 healthful and beautiful. Fortunately, in this enlight- 
 ened age ideas of physical culture are so modifying 
 old-time ideas of beauty that the wasp waist, the 
 multitudinous and voluminous skirts, the awkward 
 and deforming bustle, the high-heeled boot, are fast 
 becoming relics of the past. Among the dress- 
 reform systems now in existence there is none so 
 fully meets my views of healthful and beautiful 
 
 3 
 
34 
 
 OBSTETRICAL NURSING. 
 
 dressing as the Jenness-Miller System. But few 
 garments constitute the costume, and these are so 
 constructed as to allow perfect freedom of every 
 part of the body. 
 
 Fig. 4. 
 
 Fig. 5. 
 
 Jenness-Miller Divided Skirt. 
 
 A complete costume for sum- 
 mer wear, according to this 
 system, would consist in the 
 chemilette — a combined chemise 
 and pair of drawers — around the 
 waist of which buttons may be fastened, to which 
 the second article of dress, the divided skirt or 
 Turkish leglette is* buttoned. The latter is made 
 
 Jenness-Miller 
 Chemilette. 
 
MANAGEMENT OF PREGNANCY. 
 
 35 
 
 so full that it takes the place of petticoats, and the 
 dress may be comfortably worn over it. Should 
 the dress be of some very sheer material, one addi- 
 tional muslin petticoat may be worn, similarly 
 fastened to the waist of the chemilette. If a person 
 
 Fig. 6. 
 
 Fig. 
 
 Union Undergarment. 
 
 Jenness-Miller Leglette. 
 
 is accustomed to wearing merino or silk underwear 
 both summer and winter, the jersey-fitting union 
 under-garment may be worn beneath the chemilette, 
 or, the latter being dispensed with, the Jenness- 
 Miller " model bodice," or the Equipoise waist and 
 
36 OBSTETRICAL NURSING. 
 
 divided skirt, may be worn alone over the union 
 under-garment. 
 
 For winter wear, plain leglettes of flannel, cash- 
 mere or silk, or the same material as the dress, may 
 be worn over the union under-garment and directly 
 beneath the dress. Thus under-skirts are entirely 
 dispensed with and all the clothing is supported 
 from the shoulders. 
 
 The skirts of winter dresses, being comparatively 
 heavy, should be fastened to a waist of their own 
 which has comfortably-cut armholes. 
 
 Garters fastened to the waist are discountenanced, 
 according to this system — as they should be, for 
 they produce too much dragging on the waist, and 
 the spiral-spring Duplex Ventilated garter is recom- 
 mended to be worn until something better is devised. 
 
 It is probable that the fashion will come into vogue 
 of combining the stockings with the union under-gar- 
 ment, when garters will be done away with entirely. 
 
 Slender women can well wear the chemilettes, 
 dispensing with all boned waists. Stout women, 
 having busts, find more comfortable the model 
 bodice, or the Equipoise waist,* which, I believe, is 
 not one of the garments of this system, but an 
 
 exceedingly comfortable one, in my opinion. Mrs. 
 
 ■ ■ • ■ — — — ■ 
 
 * This, with the other garments mentioned, may be obtained 
 through the Dress Reform Emporium in Philadelphia, or similar 
 agencies in other cities. 
 
MANAGEMENT OF PREGNANCY. 37 
 
 Jenness-Miller is now devising some form of breast 
 support which aims to support the weight of the 
 breasts from the shoulders, so that waists contain- 
 ing bones may not be regarded as a necessity, even 
 by the stout. Both the " model bodice " and Equi- 
 poise waist (the latter of w 7 hich I prefer) contain 
 bones, but dispense with the front steels, so injurious 
 in the ordinary corset. 
 
 Fig. 8. 
 
 The Equipoise Waist. 
 
 For the changes in shape induced by advanced 
 pregnancy the union under-garments will need to be 
 of larger size than those ordinarily worn (about two 
 sizes larger). Many beautiful designs for dresses 
 and other outer-garments have been devised by Mrs. 
 Miller, patterns for which may be obtained of the 
 Jenness-Miller Co., in New York, or its agencies in 
 other cities. Before leaving the subject I would 
 mention, as one especially praiseworthy feature of 
 
38 OBSTETRICAL NURSING. 
 
 this system, the perfect use of the arms permitted 
 by the ingeniously devised patterns for sleeves and 
 shoulder straps. 
 Abdominal When the abdominal walls are much relaxed, from 
 
 binder. 7 
 
 stretching, allowing the womb to fall forward, it is 
 well to use an abdominal binder or belt, especially 
 during the last month of pregnancy. This helps to 
 keep the uterus in proper position. 
 Flannel Flannel should be worn — at least during 
 
 underwear. ° 
 
 pregnancy — both summer and winter. A lighter 
 flannel can be substituted in summer for that which 
 would be worn in winter. The use of flannel is to 
 prevent chilling of the surface, and this is especially 
 important where — as in pregnancy — the kidneys are 
 overworked. It is important also for the condition 
 of the heart and lungs. Coughs often cause pre- 
 mature labors. The jersey-fitting knit union under- 
 garment, before referred to, may be obtained in all 
 grades and sizes and is well suited to the purpose. 
 Bathing. Bathing is very necessary for a patient during 
 
 her pregnancy, as at other times. As regards the 
 character of the bath, she can do as she has been 
 accustomed to, using warm or cold water. A 
 change from warm to cold water, or vice versa, is, 
 however, not allowable. A sponge-bath, followed 
 by brisk rubbing, is the most desirable. The skin 
 is thus kept in good condition. Shower-baths 
 should be avoided. 
 
MANAGEMENT OF PREGNANCY. 39 
 
 Sea voyages are injurious, because of the danger Sea 
 of receiving falls or blows in consequence of the vc 
 motion of the vessel, and also because of the lia- 
 bility to sea-sickness induced by them. When it is 
 absolutely necessary to take a sea voyage, there is 
 probably least danger in the last three months of 
 pregnancy, because the placenta, or afterbirth, is 
 then well developed and its attachment to the 
 uterus close. 
 
 The regulation of the diet during pregnancy isDietduring 
 
 r • a • 1 1 1 1 -1 pregnancy. 
 
 of great importance. A patient should eat heartily 
 for breakfast and dinner, but the evening meal 
 should be light, especially from the seventh month 
 on to the close of pregnancy. The meal should 
 consist of stale bread, with butter and cooked fruit, 
 as stewed apples, and a glass of milk or weak tea. 
 Digestion is less active in the latter part of the day, 
 and often a hearty meal may prove the direct ex- 
 citing cause of convulsions. The food should be 
 plain, wholesome, nourishing, well-cooked, and 
 chosen in each case with special reference to the 
 avoidance of digestive disturbances and constipa- 
 tion. Meat in moderate quantity, broths, milk, 
 eggs, and fresh fruit should constitute an important 
 part of the dietary. Pastry and confections should 
 be avoided. _ . .. 
 
 Pruit diet. 
 
 There is a mistaken theory prevalent in this day 
 that a mother, by abstaining from certain kinds of 
 
40 OBSTETRICAL NURSING. 
 
 food, as meat, eggs, milk, etc., and confining herself 
 chiefly to a fruit diet, may thus, by preventing the 
 hardening of the bones of the child, do away 
 largely with the pains of labor. The truth of the 
 matter is this: that during pregnancy all the func- 
 tions of the mother's body are especially active in 
 promoting the development of the child, hence an 
 insufficient supply of essentially nourishing food 
 will first affect the mother's system and render her 
 unfit for the demands upon her strength at the time 
 of parturition. 
 
 Should a restriction to the fruit diet effect what 
 it is claimed to do as regards the infant, it would 
 result in the production of sickly, rachitic children, 
 poorly developed mentally and physically. 
 Exercise. Moderate exercise is essential during pregnancy. 
 Walking on a level, not riding, is the best form of 
 exercise. A daily walk should be taken, not, how- 
 ever, after nightfall. The patient should avoid lift- 
 ing — in fact, all straining movements — and most 
 particularly should she avoid the use of the sewing- 
 machine. 
 
CHAPTER III. 
 
 ACCIDENTS OF PREGNANCY 
 
 A discharge of blood from the womb, known as Hemor- 
 rhage. 
 " uterine hemorrhage, may occur at any time dur- 
 ing the pregnancy, and is usually a sign that the 
 patient is threatened with a miscarriage. However 
 slight the flow, the nurse should have the patient Rec r umbent 
 
 & ' -L position. 
 
 lie down until the doctor has been told of its occur- 
 rence, and decides what the patient should do. A 
 note should be sent to the doctor, telling just what p^ysidan. 
 has happened, and clearly making him understand 
 the urgency of the symptoms — that is, the amount 
 and character of the flow — and the condition of the 
 patient. A nurse should not trust to a verbal mes- 
 sage, as the physician may fail to respond to the 
 call promptly, not being aware of the urgency of 
 the symptoms. The patient should be required to 
 use the bed pan, or, at least, a vessel the contents 
 of which can be thoroughly examined, both for the 
 bowels and the passage of urine. All discharges, Preservation 
 soiled clothing, clots, etc., should be carefully saved Changes. 
 for the inspection of the physician. 
 
 Meantime, an effort should be made on the part Efforts of 
 of the nurse to control the flow. The patient should "ontroFflow. 
 
 41 
 
4 2 
 
 OBSTETRICAL NURSING. 
 
 To prevent 
 fainting. 
 
 Vaginal 
 
 injections. 
 
 Causes of 
 hemor- 
 rhages. 
 
 Unavoidable 
 hemorrhage. 
 
 lie with her head low, and a pillow under her hips ; 
 she should not be warmly covered, plenty of cool, 
 fresh air should be admitted into the room and she 
 should be kept exceedingly quiet. 
 
 Should the symptoms become more urgent, the 
 patient being threatened with fainting, the head may 
 be lowered by raising the foot of the bed, placing 
 bricks or chairs under it in such a way as to make 
 a decided inclined plane of the bed. The patient 
 should be fanned, given hartshorne to inhale, and 
 her limbs rubbed, to keep them warm, with alcohol 
 or whiskey. Small doses of whiskey or aromatic 
 spirits of ammonia may be given her in cold water, 
 if able to swallow, or black coffee, or tea, not too 
 warm. If there is much blood flowing from the 
 vulva, vaginal injections of hot water, at a tempera- 
 ture of about no° to 1 1 5°, may be kept up until 
 the flow ceases. 
 
 Alarming hemorrhages are often the result of 
 accidents, falls or blows, or they may be caused by 
 heavy lifting. 
 
 Hemorrhage from a low attachment of the pla- 
 centa, or afterbirth, or when the afterbirth occupies 
 an unusual position — -that is, at the side of or over the 
 mouth of the womb — occurs without any history 
 of accident. It takes place at any time from the 
 seventh month of pregnancy on to its termination, 
 and without any premonitions of its coming. It may 
 
ACCIDENTS OF PREGNANCY. 43 
 
 occur at night while a patient is lying in bed. The 
 management of this condition would be the same as 
 that described above, until the doctor comes. 
 
 Women suffering from enlarged, swollen veins, Hemorrhage 
 
 . •■»-«•>* fit 1 • from rupture 
 
 varicose veins, or varices, of the lower extremi- of varicose 
 
 vein. 
 
 ties, if not careful in keeping the limbs bandaged or 
 supported by elastic stockings may have hemor- 
 rhage occur by the bursting of one of these over- 
 distended veins. The amount of blood lost may be 
 so great as to imperil the patient's life. Should 
 such a rupture of a vessel occur, compression should 
 be made just below the point of rupture, to control 
 the bleeding, until the physician, who should have 
 been sent for, arrives, when he will resort to the 
 measures necessary for securing against further 
 hemorrhage. 
 
 Miscarriages are apt to recur, hence a patient Miscar- 
 who has once suffered from one, should be cau- 
 tioned to take additional care of herself during any 
 subsequent pregnancy. Any sensation of weight P f r ^ ntion 
 about the hips, with the recurrence of a "show," or carria § es - 
 slight discharge of blood, and cramp-like pains, 
 should warn her to lie down and send for her phy- 
 sician. Such a patient should also take the precau- Precaution 
 
 1 p L during men- 
 
 tion to lie down as much as possible (if not in bed, struation - 
 
 on a lounge) during the time when, under other 
 
 circumstances, she would have her monthly flow. 
 
 Any patient having had a number of miscarriages 
 
44 OBSTETRICAL NURSING. 
 
 should keep herself under the care of her physician 
 from a very early date in the pregnancy, being 
 placed under a regular course of treatment. 
 After-treat- It is well, in this connection, to speak of the im- 
 
 ment of mis- 
 carriages, portance of care in the after-treatment of miscar- 
 riages. Not uncommonly, patients, especially of 
 the working classes, get up and go about their work 
 a day or two after the occurrence. This is a dan- 
 gerous proceeding, for, though the ill-effects may 
 not be felt for a time, chronic disease of the uterus 
 is apt to result. 
 £ bed ement It * s rea lly necessary to give more time to the 
 recovery from the effects of an abortion, than to 
 recovery from a confinement at term, and the pa- 
 tient should be willing to remain in bed at least a 
 week or ten days, or longer, if thought best by her 
 physician. The patient should not leave her bed 
 so long as any discharge of blood continues. 
 
 Premature rupture of the membranes enclosing 
 the child, with a discharge of colorless liquid, com- 
 monly known as "breaking of the waters," is another 
 of the accidents of pregnancy, and is invariably 
 followed, within a few days, at least, by the expul- 
 sion of the child. The patient will complain of her 
 clothing becoming wet, either by a sudden dis- 
 charge of a quantity of liquid, or by a slow but 
 continuous flow. The nurse can assure herself 
 that this liquid is not urine by her sense of smell. 
 
 Premature 
 rupture of 
 membranes 
 
ACCIDENTS OF PREGNANCY. 45 
 
 The smell of urine is characteristic. With the am- 
 niotic liquid surrounding the child, there is almost 
 an entire absence of smell, a peculiar, faint, musty 
 odor being alone recognizable. 
 
 It is best, in removing this wet clothing from the Saving 
 
 . . . clothing for 
 
 patient, to set it away, that the physician may judge inspection. 
 for himself of the character of the liquid. The pa- 
 tient should at once lie down, not taking the erect 
 position for any cause, not even for defecation and 
 urination, and the physician should be sent for, with 
 a written statement as to what has occurred. It is 
 important that the physician should see the pa- 
 tient as soon after the rupture of the membranes as 
 possible, because the sudden loss of water may have 
 brought about changes in the position of the child 
 which may endanger its life. The loss of the entire 
 amount of liquid contained in the sac would cause 
 also difficulties in the delivery, or what is known as 
 "a dry labor." Dry labor. 
 
 Convulsionsmay sometimes occur during the preg- convulsions. 
 nancy. The symptoms which threaten this trouble 
 are extreme restlessness and uneasiness on the part 
 of the patient ; severe headache, often confined to 
 one side of the head; disorders of vision, as seeing 
 things double, or seeing but the part of an 
 object, sometimes very imperfect vision, and occa- 
 sionally absolute loss of sight; twitchings of the 
 muscles, especially of the face, may occur. The 
 
46 OBSTETRICAL NURSING. 
 
 convulsion is ushered in by this restlessness and 
 twitchings beginning first about the eyes and ex- 
 tending rapidly to the mouth, arms and lower 
 extremities. The movements are not violent, hence 
 the patient is not likely to throw herself out of bed. 
 The physician should be sent for; meantime, the 
 nurse should see that the patient is kept lying down, 
 that her clothing is well loosened, especially about 
 the head and chest, that plenty of fresh air enters 
 the room, and that the patient is kept from biting 
 her tongue. A folded handkerchief or towel 
 slipped in between the teeth, pushes back the 
 tongue and prevents the teeth from coming down 
 upon it. 
 
 The patient's feet should be kept warm and head 
 cool. The members of the family must be kept 
 calm and prevented from meddlesome interference, 
 for the attempt to make the patient swallow any 
 stimulant while struggling and unconscious, may 
 result very disastrously. Should the attending 
 physician live too far away or be delayed in coming, 
 the nearest physician should be sent for. 
 
CHAPTER IV. 
 PREPARATIONS FOR THE LABOR. 
 
 The relations between nurse and patient begin 
 from the time the engagement is made for a nurse's 
 attendance upon the confinement. 
 
 The nurse is generally consulted beforehand as Advice to 
 to the articles that will be needed at the time of 
 the confinement and for the baby's outfit. Also, 
 she is sometimes asked concerning the choice of a 
 room for the labor and lying-in. 
 
 The room is a most important consideration. It choice of 
 
 room. 
 
 should be light, having the free entrance of sun- 
 light ; quiet and well ventilated. It should not be 
 too near a water closet ; in fact, it is far better to 
 have the water-closet out of the house entirely. 
 There should be no stationary washstand in the 
 confinement room ; or, if this cannot be avoided, 
 the connection with the sewer pipe should be cut 
 off, or the holes and escape pipe in the basin 
 plugged up, the basin being kept filled with fresh 
 water frequently changed. No slop jar or any 
 vessel containing wash water, discharges, etc., 
 should be allowed in the room. An ounce of 
 prevention, in the way of keeping disease germs 
 
 • 47 
 
48 OBSTETRICAL NURSING. 
 
 out of the room, is worth more than a pound of 
 cure. 
 
 Mother's ^ s re g arc [ s the mother's dress, she should be 
 advised to have a sufficient number of good-sized 
 merino or flannel vests, to be able to change night 
 and morning, so that the same vest shall not be 
 worn both day and night. These are more readily 
 changed if opened all the way down the front and 
 fastened with tapes. The free action of the skin 
 after delivery necessitates the use of flannel or 
 merino to prevent chilling. If a long night-dress 
 is worn, there is no necessity for the chemise. The 
 night-dress, also, should be opened all the way 
 down the front, as it renders easier for the patient 
 the frequent changes which are necessary. Suf- 
 ficient night-dresses and vests should be provided 
 to make it possible for the clothing to be changed 
 every day. 
 
 wi ages al Two or three abdominal bandages, also, should 
 be provided, either fitted to the patient's person or 
 straight. If fitted, the bandages should be pre- 
 pared when the patient is about six months' preg- 
 nant, to be the right size after delivery. The 
 bandages should extend from the pubic bone (the 
 bone just above the external generative organs) to 
 the breast bone, being about a half-yard wide and 
 long enough to go once around the body and 
 overlap one-third. It is best made of soft muslin 
 
PREPARATIONS FOR THE LABOR. 
 
 49 
 
 doubled, the seams being turned in at the edges. 
 Large safety pins should be provided for fastening 
 this bandage down the front. 
 
 When the breasts are large and pendulous, some Breast 
 bandage may be required^ for their support. An 
 abdominal bandage may be used for this purpose, 
 though it is rather wider than is necessary. 
 
 When the physician does not require the anti- 
 
 bandages. 
 
 Fig. 9. 
 
 Occlusion Dressing (Dr. Garrigues). 
 
 ;ins. 
 
 septic dressings, now almost universally used, at 
 least two dozen napkins of diaper linen should be Napki 
 provided for the mother, as very frequent changes 
 of the napkin are essential during the first few days 
 after the delivery, while the discharges are free. 
 
 The antiseptic dressings used in the Woman's Antiseptic 
 Hospital, of Philadelphia, are essentially the same 
 as those recommended by Dr. Garrigues, of New 
 York, known as the occlusion dressing. They 
 
 4 
 
So 
 
 OBSTETRICAL NURSING. 
 
 Perineal 
 pad. 
 
 Quantity 
 needed. 
 
 Where 
 obtained. 
 
 consist of a piece of dry patent lint, 6x8 inches, 
 which has previously been rendered antiseptic by 
 saturation in a solution of bichloride of mercury 
 i-iooo. This is placed, doubled in its width, so as 
 to make a dressing, 3 x # 8 inches, directly over the 
 external organs of generation. This lint is covered 
 by apiece of gutta-percha tissue, 4x9 inches, which 
 is wet in a 1-4000 solution of bichloride of mercury. 
 
 These dressings are kept in place by a napkin of 
 sublimated cheese cloth, 18 inches square, folded 
 to form a diagonal, 5 inches in width, within whose 
 folds a pad of oakum is enclosed. The napkin is 
 tightly fastened to the abdominal bandage, both 
 anteriorly and posteriorly, by means of safety-pins, 
 and the access of air to the vagina is thus pre- 
 vented. These dressings are changed at least once 
 in three hours, the dressing removed being at once 
 burned. It is seldom necessary to continue the 
 dressings longer than two weeks. They should be 
 kept up, however, so long as the discharge persists. 
 
 After the above statement it will be seen that a 
 nurse should have the patient obtain of each of 
 the articles comprising the dressing the following 
 quantity: Cheese cloth, 12 yards; gutta-percha 
 tissue, 1 yard ; patent lint, 2 yards ; oakum, )/ 2 to 
 1 pound. 
 
 The cheese cloth may be obtained at any dry- 
 goods store, and prepared by first thoroughly wash- 
 
PREPARATIONS FOR THE LABOR, 
 
 51 
 
 ing with soft-soap and boiling, and then wringing it Preparation 
 out in a solution of bichloride of mercury i-iooo.cioth e and 
 The patent lint should be rendered antiseptic in the " 
 same way. The gutta-percha tissue, patent lint and 
 oakum may be obtained at a drug store; the gutta- 
 percha tissue may be more readily obtained directly 
 
 Fig. to. 
 
 C 
 
 Nightingale Wrap. 
 
 from a rubber store, where the syringe also may 
 be bought. 
 
 In winter it is well for the mother to be provided Nightingale 
 with a " nightingale wrap." This is made of two 
 yards of flannel of ordinary width. A straight slit, 
 six inches deep, is cut in the middle of one side, 
 
 wrap. 
 
52 OBSTETRICAL NURSING. 
 
 the points so formed being turned back to form a 
 collar. The corners farthest from this collar are 
 also turned back to form cuffs. The whole may 
 be bound or pinked around the edge and fastened 
 by means of buttons or ribbons. 
 doth b for F° r the confinement bed the patient should pro- 
 confinement yide tw o pieces of rubber cloth, a yard and a half 
 square. For a single bed two rubber army blan- 
 kets may be used, if, as in the maternity practice in 
 the Woman's Hospital, it is desired to cover the 
 whole bed. The arrangement of the bed will be 
 explained in a later chapter. White rubber gum- 
 cloth is the best when it is obtained in the piece. 
 If the patient is poor, table oil-cloth may be used; 
 it is cheaper and answers the purpose as well, or 
 layers of newspapers tacked together will make 
 very good temporary pads. 
 Si-cioth. A piece of floor oil-cloth is the best protection 
 
 for the carpet at the side of the bed. 
 Precautions. Rubber-cloth should never be used but for one 
 confinement. The rubber cracks when folded and 
 put away and no longer serves its purpose of pro- 
 tecting the bed. Then, too, it is very important to 
 be sure that everything about the confinement bed 
 is perfectly fresh and clean. Hence, a rubber-cloth 
 used for confinement should never be borrowed 
 nor lent. 
 
 Sleeping on rubber-cloth makes a person per- 
 
PREPARATIONS FOR THE LABOR. 53 
 
 spire, hence it is desirable to get rid of it as soon Effect of 
 
 t, • 11 -, n sleeping on 
 
 as one can. It is seldom necessary to use it alter rubber 
 
 r r • i i cloth. 
 
 the fifth or sixth day. 
 
 Other articles necessary to have on hand will be other 
 half a dozen old sheets, about a dozen towels, a confinement 
 
 / r . . , . . , room. 
 
 new syringe (a fountain syringe, large size, is the 
 best), a bed-pan (French pattern), nail-brush, white 
 Castile soap, a jar of cosmoline or vaseline. 
 
 I desire, in this connection, to emphasize the fact The syringe, 
 that the syringe should be a new one. This is an 
 antiseptic precaution. Hence, advise the patient 
 strongly against the use of any syringe which may 
 have been used for other purposes, however well it 
 may work. Of course, the borrowing of such an 
 article from a neighbor or friend should be strongly 
 discountenanced. 
 
 Regarding the baby's clothes — if they are made infant's 
 too elaborate they will not be washed often enough, c 
 hence they should be plain. As the depressing in- 
 fluences of cold are very injurious to babies, the 
 clothing should be warm, hence a flannel garment 
 with long sleeves and high neck should be worn 
 next the skin — the thickness varying with the sea- 
 son of the year. The activity of the life processes 
 make it important that every organ of the body 
 shall be unimpeded in its action and free from pres- 
 sure, hence the clothes should be very loose and 
 light in weight. 
 
54 OBSTETRICAL NURSING. 
 
 Outfit for The only articles absolutely needed to constitute 
 
 baby. J 
 
 an outfit are, 1st, a soft flannel shirt, with high 
 
 neck and long sleeves, opened in front. This is 
 
 The under- better than the merino vests or the knit shirts, 
 
 vest. > 
 
 which shrink on washing, and are then difficult to 
 put on and take off. 2d. A binder, or bandage of fine, 
 soft flannel, four inches wide, and long enough to 
 go around the abdomen once and lap over about 
 one-third. This should be made without a hem, 
 the raw edge being overstitched to prevent raveling. 
 
 The binder. The binder is best fastened by means of two pieces 
 of tape attached to one of its edges. 
 
 This arrangement does away with the necessity 
 for pins in fastening the binder, the pieces of tape 
 being simply wound around the body to secure the 
 
 Knitted binder and tucked in at one edge. Some prefer 
 the knitted wool band, made of single zephyr and 
 knitted in the ribbed stitch, as wristlets or mittens 
 are often knit, to permit of greater elasticity. These 
 bands are made a little narrower in the centre than 
 at either extremity, so as to be held in place better. 
 They are made perfectly circular, just like a wrist- 
 let, and are so elastic that they can readily be drawn 
 
 Na kins U P over the hmbs and adjusted to the body. 3d. A 
 napkin of cotton or linen diaper is the best ; Can- 
 ton flannel makes a very poor baby's napkin, as it 
 becomes stiff when washed. Napkins are generally 
 made too large for a new-born baby, and require to 
 
PREPARATIONS FOR THE LABOR. 55 
 
 be folded into too many thicknesses. A napkin 
 which when folded once is half a yard square, is of 
 ample size. The number of napkins supplied 
 should be generous, so as to permit of frequent 
 washing and thorough airing. Napkins should 
 always be fastened by safety pins. For the protec- 0/°^°" 
 tion of the outer garments from dampness due to £°™ damp_ 
 frequent urination, it is well to have a second napkin 
 folded and laid beneath the baby's hips. The use 
 of rubber-cloth over the napkin for this purpose is 
 much to be condemned, as it overheats the parts 
 and makes the skin tender. 4th. A flannel slip of Fiannd 
 heavier or lighter texture, according to the season, 
 serves the purpose both of petticoat and dress. 
 This should be made just long enough to cover 
 the baby's feet — about twenty-five inches from 
 neck to hem, and should be fastened in front. 
 The ordinary fashion of making a baby's clothes Length of 
 very long is objectionable because of the greater^ 
 weight of the clothes preventing free movement of 
 the child's limbs and the development of its mus- 
 cles. The object of fastening the clothing in front 
 rather than in the back is to avoid the necessity of 
 the baby's lying on the uneven surfaces produced 
 by buttons, tapes and hems, which no doubt are 
 often a source of discomfort to its tender skin. 
 5th. Knit woolen socks are necessary to keep thesocks. 
 baby's feet warm, and it is well to have them 
 
56 
 
 OBSTETRICAL NURSING. 
 
 Support 
 
 from 
 
 shoulders. 
 
 extend pretty well up the leg, reaching even to the 
 knee; as cold feet are often an exciting cause for 
 colic. 
 
 The above are the only essential articles of cloth- 
 ing for a baby. Should the mother prefer, for the 
 sake of effect, to see her baby in white muslin, a 
 Muslin slip. s iip f muslin can be worn over the flannel slip. 
 These garments do away with all waistbands and 
 the constriction of the chest thereby induced. 
 Should the garments be made with waistbands, 
 they should be supported from the shoulders by 
 means of straps, or armholes should be made in 
 the bands just as in the case of an older child; 
 they will not need then to be drawn so tightly 
 around the child to be retained in place. 
 
 A blanket is not needed to wrap the baby in, in 
 a room at the temperature of the lying-in room — 
 from 68° to 70 ; but should it be carried from one 
 room to another, or when it sleeps, a blanket, or 
 some wrap, ranging in weight with the season, will 
 need to be thrown over it. 
 
 When a baby has but little hair on its head, and 
 shows a tendency to catch cold readily, a plain 
 cambric or light flannel cap may be employed as a 
 head covering. This is a preventive against ca- 
 tarrhal troubles affecting the nose and throat. 
 
 A recent journal has described an outfit for babies 
 which has obtained much favor among mothers. 
 
 Blanket 
 wrap. 
 
 Cambric 
 cap. 
 
PREPARATIONS FOR THE LABOR. 57 
 
 It is called, I believe, the " Gertrude Suit," and con- "Gertrude' 
 sists of three garments ; the first, or undergarment, 
 is made of soft flannel, and is long enough to ex- 
 tend from the neck to ten inches below the feet. 
 The next garment, cut in the same way, but a half 
 inch larger and five inches longer, is made of mus- 
 lin. Over these comes the " slip," also Princess 
 style, and the only one of the garments with long 
 sleeves. (This is the most objectionable feature of 
 the suit ; a baby's arms should be well covered.) 
 It has a longer skirt than either of the other gar- 
 ments. All are fastened behind by small buttons. 
 These three garments are put together and all 
 slipped on to the baby at one time, facilitating the 
 process of dressing very much. 
 
 In our opinion, however, this suit has not the 
 same advantages as that worn in the Maternity ^"S 
 of the Woman's Hospital of Philadelphia, and first ^ u ^ ltal 
 described. The fastening of the clothing in front, 
 the fewer number of articles comprising the ward- 
 robe, and the fact that they may be very easily 
 taken off and put on, while they meet all the re- 
 quirements of warmth, looseness and lightness, 
 make this outfit preeminently a comfort to the baby. 
 
 The articles provided for the baby-basket may be Articles for 
 
 - r n . the baby's 
 
 the following : — basket. 
 
 Three or four pieces of linen bobbin, about eight 
 inches long. 
 
58 OBSTETRICAL NURSING. 
 
 A pair of blunt-pointed scissors. 
 
 Large and small safety-pins. 
 
 Several small squares of soft linen, about four 
 inches square, for dressing the cord, and two inches 
 square, for washing the eyes and mouth. 
 
 A soft hairbrush. 
 
 A powder box and puff, with lycopodium or fine 
 starch powder. (The scented powders are often 
 irritating.) 
 
 A small jar of cold cream. 
 
 Two soft towels. 
 
 A full suit of clothes, as described above, for the 
 baby. 
 
 A woolen shawl or wrap. 
 
CHAPTER V. 
 
 SIGNS OF APPROACHING LABOR— THE PROCESS 
 
 OF LABOR. 
 
