§ {
CLARA BARRUS, M. D.
y
MIDDLETOWN
THE CONGLO MERATE PRESS
I895


LECTURES TO NURSES.
LECTURE l. ! LECTURE lll,
own ecology obstetrics core
--- ---
LECTURE ll, | LECTURE IV.
OBSTETRICS, | NFANCY,
BY CLARA BARRUS, M. D.
N.
DELIVE REL) BEFORE THE WOMEN NURSES IN
THE TRAINING SCHOOL OF THE MIDDLE-
TOWN STATE HOMOEOPATHIC HOSPITAL
AT MIDDLETOWN, N. Y., A. D., 1895.
LECTURE 1.
GYNAECOLOGY.
@*.*.* is that part of medicine which has to do
with the diseases of the reproductive Organs of
WOIIle11.
The reproductive or generative organs of women are
divided into two classes—the external and internal geni-
tals. Without studying very particularly the anatomy of
these parts, I want to tell you enough about them that
you may know how to express yourselves clearly and in-
telligently in speaking of your patients, and their disor-
ders. I want you to understand the proper terms to use,
and can best explain them by showing a few plates, and
pointing out the various parts.
The name vulva is given to the external parts as a
whole. Many people are at a loss how to designate this
portion of the anatomy, and it is a source of embarras-
ment to the nurse, and of annoyance to the physician,
when a nurse is unable to express herself in the proper
terms, or to understand them when the physician uses
them to her.
The various parts of the vulva receive different names,
for convenience in designating the especial part of which
one is speaking. The top and fleshy part of the vulva
over the point where the bones of the pelvis
meet in front, (see plate), is called the mons
veneris. The thick fleshy folds which meet to
form this prominence are called the Zabia mayora
2 [...ECTURES TO NURSES
(meaning large lips—singular is ſabilt/l ſtayus). A pa-
tient often has a boil or abscess on this portion of the
vulva. It is called a labial abscess, and you will often
find it convenient and less embarrasing to be able to tell
the physician that a patient has a labial abscess, than to
have to say that she has an abscess coming; and then blush
and hesitate, and leave him to guess by your manner that
it is somewhere on the genital organs, or in some of the
neighboring parts; for people find quite as much diffi-
culty in expressing themselves about some of the neigh-
boring organs. And right here I may tell you the proper
terms for the portion of the body on which one rests
when sitting. The mass of large muscles and adipose
tissue in this region has received the name of the gluteal
region, on account of the gluteal muscles found here ;
and the two portions are called the right and left buttocks.
The lower part of the large intestine is called the
zcc£um, the opening itself is the an//s, the space between
the anus and the vulva is the ſcrime/ſ/. It is this part
which is ruptured in childbirth, when one says a woman
is “ torn on the outside,” (see plate). When the perineum
is so ruptured that there is a bulging of the adjoining tis-
sues of the rectum, the bulge is called a rectocele. If
the bladder dips down instead, the projection is called a
cystocele. The bladder is located in front of the uterus,
and this place above the symphysis pubis is called the
vesical region.
To return to the vulva. Just within the labia majora,
are two smaller folds of various degrees of length, in dif-
ferent women; these are the ſay///ae, or /a/ia 7/17/lora,
or small lips. These unite above in a hood-shaped
projection, called the cliforis, which also varies in
length in different individuals. It is under this hood-like
fold that secretions are apt to collect in women who are
untidy; sometimes hardening and giving rise to an irrita-
tion that may lead to masturbation in some cases. Pa-
tients who are in bed should receive daily care in this
respect, and all other patients on the ward should be in-
G \ NAECOLOGY. 3
structed in the necessity of daily attention to the cleanli-
ness of the genitals as much as to any other part of the
body.
There are two openings in the vulva; one at the upper
part leading to the bladder; this is the urethral opening.
The narrow passage, of which this is the opening, is the
urethra. This opening is the one into which the catheter
is introduced in emptying the bladder. There are so
many variations in its exact location, in different individ-
uals, that it is sometimes necessary to look at the parts to
avoid giving the patient unnecessary annoyance in the
use of the catheter. If a metal catheter be used, its point
should be warmed, and the end of any catheter should be
oiled before attempting to introduce it. The other open-
ing in the vulva is a larger one, and is below the urethral
opening ; it is the vaginal orifice. In the virgin this is
covered by a thin crescentic-shaped mucous membrane,
called the hymen. Great care should be taken in the giv-
ing of douches not to rupture this membrane, which with
care can be gently distended for the introduction of the
nozzle of the douche pipe. In women who have been mar-
ried, or who have borne children, the remains of the hy-
men are usually seen as ragged, irregular projections
around the edges of the vaginal orifice. The passage
which connects this opening with the uterus is the vagina.
This canal is from two to two and a half inches long in the
anterior wall, and from three to four inches in its poste-
rior portion. It is into this membranous canal that the
nozzle of the syringe is introduced in giving vaginal
douches. The mozzle does not enter the uterus, as many
erroneously suppose. The uterus, or womb, is divided
into two portions, the body and cervix, or neck. The
upper part of the body of the uterus is the fundiſs. The
uterus is shaped like a pear, flattened from front to back;
the cervix is the only part visible on inspection through
the vagina. The average length of the Vigin uterus is
about three inches, the length of the cavity about two and
a half inches. At the center of the cervix, which corres-
4 LECTURES TO NURSES.
ponds to the small end of the pear, and at the point
where the stem is united to the pear, is the os iſ ſcri, or
mouth of the womb. This is the external os; a little
farther inside the cervix is a constricted portion of the
neck, called the internal os. It is the cervical portion, the
neck of the womb, that is torn in child-birth, when one
says that a woman is “ torn on the inside;" in other
words, she has a lacerated cervix, the operation for the
repair of which is called trachelorraphy.
One formerly heard a great deal about ‘‘ ulcers on the
womb.” It is now more scientific to speak of these con-
ditions as cervical erosions; they vary all the way from a
slight irritation about the Os to a deep granular erosion,
involving the entire cervix.
Higher up in the fundus of the uterus are two minute
openings leading to the right and left Fallopian tubes
(see plates). These are hollow passages through which the
ova pass from the ovaries to the uterine cavity.
The ovaries are two rounded, almond-shaped bodies,
lying a little distance to the right and left of the uterus;
they are one to one and a half inches in length. They
continue minute bodies called ovules; one of which ma-
tures and pushes to the surface about very twenty-eight
days, is grasped by the fimbriated extremity of the Fal.
1opian tube, moves along the narrow passage of the tube,
and enters the cavity of the uterus, to be carried off
through the vagina with the regular monthly flow, or to
remain in the uterine cavity, and develop into a little
child, if it comes in contact with the seminal fluid of the
male. Our bodies are wonderful in every part of them :
in the structure of muscle, nerve and bone; and in the
Iminute anatomy of every organ and structure; but no-
where is the marvelous Creative Power so marked as in
the anatomy and physiology of the organs of reproduc-
tion. That the union of the tiny spermatozoa (the little
animal-like structures in the seminal fluid of the male),
with the tiny Ovule of the ovary, results in the develop-
Iment of an embryo which grows and receives its susten-
GYNAECOLOGY. 5
*s- e-º-º- + ---------> -- ~~~~ * ~~~~~~-----
ance from the organism of the mother, through a wonder-
ful system of blood vessels, is something over which the
thoughtful person cannot fail to wonder. And that the
little organ, the uterus, only two and a half or three
inches long can grow to a size to accommodate and shield
and nourish its little temporary inhabitant, and that the
vagina can be distended to afford an exit for the fully
developed child — all these things challenge our
wonder and admiration, and the knowledge of them
should divest the entire subject of any thoughts of shame
in the study or discussion of them.
I want to explain a few of the gynaecological terms
used by physicians, which the trained nurse is expected
to understand. Prolapsus of the uterus is simply a fall-
ing of the womb, the uterus is normally held up in posi-
tion by various ligaments, but through unhygenic modes
of living and dressing, these ligaments often become
weakened, and allow the uterus to sag down, the condi-
tion being known as proſapsus uteri. There can also be a
prolapsus of the rectum, of the vagina, or of one or both
ovaries. I have mentioned what a cystocele and a recto-
cele are ; it is not uncommon for patients and nurses to
mistake the bulging of a cystocele for a prolapsus uteri.
A little observation will easily show you the difference.
A complete falling of the uterus, so that the entire organ
protrudes from the vulva, is called procidentia,
A tipping of the uterus forward so that it presses
against the bladder is called anteversion (turning for-
ward), a bending forward of the uterus on itself is ante-
flexion. A tipping of the uterus backward against the
rectum is called retroversion (turning backward), a bend-
ing backward of the uterus on itself is retroflexion (see
p/afe.) A turning of the uterus to one or the other side
of the median line is called latero-version. One or the
other ovary may be prolapsed; that being the case, it is
usually felt near the cervix—a small rounded body ex-
quisitely sensitive to the touch,
By digital examination of the vagina, one means the
6 [, ECTURES TO N U RSES.
examination made with the finger. Bi-manual examina-
tion is when one finger is used in the vagina, and the
other hand over the symphisis pubis to press down the
abdominal walls, and feel the body of the uterus between
the two hands. A specular examination is one made
through the speculum, by which the walls of the vagina,
the condition of the Os and of the cervix may be seen.
A simple occular examination comprises whatever may be
seen with the eyes, unaided by a speculum of any sort.
This is used chiefly for inspection of the external organs,
the anus, etc.
There are several positions for examining used in gyn-
aecological investigations, the most common of which is
the dorsal position—flat on back, with hips at edges of
examining chair or table, and knees drawn up so that
thighs are flexed on body; this relaxes the abdominal
muscles, and makes an examination as easy as possible.
In the Sim's position the patient lies on the left side, low
pillow under head, left arm thrown out behind, left
shoulder, lower half of chest and 1eft hip touch the table.
The thighs and knees are flexed at right angles to body.
right knee slightly ºverlapping the left (see //a/c.) The
genu-pectoral, or knee and chest position, is where the
patient rests on the knees and the chest, one side of the
face on a low pillow, the thighs are at right angles to
the pelvis, the knees separated, and the buttocks raised to
a perpendicular height above the table. In preparing a
patient for a gynaecological examination, the nurse should
see that the rectum is thoroughly evacuated. It is al-
ways well to give a vaginal douche also, unless the phy-
sician expresses a special desire to see the condition with-
out a removal of the vaginal secretions. The bladder
should also be emptied.
It would hardly seem necessary to mention that the
patient should have on clean clothing, and that the exter-
mal genitals should be scrupulously clean, yet patients
have presented themselves for examination, and have
been presented for examination, where the condition has
GYNAECOLOGY. 7
been such as to cause a sickening disgust to the exam-
ining physician.
