impossible for the probable date of confinement to

be calculated according to the rule laid down in the preceding paragraph (as,

for example, when the date of the last menstruation is uncertain, or when one

pregnancy succeeds another so quickly that menstruation has not been re-established in the interval), it may be approximately arrived at by reckoning it as

four and one-half months after the date of " quickening."

MANAGEMENT OP PREGNANCY: General Rules— Constipation — Piles — Hardening the Nipples — Swollen Breasts—

Varicose Veins— Falling Forward of the Womb — Obstinate

Vomiting — DiflB-Culty in Passing Urine, &c.

Proper Treatment of Pregnancy. — The proper treatment of pregnancy consists for the most part in paying increased attention to the laws of

health.

A pregnant woman requires a full allowance of rest, and should

therefore be careful to avoid late hours.

She should take plenty of outdoor

exercise whenever the state of the weather permits; and, while avoiding all

unnecessary strain, such as the lifting of heavy weights, or reaching things

DB. CHASETS RECIPES

280

m

from a height, she may engage

the lighter duties of her house, not only

without risk, but with actual gain of health and strength. Her food should be

taken with the utmost regularity, and should be plain and simple in its nature.

Good new milk should form a considerable part of her every-day diet. Stimulants are entirely unnecessary, except when taken under special medical

direction.

As the abdomen enlarges it is of the utmost importance that the clothing

foolish regard for appearances has led many a woman

should not be tight.

into most lamentable mistakes on this point.

A

During pregnancy the mind should be attended to as well as the body.

is to be carefully guarded against, and distressing

All unnatural excitement

sights are to be especially shunned.

Action of the Bowels. — Great care must be exercised to ensure a daily

An excellent plan is to set apart a certain hour of the

day for attending to this function, whether the desire for relief be urgent or

not.

Perhaps the most convenient time for most people is immediately after

breakfast.

By following this simple rule, a habit is established which will go

action of the bowels.

far to obviate the necessity for aperient medicine.

When such medicine is

required, it should be of the simplest possible kind; for example, a compound

rhubarb pill, or a little castor-oil.

When constipation is associated with piles,

the aperient chosen should be a tea-spoonful of sulphur in a

little milk every

morning, or a similar quantity of the compound liquorice powder made into a

paste by mixing a little water with it; and the patient should be instructed to

make her daily visit to the water-closet immediately before retiring to bed for

the night.

is

By these means the aching pain which, under such circumstances,

apt to follow every action of the bowels, may be considerably diminished.

Injecting half a pint of cold water into the bowel, immediatly before the

bowels are moved, often proves highly serviceable. Should the piles become

inflamed or unusually painful, the patient must keep her bed for a day or two,

and bathe the parts with warm water from time to time. Where these measures are required, however, the medical attendant should be consulted.

The nipples, especially in first pregnancies, should be hardened by bathing

them daily during the last month or two with a mixture of equal parts of eaude-Cologne and water, in order to render them less liable to crack and become

sore and painful on the application of the child.

Inflammation and abscess

of the breast often originate in cracked nipples.

—

Sore Breasts.

When the breasts become swollen and painful, they

should be frequently fomented with flannels wrung out of hot water, and, in

the meantime, should be supported, as in a sling, by a broad handkerchief pass-

ing under the arm of the affected side and over the opposite shoulder.

Sometimes the veins of the

thighs, and lower part of the body

Under these circumstances, the patient

legs,

become swollen and uncomfortable.

should lie down as much as possible every day, and at once discontinue the

use of tight garters.

In women who have borne many children, the abdominal walls are apt to

become relaxed, and the pregnant womb, being insufficiently supported, is

I^UMSmG.

281

then in danger of falling forward, so as not only to produce deformity, but to

prove a hindrance during labor, A flannel binder, or one of the abdominal

belts sold for the purpose, should in these cases be constantly worn during the

daytime.

Now and then the sickness, already alluded to as a common accompaniment of the early months of pregnancy, becomes so troublesome and incessant

Under such circumstances consult a

as to cause serious loss of strength.

physician.

The Urine. — Towards the end of pregnancy it is not at all unusual for

some difficulty in passing urine, and for the desire to pass it to

become very frequent. Should these symptoms, however, occur during the

earlier months, and especially during the third and fourth, a medical man

should be consulted; as they may be due to a displacement of the womb,

which requires immediate attention.

Troublesome heartburn, diarrhoea, palpitation, persistent neuralgia, salithere to be

vation, itching or swelling of the external parts, swelling of the face or ankles,

all

require prompt attention, and if severe, the personal care of the medical

attendanto

UTERINE HEMORRHAGE DURING PREGNANCY:

Its

Usual Significance and Temporary Treatment — Placenta

Prse via — Precautions after Previous Abortions Treatment

—

after Miscarriage.