 Certain changes take place during the latter part indications 
 of the ninth month which indicate that labor isj^* r ching 
 approaching. One of these is the sinking of the Sinking of 
 abdominal enlargement. The upper part of the erji°rge- nal 
 womb, which has at the beginning of the ninth ment " 
 month been high enough to reach the pit of the 
 stomach, comes down gradually to a point about 
 midway between the extremity of the breast bone 
 and the navel. This sinking of the womb is known 
 as " descent " or " settling " of the child, and indi- 
 cates that the head of the child, which is ordinarily 
 the part to be born first, has stretched the lower 
 part of the womb and is finding its way into the 
 cavity of the pelvis, through which it must pass in 
 the birth. Great relief to the mother results from Relief in 
 
 breathing. 
 
 this descent of the womb, as the lungs are no 
 longer pressed upon to the same extent as before. 
 The change in the position of the womb produces, 
 however, an increased amount of pressure on the 
 lower portions of the body. Swelling of the lower lower ex - 
 
 , . . , . , . r ,i • l tremities, 
 
 limbs is apt to result in consequence of this, and from 
 
 pressure. 
 
 59 
 
6o OBSTETRICAL NURSING. 
 
 Piles. 
 
 pains. 
 
 walking is rendered difficult. Piles or hemorrhoids 
 are apt to form, and irritability of the bladder to 
 exist. 
 
 During the last two weeks of pregnancy patients 
 False'' are apt to suffer from what are known as "false 
 pains." These are cramp-like pains, so much like 
 labor pains that patients are often deceived by 
 them, and led to imagine that the labor is really 
 coming on. They are called " false pains " to dis- 
 tinguish them from the pains of labor, which are 
 painT. 6 known as " true pains." The way to distinguish 
 between the two kinds of pains is to observe 
 whether there is any regularity as to the time of 
 their occurrence; also, whether the interval grows 
 shorter, and whether, with this shortening of the 
 interval, the pains grow stronger. " False pains " 
 are irregular in their occurrence, while " true 
 pains," though starting perhaps at quite long inter- 
 vals, as three-quarters of an hour or a half-hour 
 apart, gradually come nearer together and grow 
 stronger. " False pains," also, are generally located 
 in the abdomen. " True pains " more frequently 
 start in the back, coming forward to the abdomen 
 and extending down the thighs. A strong "pain " 
 is apt to be followed by one or two weaker pains. 
 A nurse, if in doubt as to whether the pains are 
 real labor pains or not, should have the physician 
 sent for, who will make an examination to learn 
 
THE PROCESS OF LABOR. 6 1 
 
 what the condition of the parts may be. A sign 
 that makes it probable that the labor is really 
 coming on is the appearance of what is known as 
 the " show," a discharge of mucus, tinged with 
 blood, which comes from the mouth of the womb, 
 and indicates that the stretching of the mouth of 
 the womb is taking place. 
 
 The whole process of labor is divided into three i S a bf r esof 
 stages. The first is the stage of dilatation, when First stage, 
 the mouth of the womb is stretching so as to allow 
 the child to pass through it. With women who 
 have never borne children, this stage lasts on an 
 average fifteen hours, while it is a very variable 
 period for those who have previously borne chil- 
 dren — sometimes lasting but three or four hours ; 
 the average time given is from seven to eleven hours. 
 
 The second stage of labor begins after the com- second 
 
 & & stage. 
 
 pletion of the stretching of the mouth of the womb, 
 and ends with the birth of the child. For women 
 with their first birth, this period lasts from an hour 
 to an hour and a half; with others, from twenty 
 minutes to an hour. 
 
 The third stage of labor includes the interval Third stage, 
 between the expulsion of the child and the coming 
 away of the afterbirth — on an average a half an 
 hour or twenty minutes. 
 
 The time for the entire labor, in a case where it 
 is the first birth, is about seventeen hours. In 
 
62 OBSTETRICAL NURSING. 
 
 whose case other children have previously been 
 borne, the average is from eight to twelve hours. 
 Bag of The "bag of waters" is a sac of membranes in 
 
 waters. 
 
 which the child is enclosed. Within this bag is 
 found a liquid in which the child floats. The 
 presence of this liquid between the child and the 
 walls of the womb serves to protect it from the 
 effect of falls or blows to which the mother may be 
 subjected, and favors the regular development of 
 the child. When labor begins with the stretching 
 of the mouth of the womb, a small portion of this 
 sac is pushed out like a wedge beyond the rim of 
 the dilating orifice, and helps thus in the dilatation. 
 When the waters break early, labor is much more 
 tedious because the even pressure of the bag of 
 waters on the mouth of the womb is lost, and the 
 stretching cannot, therefore, go on so rapidly and 
 easily. As the mouth of the womb opens, the 
 pouch formed by the bag of waters is pushed 
 further and further out into the vagina, the pains 
 become stronger and the pouch at last bursts, 
 letting the water escape. This is " the breaking of 
 the waters," called by physicians the " rupture of 
 the membranes," and it should not take place be- 
 fore the mouth of the womb is fully open. 
 Premature Labor, however, sometimes begins with this loss 
 
 rupture of 7 ° 
 
 the mem- G f water, as has been said in the chapter on the 
 
 branes. ' A 
 
 accidents of pregnancy. 
 
THE PROCESS OF LABOR. 63 
 
 The pains of the first stage of labor are cutting, 
 grinding pains, very hard for the patient to bear, 
 and causing her to be nervous and irritable. 
 
 The cries made by the patient during the first Cries of 
 stage of labor are very different from those of the labor. 
 second stage. They are cries of complaint and suf- 
 fering, while during the second stage they are rather 
 groans accompanying a bearing-down effort on the 
 part of the patient. The pains of the second stage 
 are called " forcing " or " bearing-down pains." An 
 experienced woman will know, as soon as these 
 pains begin, that the doctor should be on hand as 
 soon as possible ; and she should send him a mes- 
 sage which will lead him to realize the necessity for 
 coming at once. 
 
 The pains during the second stage increase in change in 
 strength and frequency, the patient holds her breath of pains. 
 and bears down forcibly with each pain. The effort 
 causes her to become flushed and heated, and to 
 break out into perspiration. „ 
 
 r tr Preparation 
 
 During this time the head of the child is forced jfackfor 
 down the middle passage, or vagina, to the exter- of chad° n 
 nal opening. At the end of each pain the head 
 goes back a little, so that the birth-track may be 
 very gradually stretched. With women who have 
 previously borne children, there is often so much 
 relaxation of the tissues forming this passage-way 
 that the head of the child may be expelled by a 
 
6 4 
 
 OBSTETRICAL NURSING. 
 
 Birth of 
 child's head, 
 
 Expulsion 
 of rest of 
 body. 
 
 Expulsion 
 of after- 
 birth. 
 
 Liability of 
 
 accidents 
 
 occurring. 
 
 Importance 
 of having 
 physician to 
 bear the re- 
 sponsibility. 
 
 single pain. This sudden birth of the head often 
 causes very serious tears. 
 
 After the external opening has been sufficiently- 
 stretched by the slow advance of the head, it grad- 
 ually works out altogether, and then the worst pain 
 is over. There is then a short interval of rest be- 
 fore the remainder of the body is born, the shoul- 
 ders coming first by a strong pain, after which the 
 lower part of the body easily slips out. 
 
 The contraction of the womb, or " pains/' now 
 cease altogether from five to twenty minutes or even 
 half an hour, when there is again a little pain and 
 the afterbirth comes. 
 
 The above description is an account of what labor 
 should be if perfectly natural. There are many 
 emergencies which may arise in any case, hence, 
 for the sake of both patient and nurse, every effort 
 should be made, even in what promises to be a 
 normal case, to have the doctor on hand in time. 
 
CHAPTER VI. 
 
 DUTIES OF THE NURSE DURING LABOR. 
 
 With the occurrence of the symptoms which can for 
 indicate the onset of labor, the nurse, if not already m 
 in the house, should be immediately sent for. 
 
 A nurse should give very prompt attention to Necessity 
 
 for prompt 
 
 such a call, and lose no time in getting; to the attention to 
 
 9 S S call. 
 
 patient, as many women pass through the different 
 stages of labor very rapidly. 
 
 On arriving at the patient's house, the nurse A PP ropri- 
 should put on her working-clothes, which should ae 
 always be scrupulously clean and of wash material. 
 The uniform worn by the nurses of the Woman's 
 Hospital, of Philadelphia, consists of a blue and 
 whited striped seersucker dress, very plainly made ; 
 a large plain white apron, with bib, well protecting 
 the dress ; over-sleeves, of same material as apron, 
 for the protection of the dress-sleeves, and a white 
 muslin Normandy cap. This makes a plain yet 
 attractive dress — which is a matter of considerable ™£££^ 
 importance to the patient, who gets her first impres- appliance. 
 sions of her nurse through her personal appearance. 
 
 Woolen dresses, or those made of any material 
 which will not bear frequent washing, should never 
 5 65 
 
66 OBSTETRICAL NURSING. 
 
 importance be worn by a nurse. There is always the possibility 
 wash dresses — in fact, the probability — of such a dress having 
 been worn during her attendance upon some pre- 
 vious case of illness, in which case it would greatly 
 endanger the patient. The feeling of the wash 
 dress as it comes in contact with the patient's skin, 
 when the nurse lifts her, or works about her, is 
 much more agreeable than that of woolen stuffs. 
 Then, too, it is more business-like, looks more like 
 work, and gives the patient the comfortable feeling 
 that a nurse means to help her, rather than to sit 
 around as a fine lady, attending simply to the 
 daintier parts of attendance upon the sick. I intro- 
 duce this subject here because I find that many 
 graduate nurses, in breaking their direct connection 
 with their training-schools, set aside as a matter of 
 small moment this requirement concerning dress 
 — a requirement in which a most important prin- 
 ciple is embodied and which demands the hearty 
 support of every truly scientific nurse. 
 importance Another important point I wish to mention here, 
 
 of dressing 
 
 quickly, and that is, that a nurse should learn to dress 
 herself quickly, so that she can slip into the neces- 
 sary garments in a very few minutes, and thus, by 
 her promptness in reporting for duty, awaken 
 the confidence so essential to her management of 
 patients. 
 
 On entering the room where the patient is to be 
 
DUTIES OF THE NURSE DURING LABOR. 67 
 
 found, while exchanging the necessary greetings, First duty 
 the nurse should exercise her powers of observa- room. ter 
 tion, and rapidly take in the state of affairs, forming 
 her opinion as to how far the labor has probably 
 progressed. Should " pains " be occurring, she will Observa- 
 recognize, from what has been said in a preceding "P ains -" 
 chapter of the pains characterizing the different 
 stages of labor, whether the patient is really in 
 labor or not, also, how much time is probably left 
 for the making of preparations. She can learn from When pains 
 the patient, in the intervals of her suffering, when e§an ' 
 the pains first began, how often they occur, whether 
 the waters have broken, etc., so that she may know 
 what message to send the doctor, should the neces- Sending for 
 
 . . the 
 
 sity exist for so doing. After this duty has been physician. 
 performed, if labor has really begun, the nurse 
 should give herself to the preparation of the patient 
 and the room for the confinement. 
 
 Preparation of the patient : The nurse should p re p arat ion 
 inquire of the patient whether her bowels have been of P atient - 
 freely moved recently. If not, a simple enema of 
 soap and water may be given for the purpose of 
 
 r J ° x # L Attention to 
 
 clearing out the lower bowel and making the b o wels - 
 second stage of labor easier and cleaner. 
 
 Inquiry should be made as to whether the patient Attention to 
 
 ^ J r bladder. 
 
 has passed water freely. If not, she should be urged 
 to make the attempt, and, if not successful, the phy- 
 sician should be notified. 
 
Fresh 
 clothing. 
 
 68 OBSTETRICAL NURSING. 
 
 Warm bath. ft j s desirable, if there is time, to have the patient 
 take a full warm bath and put on entirely fresh 
 clothing. 
 
 4 n g3 tic A vaginal injection of some antiseptic solution 
 injection. ma y t j ien ^ e gi verij an d the parts about the external 
 
 generative organs washed off with an antiseptic 
 solution. In the Woman's Hospital the vaginal 
 injection consists of a solution of bichloride of 
 mercury 1-8000. The external parts are washed 
 off with a similar solution of 1-2000 or 1-4000. 
 Preparation Tablets of bichloride of mercury may be ob- 
 soiudonT 1C tained at any apothecary's, one of which, if added 
 
 Bichloride of r ... . . . r 
 
 mercury, to a pint of water, will give, as a rule, a solution ot 
 i-iooo, from which solutions of varying strength 
 may be made up by the addition of more or less 
 water. Thus, on adding seven parts of water to 
 one part of the bichloride solution i-iooo, a 
 solution of 1-8000 may be obtained. It is always 
 desirable that the nurse should have a little porce- 
 lain or agate-ware gill measure, by which she can 
 readily and quickly prepare these solutions. If 
 tablets cannot be obtained, powders of y}4 grs. 
 each of bichloride of mercury, if added to a pint 
 of water, will give a solution of i-iooo. 
 
 Creoiine. Creoline, a coal-tar preparation, four times stronger 
 in its antiseptic properties than carbolic acid, may be 
 used in place of bichloride of mercury. To make this, 
 I drachm of the creoline should be added to the 
 
DUTIES OF THE NURSE DURING LABOR. 69 
 
 pint of water. Creoline, though not so strongly anti- 
 septic as bichloride of mercury has greatly come 
 into favor of late, both because it does not have 
 the same corroding effect on instruments which 
 may be used, and because there is less liability of 
 poisoning than in the use of bichloride of mercury. 
 
 A nurse should never lose sight of the fact that Dan g erof 
 
 poisoning. 
 
 the corrosive sublimate (bichloride of mercury) 
 tablets are a deadly poison, hence there should be 
 no neglect as to care in their handling. 
 
 Carbolic solutions are used in place of either Carbolic 
 of the above by some physicians. A two per 
 cent, solution of the latter may be made up in the 
 same way as the creoline solution. 
 
 When the patient seems to be in active labor, the Position 
 nurse should keep her lying down until after theexamina- 
 physician has made an examination. He will then 
 state whether the patient may sit up or walk about 
 the room. 
 
 Because of her long confinement to bed the hair Arrange- 
 of the patient should be arranged so that it will be hair. 
 most comfortable and not readily tangled. The 
 best arrangement is that of parting the hair down 
 the back of the head and braiding it into two plaits 
 — one behind each ear. This leaves a smooth sur- 
 face at the back of the head to lie upon. 
 
 The outfit of the patient during the labor confinement 
 
 • • 1 • 1 outfit. 
 
 3hould consist of a merino vest, long night- 
 
yO OBSTETRICAL NURSING. 
 
 dress, a pair of large, roomy, open drawers, and 
 a pair of stockings. While walking about the 
 room, and until the second stage of labor begins 
 she can wear a wrapper over the rest of her 
 clothing and have on a pair of bedroom slippers, 
 which can be easily slipped off when she needs 
 to lie down. 
 for C exam y i- The patient should be told by the nurse of the 
 physidan. necessity for an examination by the physician, par- 
 ticularly if this is her first labor. When the physi- 
 tions for this cian comes, the patient should be placed on the 
 
 examina- .... 1,1 • 1 1 
 
 tion. bed, near its edge, lying on her back or side, as he 
 
 may prefer, with her limbs drawn up toward the 
 abdomen. Her clothing should be lifted above the 
 hips, and a sheet, or some light covering, used to 
 protect the lower part of the body from exposure. 
 A chair should be placed for the physician on the 
 same side of the bed, close to its edge, facing the 
 patient as she lies ; a jar of cosmoline or vaseline 
 should be brought him, and all the necessary mate- 
 
 phy^ciTrT's rials provided for the proper cleansing of his hands 
 both before and after the examination ; soap, nail- 
 brush, warm water and towels, and some disinfect- 
 ant solution, as a bichloride of mercury solution of 
 the strength 1-2000, or creoline, a drachm to the 
 pint of water. Some physicians prefer the use of a 
 saturated solution of permanganate of potassium, 
 regarding it as a more thorough antiseptic. 
 
DUTIES OF THE NURSE DURING LABOR. 7 1 
 
 The preparation of the room and bed will next Preparation 
 
 ,-i , . ofroom. 
 
 require the nurse s attention. 
 
 These preparations should be made as quietly as Systematic 
 
 arrange- 
 
 possible. The nurse should have learned before- mem of 
 
 articles 
 
 hand where things are, and she should have had needed. 
 them so arranged that but little will need to be 
 done at the time, except to put them where they 
 will be most convenient for use. It is well, if the 
 patient is walking about, to have her go into the 
 next room while the bed is made up. 
 
 A single bed is always the most convenient in preparation 
 the management of a patient, but such are rarely bed. smg e 
 found in private houses. The preparation of a 
 single bed would be as follows : First, the mattress 
 — preferably of hair — covered by a pad and rubber- 
 protective across the middle of the bed, or cover- 
 ing the bed entire (rubber army-blankets are used 
 in the Woman's Hospital for this purpose). The 
 under-sheet covers this rubber, and a draw-sheet — 
 a sheet folded four times in its length and placed 
 across the portion of the bed upon which the hips 
 would rest — comes next. (The folded side of the 
 draw-sheet should be toward the head of the bed). 
 This constitutes the first dressing, or what is known 
 
 as the "permanent bed." The different articles " Perma- 
 nent bed." 
 
 constituting this dressing are securely fastened 
 down by safety-pins. Over the " permanent bed " 
 comes the " temporary bed," consisting of a second ^ r Te b ^°T" 
 
72 OBSTETRICAL NURSING. 
 
 gum blanket, covering the entire bed, a second 
 under-sheet and draw-sheet. Covering these are 
 the upper sheet, blanket and spread. 
 
 After the confinement, the " temporary bed " can 
 be drawn from under the patient, leaving her lying 
 on the " permanent bed." The change is accom- 
 plished with much greater ease for both patient 
 and nurse than the changing of the various articles 
 separately. 
 Preparation The double bed found in most private houses is 
 
 of double L 
 
 bed - arranged as follows : First, the ordinary dressing 
 
 of the bed, the hair-mattress, pad, rubber-protective, 
 under-sheet and draw-sheet. Upon top of this 
 dressing, at the lower right-hand corner of the bed, 
 " Tempo- a " temporary dressing" should be arranged, about 
 dressing/ a varc [ anc [ a half square, consisting of a rubber 
 protective, or the paper pad before described, se- 
 curely fastened down to the bed beneath, and cov- 
 ered, if rubber, simply by a folded sheet, likewise 
 fastened down by safety-pins. If the paper pad is 
 used, an old comfortable or blanket will be needed 
 beneath the sheet. The pillow for the patient should 
 be placed at the upper and inner corner of this 
 square. After the delivery, she can be lifted to the 
 upper part of the bed, and the " temporary dress- 
 ing " removed. 
 
 The sheet, blanket and spread which are to serve 
 as her covering after the delivery can be kept from 
 
DUTIES OF THE NURSE DURING LABOR. 73 
 
 soiling during the labor if folded upon themselves Temporary 
 
 1 1 • • 1 1 1 arrange- 
 
 several times and carried to the extreme edge of mem of 
 
 covers. 
 
 the left side of the bed. Another sheet and blan- 
 ket may be used as temporary covering during the 
 delivery. It is so important that a patient shall be 
 moved as little as possible immediately after the 
 labor, because of the tendency to bleeding pro- 
 duced by motion, that the nurse should study 
 carefully the best methods of protecting patient 
 and bed from soiling, so that it will be neces- 
 sary to do but little in the way of changing the 
 clothing. 
 
 The piece of floor oil-cloth must be spread at Protection 
 
 of floor at 
 
 the side of the bed, extending from a foot to a foot side of bed. 
 and a half under the bed. 
 
 There should be a bureau with a set of drawers, System in 
 
 arranging 
 
 or a closet, with shelves, in the room, given up to articles in 
 
 bureau 
 
 the nurse for the keeping of the various articles drawers, 
 she may need, and these articles should be conven- 
 iently arranged so that there may be no confusion 
 in obtaining them when required at any time. One 
 drawer or shelf should contain sheets; another 
 towels and napkins and soft, clean muslin or linen 
 rags, to be used as napkins during the delivery ; 
 a third should contain changes of underwear for 
 the patient, and the fourth the baby's wardrobe. 
 
 A change of clothing for the mother should be change of 
 
 1 clothing for 
 
 placed — if it is warm weather — in the sun by a mother. 
 
74 OBSTETRICAL NURSING. 
 
 window ; if in winter, by the register, or stove, so 
 as to be dry and warm should it be needed. 
 Articles for The baby's suit should in the same way be aired 
 basket. anc [ warmed. The baby's basket should be placed 
 on a chair or stand near the register, with all the 
 necessary articles for its toilet and bath — a baby's 
 bath-tub or an ordinary foot-tub, soft towels, nurse's 
 flannel bathing-apron, a little rendered lard in a jar, 
 etc. Two pieces of bobbin, each eight inches in 
 length, should be put in a little vessel containing 
 some bichloride solution, 1-4000. These, with a 
 pair of blunt scissors, should be placed where they 
 can be conveniently reached for the tying of the 
 cord. Some small squares of soft muslin or linen 
 should be placed where they will be convenient for 
 the immediate cleansing of the child's eyes after 
 expulsion of the head. A flannel blanket or good 
 warm flannel petticoat should be provided for re- 
 ceiving the child upon its birth. The baby's crib 
 should also be prepared for its reception. 
 Receptacles Beneath the bed there should be two chambers 
 
 needed. 
 
 — one for urine and one for the afterbirth, or a tin 
 basin may be provided for the latter. 
 For doctor's Some receptacle should be in readiness for the 
 
 instruments. 
 
 doctor's instruments, should they have to be used. 
 The small pitcher which ordinarily accompanies 
 the modern chamber sets serves this purpose 
 very nicely. 
 
DUTIES OF THE NURSE DURING LABOR. 75 
 
 A vessel for the patient to vomit in should be Receptacle 
 on hand — a chamber, or even chamber-lid, will do to^omkV 
 very well. 
 
 A basin rilled with a warm solution of bichloride For and- 
 of mercury, 1-4000 or 1-2000, should stand near the soFutkm. 
 bed, so that the nurse or physician may repeatedly 
 cleanse the external organs of generation of all dis- 
 charges during the progress of the labor. The 
 solution in this basin should be frequently changed. 
 
 A sufficient number of soft linen or muslin rags m°usiin nen ° r 
 will also be necessary for this purpose. piec 
 
 Agate, porcelain or china basins are necessary Kind of 
 when bichloride solutions are used. For creoline needed. 
 ordinary tin basins will do. 
 
 The nurse should never allow anything from the 
 kitchen to be pressed into service for such an occa- 
 sion. The indiscriminate use of pans, basins, cups 
 and saucers is certainly vulgar, to say the least. 
 The " eternal fitness of things" should never be 
 lost sight of. 
 
 A urinal, or a soap-cup, which is a good substi- other 
 tute; a silver catheter, and an English rubber needed, 
 catheter, No. 8 or No. 9 ; a bed-pan, and the other 
 receptacles for the various purposes above referred 
 to, may be placed for convenience beneath the bed. 
 
 A towel-rack near by should contain at least 
 half a dozen fresh towels. 
 
 A few napkins, a supply of soft rags, a jar of cos- 
 
I 
 
 supply of 
 hot water. 
 
 76 OBSTETRICAL NURSING. 
 
 moline, a waste-bucket or slop-jar, with a lid, should 
 be found in the room ; and an abundant supply of 
 hot and cold water. 
 
 fuDoiv^f As soon as the patient is known to be in labor, 
 the nurse should go to the kitchen to see that the 
 fire is good, and that plenty of water is put on to 
 boil. An arrangement should also be made by 
 which some member of the family will be prepared 
 to respond to the nurse's call for more hot water 
 when it is required. The abdominal bandage for 
 the patient, with a set of the dressings and a pin- 
 cushion containing safety-pins, should be placed on 
 the stand beside the bed. 
 
 stimulants. ^\ bottle of whiskey or brandy and one of harts- 
 horn should be provided. 
 
 A pitcher of cool water and a tumbler should be 
 found in the room, as the patient may need a refresh- 
 ing drink during the progress of the labor. A 
 feeder is best provided for the patient's use, as she 
 can then drink lying down. 
 
 Arrange- The arrangement of the patient's clothes to keep 
 
 mentof & , • 1 1 • r 
 
 patient's them from soiling; during the expulsive stage of 
 
 clothing. fc> t> r fc 
 
 labor, will require some care on the part of the 
 nurse. The night-dress or vest should be folded 
 or rolled up beneath the arm-pits and fastened with 
 safety-pins over the right side of the chest. If the 
 patient wears large drawers, no further protection 
 than the cover-sheet may be necessary. Some pre- 
 
DUTIES OF THE NURSE DURING LABOR. JJ 
 
 fer having a sheet adjusted around the waist, above 
 the abdomen, and pinned under the clothing to the 
 right side; the long end of the sheet which remains, 
 and which should be the anterior part, is plaited 
 up and fastened also beneath the right arm by means 
 of safety-pins. The sheet thus resembles a skirt 
 opened at the right side. 
 
 During the early stage of labor the nurse will Dutiesof 
 
 ° J ° nurse 
 
 need to encourage the patient, and by a sensible, f t ^ ri ^ f first 
 quiet, yet cheerful bearing keep her strong. It is labor - 
 of no use for patients to hold their breath and bear ment. urage ~ 
 down during; each pain in this stage, and nurses Avoidance 
 
 O JT O > of hMrinor 
 
 should never urge their patients to do so. It should d< 
 
 of bearing 
 
 down 
 
 efforts. 
 
 be left to the physician to decide when bearing- 
 down efforts are desirable. The pressure of the back S . ure ° n 
 nurse's hand upon the back during a pain often gives 
 great relief to the patient, while the occasional bath- 
 ing of the face and hands with cold water is refresh- 
 ing. Frequent sips of cold water may be permitted. 
 
 Nourishment in the form of beef-tea, gruel, milk Nou f sh - 
 
 > <=> * ment. 
 
 and tea may be given from* time to time if the labor 
 be long. No stimulants should be given without 
 the direction of the physician. 
 
 Vomiting is a troublesome though not necessarily Vomiting. 
 a dangerous symptom during delivery. In fact, 
 the relaxation it produces is often desirable. If it 
 is excessive, however, a little iced soda water may 
 check it. 
 
78 OBSTETRICAL NURSING. 
 
 Cramps. Cramps in the lower limbs are a very frequent 
 
 accompaniment of the second stage of labor. Re- 
 lief may be obtained by stretching the limb straight 
 out, gently rubbing the painful muscles, or grasping 
 and holding them. 
 
 Exclusion of Friends and neighbors should, if possible, be 
 
 company. o » r 
 
 excluded from a confinement-room. Their injudi- 
 cious tales and expressions of sympathy are often 
 absolutely painful. The nurse has to manage this 
 with great tact. She can generally succeed best by 
 stating to the friends that it is the physician's wish 
 she should do so, and her relations toward the 
 physician require that she should implicitly observe 
 his directions. If the nurse does not allow herself 
 to become familiar with her patients, but maintains 
 a quiet dignity in the carrying out of her directions, 
 her requests will generally be observed. 
 Tact. Tact is a magic wand by which human beings 
 
 can accomplish miracles in the way of subduing 
 the obstinate. Happy is the nurse who possesses 
 it ! The best rule for acquiring it is the Golden 
 Rule, " Do unto others as you would that they 
 should do to you." A strict observance of this 
 will insure a kindness of tone and manner in the 
 making of requests which will win consent when 
 it would not otherwise be granted. 
 
 One of the most important duties of the nurse 
 during the confinement is the frequent changing of 
 
DUTIES OF THE NURSE DURING LABOR. 79 
 
 napkins, draw- sheets, towels, etc., used about the changing 
 patient. Also the frequent renewal of the antiseptic andTtheT 
 solutions to be used about her, or for the doctor's measures. 
 hands. 
 
 Antisepsis means, literally, " against poisoning," Antisepsis. 
 and implies the careful removal of all sources of 
 poisoning, such as would come from decomposing 
 blood and discharges, or dirty articles. The physi- 
 cian's and nurse's hands, therefore, require a special 
 preparation for the labor in their thorough disenfec- 
 tion. During the course of the labor thfe hands 
 should be thoroughly cleansed with a bichloride 
 solution whenever they have touched anything un- 
 clean, or whenever they come in contact with the 
 genital organs. 
 
 The patient may be delivered on her back or Position for 
 
 delivery. 
 
 lying on her left side. When the physician desires 
 the change of position, the nurse must help the 
 patient to turn on her side and bring her hips close 
 down to the edge of the bed. The upper or right 
 limb will then have to be supported by the nurse, 
 in order to well separate the thighs until the 
 delivery is affected. (When there is insufficient help, 
 a pillow may be used between the knees.) She 
 will have to get on the bed close to the patient 
 for this, and hold the leg at knee and ankle. After during "hird 
 the child has come, she should help to turn the^bor.° f 
 patient in the bed ; bring a flannel wrap to put the 
 
8o 
 
 OBSTETRICAL NURSING. 
 
 Removal 
 of child. 
 
 Prepara- baby in as it lies on the bed before the tying of the 
 receiving cord, and throw a covering over the mother's chest. 
 
 child. 01 . 
 
 Protection She should then wipe the baby's eyes with a fine, 
 
 of mother. L J J 
 
 Cleansing soft piece of linen dipped in tepid water, or a saturated 
 e ^ es - solution of boric acid ; should bring the doctor 
 
 the scissors and bobbin ; and have ready a sheet 
 for receiving the child, and a vessel for the after- 
 birth. She should hold the sheet doubled upon her 
 outstretched arms, the side toward her being held 
 out by her chin. On receiving the baby with its 
 flannel covering, she allows the edge of the sheet 
 held up by her chin to drop down over the child. 
 She then folds over the hanging ends, so as thor- 
 oughly to cover the child, and places the little 
 bundle in a crib,, to await further attentions, until 
 the mother has been made comfortable. Should 
 the child breathe imperfectly, the physician will 
 give it his own attention, or direct the nurse what 
 to do. 
 
 The vessel containing the afterbirth, if the latter 
 has been detached from the child, may be placed 
 temporarily under the bed, to await the physician's 
 examination. If the cord has not yet been tied, 
 the vessel may be put in the crib with the baby. 
 Many physicians do not tie the cord or navel-string 
 until there is no further pulsation in the vessels, 
 cleansing Should the physician not desire to do so, the 
 
 mother after L J 
 
 labor. nurse should next attend to the cleansing of the 
 
 Care of 
 afterbirth. 
 
DUTIES OF THE NURSE DURING LABOR. 8 1 
 
 mother's external parts by means of soft cloths 
 dipped in a solution of bichloride of mercury 
 1-4000. 
 