The dorsal position is the one most commonly used,
and is the one in which to place the patient unless other-
wise directed by the physician. The knees should be
well flexed. A folded towel under the hips to protect the
clothing from any applications that may be made. A
sheet should be thrown over the thighs (reaching to the
patient's face, if she prefers that covered,) and falling
Over the knees like a curtain during the digital examina-
tion. The underclothing should be all pushed to one
side. When a specular examination is to be made, and
the physician has adjusted the speculum under cover of
the clothing, the nurse should pull the sheet back from
the point where it falls over the knees, and so arrange it
Over the abdomen and around the thighs and the genitals
as to leave no part exposed, except that which can be
seen through the opening in the speculum. All these at-
tention to details are imperative among same women, and
our own sense of justice should make us take the same
precaution with the insane. For, if one of our sisters is
so unfortunate as to have lost the sense of personal mod-
esty, which we all claim for ourselves, it should be our
conscientious duty to shield her from her own immodest
exhibitions, and try in every way to inculcate and culti-
vate in her a proper amount of modesty, even though
she is lost to all sense of it herself.
Here are some of the instruments used in the ordinary
gynaecological investigations. (Show the various kinds
and sizes of vaginal specula, also rectal and urethral :)
Long vaginal forceps.
Uterine sound and probe.
Dull and sharp curettes.
Uterine dilators.
Retractors and tenacula.
Needle forceps and needles.
Insufflators, pessaries, tents, tampons, etc.
Applications most commonly used, etc.
8 LECTURES TO NURSES.
Mention the necessity of patient wearing a napkin
when coming for treatment, on account of the applica-
tions used.
Directions for giving douches, horizontal position,
hips elevated, Hank's douche pan preferable, rubber
sheet, roll clothing well back from the hips. Douche
water should be tested by the bath thermometer, the tem-
perature should range from 95 to I2O degrees, according
to the advice of the physician, always beginning with the
1ower temperature and gradually increasing to the high-
est limit. A douche for simple cleansing of the vagina
need be no more than one or two quarts of water, but as
a therapeutic measure for the relief of inflammatory and
catarrhal conditions, one and two or more gallons are
Often needed. The fountain syringe is, of course,
preferable. Hard rubber nozzles should be used, and
preferably those with openings in sides, rather than in
the end. The nozzle should be lubricated with vaseline,
and introduced in the lower part of the vaginal orifice,
and made to follow the floor of the vagina, till it reaches
the end of the vagina, back of the cervix. The douche
bag should be suspended at least three feet higher than
the body, and the stop-cock opened after the tube is in
place, and closed before the tube is withdrawn.
When the physician prescribes some particular remedy
for the douche, the regular hot water should first be
given, then (ordinarily) a tablespoonful of the remedy
added to the last pint of water—the patient remaining on
her back for I 5 or 20 minutes, so that the solution may
remain in contact with the parts.
Enemata or rectal injections are so much in vogue in
this hospital that it hardly seems necessary to instruct a
nurse here how to give them. There is, however, a
right way and a wrong way for everything. The new
nurse needs to remember the necessity for rolling the
clothing well back from the hips, of protecting the bed
with a rubber sheet, and of seeing that the douche pan is
not so cold as to strike a chill to the patient's back.
GYNAECOLOGY. 9
The rectal tube should be selected, oiled, und carefully
introduced in the anus, the syringe having been previ-
ously filled with whatever substance has been prescribed
for the enema.
Explain the following most common of gynaecological
operations:
I. Trachelorraphy—Operation for repair of lacerated
cervix.
2. Perinoerraphy—Operation for repair of ruptured per-
ineum.
3. Operation for repair of a vesico-vaginal fistula.
Operation for repair of a recto-vaginal fistula.
Curettment, or scraping the lining of the uterus.
Uterine irrigation.
Removal of urethral and uterine polypi.
Hysterectomy, or operation for removal of uterus.
Ovariotomy, or operation for removal of ovaries.
Rapid and slow dilatation of cervix.
The lectures on antisepsis give the general instructions
on this subject necessary. I will only remind you of a
few things necessary to remember in antisepsis in gynae-
cology. Scrupulous cleanliness should always be the
nurse's motto, therefore so far as her own personal toilet
is concerned, she will need but little extra preparation
for gynaecological Operations. She needs, however, to
give especial attention to the arms, hands and nails. Be-
fore any major Operation, she should have a shampoo and
a complete Outfit of clean clothing. Many a surgeon is
so particular about a laparotomy as to ascertain if a nurse
is menstruating—if she is, he dispenses with her services
at the operation, but you will not often meet with sur-
geons who carry their ideas of antisepsis so far as that.
For all operations, the patients should have a bath the
night before, or the morning of the operation, and, in
case of a laparotomy, most surgeons prefer to have the
patient have an additional mercurial bath—I to 2,000.
The bowels should, of course, be thoroughly emptied.
A vaginal douche (antiseptic) should be given just before
I
I O LECTURES TO NURSES.
placing the patient on the operating table, and the geni-
tals covered with an antiseptic pad until the surgeon is
ready to operate. For some operations it is necessary to
shave the hair from the 7/woſas weſteris, at least. This is
usually done after the patient has been anaesthetized, the
parts being previously washed with soap and water, and,
after the shaving, again washed in bi-chloride—I to I, OOO.
In preparing patients for Operation, especial care
should be taken to render the umbilicus (navel) perfectly
clean and antiseptic. If sponges are used during an op-
eration, a nurse cannot be too particular to see that each
one is wrung just as dry as it is possible for it to be,
otherwise it fails in the purpose for which it was in-
tended. Never use a sponge, or piece of cotton that has
fallen on the floor, and should an instrument be dropped
during the operation, discard it, if possible ; if not, see
that it is made thoroughly antiseptic before giving it to
the surgeon again. If sponges are used in the abdomi-
nal cavity, it is the duty of the nurse to note how many
are used, and to see that the full number are removed be-
fore the wound is closed. In operations on the internal
genitals, where sutures are placed, which will have to be
removed after union is effected, it is also well for the
nurse, if she can, to count the sutures, although this is
the duty of the physician who assists the surgeon with
the ligatures.
In the more common and Ordinary gynaecological pro-
ceedures, such as local treatments, and the minor opera-
tions, the nurse's duty is to prepare the patient for exam-
ination, get her in the proper position, see that there is a
basin of hot water for the physician's hands, and a tray
with antiseptic solution for the instruments. The nurse
should then place herself at the physician's right hand,
and be ready to hand whatever instruments he may need
to use. She should place the bits of cotton on the dress-
ing forceps for him to use in removing any cervical dis-
charge, and, after each one is used, she should remove it
to the receptacle usually prepared for the purpose. She
GYNAECOGY. I I
should assist in the preparing and Saturating of tampons,
according to the physician's instructions, assist the pa-
tient in dismounting from the chair or table, and in ad-
justing her clothing, and should thoroughly cleanse and
dry the instruments which have been used in the treat-
ment. She must bear in mind how many tampons have
been used in each case, and see that they are removed at
the proper time, the removal followed by a cleaning
douche, unless otherwise instructed. Another important
duty of the nurse of insane patients is to watch the feet
of patients at all liable to become violent, so that the
physician does not get kicked in the head or face while
engaged in treating the patient.
In addition to all these things, the skillful nurse will al-
ways be on the alert to do all the little countless things
which she ought to do, and to avoid all the countless
other little things which she ought not to do, and if she
succeeds in all these things, she will Surely be able to
add, ‘‘ and there is no health in us,” but there may be
some left in her patients, and since her whole life is one
of putting aside self for others, this will not be any real
departure from her routine business.
LECTURE ||
OBSTETRICS.
Obstetrics or midwifery, has to do with pregnancy, the
management of labor, and the care of the mother after
labor, or during the puerperal state. An obstetrical
nurse is one who deals exclusively with this class of
cases; she was formerly called a “monthly nurse.” An
obstetrician or an accom/c/cf/7', is a physician who attends a
woman in confinement,
It is important for the nurse to know the signs and Or.
dinary symptoms of pregnancy. There are what we call
/rcs/7//five and proſa &/c signs, and a few positive signs.
Among the fºrcs/7///ive signs are : Increased nervous sen-
sations, vague feelings of discomfort, headache, tooth-
ache, faintness and nausea, and changes in disposition.
The probable signs are : Cessation of the menses, a pur-
plish look to vulva and vagina, frequent desire to uri-
nate, increase in size of breasts, and a darkening of the
tissues about the nipples, gradual increase in the size of
the abdomen, stripes on the abdomen and thighs, due to
the stretching of the muscles, the “brown line '' extend-
ing from the umbilicus to Symphysis pubis, morning sick-
ness, (or even sickness throughout the day,) and “quick-
ening,” or the feeling of the movements of the child felt
by the mother. These last mentioned, though probable,
are by no means positive ; there are on/y fºuo Aositive signs
—the actual feeling of the parts of the child by the phy-
OBSTETRICS. I 3
sician, and the foetal heart-sounds heard by an experi-
enced physician. But even he may be mistaken. I once
heard an old obstetrician say: “There is but one posi-
tive sign of pregnancy—it is when the doctor sees some
part of the child escaping from the vulva.”
We must bear in mind that there may be cessation or
irregularity of the menstrual flow from anaemia, or other
forms of ill-health, from change of climate, or in one's
mode of life, or the woman may be passing the climac-
teric—the “change of life,” and thus mistake her condi-
tion for that of pregnancy. Or, in rare instances, the
woman may be pregnant and yet menstruate with more
or less regularity throughout pregnancy. There may be
nausea, which, accompanied with menstrual cessation,
Imay be a suspicious sign of pregnancy, and yet may be
due to other causes. On the other hand, nausea may be
wanting in cases of pregnancy, or the husband instead of
the wife, may suffer from this symptom.
It is not uncommon to mistake the conditions which
present themselves at the climacteric for pregnancy, es-
pecially in women who desire children very much, and
who are of an imaginative temperament; they may even
have the changes in the breast, and sympathetic nervous
disturbances, which strongly point to pregnancy. Or,
rapidly growing tumors may give rise to the belief that
the woman is pregnant—the symptoms being SO presump-
tive that even the experienced physician finds it difficult
to determine whether or not pregnancy exists. There is
also a condition called “ phantom pregnancy,” where all
the presumptive and probable signs are present, even to
the apparent movements of the foetus, and yet the pa-
tient is not pregnant, and the enlargement of the abdo-
men entirely disappears under an anaesthetic. However,
these are questions for the physician, rather than the
nurse to determine. It is well for you to know that there
are such cases.
The movements of the child are usually felt by the
mother about half-way through pregnancy. This was
I4. LECTURES TO NURSES
formerly called “quickening,” it being erroneously sup-
posed that not until then did life enter the child—a false
belief which has permitted much evil-doing, as many
really good people have believed that since there is no
life till then, there could be no harm in having abortions
performed. Whereas, life exists from the very begin-
ning, and it is murder in the second, third and fourth
month, as much as it is 1ater on, if the 1ife of the foetus
is destroyed. It is only that, at about the middle of preg-
nancy, the muscular system of the foetus. becomes suffi-
ciently developed to admit of muscular movements at
this time.
The ordinary duration of pregnancy is nine months, or
280 days. In engaging a nurse, the patient often expects
her to foretell the duration of probable confinement.