Uterine Hemorrhage, or a discharge of blood from the womb, during pregnancy, is usually a sign that miscarriage is threatening, and hence

In summoning a doctor under these cirrequires prompt medical attention.

cumstances it is always desirable to send a note, rather than a verbal message,

and to state clearly the nature and urgency of the case. Meantime an endeavor should be made to restrain the hemorrhage by causing the patient to

lie down, with the head low and a pillow under the hips, by admitting plenty

of cool, fresh air into the room, and by ensuring perfect quietness.

If possible, the services of

a trained nurse should be obtained at once, and

she, with perhaps one other person, should alone remain in the room.

Cloths,

dipped in cold water or in vinegar and water, must be applied to the external

genitals for a few minutes at a time, the application being frequently repeated.

If wet cloths are kept on for a longer period, they are sure to become warm,

and so, by acting as a poultice, defeat the object in view, and indeed tend

rather to increase than to check the flow of blood. When the hemorrhage continues, or becomes very profuse, the nurse must not hesitate to send for the

nearest doctor as well as for the ordinary medical attendant.

In such cases it

will be desirable for her to take a dry napkin or two, and, having folded them

in the form of a pad, to press them forcibly against the external genitals and

hold them there. All the discharges, whether solid or fluid, should be care-

fully retained for the inspection of the medical attendant

DR.

382

CEA8W8 RECIPES.

These alarming hemorrhages are often brought about by accidents, such

But when flooding first

makes its appearance, at the seventh month or later, and there has been no

as blows or falls, or by the lifting of heavy weights.

such accident to account for it, the probability is that the case is one of placeMa

namely, over th^

frmvia, in which the after-birth is in an unusual position

mouth of the womb, constituting a very dangerous complication. The temporary treatment of flooding due to this condition in no way differs, however,

—

from that already described.

When previous pregnancies have been cut short by miscarriage, it is very

necessary that the greatest precautions should be observed to avoid the repetition of such

an accident.

Now, we know from experience, that miscarriages

are most apt to take place at those times which, in the absence of pregnancy,

would have been the ordinary menstrual pr riods. It is on these occasions,

therefore, that preventive measures are most needed and most likely to be

Every month, then, during the time that the patient would, under

useful.

other circumstances, have been unwell, she should maintain the recumbent

posture, if not in bed, at any rate on a couch.

If this simple rule were attended

many a miscarriage would be averted.

A woman known to be liable to

to,

abortion should, moreover, be specially careful to avoid

causes;

all its

most common

she should abstain from exciting entertainments, violent exercise,

fatiguing or rough journeys, strong purgative medicines, and exposure to cold.

And, lastly, as it is very doubtful whether any of the causes I have named are

suSicient in themselves to bring on abortion, without a predisposition thereto

from some local or general weakness or disease, it is very desirable that patients

who have formed the so-called "habit"' of aborting, should consult their medical attendant at the commencement of pregnancy with a view to being placed

under a regular course of treatment.

The after-treatment of patients who have miscarried is a most important

matter, and one which receives far too little attention. It is no uncommon

thing among patients of the laboring and middle classes for women to go about

their ordinary duties as early as the second or third day, and some do not even

rest for more than a few hours.

Now, although this neglect of proper precaution may not result in any immediate ill-effects, it frequently lays the

foundation of chronic disease with much attendant misery and suffering.

Whenever nurses have an opportunity they should tell their patients what

there is in store for them if they resume their ordinary duties too soon after

such an occurrence. No absolute rule can be laid down as to the length of

time during which rest is necessary; it depends so entirely on circumstances

Thus, in a caje of abortion during the early

months, for instance, where the loss has been small and the health has not

suffered, four to six days' absolute rest in bed, followed, during the next ten to

fourteen days, by the greatest care and prudence, will, in the absence of special

directions from the medical attendant, be generally found sufficient.

When

the health is unaffected it becomes very irksome to lie in bed for the time here

indicated; nevertheless, this rule cannot be neglected without running grave

that vary in different cases.

risk.

NURSING.

283

Should the pregnancy be further advanced, or the circumstances less

Where there has been

severe or long-continued flooding, a patient is frequently reduced to a conditioi:.

of weakness quite equal to that following an ordinary confinement. In such

favorable, a longer period of rest will be required.

cases it is only reasonable to expect the same care to be exercised as after a

labor at full term.

On no account should a patient leave her bed, after a miscarriage, 3o long

as any discharge of blood continues, as, while that persists,

it

is

uncertain

whether there is not some portion of the after-birth or membranes still remaining in the womb, and rendering the patient liable to further attacks of flooding.