 Many physicians make a practice of using a vagi- Vaginal 
 nal injection of some disinfectant solution immedi- 
 ately after delivery. It will be the nurse's duty to 
 prepare this should it be called for. The " tempo- Removal of 
 rary dressing " should be removed from the patient, clothing. 
 and she should be gently lifted on to the upper 
 
 . Application 
 
 portion of the bed. The binder and dressings of binder 
 
 and dress- 
 
 must next be applied. in § s - 
 
 " The binder must be rolled up to half its length, 
 and the rolled portion passed beneath the patient's 
 back. It is then caught on the other side and un- 
 rolled, straightened so as to be free from wrinkles, 
 and made to encircle the hips tightly. The over- 
 lapping ends are then fastened together by means 
 of safety-pins down the front." The middle portion 
 of the bandage should be tightened first, as the firm- 
 est pressure should be directly over the upper por- 
 tion of the womb. The lower portion of the 
 bandage is fastened next, and the pins in the upper 
 portion placed last, as this does not need to be so 
 firmly applied. 
 
 The antiseptic dressings should next be applied 
 
 in the order described in a preceding chapter. The 
 
 napkin is spread out and fastened to the abdominal 
 
 bandage anteriorly, so as to fit over the convexity 
 
 6 
 
&2 OBSTETRICAL NURSING. 
 
 of the upper portion of the external organs of gene- 
 ration, and extend from groin to groin. Posteriorly 
 it is fastened to the abdominal bandage by but one 
 safety-pin. This makes an " occlusion dressing." 
 Making The patient's body-clothing should then be un- 
 
 patient x J ° 
 
 comfortable - fastened and drawn down (her drawers and stock- 
 ings should have been removed with the "temporary 
 dressing "). The coverings of the bed are drawn 
 up over her, and she is allowed to lie quietly until 
 the nurse cleans up the room and makes prepara- 
 tions for washing the baby. 
 
 Physician's The physician generally remains with the patient 
 an hour after the delivery, taking her temperature 
 and pulse, and watching the condition of the womb, 
 to insure against danger of hemorrhage from want 
 of proper contractions. 
 
 Nurse's After the doctor leaves, this duty devolves upon 
 
 duties after ' J *■ 
 
 thephysi- -j-j^ nur se, who should examine the dressing's fre- 
 
 cian leaves. ' <=> 
 
 quently to see that the bleeding is not too profuse, 
 and place her hand over the lower part of the abdo- 
 men to feel the womb, which, if properly contracted, 
 should be a round, hard body, about the size of a 
 child's head, immediately above the pubic bone, and 
 not reaching higher than the navel. The considera- 
 tion of the accidents of labor, and the care of the 
 infant, will be treated in other chapters. 
 
CHAPTER VII. 
 ACCIDENTS AND EMERGENCIES OF LABOR. 
 Women who have borne children before are apt Absence of 
 
 r physician 
 
 to have rapid labors, hence a nurse should be on ^ 
 her guard when in attendance upon such a patient, 
 watching for the symptoms of approaching labor, 
 and notifying the physician earlier than she would 
 feel warranted in doing with a patient expecting her 
 
 Occurrence 
 
 pains. 
 
 first confinement. As soon as the nurse suspects of ( 
 that labor pains have begun, she should put her 
 patient to bed. When " bearing-down " pains begin, stkgTof 
 the patient should not get up even to use the cham- a 
 ber. A' bed-pan should be used. The patient 
 should not be allowed, when the pains come on, to 
 catch hold of anything to increase the force of her 
 effort. Above all, the nurse should not tell her to 
 bear down. 
 
 The strength of the pains is somewhat modified Lateral 
 
 position. 
 
 if the patient is kept on her side. This position 
 is also safer for the perineum, which does not so 
 directly get the full force of a pain as when the 
 patient lies on her back. The left side is preferable, 
 as it enables the nurse to use her right hand to 
 greater advantage. 
 
 83 
 
8 4 
 
 OBSTETRICAL NURSING. 
 
 child's 
 
 Delivery of 
 head. 
 
 perineum. Should the child's head come down so that it can 
 be seen at the entrance to the vagina, the nurse 
 should place herself on the right side of the bed, 
 and as the patient lies on her left side, with the hips 
 well drawn to the edge of the bed, the nurse should 
 ,or nead. gently hold back the baby's head during a pain. 
 This is to prevent a tear from occurring by the sud- 
 den expulsion of the head. She should favor the 
 gradual stretching of the parts. She should avoid 
 interfering in any way, as in making efforts to en- 
 large the opening by stretching it with the fingers, 
 etc. All such attempts will inevitably result in 
 harm. When the opening is sufficiently stretched, 
 the head will slip out of itself. The passage of the 
 child's head is rendered easier if the patient's knees 
 are separated by a pillow. The nurse should sim- 
 ply continue to support the head with her hand, 
 and as soon as the head is born, her left hand 
 should be placed over the mother's abdomen, rest- 
 ing upon the womb, which may be distinctly felt 
 through the abdominal walls. The pressure of the 
 hand acts as a stimulant to the womb and induces 
 good contractions. A tendency to hemorrhage is 
 thus averted. The right hand of the nurse should 
 support the child's head. With one finger she 
 should feel around the baby's neck to learn whether 
 it is encircled by a loop of the navel-string or cord. 
 If so, she should gently pull first on one side and 
 
 Grasp of 
 uterus. 
 
 Loosening 
 of cord. 
 
ACCIDENTS AND EMERGENCIES OF LABOR. 85 
 
 then on the other of the cord, to see which end 
 gives. This loosens the pressure and prevents the 
 stoppage of the circulation in both cord and child's 
 neck. 
 
 When, after a pause, the pains start up again to ^ e c J ivery of 
 expel the rest of the child's body, the nurse had 
 better have some one instructed how to hold the 
 womb properly, as both her own hands will be 
 needed to receive the body of the child as it is ex- 
 pelled. The mother herself may be shown how to 
 make this pressure over the womb. If there is no 
 one to make this compression of the womb, the 
 nurse should try to manage the baby with one hand 
 and keep up the pressure over the lower part of the 
 abdomen with the other. The flannel wrap forthecareof 
 baby may be put close up to the mother's hips, and 
 the nurse can manage with one hand to lay the 
 baby down on this, cover it up, and draw it far 
 enough away from the mother's hips to keep it out 
 of the discharges. She should see that the baby's 
 mouth is free from liquids. The little finger of her 
 right hand acting as a hook, the end of the finger 
 should be passed in at one corner of the baby's 
 mouth and out at the other corner, thus scooping 
 out any liquids that may have been drawn in during 
 the birth. She should be careful to see that the 
 cord is not dragged up and that the baby breathes 
 well. Babies usually cry lustily just after the 
 
86 OBSTETRICAL NURSING. 
 
 birth. This should be a welcome sound to both 
 nurse and mother, as it insures expansion of the 
 lungs. Occasionally, a child will be born with what 
 
 "caui." is known as a " veil" or "caul," a portion of the 
 membranes, drawn tightly over the face. This may 
 cause death from suffocation unless it is quickly 
 seized by the fingers and torn off, so as to free the 
 child's mouth and nose. 
 
 Resuscita- If the baby is apparently lifeless when born, be- 
 
 infant. sides the measures spoken of for clearing its mouth 
 of liquids, it may be turned over on its face, to 
 empty out the discharges from the air-passages, 
 and efforts should be made to start breathing. The 
 head of the child should be lowered, to keep as 
 much blood there as possible. 
 
 The back may be slapped — several short, quick 
 slaps given over the buttocks. A stream of cold 
 water may be poured on the chest just for a 
 moment, and this repeated several times. 
 
 Artificial If these fail, the nurse may breathe into the baby's 
 
 breathing. J ? 
 
 mouth. To do this properly, the baby's nose should 
 be held, the nurse's lips placed closely over the 
 baby's open mouth as she breathes into it, then 
 the nurse's mouth is removed and the grasp on the 
 nose loosened, the sides of the child's chest being 
 pressed upon to press out the air. The number of 
 breaths given by the nurse in a minute should not 
 at first exceed twelve. 
 
ACCIDENTS AND EMERGENCIES OF LABOR. 87 
 
 Another valuable method of carrying on artifi- Sylvester's 
 
 . , .... o i j 11 method. 
 
 cial respiration is known as Sylvester s method. 
 The baby is placed on its back, with a roll, made by 
 
 Fig. 
 
 Sylvester's Method of Resuscitation (First Movement. ) 
 
 a towel, placed under its shoulders. The head is 
 thrown back. The arms are then slowly lifted and 
 carried well up over the head. They are held in 
 this position until five can be slowly counted. By 
 
88 
 
 OBSTETRICAL NURSING. 
 
 this movement the ribs are elevated, the chest ex- 
 panded and a vacuum produced in the lungs, into 
 which the air rushes; or, in other words, the move- 
 
 \FlG. 12. 
 
 Sylvester's Method of Resuscitation (Second Movement). 
 
 ment produces " inspiration." The arms are then 
 carried slowly downward, placed by the side and 
 pressed inward against the chest. This forces out 
 the air and produces " expiration." These move- 
 
ACCIDENTS AND EMERGENCIES OF LABOR. 89 
 
 ments should be slow, repeated about fifteen times 
 during each minute, and should be carried on until 
 the breathing becomes regular. Should there be 
 no sign of life, the efforts at resuscitation should not 
 be abandoned for at least two hours after the birth. 
 
 A third method, which, however, requires the^ c e h t ^ e ' s 
 separation of the baby from the afterbirth, is most 
 excellent. It is known as Schultze's method. It 
 would be more apt to be practiced by a physician, 
 because it necessitates the early and quick tying of 
 the cord, and is only of advantage when practiced 
 at once after the delivery. The method is as fol- 
 lows : The child is seized by the shoulders and 
 upper arms and swung head downward above the 
 operator's head. The weight of the lower part of 
 the body is thus thrown upon the chest, and any 
 liquids which may have been drawn into the air 
 passages are thus forced out. Being held thus for a 
 time, while the operator counts five, the body is then 
 brought down in reversed position between the 
 operator's knees. The weight of the lower extremi- 
 ties is thus made to drag upon the chest and enlarge 
 its capacity for the entrance of air. These two 
 movements may be kept up for a considerable time.* 
 
 * The order of these movements as given by Schultze is reversed, 
 the upward movement is practiced first, in the Woman's Hospital, 
 as it is found that the air-passages are thus best cleared of mucus 
 arid discharges before an act of inspiration is encouraged, 
 
9 o 
 
 OBSTETRICAL NURSING. 
 Fig. 13. 
 
 Schultze's Method of Resuscitation (First Movement). 
 
ACCIDENTS AND EMERGENCIES OF LABOR. 9 1 
 
 Fig. 1.4. 
 
 Schultze's Method of Resuscitation (Second Movement). 
 
92 OBSTETRICAL NURSING. 
 
 Warm Alternating with artificial respiration, warm baths 
 
 may be employed from time to time. The tem- 
 
 After-care. per ature of the bath should be ioo° Fahr. After 
 breathing is established, the child should be placed 
 in warm wraps, with bottles of hot water around it. 
 
 Jord g ° f If all is well with the child, it is best not to tie 
 the cord until all pulsation ceases in it. This 
 measure is thought to save the child some loss of 
 blood. As the pulsation may last for an hour or 
 more after the delivery, the afterbirth is generally 
 expelled before the cord is tied. To tie the cord, 
 two pieces of bobbin, each eight inches long, dipped 
 in a bichloride solution 1-4000, or in some other 
 antiseptic solution should be used. The first liga- 
 ture should be placed three inches from the child's 
 abdomen. The string should be carried under- 
 neath the cord. In making the first tie, two twists 
 instead of one should be taken to keep it from slip- 
 ping. If the thumbs are placed upon the string in 
 tying, the ligature can be drawn more tightly, and 
 the grasp of the ends of the bobbin is more secure. 
 The second knot is tied the same way. The ends 
 may then be looped, making a bow-knot. The 
 cord should be stripped, that is, the blood remain- 
 ing in the vessels squeezed out toward the afterbirth, 
 before each ligature is thrown around it. The 
 second ligature is one inch further away from the 
 insertion of the cord into the child's abdomen, 
 
ACCIDENTS AND EMERGENCIES OF LABOR. 93 
 
 After this second ligature is tightened, hold the 
 cord with the forefinger and middle finger at the 
 ligature nearest the child, the thumb and other 
 fingers at the other ligature, and cut it with a pair 
 of dull scissors between these points. The extrem- 
 ities of the scissors are thus made to look toward 
 the palm of the hand, and a sudden movement on 
 the part of the child does not result in the same 
 danger to it, as there would be were the points not 
 thus protected. After the cord is cut, squeeze the 
 remaining blood out from the end next the child. 
 The scissors for this purpose are preferably dull, as 
 the more ragged wound thus produced favors the 
 closure of the blood vessels. This lesson may be 
 learned from nature, the lower animals gnawing off 
 the cord after giving birth to their young, and thus 
 no doubt decreasing the danger of bleeding. Position 
 
 The best position for the mother during the s d t u a r ^ § of third 
 delivery of the afterbirth is on her back, hence, laor ' 
 she may be turned after the nurse has satisfied her- 
 self that the baby is in good condition. 
 
 Very occasionally, on placing her hand over the Twins, 
 abdomen, after the delivery of the child, the nurse 
 may feel another child there. In this case she must 
 simply keep the womb well contracted by rubbing 
 it gently through the abdominal walls, and wait for 
 nature to go on with the work of expulsion. This 
 baby must be cared for as the other. 
 
 The afterbirth generally comes away within ^irbfrtU 
 
94 OBSTETRICAL NURSING. 
 
 twenty minutes after the child's birth. Two or 
 three pains occur, during which the nurse should 
 keep the womb in the middle line of the abdomen 
 and make gentle pressure backward and downward. 
 With her right hand she should seize the afterbirth 
 and membranes and twist them around several 
 times to make a cord of the membranes, so that 
 they may not tear but all be expelled at once. A 
 discharge of blood and some clots generally follows 
 the delivery of the afterbirth. The nurse's left 
 hand should, still be kept carefully over the womb, 
 which should feel hard and firm and should not 
 reach above the navel. If it does not feel firm, rub- 
 bing over the lower part of the abdomen should 
 again be resorted to until the round, hard body is 
 felt. 
 
 If the afterbirth does not come for an hour, and 
 
 the physician has not yet come, send for another 
 
 doctor. 
 
 don o/ ua " After the afterbirth has come, it should be put 
 
 afterbirth j n a c ] ean vessel, and, if detached from the baby, 
 
 put in an adjoining room for the doctor to examine 
 
 when he comes. Insist upon his seeing it, to find 
 
 out whether it is all there. Have the baby removed 
 
 to its crib and placed on its right side and properly 
 
 covered. 
 
 Care after Watch the womb carefully until the doctor comes. 
 
 third stage . 
 
 of labor, if it be firmly contracted, and no more blood be 
 flowing from the vagina, place some dry napkins or 
 
ACCIDENTS AND EMERGENCIES OF LABOR. 95 
 
 a clean sheet under the patient, and wash off the cleansing of 
 
 . . , , ,. . , patient. 
 
 thighs and surrounding parts with warm water con- 
 taining bichloride in the strength of 1-4000, and 
 dry with a soft cloth. 
 
 Slip the soiled clothing from under the patient, clothing. 
 and then apply the binder and dressings, and make Binder and 
 
 dressings. 
 
 her comfortable. 
 
 As soon as the doctor comes, report to him the Report. 
 exact time when the waters broke, when the baby 
 was born and when the afterbirth came. It is 
 always best for a nurse to keep a written report 
 with a statement of what she did. She should not, 
 however, neglect her patient for the purpose of per- 
 fecting her report. 
 
 Sometimes a nurse has the misfortune to bef^ry. 
 the only attendant at a breech delivery, that is, 
 instead of the child's head coming first, the 
 breech passes out from the birth-canal. Delivery 
 in this manner is very dangerous to the life of 
 the child. The nurse should do absolutely nothing 
 here, as she would only make matters worse in 
 trying to assist. These deliveries are long enough, 
 as a rule to give ample time for the summoning 
 of some doctor to take charge of the case. In all 
 breech cases the child is apt to need to be resus- 
 citated, if it is alive at all ; hence plenty of warm 
 water, etc., should be ready for the bath. 
 
 Flooding from the womb, or " uterine hemor- Sage°. r " 
 
96 OBSTETRICAL NURSING. 
 
 rhage," is apt to occur either within the first twenty- 
 four to forty-eight hours after the birth, when it is 
 called "primary hemorrhage;" or, it may occur 
 some days after, when it is " secondary hemor- 
 rhage." The appearance of blood, either a constant 
 oozing or a sudden gush from the vagina, is, of 
 course, the earliest symptom. 
 
 A pulse of over 100 in a patient freshly confined 
 should make the nurse exceedingly watchful in this 
 respect, as it betokens a liability to hemorrhage. 
 Should the flow continue, the patient becomes pale, 
 faint, restless, gasps for breath, and finally dies, 
 unless the hemorrhage is checked. A nurse should, 
 of course, have the physician sent for at once, 
 although he may have just left the house, or 
 another doctor should be summoned. In the mean- 
 time, her first thought should be of the uterus and 
 its probable condition of relaxation. The bandage, 
 if applied, should be hastily removed and the hand 
 placed over the lower part of the abdomen. If the 
 womb is not felt, rub vigorously until it contracts and 
 is felt again as a round, hard body. Keep on rubbing 
 and holding. The nurse never should take her 
 hand off the abdomen until the doctor comes. 
 Direct some one else to take the pillows from under 
 the patient's head, have the foot of the bed elevated, 
 to keep the blood in the head and prevent fainting, 
 which induces heart-clot. Have the foot of the bed 
 
ACCIDENTS AND EMERGENCIES OF LABOR. 
 
 97 
 
 placed on the seats of chairs. The patient may be 
 fanned, cold water given her to drink, hartshorn 
 to smell. She should not be allowed even to turn 
 in bed or lift her head. If the doctor has left ergot, 
 one teaspoonful of the fluid extract may be given 
 in a tablespoonful of water. The patient should 
 
 Fig. 15. 
 
 Position of Patient in Hemorrhage after Labor. 
 
 receive this without lifting her head. Plenty of hot 
 water should be on hand, the water in the tea- 
 kettle boiling. If the physician delays his coming, 
 and the flow continues, repeated hot-water injec- 
 tions of about Ii5°-i20° should be given into the 
 
 vagina. 
 
 7 
 
98 OBSTETRICAL NURSING. 
 
 Convulsions. Convulsions may come on during the labor as 
 during the pregnancy. Their management would 
 be the same as that suggested for convulsions 
 during pregnancy. 
 
 u tems. re Other accidents, such as rupture of the uterus, 
 
 Prolapses, or the coming down of an arm or hand, or the 
 navel-string in advance of the usual part to come 
 first, are conditions in which the nurse can do 
 nothing, except to keep the patient as quiet as she 
 can, and meddle as little as possible until the doctor 
 comes, for whom, of course, she must at once send. 
 
 Demeanor At no time, in the management of a case, should 
 
 01 nuise. ° 
 
 a nurse express surprise or consternation, nor 
 should her manner indicate that she has such feel- 
 ings. Like a true soldier, she must bravely and 
 quietly face the most critical situations and meet 
 their demands. She should by her manner give 
 the mother to feel that all life's vicissitudes are best 
 met by a quiet self-control 
 Liability to Fortunately, deaths during delivery in this en- 
 
 accidents J 7 Q J 
 
 i d a U bo? g lightened age are few ; for the methods of averting 
 accidents at such times have been so thoroughly 
 studied that accidents themselves are very rare. 
 
 Prepara- As operative procedures during the course of a 
 
 tions for x l ° 
 
 obstetrical delivery may have to be resorted to very suddenly 
 
 operations. J J J J 
 
 and unexpectedly, a nurse should have things in 
 readiness should the emergency arise. The especial 
 preparations necessary will consist in the making 
 
ACCIDENTS AND EMERGENCIES OF LABOR. 99 
 
 of a cone of stiff paper, into which a towel is fitted, 
 for the purpose of giving the patient ether ; arrange- 
 ments for an abundant supply of hot water, to be 
 had at a moment's notice ; facilities for making up 
 antiseptic solutions quickly; a small pitcher con- 
 taining a warm 2 per cent, creoline solution for the 
 physician's instruments ; some kind of grease, as 
 carbolized cosmoline for lubricating these instru- 
 ments when desired ; English rubber catheter and 
 urinal conveniently at hand ; a basin with a 2 per 
 cent, creoline solution for needles, sutures, and 
 scissors ; absorbent cotton in small pads, or soft 
 linen rags dipped in an antiseptic solution, to be 
 used instead of sponges ; sufficient protection for 
 the floor at the side of the bed ; and preparations 
 for resuscitation of the infant. 
 
 The position of the patient for most obstetric 
 operations will be across the bed, with her hips well 
 over the edge. This is called a " cross-bed." Physi- f 
 
 & J "cross-bed. 
 
 cian's generally call simply for a cross-bed, in desir- 
 ing the nurse to make preparations for an opera- 
 tion, and she should understand that this refers to 
 the arrangement of protectives and sheets, adjust- 
 ment of pillow, and placing of patient in proper 
 position. Should there not be a sufficient number 
 of persons to have one hold each leg, chairs should 
 be placed in such a way at the side of the bed as to 
 support the widely-separated feet. A chair for the 
 physician should be placed between these, facing 
 
IOO OBSTETRICAL NURSING. 
 
 the bed. As there is usually some assistant to 
 give the ether, the nurse will need to help in keep- 
 ing the limbs apart and in giving the physician any 
 other aid she can in the supply of the various 
 articles as they are needed. Should the physician 
 desire her to give the ether, her whole attention 
 should be devoted to administering the anaesthetic, 
 and seeing that the patient keeps in good condition. 
 Strict watch should be kept over the respirations 
 and the pulse. Difficult breathing, or a stoppage 
 in the respirations, weakness or irregularity of the 
 pulse, blueness of the face and lips, should at once 
 be called to the physician's notice ; the ether cone 
 being removed from the patient's face. After the 
 patient is once well under ether, it takes but little 
 to keep up the anaesthesia, so that a nurse should 
 use the ether sparingly ; a few drops every few 
 minutes upon the towel are, as a rule, sufficient. 
 After etherization the patient may vomit, and there 
 will be greater tendency to bleeding because of the 
 relaxation induced by the anaesthesia, hence the 
 nurse should exercise special watchfulness and care 
 over the patient. The vomiting is often relieved 
 by a mustard paste over the stomach, while the 
 bleeding may be controlled by the hand placed 
 over the lower part of the abdomen, which, by 
 making pressure over the womb, insures good con- 
 tractions. After the nausea is relieved,, ergot, if 
 prescribed by the physician, may be given. 
 
CHAPTER VIII. 
 CARE OF THE NEW-BORN INFANT. 
 
 The mother being made comfortable after her 
 delivery, the nurse should turn her attention to the 
 infant. 
 
 Everything needed for the baby's first toilet 
 should be collected and placed conveniently at hand, 
 near the register, stove, or open fire-place. 
 
 The nurse should put on a flannel apron, or pin p r e P ara- 
 
 .. , , , n ^ • 11 ^ on f° r tne 
 
 a crib-blanket or nannel petticoat over her lap. first bath. 
 The best bath-apron is one consisting of two pieces 
 of flannel fastened to the same waistband. The 
 lower piece is the one on which the baby lies ; the 
 upper serves as a covering. A pitcher of warm 
 water and one of cold must be provided, the baby's 
 bath-tub being placed near them, the baby-basket, 
 suit of aired clothing and jar of rendered lard or oil 
 within reach. The nurse should pick the baby up 
 with its wraps and place it in her lap as she seats 
 herself on a low chair or stool near the fireplace. 
 
 The baby will be found to be covered over por- 
 tions of its body by a white, greasy substance called 
 " vernix caseosa," or " cheesy varnish." This sub- 
 stance is found in greatest quantity on portions of 
 
 IOI 
 
 Vernix 
 caseosa. 
 
102 OBSTETRICAL NURSING. 
 
 the body subjected to friction while in the womb, 
 hence it serves to protect the child's skin. 
 
 its removal. Some kind of grease is needed for its removal. 
 Rendered lard and oil are the best. Cosmoline is 
 not so good, as it is stiffer than the other two — not so 
 soluble a fat. All this cheesy substance must come 
 away with the first washing, as, if left, it irritates 
 the skin and produces sores. The most difficult 
 parts of the body to cleanse are the folds or creases. 
 The nurse should take a piece of lard about the 
 size of a walnut, rub it over the palms of both her 
 hands, and then, taking the child's head between 
 her hands, rub the grease thoroughly in, giving 
 especial attention to the ears. A second piece of 
 lard, of the same size, will be needed for the neck, 
 shoulders, arms, chest and back ; a third piece for 
 the groin, external generative organs, and lower 
 limbs. The creases and folds about the generative 
 organs, especially of a little girl baby, need very 
 careful cleansing. When the baby has been thus 
 thoroughly gone over, she should take the corner 
 of a dry sheet and rub off the grease. Many phy- 
 sicians prefer not having the baby bathed after this 
 greasing. It may then be dressed and laid in its 
 crib. 
 
 The bath. Should the bath be preferred, the nurse should wrap 
 the baby up in her flannel apron, draw the bath-tub 
 toward her and prepare the bath, filling the bath- 
 
CARE OF THE NEW-BORN INFANT. IO3 
 
 tub about one-third full of warm water at a tem- 
 perature of ioo° F., tested by the thermometer. A 
 wall-thermometer, costing fifteen cents, may be ob- 
 tained at any drug-store for the purpose. The 
 baby is then placed in the tub, its entire body, 
 excepting its head, being immersed for a moment 
 or two beneath the water. The nurse should keep 
 the baby from slipping from her grasp by allowing 
 its head to rest against her left wrist and hand, while 
 the fingers of the same hand obtain a secure grasp 
 under the child's left arm-pit. After the dip, the 
 child is lifted out on to the nurse's lap again, where 
 a soft, warm towel should have been spread for its 
 reception. In this it should be wrapped and thor- 
 oughly dried. Great care must be taken to see 
 that the arm-pits, groins and other parts of the body 
 where creases exist are entirely free from moisture. 
 After the first bath, the child receives, as a rule, but 
 a sponge-bath daily until the cord drops, whenthe 
 daily plunge-bath may be given. The baby should 
 always be thoroughly washed with simple warm 
 water over the parts of the body soiled, every time 
 the napkin needs to be changed. Soap does not need 
 to be used. Its frequent use would irritate the skin, 
 and the parts can be perfectly cleansed without it. Powder. 
 
 The use of powder in the folds and creases of the 
 body is not essential. The main object is to keep 
 rubbing surfaces dry, and should the nurse properly 
 
104 OBSTETRICAL NURSING. 
 
 attend to this duty after the bath, this, with the use 
 of flannel next the baby's skin, ought to be suf- 
 ficient to effect the purpose. Should a powder" be 
 desired, some very fine, unirritating powder such 
 as lycopodium, might be used. Many of the 
 scented powders contain substances which are 
 irritating to the skin. 
 theTavfi. After the baby has been dried, the stump of the 
 cord or navel-string should be attended to. Make 
 a loop of the stump, doubling it back upon itself, 
 and tying it tightly by means of the ends of the 
 bobbin left from the first ligature. Slit up a square 
 of soft linen to its centre. It is well to have ren- 
 dered this antiseptic by dipping in a bichloride solu- 
 tion i-i ooo or 2000 before drying. Putthis around 
 the cord which is slipped through the slit (the slit 
 looks upward toward the child's head), fold over 
 the ends, and turn the whole upon the left side. 
 Sotne physicians will direct that no dressing be 
 placed around the cord. In fact, sometimes there 
 is no ligature placed around it, but it is simply 
 well stripped of the blood and jelly-like substance 
 which help to compose it, and thus allowed to dry. 
 The placing of the loop or cord with its dress- 
 ings on the left side of the child's body is to avoid 
 pressure upon the liver, which is larger than any 
 other organ in the infant's body at birth, so large, 
 in fact, as to extend quite down to the navel. The 
 
CARE OF THE NEW-BORN INFANT. 105 
 
 abdominal bandage is put on over the dressing to 
 hold the latter in place. 
 
 Some use antiseptic gauze in the dressing of the 
 cord. A drying powder, consisting of one part sali- 
 cylic acid and five parts starch, is an antiseptic appli- 
 cation which it is often desirable to employ. 
 
 A clear substance exudes from the cord as it Wharton's 
 
 jelly. 
 
 shrinks which wets the dressings, so that it is neces- 
 sary to change the piece of linen quite often the 
 first day or two. A cord kept dry by the frequent 
 change of dressings will have no odor about it, and 
 will drop, on an average, by the fifth day. The 
 base from which the cord dropped may continue 
 moist for a few days, and is best dressed by dusting 
 over it a little of the starch and salicylic acid pow- 
 der before spoken of, and placing a small compress 
 of antiseptic linen or gauze over it. The navel-dress- The binder, 
 ing is kept in place by the application of the flannel 
 binder, which should be carefully adjusted, so as not 
 to compress the abdomen too tightly. After the 
 bandage is fastened, the nurse's hand, used flatwise, 
 should be easily slipped in between the bandage 
 and the baby's skin. Should safety-pins be used in 
 fastening the bandage, they should be placed in front 
 and not at the back, or they may cause the baby 
 discomfort in lying. The bandage fastened by the 
 tapes, which is simply wound around the body, is 
 safer on this account. 
 
Io6 OBSTETRICAL NURSING. 
 
 Great importance should be given to the proper 
 care of the navel, as it offers an open surface on the 
 child's body through which poisonous matter may 
 be taken into the blood, causing " infantile sepsis," 
 or the blood-poisoning of infants. 
 The napkin. Before the dressing of the cord, a napkin should 
 have been laid beneath the hips of the infant, as 
 there is very apt to be a free discharge of a dark, 
 greenish matter from the bowels shortly after the 
 
 " Meco- ... . 
 
 nium." birth. This is known as " meconium." It should 
 always come away within the first twenty-four hours 
 after birth, and may continue to come at intervals 
 for three or four days. When it does not come 
 away freely, the baby may suffer considerable pain. 
 A soap suppository or a small injection of warm 
 water will bring about relief, causing an evacuation 
 of the bowels. 
 
 This substance is very difficult to wash out of 
 
 napkins, hence, it is a good plan to have a soft piece 
 
 of old muslin placed inside the napkin to catch the 
 
 discharge. This may be burned when removed. 
 
 importance The baby should be washed every time the nap- 
 
 of careful J J r 
 
 washing ki n needs to be changed, even if it is only wet. 
 
 and care in ° * 
 
 use of Warm water should be used. A napkin should 
 
 napkins. L 
 
 never be used twice without washing. The habit 
 of hanging up a napkin wet with urine, allowing it 
 to dry and using it again is not only filthy, but un- 
 safe, as it renders the napkin irritating to the skin 
 
CARE OF THE NEW-BORN INFANT. IO7 
 
 and a source of possible septic infection. For the 
 same reason a napkin should be changed as soon 
 as it is wet or soiled. Though the work may be 
 irksome, a nurse should not weary of it ; for it is 
 only by eternal vigilance that children can be kept 
 in good condition. 
 
 After the application of the binder and napkin, under-vest. 
 the baby's under-vest or little, long-sleeved, high- 
 necked flannel shirt should be put on. This should 
 be fastened in front by safety-pins, or small, flat 
 buttons or tapes. 
 