After learning on what date the last monthly flow began,
count three months backward, (or nine months forward)
and add seven days. This is near enough for all practi-
cal purposes. Many nurses keep with them an obstetri-
cal calendar, which quickly computes the time of ex-
pected confinement. -
If a woman has failed to remember the date of her last
menstrual flow, the nearest approach at accuracy may be
made by adding four and one-half months to the date
when she first felt motions of the child.
Just a little about the development of the foetus at dif-
ferent stages of pregnancy. The heart begins to be
formed at the end of the second week, in the third week
the beginning of the brain is visible, in the fourth week
the lungs begin to appear, in the fifth, are the first traces
of hands and feet, and so on, from day to day, the vari-
Ous Organs appear, develop, and gradually take their
proper shape, till we witness the fully developed foetus.
Hair begins to appear on the head at the fifth month, first
traces of the nails appear in the sixth. After the sixth
month, the foetus is nearly as well formed as the full
term child—the remaining months witness the more per-
fect development of the already existing organs and parts
OBSTETRICS. I 5
and the hardening of the various bones, which are merely
soft pieces of cartilage at this stage. In cases of prema-
ture labor, the more nearly the child has approached full
term, the better are its chances of living, although an er-
roneous opinion did, and even does, prevail, that a seven
month's baby will live, when an eight month's will not.
A child is seldom viable (capable of living,) if born be-
fore the seventh month.
Care of f/c fragmanſ woman.—In the first place, she must
attend to her general health. Attention to dress, diet,
bathing, regularity in exercise, and in sleeping, plenty of
fresh air and sunlight—these are essential to the preg-
nant, as well as the non-pregnant woman. It is of great
importance all through the pregnancy to keep the bowels
regular by daily attention to them, by selection of proper
food, and by judicious exercise. Plenty of water to
drink, graham and other coarse breads, cereals, fruits in
abundance, and Occasional enemata are among the means
to be employed for securing regularity of the bowels.
Avoid massage, as it is apt to excite uterine contractions.
Irritability of the bladder, which almost invariably comes
in the early part of pregnancy, disappears after the third
month, and re-appears toward the last. It is an unavoid-
able symptom, due to pressure from the rapidly growing
uterus. The only relief from this is the recumbent posi-
tion, as it takes away the pressure from the bladder.
After the seventh month, the urine should be examined
as often as once in two weeks, at least. This should
never be neglected. If there be albumen in the urine, it
is of the utmost importance that the physician know it
early as possible. There may be leucorrhoea during
pregnancy, which is apt to be excoriating and irritating
to vagina and vulva. Bathing with a borax solution will
usually alleviate this condition.
External haemorrhoids should be treated with hot ha-
maelis applications, till shrunken, then replaced, and
care taken to keep the bowels free daily.
Toward the latter part of pregnancy, the rapidly in-
I6 - LECTURES TO NURSES.
creasing size of the uterus causes pressure and Over-dis-
tension of the blood vessels, so that the feet and legs
swell, and the veins often become much enlarged; the
external genitals may also become swollen and purple
from the congestion. Rest in the recumbent position is
the only remedy for this; the application of a bias flan-
nel bandage is a relief to the limbs when the veins are
badly swelled.
For the vomiting of pregnancy there are various sim-
ple remedies, some of which will help one case, some
another. Some cases will not yield to any treatment.
Pop corn and pepsine chewing gum are favorite remedies
with some ; two or three graham, or other crackers, taken
in the morning before the patient lifts her head from the
pillow, are often efficacious, or a cup of hot malted milk,
or hot tea or coffee.
Dress.--The pregnant woman should never wear tight
clothing, bands about the waist, or heavy skirts. The
breasts, especially, should be free from compression.
For a few months before confinement, especially in
women who have never borne children before, the nip-
ples should be daily treated to render them less tender.
The nipple bath is an easy thing. Fill a wide-mouthed
bottle with cold water, to which a little alcohol has been
added, tip it up over the nipples for five or ten minutes
each day.
Should there be any flow, however slight, during preg-
nancy, it is wiser for the patient to go to bed; the head
should be lowered, and the hips and the foot of the bed
raised, and the patient kept quiet and calm. The
physician should be sent for immediately. No hot
drinks should be given the patient if there is ten-
dency to haemorrhage. All discharges should be saved
for the inspection of the physician. If the flow becomes
alarming before the physician can be summoned, the
nurse may give a hot vaginal douche (I IO to I I 5 °,) using
the fountain syringe, and keeping the patient in the re-
cumbent position.
OBSTETRICS. 17
Preparations for labor.—The room which is chosen for
the lying in should be as free from carpets, heavy hang-
ings, and useless furniture as possible. Cheeriness and
aseptic surroundings should be secured. If there is a
set bowl in or near the room, it must be examined to see
that the plumbing is perfect, if there is any doubt, the
bowl should be filled with water.
The clot/ling which the mother needs to get ready for
lier confinement, and for the lying-in period, is: A
loose, comfortable wrapper, bed-room slippers, enough
under-vests and night-gowns so that she may have clean
Ones as Often as necessary, plenty of napkins, and an ab-
dominal binder. The binder should be fitted when the
woman is about six month's pregnant, it should be one-
half yard wide, and should lap well over the abdomen.
Some physicians do not wish a binder used, but it is well
to have One ready. Also a “Nightingale wrap,” to throw
about the shoulders, (see plate,) when the patient sits up
in bed.
There should be two rubber sheets provided, or, if ex-
pense must be considered, ordinary table oil-cloth will be
much cheaper, and answers the purpose quite as well, or a
thick pad of newspapers for the temporary bed-dressing
does nicely, and can be burned after use. The nurse
should always consider with whom and for whom she is
working, and not recommend extravagant Outlays when
less expensive things will do. It is far preferable to use
c/can old quilts, or a pad of newspapers for bed-dressing,
than to use a borrowed rubber sheet from any source—two
things which should never be borrowed or loaned are a
rubber sheet and a syringe.
A strip of floor oil-cloth should be provided for the pro-
tection of the carpet in front of the bed.
The bed should be made up perfectly clean for the con-
finement. The permanent dressing for the bed consists
of, next to the mattress, a pad, then the rubber sheet, the
long sheet, then a draw sheet placed across the bed, and
firmly fastened with safety pins. Over this is put the
IS LECTURES TO NURSES.
temporary dressing consisting of an old rubber sheet, or
the newspapers, or old quilts before mentioned, these be-
ing of sufficient thickness to absorb all discharges during
the labor. Over this is placed a second under sheet, and
the temporary draw sheet, this also being firmly fastened
to the mattress. After the birth of the child, and the re-
moval of the placenta, and after the toilet of the mother
is made, this temporary dressing may be easily removed
with but little disturbance to the patient, letting her rest
on the clean, already arranged, permanent dressing.
The permanent rubber sheet need seldom be used after
the third day.
Plenty of old sheets, and a generous supply of towels
and napkins should be provided for the confinement.
Also soap, nail brush, vaseline, and, if possible, a douche
pan, and a bed pan.
The baby's outſiſ should be simple, warm, 1oose and com-
fortable. If you are engaged 10ng enough beforehand,
and have sufficient influence with the mother, you ought,
in the interests of tortured babies, to try to induce her to
make as comfortable an outfit for her baby as possible.
What is called the Gertrude suit—a sort of dress reform
for babies, is the best of any thing I've seen. The baby
should wear, first, a flannel binder, unhemmed, the edges
pinked; it should be about four inches wide, no fancy
stitching on it. Socks should be provided. After the
binder, the socks and the diaper (which should not be too
large,) the next garment is a light-weight flannel gown,
cut princess, and with long sleeves; the length extends
from the neck to Io inches below the feet. This answers
for the shirt. A11 seams are on the outside, and the shirt
is fastened in front with tapes. The next is the skirt. It
is cut in the same way, also open in front, but without
sleeves, and 10wer in the neck; it is cut half an inch lar-
ger, and five inches longer, seams also on the Outside.
These two garments can be put together, and thus be put
on at the same time, and so do away with the numerous
turnings and twistings necessary in dressing a baby in
OBSTETRICS. I9
the ordinary way. Lastly, comes the little muslin slip, or
later, the dress; these being made to suit the fancy of
the mother, and a little longer than the skirt, but by no
means as 10ng as infant's dresses are usually made. A
baby with this costume is easily and quickly dressed, is
warmly and comfortably clothed, there is no constriction
any where, no seams, or buttons, or pins, to press into its
tender flesh—and thus we do away with a host of causes
which make a crying baby.
Artic/es for Z/ic baby basket.—A full suit of clothes; a
baby blanket, napkins, large and Small Safety pins, Some
old, soft towels, a baby hair-brush, a powder box and
puff, and lycopodium or talcum powder, a jar of cold
cream, three or four strips of bobbin eight inclies long, a
pair of blunt scissors, and some small squares of old, soft
linen for dressing the cord, and for cleansing the eyes
and mouth as soon as the baby is born.
As the trained nurse is usually engaged a long time be-
forehand, I have mentioned all these things, for many
women rely on their nurses for advice in these prepara-
tions, which, though seemingly trivial, have much to do
with the comfort of all concerned at the time of the con-
finement.
The nurse should always respond promptly to her Ob-
stetrical calls. It is hardly necessary to mention the ne-
cessity of scrupulous cleanness and tidiness of her Own
person and clothing, and gowns of “span clean,” washa-
ble material. The nurse must never go to an obstetrical
case after nursing a patient with any contagious disease.
Signs of a/proaching /abor.—The sinking of the uterus'
in the abdomen toward the latter part of the ninth month
is the first sign that labor is approaching. This is spoken
of as the “lowering of the burden,” or “settling,” and
is commonly experienced about ten days before birth.
After it takes place, the woman breathes more freely, but
she is apt to have a return of the frequent desire to uri-
nate; haemorrhoids are now more apt to appear, and the
swelling of the vulva and lower limbs usually increases.
2O LECTURES TO NURSES.
During the last two weeks, false pains, felt in the abdo-
men, often make the woman very uncomfortable, and
may lead her to think that labor is approaching. These
pains may be distinguished from true pains only by
watching them. They are irregular in occurrence and
duration, usually felt in the abdomen, and do not increase
in severity or frequency. True pains usually begin in
the back, are at first an hour, half hour, and a quarter of
an hour apart, gradually increasing in frequency and se.
verity. If there is any doubt in the nurse's mind, the
physician should be sent for.
The next most common symptom is a discharge of
bloody mucus from the vagina. This is called the
“show,” and may or may not be accompanied by a slight
or pronounced chill, by nausea, or even by vomiting. Its
appearance shows that the os uſcri is beginning to dilate.
There should be no delay in summoning the physician.
Stages of /abor.—Labor is divided into three stages.
The first stage is the longest, lasting from three to ten
hours, in women who have borne children, and from twelve
to fifteen hours in the first confinement. This is the stage
of dilatation, or stretching, of the mouth of the womb,
to allow the child to pass through. It is the most trying
period, and the one in which the nurse will have to exer-
cise the most tact, patience, and ingenuity in diverting
and encouraging the patient. The pains are of such a
nature that the most amiable and self-controlled woman
is apt to become capricious, irritable, and unreasonable.