PROCESS OP NATURAL LABOR:

Signs of Approaching

Labor — Its Division into Stages — Labor- Pains,— The "Bag

of Waters " — Description of First Stage — Of Second Stage

— Of Third Stage.

Approach of Labor Pains. — Towards the latter part of the ninth

month, certain changes take place which give warning that labor is not far off.

One of the earliest of these is sinking of the abdominal swelling; the upper

end of the womb, which at the beginning of the ninth month, reaches as high

as the pit of the stomach, now falls a little below that point.

Great relief to

the breathing follows this alteration, as the pressure upon the organs within

the chest is thereby greatly lessened.

On the other hand, owing to this change

in the position of the womb, certain new inconveniences arise from the pressure

of its lower portion on the various important parts contained in the pelvis.

Thus, walking becomes more difficult, the bladder requires relieving more frequently, and piles are apt to form.

A sign that makes

it

probable that labor is actually about to commence is

the appearance of a slight discharge of mucus, streaked with a little blood.

This is spoken of, in the lying-in room, as the "show."

Ijabor is Divided, for the Sake of Description, into Three

Stages. 77ce first of these is called the stage of dilatation of the mouth of

the womb; the second lasts from the moment when that dilatation is completed

—

up to the birth of the child; while the third, or last stage, includes the time

from the birth of the child to the coming away of the after-birth, or placenta.

The so-called pains of labor are, in reality, contractions of the muscular

wall of the womb.

At the early part of labor they are slight, occur at long

abdomen;

as labor advances, they become longer and more energetic, follow one another

more quickly, though always with a certain regularity, and are generally felt

chiefly in the back and loins.

Each pain is comparatively feeble at its commencement, increases in intensity until it reaches its height, and then gradually

intervals, and are felt mostly in the lower part of the front of the

passes

off.

This character, together with the regularity of their recurrence,

serves to distinguish pains really due to uterine contraction

other pains, for which they are sometimes mistaken.

from colicky and

DR. CHASE'S RECIPES.

i384

The bag of waters consists of

the

membranous coverings of the foetus,

enclosing within them what the doctors call, the liquor amnii, in which the child

During pregnancy this fluid serves to preserve the child from injury;

floats.

during labor it forms a pouch at the mouth of the womb, which it acts upon

Experience tells us that, when the

liise a wedge, and so assists in dilating.

waters escape early, labor is rendered more tedious. The explanation of this

is to be found in the fact that the bag of waters, being round and even, and

pressing on the mouth of the womb {os uteri) equally all around, the mouth of

the womb is opened out more rapidly and easily by this even pressure than by

the uneven surface of the presenting part of the child.

As the OS uteri opens, and the end of the first stage draws near, the pouch

formed by the protruding membranes is pushed further into the front passage,

or vagina, and, the pains becoming more violent, the membranes at last give

way during a pain more severe than the rest, and so the waters escape. In

natural labors this usually happens as soon as the mouth of the womb is fully

opened and thus Wlq first stage of labor is ended.

The head of the child now begins to pass through the os uteri.

After a

certain time, usually much shorter than that occupied

by the first stage, it

reaches the vaginal opening, through which it gradually escapes, and thus the

child is born, and the second stage is completed.

The pains of the first stage are called " grinding pains," and are different in

character from those of the second stage, which are known as "forcing" or "bearing pains." The cry which is called forth by the pains during the first stage is

also different from the groan which escapes from the patient when the pains of

the second stage commence. An experienced nurse knows from this circumstance alone that the first stage is over, and as the sending for the doctor ought

on no consideration whatever to be delayed beyond this period, it is a point of

great practical importance.

The pains now become stronger and more frequent; the patient, holding

her breath and bearing down at each return of the pain, becomes hot and

At the end of each pain

flushed, and breaks out into a profuse perspiration.

the head of the child goes back a little, which prevents the strain from being

so continuous as to be hurtful and exhausting. Nevertheless, almost every

pain marks an advance upon the one preceding. This slight withdrawal of

the head is frequently perceived by the patient herself, and unless explained

to be natural and necessary, is apt to make her think she is not making any

progress.

There eventually comes a point, however, when the head is so far

expelled that it no longer recedes between the pains. The intervals become

shorter, and the pains more severe, until at last the head slips out altogether,

and then the most painful part of the labor is over. The uterus usually now

Then the face of the child makes a little turn towards one

rests for a moment.

of the patient's thighs, generally the right, in order that the shoulders may be

brought into such a position that they may pass with the least difficulty. With

another strong pain the shoulders are expelled. The rest of the body gives

little trouble,

for no part of

it is as broad

as those which have already passed^

If^UESlNO.