 If the shirt is too large, folds should be made at 
 the sides to make it fit better ; never in the back, 
 because of the ridge this would produce under the 
 surface upon which the baby lies. 
 
 The socks come next and then the flannel slip, Socks and 
 constituting the only other garment the baby needs. 
 The petticoat with slip, or Gertrude suit, may be 
 used instead, if desired. 
 
 The eyes and mouth should each be washed out washing of 
 
 eyes and 
 
 with a separate soft piece of linen dipped in warm mouth. 
 water. 
 
 The baby's hair, if it has any, may be brushed Brushing 
 with a soft baby-brush. No comb should be used, 
 as the scalp is too tender. 
 
 The baby should then be placed in its crib, on its 
 right side, and warmly covered. The weaker the 
 baby is, the warmer it will need to be kept. Stone 
 
io8 
 
 OBSTETRICAL NURSING. 
 
 Weighing 
 the baby. 
 
 jars, when filled with hot water, are nice for this 
 purpose placed around the child, but care should 
 be exercised not to let these bottles be placed so 
 near as to cause a burn. 
 
 In another chapter we will consider the care of 
 premature infants. 
 
 The weighing of the baby devolves often upon 
 the nurse. A steelyard being provided, the nurse 
 may place the nude child in a napkin, tied or pinned 
 securely at the corners. This napkin may be swung 
 on to the hook of the steelyard as it is held up. The 
 pointer will then indicate the number of pounds 
 weight. The average weight of a new-born baby 
 is 3250 grammes (about seven pounds). 
 
 In the Woman's Hospital the ordinary grocer's 
 pan-scales are used, the weights being represented 
 in grammes. The daily weight is taken and recorded 
 on a card which hangs by a ribbon or string to 
 the baby's crib, so that its daily condition may be 
 carefully watched. For a comparison of the approx- 
 imate weights in the metric and avoirdupois scales, 
 I append the following table of equivalents : — 
 
 Relation of Avoirdupois to Metric Weights. 
 
 AVOIRDUPOIS 
 POUNDS. 
 
 GRAMMES. 
 
 I 453-592 
 
 2 907.I8 
 
 3 1360.78 
 
 4 i8i4-37 
 
 5 ....... . 2267.96 
 
 AVOIRDUPOIS 
 POUNDS. 
 
 GRAMMES. 
 
 6 ....... . 2721.55 
 
 7 3175.14 
 
 8 3628.74 
 
 9 • • 4082.33 
 
 10 4535-92 
 
CARE OF THE NEW-BORN INFANT. I09 
 
 For the first three or four days a baby will lose Loss of 
 
 . , , ... •• .-, weight for 
 
 weight, as it does not take in enough nourishment first few 
 to make up for the loss it sustains by the newly- 
 acquired activity of bowels, bladder and skin. At 
 the end of the first week the baby should weigh 
 about what it did at the birth. After that it should 
 gain, on an average, thirty grammes a day (about 
 one ounce). 
 
 A sponge-bath is sometimes given the baby at The 
 
 evening 
 
 the close of the day, when its clothing is changed bath, 
 for the night ; but this is not necessary, if it has 
 been properly attended to when the napkins have 
 been changed. The fresh clothing at night is 
 always essential. 
 
 The baby's crib should have no rockers. All The crib, 
 unnecessary swinging, rocking or jolting of babies 
 only serves to make them nervous and more trouble- 
 some to take care of. A convenient and inexpen- combined 
 sive crib and bath-tub combined, especially for and crib. 
 traveling, is described in one of the numbers of 
 " Babyhood," thus : " The frame is made some- 
 thing like a cot-bed. Straight pine sticks may be 
 used. The legs, one inch and a half square by 
 thirty inches long, are crossed and pivoted in the 
 middle on a centre bar. The side bars, one inch 
 by two inches and thirty-six inches long, are 
 securely fastened to the top of the legs. Smaller 
 bars join the legs near the bottom to stiffen the 
 
IIO 
 
 OBSTETRICAL NURSING. 
 
 frame. A piece of heavy rubber-cloth, one yard 
 and a quarter long and thirty inches wide, has an 
 inch-wide hem on each end for a casing, and is 
 drawn up to eighteen or nineteen inches with heavy 
 braid (a leather strap would probably be better). 
 This makes the ends of the tub. Along the side 
 bars of the frame are tacked, with brass-headed 
 
 Fig. 16. 
 
 Home-made Bath-tub and Crib. 
 
 tacks, the sides of the cloth, the braid (or rubber 
 straps) being securely fastened to the ends. A 
 small plait in the cloth at each corner, about an 
 inch from the end, gives a fuller shape to hold the 
 water (when it is in use as a bath-tub). The tub 
 (or crib), when not in use, can be folded and set 
 away out of sight, or it may be carried in the bottom 
 of a large traveling-trunk when on a journey. The 
 
CARE OF THE NEW-BORN INFANT. Ill 
 
 frame may be made of walnut or cherry, with turned 
 legs, etc., if so desired. A pillow put in the tub 
 makes a comfortable and portable crib for the baby." 
 
 Children should never sleep in the same bed Separate 
 
 x bed from 
 
 with their mothers. It is unsafe because there is mother. 
 danger of their being overlaid, and it is unhealthy 
 because of the discharges, breath, etc., of the 
 mother. 
 
 A baby may be trained to be contented and Proper 
 
 training of 
 
 happy as it lies in its crib. If from its earliest infants. 
 days it is taken up simply to be fed, and receive the 
 necessary attentions for keeping it clean and com- 
 fortable, it wjll not become the little tyrant a child 
 develops into when foolishly spoiled by its mother. 
 
 Babies should be fed but once in two hours Feedingof 
 during the day, and every three hours during the infants ' 
 night, unless premature, when they can take less Time, 
 and should be fed every hour. An interval is neces- 
 sary between the feedings, in order that the stomach 
 may rest and be prepared properly to carry on its 
 work of digestion. Hence, the habit some mothers 
 have of letting babies nurse whenever they cry, 
 simply serves to produce indigestion, as well as to 
 spoil the child.* 
 
 * It has been observed that when the periods between nursing were 
 short, the milk was more condensed, a fact which throws light on 
 the dyspeptic phenomena occurring in babies who are fed too often. 
 —RotcH. 
 
112 OBSTETRICAL NURSING. 
 
 First For its first nursing the baby may be put to the 
 
 breast an hour or two after the labor, if the mother 
 is sufficiently rested. The nipples should, before 
 each nursing, be carefully washed off with cold 
 water. The early secretion of the breasts, known 
 as " colostrum," helps to rid the baby's bowels of 
 their dark, tarry contents, as it is laxative. It is 
 important that the breasts should be used alter- 
 nately in feeding the infant, as this allows a longer 
 time to elapse for the accumulation of milk. For 
 the first day or two the baby needs comparatively 
 little food. Should it seem to be hungry, however, 
 and the mother unable to satisfy it, a teaspoonful or 
 two of warm water or diluted peptonized cow's milk, 
 prepared according to the suggestions to be given 
 later, may be administered at regular intervals. 
 
 Before and after each feeding, the baby's mouth 
 should be carefully washed out with a piece of soft 
 linen dipped in warm water. This is to prevent the 
 particles of milk remaining in the mouth from pro- 
 ducing soreness by souring. 
 
 a drink of Two or three times daily a baby should be given 
 
 cold water. - . . 
 
 a teaspoonful of cool water to drink, as babies suffer 
 from thirst just as their elders do. The cold water 
 assists, also, in keeping the bowels from becoming 
 constipated, 
 insufficient Should the mother not have sufficient milk for 
 her baby, it may have the bottle every other time, 
 
CARE OF THE NEW-BORN INFANT. II3 
 
 the additional food being selected with reference to 
 the child's age and powers of digestion. 
 
 When a mother has no milk, the best substitute The 
 is a good wet-nurse. A wet-nurse should always w 
 be carefully examined by a physician, that her free- 
 dom from disease may be fully determined before 
 she is employed. She should be between twenty 
 and thirty years of age, and have good, not neces- 
 sarily large, breasts, well-shaped nipples, and an 
 abundant supply of milk. The condition of her 
 own child should be considered, whether it be 
 thriving or sickly, and especially whether there be 
 any evidence of special disease. It is well, too, to 
 try to get a woman who has had more than the one 
 child, as a woman who has borne several children 
 has, by experience, learned to understand and man- 
 age babies. 
 
 The first milk that comes in the breast, and which Fore-miik. 
 appears in any quantity, about the eighth month of 
 pregnancy, is called " fore-milk," or " colostrum," 
 from a word which means " glue." It is turbid, 
 yellowish, gluey, alkaline in reaction, and easily 
 sours. It differs from true milk in having a higher 
 specific gravity, or weight ; it also contains more 
 salts and more albumen, and is more difficult to 
 digest. It is laxative in its effect upon the baby's 
 bowels. Physicians not unfrequently examine a Prognosis 
 
 r . , for nursing;. 
 
 specimen of this secretion under the microscope, to 
 8 
 
114 OBSTETRICAL NURSING. 
 
 learn what the prospect is as to the mother's nurs- 
 ing the child. If, in the last two months of preg- 
 nancy, the colostrum is scanty, and, under the micro- 
 scope, there are but few oil globules, the patient will 
 probably have poor milk and small in quantity. If 
 the colostrum is abundant, but thin like gum-water, 
 not gluey, and without yellowish streaks, it is prob- 
 able that the milk will be watery and not nourish- 
 ing. It may be either scanty or abundant. If the 
 colostrum be plenty, with yellowish streaks and full 
 of milk globules, the milk will be abundant and 
 Duration of pro od in quality. The secretion of colostrum may 
 
 secretion. ° x J J 
 
 continue from six to eight days. If it continues 
 
 longer, it is a great disadvantage, and the mother 
 
 may have to give up nursing because of the child's 
 
 inability to digest the nourishment thus afforded. 
 
 i^tics a of ter " Human milk should have a specific gravity of 
 
 niiik? n 1028-1034. It is slightly alkaline in reaction; that 
 
 is, it will turn red litmus-paper blue, and it contains 
 
 the following ingredients : — * 
 
 Water, 87-88. 
 
 Total Solids, 12-13. 
 
 Fat, 3-4. 
 
 Albuminoids, 1-2. 
 
 Sugar, 7-0. 
 
 Ash, . . o- 2. 
 
 {Rotch.) 
 
 * In a series of analyses made by Drs. Leffmann and Beam, the 
 percentage of fat rarely reached 4, ranging between 2.5 and 3 as a 
 rule, while the albuminoids were usually a fraction over 1 per cent. 
 
CARE OF THE NEW-BORN INFANT. I 1 5 
 
 It differs from cow's milk in having a higher spe- between e 
 
 . 1-11 1 r r 1 human and 
 
 cific gravity, more solids, less water, and one-fifth cow's milk, 
 the amount of albuminoids. The milk retained Regulation 
 
 of nursing 
 
 longest in the breast — the first milk drawn by the tom eet 
 
 J special 
 
 baby at each nursing — is the thinnest ; the last, the demands - 
 richest. When, therefore, a baby seems to suffer 
 from indigestion because of its mother's milk being 
 too rich for it, it should take the first secretion from 
 each breast at each nursing instead of drawing all 
 the milk from one breast. One or two teaspoonfuls 
 of water given the baby before each nursing have 
 the same object. Should it, on the contrary, not 
 seem to thrive because of the food not being suffi- 
 ciently rich, the thin milk should be pumped or 
 drawn out of each breast by the nurse or mother 
 before the baby is allowed to draw. The two breasts 
 are estimated to contain about two ounces of milk 
 at one time.* 
 
 The question of how to increase the secretion of s ti mulation 
 
 x ofincreased 
 
 milk is a very important one. The best way is by secretion - 
 a judicious regulation of the mother's or wet- 
 nurse's diet. There are no medicines which are 
 entirely satisfactory for the purpose of stimulating 
 the secretion. Therefore a nurse can do more than 
 
 *The use of from 1-5 drops of cod- liver-oil — according to the age 
 of the child — given three times daily, has been found to be a valuable 
 supplement to the food when a mother's milk lacks richness. — [Dr. 
 A. E. Broomall.) 
 
n6 
 
 OBSTETRICAL NURSING. 
 
 Testing 
 milk. 
 
 The lacto- 
 meter. 
 
 Fig. 
 
 a doctor in this line by careful feeding of her pa- 
 tient. A mixed diet is the best for making milk. 
 Beer and all kinds of liquors, as porter, etc., do 
 more to fatten the mother or nurse than to make 
 milk ; therefore they are to be avoided. The spe- 
 cial diet for a nursing woman is laid down in 
 another chapter. Good human milk should be 
 three per cent, fat.* 
 
 To determine the character of milk — human or 
 cow's milk — an instrument known 
 as the lactometer, or milk-tester, 
 may be used, aided by the micro- 
 scope. 
 
 The lactometer consists of a 
 cylindrical glass vessel or beaker, 
 which should contain the milk 
 to be tested, and a specific gravity 
 glass, which is to be floated in the 
 liquid. This glass is graduated 
 and marked at certain points with 
 certain letters and figures. Thus, 
 W., P. and F. The W. stands 
 
 CL 
 
 Lactometer. 
 
 ~y for " water,' 
 F. for " fat." 
 
 P. for "pure," and 
 Between the W. and 
 
 *Asa general rule, the amount of fat may be increased by increas- 
 ing the amount of meat in the diet, and the amount of albumin 
 decreased by moderate exercise. Too little fat and too much casein 
 make poor milk. — Rotch. 
 
CARE OF THE NEW-BORN INFANT. \\J 
 
 P., at different points, are the fractions, j{, y 2i ^. 
 Should the weighted glass sink in the liquid so that 
 the surface of the liquid reached the mark W., the 
 liquid tested would have the same specific gravity 
 as water. Should the surface of the liquid reach 
 the mark y, if it is milk that is tested, it would be 
 Y^ milk and y water. If the mark y 2 is touched, 
 it is y 2 water and y 2 milk. In this way the 
 adulteration of the milk with water is detected. 
 Should the level of the liquid stand at P., we 
 would have pure milk. Pure cream would raise 
 the weighted glass so that the level of the liquid 
 would stand at F. An ordinary urinometer may 
 be used to obtain the specific gravity of milk in a 
 similar way. Dr. Louis Starr suggests a good Determina- 
 
 t . . tion of 
 
 way to discover the proportion of cream in any proportion 
 
 r • r of cream. 
 
 given sample of milk : A narrow piece of paper, 
 four inches long, is divided in its upper half inch 
 by cross-markings into twelve equal parts. This 
 paper is then pasted on the beaker of the lacto- 
 meter with the marked portion uppermost, the 
 lower edge touching the bottom of the beaker. 
 Enough milk is then poured in to come just to 
 the top of the paper, and the whole set aside for 
 twenty-four hours. The cream rises and appears 
 as a yellow layer at the top. This layer should 
 have the depth of ten or twelve spaces, as marked 
 on the paper. 
 
n8 
 
 OBSTETRICAL NURSING. 
 
 Micro- 
 scopic ex- 
 amination 
 of milk. 
 
 Effect of 
 menstrua- 
 tion on 
 secretion. 
 
 Effect of 
 pregnancy 
 on 
 lactation. 
 
 Artificial 
 feeding. 
 
 Character- 
 istics of 
 cow's milk. 
 
 On examination under the microscope, if there 
 are but few oil globules in a specimen of milk, and 
 if these oil globules be small, the milk is poor. On 
 the other hand, if the oil globules in milk are too 
 large, this becomes a cause for its indigestibility. 
 
 Should menstruation begin with a nursing 
 mother, the milk may be so affected as to disagree 
 with the child. Ordinarily, the menstrual flow 
 does not recur until the eighth month after delivery. 
 The appearance of the flow need not lead to a ces- 
 sation of nursing, unless the milk should seem to 
 disagree with the child. The character and quantity 
 of the milk is impaired by deep or violent emo- 
 tions ; thus, anxiety, fear, anger, etc., will greatly 
 detract from a woman's ability to be a good wet 
 nurse. Pregnancy always deteriorates the character 
 of milk, and is an indication for weaning a nursing 
 child. 
 
 When the mother's milk utterly fails, and a wet- 
 nurse cannot be had, hand-feeding becomes neces- 
 sary. For this purpose diluted, sterilized cow's 
 milk may be used. 
 
 Cow's milk has a specific gravity of 1029. The 
 milk obtained from stall-fed cows gives an acid re- 
 action ; that from pasture-fed cows a less acid reac- 
 tion. Could the latter be obtained directly from 
 the cow, its reaction would be slightly alkaline, as 
 with human milk. An analysis of the same quan- 
 
CARE OF THE NEW-BORN INFANT. 
 
 Ii 9 
 
 tity of woman's milk and cow's milk is reported as Analysis of 
 
 human and 
 cow's milk. 
 
 yielding the following results : — 
 
 Water, .... 
 
 Total solids, 
 Fat, 
 
 WOMAN S MILK. 
 
 . . 87.88 parts. 
 . . 12.13 " 
 . 4.00 " 
 
 Albuminoids, . 
 Milk-sugar, . . . 
 Ash, 
 
 . 1.00 " 
 . 7.00 " 
 . 0.2 " 
 
 Bacteria, . . . . 
 
 The woman's i 
 
 . not present, 
 nilk for this 
 
 COW S MILK. 
 
 86.87 parts. 
 
 13.14 " 
 
 4.00 " 
 
 4.00 " 
 
 4-5 " 
 
 0.7 " 
 
 present. 
 
 directly from the breast. The cow's milk was, as 
 it is ordinarily obtained in cities, about twenty- 
 four hours old. 
 
 By an examination of this analysis, it will be seen points of 
 that the proportion of coagulable substances of 
 cow's milk is much greater than in human milk. 
 This is where the difficulty in its digestion lies. 
 Casein of human milk coagulates in light curds; in 
 cow's milk in firm, hard curds. 
 
 The kind of food required by different babies Quality 
 
 •11 ••ii' • a i of food 
 
 will vary with their constitutions. As a rule, a required 
 mother's milk is the best food for her child, and 
 makes a good gauge to start from in the preparation 
 of an artificial food to take its place or act as a 
 supplement when there is an insufficient supply. 
 
 If, therefore, a careful analysis is made of a 
 mother's milk and a mixture prepared which shall, 
 so far as possible, contain the same constituents in 
 
120 OBSTETRICAL NURSING. 
 
 the same proportion, we may hope that the baby 
 will thrive on it. A steady increase in the baby's 
 weight will be the best index by which we can judge 
 of the nutritive qualities of the food it is taking. 
 
 For the first four or five months of its life, a 
 child should gain on an average 20 to 30 grammes 
 (about one ounce) daily. For the remainder of 
 the first year of life, a daily gain of from 10 to 15 
 grammes will mark satisfactory progress. 
 Necessity j n ^ Q comparatively few cases in which a 
 analysis. mother's milk does not appear to have proper 
 nutritive or digestive properties, it should be 
 similarly examined, to discover in what direction 
 the deficiency lies, and the artificial food should be 
 prepared so as to supply the lack. 
 
 The nutritive constituents of milk are the albu- 
 minoids, fat and milk-sugar. 
 Preparation Cow's milk contains about four times the quantity 
 
 01 cow s t. y 
 
 milk. Q f albuminoids found in human milk, so that it 
 
 requires to be diluted with four times as much 
 water, to represent the same percentage of albu- 
 minoids. 
 
 Since the amount of fat in human milk and cow's 
 milk is about equal, this dilution would greatly 
 decrease the percentage of fat. Also, since cow's 
 milk contains a much smaller quantity of sugar of 
 milk than is found in human milk, the same dilution 
 would be greatly deficient in sugar. 
 
cream. 
 
 CARE OF THE NEW-BORN INFANT. 121 
 
 In preparing a mixture from cow's milk, there- 
 fore, which may correctly represent human milk, 
 fat, in the form of cream, and sugar of milk must 
 be added. 
 
 Cream varies very much in richness, hence it is Quality of 
 desirable to know about what percentage of fat is 
 represented by the cream used in compounding a 
 mixture. A chemical analysis of the cream is nec- 
 essary for accuracy of result in such determination. 
 It has been suggested that to prevent too much 
 variation in the percentage of fat, the cream should 
 be obtained of the same dairy, from milk that has 
 been allowed to stand each day for the same length 
 of time and in the same temperature. 
 
 A mixture made up according to the following 
 rule, probably most nearly resembles the average 
 human milk : — 
 
 To make one pint of the mixture for use in 24 cream 
 hours, take milk and cream (20 per cent.) as soon 
 as it comes in the morning, and mix as follows : — 
 
 Milk, f g ij. 
 
 Cream, . f^iij. 
 
 Water, fgx. 
 
 Milk Sugar, Z 6 K- 
 
 Put in a flask in the steamer and steam for twenty 
 minutes ; then remove the flask from the steamer, 
 and when still slightly warm add lime-water, fSj. 
 
 mixture. 
 
122 OBSTETRICAL NURSING. 
 
 Place on ice, and give the proper amount at the 
 proper feeding time. — (RotcJi). 
 
 The object in steaming the mixture is to sterilize 
 it, for human milk is sterile, and for that reason 
 more digestible than cows' milk, which, although 
 sterile while in the udder, becomes contaminated 
 as it is placed in vessels and transferred from place 
 to place. 
 
 It is believed by some that this steaming or boil- 
 ing of milk has a tendency to decrease its digesti- 
 bility. The danger from this source, however, is 
 probably much less than that which would arise 
 from the presence of germs in the milk, such as 
 have been shown to exist. 
 
 Lime water is added to make the mixture alka- 
 line — all human milk being slightly alkaline. It 
 should not be placed in the flask before boiling or 
 steaming, because experimentation has shown that 
 the lime undergoes some changes in the process of 
 boiling which causes a discoloration of the milk 
 and the deposit of a sediment. Experiment has 
 shown that water is the most efficient diluent to be 
 employed in making these mixtures, as it gives a 
 much finer curd with acids when so used than can 
 be obtained by an admixture with barley-water or 
 any of the prepared foods. 
 
 Having thus determined by analysis the quality 
 
CARE OF THE NEW-BORN INFANT. 
 
 123 
 
 of the food required for an infant, the quantity must 
 be determined and frequency of feeding. 
 
 As to quantity the observations made by Dr. Quantity of 
 Snitkin, of St. Petersburg, have led to the forma- 
 tion of a rule by which one one-hundredth of the 
 baby's weight should be taken as the figure with 
 which to begin the computation, and to this should 
 be added one gramme for each day of life. 
 
 A table prepared by Dr. Rotch, of Boston, has 
 arranged in very convenient form the quantity and 
 intervals of feeding for the first year of a child's 
 life:— 
 
 GENERAL RULES FOR 
 
 FEEDING.— 
 
 {Rotch.) 
 
 Age. 
 
 Intervals 
 
 of 
 Feeding. 
 
 Number 
 
 of 
 Feedings 
 
 IN 
 
 24 Hours. 
 
 Average 
 
 Amount at 
 
 Each Feeding. 
 
 Average 
 
 Amount in 
 
 24 Hours. 
 
 1st week. 
 
 2 hours. 
 
 10 
 
 1 ounce. 
 
 10 ounces. 
 
 1-6 weeks. 
 
 2% hours. 
 
 8 
 
 1 %-2 ounces. 
 
 12-16 ounces. 
 
 6-12 weeks and 
 
 possibly 
 
 to 6th month. 
 
 3 hours. 
 
 6 
 
 3-4 ounces. 
 
 18-24 ounces. 
 
 At 6 months. 
 
 3 hours. 
 
 6 
 
 6 ounces. 
 
 36 ounces. 
 
 At 10 months. 
 
 3 hours. 
 
 5 
 
 8 ounces. 
 
 40 ounces. 
 
 Another table arranged by Dr. Rotch shows the 
 
124 
 
 OBSTETRICAL NURSING. 
 
 amount required at each feeding according to the 
 
 weight of the child. 
 
 DETERMINATION OF AMOUNT OF FOOD BY WEIGHT 
 IN CASES OF SPECIAL DIFFICULTY. 
 
 Initial 
 
 
 Each Feeding. 
 
 
 Weight. 
 
 EARLY DAYS. 
 
 at 15 DAYS. 
 
 AT 30 DAYS. 
 
 3000 
 grammes. 
 
 30 grammes. 
 (About 1 ounce.) 
 
 30+15=45 grammes. 
 (About \]4, ounces.) 
 
 30 + 30=60 grammes. 
 (About 2 ounces.) 
 
 4500 
 grammes. 
 
 45 grammes. 
 (About T.y 2 ounces) 
 
 45 + I 5~6o grammes. 
 (About 2 ounces.) 
 
 45 +3°= 75 grammes. 
 (About 2^ ounces.} 
 
 6000 
 grammes. 
 
 6"> grammes. 
 (About 2 ounces.) 
 
 60 + 15 = 75 grammes. 
 About 2% ounces.) 
 
 60+30—90 grammes. 
 (About 3 ounces.) 
 
 A new born infant's stomach holds about iy 
 ounces. The average daily quantity of food re- 
 quired for the first 2-3 months is 20 ounces ; after 
 3 months, 23 ounces ; after 4 months, 27 ounces ; 
 6 to 12 months, 30 ounces. The child's appetite, 
 however, if it be healthy, is a good gauge. During 
 the first month 1 y 2 ounces of the prepared cow's 
 milk may be given at each feeding, and twelve 
 feedings given daily. 
 
 Peptonized food diluted has been employed 
 with great success by some physicians, where 
 the digestive powers in early childhood, seemed 
 
CARE OF THE NEW-BORN INFANT. 125 
 
 at fault. The following formulae may be used for 
 the purpose : — 
 
 Into a clean quart-bottle put one measure or five Formulse . for 
 
 1 A peptonizing 
 
 grains of extractum pancreatis (Fairchild's) and one milk - 
 measure or fifteen grains of bicarbonate of soda, 
 and a gill of cold water ; shake, then add a pint of 
 fresh cold milk, and shake the mixture again. Place 
 the bottle in water about no° or 1 1 5 °, or so hot 
 that the whole hand can be held in without discom- 
 fort for a minute. Keep the bottle there for twenty- 
 minutes. At the end of that time put the bottle on 
 ice to check further digestion and keep the milk 
 from spoiling. 
 
 If heat cannot be conveniently provided, after 
 the ingredients have been thoroughly mixed and 
 shaken, the bottle may be placed on ice and allowed 
 to stand for an hour before it is used. 
 
 It must be remembered that peptonized milk 
 cannot be sterilized, or it becomes unfit for food — 
 the process of digestion being carried on so far as 
 to curdle the milk and render it extremely unpal- 
 atable. 
 
 If an additional aid to the digestion should be 
 necessary, a little pepsin may be given to the 
 child just before each feeding, or the milk may 
 be partially digested by putting a powder of Fair- 
 child's pancreatic extract, ^ gr., and baking soda, 2 
 grs., into the nursing bottle at the time of the meal. 
 
126 OBSTETRICAL NURSING. 
 
 A preparation of peptonized milk, which has 
 been much used by Dr. Broomall, is the following : — 
 
 Peptonized milk, 6 tablespoonsful. 
 
 Milk-sugar, y^ teaspoonful. 
 
 Barley water, 2 tablespoonsful. 
 
 Lime water, . . I tablespoon ful. 
 
 Another favorite formula in Philadelphia is that 
 of Dr. Meigs, known as Meigs' Food : — 
 
 2 parts cream. 
 
 1 part milk. 
 
 2 parts lime water. 
 
 3 parts sugar water. 
 
 The sugar water is prepared by putting 18 table- 
 spoonsful milk-sugar to a pint of water. 
 
 Dr. Louis Starr gives a very useful dietary for 
 infants, which has also met with great success. 
 Those formulae which especially concern the obstet- 
 ric nurse are as follows :— 
 
 Diet for first week : — 
 
 Cream, 2 teaspoonsful. 
 
 Whey,* 3 teaspoonsful. 
 
 Water (hot), 3 teaspoonsful. 
 
 Milk-sugar, j£ teaspoonful. 
 
 * Whey is made by adding 3 teaspoonsful of wine of pepsin to 
 a quart of warm fresh milk and placing the mixture near the fire 
 for two hours. The curd is removed by straining through muslin. 
 
CARE OF THE NEW-BORN INFANT. \2J 
 
 For each portion ; to be given every two hours, 
 from 5 a. m. to 1 1 p. m., and in some cases once or 
 twice at night, amounting to 12 fluid ounces of 
 food per day. 
 
 Diet from the second to the sixth week : — 
 
 Milk, . 1 tablespoonful. 
 
 Cream, 2 teaspoonsful. 
 
 Milk-sugar, ]^ teaspoon ful. 
 
 Water, 2 tablespoonsful. 
 
 For one portion, to be given every two hours, 
 from 5 a. m. to 1 1 p. m., amounting to 17 fluidounces 
 of food per day. 
 
 The proportion of milk in the mixture and the 
 quantity given at one time, are carefully increased 
 during the succeeding weeks. 
 
 The temperature of the food should be qq° Fahr. Tempera- 
 
 1 -^ ture of food. 
 
 It is a great mistake to make it too hot. The 
 warming of the child's food should be accom- 
 plished by setting the filled nursing bottle into a 
 vessel of hot water. It may be heated quickly 
 over a gas jet by setting the bottle into a tin mug 
 filled with water and holding it over the flame. 
 Suggestions concerning the modification of food, 
 when milk thus prepared does not agree with 
 infants, will be given in another chapter. When Artificial 
 the mother's supply of milk is scanty, and the suptf/nTent 
 baby cries with hunger, occasional meals of the miik? thers 
 
128 OBSTETRICAL NURSING. 
 
 above preparations will be a great aid in its manage- 
 ment. 
 
 of e miik? tlon In the artificial feeding of infants in the Woman's 
 Hospital, sterilized milk is used for the various 
 preparations employed, as a rule. 
 
 By sterilizing milk is meant the process of de- 
 stroying any poisonous matter which may have 
 found its way into it. Exposure to the atmosphere 
 and admixture with particles of dust and dirt during 
 its transportation, with want of care as to cleanli- 
 ness of vessels, etc., in which the milk is kept, 
 induce certain fermentative changes, which cause 
 it to sour and to produce digestive disturbances. 
 Sterilization destroys the germs of poisonous matter 
 by subjecting the milk to a high degree of heat 
 
 for sferfUza- under pressure. Many forms of apparatus have 
 been devised for this purpose. The one in use at 
 the Woman's Hospital is called Blair's Sterilizing 
 Apparatus.* It is very similar in general construc- 
 tion to the one devised by Dr. Louis Starr and 
 shown in the cut. This consists of an oblong case 
 of tin fitted with a tight cover. Into this a movable 
 wire basket, holding ten bottles, is placed. The 
 bottles are of flint glass, graduated and fitted with 
 rubber corks having a glass plug fitted into an 
 
 * Arnold's Steam Sterilizer has also been employed more recently 
 with very satisfactory results. By this arrangement the milk is steamed 
 instead of boiled. It may be obtained through any drug store. 
 
 tion. 
 