She is sure she will never live through it, and these fore-
bodings, and constant statements that she will die, make
it a very trying and depressing time to the nurse. Keep
cheerful and hopeful yourself, do not express by tone,
look, or manner, the slightest doubt of the favorable ter-
mination of the labor. You must study your patient to
know whether the joke, or the assurance of the favorable
outcome, is to be the means employed. You may laugh-
ingly assure her that you have heard lots of others talk
that way before, and she may ‘‘snap your head nearly
OBSTETRICS. 2 I
off '' in return, or be quieted by the information—there is
no telling what will suit her—you have only to try, and,
above all things, keep your temper, however unreasonable
she may be.
The second stage is after complete stretching of the os,
to the birth of the child. This is much shorter, but may
last from one to one and one-half hours, or may be only
twenty or thirty minutes.
The third stage is after the birth of the child until the
birth of the placenta, or “after birth.” This may come
away immediately, or the stage may last twenty or thirty
minutes, or even longer.
Some time in the first stage the membranes rupture, or,
as is commonly said, “ the waters burst.” The child is
enclosed in a bag of membranes, filled with a fluid in
which it floats about, and the bag, in turn, is enclosed in
the uterus. As soon as the mouth of the womb begins to
dilate, a portion of the bag wedges itself in the opening,
and helps by its pressure to dilate still further. It is of
the utmost importance that the examinations should be
made so carefully that the membranes are not ruptured,
for then the water drains away, and the wedge being no
longer present, the labor is slower, and more difficult.
When the membranes rupture some days previous to the
birth of the child, the labor is called a “ dry labor.”
Sometimes there is only a partial rupture of the mem-
branes so that some of them still cling to the child, and
envelop its head, then the child is said to be born with a
veil—an occurrence which has given rise to many fool-
ishly superstitious notions concerning such a child.
During the first stage of labor, the pains are of a grind-
ing character, during the second they are forcing, the pa-
tient wants to bear down, and should then be encouraged
to do so, but not until the pains assume this forcing char-
acter. All bearing down efforts before that time are
worse than useless, as they only serve to exhaust the wo-
man's strength.
If the nurse be called when labor is already in progress,
22 LECTURES TO NURSES
she should quickly don her nurse's costume, and appear
before her patient ready to begin her helpful offices at
once. She must learn when the pain began ; by the char-
acter of them she can tell what stage the woman is in ; she
must inquire if there has been a “ show.” If the mem-
branes have ruptured, she must assure herself that the
bowels and bladder are thoroughly evacuated. If the
woman has not had a thorough movement of the bowels
that day, an enema must be given, or if there is not time
for that, a glycerine suppository, at least, may be used.
If the nurse is on time, she should see that the patient
has a full bath and clean underclothing, A vaginal
douche is always a wise precaution—I to 3, OOO mercurial
solution.
After the membranes have ruptured, the patient must
not be allowed to get up, as the child may come quickly,
and be in great danger of injury. But previous to that it
is well to encourage the woman to keep about even against
her inclination. It not only makes the labor seem less
tedious, but favors descent and dilatation.
Patient's hair should be neatly and firmly braided down
the back. If very heavy and long, braid it in two braids.
The patient should have on an undervest, a night-gown,
which buttons all the way down, large, open drawers, hose
and slippers. Over these she should put a wrapper while
keeping about the room. When she goes to bed, the
night-gown may be smoothly folded, and pinned above
the hips, and a sheet, or short skirt, fastened around the
hips to protect the lower part of the body from exposure.
This can be easily withdrawn after the labor terminates,
and the clean night-gown pulled down in place.
The bed should be so arranged, if possible, that it can
be approached from either side. It should, at least, be so
that the physician can use his right hand in making ex-
aminations. Many physicians prefer the patient across
the bed, with hips near the edge. Some wish her on the
side, but the majority of physicians prefer the dorsal po-
sition with the knees drawn up. See that there is a jar
OBSTETRICS. 2 3
of vaseline, soap, water and towels for the physician's
use before and after an examination. If he wishes an an-
tiseptic, he will let you know. Or it will do no harm to
ask him if he wishes bi-chloride sol. (I to 2,OOO, ) for his
hands.
The nurse must have everything in readiness. She
should know beforehand in just which drawer are the
mother's clothes, towels, sheets, where all the baby's out-
fit is to be found. If she sees that the mother has no sys-
tem, she should help her to arrange these things so that
they may be found at a moment's notice. A woman in
confinement is always impatient of question as to where
this and that is to be found, yet it is often the case that
she alone knows, hence the necessity of ascertaining all
these things beforehand.
The bed clothing should be watched by the nurse; a lit-
tle care will usually prevent its getting soiled—the blank.
ets, counterpane, etc.
Toward the latter part of the second stage of labor, the
baby's basket and outfit should be brought out, the cloth-
ing aired and warmed ready for use. Plenty of hot and
cold water must, of course, be accessible ; also, a hot
Water bag, syringe, etc.
It is well to have a flannel apron to wear while washing
and dressing the baby. The bobbin, two pieces, dull
scissors, the soft bits of old linen for mouth and eyes—
all must be in convenient readiness. The nurse should
hand to the physician these bits of cloth as soon as the
head is born ; or, if he is otherwise engaged, she should
carefully wipe the eyes herself. An old shawl, or piece
of blanket should be warmed and ready to receive the
baby as soon as it is born.
There should be two vessels under the bed, or a vessel
and a basin, one for urine, and one for the placenta. A
pitcher should be in readiness for the instruments, in case
they have to be used. Also a light tin or agate iron
basin in readiness in case the patient has to vomit. DO
not use antiseptic solutions in fin basins. Do not use
24 LECTURES TO NURSES.
pans, cups, basins, etc., from the kitchen, if possible to
avoid it. It is well to have brandy and ammonia handy :
it is convenient to have a feeder for the patient, so that
she need not lift her head when taking nourishment; if
the labor is long and fatiguing, the patient may require
some warm tea; she usually wants drinking water during
the 1abor.
The nurse can often assist the patient by pressing
against her back during a pain. Don't be afraid to give
her your hands, and tell her to pull; the human hand is
better than all the folded sheets, or ropes arranged at the
foot of the bed, yet this should also be prepared, as the
patient likes to have many resources, that she may try
first One then the Other.
If she is faint and prespiring, Occasional sponging Of
the face and hands with alcohol and water, is very re-
freshing.
Exclude the friends and neighbors from the house, ex-
cept the few who are to be of use. By all means send
the children away.
The baby should be wrapped up, even before the cord
is tied, unless the physician says otherwise. When he is
ready to tie the cord, hand him the pieces of bobbin, one
at a time. After he has tied it in two places, hand him
the scissors, that he may cut the cord. Receive the child
from him, carefully wrap, and put it in a safe place, mak-
ing sure that it is not smothered by the blankets, nor put
where any one would sit down on it. For a little while
the mother will need the attention of both the physician
and you. Be ready with the vessel for the placenta, or
you may have to hold down the fundus, or otherwise as-
sist the physician.
Do not take the placenta from the room till you have
ascertained if the physician wishes to examine it further.
After he has done so, burn it.
In the interval between the birth of the baby and the
placenta, there is apt to be more or less excitement, pos-
sibly haemorrhage. This may be alarming. The nurse
OBSTETRICS. 25
must keep her wits about her. She must not be flurried,
but must be ready with hot and cold water, restoratives,
syringe—whatever the emergency calls for.
If the labor goes along all right, the mother can be
bathed soon after the birth of the placenta, the wet and
soiled clothing, and the temporary dressings removed,
and the binder and napkins applied, all the time moving
and disturbing the patient as little as possible. Things
must be done quickly, yet without apparent haste. Al-
ways remember that even in the easiest labor, the woman
has gone through an experience which has made a pro-
found impression on her entire being. She is entitled to
the most scrupulous and considerate care you can give
her. Reassure her in a few low spoken, sincere words,
that all is well, that you will take all the care from her,
and that she need do nothing now but rest and keep quiet.
Many patients, after the few whiffs of chloroform which
the physician administers in the last part of the second
stage, become excited, talkative, jolly, and almost intoxi-
cated from the effects of the drug. Do not laugh at
them, or encourage them to talk, however amusing it may
be.
In applying a binder, tighten it first in the middle part,
next the lower part, and the upper part last. Then fasten
the napkin to the lower border of the binder, in front
and behind. Remove all soiled clothing, unnecessary
vessels and utensils from the room as Soon as possible,
and restore order and quiet.
After the physician leaves, the nurse must frequently
look to see if there is undue haemorrhage, and if the
uterus keeps properly contracted. It should be felt a
hard, round body, the size of a child's head, just above
the pubis, or a little to one side of it.
LECTURE ||[.
OBSTETRICS.
(CONTINUED.)
Com//ications and c/acrgc//cies.—There is always the pos-
sibility that the physician will not arrive in time, especi-
ally in women who have had children before, some of
whom have very rapid labors. The nurse needs courage
to face this emergency, and to conduct the labor, or such
part of it as is necessary, alone.
After the rupture of the membranes, remember the pa-
tient is on no account to get up, even to urinate. A bed
pan must be used. Remember the necessity for attention
to the bowels and the bladder at the beginning of labor.
Do not urge the woman to bear down till the forcing
pains come, then she will need no urging, as a rule,
though she may need some encouraging. Do not allow
the patient to feel that you are at all timid about conduct-
ing the labor alone, although you may keep encouraging
her to believe that the physician will be there in ample
time.
Should the head descend so low that you find it neces-
sary to deliver the child, encourage the woman to cry out
at this stage, rather than to bear down during the last
pains, when the head is distending the perineum. This
will help to save it from rupture. Receive the head in one
hand, supporting it so that its weight does not drag on the
OBSTETRICS. 27
parts, thus increasing the danger of rupture; with the
other hand, wipe out the eyes and mouth with the old
pieces of cloth previously mentioned, and patiently wait,
without pulling, until another pain shall come, and expel
the entire child, which you are to receive in the other
hand, the one hand still holding the head. Lay the child
on the bed, at one side, and wait for the expulsion of the
placenta. Follow down the uterus with one hand, or feel
about in the abdomen till you feel a round, hard ball, and
grasp or rub this gently to secure its contractions. There
may be an interval of one-half hour, or even more, be-
fore the placenta comes, then after a few pains, it usually
appears, and should be gently removed, by taking the
cord in one hand, and the bulk slowly removed by a ro-
tary motion, which suffices to keep the ragged pieces of
membrane from remaining behind. If you deliver the
placenta before the arrival of the physician, remove it to
another room for his inspection, when he shall come.
Should the child cry lustily and breathe properly, you
can tie the cord, and remove the child to its crib while
waiting for the birth of the placenta. Tie the cord about
two and one-half inches from the navel, then leaving
about an inch space, tie again on the side of the mother,
then cut between the two knots. When tying, take two
twists instead of one, to make it secure. The only rea-
son for leaving the child attached to the placenta is that
it may have the benefit of the circulation through that
until its own circulation and respiration are properly es-
tablished. You must be careful after the head is born, to
ascertain if the cord is around the child's neck. If it is,
it must be loosened, and the head allowed to pass
through, otherwise the child will be suffocated.