285

The contractions of the womb now cease for a short time, varying from

when a little pain is again felt, and the after-

five to ten or twenty minutes,

birth and membranes are discharged, along with a small quantity of blood,

with which a few clots are generally mixed.

Such is a brief account of the order of events in a perfectly natural labor.

DUTIES OP A NURSE DURING LABOR— Articles Needed

in the Lying-in Room — Preparation of the Bed— Personal

Clothing of Patient — Number of Persons in the Room

Caution in Conversation— Attention to the State of the

Bladder — Food — Vomiting — Cramp Fomenting the Per-

—

ineum in First Labors.

If the nurse is not already in the house, the appearance of the first discharge or " show " is a sufficient warning that she should be summoned. No

time should be lost in obeying the call, for many women, especially if they

have borne children previously, pass through all the stages of labor very quickly.

On arriving at the house the nurse should make the necessary changes in her

dress, and appear before the patient ready for duty.

An opportunity will soon

occur of forming a judgment as to whether the patient is really in labor, and,

if so, how far it has advanced.

If labor has actually commenced, the patient

win, before long, cease speaking, suddenly grasp the nurse's arm, or the back

of a chair, or whatever happens to be at hand, and exhibit other signs of suffering.

The nurse will know, by the characters enumerated on a previous

page, whether this is a genuine labor-pain or not, and will observe how long it

lasts and the degree of its severity. When it is over, she should inquire when the

pains began, how often they return, whether the waters have been discharged,

and other similar questions, in order that she may know what kind of message

she is to send to the medical attendant, who ought at once to be informed that

his patient is in labor.

Let

me now suppose that the nurse has made sure that her patient is in

labor, and that she has acquainted the medical attendant.

If the bowels have not been freely opened within the last six hours, it will

be desirable to give a simple enema of soap and water. The emptying of the

lower bowel will facilitate the labor, and will save both the patient and attendant

the annoyance caused by the passing of faeces during a later stage.

This having been attended to, the patient may be allowed to sit up in a chair or walk

about the room, according to her inclination, provided it is clear that the labor

has not yet reached its second stage. If it is night-time, however, it is better for

her to remain in bed, in order that she may, if possible, get a few moments'

sleep between the pains.

During the early stage of labor it is of no use for

patients to "hold their breath and bear down" during each pain, as they are

often urged to do by untrained and inexperienced nurses. It must always

be left to the medical attendant to decide when bearing-down efforts have

become desirable and ought to be encouraged.

DB CHASE'S BECIPE8.

286

It is often a great relief to a patient for the nurse to support her back with

her flat hand during a pain. In the meantime she should see that all things are

The following are always wanted:—

in readiness for the actual confinement.

Basins.

Binder.

Napkins.

Needles and Thread.

Nursery, or safety, pins

Olive-oil.

Pieces of old linen.

Receiver.

Roller-towel.

Thread, or

strong worsted, for

tying cord.

Towels.

Vaseline, cold cream, or lard.

Water, hot and cold.

Waterproof sheeting.

Puff-box, and complete set of

clothes for the baby.

Scissors.

In addition to the above it is advisable to have in the room some good

brandy, a fan, a syringe, a foot-bath, and a nursing-apron.

The Binder usually consists of two pieces of stout twilled cotton, each

two yards long and of good width, the edges of which are stitched together so

On an emergency, a small tableas to make the binder of double thickness.

cloth or cotton sheet, suitably folded, answers the purpose very well.

The Receiver should be of flannel made of double thickness, and large

enough to wrap the child thoroughly. The flimsy receivers sometimes used

are only fit to protect a doll.

A good thick fiaimel petticoat, or a cot-blanket,

is as good as anything.

The Thread or Worsted for Tying the Cord must be made ready

Twelve equal lengths, measuring about a foot, are to be

and arranged evenly. Six of these lengths, are then to be

knotted together at a distance of about two inches from each end, and the

remaining six in the same way. Having been thus prepared, the threads must

be laid on the dressing-table, and a pair of good scissors by the side of them,

ready for handing to the medical attendant at the proper moment.

in the following way:

laid side by side

The Preparation of the Bed is a matter of considerable importance,

and ought to be attended to during the early part of labor. Women are usually delivered lying on the left side, with the knees drawn up towards the

abdomen. The right side of the bed, therefore, is the one which requires

preparing, and that part of it near the foot is preferable because the upper part

of the bed is thus kept clean and comfortable for the patient when the labor is

over, and because of the help derived from being able to plant the feet firmly

against the bed-post during the pains.

The mattress being uncovered, a large

piece of

rubber cloth

is

to be

Next to this should

come the clean under-sheet, on which the patient is to lie, and upon that

another piece of waterproof sheeting, large enough to reach above the hips.