CARE OF THE NEW-BORN INFANT. 
 
 129 
 
 opening in their centres. The rules for using the Rules for 
 sterilizing apparatus are as follows : — mUk. lzl 
 
 1st. Cleanse the bottles thoroughly. 
 
 2d. Fill each with the milk you wish to use, put 
 
 Fig. 18. 
 
 Sterilizer (Dr. Louis Starr) * 
 
 in the rubber cork without the glass plug (this 
 leaves a small opening in the rubber cork) ; set the 
 bottle in the basket, then in the boiler; fill the 
 boiler with water almost as high as the milk in the 
 bottle ; boil about ten minutes, or, better, as Dr. 
 
 * " Hygiene of the Nursery." 
 
130 OBSTETRICAL NURSING. 
 
 Starr expresses it, " until the expansion that pre- 
 cedes boiling has taken place in the milk ; " then 
 put the glass plugs tightly in each stopper and boil 
 for fifteen to twenty minutes more. Should the 
 rubber corks incline to come out during the second 
 boiling, put them in firmly. 
 
 3d. Keep in a cool place till needed for use. 
 
 4th. When to be used, place a bottle of the milk 
 thus prepared in the tin mug which accompanies 
 the apparatus. Pour hot water in the mug until it 
 is as high as the milk in the bottle. Heat the milk 
 to the temperature desired for feeding (99 ° Fahr.) ; 
 remove the rubber cork and put on rubber nipple, 
 and feed. 
 
 5th. Cleanse each bottle immediately after the 
 milk in it is used. Do not keep milk in a bottle 
 that has had some used out of it. 
 
 6th. If the steaming process is preferred, place 
 the basket, without the bottles, in the boiler, fill 
 with water up to but not above the bottom of the 
 basket, place the bottles in the basket and proceed 
 as before. 
 
 Milk should be sterilized as soon as possible 
 after it has been served each morning. Each bottle, 
 when emptied, should be thoroughly washed. If 
 the whole contents of the bottle are not" used after 
 it is opened, the remainder must not be used for the 
 child nor allowed to remain in the bottle. 
 
CARE OF THE NEW-BORN INFANT. 1 3 I 
 
 Milk sterilized in this way will keep for days Length of 
 without spoiling, as it is hermetically sealed and sterilized 
 
 . 111 -r-x mu k w iH 
 
 has been deprived of all unhealthy germs. Dr. keep. 
 Louis Starr makes the assertion that it will keep 
 for eighteen days if the heating is continued for 
 thirty minutes. 
 
 Sterilized milk is useful when traveling, as it may convenience 
 be carried without any trouble, the difficulty ofing!" 
 obtaining fresh milk being thus overcome. Its use 
 makes the management of babies during the heat 
 of summer much easier. 
 
 A word remains to be said concerning feeding;- Nursing 
 
 ° bottles and 
 
 bottles and rubber nipples. rubber 
 
 ll nipples. 
 
 The bottle should be of clear glass, with a 
 rounded bottom, of a shape convenient to clean, 
 so that no particles may cling about corners which 
 cannot be reached, serving as a source of trouble 
 afterward. The graduated bottle is very nice, as it 
 enables the preparation of the feeding to be mixed 
 directly in the bottle, instead of being first measured 
 out in a graduate. 
 
 Feeding-bottles with India-rubber tubes are very 
 objectionable, for the tubes are difficult to keep 
 clean, and a drop or two of milk left behind will 
 often be sufficient to turn the next supply sour, 
 causing the infant much sickness and suffering. 
 Nurses are prone, also, with these tubes, to place 
 the baby in its crib with the bottle of milk by its 
 
132 
 
 OBSTETRICAL NURSING. 
 
 side and the nipple in its mouth. The heat of the 
 child's body tends to sour the milk, the liquid may 
 run low, and the child suck in considerable air. 
 
 Fig. 19. 
 
 Graduated Nursing Bottle (Dr. Louis Starr). 
 
 The neck of the bottle should always be kept filled 
 with the liquid while the child is nursing, hence 
 the position of the bottle must be changed. A feed- 
 
CARE OF THE NEW-BORN INFANT. 1 33 
 
 ing-bottle fitted with a rubber nipple requires to be 
 held in the nurse's hand during the feeding, and is, 
 on that account, to be preferred. There should 
 always be two nursing-bottles for each baby, one 
 being kept under water or filled with a soda solu- 
 tion while the other is in use. Immediately after 
 the meal the bottle should be cleaned, etc. Scald- 
 ing water should be used, and then the bottle nursing g ° f 
 filled or placed beneath a solution of bicarbonate bottle ' 
 of sodium — ordinary baking soda — a teaspoonful 
 to the pint, until it is again needed, when the soda 
 solution should be emptied out and the bottle thor- 
 oughly rinsed with cold water. Some use salicyl- 
 ate of sodium for the cleansing solution in prefer- 
 ence to the bicarbonate. 
 
 Two nipples should be in use at the same time, 
 being used alternately, and no nipple should be^ 11 ^ 
 used longer than two weeks. A soft rubber nipple of 
 conical shape is the best, because it can be more 
 readily cleaned. The black rubber is generally 
 softer than the white and is to be preferred. The 
 opening at the top of the nipple should not be too 
 large, as that would permit the milk to flow through, 
 when the suction produced by the child's mouth is 
 necessary to the food being taken in a natural man- 
 ner. So soon as the meal is over, the nipple should 
 
 be removed from the bottle, brushed with a stiff cleansing 
 
 11 «iii 1 1 of ru ^ ber 
 
 brush, wet with cold water on the outside, tnenni PP ie. 
 
Time 
 required 
 
 134 OBSTETRICAL NURSING. 
 
 turned inside out and similarly brushed on its inner 
 surface. It should then be put in cold water and 
 allowed to stand until wanted. A nurse's sense of 
 smell should be keen enough to enable her to 
 detect the slightest sourness about a bottle or 
 nipple. 
 
 The baby should be fed slowly — taking often ten 
 to twenty minutes for its meal. Sucking from an 
 
 for feeding. em p|-y bottle should never be permitted. 
 
 Fig. 
 
 Rubber Nipple (Starr). 
 
 Preparation It is a bad plan to make the whole day's supply 
 of food in the morning, unless the facilities for keep- 
 ing it are such as to insure against its spoiling. 
 When a sterilized preparation is used it is desirable 
 to have the whole amount prepared at once in a 
 number of small flasks, each containing the amount 
 for one feeding. 
 
 The sterilization of the quantity of milk to be 
 used during the day may all, however, be accom- 
 plished at one time. 
 
CARE OF THE NEW-BORN INFANT. IJ5 
 
 In lieu of the regular sterilizing apparatus, milk improvised 
 
 i «i i 1 m i • i i r ii sterilization 
 
 may be similarly boiled in a water-bath formed by apparatus. 
 an ordinary boiler, the milk being contained in a 
 glass fruit-jar with a screw lid. After coming to 
 the boiling-point, or boiling about two minutes 
 without the lid, the latter may be screwed on and 
 the boiling continued. A better way is to put the 
 jar in a colander placed over a steaming tea- 
 kettle in place of the lid. The milk should be 
 allowed to boil in the open jar for about two 
 minutes ; the jar lid then being screwed down, it 
 should steam for twenty minutes. 
 
 Beside good food and sufficient warmth, babies Free 
 
 ventilation. 
 
 need an abundant supply of fresh air, hence the 
 room should be kept pure and wholesome. 
 
 In fine weather, after the first three or four weeks, T h e daily 
 a baby should be carried out in the open air every airmg * 
 day for a time. 
 
 It is preferable to carry the child in the arms, 
 rather than to place it in a baby coach. It can 
 thus be kept warmer, and any evidence of chilling 
 will be sooner detected by the appearance of the 
 baby's face! 
 
CHAPTER IX. 
 MANAGEMENT OF THE LYING-IN. 
 
 Rest - Immediately after the delivery it is necessary 
 
 that the patient should have rest. The room 
 should be kept exceedingly quiet and the shades 
 drawn down so as to subdue the light. 
 
 Light sleep. The patient may be allowed to sleep, but the 
 nurse, during this time, should watch her very 
 carefully, as there is a liability to bleeding when 
 the sleep is too deep, owing to the general relaxa- 
 tion induced by sleep. She should draw the bed- 
 clothes up at one side from time to time, to see 
 how much blood is lost. 
 
 Absence of There should be no unpleasant smell about a 
 
 odor. r 
 
 confinement room, plenty of fresh air should be 
 allowed to enter, and all discharges should be at 
 once removed from the room. 
 Attention While the patient sleeps, and after the child has 
 
 to soiled . . 
 
 clothing, received proper attention, the nurse should place 
 the soiled sheets, towels and all articles stained 
 with blood, in cold water, to soak. 
 
 afterbkth The afterbirth, also, should be disposed of. If 
 in the country, it should be buried in a hole dug in 
 the yard, two or more feet deep. It should never 
 
 136 
 
MANAGEMENT OF THE LYING-IN. 1 37 
 
 be thrown down a water-closet or privy. In the 
 city it is best to burn it, at night. It may be put in 
 the range or stove and well covered up with coals. 
 Clots of blood may safely go down the water- 
 closet, as they readily dissolve. 
 
 To return to the soiled clothing left after a con- Dutiesof 
 
 <=> nurse as 
 
 finement — though a trained nurse will not often be rega /. ds 
 
 o washing. 
 
 called upon to attend to the washing of these 
 articles, there will be times when it would be better 
 that she should do so, both to save the patient 
 expense and trouble and to prevent their lying 
 about too long. At any rate, she should know 
 how it should be done. Should the clothing be 
 put to soak before the blood has dried into it, and 
 allowed to remain for a few hours, the water being 
 changed as often as needed, the washing will not 
 be difficult. 
 
 As a rule, it is not best that a nurse should leave 
 her patient or the baby long enough to attend to 
 this wash, hence it is advisable to have it put out 
 or done by some one else in the house. The soak- 
 ing ought, however, always to be attended to by 
 the nurse because it facilitates the subsequent 
 washing. 
 
 In the after-care of the patient the nurse should 
 attend to the washing of the mother's and baby's 
 napkins. She should, if needed, wash the baby's 
 flannels and slips. 
 
138 
 
 OBSTETRICAL NURSING. 
 
 Visitors. 
 
 Puerperal 
 mania. 
 
 Food of 
 lying-in 
 patient. 
 
 Dietary of 
 the lying-in 
 
 For a week a newly-confined patient should see 
 no visitors. Even the husband should not remain 
 in the room long at a time. No painful or exciting 
 news should be communicated to the patient, as a 
 distressing form of mental trouble to which lying- 
 in women are prone may be thus induced. This 
 is known as " puerperal mania." 
 
 After the patient rouses from her first sleep she 
 is generally hungry. The nurse should have 
 learned from the physician before he left what he 
 would prefer her having. A cup of warm milk or 
 tea — not too hot — may be given directly after the 
 confinement when ether has not been taken, and 
 this followed in three or four hours by a light meal, 
 as toast and tea or gruel. With regard to the diet 
 of the lying-in, nurses must be prepared to follow 
 the rules of the physicians for whom they work. 
 Some physicians allow considerable variety in the 
 food from the beginning. 
 
 The following directions concerning the diet are 
 given to the nurses of the Woman's Hospital : "It 
 should be remembered in the diet of the lying-in 
 woman, that the amount of liquids must be limited, 
 not only until after the secretion of milk, but 
 also until the supply of milk adapts itself to the 
 demand, for the first five or six days after the 
 confinement. 
 
 As soon as the patient is made comfortable after 
 
MANAGEMENT OF THE LYING-IN. 1 39 
 
 the birth, she should have a cup of warm milk or 
 
 weak tea or warm water and milk. 
 
 First meal time : Plate of milk toast or bowl of oat- 
 meal gruel, or saucer of wheat germ or boiled rice. 
 
 Second meal : Cup of weak tea or warm milk, dry 
 toast, or milk toast, or water toast, or soda 
 crackers soaked in hot milk. 
 
 Third meal : Saucer of oatmeal mush or wheaten 
 grits, with a cup of tea or warm milk, with 
 Graham biscuit or dry toast. 
 
 Forenoon, afternoon, bedtime: Lunch, a cup of 
 warm milk, with a piece of dried bread or zwie- 
 back. 
 
 Second Day. — The same as above. 
 
 Third Day. — The same, with the addition of stewed 
 apples or baked apples for supper. 
 
 Fourth Day. — Breakfast : Soft-boiled egg, dried 
 bread, stewed fruit and cup of milk or weak tea. 
 
 Dinner : Plain beef or mutton-broth, dried bread, 
 and farina or junket. 
 
 Supper: Baked apples or stewed prunes, saucer of 
 wheat germ or zwieback. 
 
 Fifth Day. — Breakfast : Cup of weak coffee or 
 cocoa, mutton-chop, oatmeal mush, dried bread, 
 and a sweet orange or ripe apple. 
 
 Dinner: Beef or mutton-broth or oyster-stew, baked 
 potato, stewed tomatoes, dried bread, farina, jun- 
 ket, or rice. 
 
I40 OBSTETRICAL NURSING. 
 
 Supper : Stewed fruit, Indian-meal mush and zwie- 
 back. 
 Sixth Day. — Ordinary plain diet, avoiding salads, 
 sour fruit, fried or highly-seasoned meats, fancy 
 desserts, or sweets of any kind." * 
 This holds good of all subsequent meals. The 
 above dietary will require to be modified when 
 special indications arise. Should the patient's tem- 
 perature rise to ioo° Fahr., or above, she should 
 be kept on liquid diet, as milk and beef-tea, alter- 
 nately every two hours. 
 
 As liquids favor the secretion of milk, liquid food 
 should constitute a large proportion of the nourish- 
 ment taken by nursing women throughout the 
 lying-in, provided there is not a tendency to over- 
 secretion. The diet should be plentiful and nutri- 
 tious, but selected carefully with reference to its 
 digestibility. As the patient must remain inactive 
 for some time, it will not do for her to eat the 
 starchy vegetables, pastry or warm breads, for all 
 these require very active powers of digestion. 
 
 A nurse should thoroughly understand the art of 
 cooking, and be able to provide her patient with 
 palatable and nutritious dishes, daintily and prettily 
 served on a tray, until, with the physician's consent, 
 she takes her place at the family table. Even then 
 
 *Dr. Anna E. Broomall. 
 
MANAGEMENT OF THE LYING-IN. I4I 
 
 a nursing woman will need to receive some nour- 
 ishment, as gruel, beef-tea, milk, etc., between the 
 regular meals, for she must not only provide for 
 herself but her child. 
 
 The lying-in lasts six weeks. During this time^^^ nof 
 the organs of generation are returning so far as 
 possible to their former condition. It is important 
 that the patient should have rest, and for at least £°ntto~bed 
 two weeks of this time should be in bed. 
 
 The process of changes by which the womb 
 shrinks to its normal size is known as " involution." "ti n on°"~ 
 This process is favored by the patient lying as much 
 as possible on her back, so that the womb does not 
 incline too much to one side or the other. 
 
 The discharges of the mother continue about two "Lochia." 
 weeks, and they are called the " lochia." For the 
 first twenty-four hours they are blood; the second 
 and third day, watery blood ; from the fourth to the 
 sixth day they have a greenish-yellow coloration, 
 and from the tenth to the twelfth day they become 
 white. This white discharge may continue for a 
 long time after the confinement. The character of 
 the discharge will indicate the progress of involution, 
 hence the physician should see daily the napkins or 
 dressings removed from the patient. Soiled nap- 
 kins and dressings should never be kept in the 
 patient's room, but in some closed vessel, as a clean 
 chamber or a slop jar, with a close-fitting lid, in 
 
142 OBSTETRICAL NURSING. 
 
 another room. The existence of the least odor 
 
 about the discharges should at once be brought to 
 
 changes of the physician's attention. If napkins are used, they 
 
 napkins and A J r 7 J 
 
 dressings. w jh need to be changed during the first day about 
 every two hours, sometimes oftener, the second 
 and third day about every three hours, the fourth 
 and fifth day every four hours, until, by the tenth day, 
 about three changes are sufficient. The antiseptic 
 dressings are changed, as a rule, every three hours 
 until the discharge ceases. If it be very scant, a 
 change once in six hours may be sufficient. These 
 
 After-care antiseptic dressings should be burned. The napkins 
 
 of napkins a o 1 
 
 a , nd . should be soaked in cold water until the blood is 
 
 dressings. 
 
 well out of them, and then thoroughly washed and 
 boiled. The boiling is sufficient, if properly done, 
 to render them aseptic, but, as an additional pre- 
 caution, they may be wrung out in a 1-2000 bichlo- 
 cieansin of 1 *^ solution before drying. The patient should 
 patient. fo e washed off each time the napkin is changed with 
 a warm antiseptic solution, as 1-4000 of the bichlo- 
 ride of mercury. Care should be taken not to 
 irritate the parts. Instead of using a soft cloth to 
 wash off the parts, the water may be poured in a 
 small stream over them, and a soft, dry cloth pressed 
 gently over them to remove all moisture. Especial 
 care should be taken, where there are stitches, not 
 to pull upon them in any way. 
 Bathing. One daily washing of the entire body is, as a rule, 
 
MANAGEMENT OF THE LYING-IN. 1 43 
 
 desirable. The doctor's advice, however, should be 
 asked concerning the matter. This wash, when given 
 as a sponge-bath, need not exhaust the patient, nor 
 cause too much movement of her body. The pa- 
 tient should never feel chilly during this bath ; should 
 she do so, the bath must at once be stopped. The 
 bath should, of course, be given under cover. The 
 increased activity of the skin necessitates especial 
 cleanliness, and the daily bath is found, when 
 properly given, to be very refreshing. Frequent 
 changes of bed and body clothing, too, are neces- 
 sary — the body clothing, if possible, daily until the 
 discharges cease. 
 
 The bladder is frequently paralyzed after confine- t^ 
 ment, as a result of the pressure to which it has 
 been subjected during the birth. When it is filled 
 beyond a certain limit, it may respond to the irrita- 
 tion and a little urine be voided, but the bladder 
 not be emptied. The nurse can tell by the amount 
 passed whether the patient has probably emptied 
 the bladder or not. The secretion of urine early in 
 the lying-in is very free, hence the quantity passed 
 should never be scant.. By placing the hand over 
 the lower part of the abdomen, the bladder may be 
 felt as a soft tumor on one or the other side, above 
 the pubic bone, the womb being felt as a harder 
 mass pushed to the opposite side. 
 
 The catheter should not be used without the^° t f er 
 
144 OBSTETRICAL NURSING. 
 
 physician's sanction, but a nurse should never for- 
 get to ask very particularly about this matter before 
 he leaves the house after the delivery. It is generally 
 undesirable to allow a patient to go longer than six 
 hours without freely emptying the bladder. As 
 over-distention of the bladder prevents proper con- 
 tractions of the womb, and, as a relaxed womb is a 
 frequent cause of after-pains, it is best to have the 
 bladder quite frequently emptied during the first 
 twenty-four hours. Hence, if the catheter is per- 
 mitted to be employed, it may be well to use it 
 about three hours after delivery for the first time 
 (the physician having used it, if necessary, immedi- 
 ately after delivery) Its subsequent use should be 
 limited to about once in six hours, unless its more 
 frequent use is demanded by the interference with 
 the contractions of the womb caused by over-dis- 
 tention of the bladder. The patient should be en- 
 couraged to make a trial to urinate as soon as 
 possible, so that the use of the catheter may be 
 Precautions entirely dispensed with. Great care is necessary 
 cath S e e te°r. in the use of the catheter : ist, to see that the instru- 
 ment is thoroughly clean and kept clean ; 2d, to 
 see that none of the vaginal discharges are carried 
 into the bladder during its introduction ; 3d, to do 
 no injury to the mother's parts or give her need- 
 less pain. 
 
 The instrument, a silver or glass catheter, should 
 
MANAGEMENT OF THE LYING-IN. I45 
 
 be thoroughly boiled if there is any doubt about its 
 being aseptic. When withdrawing it the outer 
 extremity should be kept lowered, so that all the 
 urine remaining may flow out from it, and no sedi- 
 ment settle in the closed end to become a source of 
 contamination at some future time. It should then 
 be thoroughly washed in hot water, which should 
 be allowed to flow through it from the inner toward 
 the outer extremity, carrying out any sediment from 
 the urine, and it may be kept during the intervals 
 of its use in an antiseptic solution — a 2 per cent, 
 solution of creoline or carbolic acid. To prevent the 
 carrying of the vaginal discharges into the urethra 
 the parts should be carefully washed off with an 
 antiseptic solution, either by irrigation or by means 
 of a soft cloth, before the insertion of the catheter. 
 
 The index finger of the nurse's right hand (which Method of 
 should each time be thoroughly cleansed in an anti- Whiter.* 
 septic solution) should be slipped into the vagina 
 as far as the second joint, and made to follow the 
 anterior vaginal wall down in the median line to 
 the vaginal entrance, when a little elevation of the 
 surface will be felt, immediately above which the 
 orifice of the urethra is to be found. If the finger 
 be held with its palmar surface upward and rest- 
 ing lightly upon this elevation, the finger being held 
 horizontally, a catheter slipped along it will enter the 
 
 * Some physicians prefer its use by sight. 
 IO 
 
I46 OBSTETRICAL NURSING. 
 
 small orifice of the urethra. Should the extremity 
 of the catheter seem to meet with any obstruction 
 after its entrance into the urethra, a slight with- 
 drawal and rotation of the instrument will generally 
 carry it in. The use of the catheter need not involve 
 the slightest exposure of the patient. A cultivated 
 touch will enable a nurse to do better than by sight 
 in its use. Hence, it may all be done under cover. 
 Difficulty in For the first twenty-four to forty-eight hours after 
 
 urination J • o 
 
 fr ° m delivery, particularly if the labor has been a difficult 
 
 oedema. J > r J 
 
 one, there is considerable swelling of the parts, which 
 offers a mechanical hindrance both to voluntary 
 urination and the passage of the catheter. Great 
 gentleness is therefore required in the necessary 
 manipulations. This swelling in an ordinary case 
 should disappear at the end of twenty-four to forty- 
 eight hours. Should the inability to urinate per- 
 sist after this, it is in all probability due to the 
 condition of paralysis before referred to. Especial 
 medication by the physician, as the use of muscle 
 and nerve tonics, fomentations over the lower part 
 of the abdomen and external generative organs, 
 hot water in a bed-pan, placed beneath the patient's 
 hips, may serve to stimulate voluntary urination. 
 The attempt to induce this should be made each 
 time before a resort to the catheter, as the con- 
 stant use of the latter will only keep up the diffi- 
 culty. 
 
MANAGEMENT OF THE LYING-IN. 1 47 
 
 As a rule, there is no movement of the bowels constipa- 
 for the first three days, constipation being due to 
 paralysis of the bowels caused by the pressure of 
 the gravid womb upon the bowels. Regulation of 
 the food will do much to correct this habit, as a 
 laxative diet composed mainly of brown bread, oat- 
 meal gruel, prunes, etc. An occasional enema of 
 warm soap-suds may be needed, or from a tea- 
 spoonful to a tablespoonful of glycerine may be 
 injected into the lower bowel, or a glycerine or 
 gluten suppository be given. If these means do 
 not suffice, some medication may be needed. The 
 laxative chosen by the physician will depend upon Sative° f 
 the condition of the breasts, as well as its liability 
 to affect the milk. 
 
 Should the breasts be over-distended, a saline 
 laxative will be preferred. Thus, two teaspoonfuls 
 of Rochelle salts in a half-tumblerful of cold water 
 may be given, an additional tumblerful of pure 
 water being taken after it. Sulphate of magnesia 
 or Epsom salts may be used in the same way, or a 
 teaspoonful of cream of tartar may be taken night 
 and morning in a cup of sweetened water. 
 
 When the secretion of milk is scanty, a vege- 
 table laxative is to be preferred, as rhubarb, aloes, 
 or cascara sagrada. 
 
 At times there is such impaction of the contents Enema of 
 of the lower bowel that an oil injection will be 
 
I48 OBSTETRICAL NURSING. 
 
 needed. A gill of cotton-seed oil may be intro- 
 duced into the lower bowel and retained for three 
 or four hours, after which a small soap and water 
 injection will lead to a thorough evacuation of the 
 bowel. 
 
 ^p r pie°s f and The care of the nipples and breasts is very 
 important. If this matter has received proper atten- 
 tion during the pregnancy, there will be compara- 
 tively little trouble during the lying-in. It is 
 important to keep the nipples clean. Milk should 
 not be allowed to collect about them, hence imme- 
 diately after nursing, while they are swollen and 
 soft, they should be washed ; a soft piece of linen 
 may be used and cold water, after which they may 
 be dried with a soft cloth. This should be repeated 
 after every nursing. 
 
 nippfe If the skin of the nipple be unusually thin, it is 
 
 best to avoid having the baby pull directly upon the 
 nipple until the milk flows freely, hence a nipple 
 shield should be used at least for the first two or 
 three days, if not longer. 
 
 Application Should the nipple become sore at any time, the 
 
 to sore rr J 
 
 nippies. nipple shield should again be resorted to and used 
 until the sore is healed. 
 
 Some application, as a 10 per cent, solution of 
 tannic acid in tincture of myrrh, balsam of Peru, 
 or a weak solution of nitrate of silver, according to 
 the order of the physician, may be painted with a 
 
MANAGEMENT OF THE LYING-IN. 1 49 
 
 camel's-hair brush over the nipple while it is soft 
 and swollen, immediately after nursing. 
 
 For any nipple shield to work perfectly it must Qualities of 
 fit tightly, hence an entire rubber shield is not so shi eid. 
 good as some others. Some shields are made of 
 part metal and part rubber, others part metal and 
 part glass. The cheapest are the ordinary glass 
 
 Fig. 21. 
 
 Nipple Shield. 
 
 shields with rubber nipples. These cost about 
 fifteen cents and are quite as good as those that are 
 higher priced. 
 
 A shield is not good if it allows the nipple to be 
 drawn out too far. In the intervals of nursing the 
 rubber nipple should be kept in cold water after 
 having been turned inside out and thoroughly 
 cleaned with a brush. 
 
150 OBSTETRICAL NURSING. 
 
 Nipple Nipple protectors are worn only in the intervals 
 
 protectors. . .• . 
 
 of nursing, or during pregnancy, for shaping the 
 nipple.* These may be made of lead, glass, or wood. 
 Leaden protectors keep the nipples soft in the 
 intervals of nursing and have a healing effect upon 
 the abrasions and cracks of a tender nipple. Unless 
 care be taken, however, to cleanse the nipple thor- 
 oughly before the baby nurses, there is danger of 
 lead-poisoning. Nipple protectors of glass and 
 wood, being open at the top, are intended more to 
 keep the clothing of the patient off the tender 
 nipple. The nipple may, in addition, be kept moist 
 in the intervals of nursing by the application over it 
 of a piece of absorbent cotton saturated with a 
 mixture of one part glycerine to two parts water, 
 l^sha^of Nipples vary much in shape — thus, they may be 
 nippies. cone-shaped, hollow, mushroom-shaped and de- 
 pressed. 
 siTtd ^^ e cone_s haped nipple is the best, as it can be 
 
 nipple. readily seized by the child's mouth and the pres- 
 sure of the baby's lips does not constrict the nipple at 
 its base, so as to prevent the free escape of milk 
 from the mouths of the milk ducts which open at 
 Mushroom ^e ^°P °^ *-he nr Ppl e - The mushroom-shaped nip- 
 shaped pi e h as so narrow a base that the free flow of milk 
 
 nipple. J^ 
 
 may be thus prevented. 
 Sppi°eT The hollow nipple is apt to get sore from two 
 
 * See Fig. 3, page 33. 
 
MANAGEMENT OF THE LYING-IN. 
 
 151 
 
 causes : first, by the forcible suction made by the 
 child in emptying the breast; second, by the accu- 
 mulation of milk in the depressed portion of the 
 apex. 
 
 The depressed nipple differs from the last class Repressed 
 
 1 L L nipple. 
 
 in the fact that there is no elevation of the nipple 
 above the surface of the breast, but where the 
 nipple should be there is a corresponding depres- 
 
 FlG. 22. 
 
 Cone-shaped. 
 
 Hollow. 
 
 Mushroom-shaped. 
 
 Depressed. 
 
 sion. Very little may be done for such a nipple, 
 and all efforts to make a nipple by drawing it out 
 must generally be abandoned, as they simply irritate 
 the tender skin. 
 
 It is best when nipples of this last class exist to Bandaging 
 abandon the idea of nursing the child, and prevent ofbreasts - 
 the accumulation of milk in the breasts by bandag- 
 
152 
 
 OBSTETRICAL NURSING. 
 
 ing. This should also be done where there is a 
 previous history of breast abscess — the breast 
 affected being thus bandaged to prevent the attempt 
 at secretion by the gland. 
 
 Fig. 23. 
 
 Figure-of-eight of One Breast. 
 
 The firmest bandage is the figure-of-eight of the 
 breasts, which may be applied to one or both the 
 breasts according to need. If it cannot be used, 
 the wide, straight bandage, similar to an abdominal 
 
MANAGEMENT OF THE LYING-IN. 
 
 153 
 
 bandage, may be employed, or the straight bandage 
 with straps to fasten it over the shoulders, accord- 
 ing to the pattern used by Dr. Garrigues, of New 
 
 Fig. 24. 
 
 Figure-of-eight of Both Breasts. 
 
 York. Were the milk permitted to accumulate in 
 
 the breast, and there be no ready outlet for iVgJjjJ*., 
 
 " caked breast " would be apt to ensue. 
 
 By " caked breast" is meant a collection of milk 
 
154 
 
 OBSTETRICAL NURSING. 
 
 Rubbing 
 of breast. 
 
 in one or the other part of the breast, due to block- 
 ing up of a milk-duct. The indications for its 
 relief are to empty the breast. The milk may be 
 drawn out by a baby if there is a proper nipple, or 
 by the use of the breast-pump. 
 
 The breast may be gently rubbed with warm oil 
 and stroked from the base toward the nipple to aid 
 in carrying the milk toward the mouths of the 
 
 Fig. 25. 
 
 Garrigues' Breast Bandages. 
 
 Fomenta- 
 tions. 
 
 milk ducts. Camphor liniment is sometimes used 
 as an inunction, alone or combined with laudanum, 
 but unless it is the intention to help to dry up the 
 milk, camphor should be avoided. 
 
 The use of fomentations before rubbing greatly 
 helps to soften up the breast. By fomentation is 
 meant the application of flannels wrung out in hot 
 water, constantly changed as they cool. These 
 applications should be continued for fifteen to twenty 
 
MANAGEMENT OF THE LYING-IN. 
 
 155 
 
 minutes at a time. After their use, if the baby be 
 put to the breast or the breast-pump be used, the 
 milk will generally flow quite freely. • 
 
 Those breast-pumps are the best which depend Breast 
 
 x x x pumps. 
 
 for suction on the power of the mouth. The 
 
 Phoenix breast-pump is the one generally preferred. 
 