J/c//od's of resuscitating f/c c/i/a". –If the child does not
cry, and if respiration is not immediately established,
you will have to turn your attention to the child instead
of the mother. You have already wiped the eyes and
face, and removed all mucus from the mouth, sometimes
a few vigorous strokes on the buttocks, or the bottom of
28 LECTURES TO NURSES
the feet will be sufficient to make the child breathe and
ery. If this does not suffice, dash cold water on the
chest, then hot, and so alternate these for a time. Or, a
few drops of whiskey, rubbed on chest and abdomen,
may stimulate respiration. Or, vinegar, dropped from a
height, sometimes has excellent effect. These measures
failing, you will have to resort to artificial respiration.
In all your measures, remember to keep the head as low
as possible to favor the determination of blood to the
brain.
One method of artificial respiration is to hold the child's
nostrils while you breathe into its mouth, then let go the
nostrils, and press the sides of the chest, to expel the air.
This must be done slowly—twelve to fifteen times a min-
ute. Or, Sylvester's method may be tried. You have
had this explained to you in your lectures on Emergen-
cies.
After respiration is established, to facilitate the produc-
tion of bodily heat, the child may be placed in a hot bath
—IOO 9 —for a few minutes, then wrap the body well, and
l:eep in a warm place. It should lie on the right side.
win / regiſlaw/cies.—We have spoken of tying the cord
twice, once on the side of the mother, (see plate), and
once on the side of the child. The second ligature is
made, partly for the reason that there may be a second
child in the womb. In twin pregnancies sometimes there
are two placentas, or the two children may be attached to
the one placenta. If the fundus of the uterus is followed
down after delivery by the hand of the nurse, or physi-
cian, it can be determined by its contractions, whether or
not the uterus is empty, or whether there is a second
child there. If another baby is felt in the womb, all
there is to do is to wait for its delivery, rubbing the fun-
dus meanwhile to excite contractions as much as possible.
In this complication, of course, there is just so much ex-
tra work; only, knowing what to do for one baby, you
know that your duties will be the same for the other.
Should there be any delay in the delivery of the pla-
OBSTETRICS. 29
centa, more than twenty or thirty minutes, and the physi-
cian does not then arrive, another physician should be
summoned at once.
If it be a case of adherent placenta, the physician will
have to put his hand in the uterine cavity, and forcibly re-
move the placenta. Antiseptic uterine douches are al-
ways given after this procedure, but are always adminis-
tered by the physician.
Brecc/, //resentations.—This is where the breech, or 10 wer
part of the body is born first, instead of the head. This
is always more dangerous to the life of the child, as the
hardest part, the head, is born 1ast. The labor is usually
longer, and unless very unfortunate, you can secure the Ser-
vices of another physician, should the first one be delayed
in coming. Make your preparations for the resuscitation
of the child, as it is almost sure to be lifeless, or nearly
so, at birth.
Aſºmorrhage.—Haemorrhage, in confinement, is always
a startling and dangerous symptom. The condition
known as //acenza practia, where the “ after birth '' is at-
tached, too low down and near the os iſ ſcri, is attended
with haemorrhage from the uterus, which usually begins
in the sixth or seventh month, and at the time of confine-
ment, becomes alarming. The physician usually finds it
necessary to interfere, and assist nature in hastening the
completion of the labor. He sometimes finds it neces-
sary to perform version, or turning, altering the position
of the child, and bringing it down, and delivering, so as
to empty the uterus, that it may contract on the bleeding
vessels. For this condition no means of arresting haem-
orrhage will avail, except the emptying of the uterus.
But the haemorrhage may be post partem—after delivery
and may be either primary, (within twenty-four to
forty-eight hours), or secondary—any time after the Sec-
ond day. The physician usually remains with the patient
till all danger of immediate haemorrhage has passed.
The symptoms which will make you suspect approach-
ing haemorrhage, are : Pulse above IOO, pallor, dizziness,
3O LECTURES TO NURSES.
faintness. If there is any flow, beyond the natural, the
patient usually becomes pale and pinched in appearance,
the extremities become cold, the respiration quickened,
and the patient presents the usual symptoms of shock.
Before the doctor arrives do all you can to excite uter-
ine contractions, by rubbing the fundus vigorously, and
l:eeping your hand on it to prevent further relaxation.
Lower the head, raise the hips, and the foot of the bed,
have plenty of fresh air in the room. If these measures
fail to stop the flow, make a tampon of absorbent cotton,
saturate it with vinegar, and place it in the mouth of the
womb. Do not allow the patient to move, even to turn
on her side. Ammonia may be given her to inhale.
Coſzz///sions.—Should these occur before labor is termin-
ated, the physician usually gives chloroform, and hastens
the delivery. Should they occur after confinement, send
immediately for the physician, and keep the patient from
biting her tongue, or otherwise injuring herself.
A masſ/c/acs in labor...—Chloroform is more commonly
used than ether, on account of its taking effect quicker,
and requiring less quantity to deaden the pain. But it is
not so safe, and its administration should always be at-
tended with the utmost care. Many physicians will not
give it at all, and most prefer to give it only in the latter
part of the second stage, when the head is pressing on the
perineum. A small vial (two dram) is filled with chloro-
form, and a piece cut out of the side of the cork, so as to
allow only the escape of a few drops at a time. The
drops are sprinkled on a folded handkerchief, and the
landkerchief held over the nose of the patient during a
pain, and removed as the pain dies away. The patient
should be encouraged to go without the chloroform as
1Ong as possible, not only because its use lessens the force
Of the contractions, and so retards labor, but also be-
cause of the stupefying effects of the chloroform on the
child. If prolonged anaesthesia is necessary during labor,
for any operation, ether is usually used. A cone, made of
a folded towel, with some pasteboard rolled in, to make it
OBSTETRICS. 3 I
stiff, may be arranged by the nurse, if the physician
does not have an ether apparatus with him. Your lec-
tures on anaesthetics make it unnecessary to enter into
further details on this subject.
There are various operations which may require etheri-
zation. The position of the child in the womb may have
to be altered, its delivery may have to be effected with
forceps, labor may have to be induced prematurely, or
embryotomy, or Caesarian section may have to be per-
formed. In embrytomy the child has to be sacrificed, and
its body removed piece by piece. In craniotomy, the
bones of the head have to be crushed, in order to reduce
the size of the head, and allow its delivery. These dis-
tressing operations are fortunately not frequent, but are
sometimes necessary, either because of a dwarfed or de-
formed pelvis of the mother, or an unnatural develop-
ment of the head, or body of the child. Caesarian sec.
tion is an operation which promises possible safety to both
mother and child. It is a grave operation, but has often
been done successfully. The incision is made in the ab-
domen, then through the uterine wall itself, (see plate),
and the child removed in that way.
After normal labor, even with great care on the part of
the physician, a ru//ured ſerinciſm may result. Some phy-
sicians prefer to repair this rupture immediately after 1a-
bor terminates, as the parts are usually more or less
numb, making an anaesthetic unnecessary: besides, the
repair can be effected without freshening the edges.
After perinoerrhaphy has been performed, the physician
usually prefers to have the patient catheterized for a few
days, and great care has to be exercised in the use of the
catheter, and in the giving of douches, so as not to dis-
turb the stitches, or prevent healing of the parts. (There
is quite apt to be an oedema of the vulva after labor,
which may make catheterization difficult.) It is also de-
sirable to delay the movement of the bowels for a week,
at 1east, or, if a movement is inevitable, a rectal injection
should be administered, so to secure a soft stool.
3
2
1_ECTURES TO NURSES
For most operations the patient will need to be across
the bed, with hips close to the edge of the bed, and chairs
so placed as to hold the legs in a flexed position.
Al/anageſ/eenſ of f/c /ying-in.—The patient may suffer
from “after pains.” These are more common among
multipara than primipara. The pains are due to the ef-
forts on the part of the uterus to expel clots, and are usu-
ally alleviated by the use of internal remedies. There
may be cramps in the 1egs, before or after delivery.
Rubbing the legs tends to relieve this complaint.
The ſoc/lia is the name given to the discharges from
the vagina after delivery. For the first day, the flow is
red, later it becomes pinkish, and still later almost color-
less. It should never be offensive, and should never 1ast
much longer than two weeks. If it does last 1onger than
this, it shows that the process of involution (the return of
the uterus to its normal size), is not taking place, and
that the woman should keep her bed until this symptom
disappears, even though the traditional nine days are 10ng
past.
The nurse is usually expected to attend to the washing
of the baby's flannels, and its napkins. She is expected
to keep the lying-in room clean, and in order, and, of
course, the care of the mother and child devolve upon her
except at the times when she is taking out-of-door exer-
cise and sleep. Attention to these things she owes to her-
self and the patient as well, and arrangements should be
made so that she may get out a little each day, while
Some competent person sits with the mother.
No visitors except the husband, and perhaps some near,
judicious relative, are allowed for the first ten days, un-
less by permission of the physician.
Dicſ.=Following labor, after the patient has had a nap,
she should be urged to take some light, nourishing drink,
hot milk, malted milk, or cocoa. For the first three days
her diet should be light, easily digested, nourishing food.
After that, if all goes well, the diet may be more gener-
ous, though due attention must be given throughout the
OBSTETRICS. 33
puerperal state to foods, which shall agree with mother
and child. Beginning with gruel, milk toast, milk and
boiled rice, as the days advance, it may be increased to
soft boiled eggs, baked apples, mutton broth, Oyster stew,
chicken broth, and still later, to oysters, mutton chop,
baked potatoes, stewed prunes, fresh fruits, etc., and after
the sixth day, ordinary light diet.
Care of Z/e Arcasts.--The milk usually begins to come
into the breasts from thirty-six to seventy-two hours after
birth. This is some times attended with a slight rise in
temperature. After the flow of milk is established, if it
be abundant, the patient will need to decrease the amount
of liquid nourishment. If it be scanty, increase it with
milk, cocoa, etc. The nipples should be bathed, and the
child's mouth bathed, after each nursing. If the nipples
become at all sore, nipple shields should be used. If, for
any reason, it is desired to prevent the secretion of mill;
in the breasts, they may be bandaged with a figure-of-
eight (8) bandage. Otherwise, the breasts may become
‘‘ caked.” If the baby is not able, or, for any reason,
does not draw the milk from the breasts, they must be
emptied with the breast pump. The pain and lumpiness
may be alleviated by rubbing the breasts with warm oil,
stroking gently, but firmly, from base to nipples. Flan-
nels wrung out in hot water, and applied, help to soften
and relieve the pain and tenderness.
Should an abscess form in the breast, hot poultices will
have to be applied, and the physician may need to lance
the abscess, after which the poultices may be reapplied,
and the breasts daily syringed with an antiseptic solution.
Baſ/ling of patient.—The patient should, as a rule, have
a complete sponge bath under cover, every day, and the
external genitals should be frequently bathed each day.
Most physicians wish mild antiseptic douches given daily.