Over this upper rubber, and ready to be removed with it after the labor is

spread over it, and upon this a sheet folded several times.

over, are to be then placed a folded blanket, and, lastly, a folded cotton sheet,

both of which should reach well above the hips, so as to absorb the dischargea

NUESIIfG.

287

Two pillows are then to be put in the centre of the bed, so that the patient may

body directly across the bed, the hips being as

The upper bed-clothing during labor should consist

of a sheet, one blanket, and a thin counterpane, which should completely hide

lie with

the upper part of the

near the edge as possible.

from exposure every part of the patient's person, except the head and neck,

A long roller-towel should be fastened to the bed-post at the patient's feet.

Nurses often make the mistake of fixing this to the post at the opposite corner,

A very little consideration, howBy grasping

ever, will make the inconvenience of this arrangement apparent.

the end of a towel, attached in the way I have recommended, the patient pulls

herself still closer to the edge and foot of the bed whereas, by pulling at a

towel fastened to one of the posts on the further side of the bed, she drags

herself away from the very position which it is desirable she should preserve.

The same objection, of course, applies to supplying the place of the towel by

means of the hands of an attendant standing on the left side of the bed. This

should never be encouraged, as it always has a tendency to displace the patient,

and to render it difficult for the medical attendant to give needful assistance.

As labor advances, and it becomes necessary for the patient to be placed in

bed, she should put on a clean chemise and night-dress, which should be rolled up

under the armpits out of reach of the discharges, while the soiled chemise and

night-dress should be slipped down from the arms and shoulders, and loosely

fastened round the waist. (Amongst the working classes it is still too much the

custom for women to be confined in their every-day dress. It is a practice that

ought always to be discountenanced.) The hair should be dressed in such a way

that the continuous lying in bed after the confinement will not drag upon or

entangle it more than is inevitable.

It is very undesirable for a woman in labor to be surrounded by a number

of friends and neighbors. In most cases the nurse herself is the only attendant

that is really needed, although the presence of one other person (the husband)

should not be objected to, if the patient wishes it.

No nurse should ever allow herself to be teased into prophesying that the

labor will be over by a certain hour. If such prophesies turn out incorrect, as they

All gossip is

are most likely to do, the patient loses courage and confidence.

to be avoided, and nurses should be particularly careful to make no reference

or even to one of the posts at the bed's head.

;

have been unfavorable. A good,

kind nurse v ill not be at a loss for a few helpful and encouraging words as

labor goes on, and will not need to have recourse either to foolish promises or

to their past experiences, especially such as

dismal anecdotes.

Every now and then the patient should be reminded to pass water, lest the

This point is often neglected,

bladder should become so full as to binder labor.

partly because the attention is so preoccupied that the desire to empty the blad-

der is scarcely perceived, and partly because when the waters have broken, the

escape of a little gush of amniotic fluid during each pain often misleads the

patient,

making her think she has passed urine when really she has not.

Food for the Patient. —In the early part of labor when pains are slight

and the intervals long, there is no reason for interfering either with the charac-

DB. CEASE'S RECIPE8.

28P

ter or regularity of the patient's ordinary meals, provided there exist the desire

During the later stages, however, it is wise to confine her to

milk, and tea, and to administer them in small

quantities at a time, so as not to overload the stomach and excite sickness.

Patients often ask for a little cold water, and many nurses, influenced by old

traditions, fear to gratify the wish.

A sip of pure water can never do harm,

only it must be a "sip" and not a tumblerful, the patient being assured that

for solid food.

fluids, such as beef-tea, gruel,

small draughts, frequently repeated, assuage thirst far better than larger quan-

On no account must stimulants be given, except when expressly ordered

by the medical attendant.

Vomiting is a troublesome symptom and distresses the patient, but its

influence on the progress of the labor is in no way unfavorable.

Should it,

however, be excessive, it is well to give a little iced effervescing water from time

tities.

to time.

Cramps During Labor. — Many patients suffer very severely from

cramp during labor.

Relief can frequently be obtained by stretching the limb

straight out, and at the same time bending the ankle so as to put the muscles of

the calf well on the stretch.

Gentle rubbing of the affected part with the hand

also affords great comfort.

In the case of patients who have not borne children previously, it is an

excellent plan to diligently foment the perineum from the very outset of labor,

so as to render the skin softer and

more yielding, and lessen the risk of tearing.

DUTIES OF A NURSE DURING SECOND STAGE OF LABOR:

—What to do in the absence of the Medical Attendant —

Supporting the Perineum— Assisting at the Birth— Tying

the Cord Breech Cases The Third Stage Application of

The Binder, &c.— Convulsions— Fainting— Palling Forward

of the Womb.