 They may be used by the nurse, or a patient may 
 
 use such a pump herself should a nurse not be 
 
 Fig. 26. 
 
 Breast Pump. 
 
 present. Hand pumps are not good, as too much 
 force is apt to be used in making suction — the nip- 
 ple may thus be torn off. Where a breast-pump 
 cannot be had, a simple contrivance may be resorted 
 to for emptying the breasts which is often very 
 effective. A bottle filled with very hot water may 
 be emptied of its contents, and while still hot the 
 mouth of the bottle closely applied over the nipple. 
 
i 5 6 
 
 OBSTETRICAL NURSING. 
 
 As the bottle cools the' nipple is drawn up into the 
 neck of the bottle, and the flow of milk induced. 
 When the breasts are pendulous, handkerchief 
 b^r ° f bandages, properly applied, make a good support. 
 
 Handker- 
 chief 
 
 Fig. 27. 
 
 Handkerchief Bandage of Breast. 
 
 Their application is as follows : " The base of the 
 handkerchief, folded as a triangle, should be placed 
 obliquely across the chest and under one breast, 
 with the apex or summit of the triangle over the 
 
MANAGEMENT OF THE LYING-IN. 1 57 
 
 corresponding shoulder ; one angle is carried over 
 the opposite shoulder, the other under the axilla, 
 or armpit, of the same side. These ends should be 
 tied on the back of the shoulder, and the apex of 
 the triangle pinned to them/' — (Smith.) 
 
 Should both breasts need support, a similar ban- 
 dage may be applied to the other breast. To pre- 
 vent the base of one or both of these bandages from 
 slipping up, the ordinary handkerchief bandage has 
 been modified in the Woman's Hospital by the Modification 
 addition of a belt, around the waist of a strip of mus- chief" 
 lin or ordinary roller bandage, to which the base breast, 
 of the bandage may be fastened by safety-pins. 
 
 A simple straight bandage, with a compress to straight 
 lift the outer, pendulous portion of each breast, is breast. 
 sometimes used. 
 
 Another bandage, which has the advantage of 
 
 .-.-** ° Double Y 
 
 not requiring to be removed when the baby nurses, bandage. 
 is the double-Y bandage, used in the Boston Lying- 
 in Hospital. The manner of putting it on is thus 
 described by Dr. Worcester : " A single T bandage 
 is first made by folding a napkin lengthwise so that 
 for an average-sized patient it shall be 32 in. long 
 by 3 in. wide. At the middle of this, and at right 
 angles to it, is pinned, just between its folds, a nap- 
 kin of the same size, similarly folded. This T ban- 
 dage is next made into a Y bandage, by making a 
 diagonal fold in the middle of the cross-piece, and 
 
i 5 8 
 
 OBSTETRICAL NURSING. 
 
 fastening the corners of the plait with safety-pins 
 on the outside. The bandage is now ready to put 
 on. The tail-piece is passed under the woman's 
 
 Fig. 2 
 
 Worcester's Y-Bandage. The upper figure shows the double Y-breast bandage 
 in position ; the lower left-hand figure shows how the Y-bandage is made. 
 The third figure shows how the double Y-bandage is completed by 
 fastening the arms of the Y to the tail-piece on the patient's opposite side. 
 
 back, snug up to her armpits, so that the fork of the 
 Y just clears one nipple when that breast is held 
 upward and inward on the chest. The tail-piece 
 
MANAGEMENT OF THE LYING-IN. 1 59 
 
 on the other side is carried up on the chest directly 
 over the breast. The arms of the Y are then 
 brought over the chest, one above and the other 
 below the breasts, and their ends pinned to the 
 tail-piece, so as to hold both breasts in similar posi- 
 tion. A compress of soft linen may be placed 
 between the bandage and the outside of the breasts 
 and also between the breasts, to prevent their chaf- 
 ing. To keep the bandage from slipping down 
 
 Fig. 29. 
 
 Obstetrical Breast Support, with Knitted Bosoms. 
 
 straps of muslin may be passed over the shoulders 
 and pinned back and front ; to keep it from slip- 
 ping up, it may be fastened to the abdominal 
 bandage." The bandages referred to are very use- 
 ful while the patient is in bed, but when she begins 
 to sit up and wear ordinary clothing they will be 
 found to be cumbersome. Some such breast sup- 
 port as is shown in Fig. 29 may be found very 
 useful. It may be obtained at the Dress Reform 
 
i6o 
 
 OBSTETRICAL NURSING. 
 
 Gathered 
 breasts. 
 
 Septic 
 inflamma- 
 tion of 
 breasts. 
 
 Emporium, in Philadelphia, and at similar agencies 
 in other cities. 
 
 There is nothing in the care of a lying-in patient 
 for which a nurse receives more blame than in the 
 occurrence of gathered breasts. Abscesses will 
 sometimes come, however, in spite of all precau- 
 tions, even before confinement. Extreme watchful- 
 ness and a prompt reporting of any symptoms of 
 beginning trouble, as chilliness, hardness of the 
 breasts, sore nipples, etc., will do much to avert 
 them. It must never be forgotten that sore nipples, 
 by offering an open surface upon the mother's body, 
 may become avenues of septic infection. Dirty 
 hands or dirty garments touching these surfaces, or 
 poison from the baby's mouth, may thus enter the 
 mother's system. One of the most serious forms 
 of inflammation of the breast may thus result from 
 blood-poisoning. If the breast has once gathered, 
 there will be a tendency for it to gather again. 
 Should an abscess threaten by beginning inflamma- 
 tion of the breast, the treatment will, of course, 
 be directed by the physician. What milk is in the 
 breast must be drawn out, and some means used to 
 prevent further secretion. Belladonna breast plasters 
 were at one time much used, the circular breast 
 plasters being obtained at any drug store. The 
 belladonna ointment spread on patent lint, shaped 
 to the breast, is preferred by some physicians. 
 
MANAGEMENT OF THE LYING-tN. l6l 
 
 Simple compression of the breast by a firm bandage 
 is generally sufficient, without the aid of other 
 measures, in the checking of the secretion. 
 
 Should the breast gather, lancing is inevitable, 
 and the sooner the better, so that a nurse should 
 keep the physician carefully informed as to the con- 
 dition of the breast. Flaxseed poultices may need 
 to be applied for a time, both before and after lanc- 
 ing. The poultices, to do any good, should be ap- 
 plied as hot as possible. The nurse can test the heat 
 of the poultice by laying her cheek against it. If she 
 can bear the application without finding it too hot, 
 the patient will also probably be able to bear it. If 
 the poultice be made on flannel it will not lose its 
 heat as quickly as when made on muslin. The 
 poultices will require changing about once in two 
 hours, or often enough to keep them warm ; and 
 should be kept up until the abscesses point and are 
 evacuated. The nurse should encourage the patient 
 to have an abscess lanced, and should have pre- 
 pared, at the time of the operation, the antiseptic 
 solutions preferred for the physician's hands and 
 for washing out the abscess cavity, a syringe, if 
 possible, a pus-pan having a concave side to fit 
 closely under the breast, some charpie (linen 
 threads arranged in bundles for packing abscess 
 cavities), soft towels and some absorbent cotton to 
 be used in place of sponges for cleansing the 
 II 
 
1 62 OBSTETRICAL NURSING. 
 
 breast. Before the operation, the breast should be 
 washed off with an antiseptic solution. Between 
 the applications of the different poultices the breast 
 should be similarly washed off by the nurse. The 
 physician will probably desire to wash out the 
 abscess cavity daily so long as the discharge of pus 
 continues, in which case the nurse should have every- 
 thing in readiness at the time of his expected visit. 
 
 flow S of n miik. Sometimes milk runs constantly from the breasts. 
 Much may be done to prevent this by regular 
 nursing. If it persists, the amount of liquid in 
 the food should be restricted. Sometimes the milk 
 runs from the opposite breast while the baby is 
 nursing at one. There is no way to prevent this. 
 The milk may be collected in a form of glass shield 
 which also serves to protect the clothing. 
 
 insufficient jf t ^ e mo ther has only sufficient milk for half the 
 day, the baby had better be artificially fed by day, 
 the breast milk being reserved for the night, as 
 giving less trouble when the care of the child de- 
 volves upon her. 
 
 After-pains. After-pains are the same as labor-pains, being 
 caused by contractions of the womb. They are 
 called " after-pains " because they occur after con- 
 finement. A woman, after the birth of her first 
 baby, seldom has after pains. They may occur 
 with varying severity in women who have pre- 
 viously borne children. If the bladder and the 
 
MANAGEMENT OF THE LYING-IN. 1 63 
 
 bowels are properly attended to, and the womb 
 kept well contracted, the patient is not likely to 
 suffer much from after-pains. 
 
 These pains seldom last over the second day. 
 Should they do so, it is probable that the patient 
 is threatened with some inflammation. 
 
 The occurrence of after-pains should, of course, 
 be at once reported to the doctor, and such meas- 
 ures for relief carried out as he may suggest. 
 
 The womb will be found to be in two entirely 
 different conditions with the occurrence of these 
 pains. Hence, we divide the pains into two classes, 
 the "expulsive " and the " spasmodic/' or " neuralgic." 
 
 With expulsive after-pains the womb, as it is felt«Ex P ui- 
 through the abdominal walls, will be found to be after- 
 large and soft, and the patient will often pass clots. pal 
 The bladder will be frequently found to be over-full 
 and the womb pushed high up or to one side. The 
 indications are to empty the bladder and to secure 
 good contractions of the womb. After the bladder 
 is emptied the pain may be relieved by the applica- 
 tion of a hot poultice over the lower part of the 
 abdomen, and simple fluid extract of ergot may be 
 given, if desired by the physician {y 2 teaspoonful 
 every three hours),until the womb is well contracted. 
 A nurse should never give any medicine without 
 the direction of the physician. Before entire relief 
 is obtained, it may be necessary for the physician to uterine 
 break down and wash out the clots within the womb. 
 
164 OBSTETRICAL NURSING. 
 
 The nurse should slip drawers and stockings on 
 the patient in preparation for this operation, as she 
 may need to lie across the bed with her hips drawn 
 to its edge. A bed-pan, syringe, antiseptic solu- 
 tions, receptacle for waste water, and rubber pro- 
 tective for bed and floor, should be prepared. 
 
 after-pafns. When spasmodic after-pains occur, the womb is 
 felt in the lower part of the abdomen as a firm, 
 round ball of stony hardness. This is caused by 
 a spasm of the muscle fibres in the womb. The 
 remedies which would help expulsive pains would 
 only aggravate this condition. Something must 
 be employed which will quickly relax the spasm. 
 The most efficient agent is chloroform liniment, 
 which may be applied on flannel over the lower 
 part of the abdomen. The active counter-irritation 
 thus produced will give relief. Should the spasm 
 be very severe, the physician may apply pure chlo- 
 roform, sprinkled on blotting-paper, for a few 
 seconds over the lower part of the abdomen, until 
 it well reddens the skin. Should no chloroform 
 liniment be at hand, a warm flaxseed poultice may 
 help to some extent, though not so efficient, as a 
 rule. 
 
 The report. ^\ careful report should be kept by the nurse, 
 from which the physician can learn all that has 
 transpired in the intervals of his visits. 
 
 Sheets of paper ruled and having headings, as in 
 the following plan, are used in theWoman's Hospital. 
 
MANAGEMENT OF THE LYING-IN. 
 
 165 
 
 
 >S1 
 
 OS 
 < 
 s 
 
 w 
 
 
 'SIN3W 
 
 •3AOW 
 
 iHA\oa 
 
 
 •HNiiin 
 
 
 ■ 
 
 H 
 M 
 H 
 
 ^ W 
 W § 
 
 5 
 
 u 
 
 s * 
 
 w 
 
 
 Q 
 O 
 O 
 h 
 
 
 •JSHH 
 
 
 •JIMHX 
 
 
 •Hsina 
 
 
 •anoH 
 
 
 "Hiva 
 
 
 
1 66 
 
 OBSTETRICAL NURSING. 
 
 Special 
 symptoms 
 to be 
 reported. 
 
 Chill. 
 
 Rise of 
 
 tempera- 
 ture. 
 
 Pains. 
 
 Puerperal 
 fever. 
 
 The occurrence of pain, any complaint of chilli- 
 ness or a decided chill, rise of temperature, rapid 
 pulse, sleeplessness, headache, want of appetite, etc., 
 should be carefully noted and brought to the physi- 
 cian's attention. 
 
 For the first week or ten days it is well to take 
 the temperature and pulse in the morning, at noon, 
 and in the evening ; after which, if the patient is 
 doing well, the morning and evening temperature 
 and pulse will be sufficient. 
 
 Should the slightest complaint of chilliness be 
 made, the nurse should place extra covers around 
 the patient, hot water bottles, if necessary, to warm 
 her up, and at the same time give her a warm 
 drink, as a cup of hot tea or even hot water. 
 
 The temperature should always be taken after a 
 complaint of chilliness, and taken quite frequently, 
 as every hour or two, when, if it be found to be 
 rising, a note should at once be sent to the physi- 
 cian, who may want, under the circumstances, to 
 see the patient at once, or institute some new line 
 of treatment. Pain may be temporarily relieved by 
 the application of a hot flaxseed poultice. Grave 
 inflammatory and septic troubles are ushered in by 
 such symptoms as the above, hence no time should 
 be lost in notifying the physician of their occurrence. 
 
 The use of blisters, poultices, packs, vaginal injec- 
 tions, and medicinal remedies required in the treat- 
 
MANAGEMENT OF THE LYING-IN. 1 6/ 
 
 ment of the various forms of " puerperal fever" 
 must, of course, be in exact accordance with the 
 physician's directions. 
 
 Such troubles are generally septic, that is, arise 
 from blood-poisoning ; and one very important duty 
 of the nurse will be to see that the patient takes 
 sufficient nourishment to combat the poison in the 
 blood. 
 
 Stimulants should never be given without a physi- 
 cian's advice, but when ordered great care should be 
 exercised in their faithful administration. Egg-nog, 
 milk-punch, w 7 hiskey-punch, wine-whey, milk in the 
 various liquid and semi-liquid preparations, beef-tea, 
 broths, etc., will be called for. The nurse should 
 be ready with devices to tempt her patient to eat, 
 and thus give the most important aid to the arrest 
 of the disease. The support of the strength, with 
 extreme cleanliness and thorough antisepsis, will 
 do much to arrest the course of the terrible mala- 
 dies due to blood-poisoning. 
 
 The existence of any sores about the vulva or puerperal 
 vagina, when discovered by the nurse, should at u 
 once be reported to the doctor. These are espe- 
 cially dangerous when they take on a grayish sur- 
 face, as this indicates that they have already become 
 infected by poison. If the disease is not arrested 
 here, the whole system may be involved. 
 
 A swelling of one or both legs sometimes comes MUk-ieg." 
 
1 68 OBSTETRICAL NURSING. 
 
 on after delivery. It is ushered in by acute pain 
 and lines of redness accompanying the swelling — 
 the vessels of the groin, under the knees or in the 
 leg will often feel like cords. This is due to an 
 inflammation involving the veins. Sometimes blood 
 clots form in the veins, which may be dislodged and 
 carried to the heart and lungs, when they are the 
 source of the gravest danger. Sometimes abscesses 
 form in the leg. The great danger of clots being 
 carried in the blood current makes absolute quiet 
 imperative. The patient should lie flat on her back, 
 and the limb be elevated on pillows or on an inclined 
 plane, such as the fracture-box used in certain 
 fractures of the lower extremity. 
 
 The application of some soothing ointment, as 
 iodine and belladonna ointment in equal parts, over 
 the cord-like veins, a hot flaxseed poultice being 
 kept over the ointment, will help to relieve pain and 
 diminish inflammation. The whole limb should be 
 kept warm by a wrapping of cotton batting. The 
 limb is most comfortable when slightly bent at the 
 knee joint. Should the weight of the bed-clothing 
 cause pain, a cradle may be made of barrel hoops 
 for lifting them ofif the limb. The cradle is also 
 very useful in cases of peritonitis when the same 
 difficulty exists. 
 Bed-sores. Lying-in women should not be subject to bed- 
 sores, but should some complication occur, as in 
 
MANAGEMENT OF THE LYING-IN. 1 69 
 
 some form of blood-poisoning, or should some other 
 disease attack the patient during this time, necessi- 
 tating long lying, special care is necessary to pre- 
 vent bed-sores, The parts of the body subjected to 
 most pressure should be kept thoroughly dry and 
 rubbed with alcohol and alum (a saturated solution) 
 once or twice daily. A little cosmoline may then 
 be rubbed into the skin, or some drying powder, 
 as zinc or starch may be used. When a sore 
 occurs it must be dressed, according to the physi- 
 cian's order, with zinc ointment or cosmoline. All 
 pressure should be kept off it, if possible, by the 
 adjustment of pads and pillows or a rubber-ring 
 cushion. 
 
 Puerperal mania is a form of mental trouble which Puerperal 
 
 ... -ill mania. 
 
 may affect lymg-in patients, particularly when they 
 are exhausted from any cause, whether it be mental 
 worry or physical ill-health. In true mania the 
 patient may be violent and very difficult to 
 control. In the melancholic type of this trouble 
 she is exceedingly depressed, distrusts her best 
 friends, and cannot be roused to take an interest in 
 her surroundings. 
 
 As soon as it is noticed that the patient's mind is Removal of 
 not well balanced the baby should be removed from 
 the room, only being brought to the mother when 
 asked for. The nurse should then keep a close 
 watch over it, as one of the chief symptoms of this 
 
I70 OBSTETRICAL NURSING. 
 
 trouble is a strong aversion to the baby and desire 
 to destroy it. 
 ofwatcwuf- I* should never be forgotten that an insane pa- 
 ness - tient should not be left alone for a moment. The 
 
 insane are very cunning, and though apparently 
 asleep, may be but watching their opportunity to 
 indulge in some mad freak, as jumping out of the 
 window, dashing down the stairway and out of 
 doors, etc. The windows, therefore, should be in 
 some way protected. A nail or screw may be 
 driven into the window-casing so as to prevent the 
 raising of the sash, except so far as ventilation re- 
 quires. The door had best be kept locked, the 
 nurse keeping the key. 
 
 The treatment will mainly consist in keeping up 
 the nourishment and in kind, gentle, tactful man- 
 agement. The patient should be made to interest 
 herself in outside things, by the judicious turn given 
 to the conversation by the nurse, by engagement in 
 some kind of fancy-work, or in games which will 
 help to divert the mind. 
 
 She should not be crossed, neither should she be 
 deceived. The nurse should so manage her as to 
 inspire a thorough confidence and liking toward her 
 on the part of the patient. If she has not these, 
 she had best give up the case, as she will not be 
 able to help the patient. 
 
 Should the patient absolutely refuse to eat, the 
 
 Treatment. 
 
MANAGEMENT OF THE LYING-IN. 171 
 
 physician may direct the nurse to introduce the Forced, or 
 food into the stomach by means of a rubber tube feeding. 
 passed through the nostrils and down the oesopha- 
 gus, or gullet. Care should be taken to do no 
 injury in the introduction of this tube, which should 
 be well greased with cosmoline and made to follow 
 closely the direction of the passages it is made to 
 enter. A funnel is then connected with the outer 
 extremity, through which the milk or broth, etc., 
 may be poured into the stomach. 
 
 Should the patient be exceedingly restless and^ e a c H^ of 
 disposed to jump out of bed, to her own detriment, patient * 
 she may be fastened into the bed by means of a 
 sheet, doubled lengthwise, placed over the middle 
 portion of the body from the arm-pits to below the 
 knees and carried under the bed, to be fastened 
 either beneath the bed or to one side of it. The 
 feet may be bound together loosely at the ankles 
 by a piece of roller bandage and fastened to the 
 footboard of the bed. The hands may be bandaged 
 together (being placed the one on top of the other) 
 by means of a roller bandage, though this is not 
 necessary except when they are used to do herself 
 injury. Where patients are so violent as to need| 
 such restriction, however, it is better to have them forthe 
 removed to some institution for the insane as soon 
 as possible, where there is better provision made 
 for their management. The use of sedative reme- 
 
 Trans- 
 
 rence to an 
 institution 
 
 insane. 
 
172 
 
 OBSTETRICAL NURSING. 
 
 Protection 
 
 from 
 
 poisoning. 
 
 The first 
 sitting-up 
 after 
 delivery. 
 
 Subinvolu- 
 tion. 
 
 dies by the physician will generally prevent the ne- 
 cessity for resorting to such extreme measures for 
 confining the patient in ordinary cases. 
 
 Medicines should, of course, never be left in the 
 patient's room, even when the nurse is there, unless 
 under lock and key. The duration of this malady 
 varies from weeks to months, in some cases be- 
 coming chronic. Convalescence is generally very 
 gradual. Patients may have long periods of lucid 
 thought, and seem apparently well, only to unex- 
 pectedly return to their vagaries ; so that the nurse 
 should never relax her quiet vigilance while in 
 charge of the case. 
 
 The old, time-honored belief that a woman 
 should sit up on the ninth day is subject to many 
 exceptions, which should be understood by the 
 nurse as well as by the physician. The true gauge 
 is the progress of involution. This may be de- 
 termined by the height of the uterus (which ought 
 to sink behind the pubic bone before the patient is 
 allowed to sit up) and by the character of the dis- 
 charges. So long as there is any blood in the dis- 
 charge the patient should not sit up, for this is an 
 indication that involution, or the shrinking of the 
 womb is not going on properly. This condition is 
 known as " sub-involution," and if neglected may 
 lead to chronic disease of the womb. The use of 
 the recumbent posture, frequent hot injections 
 
MANAGEMENT OF THE LYING-IN. 1 73 
 
 given by the nurse, or medicines administered by 
 the physician, may be necessary to overcome it. 
 Let the patient understand the wisdom of her con- 
 finement to bed under such circumstances, and she 
 will generally yield gracefully to the necessity. 
 The first sitting-up should be in bed, the patient's 
 back being supported by a bed-rest. Should no 
 bed-rest be found in the house, a chair turned 
 upside down, with its back toward the patient, over 
 which a pillow is placed, offers a very good sub- 
 stitute. 
 
 After sitting up in bed for a day or two, from a 
 half-hour to an hour if there be no discharge, the 
 patient may have her flannel wrapper and stockings 
 and bedroom slippers put on, and be allowed to sit 
 up in an easy chair. It must be remembered that 
 this is the time when the patient will be most sus- 
 ceptible to cold, therefore every precaution must be 
 taken to prevent her exposure to draughts. Should 
 the patient seem to grow tired before the half-hour 
 or hour is up, she should be put back in bed. The 
 interval for sitting up may be gradually increased 
 from day to day, until she is up the greater part of 
 the day. No going up and down stairs should be 
 permitted until the physician sanctions it, which is, 
 in ordinary cases, about the fifth or sixth week, 
 when one such journey a day is generally per- 
 mitted. 
 
174 
 
 OBSTETRICAL NURSING. 
 
 Observance 
 of physi- 
 cian's 
 orders. 
 
 Order 
 board. 
 
 That there may be no misunderstanding between 
 physician and nurse, the orders of the physician in 
 every case should be immediately set down in 
 writing when given, so that by constant reference 
 to them the nurse may do her full duty by the pa- 
 tient. It is well, for this purpose, to have a piece of 
 paper ruled so that at the right side there shall be 
 two columns, one headed A. M., the other P. M. 
 The stated hours for the administration of medi- 
 cine or carrying out of treatment may then be 
 placed opposite the special directions for each, and 
 a pencil mark be drawn through the figure repre- 
 senting the hour when the matter has been at- 
 tended to. 
 
 An order board, as used in the Woman's Hos- 
 pital, is prepared as follows : — 
 
 Orders for Treatment of Mrs. Richards, Oct. ioth, 1891. 
 
 Full breakfast, dinner and supper, .... 
 A teaspoonful of medicine (light or dark). 
 
 Sponge bath, 
 
 Lunch of gruel or beef-tea, 
 
 Glass of milk at bedtime, 
 
 To sit up half an hour with bed-rest, . . 
 
 A. M. 
 
 6 
 
 6.30 
 
 10 
 
 9 
 
 P. M. 
 
 12, 6 
 
 I2.3O, 6.3O 
 
 3 
 8 
 2 
 
 Nurse's Name y 
 
MANAGEMENT OF THE LYING-IN. 1 75 
 
 A fresh board should be prepared for each day's 
 work. In ordinary cases, which run an uneventful 
 course, these boards, with the hours crossed off, 
 serve the purpose of a report as well. 
 
CHAPTER X. 
 
 Average 
 
 weight of 
 
 new-born 
 
 baby. 
 
 Average 
 
 length. 
 
 Peculiari- 
 ties of de- 
 velopment, 
 
 Skin. 
 
 " Baby 
 jaundice 
 
 CHARACTERISTICS OF INFANCY IN HEALTH 
 AND DISEASE. 
 
 A healthy baby, if born at full term, should 
 weigh 3250 grammes, or about 7 flbs. Its length 
 should be, on an average, 50 cm., or 20 inches. 
 
 The head and trunk of the child are developed 
 out of proportion to the limbs, so that the navel is 
 below the middle of the child's bodv. This greater 
 development of the upper part of the body is due 
 to the fact that in the womb this portion of the 
 child's body receives the greater amount of nour- 
 ishment. The subsequent growth consists largely 
 in the development of the lower limbs. 
 
 The skin of a newborn baby varies in color from 
 a pink to a decided red. The redness is more 
 marked in premature babies. From the third to 
 the fourth day this redness disappears, and the 
 tt peculiar yellowish tinge, known as " baby jaun- 
 dice," appears, as a result of the changes in 
 the circulation. This is not true jaundice. This 
 yellowish tinge of the skin should disappear by the 
 end of the second week. At the same time that 
 the skin begins to change color, from the third to 
 
 176 
 
FEATURES OF INFANCY IN HEALTH AND DISEASE. 1 77 
 
 the fourth day, it begins to scale or peel off. This 
 is most noticeable about the fifth day, and lasts 
 about sixteen days. 
 
 The baby's limbs should be plump and well- The form, 
 rounded. The abdomen is prominent, as compared 
 with the chest. 
 
 The shape of the head varies very much. At shape of 
 times it is perfectly rounded, again it will be elon- 
 gated and oval-shaped. 
 
 Pressure during labor, either from the walls of Effect of 
 the pelvis or as a result of the use of instruments, 1 "" 
 will cause at times considerable temporary distor- 
 tion in the shape of the head. To allay swelling 
 and prevent discoloration induced by bruising, 
 fomentations may be used, either of simple hot 
 water or hot water containing a little fluid extract 
 of hamamelis. 
 
 When there has been a good deal of pressure on 
 the baby's head during the birth, the bones will 
 sometimes override each other, and this will be 
 shown by elevations or ridges upon the baby's 
 head, which soon disappear when the head is no 
 longer subjected to pressure. These ridges, which 
 are converted into soft grooves on the removal of 
 pressure, indicate the separation between the dif- sutures. 
 ferent bones of the head, and are called " sutures." 
 The larger soft places are called " fontanelles." The Fontanels, 
 largest is on top of the head just above the fore- 
 12 
 
I78 OBSTETRICAL NURSING. 
 
 head. It is called the " anterior fontanelle," com- 
 monly known as " the opening of the head." It is 
 about large enough for the tips of two fingers to 
 cover, when of normal size, and is kite-shaped. A 
 much smaller three-cornered fontanelle is found at 
 the back of- the head and two behind the ears. 
 These very soon fill up with bone. 
 
 anterior The large anterior opening does not close entirely 
 until a child is about eighteen months of age. 
 Should it remain open longer, it is a sign of con- 
 stitutional weakness. In a healthy baby the sur- 
 face of this fontanelle should be on a level with the 
 
 Pulsation of surrounding bones of the skull. A slight pulsation 
 
 fontanelle. « . 
 
 may be noticed in it, due to the pulsation of the 
 blood vessels in the brain. Should the fontanelle 
 Depression fo Q mu ch depressed at any time, it would indicate a 
 fontanels. low state of v j ta ij ty< Care should be taken not to 
 Avoidance permit any undue pressure on this part of the baby's 
 of pressure - head, as the brain here lies very near the surface. 
 
 The fashion some old monthly nurses have of 
 trying to shape the head by the pressure of the 
 hands is dangerous, as the brain may be thus 
 injured. As the head bones are soft, the child 
 should not be allowed to lie too continuously on 
 either side or on the back, as this will cause flatten- 
 ing of the part pressed upon. 
 weigh g t esin For the first two days of a baby's life it loses 
 weight, but by the third day it begins to gain, and 
 
FEATURES OF INFANCY IN HEALTH AND DISEASE. 1 79 
 
 by the end of the first week it should weigh what 
 
 it did at birth. The average daily gain is 30 Average 
 
 daily gain. 
 
 grammes, about 1 oz. The following; facts con- 
 
 T rl 
 
 cerning the early changes in weight are obtained gain. 
 from Gregory : — 
 
 An infant born at full term weighs from 6 to 7 
 pounds, 7 pounds being an average weight. For 
 the first two or three days of life there is a loss of 
 4 ounces to 7 ounces, then a regular gain, so that 
 by the eighth to the ninth day the initial loss has 
 been made good. The following figures express 
 the average daily loss and gain during the first six 
 days of life : — 
 
 First day, . 
 Second day, 
 Third day, 
 Fourth day, 
 Fifth day, 
 Sixth day, 
 
 Loss of 139 grammes, or nearly 5 ounces. 
 " 64 " " 2^ ounces. 
 
 Gain of 33 " about I ounce. 
 
 " " \% ounces. 
 
 " " 1 3^ ounces. 
 
 " "15/ ounce. 
 
 (1 
 
 50 
 
 tt 
 
 50 
 
 a 
 
 36 
 
 The child's weight should be doubled in the fifth 
 month, and trebled in the twelfth month. The 
 baby should be able to hold up its head in the 
 sixteenth week, at the same time sitting up. It 
 should stand by the thirty-eighth week. It should 
 "take notice" and be able to grasp things by the 
 third to the fourth month. 
 
 It is important that a nurse should know the 
 
l80 OBSTETRICAL NURSING. 
 
 above facts as to the child's development, to be able 
 to report satisfactorily concerning its condition to 
 the physician in attendance. 
 
 sleep. A large proportion of the time of early infancy 
 
 is spent in sleep. The more premature the baby, 
 the more constantly does it sleep. During sleep 
 the eyelids should be tightly closed. A partial 
 separation of the lids, showing the whites of the 
 eyes, is an indication either of some disease, or of 
 pain, from whatever cause. 
 
 tions. c The respirations of a healthy baby when awake 
 
 may be very irregular, some inspirations being 
 shallow and others deep — at times hurried, and 
 again slow. The only time when the respirations 
 can be satisfactorily counted is when the child is 
 asleep, for then the breathing is more regular. The 
 rise and fall of the abdomen may then be noted 
 (for the breathing of an infant is abdominal). The 
 number of respirations in a minute average 44. So 
 quiet is the healthy breathing of early infancy that 
 there is no motion of the nostrils or of the lips, or 
 even of the chest, to indicate the incoming and out- 
 
 increasein going of air. Fever, colic and lung trouble will 
 
 respira- o » > c> 
 
 greatly increase the number of respirations in a 
 minute, making them mount up to 60 or 80, or 
 even higher. Nervous excitement has a similar 
 effect, though this is temporary. 
 