These help to keep the patient and bed free from the un-
pleasant odors so often noticed in the lying-in room,
when scrupulous cleanliness is not observed. Any offen-
siveness of the lochia should be immediately reported to
34. LECTURES TO NURSES.
the physician ; also any sudden and noticeable diminution
in its quantity.
Among the com//ications to be dreaded in the lying-in
period, or the puerperal state, aside from trouble with the
breasts, are: Puerperal fever, puerperal mania, and
“milk leg.” If, at any time during the period, there ap-
pears marked pain, a chill, or even a chilly feeling, a
rapid pulse, or rise in temperature, or sleeplessness and
headache, the nurse should lose no time in letting the
physician know of these things.
The temperature should be taken morning and evening
for the first ten days, no matter how well the patient ap-
pears, and oftener, if there is anything abnormal about it.
If the patient experiences a chill, place extra covers on
the bed, put hot water bottles to the feet, and give her
warm drinks, immediately.
Puer/era/ſever is a septic condition, and may be con-
tracted in various ways. The nurse or the physician may
bring the infection in the clothing, or the neglect of pro-
per antiseptic precautions may allow the entrance of
germs, which result in blood poisoning, or there may be
what is called auto-infection—the poison being derived
from the woman herself. Puerperal fever is always a
grave condition, and is usually ushered in by a chill, or
shudderings, rise in pulse and temperature, tenderness in
abdomen, and suppression of the lochia. The patient
may appear anxious, or she may be indifferent to her con-
dition, declaring that she feels all right, while it is all too
apparent to those about her that she is in a dangerous
condition.
The nurse's duties are to follow the directions of the
physician implicitly, strict antisepsis in the use of douches,
bathing, etc., and efforts constantly directed to keep up
the patient's strength, by an abundance of easily-digested,
regularly administered, nourishing diet. The re-estab-
lishment of the lochia, the disappearance of tenderness,
and the reduction of the pulse and temperature, are favor-
able symptoms. It is a terrible disease. You will have
OBSTETRICS. - 35
------ - -- - - ---------------- ſº
to make a long, continued and brave fight for the pa-
tient's life, and the recovery depends largely on the nurs-
ing.
A/i/% /cg.—Another name is pſi/cg/lasia a/ba do/ens. This
condition does not usually appear before the second week.
It is generally ushered in with a chill, a general sick, weak
feeling, a dragging pain in the leg, or thigh, fever, and
finally swelling of the leg. The skin of the leg becomes
white and shiny, with sometimes red streaks in various
parts, the veins swell, and the pain is intense. Milk leg
is an improper term. The condition is due to an inflam-
mation of the veins. Blood clots sometimes form in
them, and are in danger of being dislodged, and carried
to the heart, where they may cause death. Therefore,
abso/u/c rest is of the utmost importance in this disease.
The nursing of this condition is very tedious and exact-
ing, recovery is always slow, and the patient requires con-
stant and scrupulous care. Hot hamamelis fomentations
do much to relieve the pain, also supporting the partially
bent 1eg on a pillow, and wrapping it in Cotton batting,
afford some relief. The pain caused by the weight of the
bed clothes may be obviated by making a cradle of barrel
hoops.
Pucz/ſcra/ mania, or ſyncſanchoſia may come on immedi-
ately after confinement, or in the later weeks when the
patient is exhausted with nursing the baby, with worry,
or with physical ill-health. Whether the condition is one
of exaltation or depression, the child's life is usually un-
safe, when near the mother, and its presence usually only
serves to aggravate the mother's condition. The patient
is usually suicidal, and very shrewd and sly. S/he must
not be /eft alone a minute. She may feign sleep, in order
to get the nurse off her guard. The windows must be
guarded, the doors locked, all medicines and instruments
kept under lock and key, and everything removed from
the room with which she could in any way injure herself.
Abundant nourishment is one of the most important parts
of the treatment, and forced feeding may have to be re-
36 LECTURES TO NURSES.
sorted to. Your experience with insane patients makes it
unnecessary to dwell on this disease, as you know the
dangers to avoid, and the objects to be attained better
than in almost any other puerperal condition. These pa-
tients are best cared for in an institution, and the friends
generally recognize this after being convinced of the dis-
advantages of home treatment.
The next talk will be on the care of the new born
child, and the normal and abnormal development of early
infancy.
LECTURE IV.
|NFANCY,
In this talk, on Infancy, I have drawn 1argely from a
work by Dr. Anna Fullerton, on Obstetrical Nursing—a
book which I advise you all to procure for yourselves.
Care of the new born child.—The first thing is to care-
. fully cleanse the eyes and mouth. We will briefly review
the separation of the child from the mother. After the
cord has ceased to pulsate, it should be stripped back to-
ward the navel, and a ligature firmly tied, with two twists
in the first tying, about two inches from the child's body,
care being taken not to pull on the navel at all, either be-
fore or after the separation of the child from the pla-
centa. Another ligature is placed about an inch away
from this, on the maternal side of the cord, and the cord
cut between them with a pair of round pointed, dull scis-
sors. The cord is then wiped on the end, and carefully ex-
amined, to see if there is any oozing from the cut end. If
the child is breathing properly, it may be wrapped in a
warm shawl, and laid on its right side, in a safe, warm
place, until you are ready to begin its toilet.
A11 articles of the toilet should be at hand before be-
ginning to dress the baby. Sit by the stove, fire, or radi-
ator, while doing this. A flannel apron, made by sewing
two aprons to one band, is a very nice thing to have in
caring for a young baby. The child can lie on one of the
pieces of flannel, and the other piece can be used to cover
38 LECTURES TO NURSES.
the child, or to wrap around it in the intervals of the
bathing.
At birth, the child is covered with a white, tenacious
substance, called vernir cascosa. This sticks, especially
to the head, in the folds of the skin, behind the ears, and
on the buttocks, and should all be removed at the first
washing. Be particular to remove a11 this from the folds
in the external genitals of girl babies. This is best re-
removed by annointing the entire body with sweet oil or
lard, (better than vaseline), rubbing the skin well with it,
and then rubbing it off with a soft, old cloth. Many phy-
sicians prefer not to have the baby washed, except the
face and hands, for a few days, but simply oil and rub it
well. If this is done thoroughly, the baby is as sweet and
clean as from a washing, and the bodily heat is not so
much reduced as though it were given a bath. If water is
used, the temperature should be IOO 2. Quickly dip the
body in water, taking care that the child does not slip,
and get its mouth and nose under water. After the first
dip, the child usually receives only a sponge bath daily,
until the cord falls. The bath water should be about 92 °
the first six months, after that 90 °. After thoroughly
drying the skin, a toilet powder may be dusted in the ax-
illae, groins, and in the flexures of the joints. Care must
be taken to thoroughly dry the hair on the baby's head; a
soft brush should be used, and not a comb.
The child should have a complete change of clothing
day and night, never wearing anything at night that is
worn in the day. When the day clothing is removed, the
entire skin should be rubbed with a rough towel—a pro-
cess which baby usually shows you that he appreciates.
In the morning, a sponge bath, or the quick dip should be
used. If these rules are followed out, a “good,” as well
as a healthy baby is the result.
Dressing t/le cord.—Physicians differ in their choice of
dressing for the cord, but the majority prefer a dry,
asceptic dressing. A square of soft linen is slit up the
centre, and placed under the cord close to the abdomen ;
INFANCY. 39
the cord is then folded on itself to form a loop, and the
edges of the linen folded over from all sides to form a
smaller square (illustrate), and the whole placed on the
left side of the abdomen, so as to avoid pressure on the
liver. This is held in place by the abdominal binder
mentioned in the first lecture on obstetrics. Many old
nurses have certain whims, such as burning a hole in a
rag, and slipping the cord through this. The dressing of
the cord should be changed as often as it becomes moist,
and if kept dry and clean, it dries up, and falls off on the
fifth or sixth day, there having been no odor and no sore-
ness. If there is any redness about the navel, a little ly-
copodium powder, sprinkled on, usually obviates the diffi-
culty. Any bulging or puffiness at the navel should be
reported to the physician. If this increases when the
child strains or cries, it is probably a hernia. The band-
age to hold the cord in place should not be so tight but
that the nurse can put her flat hand between the bandage
and the skin. Safety pins should, of course, be put on
the front of the binder.
The new born child sleeps the most of the time for the
first month, and seldom needs tending, except to be fed
and kept clean.
Aoweſs.-Just at birth, or any time within the first
twenty-four hours, a dark, tarry-looking substance, called
//ecconium, should escape from the anus. #f this does not
come away freely, the baby is apt to have pain. You may
need to assist with a soap suppository. This ſecconiuſ // is
very hard to wash out of the napkins; it is well to use
small, old pieces of cloth inside the diaper for the first
few days. These may be burned, and thus save much ex-
tra washing.
A baby should be washed and thoroughly dried every
time it soils its napkins, whether with urine or stool. A
napkin should never be dried and then used again, with-
out having been previously washed. Many nurses and
mothers form this untidy habit because of the extra work
that follows, if they do things the proper way. Atten-
4O LECTURES TO NURSES.
tion to these details not only helps to keep a baby sweet
and clean, but does away with many irritating skin trou-
bles which we see in 1ess carefully tended babies.
The stools of a healthy baby are yellow, or orange
color, and mushy in consistency. Three or four stools a
day are perfectly normal. Bottle-fed babies have lighter
colored and more offensive stools. Curds in the stools
show some impairment in digestion.
B/adder.—There is no rule for the amount or frequency
in the urine. But any marked scantiness should be re-
ported to the physician. Sometimes hot cloths placed
Over the bladder stimulate the flow.
The baby's head is often badly formed at birth, Owing
to the long continued pressure during labor. Don't at-
tempt to shape the head at all; it will right itself in a
few days, and need cause no anxiety. There is some-
times a swelling on one side of the head—the remains of
the “caput '’ which forms during labor—this also sub-
sides within a few days. There are two openings in the
skull, called ſom/a/c//es, one on the top, and one on the oc-
ciput. These do not close until some time after birth, es:
pecially the one on the top of the head—“the soft spot,”
as it is called. You can see the pulsations there when the
child cries. This often sinks very noticeably in exhaus-
ting diseases, and is a grave symptom. If the anterior
fontanelle fails to close soon after the baby is eighteen
months old, it shows that something is wrong with the
child.
Brcas/s.-There is sometimes milk in the breasts of ba-
bies. Meddlesome nurses try to press this out, and so
cause a trouble that would amount to nothing if the
breasts were left entirely alone.
Weight and growt/, of child,—The average weight of a
new born baby, with only a napkin on, is seven pounds. It
usually loses after the first day for a few days, so that its
weight at the end of the first week is about what it was at
birth. After that it gains about an ounce a day. A baby
should double its weight in six months, and treble it in a
INFANCY. 4 I
year, if its nutrition is good.
A child should grow nearly three-quarters of an inch
every month, during the first year, and one-half inch
during the second.
If a baby kicks at night, and will not keep covered, it
is a good plan to make a long, loose flannel gown, which
shirs at the bottom. Then the child can kick all it likes,
and still not get uncovered.
The baby can safely be taken out for its first airing in
the third or fourth week. After that the practice may be
kept up daily, and the child easily accustomed to all kinds
of weather.