—

—

—

When the pains alter in character, compelling the patient to make efforts

to bear down, and the face begins to get flushed and the skin to

become moist

with perspiration, the nurse may feel pretty well assured that the first stage is

over; and if the medical attendant has not arrived, she should request him to

be summoned without delay. In the meantime, the patient must be put to

bed, and encouraged to bear down and assist the pains.

The binder, napkins,

and receiver must be spread near the fire in readiness.

Should the child's head press upon the perineum before the arrival of the

medical attendant, a warm folded napkin may be placed in the palm of the

nurse's left hand and held against the bulging perineum, the fingers being

directed backwards, so that the front edge of the perineum may receive the

The object of this is to prevent the child's head passing too

quickly and suddenly forwards to the vaginal outlet and to preserve the perineum from being torn. The great point at this stage is to avoid doing too much.

chief support.

Nothing but harm is likely to result from attempts to enlarge the opening by

stretching the lips apart with the fingers, or to push back the edge of the perin

J^UHSING.

289

eum in the hope of facilitating the escape of the head. Contrary to the popular

belief, the attendant's duty is rather to keep back the

head by gentle pressure,

than to hasten its expulsion. Above all things there should be no pulling;

Nature is to be allowed to do her own work.

If the medical attendant be still absent when the head is born, the nurse

must spread the flannel receiver close up to the vaginal orifice, and receive the

head of the child upon her right hand, still keeping up the gentle pressure

upon the stretched perineum until the shoulders have passed out. Even then

the body and legs must be left to follow of themselves, the nurse meanwhile holding up the parts which are already born. The upper bed-clothes should be

now turned back sufficiently to allow the child to breathe, without causing any

exposure of the patient herself. If the navel-string is found coiled around the

child's neck, it must be slipped over its head as quickly as possible, lest the

life of the child should be sacrificed owing to a stoppage in the circulation of

the blood through the cord.

Very occasionally it happens that the child is

born with the membranes unbroken they will in such cases be found drawn

tightly over the little face, and will cause death from suffocation, unless quickly

torn open and the mouth freed. Amongst some people this occurrence is

;

known as being born with a veil or caul.

The cry which a child usually utters as soon as it is born, helps to fill the

lungs with air, and is on that account rather to be encouraged than checked.

If the child does not cry, the nurse must examine the mouth to ascertain

whether there is anything either over it or within it, preventing the breathing.

Sometimes there is some frothy mucus in the mouth which can be cleared away

with the finger.

It is often useful, also, when breathing is delayed to turn

the child on its face, and give it a few gentle slaps on the back with the flat

hand.

it

The navel-string must not be tied until the breathing is established, unless

quite evident that the child is still-born.

The first ligature must be

is

tied an inch and a half

from the navel, and the knot must be pulled tightly two

or three times so as to squeeze out of the way the jelly-like material which

surrounds the blood-vessels of the cord; otherwise the vessels may not be closed

by the ligature, and bleeding from the stump may occur to a fatal extent while

the nurse

is attending to the mother.

The second ligature is placed an inch

further from the child than the first one, and the cord is then divided with scis-

sors mid-way between the two. All this must be done outside of the bed-clothes,

lest some other part than the cord

be cut in mistake.

Now and then it happens that a nurse has to take the temporary charge of

cases where not the head, but the breech, passes out first.

Delivery with the

child in this position is full of danger to the life of the child. The nurse must

not hasten matters by pulling, even when the legs are already born; but, when

the whole of the child's body has passed except the head and arms, and when

these parts appear to be arrested, she may endeavor to assist Nature by bringing

down the arms from the sides of the child's head in the following manner: —

Passing her forefinger up the child's back, and over its shoulder, she draws the

19

DR. CHASE'S RECIPES.

290

arm gently down across the front of the chest by hooking her finger into the bend

of the elbow. The same mancEuvre is repeated with the other arm. The head will

then be the only part remaining nnborn. It is possible that, now that the arms

have been brought down, the efforts of Nature may be equal to the task of

Should the pains, however, prove ineffectual, the nurse

expelling the head.

may render further assistance by pressing with the fingers of one hand against

the back of the child's head and so tilting the head forwards, while with the

two first fingers of the other hand, placed 'one on each side of the nose, she

endeavors to draw down the face. This plan is generally preferable to the one,

not unfrequently adopted, in which traction is made by placing the fingers in

the child's mouth. In all breech-cases a warm bath should be in readiness, in

the event of the child requiring to be resuscitated.