 In brain trouble, a slowing of the respirations 
 
 tions. 
 
FEATURES OF INFANCY IN HEALTH AND DISEASE. I 8 I 
 
 occurs, so that they may get down to 8 in a minute, slowing of 
 
 ttti i r i t • • r i respirations. 
 
 When the act of breathing is painlul a moan or cry Painful 
 
 . r ... ™ breathing. 
 
 accompanies each act of respiration, lhe expan- 
 sion of the nostrils with each inspiration indicates 
 a want of sufficient air space in the lungs. In con- 
 nection with any lung trouble a bluish coloration " is c ,? ano " 
 of the lips and face generally is a bad symptom, as 
 it indicates that sufficient air does not enter the 
 lungs to purify the blood. 
 
 Little reliance is to be placed upon the pulse of infantile 
 a baby as indicative of disease, for it is characteris- pu 
 tic of the infantile pulse that it is very rapid, very 
 easily affected by external or internal causes, and 
 notably irregular. The average pulse of the new- 
 born baby is 140. If a baby is well-nourished, it 
 is too fat to enable the pulse in the radial artery 
 to be counted. Hence the pulse is more easily 
 obtained in the temple, or at the ankle. If not 
 thus readily obtained, the heart beats may be 
 counted by holding the hand over the baby's heart. 
 The temperature of a child of this age is also Tempera- 
 subject to rapid changes, the result of slight ure " 
 causes. The average temperature is 99 Fahr., 
 but a cold or an attack of indigestion may cause 
 a sudden increase, with as sudden a return to 
 normal when the cause is removed. 
 
 A sub-normal temperature is an indication of Sub . normal 
 lowered vitality, the result of some drain upon the[^ era " 
 
182 
 
 OBSTETRICAL NURSING. 
 
 Symptoms 
 of lowered 
 vitality. 
 
 The 
 
 language of 
 a cry. 
 
 Of hunger. 
 
 Ear-ache. 
 
 Brain 
 trouble. 
 
 Lung 
 trouble. 
 
 Colic. 
 
 system, as of an exhaustive diarrhoea, or of some 
 constitutional weakness. This fall of temperature 
 is a dangerous symptom in infants. The tip of the 
 nose and the extremities of the child, if cold, also 
 indicate a condition of low vitality, and require that 
 the child should receive very especial care from the 
 nurse as to the supply of food and warmth. In 
 fever the back of the child's head feels very hot, as 
 also do the palms of the hands. The cries of a 
 child form a special language by which its needs 
 may be made known. Every nurse should learn to 
 distinguish the peculiarity in the different kinds of 
 cries, so as to meet the varying demands thus indi- 
 cated. A healthy, well-trained baby rarely cries, 
 unless hungry, when the cry will be constant and 
 very persistent until the want is satisfied ; the upper 
 part of the body is moved at the same time, espe- 
 cially the arms and head. The cry induced by ear- 
 ache is also unappeasable, and generally accom- 
 panied by a drawing of the hand up to the head. 
 A similar gesture accompanies the cry induced by 
 brain trouble, which is a shrill scream, often wak- 
 ing the child during sleep. 
 
 A cry accompanying a cough is an indication of 
 pain in the chest. The paroxysmal character of 
 colic is indicated by the characteristic cry which 
 accompanies it — a sharp, sudden cry — the limbs at 
 the same time being drawn up toward the abdomen. 
 
FEATURES OF INFANCY IN HEALTH AND DISEASE. 1 83 
 
 An evacuation of the bowels may precede or follow 
 the cry. 
 
 If, in nursing, a baby seizes the nipple by the Sore mouth. 
 mouth and drops it suddenly with a cry, doing this 
 repeatedly, there is in all probability some soreness 
 of the mouth, which should be discovered and 
 treated. However heartrending the cry, the baby Secretion 
 does not secrete tears until the third month of i n - oftears - 
 fancy. Hence the common saying, that a baby 
 cannot suffer pain because it sheds no tears while 
 crying, is not supported by fact. 
 
 A wrinkling of the forehead vertically, produced Facial 
 by drawing the eyebrows together, indicates pain 
 about the head. A sharpening or play of the nos- 
 trils exists in lung troubles. A draVvn look about 
 the mouth is found with digestive troubles, as flatu- 
 lent colic. The stools of a very young baby fed Bowel 
 on breast milk should be of a yellow or orange 
 color. Three or four evacuations a day are 
 natural. They should contain no curds. Stools of 
 bottle-fed babies are lighter and more offensive. 
 The number of times a new-born baby urinates urination, 
 will vary much with the weather and the conditions 
 under which the child is placed. It is not unusual 
 in cold weather for the napkin to need changing 
 almost every hour. • Healthy urine should not 
 stain the napkin. 
 
 movements. 
 
CHAPTER XI. 
 THE AILMENTS OF EARLY INFANCY. 
 
 i^fan n C y ion ° f ^ * s not proposed in this chapter to take up all 
 the ailments of infancy, for the term " infancy" 
 comprises a time beginning with the birth of the 
 child and lasting until the first dentition. 
 
 The obstetric nurse remains with the patient from 
 four to six or eight weeks. During this time many 
 deviations from the normal, healthy state may be 
 met with in the child, and these she should be quick 
 to observe and know how to manage. 
 
 Prematurity. One of the most important conditions of this 
 period is " prematurity," a result of the too early 
 birth of the child. 
 
 A premature birth is one that occurs at any time 
 after the child is " viable," that is, capable of living 
 
 viability, after its birth. The term of viability has been set 
 at twenty-eight weeks, or seven lunar months. 
 Deliveries occurring previous to this time are called 
 
 " miscarriages." 
 
 It may be that with improved methods of man- 
 agement, the period of viability may be placed at 
 an earlier date, but this is as yet a matter for proof.* 
 
 * The French claim that by means of gavage and the couveuse, 
 
 184 
 
THE AILMENTS OF EARLY INFANCY. 1 85 
 
 It has generally been conceded that a child born 
 at six lunar months cannot live, that at seven 
 months it stands little chance, that at eight months 
 its chances are better, and at nine still better. 
 
 The popular notion that an eight-month baby 
 (counting the calendar months) does not stand as 
 good a chance of living as a seven-month baby is 
 altogether wrong. Great care is needed for prema- 
 ture babies. They especially need regular feeding 
 and to be kept very warm. The skin being thin 
 and delicate, will also require very careful atten- 
 tion. 
 
 Until within a few years the matter of keeping The 
 the baby sufficiently warm was exceedingly difficult 
 to manage. The French invention of the " cou- 
 veuse," or " brooder," has simplified the matter 
 very much. It was first used in some of the French 
 lying-in hospitals in 1881. Since then it has come 
 into quite general use in France, being employed 
 even in private houses. Many different forms of 
 the apparatus now exist. The one most commonly 
 used in France is Tarnier's invention. This has 
 been used for some time with great satisfaction in 
 the Woman's Hospital, of Philadelphia. 
 
 It consists of a wooden box, whose interior is 
 divided into an upper and lower compartment. 
 
 or hatching-cradle, the actual period of viability has approached six 
 months of intra-uterine life, 
 
 couveuse. 
 
1 86 
 
 OBSTETRICAL NURSING. 
 
 There is a space about four inches wide at one 
 end of the upper compartment which communicates 
 with the floor below. Here two or three large 
 sponges on a wire stem are placed. The lid of the 
 box at the opposite end contains a chimney, in 
 which a helix rests on a pivot. 
 
 The upper compartment of the box is intended 
 
 Fig. 30. 
 
 Tarnier's Couveuse. 
 
 for the baby, in the lower end are several stone jars, 
 which are to be kept filled with very hot water. At 
 the end of the box furthest away from the open 
 space which communicates with the chamber above, 
 a register is fixed, which may be opened or closed 
 at will. The air enters through the register, is 
 heated by passing over the hot stone jars, moistened 
 
THE AILMENTS OF EARLY INFANCY. 1 8/ 
 
 by the wet sponges in the space between the upper 
 and lower chambers, and finds its exit from the 
 chimney, in which it keeps the little wheel revolv- 
 ing. The motion of this wheel indicates whether 
 the circulation of air within the couveuse is perfect 
 or not. A thermometer fastened to one side of the 
 interior of the box assists in the regulation of the 
 temperature, which should be kept at from 85 ° to 
 95 Fahr., according to the indications in each 
 case. A frame containing a pane of glass, forms 
 the top of the box. Through this the record of 
 the temperature and the condition of the child can 
 be watched.* 
 
 The following directions for the use of the cou- Directions 
 veuse are given by Dr. Auvard, who superintended 
 its introduction into the Maternite, at Paris : — 
 
 To keep up an even temperature, one of the 
 stone jars should be refilled every hour, hour and 
 a half, or two hours. 
 
 The apparatus being more difficult to heat when 
 it stands in a draught of air, it should be placed so 
 as to avoid this. 
 
 Should the temperature rise too high, the cover 
 may be slipped down a little, so as to allow of the 
 
 * Dimensions of couveuse for a single infant: Width, 36 cen- 
 timetres; length, 65 centimetres; height, 55 centimetres. For 
 twins, a larger case is necessary, which holds a correspondingly 
 greater amount of hot water. 
 
1 88 OBSTETRICAL NURSING. 
 
 entrance of air from above, or the inferior register 
 may be opened so as to admit a larger quantity of 
 air. The partial closure of the register so as to 
 admit less air, would help to raise the temperature 
 when it tends to fall below the desired point, as also 
 would the addition of hotter water to the jars. 
 
 The child should be placed in the upper com- 
 partment of the couveuse as in its cradle, being 
 removed simply for nursing, its bath and toilette. 
 When removed from the couveuse, care should be 
 taken to have the temperature of the room suf- 
 ficiently warm. Auvard sets this temperature at 
 6i.2°. We should be inclined to require a higher 
 temperature, as from jo° to 75 ° Fahr. 
 
 The length of time the child remains in a cou- 
 veuse will vary from fifteen days to three weeks, a 
 month, or even more. It should not be removed 
 permanently until it has acquired sufficient vigor to 
 live in the ordinary atmosphere of the apartment. 
 To accustom the child to this atmosphere, it should, 
 as it grows stronger, be removed for an hour at a 
 time from the couveuse during the warmest part of 
 the day. 
 
 It is best to continue the use of the apparatus at 
 night for some time after the child becomes accus- 
 tomed by day to removal from the couveuse, for the 
 danger of chilling from changes in the atmosphere 
 is greater at night. 
 
THE AILMENTS OF EARLY INFANCY. 1 89 
 
 Auvard recommends the use of the couveuse in 
 all cases where the vitality of the child is 
 enfeebled either by external causes, as cold, or 
 internal causes, as prematurity, congenital feeble- 
 ness, cyanosis, or " blue disease," wasting, or other 
 general maladies enfeebling to the new-born. 
 
 To overcome the difficulty in the management 
 of this couveuse, owing to the necessity for the fre- 
 quent removal of the hot water jars, Auvard has 
 devised an improvement, which is shown in Figs. 
 31 and 32. 
 
 A cylindrical reservoir of metal takes the place of 
 the hot-water jars in the lower compartment of the 
 couveuse. This reservoir is filled by means of a 
 metallic funnel fastened to one end of the box and 
 communicating with the cylinder through a metallic 
 tube. 
 
 The overflow of the cylinder is provided for by a 
 curved metallic tube at the lower part of the 
 cylinder beneath the inlet through which the 
 reservoir is filled. 
 
 The air enters by a register on one side of the 
 couveuse instead of at the end, as in Tarnier's 
 apparatus. The other portions of the apparatus are 
 the same as Tarnier's. 
 
 The metallic cylinder is capable of holding ten 
 litres of liquid (a litre is a little over a quart). To 
 start the apparatus, about five litres of boiling 
 
190 
 
 OBSTETRICAL NURSING. 
 
 water should be poured in, after which three litres 
 may be poured in every four hours. When ten 
 litres are contained in the cylinder,*the overflow- 
 pipe carries off the excess. Auvard suggests 
 having two vessels, capable of holding three litres 
 
 Fig. 31. 
 
 Auvard's Couveuse (Interior View). 
 
 each, keeping one under the escape-pipe and the 
 other over the fire, reheating the water in the vessel 
 filled by the escape-pipe and having it in readi- 
 ness for the next change. The two vessels may 
 
 * Archives de Tocologie. 
 
THE AILMENTS OF EARLY INFANCY. 
 
 I 9 I 
 
 be thus used alternately, and but little time con- 
 sumed in the heating of the apparatus as compared 
 with that required in the use of Tarnier's inven- 
 tion. 
 
 To empty the cylinder, a rubber tube is attached 
 to the escape-pipes, by which it is made to act as a 
 
 Fig. 32. 
 
 Auvard's Couveuse (Exterior View). 
 
 siphon — a small quantity of water poured into the 
 cylinder through the funnel being sufficient to start 
 the liquid. 
 
 Before the couveuse was known premature 
 babies were swaddled in cotton, in order to be kept 
 
Cotton 
 swaddling. 
 
 192 
 
 OBSTETRICAL NURSING. 
 
 sufficiently warm. The directions for doing this 
 are as follows : — 
 
 Take a square baby-blanket and place it diagon- 
 ally on the table or bed. Turn down one corner 
 for four inches distance, to come up over the 
 baby's head. Spread over this blanket a lap of 
 raw cotton. Have the baby's napkin and binder 
 on and a flannel undervest. Make a cap out of 
 the cotton, fitting it over the baby's head and 
 
 Fig. 33. 
 
 Swaddled Baby. 
 
 bringing it down well under the chin. Then roll 
 the baby up in the cotton lap. Bring the blanket 
 around this firmly, so as to hold it ; the portion of 
 the blanket on the baby's right being brought over 
 and tucked in on the left side, the portion on the 
 left being correspondingly folded over toward the 
 right. The corner of the blanket left at the feet is 
 then folded up over the front, and the whole held 
 in place by means of a strip of muslin bandage or 
 
THE AILMENTS OF EARLY INFANCY. 1 93 
 
 ribbon. The bandage is first applied beneath the 
 chin, crossed under the back, again crossed in 
 front, the ends being brought forward to fasten in 
 a bow-knot at the feet. 
 
 The great disadvantages of this method may be 
 seen in the restriction it gives to the movements 
 of the child's limbs and the difficulty of determining 
 when the child's napkin needs changing, also the 
 frequent exposure of the child during these changes 
 to the ordinary atmosphere. 
 
 The skin of a premature baby should be well Protection 
 
 . r . , .. of skin. 
 
 greased alter every bath, or some oil, as cotton or 
 sweet oil, may be used, and will serve the double 
 purpose of protecting the skin and giving nourish- 
 ment by absorption. 
 
 The child should be fed every hour. As it is Food. 
 usually too weak to suck, it is safer to feed the 
 baby with a spoon or with a dropper, to make sure 
 of its obtaining a sufficient amount of food. From 
 one to two teaspoonsful should be given every hour. 
 Breast milk is, of course, the best. It may be 
 drawn from the mother's breast and fed to the 
 child while warm. The nurse should introduce 
 her little finger into the child's mouth and allow 
 the milk to trickle slowly down the finger, so as to 
 enter the mouth drop by drop, while the child 
 sucks the finger. Should the mother have no milk, 
 the first week's feeding recommended by Dr. Starr, 
 
 J 3 
 
194 OBSTETRICAL NURSING. 
 
 or sterilized peptonized milk diluted two-thirds 
 with boiled and filtered water, should be used — if 
 no wet-nurse can be had as a substitute. 
 Gavage. Should the baby drink badly and throw up a 
 
 large proportion of the liquid given to it, " gavage " 
 may have to be resorted to. The physician must 
 authorize the nurse to carry this out, for she should 
 never undertake it otherwise. The directions for 
 practicing gavage, as given by Dr. Louis Starr, are 
 as follows : — 
 
 The apparatus used is quite simple, being nothing 
 more than a urethral catheter of red rubber (No. 
 14-16, French), at the open end of which a small 
 glass funnel is adjusted. The infant upon whom 
 gavage is to be practiced is placed on the knee, 
 with its head slightly raised ; the catheter, being 
 wet, is introduced as far as the base of the tongue, 
 whence, by the instinctive efforts at swallowing, it 
 is carried as far down as the oesophagus (or gullet) 
 and into the stomach. 
 
 The liquid food is next poured into the funnel, 
 and by its weight soon finds its way into the 
 stomach. After a few seconds the catheter must 
 be removed, and here is the great point in the 
 operation ; it must be removed with a rapid motion 
 and at once, for if it be withdrawn slowly all the 
 food introduced will be vomited. 
 
 Mother's milk is the best for gavage, as at any 
 
THE AILMENTS OF EARLY INFANCY. 1 95 
 
 time, but other kinds of food may be used. The 
 amount given and the number of meals will vary 
 with the age and strength of the child. From a 
 teaspoonful to a dessertspoonful at one time is 
 sufficient for a very young child, given every hour. 
 Too much food would produce indigestion. As the 
 child grows stronger this mode of feeding may be 
 made to alternate with nursing. Diluted sterilized 
 milk peptonized may be used for the alternate 
 feedings. 
 
 Colic is a very troublesome affection of infancy, colic. 
 It corresponds to the dyspepsia of grown people, 
 and indicates that the food is either improper in 
 quality or quantity. A colicky cry is a sudden, 
 sharp cry, the baby drawing up its feet and legs at 
 the same time. The feet are generally cold, and 
 one indication for treatment is to warm them ; warm 
 socks or woolen stockings should be worn, or hot 
 bottles applied to them. 
 
 The abdomen should also be kept warm by thecounter- 
 
 . r -in 1 • i • irritation 
 
 application of heated flannels, or a spice poultice and 
 wrung out in hot whiskey, or a flaxseed poultice, 
 and kept applied until the baby gets relief. 
 
 To make a spice plaster, a teaspoonful each of s p i ce 
 ground allspice, cloves, cinnamon, ginger, and cay- paster 
 enne pepper, with four teaspoonfuls of flaxseed meal, 
 may be quilted into a bag of flannel, 4x8 inches, 
 which will fit entirely over the baby's abdomen. 
 
inunction. 
 
 Anise seed 
 tea. 
 
 I96 OBSTETRICAL NURSING. 
 
 When the spicy smell is lost the plaster is no longer 
 good for use. 
 P u Warm oil rubbed gently in over the abdomen for 
 
 ten to fifteen minutes at a time, will often give relief 
 by leading to the expulsion of the wind causing the 
 pain. 
 
 If the application of heat is not sufficient, 
 anise-seed tea should be given. It is made as 
 follows : — 
 
 Over a half-teaspoonful of anise-seed pour a half- 
 teacupful of boiling water. Allow it to steep a 
 few minutes, until the water tastes strongly of the 
 anise-seed. A half-teaspoonful of this may be given 
 warm, every ten minutes, until the baby has had 
 four doses. This brings up wind from the stomach, 
 and thus gives relief. Simple hot water will help 
 in the same way should anise-seed not be on hand. 
 Catnip tea may be made and used according to the 
 same directions. These teas are preferred to the 
 drop-doses of gin so frequently given. 
 Frequent Frequent stools do not always indicate diarrhoea. 
 For the first six weeks of its life a child averages 
 three or four movements every twenty-four hours, 
 after which it has about two a day until it is two 
 years old. 
 
 A natural passage for an infant would be of a 
 mushy consistency and a yellow or orange color. 
 It should contain no curds. Bottle-fed babies have 
 
 stools. 
 
THE AILMENTS OF EARLY INFANCY. 1 97 
 
 whiter and more offensive stools than breast-fed 
 babies. 
 
 In diarrhoea there is a change in consistence or 
 appearance. A liquid stool, or one colored green, 
 or white, or like putty would be abnormal. The 
 presence of curds also would show an inability to 
 digest the food properly. 
 
 If, therefore, these curds exist in the stools, or the j^° d !>f C food. 
 matters vomited be curdy, the indication would be 
 to use some alkali or a small quantity of some 
 thickening substance, as barley-water, gelatine, or 
 one of the prepared foods intended to serve the same 
 purpose, or the milk may be peptonized. 
 
 Lime-water is the alkali most usually employed. Lime-water. 
 Lime-water contains but about half a grain of lime to 
 the fluidounce of water, so that at least a third of 
 the feeding should be lime-water where it is used to 
 correct indigestion. To make lime-water a piece of 
 lime about the size of the fist should be placed in 
 an earthen vessel ; about three or four quarts of water 
 may be poured over this, strained thoroughly, and 
 then allowed to settle. The water should be used 
 only from the top of the vessel. It is better to filter 
 it before use. The vessel may be kept filled with 
 water so long as any of the lime remains in it, when 
 it will be necessary to add more lime. 
 
 When lime-water cannot be obtained, a small 
 powder of baking soda — three or four grains — may 
 
I98 OBSTETRICAL NURSING. 
 
 be added to the nursing-bottle. These rules apply 
 when the baby is artificially fed. Should the baby be 
 nursing the breast a teaspoonful oflime-water mixed 
 with an equal quantity of boiled and filtered water 
 may be given it before each time it is put to the 
 breast. 
 
 Of the thickening substances used to help in the 
 
 Barky- digestion of food, barley-water is one of the best. 
 To make barley-water a gill of boiling water should 
 be poured over a teaspoonful of washed pearl bar- 
 ley, freshly ground in a coffee-mill and boiled for a 
 quarter of an hour, then strained. It should be 
 mixed with milk in the proportions required, two- 
 thirds, a half, or one- third. 
 
 Gelatine. Gelatine is sometimes used instead of barley- 
 water. A piece an inch square of plate gelatine is 
 put into a half tumblerful of cold water and allowed 
 to stand about three hours. This may then be 
 turned into a teacup and set in a pan of hot water 
 and boiled. The gelatine thus dissolves, and when 
 allowed to cool, forms a jelly, of which one or two 
 teaspoonsful may be added to a feeding. 
 
 £foods'» Of the various kinds of " infant's food," those in 
 which the starch has been made into dextrine or 
 grape sugar are the best. " Mellin's Food " and 
 " Horlick's Food " belong to this class. A tea- 
 spoonful of these dissolved in a little hot water — 
 about a tablespoonful — may be added to the milk 
 
THE AILMENTS OF EARLY INFANCY. 1 99 
 
 for the feeding. These starch foods cannot be well 
 borne by a child before it is five or six months old, 
 as a rule.* 
 
 Condensed milk contains a large proportion of condensed 
 sugar, hence tends to make fat. It is not as nour- 
 ishing as many other forms of food. Babies fed on 
 it, though large, are generally far from strong, and 
 are very apt to suffer from indigestion. 
 
 A careful regulation of the diet, as suggested by ^ 1 r ; s Broom " 
 Dr. Anna Broomall, for the early weeks of infancy, dietar y- 
 with the addition of barley-water, lime-water or 
 gelatine as indicated, in place of plain water, has 
 been found most satisfactory in the care of infants 
 in the Woman's Hospital. The use of water alone 
 as a diluent is preferred. 
 
 Constipation is not an infrequent occurrence in Constipa- 
 infancy. Its management consists principally, in 
 the use of mechanical irritants for stimulating the 
 bowels ; thus a soap suppository, an injection of 
 warm oil or water, gentle friction over the bowel, 
 especially following the direction of the large bowel 
 from right to left, are among the most effective 
 methods for overcoming this condition. 
 
 The soap suppository is made by taking a piece 
 
 * The prepared foods are not to be recommended, notwithstanding 
 their efficacy in certain cases. Made by the quantity — their com- 
 position is of necessity often uncertain, and they must frequently be 
 stale as obtained for use. 
 
200 
 
 OBSTETRICAL NURSING. 
 
 of Castile soap, about one inch long, and shaping it 
 into a cone and making it very smooth, so that it 
 will not be larger around than the end of the little 
 finger. This should be gently insinuated about 
 half its length into the bowel and held in the open- 
 ing until it excites the bowel to act. 
 
 Fig. 34. 
 
 Single-bulb Syringe (Starr). 
 
 The bowel injection may be given by means of 
 the single-bulb syringe, known as the " eye and 
 ear syringe." The bulb holds about two table- 
 spoonsful of liquid. This may be warm cotton-seed 
 oil, sweet oil, or warm water. The nozzle used 
 
THE AILMENTS OF EARLY INFANCY. 201 
 
 should be small, smooth and well oiled. It should 
 be very carefully introduced into the bowel, being 
 directed a little to the left side, and the bulb gently 
 squeezed to force the contents into the bowel. It 
 is best that the liquid should be retained for a little 
 time before it is forced out. The keeping up of a 
 slight pressure over the entrance to the bowel for a 
 short time will aid this. 
 
 Rubbing the abdomen for about ten minutes 
 (either with or without oil) in the direction of the 
 large bowel — that is, upward on the right side as 
 far as the border of the ribs, then across to the left 
 side and down this side to the pelvis, is often 
 efficient. 
 
 Of medicinal measures, glycerine, gluten or cocoa- 
 butter suppositories may be resorted to, or manna 
 may be given, a piece the size of a pea in the 
 child's milk one, two or three times a day, or a 
 spoonful of water sweetened with dark-brown sugar. 
 Should the child be on artificial food, oatmeal-water 
 may be substituted for barley-water in the prepara- 
 tion of the food. 
 
 Babies vomit very easily, because their stomachs vomiting, 
 are placed more vertically in the body than when 
 they grow older, and over-feeding will cause them 
 to bring up the amount in excess of what the stom- 
 ach can hold. This vomiting is, of course, not 
 serious. Should the vomited matter be sour and 
 
202 OBSTETRICAL NURSING. 
 
 curdy, the child seem to suffer from nausea, weak- 
 ness or fever, it indicates a condition of indigestion 
 which should receive attention. The management 
 would largely consist in the regulation of the 
 quality and the quantity of the food, as has just 
 been said. 
 
 Thrush. Thrush is a disease due to want of care of the 
 
 baby's mouth. If milk be allowed to collect on 
 the tongue, it sours, and the presence of this acid 
 favors the development of thrush, which is really 
 a vegetable parasite. White patches may be seen 
 on the soft palate, inside the cheeks, lips and 
 tongue. The attempt to rub off these patches 
 causes bleeding. Gastric catarrh and diarrhoea 
 usually accompany this trouble. Care in cleansing 
 the child's mouth after each nursing, will prevent 
 the occurrence of thrush. Its treatment consists 
 in the use of an alkaline wash, as borax and water 
 (twenty grains to the ounce), or some antiseptic 
 wash prescribed by the physician. 
 
 "Redgum." " R ec j g um " j s an eruption which comes out over 
 the baby in the first or second week of its life. 
 Sometimes these little points of elevation on the 
 skin are white. The eruption is then called " white 
 
 " White 
 
 gum." gum." These eruptions are due to changes in the 
 skin and irritation from exposure to air, and are not 
 serious. They rarely last over a week. 
 Blisters. The occurrence of little blisters on the child's 
 
THE AILMENTS OF EARLY INFANCY. 203 
 
 body, especially on the palms of the hands and 
 soles of the feet, is a matter of more moment and 
 should at once be brought to the attention of the 
 physician, as also should sores around the finger 
 nails. These indicate a condition of the blood for 
 which the use of remedies prescribed by the phy- 
 sician will be necessary. 
 
 Sometimes a whitish, glairy discharge comes from Leucor- 
 
 . ** 7 & rhcea,"the 
 
 the privates of little girl babies. This is simply the whites." 
 matter found there at birth. Occasionally a little 
 blood may be mixed with it, the result of an abra- 
 sion in the vagina, and may last a day or two. The 
 nurse need not be afraid to remove this matter ; 
 in fact, if left, it causes irritation of the skin. 
 
 A healthy baby usually wets its napkin very fre- urine, 
 quently. It may be every hour during the day, 
 and four or five times at night. Sometimes several 
 hours may pass and yet the napkin remain dry. 
 Either of these conditions may exist in health, 
 being dependent largely upon the weather, the food, 
 etc. If urine is not passed for twelve hours, the 
 condition should be reported. 
 
 The nurse may try to make the baby urinate by 
 using fomentations over the bladder and kidneys 
 before reporting the matter to the physician. 
 
 The skin of new-born babies is soft and thin, and care of 
 
 skin in ex- 
 
 apt to become sore, especially when two surfaces conations. 
 rub. First, a little crack is noticed, next day this 
 
204 OBSTETRICAL NURSING. 
 
 will have widened until, sometimes, a large surface 
 is left bare. To prevent this, proper care of the 
 baby from the very beginning is important. Never 
 use soap. Use warm water in washing it, either 
 plain warm water or water with sufficient powdered 
 borax to make it soft, and wash the part very care- 
 fully ; wipe or mop carefully with a soft cloth. 
 Then, to prevent further rubbing of the parts, par- 
 ticularly if the skin be broken, use a piece of patent 
 lint or soft Canton flannel, with some salve, as zinc 
 ointment, containing 20 grs. of boric acid to the 
 ounce, spread over it, and carried into the crease 
 between the rubbed surfaces. This should be 
 changed at least three times a day, or as often as 
 the baby soils the napkin. 
 Sore eyes. Baby's sore eyes generally come about from some 
 infection of the eyes through the mother's dis- 
 charges at the time of the birth, or in lying-in hos- 
 pitals one baby infects another. Hence, should care 
 be taken to cleanse the eyes immediately after the 
 delivery with a saturated solution of boric acid, or 
 even clean warm water, they may be prevented, as 
 a rule, from getting sore. Should the inflammation 
 occur, however, the nurse must remember that the 
 affection is contagious, through the matter which 
 forms in the eye. This matter is capable of setting 
 up an inflammation elsewhere, as when a towel 
 used about the eyes may produce a similar inflam- 
 
THE AILMENTS OF EARLY INFANCY. 2C>5 
 
 mation about the privates ; a scratch or wound in 
 the hands may be affected by it. The discharge 
 from affected eyes is greenish white. The poison it 
 contains is not destroyed by drying ; it catches and 
 clings to the room, as the poison of smallpox. 
 Hence, a nurse's hands should be thoroughly 
 cleansed after washing the eyes, and the nails 
 cleaned with a nail-brush. The cloths used in wash- 
 ing the eyes should be burned at once after using. 
 The greatest precautions must be taken not to 
 carry the poison. The nurse's chief care, apart from 
 preventing the spread of the trouble, in such a case, 
 would be to keep the eye or eyes free of the dis- 
 charge by frequent cleansings with warm water 
 gently syringed into the eye from the inner toward 
 the outer angle, the lids being held everted by their 
 gentle separation by the thumb and finger of one 
 hand. This w r ashing may need to be done every 
 hour. The baby's hands should be kept down by 
 fastening a towel around the child's body, pinning 
 it in the back. The baby may be held between the 
 nurse's knees and its head inclined over a basin, 
 which will receive the water from the washing. 
 Another basin should contain the clear water to be 
 used. Should only one eye be sore, in placing the 
 baby in its crib, or laying it down at any time, the 
 nurse should be careful to place it with the sore 
 eye down, so that any discharge from it may not 
 
206 
 
 OBSTETRICAL NURSING. 
 