If a child has ‘‘snuffles,” it may be due to the practice
of not drying the hair thoroughly after the bath, or of
taking the child into rooms of different temperature with-
out extra covering. If the complaint persists, there is
probably some constitutional difficulty, and the physician
should be told of the symptom.
Vaccination.—Any time after the fourth month it is wise
to have this done, as one never can tell when there will
be exposure to small pox.
Feeding t/le baby.—After the baby has been washed and
dressed, give it a spoonful of water, and make it a prac-
tice to give it water three times a day, for babies suffer
from thirst just as much as grown people do. In about
an hour after birth, the child may be put to the breast.
There is no milk so early, but a substance called colos/rum
is there which acts as a laxative for the child, and satisi-
fies hunger until the milk comes. The breasts should be
nursed alternately, and the nipples carefully washed and
dried after each nursing. Also the baby's mouth washed.
These attentions are very exacting, but they do away
with sore nipples and sore mouths, and are therefore well
worth the trouble. The nipples become congested after
nursing, and the bathing of them helps to lessen this con-
gestion, and to keep them in a healthy condition. Until
the milk comes, unless the baby cries from hunger, it
needs nothing more than the slight secretion from the
42 LECTURES TO NURSES.
breast, and its three or four drinks of water daily. But
if very hungry, a little water, with a few drops of milk,
and a few grains of sugar, may be given to relieve the
hunger.
When the milk comes, establish regular times for feed-
ing, and do not form the habit of feeding every time the
child cries. A baby should be fed every two hours dur-
ing the day, and twice during the night for the first three
months. From the third to the sixth month, it should be
fed every three hours during the day, and once during
the night. From the sixth to the twelfth month the time
should be gradually lengthened to every four hours.
Premature babies should be fed oftener, and less quanti-
tities than others.
If a mother has insufficient milk, you may have to sub-
stitute the bottle every other nursing. Means for pro-
moting or diminishing the secretion of milk were men-
tioned in a previous talk.
If you notice a clicking sound when the child nurses, or
if it fails to take hold of the well formed nipples, you
may suspect that it is tongue-tied. A slight snipping of
the tissues under the tongue remedies this difficulty. It
must, of course, be done by the physician.
If the mother's milk is too rich, let the child nurse less
frequently; if too poor, at shorter intervals. Remember
that fright, anger, the menses, and pregnancy, affect the
mother's milk, and through that, the child. Children
lmave often been thrown into convulsions, or into violent
colic, after being nursed by a mother in a fit of passion.
Certain articles of food must be prohibited. Turnips are
especially to be avoided by the nursing woman. If a
woman has erysipelas, she should stop nursing her child.
Every true mother wishes to nurse her baby, if she pos-
sibly can, but if for any reason it seems best to the physi-
cian that she refrain from this duty, we then have to re-
sort to artificial feeding, and herein are the chief dangers
of infancy. A wet nurse, if she can be secured, is the
best substitute for the mother's milk. Her selection
INFANCY. 43
should be conscientiously attended to by the physician.
If however, you have to depend on artificial food, there
are many things to be observed.
First, the bottles, the nipples, and every thing used in
the preparation of the food, must be kept scrupulously
clean. Two bottles should be used, the one not in use
being kept in a solution of soda, the bottles being alter-
nated in their use. The bottles should be immediately
cleansed after using, by scalding them in clear water,
then left standing in soda water till ready to be rinsed,
and filled with the food. Round bottomed, graduated
bottles are preferable to any others. The nipples should
be of black rubber, and should be changed after two
weeks for new ones. Each time after using, they should
be turned wrong side out, thoroughly cleansed from every
particle of food, and should be left to soak in cold water
till ready for use.
Cow's milk is so different from human milk that it re-
quires to be diluted about four times, in order to be di-
gested properly. It also needs the addition of a little
cream, and a very little sugar.
Here is a formula for preparing a pint of food
cient quantity for twenty-four hours:
a suffi-
Cow's milk.................................... 2 fluid ounces.
Cream........' ................................. 3 . . . { {
Water............................................. 10 “ { {
Milk sugar .................................... 6; drachms.
Put this in a flask in a steamer, steam for twenty min-
utes, remove, and when slightly warm, add one fluid
ounce of lime water, and set away to cool. During the
first month, the baby needs about two ounces of this food
twelve times a day.
There are various prepared artificial food—Liebig’s,
Mellin's, and Nestle's, are among the best. Some agree
with one baby, and some with another. Some physicians
prefer peptonized milk. If so, they have their pet ways
of preparing it, and all you have to do is to follow direc-
tions implicitly and conscientiously. There are various
44 LECTURES TO NURSES
apparatuses for sterilizing milk, but with all of them
come elaborate directions for use, so that we need not
dwell on them here.
The baby's food should not be given to it hot, but just
at blood heat. This is best done by setting the bottle
with the food, already prepared, in a vessel of hot water,
providing a quantity has been prepared, and set away On
ice to cool.
The baby should be held while nursing the bottle, that
its position may be as near that of the child at the breast
as possible. The milk should be kept in the neck of the
bottle during nursing, so the nurse will need to alter the
position of the bottle as the feeding progresses. Never
allow the child to nurse an empty bottle, or to suck its
thumb.
Development of f/he child at birt/..—The head and trunk
are much larger in proportion than the limbs. The abdo-
men is very prominent, because the liver, at birth, is dis-
proportionately large.
The physician will, of course, examine the child to see
if it is normal in every way. If it is not, you must not
1et the mother know it, as the shock might prove disas-
trous to her in her delicate condition.
SAEin. The skin is usually very red at birth, but after
four or five days becomes yellowish. The condition is
called ‘‘ baby jaundice.” This usually disappears after
the second week.
There is a condition known as the “blue baby,” where
the little valve between the right and left auricles fails to
close at birth, and the circulation is thereby not properly
established. These children seldom live beyond infancy,
and ordinarily die within a few days.
Spina ſidia is a condition of the vertebral column where
the bony formation is defective, and a tumor along the
spinal column is detected. These children sometimes
live to grow up, though it is always a condition causing a
great deal of anxiety to parents, as the child is apt to be
deficient in mental capacity.
INFANCY. 45
Pu/sc, temperature and respiration.—These are all so easily
disturbed by slight things which affect the baby's health,
that they are not as useful in diagnosing diseases in in-
fants as in adults. The pulse of a new-born child is 140,
the average temperature is 90 °, and the respiration is 44.
Diseases of infancy —/nflammation of the cycs.—If you
have attended to the eyes at birth there is seldom liability
of trouble later on, but neglect to remove the vernia.
caseosa, or the introduction of a little soap in the eyes,
may set up an inflammation. There may be partial clos-
ing of one eye, the lid may be glued together, or the eyes
may be slightly injected. Frequent bathing of the eyes
with the solution prescribed by the physician, and care in
shielding the eyes from the light, will usually result in
relief of this condition. Most physicians use a solution
of boracic acid for the eyes, at birth, to avoid trouble of
this kind. The clothes that are used for washing these
inflammed eyes should be burned each time, immediately
after use, a different one being used for each eye.
Thrus/..—This sore mouth which appears in the first or
second week of a baby's life, is due to want of cleanliness
of nipples and mouth. The appearance is as though the
mouth had been sprinkled with flour. There may be
some feverishness, and diarrhoea may accompany it.
A'ed gum.—This is a fine, red eruption, appearing first
on the face, then on the entire body. It may appear one
week after birth, or any time during dentition. It is
sometimes due to digestive disturbances, sometimes to
keeping the baby too warm. “Prickly heat” is another
term for a milder form of this trouble.
Acce/la, or “sca/d/cad,” is a troublesome and distress-
ing affection, and, of course, requires medical attention.
It may attack one cheek, the scalp, or may cover the
child's face and head, rendering it a pitiable sight. The
child must have mits on, or have its sleeves fastened,
with safety pins, to the bed to prevent it from scratching,
and the physician's orders must be obeyed in the care of
this condition. Water only aggrevates the trouble. Cold
46 LECTURES TO NURSES.
cream locally gives some relief.
Co/ic.—This may result from indigestion, from a cold,
or from the child nursing after a fit of anger, or fright on
the part of the mother. Hot fomentations over the ab-
domen, or even the warm hand held there, a rubbing
with sweet oil, or a soap suppository, may relieve.
Constipation.—Artificially fed babies are often troubled
with constipation. Soap supposition gives relief. Bar-
ley water in the milk tends to regulate.
Convulsions.—These may arise during dentition, or from
other causes. Give the child a warm foot bath, test the
water with your elbow, or you may give it an entire hot
bath. If the child is drowsy afterwards, and sleeps with
half closed eyes, it is a grave symptom. If the convul-
sions are due to attempt of the teeth to come through, the
gum will look thin, white and shiny. Sometimes rub-
bing with a silver thimble gives relief, sometimes lancing
the gums has to be resorted to.
Diarrhaca and dysc/u/cry are the most common complaints
of early infancy. The infant's food must be closely ex-
amined to see if it is of good quality, the nursing bottle,
etc., inspected, and any carelessness there immediately
corrected.
A child with tendency to bowel trouble, would better
wear a flannel bandage till all symptoms have disap-
peared. The feet and legs must always be warmly
clothed.
Corn starch, boiled flour in milk, and black tea, are
simple domestic remedies which may be tried, but if it is
not immediately checked, do not delay in sending for the
physician.
Dysentery differs from diarrhoea in the character of the
stools, and in the accompanying symptoms. It is usually
preceded by diarrhoea. Pain, fever, vomiting, and ema-
ciation, make us aware of the gravity of the disease.
The stools are thin, pasty, gluey, and like the washing of
meat, the extremities are cold, the tongue red at the tip,
the child moans and cries, gags at the sight of food, has
INFANCY. 47
extreme thirst, the abdomen is tender and bloated, and
blisters may appear on the tongue and roof of the mouth.
As the disease continues, the child becomes indifferent.
It lies in a stupor, does not mind flies on its face, and
death is not long in coming, unless relief is obtained.
The great difficulty is in getting food which can be re-
tained, and which will nourish it. Rubbing the abdomen
with warm oil helps to nourish the child.
A'ickets. This is a disease of the bones, due to a defi-
ciency of earthy matter. They are too soft, and easily
bent out of shape. The child may become bow-legged, if
he attempts to walk too soon. He may have curvature of
the spine, or may become otherwise deformed. The child
has a waxy complexion, it prespires too freely, especially
about the head. It can't hold its head up well, has green
stools, its teeth are slow in coming, it is slow in walking,
and the fontancſ/es are slow in closing. Such children
need an abundance of nourishing food, plenty of fresh
air and sunlight, and constitutional remedies.
Pſydrocepha/us.—This is a grave condition. It is com-
monly called “water on the brain.” The prominent
symptoms are vertigo, squinting of the eyes, shrill
screams, thirst, vomiting, abdomen becomes boat-shaped,
the child grates its teeth, bores its hands into its nose and
mouth, the hearing is usually acute, convulsions set in,
followed by paralysis, the feet swell, the eyes become
glassy, and death finally puts an end to one of the most
distressing diseases that can happen to a child.