The child, having been now separated, is to be wrapped in the receiver,

with the face alone exposed, and placed out of harm's way on the other side of

the bed. The patient must be warned to lie perfectly still, and to wait patiently

for the one or two insignificant pains which accompany the expulsion of the

These generally occur from five to twenty minutes after the birth

after-birth.

of the child. Meanwhile the nurse must provide the medical attendant with a

basin or other vessel, previously warmed before the fire, to receive the afterbirth, and one or two warm napkins.

Should the medical attendant, however, be still absent, the nurse must

place her hand upon the abdomen of the mother and ascertain whether there is

If she should find such to be the case, she must convey the

news to the mother very cautiously, assuring her that the second child will be

born with much less pain than the first. If there is no second child to be felt,

the nurse will do well to keep her hand laid upon the mother's abdomen until

a slight pain occurs, when she must spread out her hand like a fan and gently

another child.

press the uterus so long as the pain continues.

Meantime, she is to hold a suit-

hand ready to receive the placenta when it is expelled,

taking care on no account to pull the cord. Sometimes the placenta and membranes are expelled during the first pain; more frequently two or three pains

able vessel in her left

occur before this takes place.

If the uterus can be felt, under the hand, hard, firm, and as small as a good-

sized cricket-ball, the placenta, if it has not already made its appearance, will

in all probability be found lying in the vagina.

this,

In order to make sure about

the hand may be withdrawn from the front of the abdomen, and the fore-

finger passed gently up

by the side of the cord.

If the insertion of the cord

into the after-birth can be easily and distinctly made out,

it

is

pretty certain

that the placenta has escaped from the uterus into the vagina, and it may, there-

fore be carefully liooked

down with the finger.

As the placenta passes out, it

round once or twice, so as to make a vdsp of

the membrane and bring them all away at the same time.

A slight discharge

of clotted and fluid blood usually accompanies the termination of the third

is a good

precaution to twist

it

When the placenta and membranes have come away, the hand should again

be placed over the uterus, in order to make sure that it is firm and well con-

NUBSING.

traded.

If,

instead of this being the case,

291

it

is felt

to be large, soft,

and

uncontracted, firm pressure should be continued, so as to excite contraction and

prevent flooding, which, in such circumstances, is greatly to be feared.

Should a gush of blood make its appearance in spite of the pressure, the

hand must still be kept over the uterus and the pressure increased, cold wet

cloths being in the meantime repeatedly applied with suddenness to the external

genitals.

Of course, if the medical attendant has left the house, he must be

again summoned at once.

The uterus being firmly contracted, and the flow of blood having ceased,

the thighs and surrounding parts are to be gently sponged with warm water

and dried by means of a soft warm napkin.

If there has been no flooding, the soiled chemise and night-dress may now

be drawn down, and, along with the folded sheet, blanket, and upper rubber,

removed from beneath the patient, who must not be permitted to make the

slightest eflfort while this is being done.

Then she may be slowly rolled over

on to her back, to allow of the application of the binder. The binder, well

aired, must be rolled up to half its length, and the roll passed underneath the

lower part of the patient's back. Being caught on the other side, it is then

unrolled, and having been smoothed out free from wrinkles, it is so applied as

to encircle the hips tightly, and the overlapping end is then secured by means of

All this is to be done with as little exposure of

three or four good safety-pins.

the patient as possible. The pillows having been duly replaced, the patient

may now be carefully lifted into her usual position in bed; a fresh warm napkin

being applied against the vulva, and the clean chemise drawn down into its

place.

If,

however, there has been any flooding, the patient, must still remain

undisturbed for some time after the discharge has ceased, the nurse from time

to time

examining the napkins to make sure that there is no return of the

bleeding.

When the medical attendant is present, he will probably prefer to under'

take many of these duties himself; at any rate he, being the responsible person,

will give instructions according to the requirements of each individual case,

which instructions it will be the nurse's simple duty to obey.

During the passage of the child's head, it facilitates matters if the patient's

knees are separated. This is sometimes effected by placing a pillow between

them, but the pillow is apt to be in the way, and a better plan is for the

nurse to pass her hand beneath the right knee, and keep it well raised during

each pain.

Sometimes the medical attendant desires the nurse to make pressure upon

the womb during the third stage of labor, to assist it in expelling the afterbirth.

To do this she should stand behind the patient at the doctor's left hand,

and passing the hand under the bedclothes, she should place it on the abdomen,

where she will feel the round, firm body of the uterus above the pubes.

Spreading out her hand over this organ, she should keep up a steady pressure

downwards and backwards as long as the attendant desires it.

DR. CHASE'S RECIPES.