 Snuffles. 
 
 Discharge 
 from ears. 
 
 Enlarge- 
 ment of 
 breasts. 
 
 enter the other eye. Any further irritation, as of a 
 strong light, should be prevented by keeping the 
 baby in a darkened place. Want of attention in 
 these cases may cause a child the loss of its sight. 
 A room occupied by a baby with sore eyes must 
 afterward be carefully disinfected. 
 
 Snuffles, or a cold in the head, shown by watery 
 eyes, sneezing, stopping up of the nose, hence diffi- 
 culty in nursing, should be managed by keeping 
 the nose cleaned out by means of soft linen twisted 
 into a cone, greasing the nose well afterward with 
 a little oil by carrying it up the nostrils on a twist 
 of cotton, greasing the outside of the nose between 
 the eyes, and keeping the baby warm. If the baby 
 has no hair, the head may be kept warm by a little 
 mull, or in winter thin flannel, cap. 
 
 Running at the ears is generally very serious in 
 new-born babies, especially when the discharge is 
 matter or blood. Some trouble with the brain may 
 be indicated, hence the physician should be told of 
 it as soon as it is noticed. Of course, the discharge 
 entering the ears at the time of the birth should be 
 carefully excluded from this disorder. The breasts 
 of new-born babies often swell. Generally this 
 occurs about the seventh day or during the second 
 week. Occasionally they gather, and must then be 
 lanced by the physician. Nothing should be done 
 for this swelling, except to see that the clothing is 
 
THE AILMENTS OF EARLY INFANCY. 207 
 
 loose. It disappears in a few days, as a rule. The 
 
 same may be said of swellings on the head orJ^ ldin s° f 
 
 about the face, which are due to pressure during 
 
 the birth. One form of scalp tumor may last sev- f^ ISt 
 
 eral weeks before its entire disappearance. The 
 
 latter is the result of temporary injury to the bone, 
 
 and not simply the ordinary swelling which comes 
 
 from interference with the circulation of the blood 
 
 in the soft tissues of this portion of the scalp. 
 
 A child maybe born with some deformity, as^ e e s formi - 
 hare-lip, or cleft-palate, or club-foot, or there may 
 be some malformation about the external organs of 
 generation or the bowel. Whatever the deformity 
 may be, the nurse should avoid letting the mother 
 know anything about it until the physician has told 
 her of it. The shock produced by the knowledge 
 may do the mother much injury; hence the phy- 
 sician should bear the responsibility of making the 
 announcement. A nurse will need considerable 
 tact in managing this, as the mother is apt to ask 
 to see her baby very soon after its birth. An ex- 
 cuse may be made by stating the necessity for 
 washing and dressing the child first, or it may be 
 asleep and the nurse hesitate to disturb it. 
 
 Quite frequently the bridle beneath the baby's Tongue-tie. 
 tongue is too short, and interferes w T ith the free 
 movement of the tongue. This is called " tongue- 
 
208 OBSTETRICAL NURSING. 
 
 tie." It may prevent the child's nursing, and thus 
 interfere with its nutrition. If the baby can extend 
 the tip of the tongue beyond its lips, it is not prob- 
 able that there will need to be anything done, as 
 the baby ought to be able to suck a good nipple 
 with ease. If the nurse should introduce the tip 
 of her little finger into the baby's mouth and allow 
 the child to draw on it for a few minutes, she can 
 tell whether the act of sucking can be properly ac- 
 complished. Should it not be able to suck, the 
 attention of the physician should be called to the 
 matter, as the bridle will have to be nicked — an 
 operation following which there may be consider- 
 able loss of blood, hence it should not be attempted 
 except by a physician. 
 from d thf Bleeding from the cord or navel string may 
 cord ' occur within a few hours after birth. It may be 
 that the cord has not been tied sufficiently tight, or 
 there may have been a very thick cord, which, in 
 shrinking, has loosened the ligature. If, after tying, 
 the cord has been looped, back upon itself and tied 
 in a single double bow-knot, this may be untied by 
 the nurse and fastened more tightly, so that the 
 bleeding may be controlled, or another ligature 
 may be thrown around the cord a little nearer the 
 body of the child than the first one. Should this 
 not check the hemorrhage, the nurse should hold 
 
THE AILMENTS OF EARLY INFANCY. 2O9 
 
 the cord firmly between thumb and finger, making 
 compression until the physician, who should be 
 sent for, arrives.* 
 
 The cord commonly falls off about the fifth day. "/ailing" 
 
 J of cord. 
 
 The process of ulceration, by which it falls off, 
 leaves an open surface on the child's body which 
 offers an avenue for septic infection. Great care 
 should therefore be taken that the nurse's hands 
 and anything else that comes in contact with this 
 surface are perfectly clean. Should any moisture 
 exist about the stump, the use of the antiseptic 
 powder of salicylic acid and starch, before spoken 
 of, or some other drying-powder of the kind, is 
 indicated. It is necessary, also, to see that the 
 dressing used is thoroughly antiseptic. When infec- faction of 
 tion does exist, it shows itself in the occurrence of nave1 ' 
 inflammation around the navel, or some other part 
 of the body ; the child loses flesh, becomes puny 
 and emaciated, and abscesses form in various places. 
 In the majority of cases it dies, not having suffi- 
 cient vitality to survive the poisoning. 
 
 The physician will, of course, prescribe the treat- 
 ment for such a child; the nurse will be required 
 
 * Bleeding from the base of the stump after the cord has fallen 
 is a more difficult condition to manage. The physician needs 
 sometimes to control the hemorrhage by a ligature drawn beneath 
 transfixion pins. The nurse must keep up pressure over the site " 
 until the doctor comes. 
 
 14 
 
2IO OBSTETRICAL NURSING. 
 
 to see that these directions are faithfully carried out, 
 and especially that the child gets all the nourish- 
 ment and stimulation required, 
 jaundice of j± peculiar yellowish coloration of the skin is to 
 
 infancy. x J 
 
 be noticed with babies a few days after the birth. 
 This disappears, as a rule, by the end of the second 
 week, and is due to changes in the circulation. 
 
 Should the jaundice be very marked and seem to 
 persist, warm baths once or twice a day, with gentle 
 friction over the liver with soap liniment, helps, 
 with free action of the bowels, to overcome the 
 condition. 
 
 When the child is suffering from blood-poisoning, 
 the peculiar coloration of the skin is due to this 
 cause. 
 Convulsions. Convulsions may occur in very young infants at 
 varying periods after their birth, according to the 
 cause which excites them, as, injury during labor, 
 indigestion, brain trouble, or other causes. The 
 convulsive seizure is generally preceded by twitch- 
 ings of the limbs, a rolling-up of the eyeballs, so 
 that a large part of the whites of the eyes is seen, 
 the thumbs are drawn into the palms of the hands, 
 and the fingers tightly clasped over them, or the 
 toes may be turned upward or drawn downward. 
 During the convulsion the child grows rigid. 
 
 When the attack comes on the nurse should 
 quickly undress the child and place it in a warm 
 
THE AILMENTS OF EARLY INFANCY. 211 
 
 bath. A tablespoonful of mustard added to the 
 water will help to stimulate the skin, and the con- 
 vulsion will gradually subside. The child, on its 
 removal from the bath, may be wrapped in a heated 
 blanket, and allowed to perspire freely. On the 
 recurrence of the convulsion, the same measure of 
 placing the child in the bath should be resorted to, 
 until the physician comes and institutes such other 
 treatment as he may think proper. 
 
 Bruises, the result of falls or blows, should be Bruises. 
 treated by the repeated application of hot com- 
 presses. This will relieve pain and prevent swell- 
 ing, and the black and blue coloration of the skin 
 which would otherwise result. 
 
 The occurrence of a fall or blow should be care- Falls and 
 
 blows. 
 
 fully reported by a nurse, as the child should be 
 carefully examined for the discovery of any injury, 
 the serious consequences of which may be averted 
 by prompt treatment. The occurrence of paleness 
 or vomiting after any such accident is a serious 
 symptom and should receive immediate attention 
 by the physician. 
 
 A hot, dry skin may accompany various of the Fever, 
 disorders of infancy, notably inflammatory condi- 
 tions of the digestive organs and of the lungs. 
 The normal temperature of a new-born baby is 
 99 Fahr., the pulse 140, the respiration 44. 
 
 Should the child seem to be ailing, its tempera- 
 
212 OBSTETRICAL NURSING. 
 
 ture should be taken. A clinical thermometer may- 
 be held the requisite number of minutes in the 
 groin or in the folds of the neck. Some slip the 
 bulb of the thermometer into the rectum. Should 
 the temperature be raised, the pulse rapid and the 
 
 doubles, respiration hurried and difficult, some lung trouble 
 probably exists. A catch in the breath, noisy 
 breathing, a distention of the nostrils on taking an 
 inspiration, would indicate the same thing. The 
 frequent rubbing of the chest with some counter- 
 irritant liniment, as St. John Long's liniment, the 
 use of the cotton-jacket for the protection of the 
 chest, and, if the child is very feverish, the use of a 
 drop of sweet spirits of nitre in a teaspoonful of 
 water once in three hours, will constitute the nurse's 
 management of the case until the doctor has seen 
 the baby and laid down his plan of treatment. The 
 
 jacket! cotton-jacket is made by taking a high-necked, long- 
 sleeved merino vest a size or two larger than would 
 be needed by the baby for ordinary wear, opening 
 it down the front, and fastening tapes an inch or 
 two from each edge in front, by which the jacket 
 may be closed. The inner surface of this vest, 
 back and front, should be quilted with sheep's wool 
 or cotton-batting, the outer surface with oiled silk 
 or oiled muslin. This makes a very warm covering 
 for the chest. 
 
 Cyanosis, or " blue disease," comes from the 
 
THE AILMENTS OF EARLY INFANCY. 21 3 
 
 imperfect closure of an opening which exists in Cyanosis or 
 
 " blue 
 
 the heart before birth. The baby is called a "blue disease." 
 baby," and is very delicate in consequence of this 
 imperfection in its circulation. Such babies gener- 
 ally die, if not during infancy, some time during early 
 childhood. With great care they sometimes live, 
 and the opening in the heart gradually closes up. 
 The special care required is to keep the child warm 
 and to handle it very carefully, so that it may be 
 subjected to no jar or nervous fright. The child 
 should be kept lying on its right side, or on its 
 back, in order that there may be as little interfer- 
 ence as possible with the action of the heart, and 
 that the tendency of the blood to flow through this 
 opening in the upper chambers of the heart — from 
 right to left — may be overcome. 
 
 Rickets is a disease of the bones — the result of Rickets, 
 poor nutrition. There is not sufficient deposit of 
 earthy matter in the bones, hence they remain too 
 soft and are subject to all kinds of distortions in 
 consequence of this. The child may be bow-legged 
 and is stunted in its growth, curvatures of the spine 
 may exist, or an unnaturally large head, known as 
 hydrocephalus, or " water on the brain." 
 
 The baby having this disease is very weak, can- 
 not hold up its head well, perspires very freely, 
 especially about the head. The complexion is very 
 
214 OBSTETRICAL NURSING. 
 
 white. The baby has constant trouble with its 
 bowels, having green stools nearly all the time. 
 The opening in the front of the head is depressed 
 and the child seems to waste. 
 
 As the baby grpws older, unless well cared for, 
 the evidences of disease increase, the joints are 
 enlarged, the baby cannot support itself on its 
 limbs, its teeth are slow in coming, etc. 
 
 The mother can do much for the health of her 
 child while still carrying it, by a careful regard for 
 her own general health. After the baby's birth it 
 should be kept well nourished, to overcome any 
 tendency to this disease. Salt baths, oil baths, and 
 the use of tonics ordered by the physician, as cod- 
 liver oil, together with careful attention to the 
 quality and quantity of nourishment, will do much 
 to prevent the progress of rickets. 
 tTon C msh The q ues tion often arises as to how soon a baby 
 
 should be vaccinated, particularly if smallpox be 
 prevalent. As a matter of experience, it is found 
 that the vaccination does not " take " well before 
 the third month, though, if a younger baby is to 
 be exposed to the poison, it would be well to have 
 it vaccinated. Vaccination should be avoided, if 
 possible, when the baby's health is run down from 
 any cause, also at the time of teething. A peculiar 
 and distressing form of rash sometimes occurs, or 
 
THE AILMENTS OF EARLY INFANCY. 215 
 
 there is a great deal of inflammation following the 
 vaccination, leading the parents to imagine that the 
 baby has been poisoned by the virus used. 
 
 An insight into the frailty of human life in its t^ „ 
 
 J world s 
 
 earliest days proves how much the world owes to debtto 
 
 J L nurses and 
 
 the faithfulness of mothers and nurses for the exist- mothers - 
 ence of its great and good men and women, and 
 should be a stimulus to scientific research in the 
 discovery of improved methods for the manage- 
 ment of infancy. 
 
INDEX TO MARGINAL HEADINGS 
 
 Abdominal binder, 25, 38 
 
 bandages, 48 
 Absence of physician during labor 
 
 83 
 
 Accidents of pregnancy, 41-46 
 
 of labor, 83-100 
 Afterbirth, delivery of, 93, 94 
 
 care of, 80 
 After-pains, 162-164 
 Ailments of early infancy, 184-2 1 5 
 Albuminuria, 26 
 Analysis of human and cow's 
 
 milk, 119 
 Anise-seed tea, 196 
 Antisepsis during labor, 68, 69 
 Antiseptic dressings (Garrigues'), 
 
 49> 5o 
 precautions after labor, 95, 
 141-143 
 Apparatus for sterilization of milk, 
 
 128, 129 
 Arrangement of patient's clothing 
 
 during labor, 76 
 Articles needed in confinement 
 room, 53, 75 
 for baby's basket, 58, 74 
 Artificial breathing, 86-91 
 
 feeding, 1 18-135 
 Average length of a new-born 
 
 baby, 176 
 Average weight, 176 
 Avoidance of pressure of foetal 
 
 head, 178 
 Auvard's couveuse, 1 90-1 9 1 
 
 Bag of waters, 62 
 Bandaging breasts, 151-160 
 Barley water, 198 
 Bathing after delivery, 142-143 
 
 during pregnancy, 38 
 
 of the new-born infant, 101- 
 103 
 Bearing-down pains, 63, 77 
 Bed-sores, 168, 169 
 Bichloride of mercury, 68 
 Binder (infant's), 105 
 
 abdominal, 81 
 Bladder during lying-in, 143 
 
 during pregnancy, 24-26 
 Bleeding from cord, 208, 209 
 Blue disease, 212, 213 
 Bowel movements of infancy, 183, 
 
 196, 197 
 Breast bandages, 49 
 Breast pumps, 155 
 Breasts, care of, 1 48-1 62 
 Breech delivery, 95 
 Brown line of pregnancy, 19 
 Bruises, 211 
 Blisters, 202, 203 
 
 Caked breast, 153, 154 
 
 Call for nurse, 65 
 
 Carbolic acid solution, 69 
 
 Care of third stage of labor, 94, 
 
 95 
 of afterbirth, 80, 136 
 of breasts in pregnancy, 32 
 
 217 
 
218 
 
 INDEX TO MARGINAL HEADINGS. 
 
 Care of infant at birth, 85 
 of napkins, 106 
 of the new-born infant, 101- 
 
 135 
 
 of new born infant's eyes 
 
 and mouth, 107 
 of perineum, 83 
 
 Catheter, use of during lying-in, 
 143-146 
 
 Caul, 86 
 
 Cessation of menstruation, 17 
 
 Changes of clothing, 73, 74 
 
 in urinary organs during preg- 
 nancy, 24-26 
 in weight of infant, 108, 109 
 
 Characteristics of infancy, 176 
 
 Chemilette, 34 
 
 Chill, 166 
 
 Cleansing of baby's eyes, 80 
 of mother after labor, 80 
 of nursing-bottle, 133 
 of physician's hands, 71 
 of rubber nipple, 133 
 
 Closure of fontanelle, 178 
 
 Clothing during pregnancy, 33- 
 
 38 
 Colic, 182, 195, 196 
 Colostrum, 113 
 Company, 78, 138 
 Condensed milk, 199 
 Cone-shaped nipple, 150 
 Confinement room, 47 
 
 outfit, 70 
 Constant flow of milk, 162 
 Constipation, 22, 147, 198-201 
 Convulsions, 45, 46, 98 
 
 of infancy, 210, 211 
 Cooking for lying-in patients, 140, 
 
 141 
 Cotton jacket, 212 
 Couveuse, 1 85-1 91 
 Cramps during labor, 78 
 Creoline, 68 
 Cross-bed, 99 
 
 Cream, proportion of in milk, 1 17 
 Cry, in brain trouble, 182 
 
 in colic, 182 
 
 in lung trouble, 182 
 
 of earache, 182 
 
 of hunger, 182 
 Cyanosis, 181, 212,213 
 
 Daily airing of infant, 135 
 Deepened color of vulva, 18 
 Deformities of new born, 207 
 Delivery of head, 84 
 
 of body, 85 
 Demeanor of nurse, 98 
 Depressed nipple, 151 
 Depression of fontanelle, 178 
 Descent of child, 59 
 Development of breasts, 18 
 Diarrhoea, 23, 197 
 Diet during pregnancy, 39 
 Dietary of lying-in, 138- 141 
 Discharge from ears, 206 
 Divided skirt, 34 
 Double Y bandage of breasts, 157— 
 
 159 
 
 Drawing of teeth during preg- 
 nancy, 31 
 
 Dressing of cord, 104 
 
 Dry labor, 45 
 
 Effect of menstruation on lacta- 
 tion, 118 
 
 of pregnancy on lactation, 118 
 Emergencies of labor, 8^ 
 Enlargement of abdomen, 18 
 Equipoise waist, y] 
 Etherization during labor, 100 
 Examination by physician, 70 
 
 of urine, 26 
 Excessive acidity of urine, 25 
 Excoriation of vulva, 25 
 1 Exercise during pregnancy, 40 
 
INDEX TO MARGINAL HEADINGS. 
 
 219 
 
 Expulsion of afterbirth, 64 
 
 of child, 64 
 Expulsive after pains, 163 
 
 Facial expression in infancy, 183 
 False pains of labor, 60 
 Feeding of infant, ill 
 
 of premature infant, 193, 194 
 Fever of infancy, 211 
 Figure~of-8 of breast, 152, 153 
 First sitting up after pregnancy, 
 
 172, 173 
 
 Flannel underwear, 38 
 
 Fomentations, 154 
 
 Fontanelles, 178 
 
 Food recipes, 126, 127 
 
 Forced feeding in puerperal mania, 
 
 171 
 Fore milk, 113 
 Form of new-born baby, 177 
 Fruit diet during pregnancy, 39, 
 
 40 
 Frequent stools, 196 
 
 Garrigues' breast bandage, 154 
 
 Garters, 36 
 
 Gathered breasts, 160 
 
 Gavage, 194, 195 
 
 Gelatin, 198 
 
 Gertrude suit, 56, 57 
 
 General rules for feeding, 123, 124 
 
 Graduated nursing bottle, 132 
 
 Handkerchief bandage of breast, 
 
 156, 157 
 Hemorrhage after labor, 95-9 7 
 during pregnancy, 41, 42 
 from rupture of varicose veins, 
 
 Hemorrhoids, 28, 60 
 Hollow nipple, 151 
 Hygienic dressing, 35-38 
 
 Improvised sterilizing apparatus, 
 
 Incontinence of urine, 24 
 Infancy, 184 
 Infant's binder, 54 
 
 blanket wrap, 56 
 
 caps, 56 
 
 clothing, S 3-5 7 
 
 crib, 109 
 
 flannel slip, 55 
 
 foods, 198, 199 
 
 socks, 107 
 
 under-vest, 54, 107 
 Injuries, 211 
 Insufficient milk, 162 
 Intra-uterine injections, 163, 164 
 Involution, 141 
 Irritability of bladder, 24 
 
 Jaundice of infancy, 176, 210 
 
 Kidneys during pregnancy, 26 
 Knitted wool band, 54 
 
 Lactation, 113, 115 
 Lactometer, 116 
 Lancing of breasts, 161 
 Language of a cry, 182 
 Lateral position during labor, 8^ 
 Laxatives during lying-in, 147, 148 
 Leglettes, 35 . 
 
 Length of new-born baby, 176 
 Leucorrhcea, 27 
 
 of infancy, 203 
 Lime-water, 197 
 Lochia, 141 
 Lung trouble, 212 
 Lying-in, duration of, 141 
 
 Management of lying-in, 136, 175 
 of pregnancy, 22, 40 
 
220 
 
 INDEX TO MARGINAL HEADINGS. 
 
 Mask of pregnancy, 19 
 
 Mastitis in infancy, 206, 207 
 
 Meconium, 106 
 
 Message to physician, 67 
 
 Methods of reckoning termination 
 of pregnancy, 20 
 
 Microscopic examination of milk, 
 118 
 
 Milk, cow's, 118 
 
 human, 114, 115 
 characteristics of cow's, 118 
 determination of fat in, 117 
 preparation of, 120, 122 
 
 Milk-leg, 167, 168 
 
 Miscarriages, 43, 44 
 
 Modification of infant's food, 197 
 
 Morning sickness, 19 
 
 Mother's dress during labor, 48 
 
 Moulding of head of new-born 
 infant, 206, 207 
 
 Mushroom nipple, 150 
 
 Napkins, after care of, 142 
 
 changes of, 142 
 
 for infant, 54 
 
 for mother, 49 
 Nightingale wrap, 51, 5 2 
 Nipple bath, 32 
 
 protector, 32, ^ I S° 
 
 shape of, 1 50-15 1 
 
 shield, 148-149 
 Nipples, 1 31-134 
 
 care of, during the lying-in, 
 148-15 1 
 
 sore, 148 
 Nourishment during labor, 77 
 Nurse dress, 65 
 
 report, 1 64-166 
 Nursing, 113 
 
 bottle, 1 31-133 
 • 
 
 Observation of pains, 67 
 Obstetrical breast support, 159 
 
 Occlusion dressing, 49, 50 
 Odors in lying in room, 136 
 Oil, enema, 147, 148 
 
 inunctions, 196 
 Order board, 174, 175 
 Outfit for baby, 54-57 
 Over-distention of bladder, 26 
 
 Pain during lying-in, from disten- 
 tion of abdominal walls, 30 
 
 in back during pregnancy, 30 
 Painful breathing, 181 
 Pains of first stage of labor, 63 
 Peptonization of milk, 124-126 
 Perineal pad, 50 
 Perineum, care of, 84 
 Position during second stage of 
 labor, 8^ 
 
 third stage of labor, 93 
 Positive signs of pregnancy, 20 
 Powder, 103 
 Premature rupture of membranes, 
 
 44, 45, 62 
 Prematurity, 184 
 Preparations for labor, 47-58 
 
 for obstetrical operation, 98- 
 100 
 
 of antiseptic solution, 68 
 
 of confinement room, 71 
 
 of double bed, 72 
 
 of patient for labor, 67-70 
 
 of permanent bed, 71 
 
 of single bed, 71 
 Pressure on foetal head, 177 
 Probable signs of pregnancy, 17 
 Process of labor, 61-64 
 Prolapses, 98 
 Protection of the bed during labor, 
 
 52 
 of floor during labor, 52, 73 
 Puerperal fever, 166, 167 
 mania, 169-172 
 ulcers, 167 
 
INDEX TO MARGINAL HEADINGS. 
 
 221 
 
 Pulsation of fontanelle, 178 
 Pulse of infancy, 181 
 
 Quantity of food required for in- 
 fants, 124 
 Quickening, 20 
 
 Rapid labors, 83 
 
 Red gum, 202 
 
 Respirations of infancy, 180, 181 
 
 Resuscitation of infant, 86-91 
 
 Rest for lying-in patient, 136 
 
 Retention of urine, 24 
 
 Rickets, 213, 214 
 
 Rise of temperature during lying- 
 in, 166 
 
 Rubber nipples, 131-133 
 
 Rules for sterilization of milk, 
 128-131 
 
 Rupture of uterus, 98 
 
 Salivary glands during pregnancy, 
 
 Scalp tumors, 207 
 
 Schultze's method of resuscitating, 
 
 89-91 
 Sea-voyaging during pregnancy, 
 
 39 
 Second stage of labor, 61 
 Secretion of tears in infancy, 183 
 Securing of maniacal patients, 1 7 1 
 Septic infection of navel, 209, 210 
 inflammation of breasts, 160 
 Serious symptoms during lying-in, 
 
 166 
 Shape of new-born baby's head, 
 
 177 
 Signs of approaching labor, 59, 60 
 
 of pregnancy, 17 
 Skin of new-born baby, 176, 193 
 Sleep after delivery, 136 
 
 of infancy, 180 
 Snuffles of infancy, 206 
 
 Soiled clothing after labor, 136, 
 
 137 
 Sore eyes of infancy, 204, 205, 206 
 
 mouth, 183 
 
 nipples, 148 
 Spasmodic after-pains, 164 
 Spice-plaster, 195 
 Stages of labor, 61, 83 
 Sterilization of milk, 1 28-1 3 1 
 Stimulants, 76 
 
 Straight bandage of breasts, 157 
 Striae, 1 9 
 
 Subinvolution, 172, 173 
 Suspicious signs, 17 
 Sutures, 177 
 Swaddled baby, 192 
 Swelling of breasts of infancy, 206 
 
 of extremities, 28, 5.9 
 
 of vulva after delivery, 146 
 Sylvester's method of resuscita- 
 tion, 87, 88 
 Symptoms of lowered vitality, 182 
 Syringe, 53 
 
 single bulb, 200 
 System, 73 
 Suppositories, soap, 200 
 
 Tact, 78 
 
 Tarnier's couveuse, 186 
 
 Teeth during pregnancy, 30 
 
 Temperature of infancy, 181, 182 
 
 of infant's, food, 127 
 Temporary bed, 71, 72 
 Testing milk, 116 
 Third stage of labor, 61 
 Thrush, 202 
 Time required for feeding infants, 
 
 134 
 Tongue-tie, 207, 208 
 Training of infants, in 
 Treatment of caked breasts, 153- 
 
 of puerperal mania, 170 
 
222 
 
 INDEX TO MARGINAL HEADINGS. 
 
 True pains of labor, 60 
 Twins, 93 
 Tying of cord, 92 
 
 Union undergarment, 35 
 Urination in infancy, 183, 203 
 Use of catheter, 26, 143-146 
 
 Vaccination, 214 
 Vaginal injections, 81 
 Ventilation, 135 
 Vernix caseosa, 101-102 
 
 Viability, 184, 185 
 Visitors during lying-in, 138 
 Vomiting during labor, 77 
 of infancy, 201 
 of pregnancy, 31 
 
 Wash dresses, 66 
 Weighing the baby, 108 
 Weight of new-born baby, 176 
 Wet nurse, 113 
 Wharton's jelly, 105 
 White gum, 202 • 
 
CATALOGUE No. 7, 
 
 AUGUST, 1891. 
 
 A CATALOGUE 
 
 OF 
 
 Books for Students. 
 
 INCLUDING THE 
 
 ? QUIZ-COMPENDS ? 
 
 
 CONTENTS. 
 
 
 
 PAGE 
 
 
 PAGK 
 
 New Series of Manuals 
 
 >, 2,3,4,5 
 
 Obstetrics: . 
 
 . IO 
 
 Anatomy, 
 
 . 6 
 
 Pathology, Histology, . 
 
 . II 
 
 Biology, 
 
 
 II 
 
 Pharmacy, . 
 
 . 12 
 
 Chemistry, . 
 
 
 6 
 
 Physiology, . 
 
 . II 
 
 Children's Diseases, 
 
 
 7 
 
 Practice of" Medicine, . 
 
 II, 12 
 
 Dentistry, 
 
 
 8 
 
 Prescription Books, 
 
 . 12 
 
 Dictionaries, 
 
 
 8 
 
 ?Quiz-Compends ? . 
 
 *4» 15 
 
 Eye Diseases, 
 
 
 9 
 
 Skin Diseases, 
 
 . 12 
 
 Electricity, . 
 
 
 9 
 
 Surgery, 
 
 • x 3 
 
 Gynaecology, 
 
 
 IO 
 
 Therapeutics, 
 
 . 9 
 
 Hygiene . 
 
 
 9 ' 
 
 1 Urine and Urinary Organs, 13 
 
 Materia Medica, . 
 
 
 ■ 9 
 
 Venereal Diseases, 
 
 • *3 
 
 Medical Jurisprudence 
 
 
 IO 
 
 
 
 PUBLISHED BY 
 
 P. BLAKISTON, SON & CO., 
 
 Medical Booksellers, Importers and Publishers. 
 
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THE NEW SERIES OF MANUALS. 
 
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 SECOND EDITION. 
 
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 Evelina Hospital for Children ; Asst. Phys. to 
 Guy's Hospital, London. Second American Edition. 
 Edited and Rearranged by Louis Starr, m.d., Clinical 
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 pital, Phila. Containing many new Prescriptions, a list 
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 No. 7. MEDICAL JURISPRUDENCE AND 
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6 STUDENTS' TEXT-BOOKS AND MANUALS. 
 
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STUDENTS' TEXT-BOOKS AND MANUALS. 11 
 
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12 STUDENTS' TEXT-BOOKS AND MANUALS. 
 
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STUDENTS' TEXT-BOOKS AND MANUALS. 13 
 
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 published separately. 16 Lithograph Plates, New- 
 Tables and 117 other Illustrations. By Samuel O. L. 
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 cisco. 
 
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 Medicine in Jefferson Medical College, Philadelphia. In two parts. 
 
 Part I. — Continued, Eruptive and Periodical Fevers, Diseases 
 of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, 
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 lished. 
 No. 4. PHYSIOLOGY, including Embryology. Sixth 
 
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 Penn'a College of Dental Surgery ; Demonstrator of Physiology 
 
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 with new Illustrations. 
 
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BLAKISTON'S ? QUIZ-COMPENDS ? 
 
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 unomcinal remedies. By Samuel O. L. Potter, m.a., m.d., 
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 Cooper Medical College, San Francisco. Improved and Enlarged, 
 with Index. 
 
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 No. 9. SURGERY, Minor Surgery and Bandaging. Illus- 
 trated. Fourth Edition. Including Fractures, Wounds, 
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 Diseases of the Spine, Ear, Bladder, Testicles, Anus, and 
 other Surgical Diseases. By Orville Horwitz, a.m., m.d., 
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 and Enlarged. 84 Formulae and 136 Illustrations. 
 
 No. 10. CHEMISTRY. Inorganic and Organic. For Medical 
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 and Rewritten, with Index. 
 
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 of Pharmacy." By F. E. Stewart, m.d., ph. g., Quiz-Master 
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 to the Dental student. By Geo. W. Warren, d.d.s., Clinical 
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JUST PUBLISHED. 
 
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 Small octavo, 520 pages, Half-Dark Leather, . $3.25 
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