It is well to remember in any brain trouble to shield
the child from noise and light. Avoid talking in such a
sick room, even if the child is too young or too ill to un-
derstand what is said, he is affected by the noise.
Premature babies.—They require extra warmth, extra
sleep, extra clothing, and extra care. Sometimes they
are kept wrapped in rolls of cotton batting for a few
weeks, and sometimes the couveuse, or “brooder,” is
used. This is a wooden box with a bed inside, below the
bed are stone jars, kept filled with hot water, and in the
48 LECTURES TO NURSES.
end is a register for the entrance of fresh air. This
superheated atmosphere is more nearly suited to the pre-
mature child than any other means we have at hand for
supplying sufficient heat. Sometimes the “brooder” has
to be used only two or three weeks, sometimes six. The
child has to be weaned from the “brooder” by removing
it to the ordinary atmosphere for an hour a day, till it be-
comes accustomed to 1ess sheltering surroundings. Pre-
mature babies should be oiled twice a day, and fed every
nour. If a child is too weak to nurse, draw the milk
from the mother's breast, and feed the child with a spoon.
Gavage is a sort of forced feeding for babies. A small
catheter is put in the Oesophagus, a glass funnel in the
other end, and the food poured in the funnel. The tube
must be withdrawn quickly, or the child will vomit.
Indications in infancy —/language of the cry.—The cry is
the only way the baby has of talking to us, and we must
learn to interpret it. You will find it as varied and as
capable of expression as the human voice.
The cry of hunger, or thirst, is loud and persistent, un-
til these conditions are relieved. The baby should move
its arms and head at the same time.
In earache, the child usually puts his hand to its ear or
head as it cries. It also likes to lie with its head pressed
against the bosom of the nurse. This crying is also ob-
stinate and continuous.
The cry from a pin pricking will also be loud and pas-
sionate, and will not cease until you remove the cause.
Some add the cry of “original meanness,” but babies are
not Originally mean. Instead of saying hard things of
them, we would better set our wits to work to find the
cause of the pain.
In brain trouble the cry is a shrill, piercing one, often
waking the child from sleep. Its hand may or may not
go up to its head.
Crying while coughing indicates pain in the chest.
The pleuritic cry is loud and shrill, and is aggravated by
moving the child, or by its coughing. In pneumonia and
INFANCY. 49
bronchitis, the cry is moderate, peevish and muffled, and
has been described as though a door were shut between
the child and the hearer. The cry of croup is hoarse,
metallic, and with a crowing inspiration.
The cry of colic is paroxysmal, sharp, sudden, and ac-
companied by drawing up of the legs, and sometimes by
a stool.
Crying during nursing, with dropping the nipple, indi-
cates sore mouth.
In all intestinal troubles, the crying is usually accom-
panied with writhing before stool. In dysentery and tu-
bercular diseases of the bowels, the child moans and
wails.
Exhaustion is shown by a whine. Sudden cessation of
Crying, in severe illness, is a grave symptom, as it indi-
cates that the child is too weak to cry.
Language of the cough. —A dry, persistent cough is from
digestive troubles.
Sonorous cough—spasmodic croup.
Hoarse, rough cough—true croup.
Clear, distinct cough—bronchitis.
Suppressed, painful cough—pleurisy.
Convulsive cough, with or without a whoop—pertussis,
Or whooping Cough.
Dry, painless cough — typhoid, intermittent fevers,
worms, digestive troubles, or dentition.
7 ears. —A child does not shed tears till after it is three
months old. Absence of tears in a child while crying,
when Over four months of age, indicates some impending
fatal disease.
Contraction of the eyebrows, turning the head to avoid
the light, may indicate pain in the eyes, or pain in the
head.
Fan-like motions of the nostrils indicate distress in
breathing, pneumonia, etc.
Drawn look to the mouth—digestive troubles. Babies
who have had dysentery for sometime, have a peculiar,
old, wizened 10ok.
5O LECTURES TO NURSES.
Congestion of the cheeks—inflammation and fever.
Sudden flushing of the face and ears, and as suddenly
disappearing, with strabismus, fever, flickering of the
eyelids, and irregular pupils—cerebral affections. If the
head is drawn back and the body rigid, it also indieates
cerebral diseases.
Marked progressive emaciation indicates grave chronic,
or sub-acute affections.
Enlargement of the ends of the fingers, and curving
nails, indicate abnormal circulation.
Enlargement of spongy portions of the bones—rac/litis,
Or rickets,
Thick, purulent secretion from the glands on the eye-
lids—prostration of the general powers.
Continued lividity, or lividity produced by excitement,
with normal respiration—faulty formation of the heart, or
great blood vessels.
Temporary lividity—grave acute diseases of the respir-
atory Organs.
Irregular muscular movements, partially controlled
when the patient is awake—chorae, or St. Vitus' dance.
Child carries finger to the mouth, much agitated—ab-
normal condition of the larynx.
Hoarseness, indistinct voice—laryngitis.
Slow, intermittent respiration, with sighing—cerebral
disease.
Accelerated, intermittent respiration—trouble in larynx
or trachea.
If a child lies flat on the back, with the hand lying list-
lessly between the thighs, it betokens extreme prostra-
tion.
INDEX.
LECTURE I.—GYNAECOLOGY.
Gynaecology defined - - - - - - - - - - - - - - - - - - - - - - - - - - -
Anatomy of reproductive organs (external and in-
ternal) -------------------------------------
Menstruation - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Reproduction. -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Gynaecological terms—misplacements, pathological
condition, etc - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Examinations—Ocular, digital, bi-manual, specular
Gynaecological positions—dorsal, Sim's, genu pec-
toral, etc. -----------------------------------
Preparation of the patient for examination - - - - - - -
Duties of the nurse during examination and treat-
ment ---------------------------------------
Directions for douches, enemata, and catheteriza-
tion ----------------------------------------
Gynaecological operations—names, definitions, pre-
parations for the same - - - - - - - - - - - - - - - - - - - - - - -
Antisepsis in Gynaecology - - - - - - - - - - - - - - - - - - - - - -
LECTURE II. —OBSTETRICS.–PART I.
Definitions. -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Signs of pregnancy (presumptive, probable, and
Positive).--------------------------------
Conditions mistaken for pregnancy - - - - - - - - - - - - - -
Duration of pregnancy, and methods of determin-
ing time of confinement. - - - - - - - - - - - - - - - - - - - - -
Development of foetus at various stages - - - - - - - - - -
Viability of child. - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I 4
I4.
I 5
ii INDEX.
Care of the pregnant woman - - - - - - - - - - - - - - - - - - -
General hygienic measures (dress, diet, exer-
cise, bathing, sleep - - - - - - - - - - - - - - - - - - - - - -
Irritability of bladder- - - - - - - - - - - - - - - - - - - - -
Examination of the urine - - - - - - - - - - - - - - - - - -
Leucorrhoea, constipation, haemorrhoids. . . . .
Oedema of legs- - - - - - - - - - - - - - - - - - - - - - - - - - -
Vomiting of pregnancy - - - - - - - - - - - - - - - - - - - -
Preparation of the nipples - - - - - - - - - - - - - - - - -
Haemorrhage during pregnancy - - - - - - - - - - - - -
Preparations for labor - - - - - - - - - - - - - - - - - - - - - - - -
Room, furniture, clothing - - - - - - - - - - - - - - - - - -
Arrangement of bed- - - - - - - - - - - - - - - - - - - - - -
Baby's outfit, clothing, articles for baby basket
Prompt responses to obstetrical calls - - - - - - - - - - - -
Personal toilet of nurse—liability of carrying con-
tagion--------------------------------------
Signs of approaching labor- - - - - - - - - - - - - - - - - - - - -
Stages of labor, defined and described—duties of
nurses in various stages - - - - - - - - - - - - - - - - - - - - - -
Toilet of the mother- - - - - - - - - - - - - - - - - - - - - - - - - -
Things to be remembered after confinement. - - - -
LECTURE III. —OBSTETRICS.–PART II.
Complications and emergencies - - - - - - - - - - - - - - - -
Non-arrival of physician--nurse must act as ac-
coucheur-things to be remembered—save pla-
centa for inspection—tying the cord - - - - - - - -
Methods of resuscitating the child - - - - - - - - - - - - - -
Twin pregnancies - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Adherent placenta- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Breech presentations - - - - - - - - - - - - - - - - - - - - - - - - - - -
Haemorrhage — placenta praevia — post-partem
haemorrhage—symptoms of haemorrhage–treat-
ment---------------------------------------
Convulsions. -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Anaesthetics in 1abor—chloroform—ether - - - - - - - -
Operations—version, forceps delivery, induction
of labor, embryotomy, craniotomy, Caesarian
section, repair of the perineum, after care of the
perineum-----------------------------------
24,
29,
I 5
I 5
I 5
I 5
I 5
I6
I6
I 6
I6
I 7
I 7
I 7
I 8
I 9
IO
I 9
22
25
A->
27
27
28
29
29
3O
3O
3O
3 I
INDEX. iii
Management of 1ying-in, after pains, Cramps in
legs, lochia, etc - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 32
Nurse's duty to patient, baby and self, visitors,
diet, etc.------------------------------------ 32
Care of the breasts—sore nipples, increasing and
decreasing the secretion of milk, mastitis- - - - - 33
Bathing of patient, temperature of patient - - - - - - 33, 34
Puerperal fever—milk leg—puerperal mania or
melancholia- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 34, 35
LECTURE IV.- INFANCY.
Care of the new-born child—Eyes, mouth, cord, etc. 37
Baby's toilet—oiling, bathing and dressing
the child ------------------------------- 3
Bowels ----------------------------------- 39
Bladder ---------------------------------- 4O
Shaping of head, the “caput,” fontanelles-- 4O
Breasts----------------------------------- 4O
Weight and growth of child - - - - - - - - - - - - - - - 4O
Kicking babies—the first airing—Snuffles—
vaccination ----------------------------- 4. I
Feeding the baby - - - - - - - - - - - - - - - - - - - - - - - - - 4 I
Regularity and time for nursing, tongue tie,
precautions about nursing, wet nurse - - - - - - 42
Artificial feeding, care of utensils, prepared
foods, position of child while nursing from
bottle ---------------------------------- 43
Development of the child at birth, dispropor-
tion of parts, monstrosities, etc - - - - - - - - - - - 44
Skin, baby jaundice, ‘‘ blue baby” - - - - - - - - - - - 44
SA* ºftda -------------------------------- 44
Pulse, temperature, and respiration - - - - - - - - - 45
Diseases of infancy : Inflammation of eyes,
thrush, red gum, eczema, or “scald head,”
colic, constipation, convulsions, diarrhoea
and dysentery, rickets, hydrocephalus - - - - - 45, 46
Premature babies, the couveuse, gavage, etc. 47, 48
Indications in infancy; Language of the cry,
the cough, tears, facial expression, and
other indications of disease, with their re-
Spective significations - - - - - - - - - - - - - - - - - - - - 48, 5O
THE UNIVERSITY OF HIGAN
FARS" cV NSS