292

Convulsions, coming on during labor, are always alarming, and place

Should they occur before the arrival of the

medical attendant, no time should be lost in sending for him. In the meantime

all that the nurse can do is to keep her patient lying flat down; to see that there

is no tight clothing about her head and chest; to prevent biting the tongue by

pushing it, if possible, behind the teeth, and placing a cork or piece of Indiarubber between them; to admit plenty of fresh air into the room; and, lastly,

It is altogether worse

to restrain the meddlesome interference of bystanders.

than useless to attempt to force water or stimulants down the throat while the

patient is struggling and unconscious; and although sprinkling the face with

water, rubbing the hands, and applying smelling salts to the nose, can do no

harm, it is more than doubtful whether they ever produce any benefit. "When

the fit is over, should the medical attendant not have arrived, the nurse may

administer a soap-and-water enema with advantage.

the patient's life in great danger.

Fainting during labor should always lead to a suspicion that there is

some loss of blood going on, and the medical attendant ought to be immediately summoned, even if there is no blood to be seen externally, for internal

bleeding may be going on, notwithstanding. The important point to remember

about fainting is, that the patient is on no account to be raised up, however

much she may desire it.

The level posture, plenty of cool, fresh air, sprinkling

on the face, and firm, steady pressure with the hand over the

uterus, comprise all that it is desirable for a nurse to do in the way of treatment. If there is external hemorrhage, an endeavor must be made to con.

a

little water

trol it in the manner described later on.

Some women, who have previously borne children, suffer from a falling

forward of the womb, causing an unusual prominence of the lower part of the

abdomen. Such persons require to be put to bed at a very early stage of labor,

and should either be allowed to lie flat on the back, or be supported in the halfThe late Dr. Radford, of England, to whom I am indebted

sitting posture.

for the recommendations contained in this paragraph, has recorded two fatal

cases in which this condition was present, and in each of which rupture of the

uterus took place at the very moment of the patient rising to her feet during

labor.

He suggests that, in order that the uterus may be safely guided into, and

maintained in such a position as will facilitate labor, the nurse should, in all

such cases, put on a broad bandage at a very early period of the labor, and

After the membranes have ruptured and the

tighten it as labor advances.

—

waters have been discharged, this bandage should be applied as follows: The

end lying upon the bed is to be fastened to the side of the bed, so as to constitute a fixed point, while the other end is held obliquely by the nurse, and gradually tightened as the child descends into the pelvis.

The direction of the

pressure will thus be slightly upwards as well as backwards.

This mode of support, by what he terms a " regulating bandage," effectually assists the entrance of the child's head into the pelvis.

NURSma.

293

MANAGEMENT OP THE NEWLY-BORN CHILD: Washing

and Dressing — Feeding and Feeding-bottles — Aperients

— Warmth and Fresh Air — Separation of Navelstring— Swelling of the Breasts in the Newly-born — The

Sleep

•'Thrush."

After making the mother comfortable, the next duty of the nurse is to

This should be done, if possible, before the

medical attendant leaves the house, in order that he may have an opportunity

attend to the washing of the child.

of examining the child thoroughly. For the washing, a foot-bath is required,

or a basin at least one foot broad, one foot deep, and two feet long, so that the

whole body, with the exception of the head, may be placed in the water for a

minute or two. The nurse must also be provided with a piece of soft flannel,

some olive-oil, a piece of good, unirritating soap, and, for the dressing, in

addition to the clothes, a needle and thread, some safety-pins, and a piece of

linen rag six inches square, with a hole cut in

the navel-string.

its centre large enough to admit

Sitting at a convenient distance from the fire, she then pro-

ceeds to unfold the flannel wrapper and anoint the child's skin with warm

olive-oil wherever it is covered with the white

greasy material usually present.

This having been done, the child is to be put into the water, the temperaturf

of which should be about 90°, and the head supported on the left hand out of

the water. After having rested there for about two minutes, it is to be taken

on the lap and washed with soap and flannel, the eyes being carefully cleaned

first, then the head, and afterwards the remainder of the body, great pains

being take to cleanse the little wrinkles at the various joints. After gently

drying the skin with a soft warm towel, it must be well powdered, and especially those parts near the joints where chafing is most likely to occur; viz..

under the knees and armpits, in the groins, and between the thighs. The

piece of flannel used for the first washing should be burnt.

The skin having now been wdl washed, dried, and powdered, the square

of old linen is to be held near the fire for a minute and slipped over the remains

of the navel-string, which is to be folded in it and turned upwards upon the

child's abdomen, where it is to be retained by means of the flannel binder until

its separation, which usually takes place about the fourth or flfth day.

Up to the time of this separation, the child must be washed from head to

foot on the nurse's lap, night and morning. Afterwards, when there is no

longer any fear of injuring the navel, the child should be placed in the water

for two minutes during the morning washing, the evening washing being done

on the nurse's lap as before.